Pasco County. "Bringing Opportunities Home" EMERGENCY SOLUTIONS GRANT PROGRAM. REQUEST FOR FUNDING Program Year

Transcription

1 o Pasco County "Bringing Opportunities Home" EMERGENCY SOLUTIONS GRANT PROGRAM REQUEST FOR FUNDING Program Year DEADLINE: May 24, :00 PM Submit Completed Application to: Pasco County Community Development Division 5640 Main Street, Suite 200 New Port Richey, FL (727) (West) (352) (Ext. 3445) East (813) (Ext. 3445) Central (727) FAX

2 APPLICATION INSTRUCTIONS The Emergency Solutions Grant (ESG) is a Federally funded program through the U.S. Department of Housing and Urban Development (HUD). Pasco expects to receive at least $204, for program year , which will provide funding for Street Outreach, Shelter Services, Homeless Prevention, Rapid Rehousing, and the Homeless Management Information System. Pasco County is an Entitlement Community for Community Development Block Grant (CDBG), HOME Investment Partnerships (HOME), and the Emergency Solutions Grant (ESG) Programs Federally funded through the U.S. Department of Housing and Urban Development (HUD). Pursuant to 24 Code of Federal Regulations (CFR), Part 91, Pasco County s Consolidated Five-Year Plan (Plan) and 2013 Annual Action Plan is required to be submitted to HUD prior to August 15, The Plan serves as a five-year strategic planning document for the entitlement funds, setting forth the program goals to provide decent housing, create suitable living environments, and expand economic opportunities primarily for low- and moderate- (L/M) income persons I. ESG APPLICATION PROCESS: Please submit only ONE original completed application. FACSIMILE APPLICATIONS WILL NOT BE ACCEPTED. Incomplete applications will NOT be reviewed for funding. Completed applications must be submitted on or before May 24, 2013, 5:00 P.M. Applications received after the deadline will NOT be reviewed for funding. Applications must be signed by the President or Vice-President of the agency or a designee duly authorized by the agency Board of Directors. Proof of signature authorization must be submitted with the application. NOTE: An electronic copy of the Request for Funding is available on the Pasco County website, Community Development Division page at: The "Program Guidelines" outlined in the following pages is to aid the agency in applying for ESG funds. The elements of this packet are somewhat different from the guidelines of previous years. Program Guidelines have been revised to broaden existing emergency shelter and homeless prevention activities, as well as to add rapid rehousing activities. The Pasco County Board of County Commissioners has attempted to simplify all grant applications. Agencies are encouraged to apply for funding under the ESG guidelines to provide services through four categories under which individuals and families may qualify as Homeless, as defined in Section 103 of the McKinney-Vento Homeless Assistance Act, amended by S. 896, The HEARTH Act of All application requests for funding shall be based upon documented need, agency history in providing similar services in the past, experience of the staff providing these service(s) and conformance to the program and national eligibility requirements specified by HUD. Page 2 of 21

3 II. ESG COUNTY CONTACTS: Charlene Daprile, AICP Assistant Community Development Division Manager (727) Lisa Crenshaw Community Development Specialist (727) III. APPLICATION MAILING INFORMATION: The application proposal may be hand-delivered, mailed or sent by courier service to: Pasco County Community Development Division 5460 Main Street, Suite 200 New Port Richey, FL IV. APPLICATION ELIGIBILITY CRITERIA: A. Overall Criteria: 1. Is the request for funding complete? 2. Is the proposal an eligible activity according to HEARTH/ESG regulations? 3. Is the agency an eligible subrecipient? 4. Are the beneficiaries residents of Pasco County? 5. Is the proposed activity consistent with the approved Consolidated Plan? 6. How will you qualify applicants for eligibility? B. Benefit (compared to other proposals): 7. How many persons/households are expected to benefit from the program? 8. What percentage of the beneficiaries are very-low, low/moderate-income persons, homeless, or imminently at risk of homelessness? C. Need: 9. Is the need documented? 10. Is the proposed program adequately described? 11. Have the services/activities/projects been described in quantifiable terms in the proposal? 12. Is the Performance Schedule consistent with the Scope of Services? D. Budget & Fund Leveraging: 13. Does the budget appear to be cost-effective and provide sufficient information? 14. Have funds from other sources been leveraged and identified for leverage? 15. Have program services increased compared to previous years? Does it appear that the program is depending upon ESG funds for continuation? E. Organizational Capacity: 16. Does it appear that the agency is capable of implementing the program? 17. Is the agency currently adequately staffed and/or will it be adequately staffed with increased level of services with availability of the ESG grant? 18. Are the agency's accounting/administrative systems adequate to meet ESG requirements, OMB circulars, etc.? 19. Does the Agency demonstrate their ability to provide the 100% match? Page 3 of 21

4 V. APPLICATION SCHEDULE: The schedule for ESG Grant application for the Program Year is as follows: DATE TIME ITEM ON SCHEDULE LOCATION April 24,, 2013 Publication of Advertisement for Grant Kickoff Meeting (Public Hearing) Community Development Webpage, Distribution, and Newspaper May 10, :00 p.m. Grant Kickoff Meeting (Public Hearing) Explanation of changes by The HEARTH Act. Community Development Division 5640 Main Street, Suite 200 New Port Richey, FL May 24, :00 p.m. Application Submission Deadline Community Development Division 5640 Main Street, Suite 200 New Port Richey, FL June 2013 Advertisement of proposed Annual Action Plan; staff-recommended proposed projects; and public comment period (subject to change) June 2013 Environmental Reviews to be completed for affected projects July :00 p.m. Second Public Hearing (Annual Action Plan Presentation) Community Development Webpage, Distribution, Pasco TV and Newspaper - TBA August 13,201 3 October 1, October- November October 2013 March 2014 Proposed Five-Year Consolidated Plan and Annual (1-Year) Action Plan presented to the Board of County Commissioners for review and approval. Approved Plan sent to HUD for review and approval. Start of Program Year. Funds assigned to agencies, after all Federal requirements have been met. Workshop(s) with funded agency/ subrecipient for training and information on program implementation. Subrecipient agreements presented to Board of County Commissioners for approval of the project. Dade City BCC Meeting - TBA NOTE: The first three dates are firm, with the remainder being subject to change. VI. ELIGIBLE AGENCIES: The County has many options for implementing the ESG program. The County can grant all or a portion of the funds to projects implemented by existing County staff and/or to projects administered primarily through agencies or community groups. VII. ELIGIBLE ACTIVITIES: There are four eligible activities under the ESG program. project must meet the following criteria: In order to be approved for funding, the A. Street Outreach ( ) Providing essential services necessary to reach out to unsheltered Page 4 of 21

5 homeless people: 1. Connect them with emergency shelter. 2. Provide urgent, non-facility-based care to unsheltered homeless people who are unwilling or unable to access emergency shelter, housing, or an appropriate health facility. 3. Engagement Activities to locate, identify, and build relationships with unsheltered homeless people and engage them for the purpose of providing, immediate support, intervention and connections with homeless assistance programs and/or mainstream social services and housing programs. 4. Case Management assessing housing and service needs, arranging, coordinating and monitoring the delivery of individualized services to meet the needs of the program participant. 5. Emergency health services For direct outpatient treatment of medical conditions that are provided by licensed medical professionals operating in community-based settings, including streets, parks, and other places where unsheltered homeless people are living. 6. Emergency mental health services Direct outpatient treatment by licensed professionals of mental health conditions operating in community-based settings, including streets, parks and other places where unsheltered people are living. 7. Transportation Costs for travel of outreach workers, social workers, medical professional, or other service providers. B. Emergency Shelter Services ( ): 1. Essential Services: Provides services to homeless Individuals and families for the period during which the ESG assistance is provided without regard to a particular site or structure as long as the same general population is served. Provides case management; monitoring and evaluating program participant progress; ongoing risk assessments; developing individual housing and service plans; educational and employment services as follows: Case Management Delivery of individualized services to meet the needs of the program participants. a. Conducting initial evaluation required under (a), including verifying and documenting eligibility; b. Counseling; c. Developing, securing and coordinating services and obtaining Federal, State and local benefits; d. Monitoring and evaluating program participant s progress; e. Providing information and referral to other providers; f. Providing ongoing risk assessment and safety planning with victims of domestic violence, sexual assault, and stalking; and g. Developing an individualized housing and service plan, including planning a path to permanent housing stability (child care and Education services are included when necessary). 2 Shelter Operations: Operating Costs include expenses incurred by an agency for: Routine maintenance and repair costs, security, fuel, equipment, insurance, utilities, food, furnishings, and supplies necessary for the operation of the emergency shelter. and security of such housing: Page 5 of 21

6 C Homeless Prevention ( ): Assists individuals and families who are thirty (30) percent below AMI and will imminently lose their primary nighttime residence provided that: the primary residence will be lost in fourteen (14) days of the date of application for homeless assistance; no subsequent residence can be identified; and the individual or family lacks resources or a support network. Assistance will be in the form of short- and medium-term rental assistance to prevent individuals or families from moving into an emergency shelter. Homeless prevention activities do not include assistance received to supplement pre-existing homelessness prevention activities from other sources. D Rapid Rehousing ( ): Provide housing relocation and stabilization services and shortand/or medium-term rental assistance as necessary to help a homeless individual or family move as quickly as possible into permanent housing and achieve stability in that housing. The program participant must meet the criteria under 24 CFR 576.2, paragraph (1) or the criteria under paragraph (4). E Housing Relocation and Stabilization Services ( /106): Financial assistance Includes short-term (up to 3 months) and medium-term (up to 18 months) rental assistance, security deposits, utility deposits, and utility payments. No financial assistance is to be provided directly to the client; all funds must be distributed to a third-party. This includes services such as: 1. Rental application fees; 2. Security deposits; 3. Last month s rent; 4. Utility deposits; 5. Utility payments; F. Homeless Management Information Systems (HMIS) ( ) Funds to pay cost of contributing data to the HMIS designated by the Continuum of Care for the area, including cost of: 1. Purchasing or leasing computer hardware; 2. Purchasing software or software licensing; 3. Purchasing or leasing equipment, telephones, fax machines and furniture; 4. Obtaining technical support; 5. Leasing office space; 6. Paying salaries for operating HMIS VIII. REQUIRED FUNDING MATCH ESG subrecipients must match the funding provided by HUD with an equal amount of funds from any source, including any Federal source other than the ESG. Furthermore, regulations require that all subrecipients provide HUD with details on the match, including all individual sources and corresponding amounts. Contributions used to match a previous ESG grant may not be used to match a subsequent ESG grant. Matching funds may include: 1. Cash Contributions as defined OMB Circulars A-87 (2CFR part 225); 2. Noncash contributions the value of any real property, equipment, goods or services contributed to recipients; 3. Time contributed by volunteers (currently an estimated cost of $5.00 per hour); 4. Value of donated items, building(s) and/or lease(s) calculated using a Page 6 of 21

7 reasonable method to establish a fair market value. IX. PERFORMANCE MEASURES Grantees are required to incorporate the prescribed performance measurements into their Consolidated or Annual Action Plans. The grantee must also determine which established Objectives and Outcomes best achieve the goals of the Consolidated Plan for each proposed activity based on the type of activity and its purpose. Objectives reflect the statutory goals of providing decent housing, a suitable living environment and expanding economic opportunity; Outcomes refer to benefits to the public/program participant(s) who are external to the program; and the Outcome Statement connects each outcome to an overarching objective to produce a statement that can be used by HUD to develop narratives which will document results of program activities at the national level. PLEASE NOTE THAT: The Community Development Division staff will be available at all times to provide technical assistance. There is neither a minimum nor a maximum funding amount. Requests should be based upon documented need of the agency, its level of expertise and experience in providing the service and meeting HUD requirements. END OF INSTRUCTIONS Page 7 of 21

8 PASCO COUNTY EMERGENCY SOLUTIONS GRANT (ESG) PROGRAM REQUEST FOR FUNDING PR OGRAM YEAR AGENCY INFORMATION 1. NAME OF AGENCY: 2. OFFICE ADDRESS: 3. MAILING ADDRESS (if different from above): 4. FEDERAL ID NO.: 4a. DUNS NO.: 5. NAME AND TITLE OF CONTACT PERSON: 6. NAME AND TITLE OF AUTHORIZED SIGNATORY: NOTE: Authorized signatories include either the President or Vice President of the agency, as shown on the Division of Corporation filing. These are the only members of the agency who are authorized to sign and enter into a subrecipient agreement, binding the agency and Pasco County to the terms of the agreement. Other designated official(s) will be considered as authorized signatories only if an official and approved copy of a Board resolution is attached with the application, specifying that the official is authorized to act on behalf of the President/Vice President for the ESG Program. 7. TELEPHONE NO. : 8. FAX NO.: 9. ADDRESS OF CONTACT PERSON: 10. ADDRESS OF AUTHORIZED SIGNATORY: 11. IS THIS A FAITH-BASED ORGANIZATION? Yes No Not applicable Page 8 of 21

9 12. TOTAL AMOUNT OF ESG FUNDING REQUESTED: $ New project Existing project ACTIVITY DESCRIPTION THIS SECTION MUST BE COMPLETED BY ALL APPLICANTS IN DETAILS. 13. NAME OF ACTIVITY OR PROJECT: 14. DESCRIPTION OF THE PROPOSED ACTIVITY OR PROJECT: 15. ATTACH A PROBLEM STATEMENT OR STATEMENT OF NEED, ADDRESSING THE OVERALL PROBLEM THAT THE PROJECT OR ACTIVITY WILL ADDRESS. NOTE: Please substantiate your description with: Statistical evidence (local data) Information from valid studies completed in similar projects or fields Statements by experts Other data Sources of the statistics/information/statements/data used above 16. DESCRIBE SPECIFIC AREA(S) OF THE OVERALL PROBLEM THAT THE PROJECT OR ACTIVITY WILL FOCUS ON. 17. EXPLAIN WHY FINANCIAL ASSISTANCE FROM ESG IS NECESSARY TO ADDRESS THE PROBLEM, INCLUDING OTHER FUNDING SOURCES THAT HAVE BEEN SOUGHT OR WILL BE SOUGHT CONCURRENTLY WITH THIS PROPOSAL TO SUPPLEMENT THE PROJECT. Page 9 of 21

10 18. PLEASE IDENTIFY THE PROPOSED CLIENTELE FOR THE PROJECT OR ACTIVITY. 19. IDENTIFY THE METHODS OF OUTREACH THAT WILL BE USED TO IDENTIFY THE POTENTIAL CLIENTELE. 20. DESCRIBE THE PROPOSED WORK PLAN, INCLUDING QUANTITATIVE INDICATORS, PERFORMANCE MEASURES AND OUTCOMES THAT WILL BE USED FOR THE PROJECT OR ACTIVITY. TABLE 1 PERFORMANCE MEASUREMENTS (What will the project/activity do to fulfill its mission) INDICATORS (Direct products of the project/activity) OUTCOME (Benefits from the project/activity) 21. IDENTIFY THE LOCATION OF THE ACTIVITY OR PROJECT (including the Street Number, Street Name, City, Zip Code, Parcel ID AND attach a map showing the site location clearly). Page 10 of 21

11 BENEFICIARY NFORMATION 22. INDICATE THE ESTIMATED NUMBER FOR THE FOLLOWING: a. Persons served by each of the activities listed in Table 2 below. TABLE 2 CHECK BOX ACTIVITY PROPOSED TOTAL Emergency or transitional shelter facilities: ~ Number of adults annually ~ Number of children annually Homeless Prevention Services: ~ Number of adults annually ~ Number of children annually Rapid Re-Housing Services: ~ Number of adults annually ~ Number of children annually TOTAL number served annually b. Clientele who would be served by the proposed program by race and ethnicity in Table 3 below. TABLE 3 DEMOGRAPHIC INFORMATION CHECK BOX RACE/THNICITY ESTIMATED HISPANIC White Black/African American Asian American Indian/Alaskan Native Native Hawaiian/Other Pacific Islander White & Black/African American White & Asian White & American Indian / Alaskan Native Black / African American & American Indian / Alaskan Native Other Multi-Racial All Races and Ethnicities ESTIMATED TOTAL (including Hispanic) c. Project(s) and Services by type in Table 4 below. TABLE 4 CHECK BOX PROJECT / SERVICE PROPOSED TOTAL Emergency Shelter Facilities Transitional Housing Vouchers for Shelters Outreach Services Drop-in Centers Page 11 of 21

12 Soup Kitchens/Meal Distribution Centers Food Pantry Health Care Services Mental Health Services HIV/AIDS Services Anti-Drug/Alcohol Programs Employment Services Child Care Services Mainstream Resources (Food Stamps, Medicaid, etc.) Homeless Prevention Services Rapid Re-Housing Services Transportation Services Other Services: d. Persons and/or households served by Emergency and/or Transitional Shelters in Table 5 below. TABLE 5 CHECK BOX NUMBER SERVED ANNUALLY ESTIMATED MALES Households with singles living alone: ~ Unaccompanied persons UNDER 25 years ~ Unaccompanied persons 18 years and ABOVE Households with children headed by: ~ Unaccompanied youth UNDER 25 years ~ Single person 18 years and ABOVE ~ Two parents UNDER 18 years ~ Two parents 18 years and ABOVE Households with no children ESTIMATED FEMALES e. Persons served for each of the categories listed in Table 6. If more than one category of clientele are served by your agency, overlapping (duplicate) numbers may be used. For example, if 15 persons with chronic substance abuse issues are served, and 5 of them are veterans, then the proposed total with chronic substance abuse issues should be listed as 15, and total veterans as 22 (to include the 5 and 17 additional veterans who would be served. TABLE 6 CHECK BOX CATEGORY PROPOSED TOTAL Chronically Homeless (in emergency shelters only) Severely Mentally Ill Chronic Substance Abuse Veterans Persons with HIV/AIDS Victims of Domestic Violence Elderly f. Persons housed at each shelter funded through the ESG program at any given point in time listed in Table 7. TABLE 7 CHECK BOX SHELTER TYPE PROPOSED NUMBER OF PERSONS (housed at any given time) Barracks Group/Large homes Scattered Site Apartments Page 12 of 21

13 Single-Family Detached Homes Single-Room Occupancy Mobile Home/Trailers Other (describe): g. Persons assisted with ESG at any given point in time listed in Table 8. TABLE 8 CHECK BOX PREVENTION Evictions-Imminent loss of housing within 14-days Utility Payments Other (describe): RAPID RE-HOUSING Lacks fixed residence Living in supervised operated shelter Other (describe): PROPOSED NUMBER OF PERSONS (housed at any given time) 23. TABLE 9 BELOW LISTS THE OBJECTIVES AND OUTCOMES FOR ACTIVITIES AND PROGRAMS THAT WILL BE SUPPORTED DURING THE PROGRAM YEAR, TABLE 9 Objectives Outcome 1: Availability/Accessibility Outcome 2: Affordability Outcome 3: Sustainability Objective 1: Suitable Living Environment Accessibility for the purpose of creating suitable living environments. Affordability for the purpose of creating suitable living environments. Sustainability for the purpose of creating suitable living environments. Objective 2: Decent Housing Accessibility for the purpose of providing decent housing Affordability for the purpose of providing decent housing. Sustainability for the purpose of providing decent housing. Objective 3: Economic Opportunity Accessibility for the purpose of creating economic opportunities Affordability for the purpose of creating economic opportunities Sustainability for the purpose of creating economic opportunities. Suitable Living Environments: Activities that benefit communities, families, or individuals by addressing issues in their living environment, such as emergency shelters and transitional shelters for homeless persons including rehabilitation, operations and services. Decent Affordable Housing: Housing activities that meet individual, family, or community needs, such as homeless prevention activities. Creating Economic Opportunities: Development activities related to economic development, commercial revitalization, and job creation, but does not include job training or educational services. Availability/Accessibility: Activities that provide accessibility and availability to shelter and services, such as rehabilitation, operations and related services at emergency and transitional shelters for the homeless. Page 13 of 21

14 Accessibility is not restricted to removal of physical barriers only. Affordability: Activities that provide affordability, such as assistance with payment of rent/mortgage, utilities, and first month rent/security deposit for rented unit and landlord/tenant mediation/legal services to prevent h omelessness. Sustainability: Activities that promote livable or viable communities and neighborhoods by removing slums or blighted areas. Which of these Objectives best describes your proposal? Which of the Outcome Measures best describes your proposal? How will you measure the success of your objectives? What activities will you use to measure the outcomes of program? COALITION INVOLVEMENT 24. DESCRIBE YOUR AGENCY S INVOLVEMENT WITH THE COALITION FOR THE HOMESLESS FOR PASCO COUNTY, INC., INCLUDING COMMITTEE MEMBERSHIP, POINT-IN-TIME SURVEY, AND PARTICIPATION IN THE ANNUAL UPDATE OF THE CONTINUUM OF CARE PLAN. Page 14 of 21

15 25. IS YOUR AGENCY ACTIVELY PARTICIPATING IN THE HOMELESS MANAGEMENT INFORMATION SYSTEM (HMIS)? a. IF SO, TO WHAT EXTENT (SUCH AS HMIS USER GROUP, INPUT OF SAMPLE AND REAL DATA ETC.)? b. IF NOT, PLEASE EXPLAIN THE REASONS FOR NOT PARTICIPATING? NOTE: Active HMIS participation is mandatory for agencies receiving ESG funding. HMIS activity will be reviewed prior to release of invoiced funds. Page 15 of 21

16 BUDGET DESCRIPTION 26. PROVIDE A COMPLETE ESG ANNUAL BUDGET, INCLUDING ALL REVENUE, EXPENDITURES AND ANTICIPATED EXPENDITURES BY FUNDING SOURCE(S) AND AMOUNTS. USE ADDITIONAL PAGES IF NECESSARY TO SUBSTANTIATE YOUR ANSWER. 27. IN TABLE 10, INDICATE THE AMOUNT BUDGETED FOR EACH ITEM OR ACTIVITY WITH ESG PROGRAM FUNDS AND MATCHING FUNDS FROM OTHER SOURCES, AS DESCRIBED IN SECTION VIII. INCLUDE THE FOLLOWING SOURCES OF MATCHING FUNDS: a. Other Federal sources (such as pass-through funds such as County CDBG, County FEMA etc.) b. State and/or Local Government funding (such as Challenge Grant funds, funds from outside agency, etc.) c. Private sources of funding (such as fund-raising, cash, United Way funding, loans, building value or lease, donated goods and computers, new staff salaries, volunteers, volunteers providing medical/legal services etc.) INCLUDE APPROPRIATE DOCUMENTATION AND ESTIMATES TO SUBSTANTIATE THE AMOUNT OF FUNDING REQUIRED FOR VIABILITY OF THE PROGRAM. TABLE 10 FUNDING SOURCE ESG: Matching Federal (list each source below): FUNDING AMOUNT ($) PERCENT OF ESG (%) DATE FUNDING RECEIVED OR AWAITING RECEIPT MATCHING SUB-TOTAL 1 (Federal) Matching State / Local Government (list each source below): Page 16 of 21

17 MATCHING SUB-TOTAL 2 (State / Local Government) Matching Private (list each source below): Fund-raising / cash United Way Loans Building value or lease Donated goods Donated electronics (such as computers, etc) New staff salaries Volunteer time (in dollars at the rate of $5.00/hour) Medical / Legal volunteer time (in dollars) Other: MATCHING SUB-TOTAL 3 (Private) TOTAL FUNDING (ALL SOURCES) NOTE: The Percent column should add up to 100% e xcluding ESG percentage 29. INDICATE THE AMOUNT OF ESG FUNDS THAT YOUR AGENCY IS REQUESTING FOR THE PROGRAM(S) FOR THE CATEGORIES SHOWN IN TABLE 11 BELOW. TABLE 11 FUNDING ITEM ESG FUNDS ($) MATCHING FUNDS ($) TOTAL FUNDS ($) Street Outreach Shelter Services Homeless Prevention Rapid Re-Housing Homeless Management Information System Housing Relocation and Stabilization Services Other Total 30. PROVIDE A DETAILED DESCRIPTION OF EACH OF THE TASKS LISTED IN TABLE 12 BELOW? TABLE 12 Page 17 of 21

18 TASK Street Outreach Shelter Services: Operations Essential Services Homeless Prevention Case Management Direct Services Rapid Re-Housing Services Case Management Direct Services Other TASK DESCRIPTION When applying for salaries, include the job title and description, a breakdown of the salary and benefits, all funding sources used to pay that salary. This information is very important. If it is not included in the application, it is very likely that this request will not be approved. 31. DOES YOUR AGENCY HAVE QUALIFIED AND ADEQUATE STAFF, AND FUNDING TO PERFORM ALL THE PROPOSED FUNCTIONS FOR IMPLEMENTATION AND ADMINISTRATION OF THE PROJECT? 32. WOULD ANY AGENCY STAFF MEMBER(S), AGENT(S), OFFICER(S), OR MEMBER(S) OF THEIR FAMILIES STAND TO GAIN FINANCIALLY FROM AN AWARD OF ESG FUNDS TO YOUR AGENCY? IF YES, EXPLAIN. 33. HOW WOULD THE PROJECT BE IMPACTED, IF THE ENTIRE AMOUNT REQUESTED FROM ESG IS NOT RECEIVED? Page 18 of 21

19 34. HAS ANY PROGRAM ACTIVITY BEEN FUNDED THROUGH ESG PREVIOUSLY? IF YES, ATTACH A DESCRIPTION OF THE PROJECT(S), THEIR OUTCOMES, STATUS AND STATE IF ANY OF THEM ARE CURRENTLY OPEN. Note: Funding considerations will be based on a history of timely expenditures and outcomes of any current or previous ESG funding. NOTE: If proposed program activity receives ESG funding, the funds MUST BE committed within six months after notification is received from the Community Development Division to proceed. (The definition of commitment is: The issuance of a formal contract or purchase order between a subrecipient and Pasco County, or a firm or individual(s) for the provision of goods, services, or property being funded wholly or in part with ESG funds.) FOR NON-GOVERNMENTAL ORGANIZATIONS ONLY 35. DESCRIBE THE GOALS AND OBJECTIVES OF YOUR AGENCY. Page 19 of 21

20 36. DESCRIBE THE ORGRANIZATIONAL STRUCTURE OF YOUR AGENCY. 37. HOW LONG HAS YOUR AGENCY BEEN IN EXISTENCE WITHIN PASCO COUNTY? 38. DESCRIBE THE EXPERIENCE OF THE STAFF WHO WOULD BE INVOLVED WITH THE PROPOSED PROJECT. 39. ATTACH THE FOLLOWING DOCUMENTS WITH THIS APPLICATION AND USE THE CHECK BOXES IN TABLE 13 TO INDICATE. IF THEY ARE NOT ATTACHED, STATE THE REASON FOR NOT ATTACHING THE DOCUMENT(S). IF DOCUMENTS ARE NOT ATTACHED, APPLICATION WILL NOT BE REVIEWED FOR FUNDING. TABLE 13 DOCUMENT NAME ATTACHED REASON DOCUMENT IS NOT ATTACHED Latest budget for your agency, showing ALL projects and their funding sources Articles of Incorporation and Bylaws IRS 501(c)(3) tax determination letter Address and occupations of the current Board of Directors Copy of the most recent annual financial audit or Page 20 of 21

21 management statement Copy of the most recent procurement policies or statements showing the procedures for agency purchases. Evidence of insurance Agency letter indicating the persons who have legal signing authority to make decisions or sign on behalf of the agency. I certify that I have reviewed this application thoroughly, and all the information provided in this application is true to the best of my knowledge and belief. PRINT NAME OF SIGNATORY PERSON PRINT TITLE OF SIGNATORY PERSON SIGNATURE OF SIGNATORY PERSON DATE Page 21 of 21