CA STATE COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM

GENERAL CONDITIONS CLEARANCE CHECKLIST

MULTI-FAMILY REHABILITATIONPROJECT

JURISDICTION: GRANT NUMBER: DATE SUBMITTED:

PROJECT DESRIPTION:

PREPARER NAME: TITLE: PHONE:

EMAIL:

Fill in checkboxes, data or dates as required, and use the Comments box for explanations. If you have questions or need assistance, contact your CDBG Representative.

  1. Exhibit E Special Conditions

If Standard Agreement contains Special Conditions in Exhibit E, check the box and submit documentation required to clear all Special Conditions. If you have questions regarding required documentation, contact your CDBG Program Representative.

COMMENTS:

Cleared: (CDBG use only)

  1. Environmental Compliance

If Project is Categorically Excluded (CE), Subject to 58.5, and converts to Exempt, complete the following. However, do not submit any NEPA forms, but keep the forms in your Public Environmental Review Record (ERR) Folder:

Level of Environmental Review Form

Statutory Worksheet, with no back-up documentation

If Project is Categorically Excluded, Subject to 58.5, and does not convert to Exempt, submit the Statutory Worksheet with no back-up documentation, and the items listed below, as applicable:

Level of Environmental Review Form

Eight-Step Planning Process and Noticing for Floodplain/Wetland Mgmt N/A

Proof of publication:

a. for CE Subject to 58.5, submit Notice of Intent to Request Release of Funds (NOI/RROF)

b. for EA, submit the Combined Notice of Finding of No Significant ImpactandNOI/RROF

RROF and Certification Form (with original signature)

If Project requires Environmental Assessment (EA), please contact your CDBG Rep to discuss. It is unlikely a Multi-Family Rehab project would require an EA.

COMMENTS:

Cleared: (CDBG use only)

  1. Acquisition Compliance (URA)

Does this Project include the acquisition of real property? No Yes

If No, skip to next item, below.

If Yes, check box and follow instructions below as applicable, then move on to item #6:

Proper Notice to Seller was or is being provided as part of execution of property sales agreement, prior to close of escrow. If checked, submit Notice to Seller (draft or final version)

COMMENTS:

Cleared: (CDBG use only)

  1. Site Control

Who has Site Control of the project presently? Name:

Will this same entity own the property at the completion of the project? Yes No

If no, who will owner the property after the completion of the project? Name:

If the owner of the project at the completion of the activity is not the present owner, indicate method/manner of Site Control, and submit documentation if different from documentation included in Application.

Fee Title

Leasehold Interest

Option to Purchase or Option to Lease

Public Rights-of-Way

A Land Sale Contract

Deed

Other (or combination of above) -- Describe:

What will the loan terms be?

Performing Loan? Describe:

Deferred Loan? Describe:

Grant?

Other (describe in comments below)?

If the Grantee will support the project with a grant, please use the comments below to discuss how the jurisdiction came to the conclusion that the project would not be able to take on additional debt and why a deferred loan would not be appropriate.

COMMENTS:

Cleared: (CDBG use only)

  1. Relocation Compliance (URA & Section 104(d))

Willthis Project trigger Relocation or Displacement?

No. Nothing to submit; skip to next item.

Yes, projectwill trigger relocation/displacement compliance: Check all that apply below and submit documentation

Copies of signed GIN Notices

A copy of Temporary Relocation Plan for project, as required under URA law

A copy of Permanent Displacement Plan for project, as required under URA law

A copy of Replacement Unit Plan for project, as required under Section 104(d) relocation law

COMMENTS:

Cleared: (CDBG use only)

  1. Funding Commitments

Has project funding changed compared to funding described in Application? No Yes

If No, skip to item next item, below. (All funding documented and committed)

CDBG is only funding source, but amounts have changed. Describe:

For any other funding commitments that are new or changed, submit (1) name of source, (2) dollar amount, and,(3)the document confirming the funding commitment (Award Letter, Grant Cover Page, Bank Commitment Letter, etc.)

Other Federal or State funding source(s):

Local funding source(s):

Other funding source(s):

New, Total Project Cost will be? $

COMMENTS:

Cleared: (CDBG use only)

  1. Cost Estimates

Has project Cost Estimate changed compared to the Application? No Yes

If No, skip to next item number 9, below. If Yes, submit Architect’s Revised Cost Estimate.

COMMENTS:

Cleared: (CDBG use only)

  1. Timeline or Schedule

Has project Timeline or Schedule changed compared to the Application? No Yes

If No, skip to next item on Checklist. If Yes, submit Architect’sRevised Timeline/Schedule.

COMMENTS:

Cleared: (CDBG use only)

  1. Procurement – Grant and Activity Administration

NOTE:

  1. The CDBG program uses 24 CFR 85.36 as the principle rule for procurement.
  2. All procurement must be approved by CDBG prior to signing any consultant, subrecipient, or contract employee contracts.

Check all that apply.

Jurisdiction is using in-house staff only for this project.

If Yes, skip to next clearance item on the General Conditions Checklist.

______

Jurisdiction is using a Subrecipient for this project. If Yes, submit the following:

Subrecipient Agreement with Scope of Work and all attachments or exhibits. If Not yet executed, submit a ready-to-sign draft Subrecipient Agreement for approval.

Proof of Non-Profit status (501c3 or Governmental Non-Profit)

Proof of non-debarment

______

Jurisdiction is using the Sealed Bid Procurement Method for contracting with a Construction Contractor. If Yes, the CDBG Program does not need to review this portion of the jurisdiction’s procurement activity, unless only one bid is received for the construction work. If that is the case, please contact your CDBG Program Representative for Sole Source Approval submittal requirements.

______

Jurisdiction is using the Small Purchase Procurement Method for contracting with a Consultantunder the restrictions of CDBG Management Memo 13-05. Yes No If Yes, retain all Procurement documentation in jurisdiction’s Public Information file. NOTE: Sole Source Procurement is not allowable under Small Purchase Method.

______

Jurisdiction is contracting with a Consultant through aRequest for Proposals (RFP), and/or an Architect or Engineer through a Request for Qualifications(RFQ).

If Yes, check the appropriate box(es), then complete the checklist below and submit the followingfor each position to be hired:

Consultant position via RFP process

Architect/Engineer position via RFQ process

Is this a Sole Source Request for Procurement? Yes No

If yes, submit evidence of:

  • A matter of extreme urgency;
  • No other source for this service available in the region; or
  • Only one responsive bid/proposal was submitted; and
  • All items in numbers 1 to 8 below.

If no, submit all items in numbers 1 to 8 below.

1. Copy of RFP/RFQ(with all exhibits and attachments)

2. Cost reasonableness analysis, completed prior to issuing RFP/RFQ (or at minimum, before receiving bids)

3. Solicitation list, public notices (with proof of publication) and/or other method(s) of distribution, including proof that RFP/RFQ was delivered to the solicitation list.

Describe:

  1. List of bid respondents with bid amounts.
  2. Full copies of all bids received.
  3. Review/scoring results for each respondent/bidder, which matches the selection criteria indicated in RFP/RFQ, including names of jurisdiction’s review panel.
  4. Proof of non-debarment of selected consultant
  5. Complete draft contract (ready-to-execute).CDBG approval required prior to execution of contract.

Or

Previously executed contract:

Contractor name:

Contractor DUNS #:

COMMENTS:

Cleared: (CDBG use only)

  1. Davis-Bacon Labor Standards Compliance

Will the project trigger Federal Prevailing Wage? Yes No

If Yes, continue below and submit the appropriate form.

If not, please use the comment field below to explain.

Assignment of Labor Standards Compliance Officer formN/A

Force Account N/A

Does your jurisdiction anticipate hiring a labor standards consultant to assist on this project?

No Yes(If “Yes”, see Procurement sectionabove)

COMMENTS:

Cleared: (CDBG use only)

  1. Section 504 Accessibility Requirements

Will this project trigger Section 504 Accessibility requirements? No Yes

If No, the checklist is complete. If Yes, check the appropriate boxes below:

Letter from Authorized Representative stating they will comply with Section 504 Accessibility Regulations; OR

If Engineer not secured at the time of clearing special conditions, a letter from the jurisdictionmust be submitted stating they will comply with Section 504 compliance and will ensure compliance by Engineer and will provide letter from Architect once secured.

Letter documenting that Section 504 Accessibility requirements are not required for this project.

COMMENTS:

Cleared: (CDBG use only)

CDBG USE ONLY:

REVIEW COMMENTS:

Representative: ______Date: ______

Manager: ______Date: ______

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Rev. 09-01-2014