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Expression of Interest Form

Capital Funding for Services Providing Temporary Shelter

This call for Expression of Interest (EOI) supports the planning and development of services providing temporary shelter for Community and Social Services clients.

Please complete the following form to submit an EOI for capital funding.

Successful projects from the EOI process will be required to provide more detailed proposals.

Proponent Information

Name of Proponent:
Contact Name:
Address:
City: / Province: / Postal Code:
Phone: / Fax: / Email:
Proposed Project Name:

Project Information

Project Description
(2,000 word maximum) / Please include (but not limited to): information detailing the need/demand for the project/facility in your community; target population of those sheltered within the project/facility; support model proposed and project alignment with principles of provincial and local homelessness plans.

Select the most appropriate activity being proposed in this EOI:

☐ Repurposing an existing property

☐ Ground up builds/New builds

Project Duration / Estimated Start Date:
Key Project Milestone Dates: / Detailed Engineering
Regulatory Authorizations (i.e. Development Permit)
Tender
Construction
Other (please describe):
Estimated Completion Date:
Please expand (if required):

Community Engagement Plan

§  Using the space below, please describe how key stakeholders, including service providers, will be involved in the planning and development of the project. In addition, please detail your proposed engagement plan for the geographic community around where the project will be developed. Resources that could help support your community engagement can be found https://policywise.com/wp-content/uploads/2016/07/Annotated-Bibliography-Community-Inclusion-Frameworks-for-Vulnerable-Populations-and-Strategies-for-Combating-NIMBY-Attitudes-to-Social-Housing-Projects.pdf.

Please detail your community engagement plan here:

Financial Information

Applicants for the Capital Funding for Services Providing Shelter are required to submit the following financial information:

a)  Proforma Statement of Capital Cost and Sources of Funding

b)  Proforma Operating Budget (if applicable)

c)  Copies of the Proponent’s Latest Three Years of (Audited Preferred) Financial Statements

a)  Proforma Statement of Capital Cost and Sources of Funding

STATEMENT OF CAPITAL COST AND SOURCES OF FUNDING
Project Name______
ESTIMATED CAPITAL COST
Land Acquisition
Building
Professional Fees
Furniture & Equipment
Other (Specify)
Total Estimated Capital Cost: / $0
SOURCES OF CAPITAL FUNDING
Alberta Government Department/Agency
Federal Government Department/Agency
Municipal Government Department/Agency
Owner's Equity
Fundraising
Mortgage
Other (Specify)
Other (Specify)
Total Capital Funding: / $0

b)  Proforma Operating Budget

PROFORMA ANNUAL OPERATING BUDGET
Project Name______
ESTIMATED ANNUAL REVENUES
Rental Revenue
Operational Funding
Donations
Other (Specify)
Other (Specify)
Total Estimated Annual Revenue: / $0
ESTIMATED ANNUAL EXPENSES
Direct Care Expenses
Direct Care Salaries & Benefits
Care Related Supplies
Care Management
Other Direct Care Expenses
Total Direct Care Expenses: / $0
Accommodation Expenses
Food Services
Laundry/Linen Services
Housekeeping
Recreation Supplies
Other Accommodation Expenses
Total Accommodation Expenses: / $0
Facility & Maintenances Expenses
Salaries & Benefits
Utilities
Building & Grounds Maintenance Equipment
Insurance
Property Taxes
Other Facility & Maintenance Expenses
Total Facility & Maintenances Expenses: / $0
Administration Expenses
Salaries & Benefits
Office Supplies
Accounting/Audit/Legal/
Interest Expense (Mortgage & bank charges)
Staff Training
Staff Travel
Depreciation & Amortization
Other Administration Expenses
Total Administration Expenses: / $0
TOTAL OPERATING EXPENSES: / $0
ANNUAL SURPLUS/(DEFICIT) / $0

Is this project eligible for funding from another program? ☐ Yes ☐No ☐Unknown

Please Describe:

§  Using the space below, please provide additional information about alternate funding sources that have been confirmed or any decisions pending:

(Examples may include: third party cost-sharing arrangements – private business, industry partners, etc.)

What is the community’s plan if funding is not immediately available for your project?

What interim and/or contingency options are available? Please describe below:

c)  Copies of Proponent’s Most Recent Three Years (audited) of Financial Statements

Authorization & Submission

Applicant Name:
Contact Name:
Signature: ** / Date:

**All applications must be signed by the person with designated authority for the proponent organization. Consultants may not apply on behalf of the applicant.

Please submit your completed grant application no later than 13:59:59 MT on Friday, August 11, 2017 to , cc: . Late or incomplete EOIs will not be considered.

For additional information please contact:

Mr. Brian Bechtel, Executive Director Ms. Sharon Blackwell, Executive Director

Cross Ministry & Community Partnership Initiatives Housing and Homeless Supports

Community and Social Services Community and Social Services

3rd floor, 44 Capital Boulevard 301, 7015 MacLeod Trail South

10044 – 108 Street Calgary, Alberta T2H 2K6

Edmonton, Alberta T5J 5E6 Phone: 403- 297-3196

Phone: 780-638-1135 Cell: 403- 815-2379

Email: Email:

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July 2017