Joint Federal Emergency Solutions Grant and California Emergency Solutions Grant Program
2017 Noncompetitive Application
For the Balance of State Allocation
State of California
Governor Edmund G. Brown Jr.
Alexis Podesta, Secretary
Business, Consumer Services and Housing Agency
Ben Metcalf, Director
Department of Housing and Community Development
NOFA Section, ESG Program
2020 West El Camino Avenue, Sacramento, CA 95833
ESG Program Email:
FINAL FILING DATE: SEPTEMBER 15, 2017, 5:00 P.M.
Table of Contents
GENERAL INSTRUCTIONS 3
APPLICATION FORMS CHECKLIST 4
FORM I: APPLICANT CONTACT INFORMATION 5
FORM II: CONTINUUM OF CARE CONTACT INFORMATION 6
FORM III: LEGISLATIVE AND CONGRESSIONAL INFORMATION 7
FORM IV: BUDGET WORKBOOK 8
FORM V: CERTIFICATE OF INDIRECT COSTS 9
FORM VI: PAYEE DATA RECORD 10
FORM VII: PROJECTED OUTCOMES 11
FORM VIII: GOVERNING BOARD AUTHORIZING RESOLUTION 12
FORM IX: CERTIFICATION OF CONTINUUM OF CARE APPROVAL FOR APPLICANT 16
GENERAL INSTRUCTIONS
This application is subject to the Emergency Solutions Grant (ESG) Program federal regulations established by the U.S. Department of Housing and Urban Development(HUD), 24Code of Federal Regulations (CFR), Parts 91 and 576, as well as 25 California Code of Regulations (CCR), Section8400etseq and the California Emergency Solutions Grant (CA ESG) Program guidelines.
A. Please read the ESG 2017 Notice of Funding Availability (NOFA) for the Balance of State (BoS) Allocation, as well as the federal and State ESG regulations and CA ESG Program guidelines cited above.
B. Application Submittal:
Applicants recommended for funding by the local Continuum of Care (CoC) should submit one original (hard copy) application with wet, original signatures in a 3-Ring Binder with pockets, and one USB flash drive that includes a copy of the application with signatures. Applicants are required to submit Application Forms I to IX; each section should have an individual tab in the submitted 3-Ring Binder.
Application forms and the budget workbook for the BoS Allocation are available on-line to download at:
http://www.hcd.ca.gov/grants-funding/active-funding/esg.shtml.
Application forms including the budget workbook must be submitted no later than 5:00 p.m. Pacific Standard Time on September 15, 2017. Application forms not submitted by the deadline will result in a denial of funds to your CoC Service Area. Applicants recommended for funding by the local CoC are responsible for ensuring that all required materials are submitted by the deadline. The Department of Housing and Community Development (HCD) will not grant any extensions.
C. All HCD funding decisions are final.
APPLICATION FORMS CHECKLIST
The checklist below summarizes the application forms required to be submitted in order to receive a funding allocation. Application forms not submitted to HCD by September 15, 2017 will result in a denial of funds to your CoC Service Area. HCD will not grant any extensions.
Form I Applicant Contact Information
Form II Continuum of Care Contact Information
Form III Legislative and Congressional Information
Form IV Budget Workbook
Form V Certificate of Indirect Costs
Form VI Payee Data Record
Form VII Projected Outcomes
Form VIII Governing Board Authorizing Resolution
Form IX Certification of Continuum of Care Approval for Applicant
FORM I: APPLICANT CONTACT INFORMATION
Note: Name of Applicant must be the same as stated in the Board Resolution and Payee Data Record.
Name of Applicant:County: / Federal Tax ID Number (EIN):
Address: / Data Universal Numbering System (DUNS):
City, State and Zip:
Private Non-Profit (501(c)3) / Victim Services Provider
Unit of General Purpose Local Government / Legal Services Provider
Authorized Representative Information (Per Board Resolution attached to this application)
Last, First and Middle Names:
/ Mr. Mrs. Ms. Other
Title:
Address: / City, State and Zip:
Area Code and Phone No.: Fax No.:
/ E-Mail Address:
Applicant Contact Information (If Different from Authorized Representative)
Last, First and Middle Names:
/ Mr. Mrs. Ms. Other
Title:
Address: / City, State and Zip:
Area Code and Phone No.: Fax No.:
/ E-Mail Address:
Applicant Fiscal Representative Information (i.e., CFO, Accountant/Bookkeeper)
Last, First and Middle Names:
/ Mr. Mrs. Ms. Other
Title:
Address: / City, State and Zip:
Area Code and Phone No.: Fax No.:
/ E-Mail Address:
FORM II: CONTINUUM OF CARE CONTACT INFORMATION
Provide information for the CoC where the applicant will provide assistance with the ESG funding requested in this application.
Continuum of Care (CoC) Name:CoC Contact: Last, First and Middle Names:
/ Mr. Mrs. Ms. Other
Title: / CoC No.:
Address: / City, State and Zip:
Area Code and Phone No.: Fax No.:
/ E-Mail Address:
CoC Homeless Management Information System (HMIS):
HMIS Software:
HMIS Lead: Last, First and Middle Names:
/ Mr. Mrs. Ms. Other
Title:
Address: / City, State and Zip:
Area Code and Phone No.: Fax No.:
/ E-Mail Address:
Victim Service Provider Comparable Database Name: If applicable
Contact: Last, First and Middle Names:
/ Mr. Mrs. Ms. Other
Title:
Address: / City, State and Zip:
Area Code and Phone No.: Fax No.:
/ E-Mail Address:
Legal Service Provider Comparable Database Name: If applicable
Contact: Last, First and Middle Names: / Mr. Mrs. Ms. Other
Title:
Address: / City, State and Zip:
Area Code and Phone No.: Fax No.:
/ E-Mail Address:
FORM III: LEGISLATIVE AND CONGRESSIONAL INFORMATION
Provide the Legislative and Congressional information for the Applicant and each activity location, (if different than Applicant location), included in this application.
To locate or verify the Legislative and Congressional information, click on the respective links below and enter the Applicant office location zip code, the activity location site zip code(s) (i.e., zip code(s) where activities are performed), and any additional activity location site(s), as applicable.
State Legislators: http://www.leginfo.ca.gov
U.S. House of Representatives: http://www.house.gov/
Applicant Office Location / District # / First Name / Last NameState Assembly Member
State Senate Member
U.S. House of Representatives
Activity Location(s) – (if different from Applicant location) / District # / First Name / Last Name
State Assembly Member
State Senate Member
U.S. House of Representatives
Activity Location(s) – (if different from Applicant location) / District # / First Name / Last Name
State Assembly Member
State Senate Member
U.S. House of Representatives
Activity Location(s) – (if different from Applicant location) / District # / First Name / Last Name
State Assembly Member
State Senate Member
U.S. House of Representatives
FORM IV: BUDGET WORKBOOK
To locate Budget Workbook:
Complete the Budget Workbook located on the HCD website at:
http://www.hcd.ca.gov/grants-funding/active-funding/esg.shtml;
Under the heading ESG NOFA for the Balance of State Allocation and Application Forms, locate the 2017 Budget Workbook.
Open the worksheet labeled Proposed ESG Budget and Match. Complete this worksheet for your total 2017 BoS allocation of ESG funds as instructed.
This worksheet must be submitted with the Application package.
FORM V: CERTIFICATE OF INDIRECT COSTS
Will the Applicant seek reimbursement for indirect costs for the 2017 ESG funds?
Yes No
I certify under penalty of perjury that:
(1) to the best of my knowledge and belief that the form is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of the ESG program. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and Title 31, Sections 3729-3730 and 3801-3812),
(2) If the applicant will seek reimbursement for any indirect costs the applicant must:
a. comply with all OMB requirements and standards including 2 CFR 200.403, 200.415, and Part 200 Appendix 4,
b. certify that the applicant and/or any subcontractor seeking reimbursement for indirect costs at the de minimis rate do not meet the definition of a major nonprofit organization as defined by OMB 2 CFR 200.414, and
c. maintain records including evidence of the Modified Total Direct Cost (MTDC) (2 CFR 200.68) calculations, indirect cost limits, and supporting documentation for actual direct cost billing.
I further certify that I am aware that there are penalties for willfully and knowingly giving false information on an application for federal or State funds, which may include immediate repayment of all federal or State funds received. I understand that the information submitted is subject to verification by State or federal personnel as part of compliance monitoring.
certification of InDIRECT COSTSPRINTED NAME OF AUTHORIZED REPRESENTATIVE TITLE
______
AUTHORIZED REPRESENTATIVE SIGNATURE
DATE
FORM VI: PAYEE DATA RECORD
To locate Payee Data Record, STD 204 Form:
Complete the form located on the HCD website at:
http://www.hcd.ca.gov/grants-funding/nofas.shtml
This form must be submitted with the Application package.
FORM VII: PROJECTED OUTCOMES
Provide the projected performance data for each ESG activity.
Activity / Projected Number of Persons Served / Projected Number of Households ServedStreet Outreach
Homelessness Prevention
Rapid Re-Housing
Household:
A household is defined as an individual or a family that will be served during the duration of the grant. For projects that serve single individuals, the household is the same as the individual. For projects that serve couples, families with children, and other multi-person households, the household outcome should be based on the head of household.
FORM VIII: GOVERNING BOARD AUTHORIZING RESOLUTION
Guidelines for Preparing the Resolution:
Resolutions need to substantially conform to the attached Sample Resolution. Any changes to the attached language must be legally sufficient language approved by HCD.
Resolution Checklist:
A. Resolution should be on the applicant’s official letterhead.
B. Resolution shows the date of the Board Action approving the Resolution.
C. Generally, the Board Action must occur subsequent to the Department’s ESG NOFA release date. However, due to the delay in the 2017 ESG NOFA release, the NOFA date in the Resolution can state “projected to be released in May or June of 2017”. Insert the date (or “projected to be released…”) of the Department’s ESG NOFA for the BoS Allocation in ParagraphA.
D. The exact wording of the sample Resolution is being used or HCD has approved alternative wording.
E. State the dollar amount being requested from the Department (e.g., in an amount not to exceed $ ______).
F. Generally, at least one person, together with their title (or multiple persons, together with their titles), is (or are) authorized to sign the Standard Agreement and other documents referenced in the attached Sample Resolution. Note: The person authorized to sign the standard agreement cannot sign the Resolution, or attested the Resolution.
There are several options for entering name and title of authorized signor(s). However, the use of “and/or” is inherently ambiguous and is not acceptable. Below are acceptable options:
Option 1: Mr. Schultz, CEO and Charlie Brown, CEA
Option 2: Mr. Schultz, CEO or Charlie Brown, CEA
Option 3: Mr. Schultz, CEO, or designee(s). When choosing this option, if a delegation of authority will be made at some point by a named, authorized person, as a predicate to that delegation becoming effective, the applicant must provide an acceptable letter of delegation on official letterhead stating expressly both the name and title of the delegatee.
Option 4: Title of local government official. (It is acceptable for municipalities or other government localities to provide only the title of the person authorized to act on behalf of the entity. However, official supporting documentation demonstrating that the person currently holding this position will be required).
Note: Both the Name and Title of all Authorized Representatives (except as indicated in “Option 4” above) must be expressly provided in the Resolution. An Authorized Representative, expressly identified in the Resolution, must sign the Standard Agreement and other Program documents.
G. The actual vote must be shown on the Resolution: Ayes, Noes, Abstentions, Absent, and the affirmative Ayes must constitute a quorum and an acceptable majority, per the entity’s organizational documents. Indicate a “0” where no votes are cast.
Applicants are encouraged to use the sample Authorizing Resolution format to avoid deficiencies that will require a new resolution. A deficiency may delay execution of the Standard Agreement and drawdown of ESG funds.
(Produce on Rapid Rehousing Provider Letterhead)
Sample Resolution
(Insert Project Name and Organization’s Resolution Number:
AUTHORIZING RESOLUTION
(Insert Name of Rapid Rehousing Provider)
[All, or a necessary quorum and majority] of [the directors, supervisors, members, council members, etc.] of [official name of entity, and type of entity: non-profit, county, municipality, etc.] (“Rapid Rehousing Provider”) hereby consent to, adopt and ratify the following resolutions:
A. WHEREAS the State of California (the “State”), Department of Housing and Community Development (“Department”) issued a Notice of Funding Availability (NOFA) dated (MM/DD/YYYY), under the Emergency Solutions Grants (ESG) Program (“Program”); and
B. WHEREAS (Insert Name of Rapid Rehousing Provider) is eligible and wishes to receive ESG grant funds submit an application (“Application”) for such funds; and,
C. WHEREAS the Department may approve funding allocations for the ESG Program, subject to the terms and conditions of the NOFA, Program guidelines and requirements, and the Standard Agreeme.t and other contracts between the Department and ESG grant recipients.
NOW THEREFORE BE IT RESOLVED THAT:
1. If (Insert Name of Rapid Rehousing Provider)receives a grant of funds from the Department pursuant to a Department NOFA, it represents and certifies that it will use all such funds in a manner consistent and in compliance with all applicable state, federal, and other statutes, rules, regulations, guidelines and laws (“rules and laws”), including without limitation all rules and laws regarding the ESG Program, as well as any and all contracts (Insert Name of Rapid Rehousing Provider)may have with the Department.
2. (Insert Name of Rapid Rehousing Provider)is hereby authorized and directed to receive an ESG grant, in an amount not to exceed $ (Insert Grant Amount), in accordance with all rules and laws.
3. If the application authorized by this Resolution is approved, (Insert Name of Rapid Rehousing Provider)hereby agrees to use the ESG funds for eligible activities as approved by the Department and in accordance with all Program requirements, and other rules and laws, as well as in a manner consistent and in compliance with the Standard Agreement and other contracts between the Rapid Rehousing Provider and the Department.