APPLICATION FOR
COMMUNITY DEVELOPMENT BLOCK GRANT FUNDS
FOR
CAPITAL IMPROVEMENT PROJECTS
IN CONJUNCTION WITH THE NOTICE OF FUNDING AVAILABILITY (NOFA)ISSUED:
JUNE 3, 2013
This application is to be completed for the “out-of-cycle” NOFA, issued to award additional 2012-13 program year CDBG funds that have become available. Eligible projects are those that can expect to have at least 75% of the CDBG awarded funds expended by February 2014.
Approximately $600,000 will be available for Capital Improvement Projects
DATES AND DEADLINES
(Except for the Application Due Date, dates are subject to change. Notices will be posted at
Notice of Funding Availability (NOFA) Issued / June 3, 2013MANDATORY Pre-Application Training
RSVP by email to
See training notice posted at for times and locations. / June 10, 2013 County Office
Or
June 14, 2013 in Buellton
Application Due Date / July 1, 2013
Capital Loan Committee Review/Recommendations and Public Hearing / On or about July 17, 2013
Public Comment Period / July 19 – August 20, 2013
Board of County Supervisors Public Hearing / August 20, 2013
Notice of Awards / September 3, 2013
Submit EIGHT bound originals, ONE unbound copy (without staples or paperclips), and ONE electronic copy ( CD, thumb drive or email*) to the address below by 5:00 P.M. on the Due Date.
*Email copy to:
Housing and Community Development Division
105 E. Anapamu Street, Room 105
Santa Barbara, California 93101
(805) 568-3520
REQUESTED FUNDING AMOUNT: $ ______
The following representatives of the applicant attended Pre-Application training:
Name / Organization or Firm / Date Attended1. Proposed Project/Program Title:
2. Legal Name of Agency/Applicant Requesting Funding:
3. Mailing Address:City: Zip:
4. Executive Director:Phone: Email:
Person to contact with questions regarding this application
NameTitle:Phone: Email:
Person who will manage the CDBG project
NameTitle:Phone: Email:
5. Agency Description:
Governmental Entity? / Yes NoJurisdiction
Department
501(c) 3 Non-Profit? / Yes No
Year Incorporated
Faith-Based Organization? / Yes No
Agency Tax ID Number:
Agency DUNS Number:
7. ProjectSummary (Two or three sentences only; detailed project information is requested later in this application:
8. Number of Unduplicated clients/personsexpected to be served during the grant fiscal year (July 1 – June 30:
9. Project/Program Site Address(es): Census Tract:
For public infrastructure, such as parks or sidewalks, attach map with project site(s) noted.
10.Applicant Certification: To the best of my knowledge and belief, the information contained in this application is true and correct; the document has been duly authorized by the governing body of the applicant; and the applicant will comply with all assurances, Federal, State, and Local laws and regulations if funding is approved.
Board President (please print): ______
Signature/Date: ______Date:
A board resolution will be required to accept the CDBG award, if funded
YOUR APPLICATION WILL NOT BE ACCEPTED UNLESS ALL THE REQUIRED DOCUMENTATION IS ATTACHED.
11. Meeting a CDBG National Objective. Please check the box that appropriately applies to your project (See Guidelines at Page 3 and Schedule C of this Application):
/ Benefit a majority (51%) of low/moderate income residents. Low/moderate income residents earn at or below 80% of the area median income, adjusted by family size. See income chart in the application guidelines / Alleviate a serious and immediate threat to the health and/or welfare of the community. Threat must be recent in origin or urgency (previous 18 months) and no other source of funds is available for the program/project;
/ Serves to prevent or eliminate conditions of slum and blight.
12. Which County of Santa Barbara FY 2010-2015 Consolidated Plan Priority does this project/program address?(See Guidelines at Page 4and Schedule C of this Application):
13. Proposed Program Service Area / Beneficiaries. Documentation of benefit to low/moderate-income persons is required for all funded projects. In order to qualify as benefiting low/moderate-income persons, your project must fall into one of the categories listed on page 5 of the guidelines. . Please read carefully and check the applicable box for this project:
A. Area BenefitAttach a map showing project boundaries and label it Attachment to Question 13A, Service Area Boundaries.
B. Limited Clientele Data must be collected and reported for all clients served by the program including household size, income level(see Attachment A of the Guidelines), race, ethnicity, and city of residency (see Guidelines at Page 5).
If your project benefits a limited clientele, please 1) describe the population served by the project/program; 2) indicate the number of unduplicated clients to be served; 3) indicate the number expected to be low/moderate-income; and 4) describe the specific method of collecting demographic data used by your project:
14. CAPITAL IMPROVEMENT PROJECT DESCRIPTION
Describe the project and list the type of activities that will occur in connection with the project i.e., acquisition, rehabilitation, construction, expansion, demolition, American with Disabilities Act (ADA) Compliance ramp/sidewalk improvements, and indicate how the CDBG funds will be used. Be specific.
15.TIMELINE / CONSTRUCTION SCHEDULE
Provide a detailed project timeline and construction schedule. Indicate how/whether at least 75% of the CDBG award will be expended by February 2014. Be sure that the budget line items in the project budget identify CDBG-funded expenses that are expected to be incurred and reimbursed by the deadline. Submit as an Attachment if additional space is needed.
See Attachment #___16. NEED OR PROBLEM TO BE ADDRESSED. Describe the need or problem to be addressed and how this proposed program/project will meet that need:
17. CAPITAL IMPROVEMENT PROJECT - SERVICES PROVIDED
Describe the benefits the completed project will offer to low/moderate income persons.
Has Capital Needs Assessment been completed? (for projects involving building acquisition or improvements) Yes No If, yes, please submit copy
Has the proposed project been submitted for inclusion in aCapital Improvement Plan? (for projects involving building acquisition or improvements) Yes No If, yes, please submit copy
18. FACILITIES OPERATION
Describe how the operation of the facility (i.e., staffing, program supplies, and maintenance) is financially supported now and how it will be supported after project completion.
19. LICENSING
List any and all licenses required to carry out the services associated with this project. For example, if the program serves infants, children, or youth, indicate if the program requires a California Department of Health Services Childcare license (See instructions for details). Licensed childcare center applicants must attach a copy of current license and Certificate of Occupancy – label Attachment to Question 19 – Licensing.
20. PROJECT LOCATION AND SIZE
Indicate the location and size of the project (e.g., square foot of building or expansion area).
21. ZONING
Specify the current zoning of the proposed site and the required zoning for the intended use. Indicate if your project will be in compliance with the current zoning, or if a variance, etc., is necessary to carry out the project. If your proposed project is exempt from County Zoning requirements please cite the exemption source.
22. PARKING
Specify whether the current parking is adequate for the intended use, meets zoning requirements, or requires rezoning or a variance.
23. ARCHITECTURAL SERVICES
Indicate what type of architectural services will be needed on the project. All commercial renovation projects require that drawings be prepared by either a licensed architect or engineer. Indicate whether an architect or engineer assisted in developing the project budget, drawings, specifications, etc., and provide the name of the firm. Indicate what design work (i.e., conceptual plans, construction drawings) has been completed for the project. Submit copies of plans and drawings, if available.
24. SITE CONTROL
Indicate if the site is owned by your agency, leased, or a pending purchase by your agency. Please indicate if there are any tenants in the building. (See Application Instructions for more details).
25. Will the proposed project meet Americans with Disabilities Act standards for accessibility to persons with disabilities? Explain. (See Guidelines for more details).
26. Discuss Neighborhood Support efforts you have undertaken, if any, to date relative to the proposed project. List dates of meetings, number of participants, and issues raised. Indicate whether the neighborhood expressed overall support or opposition and provide a summary of significant comments received.
27.PROJECT PERFORMANCE MEASUREMENTS
Define the project’s measurable goals, outputs and outcomes. Be specific.
28.PROJECT READINESS
Describe the project’s readiness to achieve completion by June 30 of the award year. (Include status of entitlements, government approvals, funding commitments and status of plans and specifications, etc.)
29. Complete and submit Exhibit A (Project Budget)
30.BACKGROUND
Outline the history of your agency, including the length of time your agency has been in operation, the date of incorporation, and the type of corporation.
- Describe the agency’s mission and purpose.
- Describe all major services/programs/program areas the Agency provides.
- List the average number of clients assisted by your Agency in a typical year and the characteristics of your clients (for Agency as a whole, in addition to those already described in Question 13B)
- Describe your agency’s capabilities of assisting these clients.
E. Organizational Chart and current Board of Directors. Attach both to application and label it Attachment to Question 30E.
31.FINANCIAL
- Does your agency comply with Generally Accepted Accounting Principles? Yes No
- Does your agency comply with OMB Circular A-87 or A-122, as applicable? Yes No
Submit copies of the agency’s most recent audited financial statements
Describe the agency’s financial capacity to carry out the proposed CDBG project
32. AGENCY PERFORMANCE HISTORY
Provide information on the two most recent CDBG funded project/programs administered by your agency. If you have never or not recently received a Santa Barbara County CDBG grant, list other, similar, recent projects/programs). Complete all fields or write N/A for not applicable.
A.PROJECT ADMINISTERED BY YOUR ORGANIZATION
Project/Program Name / Funded By / Contract Completion DateProject/Program Address:______
Project Status:
Did/Will the project complete on time and achieve the intended results? Explain.
Project/Program Name / Funded By / Contract Completion DateProject/Program Address:______
Project Status:
Did/Will the project complete on time and achieve the intended results? Explain.
33. In accordance with the Office of Management and Budget Circulars A-133, A-128, and A-110, the Federal Government requires that organizations receiving a cumulative amount of $500,000 or more in Federal financial assistance in a fiscal year must have an audit prepared at the end of the fiscal year (referred to as the “Federal Single Audit”. Agencies that fall into this category must choose one of the three following ways of meeting this requirement and state which method is chosen. Please check the applicable box for this project:
If your agency already conducts audits of all its funding sources including CDBG, you must submit a copy of your most recent audit, and may, at your discretion, include the CDBG portion of the audit cost in your CDBG project budget.
If your agency already conducts audits of its other funding sources but has neither received nor included CDBG funds in the past, the scope of the audit should be modified to incorporate CDBG audit requirements. The associated audit cost of the addition of CDBG funds could then be included in your CDBG project budget, accompanied by the auditor's written cost estimate.
If your agency does not have a current audit process in place, your agency will be required to include a 10% set-aside in the CDBG project budget for the provision of an audit.
34.ADDITIONAL INFORMATION
Please provide any additional information in the space below that you would like to be considered for this proposal.
Checklist of Required Attachments
/ ItemCompleted application
W-9
Article of Incorporation and By-Laws
Federal tax exemption letter
Organizational Chart
List of Board of Directors, their affiliations and term
Audited Financial Statements and A-133 audit, if applicable
Proof of Insurance
Conflict of Interest Statement. Identify any member, officer, or employee of your organization who is an officer or employee of Santa Barbara County, or a member of its Boards, Commissions, or Committees or has any interest which could be affected by any actions taken in execution of this application.
Project site map(s)
Plans and Drawings if available
Capital Needs Assessment and Capital Improvement Plan
Project photos
Resumes of project team
PROJECT TITLE
This schedule must be completed when the proposed capital project involves acquisition, construction and/or rehabilitation of a public facility. The project budget should include permits, utility installation, relocation and engineering and architectural services (if applicable)
Cost Component / Total Budget / County CDBG / Other funds (identify)______ / Other funds (identify)
______
LAND
Appraisals
Legal Services
Land Acquisition
Real Estate Services
Other (specify)
Total Land Cost
PROFESSIONAL SERVICES
Architects
Asbestos Survey
Archeological Monitoring
Other (Specify)
Total Professional Services
Construction
Site Improvements
Labor[1]
Material
Equipment[2]
Fees and Permits[3]
Total Construction Costs
Relocation Assistance[4]
TOTAL PROJECT BUDGET
[1] Davis- Bacon Wage Regulations will affect Construction/Rehabilitation project costs. Check with staff for wage determination.
[2] Attach list itemizing proposed acquisition of built in equipment. Equipment that is not an integral structural fixture is generally not eligible for purchase with CDBG funds.
[3] Include costs for development and permit fees payable to the County of Santa Barbara in connection with a project.
[4] Relocation costs apply when individuals or businesses are displaced as result of your acquisition, new construction or renovation
project. Please check with staff for relocation cost factors.