Request for Applications (RFA) for Homeless Outreach, Shelter, Homelessness Prevention and Rapid Re-Housing

Transcription

1 EMERGENCY SOLUTIONS GRANT (ESG) Request for Applications (RFA) for Homeless Outreach, Shelter, Homelessness Prevention and Rapid Re-Housing ORANGE COUNTY Housing and Community Development Division

2 ORANGE COUNTY ANNUAL ACTION PLAN FISCAL YEAR Request for Applications (RFA) for the Emergency Solutions Grant (ESG) INTRODUCTION The purpose of this Notice is to solicit applications from entities seeking to conduct eligible activities under the Emergency Solutions Grant (ESG) Program. Projects funded under this program will be limited to activities that are consistent with the priorities and goals identified in the Orange County Five Year Consolidated Plan. The Annual Action Plan will include specific activities to be implemented between October 1, 2015 and September 30, 2016 to meet these priorities and goals. Viable activities/projects are selected for funding at the conclusion of a competitive application process open to participation by all eligible entities. THE CONSOLIDATED PLAN The Consolidated Plan identifies various needs within the community, including homeless needs, and strategies to address those needs. The Consolidated Plan focuses on the proposed use of the following entitlement grants from the U.S. Department of Housing and Urban Development (HUD) for the planning period: Community Development Block Grant (CDBG) HOME Investment Partnership Program (HOME) Emergency Solutions Grant (ESG) Each year, an Annual Action Plan is prepared, which identifies the goals, strategies and activities the county will implement during that grant year to accomplish the goals established within the Five Year Consolidated Plan. Emergency Solutions Grant Program The Emergency Solutions Grant (ESG) program is provided by HUD and administered in accordance with the McKinney-Vento Act, as amended by the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act. The HEARTH Act, signed into law in May 2009, amended and reauthorized the McKinney-Vento Homeless Act with substantial changes. Homeless Definitions Effective January 4, 2012, there are four categories under which an individual or family may qualify as homeless. These categories are as follows: 1. Literally homeless An individual or family who lacks a fixed, regular and adequate night time residence, meaning the individual or family has a primary night time residence that is a public or private place not meant for human habitation or is living in a publicly or privately operated shelter designed to provide temporary living arrangements. This category also includes individuals who are exiting an institution where he or she resided for 90 days or less, and who resided in an emergency shelter or place not meant for human habitation immediately prior to entry into the institution. 2. Imminent Risk of Homelessness An individual or family who will imminently lose (within 14 days) their primary nighttime residence, provided that no subsequent residence has been identified, and the individual or family lacks the resources or support networks needed to obtain other permanent housing. 3. Homeless under other Federal Statutes- Unaccompanied youth (under 25) or families with children and youth who do not otherwise qualify as homeless under this definition and are defined as homeless under another federal statute, have not had permanent housing during the past 60 days, have experienced persistent instability, and can be expected to continue in such status for an extended period of time. Revised 2/14 1

3 4. Fleeing/Attempting to Flee Domestic Violence Any individual or family, who is fleeing, or attempting to flee, domestic violence, dating violence, sexual assault, or stalking. ESG Program Components and Eligible Activities ESG funds may be used for the following five program components: Street Outreach Component Subject to expenditure limits, ESG funds may be used for costs for essential services necessary to reach out to unsheltered homeless individuals and families connecting them to emergency shelter, housing or critical services. Eligible activities are Engagement, Case Management, Emergency Health Services, Emergency Mental Services and Transportation. Emergency Shelter Component Subject to expenditure limits, ESG funds may be used for costs for operating emergency shelters (maintenance, repairs, insurance, and utilities) and for providing essential services for homeless families and individuals in emergency shelters (i.e. case management, counseling, child care, education services, employment assistance and job training, legal services, substance abuse treatment, mental health counseling, and services for special populations). Shelter facilities receiving ESG funds must meet the definition of emergency shelter in Homeless Prevention Component ESG funds may be used to provide stabilization services and rental assistance necessary to prevent an individual or family from moving into an emergency shelter or another place as described in paragraph (1) of the homeless definition in or established criteria under the At risk of homelessness definition. Among other requirements, program participants must have annual incomes below 30 percent of the Area Median Income (AMI) and demonstrate that the assistance is necessary to regain stability in their current permanent housing. Stabilization Services- Costs associated with case management to prevent the individual or family from becoming homeless. Eligible costs include case management, landlord-tenant mediation, legal services, credit repair, and in some cases last month s rent, limited arrears security deposits and moving costs associated with housing search and placement. These services, when provided, must be in accordance with and Orange County s guidelines. Short and/or medium term rental assistance- Subject to the general conditions under , ESG funds may be used to provide limited rent and utility assistance necessary to avoid homelessness. Rental assistance must be provided in accordance with the stabilization requirements in and , written standards and procedures set forth in , and policies and procedures established by Orange County. Orange County has set a maximum number of months, three (3) months for short term, and up to an additional three (3) months for medium term assistance; (a total of up to six (6) months). Program participants are required to contribute to the cost of their rent. Rapid Re-housing Component ESG funds may be used for housing relocation and stabilization services, and short to medium term rental assistance to help a homeless individual or family move as quickly as possible into permanent housing and achieve stability. Program participants must meet the criteria under paragraph (1) of the homeless definition in or meet the criteria under paragraph (4) of the homeless definition and live in an emergency shelter or other place described in paragraph (1) of the homeless definition. Housing Relocation and Stabilization Services- Eligible costs include case management, housing search and placement, payments to third parties including rental application fees, security deposits, and utility deposits. Short and medium term rental assistance- Consists of limited rent and utility assistance to rapidly re-house eligible homeless individuals and families. Rental assistance must be provided in accordance to the stabilization requirements of , rental assistance requirements set forth in , and written standards and procedures established in Orange County has set a maximum number of months: three (3) months for short term, and up to nine (9) months for medium term assistance, (a combined maximum of twelve (12) months). Program participants are required to share in the costs of the rent. Revised 1/15 2

4 Homeless Management Information System (HMIS) Component The Homeless Management Information System is an electronic data collection system that gathers and integrates information from all homeless assistance and homelessness prevention programs in the area served by the HUD designated Continuum of Care. Funds may be used to pay the costs of contributing data to the HMIS, or in the case of the HMIS lead agency, for various administrative and other costs of operating the system. HOW PROJECTS ARE SELECTED FOR FUNDING A Public Notice was published in the Orlando Sentinel on February 1, 2015 announcing the availability of federal funding under the Orange County Action Plan. The anticipated funding will cover the fiscal year period beginning October 1, 2015 and ending September 30, The Request for Applications (RFA) process begins on February 1, 2015 for eligible nonprofit organizations seeking funding under the ESG program. Eligible nonprofit organizations must submit project proposals until Monday, March 20, 2015 at 5:00 p.m. The Housing and Community Development Division will review the applications and make recommendations for funding to the Community Development Advisory Board (CDAB). The CDAB is comprised of Orange County residents appointed by the Board of County Commissioners (BCC). CDAB members serve on a volunteer basis. Once a consensus is reached, the recommendations will be submitted to the BCC for approval. Eligible applications will be reviewed and selected according to the following: Application meets one or more of the Consolidated Plan priorities Final Application Ranking (based on final score) Application is consistent with ESG Program regulations Additionally, applicants should note that final budget/program funding recommendations will be subject to funding availability; therefore, there is no guarantee that any or all projects will receive funding. Since funds generally support only a limited number of projects, some projects may not be funded. Recommendations will be submitted for approval to the BCC during or prior to August 2015 as part of the Annual Action Plan, which is then submitted to HUD for approval. All funding recommendations are contingent upon HUD s approval of the Annual Action Plan and the availability of federal funds. Approved projects will be funded through a contractual agreement with Orange County. Payments will be made on a reimbursement basis. Orange County reserves the right to accept or reject any or all applications, with or without cause; to waive technicalities; or to accept applications which, in its sole judgment, best serve the interests of Orange County. PROJECT AWARD PROVISIONS To assist applicants, there will be a technical assistance session on Monday, February 16, 2015 at 11:15 a.m. at the Orange County Administration Building, in the Board of County Commissioners Chambers, to discuss the application process and federal requirements for ESG awards. Applicants should follow completion instructions and provide requested documentation. Additionally, agencies seeking funds for homeless prevention and rapid re-housing activities must meet requirements including, but not limited to the following: Agency must show capacity, experience using federal funds, a satisfactory track record providing homeless prevention and /or re-housing activities, and efficient service delivery to clients in accordance with regulations and requirements Agency manages its fiscal operations in accordance with approved standards, including conflict of interest guidelines and separation of duties and responsibilities, particularly as applicable to this grant Agency can demonstrate an existing and consistent cash flow to cover cost of rental payments, deposits, arrears, and other eligible expenses, pending reimbursement All agencies awarded funding from the ESG Program will be subject to all federal and local laws, regulations and guidelines governing the grant. A lobbying blackout period shall commence upon issuance of this Request for Applications and concludes upon contract award. Revised 1/15 3

5 FY ESG PROGRAM DESIGN ESG funding will be allocated in accordance with new program regulations, as follows: Grant Administration- Orange County may designate up to 7.5 percent of the total ESG allocation for operational costs associated with the administration and compliance monitoring of the grant. Grant Administration is not part of the RFA process. Homeless Management Information Systems (HMIS) - Orange County may allocate ESG funding for costs associated with HMIS administration and data collection. Street Outreach and Emergency Shelter Operations- Funds used for street outreach and emergency shelter activities are limited to the greater of: a) 60% of the County s total fiscal year grant for ESG, or, b) The designated hold harmless amount (the amount of FY 2010 grant funds committed for combined emergency shelter and street outreach activities only), established at $270,749 for Orange County. If ESG total funding for FY remains at $422,525, the same amount as was received for FY , Orange County will allocate up to $270,749 for Emergency Shelter and Street Outreach. Homeless Prevention and Rapid Re-Housing- The priority for ESG program funding is currently homelessness prevention and rapid re-housing. If ESG total funding for FY remains at $422,525, the same amount as was received for FY , Orange County will allocate a combined total of up to $179,009 for Homeless Prevention (including stabilization and rental assistance) and Rapid Re-housing Services (including stabilization and rental assistance). Target Populations The following homeless populations will be prioritized in keeping with consultation with the local Continuum of Care agency: First priority are homeless families with children, residents of Orange County, who lack a fixed, regular, and adequate nighttime residence; particularly families with children in Orange County Public Schools, or who have lost their primary residence within the previous fourteen (14) days. Second priority are individuals and families who are Orange County residents and who will imminently lose their primary nighttime residence within fourteen (14) days and have no subsequent residence identified and lack the resources or support networks needed to obtain permanent housing. Third priority is all other eligible homeless populations identified under the HEARTH Act (i.e. unaccompanied youth, chronically homeless, individuals and families residing at shelters, and homeless veterans). APPLICATION INSTRUCTIONS 1. APPLICATION PREPARATION All proposers must submit ALL of the information listed in this application to be considered for funding. Application Cover Application Cover Sheet (Form 1) Required Organizational Documents Checklist (Form 2) Table of Contents Organizational Capacity and Experience Project Description Approach Written Standards and Procedures for the Project (Form 3) Outcomes (Narrative) and Project Data (Form 4) Budget Justification (Narrative) and Project Budget Request (Form 5A) and Use of Funds(Form 5B) Agency /Organization Budget (Form 6) Match Certification (Form 7) 2. APPLICATION SUBMISSION All pages are to be numbered, including all attachments. Applicants are requested to submit two (2) unbound originals of the Application with requested forms and attachments, and three (3) unbound copies of the Application with requested forms (no attachments) for each proposed project. Revised 1/15 4

6 Applications should be submitted in sealed envelopes or boxes. The applicant s name and address should be indicated on the outside of each envelope or box. Submission by facsimile machine or via will not be accepted. Applications must be received no later than 5:00 p.m. on Monday, March 20, 2015 at the Housing and Community Development Division, Attn. Planning and Development, 525 East South Street, Orlando, FL Late applications will not be accepted. Applications without a signed Cover Sheet (Form 1) will be disqualified. 3. E- DOCUMENTS The Orange County Consolidated Plan is available for downloading from the County website: evelopment.aspx 4. APPEALS Limited resources and anticipated budget cuts are expected to limit the number of projects that can be selected for funding during the fiscal year. An Applicant may submit a request to receive information addressing the reasons why the project proposal was not funded or to request technical assistance for future applications. Applicants may contact the Division regarding an appeal, except for the following reasons: 1. The Division received the application after the deadline 2. The proposed activity is ineligible under ESG regulations 3. The Applicant failed to meet federal and Orange County eligibility requirements for this grant 4. The application is incomplete (missing narratives, documentation or an explanation of why the required documentation is not available. Please refer to the Application Content and Required Forms) 5. The Applicant is dissatisfied with the amount of a grant award. To appeal a recommendation, an Applicant must provide a written notice to the Manager of the Housing and Community Development Division no later than 5:00 p.m. on the third business day after the agencies have been notified of the funding recommendations. Agencies will be notified by May 29, The written notice should be addressed to: Mr. Mitchell Glasser, Manager Housing and Community Development Division 525 East South Street Orlando, FL An appeal committee comprised of the following individuals will review appeals and render a decision: One individual serving on the Community Development Advisory Board One Staff person from the Housing and Community Development Division An independent person to be appointed by the Director of the Community, Environmental and Development Services Department The Manager of the Housing and Community Development Division or his designee 5. TECHNICAL ASSISTANCE/QUESTIONS A Technical Assistance Session for ESG will be held on Monday, February 16, 2015 from 11:15 a.m. to 12:45 p.m. at the BCC Chambers, Orange County Administration Building, 201 S. Rosalind Ave., Orlando, FL Attendance at the ESG technical assistance session is highly recommended. This will be the only session held on this solicitation. To RSVP, please send an to: Elizabeth.Rico@ocfl.net The technical assistance session will provide an overview of the application, ESG guidelines, and Orange County s ESG program policies. Potential applicants will have an opportunity to ask questions regarding the application; however, the session is not intended to be a substitute for HUD training on ESG. Following the Technical Assistance Session, any additional technical questions regarding the Request for Applications must be submitted by to Nancy.Sharifi@ocfl.net referencing the specific section of the Application. Questions related to the RFA will be accepted (in writing) until March 6, Revised 1/15 5

7 APPLICATION CONTENT Applicants are requested to include the following information in the application. APPLICATION COVER The application must have a cover with the name of the project and the organization submitting the request. Applicants are asked not to bind applications (originals and copies). APPLICATION COVER SHEET Complete the Application Cover Sheet (Form 1). The form must be filled out completely. Applicant s Executive Director or designee must sign each Application Cover Sheet. Applications without signed cover sheets will not be considered for funding. If multiple organizations are submitting jointly, one organization must be designated as the primary contact. APPLICATION CHECK LIST For your convenience, an Application checklist has been provided (Form 2). Please include after the Application Cover Sheet as part of your submission package. TABLE OF CONTENTS Each section must be identified by name and page number in the table of content NARRATIVES A. ORGANIZATIONAL CAPACITY (20 points maximum) Complete the following narratives: 1. Provide information to justify your agency s capacity to conduct this project. Include management, fiscal and other staff resources such as consultants and volunteers with skills, experience and/or appropriate credentials to administer and conduct an accountable and responsible project. Identify the staff positions that will be in place to conduct the project, including the specific staff in the organization using the Homeless Management Information System (HMIS). If your agency is exempt from using HMIS (domestic violence clients only), explain how the agency will account and assess the process of each client reported under ESG outcomes. 2. Describe the facilities (i.e. number of beds, case management offices) and resources (technology, onsite child care, etc.) which will be made available to ESG clients. If license is required for the facility, provide a copy of the license or evidence that the applicant can meet license requirements prior to the award of funds. 3. Provide evidence or documentation of an acceptable and accountable financial management system that minimizes any opportunity for fraud, waste, or mismanagement. Include the project s fiscal management system and written procedures explaining the agency s cash handling procedures, accounts payable, bank reconciliations, purchase orders, designated payment approval and check signing authority; type of accounting records (manual or automated), description of accounting and payroll services (internal and/or external); ability to identify/track ESG and other Federal funds, and recording of any program income. Explain if there is separation of fiscal responsibilities and adequacy of staff positions involved in fiscal and programmatic reporting. 4. Provide documentation that confirms successful past project performance, or confirms success in initiating, maintaining, and completing similar projects. 5. Provide a recent performance evaluation for this project or similar projects (other than ESG). 6. Complete Form 2 and attach the following documents to the Application: a. Organization s mission statement b. Current Organization Chart (dated) c. Current Board of Directors roster d. Current project staff position descriptions, including project management and fiscal staff positions e. Project staff s current resumes, as applicable f. Most recent interim financial statements, and audited financial statements for the previous two years. If there were findings, provide related Management Letter. If a Management Letter is not included as part of the audit, provide an explanation g. Current Federal Tax Form 990 (If not available, explain). Revised 1/15 6

8 h. 501(c) (3) certification confirming agency has been certified for two or more years. i. Certificate of insurance with coverage for all of the following: Commercial and General Liability; Automobile Liability; Workers Compensation; Professional Liability (if funded activity provides medical, design, or, similar professional assistance); Employee Dishonesty (if all, or part of grant to agency will be used for direct financial assistance on behalf of clients). (See Form 2 checklist for minimum insurance requirements, required limits and endorsements). j. Provide your organization s Conflict of Interest Policies and Disclaimer(s). Refer to specific conflicts prohibited by of the ESG Program. k. Articles of Incorporation/By-Laws l. Location Map of Proposed Project m. Current Board resolution that approves submission of grant application; or meeting minutes approving the grant submission, or a letter certifying that agency s Director has authority to submit the application. Applications without this requirement will be disqualified. B. PROJECT DESCRIPTION (20 points maximum) This section shall include a problem statement, indicate understanding of and compliance with the new homeless definition, describe the need of the target homeless population that will be served by the project, and describe the project objectives. 1. Explain and document the problem and specific need(s) the project will address. 2. Identify the specific homeless target population and how the specific services that will be provided. Explain why the services are right for this population. 3. Describe the project objectives. 4. How will ESG funds be used? Why are ESG funds needed? 5. If your agency receives multiple funding sources for homelessness, please explain how the agency will distinguish between clients served by ESG funds and clients served by other sources. 7. Describe outreach initiatives to inform and ensure that the target homeless population is made aware of the services to be provided. Include how clients are aware the services are available to all on a non-discriminatory basis. 8. Explain how homeless clients and/or clients at risk of homelessness will access your service(s) logistically and geographically. C. APPROACH (25 points maximum) The Application shall describe how the project will be implemented, operated and administered. As required by ESG, agencies must have written standards for the project. 1. The Application shall include a work plan with the estimated timeline for implementation. 2. Provide evidence of the effectiveness of your organization s project approach; be specific. 3. Include how the organization enforces conflict of interest provisions and controls to prevent fraud. 4. Complete Form 3 (Standards and Procedures). Provide the organization s written standards for the project. The written standards should comply with the requirements of the HEARTH Act for the service proposed. These requirements include, but are not limited to the requirements identified in Form 3. Agencies requesting funding for homeless prevention and/or rapid re-housing activities must submit the additional information identified in Form 3 of the Application. 5. Indicate the specific documentation that is collected, verified and kept on records regarding the client s program eligibility. 6. Provide a copy or describe your agency s confidentiality and recordkeeping procedures. 7. Describe how the organization participates in a centralized or coordinated assessment system to initially assess the eligibility and needs of each individual or family who seeks assistance. Describe the process to connect clients and the services that are available through the coordination with other service providers. 6. Is there a fee for services? If yes, provide an explanation. Revised 1/15 7

9 D. OUTCOMES (15 points maximum) 1. The Application shall clearly indicate and describe one or more measurable project outcomes consistent with identified need(s) and project objectives in the Consolidated Plan. Outcomes should also be linked to the ESG program component(s) agency plans to serve. 2. Complete Form 4 (Outcomes and Project Data) for each proposed outcome and place in the Forms Section of the Application. (NOTE: One or more of the proposed project outcomes should be achievable within the fiscal year). If ESG funding was previously provided, indicate if agency will be providing a new service, access to an existing service by new clients, or a quantifiable increase in the service provided. Include the number of homeless clients or clients at risk of homelessness (please specify which) that will benefit, e.g., the number that will obtain shelter and case management as a result of the grant. E. BUDGET JUSTIFICATION AND LEVERAGE OF FUNDS (20 points maximum) 1. Indicate whether the project is currently or was previously funded by Orange County s ESG funds. If the project was previously funded by ESG, briefly explain how previous funding was utilized, if it was utilized in a timely manner, and what more will be accomplished with the proposed award. Is there a contingency plan in place that is intended to ensure continuity of the program beyond the current ESG funding period? 2. Provide details of any other Orange County contributions, grants, donations or awards that your organization receives. Explain if any will support or are anticipated to support this project. Explain their commitment status. Other Orange County contributions may include space, utilities, equipment, staff, or services. Failure to disclose funding from other County sources could be cause for disqualification of the application. 3. Complete Forms 5A and 5B: Project Budget Request and Project Budget Use of Funds. Identify the amount of ESG funding requested. Please note that Total Project Budget means the total cost of conducting that project in Orange County. Budget Request should reflect the portion of the total budget to be funded with ESG funds. 4. Explain and justify each proposed budget line item and why ESG funds are required. 5. Complete Form 6: Project/Organization Budget Explain other necessary project budget expenditures not being proposed for ESG funding. Identify proposed resources for other cash and non-cash budget expenditures related to the proposed project. Explain the commitment status of resources (e.g. received grant or contract, or letter of commitment.) and state plans to raise additional funding resources (e.g. fundraising activities). Identify and explain how other sources of required cash or non-cash resources, not currently committed will be obtained and when. 6. Identify if the project will be leveraged with other programs and funds and the amount or percentage of leverage for each ESG dollar. If the project is currently being funded by a resource other than ESG, explain why ESG funds are needed. 7. Complete Form 7: Match Certification. Orange County requires that agencies receiving ESG funding provide a match equal to 100 percent of the grant to be used in the program activity during the same period. Applicants must identify the match amount and source of match. Provide supportive documentation to confirm that matching funds are in place, or are anticipated to be available for the match. Revised 1/15 8

10 EVALUATION CRITERIA The evaluation criteria identified in the Application will be used to rank each Application submitted. Each criterion element will be rated separately. Applications may receive up to the maximum points allowed based on the response to each criterion element. A detailed description of each criterion is included in this Application. Applicants must adequately address the following: ALL APPLICATIONS WILL BE EVALUATED IN ACCORDANCE WITH THE FOLLOWING CRITERIA: Maximum Points Criteria I Organizational Capacity 20 Criteria II Project Description 20 Criteria III Approach 25 Criteria IV Outcomes 15 Criteria V Budget Justification and Leverage of Funds 20 TOTAL POINTS 100 The Application must include the required organizational documents identified on the checklist (Form 2) as attachments and provide evidence that the Board or authorized representative has approved the grant request. Points will be deducted for missing documents. Revised 1/15 9

11 FORM 1: APPLICATION COVER SHEET Nonprofit Organization Name: Address: Contact Person: Title: Telephone ( ) Fax: ( ) Date Designated as 501(c)(3): Federal Identification Number: Please provide proof that the 501(c) (3) is active (check if proof included) Agency DUNS # (required): Name of Project: Location of Project: ESG Component (check): Street Outreach Emergency Shelter Homelessness Prevention Rapid Re-housing HMIS Brief Description of Project Activities (Include need addressed, population served, how ESG funds will be used): Check One: New Project Currently funded through CDBG or ESG Consolidated Plan Priority: Indicate if Application(s) is being submitted in partnership or collaboration with other nonprofit organization(s): Yes No List other organization(s) by name: Requested ESG Funding: $ Percent of total Project Cost: % Available Match: _ Source of Match: Please complete the Match Certification (Form 7) in this Application. Revised 1/15 10

12 Please check all that apply: I acknowledge that if funded, the agency must state the source of its 100 percent ESG match and provide proof of its match upon notification of funding. I acknowledge that if funded, agency will accept only ESG applicants who are extremely low-income individuals and families with incomes below 30 percent of the HUD specified annual Area Median Income level. I acknowledge that if funded, the agency is required to conduct due diligence in determining eligibility status of applicants seeking to be served with ESG funds, and verification and recording of support documentation. I acknowledge that if funded, the agency is required to utilize HMIS for reporting and case management (unless exempt from this requirement). I acknowledge that if funded, the agency must comply with applicable federal requirements including the Federal Fair Housing Act of SIGN BELOW. APPLICATIONS WITH AN UNSIGNED COVERSHEET WILL BE DISQUALIFIED I certify to the best of my knowledge, that the information provided in this application reflects accurate information and data regarding need, and appropriate estimates of planned services. This application was considered and approved for submission by the Board of Directors on (date). By signing this application, the undersigned agrees that if the application is accepted, items or services for which prices are quoted will be provided, subject to final negotiation and acceptance by Orange County, and subsequent contract award. Signature of Executive Director (or designated representative) Date Print Name Title Revised 1/15 11

13 FORM 2: CHECKLIST AND REQUIRED ORGANIZATIONAL DOCUMENTS Application Cover Application Cover Sheet Table of Contents Narratives (Sections A-E including Forms 3-7) The following documents must be provided in order for your project to be considered for funding. Please provide ALL of the following required documents as Attachments to this application. Attachment 1 - Organization s Mission Statement Attachment 2 - Organizational Chart (dated) Attachment 3- Current Board of Directors Roster (including terms & dates, position on Board & occupation) Articles of Incorporation (with recorded date of approval, letter from Secretary of State, etc) By-Laws (with recorded date of approval, letter from Secretary of State, etc) Interim Financial Statements Audited Financial Statements for the previous two years (with Management Letter, as applicable) Current (Most Recent) Federal Tax Form 990 Project Position Descriptions Resumes Current (CEO, CFO, key fiscal staff, and all Programmatic staff) Project Performance Evaluation (from a source other than ESG or CDBG grant) 501(c) (3) Certificate Evidence of Insurance Conflict of Interest Disclaimer Location Map Current Board Resolution/ or authorized representative s approval to request grant (Meeting minutes or certifying letter) Revised 1/15 12

14 FORM 3: Written Standards and Procedures for the Project Provide the Agency s written standards and procedures for the project, including: Shelter and/or housing standards Procedures to ensure compliance with the homeless definition and determining eligibility Standards for assessing risks and determine which families or individuals will receive services Terms and duration of assistance Client assessment materials (if providing case management) Standards for completing data entry and maintaining the HMIS database Written Standards for Homeless Prevention and Rapid Re-Housing Policies and Procedures (Only for Agencies Applying for Homeless Prevention and Rapid Re-housing) Agencies applying for prevention and/or re-housing activities must submit the following information: Written Policies and Procedures for Homeless Prevention not included in previous narratives (At a minimum, the agency must provide eligibility determination, term of assistance and conditions for re-certification). Written Policies and Procedures for Rapid Re-housing not included in previous narratives (At a minimum, the agency must provide eligibility determination, term of assistance and conditions for re-certification) File documentation checklists Client assessment materials (include a sample case management plan to assess Client s progress towards achieving housing stability) Household s Income calculation procedures Household s Rent calculation procedures Rent search and reasonableness forms, documents and/or checklists (for rehousing activities) Landlord verification form(s) Habitability and lead paint assessment forms (for re-housing activities) Exit Strategy/ Termination policies Additional resources to help stabilize families into permanent housing Revised 1/15 13

15 FORM 4** OUTCOME(s) AND PROJECT DATA (Please complete a separate form for each proposed project outcome.) (Outcome # of ) ORGANIZATION: PROJECT: ACTIVITY/SERVICE PROVIDED: WHAT IS THE IMPACT OF THE NEED/PROBLEM ON OUR COMMUNITY: OUTCOME TO BE ACHIEVED (not output): OUTCOME INDICATORS: MEASUREMENT SYSTEM: Target Homeless Sub-populations: Identify the number of persons to be served annually Currently Served (FY ) Anticipated to be Served (FY ) All ESG clients must be low-income Households/Individuals who are less than 30% of Area s median income (AMI)). May include sub-populations below. 1. Families with Children 2. Chronic Substance Abusers 3. Persons with HIV/AIDS 4. Homeless Individuals (without children) 5. Youth 6. Veterans 7. Victims of Domestic Violence 8. Other (Specify) TOTAL (unduplicated): ** Please complete all blank spaces. If the item is not applicable, please identify as N/A. Revised 1/15 14

16 FORM 5-A: PROJECT BUDGET REQUEST ESG Components and Activities Street Outreach (Subject to Expenditure Limit) Essential Services - Case Management costs (excluding Fringe) for assessing housing and service needs, documenting eligibility and related tasks. Other Services- Direct cost of emergency or mental health treatment; Transportation of outreach workers or participant s public transportation Sub-Total Amount Requested Emergency Shelter (Subject to Expenditure Limit) Shelter Operations - Costs for routine maintenance, utilities, insurance, supplies, rent, and supplies necessary for the operation of the emergency shelter. (No administration or management costs) Essential Services -Case management (excluding Fringe) costs to counsel and coordinate services for Shelter clients. Sub-Total Homeless Prevention Stabilization Services -Case Management (excluding Fringe) and Service Costs Costs for determining eligibility, coordinating assessments and services to facilitate housing stability of clients. Stabilization Services- Financial Assistance Costs Payments to third parties in connection with housing placement (application fees, security deposits, utility deposits, moving costs) Short to Medium Term Rental Assistance - Partial rent payments, one-time payment in rent arrears. Sub-Total Rapid Re-Housing Stabilization Services -Case Management (excluding Fringe) and Service Costs Costs for determining eligibility, coordinating assessments and services to facilitate rapid re-housing of clients. Stabilization Services Financial Assistance Costs associated with housing search and placement (deposits, application fees, security deposits, utility deposits, moving costs) Short to Medium Term Rental Assistance (cannot be used in combination With other public funds) Partial rent payments, one-time payment in rent arrears. Sub-Total HMIS (Designated Agency Only) HMIS Administration- Costs such as administering, training, hosting and Maintaining the HMIS system Sub-Total GRAND TOTAL Revised 1/15 15

17 FORM 5-B PROJECT BUDGET ESG COMPONENT ACTUAL FISCAL YEAR (CURRENT) PROPOSED FISCAL YEAR TOTAL PROJECT BUDGET CURRENT ESG SUPPORT TOTAL PROJECT BUDGET STREET OUTREACH Case Management (Excluding Fringe) Other Services (Specify) EMERGENCY SHELTER Essential Services Case Management (Excluding Fringe) ESG FUNDING REQUEST Shelter Operations Maintenance Supplies Insurance Utilities Other (Specify) HOMELESS PREVENTION Stabilization Services Case Management (Excluding Fringe) Financial Assistance Short term and Medium Term Rental Assistance RAPID RE- HOUSING Case Management (Excluding Fringe) Service costs Financial Assistance Short term and Medium Term Rental Assistance HMIS Management Total Budget Note: All requested budget items must be explained and justified in the Narrative Section. Revised 1/15 16

18 FORM 6: AGENCY/ORGANIZATION BUDGET ACTUAL FISCAL YEAR (CURRENT) PROPOSED FISCAL YEAR Administration Staff Salaries TOTAL AGENCY BUDGET CURRENT ESG SUPPORT TOTAL AGENCY BUDGET ESG FUNDING REQUEST Other (Specify) Operations Rent Maintenance Supplies Utilities Telecommunications Insurance Audit Travel Equipment Security Food Other (Specify) Client Services Financial Assistance Rental Assistance Transportation Other Services (Specify) Total Budget NOTE: Total Agency Budget means the total cost of conducting the agency s business in Orange County (ESG funds requested included). ESG budget request should reflect the portion of the total budget to be funded by Orange County. The organization must identify any other source of funding leverage for the project, including other funding from Orange County, in the narrative section. Revised 1/15 17

19 FORM 7: MATCH CERTIFICATION Describe your match in terms of: Types of cash and/or non-cash resources used as match Specific amounts of resources used as the match Proposed uses of match resources in support of the program activity Sources of Local Match: (Attach supporting documentation available for match. Documentation should reflect funding availability during the ESG contract year. Contributions used to match a previous ESG grant may not be used to match a subsequent ESG grant.) Other State/Local Government Funding (except for Orange County) Other Federal (except for Orange County ESG or CDBG) Private Sources: Fundraising/Cash Loans Building Value Donated Goods New Staff Salaries rate ordinarily paid Volunteer Medical /Legal Other (Specify) Proposed Uses of Agency s Match: I certify that the match funds have been identified and committed to support the proposed ESG project and have not been used to match previous ESG awards (e.g.. value of a donated building used as match the previous years cannot be used as match for fiscal year stated in application). This form is a description of the sources and amounts of such match funds, which are not being used as match for any other federal program. Signature: Title: Date: Revised 1/15 18