Www.gwinnettcounty.com



FFY 2021 APPLICATION CYCLECommunity Development Block Grant ProgramPublic Services Application200025060960Gwinnett County Community Development ProgramOne Justice Square446 West Crogan Street, Suite 275Lawrenceville, GA 30046678-518-6008gchcd@TABLE OF CONTENTS FFY 2021 Application Instructions 3Tab A – Cover Sheet7tab b – Application Submission Requirements 8Tab C – project details10Tab D – beneficiaries12Tab E – goals and objectives14tab f – sustainability15TAB G – Proposed Budget Summary16Signature Page18Attachments19 Income Guidelines19Application Rating Form20Community Development Block Grant (CDBG) Program FFY 2021 Public Services Application Instructions PLEASE READ CAREFULLYINTRODUCTIONAs a means to support viable communities, the United States Department of Housing and Urban Development (HUD) through its Community Development Block Grant (CDBG) program provides resources to address a wide range of unique community development needs. The CDBG program provides annual grants on a formula basis to entitlement jurisdictions like Gwinnett County, seeking to provide decent housing, suitable living environments, and economic opportunities principally for low and moderate-income persons. The CDBG Program has three (3) National Objectives:Provide a direct benefit(s) to low to moderate-income households;Prevent or eliminate slum or blight; orAddress an urgent need or problem within the community. Each year, the Gwinnett County Community Development Program Office requests local agencies and government entities to submit applications to participate as a subrecipient in the program. This funding application is for the period beginning January 1, 2021, and ending December 31, 2021. A Selection Committee will review all applications for compliance with eligibility requirements, and make funding recommendations based on competitive scoring to the Gwinnett County Board of Commissioners. Please note: Incomplete applications will not be considered for funding; be sure to complete all sections of the application and provide all requested documentation.AVAILABLE FUNDINGThis application for funding is contingent upon the availability of HUD funding for the CDBG program. This program is funded and regulated at the federal level by the U.S. Department of Housing and Urban Development (HUD) and administered locally by the Gwinnett County Community Development Program office. It is authorized under Title I of the Housing and Community Development Act of 1974, as amended and regulatory compliance requirements are governed by the following:- Title I of the Housing & Community Development Act of 1974, as amended.- Title 24 of the Code of Federal Regulations, Section 570 (24 CFR 570). - Office of Management and Budget (OMB) Administrative Circular A-110, as amended. - Office of Management and Budget (OMB) Administrative Circular A-122, as amended. This funding is subject to availability, and there is no guarantee that any funds will be allocated. Submission of an application does not guarantee funding. Costs associated with application preparation shall be the sole responsibility of the Applicant. Applications submitted to the Gwinnett County Community Development Program become the property of Gwinnett County.MINIMUM ELIGIBILITY REQUIREMENTSThe application must be submitted by, or on behalf of, a nonprofit agency, public-agency, or government entity requesting CDBG funds to undertake eligible costs and activities.A minimum of 51% of total expenditures must benefit low to moderate-income persons or clientele within Gwinnett County municipal boundaries.Proposed projects must address the program priorities outlined in the Program Priorities section below.All proposed projects must serve one or more of these targeted populations: households with incomes at or below 80% (see Attachment A: Income Guidelines); abused/neglected children; abused spouses; adults with severe disabilities; elderly (62+); homeless; illiterate adults; migrant farmworkers; persons living with HIV/AIDS.CDBG STRATEGIC PRIORITIESGwinnett County’s Consolidated Plan established Strategic Priorities through consultation with community stakeholders, considered alongside data from the U.S. Census and other sources indicate specific housing and community development needs in Gwinnett County. Combined with a needs assessment survey, under the Citizen Participation Plan, Gwinnett County identified the following Strategic Priorities to address utilizing CDBG, HOME, and ESG funds in conjunction with leveraging other public and private investments.These priorities are based on the needs assessment, market analysis, and public comments received. Gwinnett County will focus its priorities on the types of projects and programs having long term impacts on low and moderate-income residents and help address other federal, state, and local priorities, such as fair housing choice and sustainability.The proposed program/project should be designed to address one or more of the priority needs listed below:Increase Access to Affordable Housing1.1 Provide Tenant-Based Rental assistance1.2 Production of new units 1.3 Rehabilitation of existing units 1.4 Acquisition of existing unitsIncrease of Non-Profit Developers2. Homelessness Reduction2.1 Outreach2.2 Emergency shelter and transitional housing2.3 Rapid Re-housing Funding 2.4 Homelessness PreventionHMIS Coordination3. Non-housing Community Development3.1 Public Facility and Infrastructure Improvements3.2 Public Services Funding3.3 Promote Economic Development Activities4. Affirmatively Further Fair Housing Choice 4.1 Increase fair housing education and build capacity for testing and enforcement of fair housing law4.2 Support improved access to community resources4.3 Continue to operate in compliance with expanded protected class definitions found in federal regulations4.4 Refer housing discrimination complaints to HUD FHEO for investigation and potential actionREQUIRED APPLICATION CONTENTSThe following information is required in each application and should be submitted and tabbed as follows:Tab A. Cover Sheet General information about the Applicant.Tab B. Application Submission RequirementsThis checklist on page 9 outlines the minimum submission requirements, along with the associated required documentation that must accompany the application. All Applicants must complete this checklist, and page 10 continues as a requirement for non-profit organizational Applicants only. Tab C. Project DetailsThis section should include all the specifications of the proposed project.Program Description — the overall purpose of the project and how it addresses CDBG program priorities.Implementation Schedule—the project implementation schedule identifies the timeline for all major activities planned. Tab D. Beneficiaries This section includes information about the area and population to be served, including the method for determining income eligibility.Proposed Need This section presents questions to identify the need or problem to be addressed by the proposed project. Also, this section should include methods used to identify the need. Include specifics as to documentation used and meetings held to assess the needs.Tab E. Goals and Objectives This section identifies the goals and objectives. Identify at least one (1) objective for each identified need/problem. Identify the activities to be conducted to achieve the stated goals and objectives. Identify how the expected outcomes would be measured. Lastly, identify any collaboration activities with other agencies to address the identified need.National Objectives—National objectives established by the U. S. Department of Housing and Urban Development (HUD) require that programs and projects target low to moderate-income clients. An activity is considered to benefit low to moderate-income limited clientele when at least 51 percent of the residents served to meet the low to moderate-income persons in accordance with HUD’s national income guidelines (See Attachment A for Income Guidelines). In this section, you must identify which national objective(s) will be met. There must be a description of how the family size and income will be documented to verify that at least 51% of clientele are persons whose family income does not exceed the low to moderate-income limits.Suitable Living EnvironmentDecent HousingEconomic Opportunity Performance—Reporting, Monitoring, & Record Keeping: The Gwinnett County Community Development Program office will require subrecipients to provide data and information for the submission of monthly, quarterly, and annual reports pertaining to the administration and expenditure of CDBG-funded activities. Tab F. SustainabilityBudget Description—in this section, answer key questions related to the Applicant’s overall budget and financial readiness.Project Staffing—This section identifies the program staffing for the proposed project, including current employees, new hires, and volunteers to be utilized in any capacity of the project.Tab G. Proposed Project Budget SummaryIn Exhibit A, complete the table outlining the total expenses for the proposed project, including source and amount of leveraged funds/matching funds (in-kind donations or service costs).Collaboration and Resource Leveraging— Collaboration and resource leveraging represents the resources the proposing agency will bring to the project to supplement the funds being requested. Collaboration/resource leveraging can be in the form of monetary resources or in-kind services. Please include other resources in the budget summary.TECHNICAL ASSISTANCETechnical assistance questions should be directed to the Gwinnett County Community Development office at: One Justice Square446 West Crogan StreetSuite 275Lawrenceville, GA 30046E-mail: CDBGHUDPlanning@ Phone: 678-518-6008SUBMITTAL INSTRUCTIONSProvide one (1) ORIGINAL UNBOUND HARD COPY AND one (1) DIGITAL COPY (flash drive only) of your complete CDBG application with attachments. All entities must meet the requirements outlined in this application. FFY 2021 Funding Cycle Application Workshops Option #1:February 11, 2020 10:00 AM - Option #2:February 19, 2019 6:00 PMOption #3:March 10, 2019 2:00 PM Location: Gwinnett County Justice and Administration Center 2nd Floor Conference Center75 Langley Drive, Lawrenceville, GA 30046 Applications must be submitted to the Gwinnett County Community Development Program Office no later than Wednesday, April 1, 2020, at 5:00 PM. 140280214036Office/Mailing AddressGwinnett County Community Development Program OfficeOne Justice Square446 West Crogan Street, Suite 275Lawrenceville, GA 3004600Office/Mailing AddressGwinnett County Community Development Program OfficeOne Justice Square446 West Crogan Street, Suite 275Lawrenceville, GA 30046 TAB A - COVER SHEETLegal Name of Applicant FORMTEXT ?????Mailing Address FORMTEXT ?????Telephone Number FORMTEXT ?????Facsimile Number FORMTEXT ?????Applicant Website Address FORMTEXT ?????How long has the Applicant served Gwinnett County residents? FORMTEXT ?????Date of 501(c)(3) certification (N/A government entity) FORMTEXT ?????Applicant’s DUNS #: FORMTEXT ?????Registered with ? FORMCHECKBOX YES FORMCHECKBOX NOApplicant’s Federal Tax Identification #: FORMTEXT ?????Chief Executive Officer or Chief Elected OfficialNAME: FORMTEXT ?????TITLE: FORMTEXT ?????PHONE: FORMTEXT ?????E-MAIL: FORMTEXT ?????Contact person for this project (if different than above)NAME: FORMTEXT ?????TITLE: FORMTEXT ?????PHONE: FORMTEXT ?????E-MAIL: FORMTEXT ?????Current Board President NAME: FORMTEXT ?????TITLE: FORMTEXT ?????PHONE: FORMTEXT ?????E-MAIL: FORMTEXT ?????Current Board Secretary NAME: FORMTEXT ?????TITLE: FORMTEXT ?????PHONE: FORMTEXT ?????E-MAIL: FORMTEXT ?????TAB B – APPLICATION SUBMISSION REQUIREMENTS Please properly label and place all required documentation in Application AppendixALL APPLICANTSSUBMISSION REQUIREMENTSDOCUMENTATIONAPPLICANTOFFICE USE ONLY The Applicant must have at least twelve (12) months experience directly related to the proposed project or program.Provide (1) funding commitments displayed on letterhead; (2) full job descriptions or resumes of principal staff and personnel directly working on the project; and (3) descriptions of the applicant’s previous related program activities. FORMCHECKBOX FORMCHECKBOX The Applicant must have audited financial statements prepared by a qualified accountant or accounting service, covering the last two most recent reporting periods of operation.One copy each of the audited financial statement that meets the criteria described. Include management letters if applicable. FORMCHECKBOX FORMCHECKBOX The Applicant must submit a written copy of its financial management policies, including staff responsibilities and required procedures.Provide (1) a copy of the Applicant’s written financial management policies; and, (2) Current organizational chart. FORMCHECKBOX FORMCHECKBOX Identify eligible project service area and eligible clientele to be served.Provide a project map that includes Census Tracts where services will take place; orProvide a description and verification process of clientele to benefit from the project. FORMCHECKBOX FORMCHECKBOX Each Applicant must submit one original hard copy and one digital copy (flash drive only) of their application. Must submit an original hard copy and one digital copy (flash drive only). FORMCHECKBOX FORMCHECKBOX *In addition to the submission requirements detailed above, nonprofit organizations must also meet the requirements detailed on the next pageTAB B – APPLICATION SUBMISSION REQUIREMENTS continuedPlease properly label and place all required documentation in Application AppendixNONPROFIT ORGANIZATIONSSUBMISSION REQUIREMENTSDOCUMENTATIONAPPLICANTOFFICE USE ONLYSubmission Requirement Items 1 – 6 for ALL APPLICANTS have been appended.See items detailed on the previous page. FORMCHECKBOX FORMCHECKBOX Must have a minimum two-year operating history after the date of receipt of its 501(c)(3)status from the Internal Revenue Service. A copy of a 501(c) (3) designation letter from the Internal Revenue Service for non-profit Applicants. FORMCHECKBOX FORMCHECKBOX Must have an annual operating budget of more than $100,000, as reflected in the most recently filed IRS Form 990 or 990 EZ.Most recent IRS Form 990 or 990EZ. FORMCHECKBOX FORMCHECKBOX The applicant must be registered to conduct business in the State of Georgia at the time of application.A current certification from the GA Secretary of State. For assistance, please visit sos.. FORMCHECKBOX FORMCHECKBOX Must have a Board of Directors with representation from the community served and committee structure that ensures the necessary mix of skills to succeed. Provide (1) a list of board members and their addresses; (2) your agency By-Laws; (3) a copy of the Conflict of Interest Statement; and (4) a brief narrative confirming your agency meets the Board submission requirements regarding representation. FORMCHECKBOX FORMCHECKBOX Must have a current written strategic or business plan for the organization that covers at least 24 months, (including the organization’s entire current fiscal year), that includes the following: mission statement, evidence of an environmental review, stakeholder participation (staff, board, etc.), strategic goals, measurable objectives, implementation plan with assigned staff and board responsibilities, on-going evaluation to keep plan current.Current Business/Strategic Plan FORMCHECKBOX FORMCHECKBOX TAB C – PROJECT DETAILSAdd additional pages as needed and tab accordingly.Legal Name of Applicant: FORMTEXT ?????Project Name: FORMTEXT ?????Project Location: FORMTEXT ????? FORMCHECKBOX Applicant owns the property FORMCHECKBOX Applicant leases the property FORMCHECKBOX A minimum 15-year lease is attached in Appendix1. Gwinnett County Commission District: FORMTEXT ?????2. Will the project serve only Gwinnett County residents? FORMCHECKBOX YES FORMCHECKBOX NO If NO, identify other counties/municipalities that will benefit. Explain the process for ensuring that Gwinnett is paying only its fair share. (1,000 characters max; include additional pages as needed and label accordingly). FORMTEXT ?????CDBG Public Services Funds Requested: $ FORMTEXT ?????Project Priority: Number FORMTEXT ?? of FORMTEXT ?? projects submitted.Project Status: FORMCHECKBOX New Project FORMCHECKBOX Existing Project/Additional FundingIf an existing project, include the following information in the Project Description: year(s) and amount of awarded CDBG funds; detailed information on how existing service will be expanded if CDBG funds are awarded; the estimated increase of persons receiving the service and discussion of additional service to be provided through project/program. The increased provision of services/beneficiaries is essential to qualify for additional funding.Check the appropriate box for the type of activity to be supported with CDBG funding: FORMCHECKBOX Childcare Services FORMCHECKBOX Crime Awareness/Prevention FORMCHECKBOX Employment Training FORMCHECKBOX Fair Housing Activities FORMCHECKBOX Food Banks FORMCHECKBOX Health Services FORMCHECKBOX Housing Services FORMCHECKBOX Legal Services FORMCHECKBOX Mental Health Services FORMCHECKBOX Neighborhood Cleanups FORMCHECKBOX Senior Services FORMCHECKBOX Services for Abused/Neglected Children FORMCHECKBOX Services for Battered Spouses FORMCHECKBOX Services for Severely Disabled Adults FORMCHECKBOX Substance Abuse Services FORMCHECKBOX Tenant/Landlord Counseling FORMCHECKBOX Transportation Services FORMCHECKBOX Youth Services FORMCHECKBOX Other Operating Service: FORMTEXT ????? FORMCHECKBOX Equipment Purchase: FORMTEXT ?????If purchasing equipment, attach at least one detailed price quote and a detailed description of the equipment, specify quantities, and estimated unit prices. FORMCHECKBOX Equipment Details Attached in AppendixTAB C – PROJECT DETAILS continuedAdd additional pages as needed and tab accordingly.Describe an experience with a project/program for which funding is requested. (1,000 characters max; include additional pages as needed and label accordingly). FORMTEXT ?????Duration of Project: FORMTEXT ?????Project Implementation Schedule:Detail your project implementation schedule, including expenditure schedule, accomplishments, and all timelines. (1,000 characters max; include additional pages as needed and label accordingly). FORMTEXT ?????Project DescriptionProvide a detailed and comprehensive narrative about your project. Be sure to highlight any significant partnerships/leveraging resources. For equipment purchase(s), provide a detailed description of the equipment, specify quantities and estimated unit prices. At least one (1) price quote is required for equipment requests. (12,000 characters max; include additional pages as needed and label accordingly). FORMTEXT ?????TAB D - BENEFICIARIESAdd additional pages as needed and tab accordingly.Service Area of Project1. Identify and describe the geographic area to be served by the project activities. FORMTEXT ????? FORMCHECKBOX Project Service Area Map Attached in Appendix (as requested in Tab B)Project BeneficiariesAt least 51% of the total number of persons served by each project must be low to moderate-income for the project to be eligible for Gwinnett County CDBG funds. Indicate the number of beneficiaries this project has served/will serve in the 12-month grant period. Persons Served in prior program year (if existing project)*Proposed Persons Served in 2021Total FORMTEXT ?????Total FORMTEXT ?????# Low to Moderate-income FORMTEXT ?????# Low to Moderate-income FORMTEXT ?????Identify any presumed benefit groups included in the project’s target population.Presumed Benefit GroupPersons Served in prior program year (if existing project)*Proposed Persons Served in 2021Abused/Neglected Children FORMTEXT ????? FORMTEXT ?????Abused Spouses FORMTEXT ????? FORMTEXT ?????Adults with Severe Disabilities FORMTEXT ????? FORMTEXT ?????Elderly (62+) FORMTEXT ????? FORMTEXT ?????Homeless Persons FORMTEXT ????? FORMTEXT ?????Illiterate Adults FORMTEXT ????? FORMTEXT ?????Migrant Farm Workers FORMTEXT ????? FORMTEXT ?????Persons Living with HIV/AIDS FORMTEXT ????? FORMTEXT ?????Other: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3. Identify the need(s) of the population to be served that are addressed by the proposed project. ((1,000 characters max; include additional pages as needed and label accordingly). FORMTEXT ?????4. How does the proposed project meet the identified need(s)? (1,000 characters max; include additional pages as needed and label accordingly). FORMTEXT ?????5. Describe how the Applicant collaborates with organizations that serve the same population. (1,000 characters max; include additional pages as needed and label accordingly). FORMTEXT ?????TAB D - BENEFICIARIESAdd additional pages as needed and tab accordingly.6. At least 51% of the total number of persons served by each proposed project must be low- to moderate-income for the project to be eligible for Gwinnett County CDBG funds. Describe the Applicant’s process for verifying household income or presumed benefit status (battered and abused spouses, homeless, etc.) of all persons served by the project for which funding is requested. (1,000 characters max; include additional pages as needed and label accordingly). FORMTEXT ?????TAB E – GOALS AND OBJECTIVESAdd additional pages as needed and tab accordingly.What National Objective does the proposed project best exemplify? (If all relevant, rank 1-3). FORMTEXT ? FORMCHECKBOX Create Suitable Living Environment [Projects that benefit communities, families, or individuals by addressing issues in their living environment, like poor-quality infrastructure and social issues.] FORMTEXT ? FORMCHECKBOX Provide Decent Housing [Projects that include a housing program component.] FORMTEXT ? FORMCHECKBOX Create Economic Opportunity [Projects related to economic development, commercial revitalization, or job creation.]What performance measurement outcome is associated with the National Objective(s) indicated above? (If all relevant, rank 1-3). FORMTEXT ? FORMCHECKBOX Improving Availability/Accessibility [Projects that make services, housing, etc. available or accessible to low to moderate-income persons and persons with disabilities.] FORMTEXT ? FORMCHECKBOX Improving Affordability [Projects that make housing, services, transportation, etc. more affordable for people with low to moderate-income.] FORMTEXT ? FORMCHECKBOX Improving Sustainability [Projects that help communities become more livable or viable by removing slum/blight or providing services that can result in more sustainable communities.]2. a. Discuss how the proposed project exemplifies the chosen performance measurement outcome(s). (1,000 characters max; include additional pages as needed and label accordingly). FORMTEXT ?????Please complete the table below, identifying the number of persons that will be served in 12 months for each activity and beneficiary type. Align beneficiaries and activity with Strategic Priorities outlined in the 2020-2024 Consolidated Plan. [Refer to pages 4-5 under the FFY 2021 CDBG Strategic Priorities section to determine which 2020-2024 Consolidated Plan Strategic Priorities align with project’s activities and beneficiary types.]Consolidated Plan Strategic Priority ActivityBeneficiary TypePersons Served in 12-monthsExamples2.1Shelter for Abused/BatteredHomeless Women256.1Job & Financial Literacy Training Homeless Women25 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Performance—Reporting, Monitoring, and Record-Keeping The Gwinnett County Community Development Program office requires subrecipients to provide data and information for the submission of monthly, quarterly, and annual reports pertaining to the administration and expenditure of CDBG-funded activities. Describe and discuss the Applicant’s experience with reporting, monitoring, and record-keeping compliance requirements with other funding agencies. Identify any previous CDBG awards. (1,000 character max; include additional pages as needed and label accordingly). FORMTEXT ?????TAB F - SUSTAINABILITYAdd additional pages as needed and tab accordingly.Budget Summary 1. What is the Applicant’s annual operating budget? $ FORMTEXT ?????2. How much of the Applicant’s annual operating budget is comprised of public [federal or state] funding? FORMCHECKBOX Less than 30% FORMCHECKBOX 31-50% FORMCHECKBOX 51-60% FORMCHECKBOX 61-70% FORMCHECKBOX 71-80% FORMCHECKBOX More than 80%3. What is the total budget for this project, and how much funding does the Applicant already have in place for this project? If this project is not awarded CDBG funding, does the Applicant have the financial means to support the proposed project? (1,000 characters max; include additional pages as needed and label accordingly). FORMTEXT ?????4. Is the Applicant willing and able to begin this project on January 1, 2021, regardless of the date funding is made available? FORMCHECKBOX YES FORMCHECKBOX NO If YES, explain how the Applicant will cover program costs while awaiting the CDBG award allocation. (1,000 characters max; include additional pages as needed and label accordingly). FORMTEXT ?????Project Staffing1. Indicate the number of full-time staff employed by the Applicant: FORMTEXT ?????2. Indicate the number of years the applicant has employed full-time staff: FORMTEXT ???3. Indicate the number of persons employed by the Applicant to work on the project? Provide position titles (case managers, program staff, etc.) and qualifications, requirements for professional certification, etc. [Do not include Contractors or Consultants (1,000 characters max; include additional pages as needed and label accordingly)]. FORMTEXT ?????4. Do any family relationships (by blood or marriage) exist between staff and Agency Board members? FORMCHECKBOX YES FORMCHECKBOX NO If YES, please explain in detail. (1,000 characters max; include additional pages as needed and label accordingly). FORMTEXT ?????5. Do any family relationships (by blood or marriage) exist between staff and Gwinnett County Board of Commissioners? Please be sure to include the organization's Conflict of Interest Statement as indicated in the Application Submission Requirements on page 10 of this application. FORMCHECKBOX YES FORMCHECKBOX NO If YES, please explain in detail. (1,000 characters max; include additional pages as needed and label accordingly). FORMTEXT ?????TAB G - Proposed Project Budget SummaryInstructionsIn Exhibit A, complete the table outlining the total expenses for the proposed project, including source and amount of leveraged funds/matching funds (in-kind donations or service costs).Include leveraged funds (other non-CDBG funds) that are immediately accessible and firmly committed to the project. Leveraged funds can include a blend of cash, loans, or in-kind resources available to finance the project costs.Staff and overhead expenses must be directly related to carrying out the proposed project/activity.In-kind contributions must have a specific dollar value established under Generally Accepted Accounting Principles. The basis of determining the value for personal services and donated materials and supplies must be identified. Volunteer services may be counted if the service is an integral and necessary part of the project. To determine in-kind volunteer contributions, use the estimated amount of what a paid worker would earn doing the same type of work (verification documentation may be requested). EXHIBIT APublic Services—OPERATING Identify project staff costs (i.e., existing staff, new hires, volunteers, etc.). Staff and overhead expenses must be directly related to carrying out the proposed project/activity.CDBGRequestLeveraged Funds(Other Non-CDBG Funds)Total in Project Costs1. Salaries $ FORMTEXT ?????__?????Source: FORMTEXT ?????__??? $ FORMTEXT ?????$ FORMTEXT ??????????2. Office Supplies$ FORMTEXT ?????__?????Source: FORMTEXT ?????__??? $ FORMTEXT ??????$ FORMTEXT ??????????3. Advertising$ FORMTEXT ?????__?????Source: FORMTEXT ?????__?? ?$ FORMTEXT ??????$ FORMTEXT ??????????4. Postage$ FORMTEXT ?????__?????Source: FORMTEXT ?????__??? $ FORMTEXT ?????$ FORMTEXT ??????????5. Printing/Copying$ FORMTEXT ?????__?????Source: FORMTEXT ?????__??? $ FORMTEXT ??????$ FORMTEXT ??????????6. Telecommunications$ FORMTEXT ?????__?????Source: FORMTEXT ?????__??? $ FORMTEXT ??????$ FORMTEXT ??????????7. Professional Services/Fees$ FORMTEXT ?????__?????Source: FORMTEXT ?????__?? $ FORMTEXT ?????$ FORMTEXT ??????????8. Reimbursable Travel [Mileage]$ FORMTEXT ?????__?????Source: FORMTEXT ?????__??? $ FORMTEXT ???????$ FORMTEXT ??????????9. Insurance & Bonding [Facilities & Program]$ FORMTEXT ?????__?????Source: FORMTEXT ?????__??? $ FORMTEXT ???????$ FORMTEXT ??????????10. Other: FORMTEXT ?????________________________$ FORMTEXT ?????__?????Source: FORMTEXT ?????__??? $ FORMTEXT ???????$ FORMTEXT ??????????Total Requested Public Services—Operating$ FORMTEXT ?????__?????Total Leveraged Funds $ FORMTEXT ??????? Grand Total $ FORMTEXT ??????Public Services—EQUIPMENT PURCHASE(S)Provide a detailed description of the equipment; specify quantities, and estimated unit prices. At least one (1) price quote is required per equipment type.CDBGRequestLeveraged Funds(Other Non-CDBG Funds)Total in Project Costs1. Equipment Type: FORMTEXT ?????$ FORMTEXT ??????????Source: FORMTEXT ?????__?? $ FORMTEXT ?????? $ FORMTEXT ??????????2. Equipment Type: FORMTEXT ?????$ FORMTEXT ??????????Source: FORMTEXT ?????__??? $ FORMTEXT ?????$ FORMTEXT ??????????3. Equipment Type: FORMTEXT ?????$ FORMTEXT ??????????Source: FORMTEXT ?????__??? $ FORMTEXT ?????$ FORMTEXT ??????????Total Requested Public Services—Equipment$ FORMTEXT ??????????Total Leveraged Funds $ FORMTEXT ????????Grand Total $ FORMTEXT ??????SIGNATURE PAGEThis page must be submitted with the application. FORMCHECKBOX Letter from Authorized Certifying Official is AttachedOR, the following is executed: FORMCHECKBOX Resolution Authorizing Submission of Application Legal Name of Applicant: FORMTEXT ?????Be it resolved that the City Council/Commission/Board of Directors of the above-referenced Applicant resolved at its meeting date referenced below, to authorize the Applicant to submit an application to the Gwinnett County Community Development Program office for grant funding. The individual referenced below is authorized to execute any documents necessary for application submission and funding.Meeting Date: FORMTEXT ?????Amount Requested: $ FORMTEXT ????? Executor: FORMTEXT ????? I hereby certify that the foregoing resolution was approved by our City Council/Commission/Board of Directors.__________________________________________________________ Date: ________________Authorized Certifying Official Signature Printed Name & Title: _______________________________________________(Insert Corporate Seal) I certify that I have completed the application for Gwinnett County Community Development Block Grant – Public Services funding. All of the information contained in this submission has been completed as thoroughly and as accurately as possible, and a governing body resolution or letter from an authorized certifying official approving this submission has been attached to this submission.Prepared by: Date: SignaturePrinted Name & Title: ______________________________________________Approved by: Date: SignaturePrinted Name & Title: ______________________________________________ATTACHMENT AIncome Guidelines[GWINNETT COUNTY, GEORGIA]MAXIMUM HOUSEHOLD INCOME LIMITS FY 2019 Income LimitsEffective: April 24, 2019NOTE: Gwinnett County is part of the Atlanta-Sandy Springs-Marietta, GA HUD Metro FMR Area, so all information presented here applies to all of the Atlanta-Sandy Springs-Marietta, GA HUD Metro FMR Area. The Atlanta-Sandy Springs-Marietta, GA HUD Metro FMR Area, contains the following: FY 2019 Income Limit AreaMedian Income FY 2019 Income Limit CategoryPersons in Family12345678Gwinnett County$79,700 Very Low (50%) Income Limits ($) $27,900$31,900$35,900$39,850$43,050$46,250$49,450$52,650Extremely Low (30%) Income Limits ($)**$16,750$19,150$21,550$25,750$30,170$34,590$39,010$43,430Low (80%) Income Limits ($)*$44,650$51,000$57,400$63,750$68,850$73,950$79,050$84,150*The maximum income threshold for eligible clientele/persons/households served using CDBG Public Services funds is the Low (80%) FFY 2019 Income Limit Category. **The FY 2014 Consolidated Appropriations Act changed the definition of extremely low-income to be the greater of 30/50ths (60 percent) of the Section 8 very low-income limit or the poverty guideline as?established by the Department of Health and Human Services (HHS), provided that this amount is not greater than the Section 8 50% very low-income limit. Consequently, the extremely low-income limits may equal the very low (50%) income limits.Source: U.S. Department of Housing & Urban Development [HUD] Datasets B5516880-250190Total Score: /100Total Score: /100FFY 2021 Application CycleCommunity Development Block Grant (CDBG) Program Public Services Application Rating Form Applicant: Funding Request: Proposed Project:Reviewer:Date:APPLICATION COMPLETENESS YESNOELIGIBLECOMMENTSTAB A – Cover Sheet TAB B – Application Submission Requirements Tab C – PROJECT DETAILSSCORE CRITERIAYESNOMAX POINTSTOTAL RECEIVEDThe project only serves Gwinnett County residents, or if the project serves non-Gwinnett residents, the Applicant provides a percentage of Gwinnett residents to be served and a method for ensuring Gwinnett only pays its fair share.YES, both answered & 51%+ Gwinnett, 4 points; less than 50%, 0 points4The applicant has experience with the project.10+ years, 5 points; 5-10 years, 4 points; 3-5 years, 3 points; 1-3 years, 2 points; less than 1 year, 1 point; NO experience, 0 points 5The applicant provides the duration of the project.Less than 6 months, 4 points; 6-9 months, 3 points, 9-12 months, 2 points; 12 months, 1 point; More than 12 months, 0 points4The proposed implementation schedule is realistic and includes expenditure schedule, accomplishments, and timelines.Clear schedule provided, 4 points; some questions remain, 3 points; unclear and many questions remain, 0 points4The project description provides a detailed and comprehensive narrative about the project.YES and NO questions remain, 10 points; YES but a few questions remain, 8 points; Almost, but many questions remain 5 points; NO, but further information needs to be provided, 3 points; NO, and all is unclear, 0 points10TAB C TOTAL27TAB D - BENEFICIARIESSCORECRITERIAYESNOMAX POINTSTOTAL RECEIVEDApplicant provides a Project Service Area Map in Appendix.YES, 1 point; NO, 0 points1The applicant identified that 51% or more total population served as low and moderate-income. YES, 5 points; NO, 0 points5Existing Projects: The total proposed to be served in 2021 is greater than the previous grant year as of the date of application. 51+% greater, 4 points; 30-50% greater, 3 points; 10-29% greater, 2 points; 1-10% greater, 1 point; 2021 equal to or less than prior year, 0 points; N/A, 4 points4New Projects: The total proposed to be served in 2021 is realistic for 12 months. YES, 4 points; NO, 0 points; N/A, 4 points4The applicant identifies the need to be addressed by the project. YES, more than one need identified and provides data/research provided, 4 points; YES, and provides anecdotal info, 3 points; YES, more than one provided but no additional info, 2 points; YES, one provided but no additional info, 1 point; NO, 0 points4The applicant’s design meets the identified need.YES, and includes data/research re: “best practices,” 5 points; YES, and provides anecdotal data, 3 points; YES, but no supportive data provided, 1 point; NO, 0 points5The applicant describes collaborative efforts with other service providers.YES, clear description, 2 points; YES, but vague, 1 point; NO/unclear, 0 points2The applicant describes a clear procedure for verifying income.YES, 3 points; NO or Unclear, 0 points3TAB D TOTAL28TAB E – GOALS AND OBJECTIVESSCORE CRITERIAYESNOMAX POINTSTOTAL RECEIVEDThe applicant identifies the performance measurement outcomes/objectives best exemplified. YES, 2 points; NO, 0 points2The applicant provides descriptions of how the project exemplifies chosen performance measurements/outcomes.YES, and both are clear, 4 points; YES, but only one is clear, 3 points; YES, but both are vague, 2 points; YES, but both are unclear, 1 point; NO, 0 points4The applicant provides clear and measurable performance goals as they relate to the proposed project.YES, clear and measurable, 5 points; YES, but some questions remain, 3 points; NO, 0 points5Applicant’s proposed project meets one or more of the CDBG Program priorities, as detailed on page 4 of the application instructions. More than one, 5 points; One, 3 points; NO, 0 points.5The applicant has experience in reporting, monitoring or record keeping.YES, and extensive, 5 points; YES, but limited (or unclear), 3 points; NO, 0 points5TAB E TOTAL 21TAB F – SUSTAINABILITYSCORE CRITERIAYESNOMAX POINTSTOTAL RECEIVEDPercentage of applicant’s budget comprised of public [federal and/or state] funding. 0% - 30%, 8 points; 31-50%, 6 points; 51-60%, 4 points; 61-70%, 3 points71-80%, 1 point; More than 80%, 0 points8Applicant has funding in place for the project.100%, 10 points; 50 – 99%, 8 points; 30 – 50%, 6 points; 10 - 30%, 2 point0-10%, 0 points10The applicant is willing and able to start the project on January 1, 2021.YES, 5 points; NO, 0 points5The applicant has employed at least one full-time staff member for at least one year prior to the request for funding.YES, 1 point; NO, 0 points1TAB F TOTAL24MAX POINTS POSSIBLESCORE RECEIVEDTAB C TOTAL27TAB D TOTAL28TAB E TOTAL21TAB F TOTAL24GRAND TOTAL100Please provide any additional comments/feedback not covered in the scoring criteria that should be considered in the decision to award funding. Please be sure to address any apparent or perceived conflicts of interest. FORMTEXT ?????FINANCIAL ASSESSMENT OF APPLICATION COMPLETENESSAPPLICATION COMPLETENESSYESNOELIGIBLE?Did Applicant include most recent audit or financial statement?Did the Applicant include an audited financial statement that is clear of any findings/concerns?Did the agency include written financial management procedures along with the current Applicant chart?Did the Applicant include their most recent IRS Form 990 or 990 EZ?Please provide any additional comments/feedback not covered in the scoring criteria that should be considered in the decision to award funding. FORMTEXT ????? ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download