Request for Proposals Community Development Block Grant (CDBG) Program

Similar documents
APPLICATION INSTRUCTIONS COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM Program Year 2017 July 1, 2017 June 30, 2018

COMMUNITY DEVELOPMENT BLOCK GRANT PUBLIC SERVICE GRANTS MOUNT VERNON URBAN RENEWAL AGENCY

COMMUNITY DEVELOPMENT BLOCK GRANT PUBLIC SERVICE GRANTS MOUNT VERNON URBAN RENEWAL AGENCY

The City of Sandusky. Community Development Block Grant Program (CDBG) Non-Profit Provider Application 501(c) 3 for Program Year 2015

HOUSING REHAB PROJECT PROPOSAL

CITY OF NORTH LAS VEGAS Community Development Block Grant Program Program Year CONSTRUCTION/REHABILITATION APPLICATION

The City of Perth Amboy Funding Application CDBG. For Program Year June 1, 2017 May 31, 2018

COMMUNITY DEVELOPMENT BLOCK GRANT

Address: Telephone #: FAX #: 3. Project Name: 4. CDBG Funds Requested ($15,000 Minimum Request): $

Applications Must Be Typed In Entirety No Applications With Any Handwritten Entries Will Be Accepted Excluding Signatures and Check Boxes

JEFFERSON COUNTY, ALABAMA. Program Year 2018 EMERGENCY SOLUTIONS GRANT APPLICATION APPLICANT:

FY COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING APPLICATION FOR FUNDING ASSISTANCE FISCAL YEAR

GOVERNOR S OFFICE OF ECONOMIC DEVELOPMENT COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM 2016 APPLICATION. H. Ranking of this Application: Rank of

Horry County Community Development 1515 Fourth Avenue Conway, SC 29526

Community Development Block Grant Program Year Application Instruction Booklet

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM OVERVIEW. Town of Union CDBG Program

Community Development Block Grant (CDBG) Fiscal Year 2018 Request for Proposal (RFP) Application due January 31, 2018 by 5:00 pm

2018 BUSINESS ENTREPRENEURSHIP PROGRAM

COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) Subrecipient Workshop

How to Use CDBG for Public Service Activities

CDBG PUBLIC SERVICES

January 17, Providers of Services and Shelter to the Homeless in Tarrant County

Community Development Block Grant (CDBG) Request for Applications (RFA) for Public Services and Housing Projects

City of Alameda Program Guidelines for CDBG FY18-19

COMMUNITY DEVELOPMENT BLOCK GRANT APPLICATION PACKET

Consolidated Grant Process

2016 Community Development Block Grant (CDBG) General Information

2016 BUSINESS ENTREPRENEURSHIP PROGRAM

2017 APPLICATION PACKET FOR NON-PROFIT ORGANIZATIONS & INTERESTED PARTIES

State of Louisiana Disaster Recovery Unit. CDBG-DR Economic Development Programs

APPLICATION FOR CITY OF MARIETTA. Community Development Block Grant Public Facilities Acquisition, Construction, and Renovation

CITY OF NIAGARA FALLS, NEW YORK

HOME Investment Partnerships Program

Grant Application Package

What is the Community Development Block Grant Program (CDBG)?

REQUEST FOR PROPOSALS

Application Guidelines

FINANCE-315 7/1/2017 SUBRECIPIENT COMMITMENT FORM

FISCAL YEAR FAMILY SELF-SUFFICIENCY PROGRAM GRANT AGREEMENT (Attachment to Form HUD-1044) ARTICLE I: BASIC GRANT INFORMATION AND REQUIREMENTS

Home Investment Partnerships Program. Application for. Home Investment Partnerships Program. Funding (HOME) FY

2018 CDBG Application Instructions

City of Syracuse Department of Neighborhood and Business Development. Emergency Solutions Grant (ESG) RFP Program Year 40 ( )

Managing CDBG. A Guidebook for Grantees on Subrecipient Oversight. U.S. Department of Housing and Urban Development

City of Urbana/Cunningham Township Application for Funding Packet Consolidated Social Service Funding Program Fiscal Year

APRIL 2009 COMMUNITY DEVELOPMENT BLOCK GRANTS/STATE S PROGRAM NORTH CAROLINA SMALL CITIES CDBG AND NEIGHBORHOOD STABILIZATION PROGRAM

EMERGENCY SHELTER GRANTS PROGRAM EMERGENCY SHELTER GRANTS PROGRAM. U. S. Department of Housing and Urban Development

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

PROPOSALS DUE: NOVEMBER 8, 12:00 PM

EMERGENCY SHELTER GRANTS PROGRAM EMERGENCY SHELTER GRANTS PROGRAM. U. S. Department of Housing and Urban Development

City of Coeur d Alene Community Development Block Grant 2017 Community Opportunity Grant Application Guidelines

Request for Proposals (RFP) Hurricane Irma. Long Term Recovery Committee Position. Proposals Due 12:00 PM EDT, April 9, 2018

Genesee County Emergency Solutions Grant Application 2018

EMERGENCY SOLUTIONS GRANT

Subrecipient Profile Questionnaire

CITY OF ALBANY EMERGENCY SOLUTIONS GRANTS (ESG) PROGRAM REQUEST FOR PROPOSALS (RFP) PROGRAM YEAR 40

Sponsored Programs and Research Compliance SUBRECIPIENT COMMITMENT FORM

New York State COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM. Microenterprise Assistance PROGRAM GUIDELINES

Community Development Block Grant (CDBG) Fiscal Year 2017 Request for Proposal (RFP) Application due January 27, 2017 by 5:00 pm

CITY OF CHINO HILLS COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

Program Year 2019 Grant Application Overview

Arizona Department of Education

APPLICATION FOR FUNDING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) AND EMERGENCY SOLUTIONS GRANT (ESG) FOR FISCAL YEAR

EMERGENCY SOLUTIONS AND COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM APPLICATION FOR FUNDING PROGRAM YEAR FY 18/19

CDBG-R SUBMISSION TEMPLATE & CHECKLIST

2018 Community Development Block Grant (CDBG) General Information

2017 Community Development Block Grant (CDBG) Application Workshop. September 27, 2016 Ankeny, Iowa

SOCIAL SERVICE GRANT GRANTEE MANUAL

Kitsap County Coordinated Grant Application Process 2019 Notice of Funding Availability

HOME Investment Partnership Program RFP Community Housing Development Organization (CHDO) Certification Year 44 ( )

APPLICATION FOR CITY OF BELLINGHAM COMMUNITY HOUSING DEVELOPMENT ORGANIZATION (CHDO) CERTIFICATION

SUMMARY OF ELIGIBLE AND INELIGIBLE COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM ACTIVITIES

Emergency Solutions Grant Program

Playing by the Rules

Micro Enterprise Assistance Program District 2 Guidelines FY

Emergency Food & Shelter Program (EFSP)

NOTICE OF FUNDING AVAILABILITY

PHASE 35 APPLICATION. Emergency Food & Shelter Program. Cobb County CDBG Program Office 192 Anderson Street, Suite 150 Marietta, GA 30060

SPRINGS. City Hall Broadway Saratoga Springs, New York Tel: x.2575 fax:

Community Housing Development Organization (CHDO) Organizational Qualification/Requalification Request. City: State: Zip: County:

Community Housing Development Organization (CHDO) Organizational Qualification/Requalification Request. City: State: Zip: County:

2015 Request For Proposals Rural Hospital Planning and Transition Grant Program

AMERICORPS APPLICATION Equal Justice Works Elder Justice Legal Corps

FREQUENTLY ASKED QUESTIONS

TEXAS GENERAL LAND OFFICE COMMUNITY DEVELOPMENT & REVITALIZATION PROCUREMENT GUIDANCE FOR SUBRECIPIENTS UNDER 2 CFR PART 200 (UNIFORM RULES)

CDBG/SSG Pre-Application Meeting. August 24, 2017

CHAPTER 9: GENERAL ADMINISTRATIVE AND MONITORING REQUIREMENTS

Fiscal Year 2018 COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM Application for Funding

Community Development Block Grant Frequently Asked Questions

DELAWARE STATE HOUSING AUTHORITY (DSHA) FY18 DELAWARE CDBG APPLICATION FORM. A. Name, address, phone number, DUNS number, and EIN number of Applicant:

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM CAPITAL PROJECT FUNDING APPLICATION

Criminal Justice Centers for Disease Control Prescription Drug Overdose Prevention for States (2018)

Alameda County Housing and Community Development Department

Pre-application Orientation

SUBCHAPTER 19L - NORTH CAROLINA COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM SECTION GENERAL PROVISIONS

Community Support Services Grant (CSSG) Program Application Fiscal Year

You created this PDF from an application that is not licensed to print to novapdf printer (

Idaho Department of Commerce Grant Programs

CITY OF HOLLYWOOD GENERAL FUND AGENCY GRANT PROGRAM APPLICATION REQUEST FOR FUNDING FISCAL YEAR 2018

Hillsborough County Affordable Housing Services Department PY 2016 CDBG Application Instructions

City of Ripon Planning & Economic Development 259 N. Wilma Ave. Ripon, CA FEDERAL GRANT PROGRAMS APPLICATION FOR FUNDING

Transcription:

2019-2020 Request for Proposals Community Development Block Grant (CDBG) Program The City of Mesquite is accepting applications from eligible entities. Application submittal deadline is 12:00 p.m., Friday, April 12, 2019. NO LATE SUBMISSIONS WILL BE ACCEPTED! This packet includes an overview of the grant program, applications instructions, review criteria, and required forms. All applicants are required to submit a complete application. For questions or more information visit: Mesquite CDBG website: https://www.cityofmesquite.com/495/subrecipient-information OR Email: kmunerlyn@cityofmesquite.com Application Submission Submit the following by Friday, April 12 from 8 a.m. 12 p.m. One (1) printed application with original signatures and One (1) scanned copy provided on a flash drive. Submit in person to: City of Mesquite Housing and Community Services Building 1616 North Galloway Avenue, Mesquite, TX 75149 (Use the front entrance near the parking lot entrance)

TABLE OF CONTENTS Application Instructions Application Review Criteria General Overview Purpose Eligible Applicants Examples of Eligible Activities Examples of Ineligible Activities Section 1: Applicant Information Section 2: Project/Activity Information Section 3: Budget and Financial Information Section 4: Construction Budget Section 5: Attachments Attachment 1: Performance Measures Attachment 2: Sources Leveraged Funds Attachment 3: Conflict of Interest Form Attachment 4: Board Authorization Form Supplemental Documents Required IRS Status Incorporation/Bylaws Organization Chart List of Board of Directors Proof of Liability Insurance Most recent Audit and Financial Statement Designation of Authorized Official Appendix 1: Application Checklist Appendix 2: CDBG Area Map

APPLICATION INSTRUCTIONS Before you submit an application, please make sure you have registered your entity in the SAM Database. System for Award Management (SAM) The System for Award Management (SAM) includes information regarding entities debarred, suspended, proposed for debarment, excluded or disqualified under the non-procurement common rule, or otherwise declared ineligible from receiving Federal contracts, certain subcontracts, and certain Federal assistance and benefits. In order to be eligible to receive a grant, applicants must register on SAM. Registration must be renewed and revalidated at least every 12 months. To register go to www.sam.gov and create an account by clicking the Create User Account and follow the directions. You will need your DUNS number and about 30 minutes to complete the process. 1. Applications may be downloaded from https://www.cityofmesquite.com/495/subrecipient-information 2. Submit one (1) printed application with original signatures and one (1) scanned copy of the signed original application provided on a flash drive. 3. Use 8½ x 11" paper for original printed copy submittal. Bind the original copy of your application with removable binder clips or paper clips. Do not print on both sides. 4. Applications must be concise and complete. 5. Place Application Checklist on top of your application (See Appendix 1). 6. A complete application consists of the following parts. SUBMIT IN THIS ORDER: a. Application Checklist b. Application i. Section 1: Applicant Information ii. Section 2: Activity and Program Information iii. Section 3: Budget and Financial Information iv. Section 4: Construction Budget v. Section 5: Attachments c. Supplemental Documents Provide all supplemental documents unless it is optional or not applicable. d. THE SCANNED COPY SHOULD BE SAVED ON THE FLASH DRIVE IN SEPARATE FILES AND NAMED APPROPRIATELY, i.e. APPLICATION OR DESCRIPTION OF THE ATTACHMENT. APPLICATION DEADLINE: FRIDAY, APRIL 12, 2019, 12:00 P.M. Deliver To: City of Mesquite Housing and Community Services Building, Front Desk 1616 North GENERAL Galloway, PROGRAM Ave, Mesquite, OVERVIEW Texas 75149

1 of 20 General Overview Purpose: Each activity, except planning and administrative activities, must meet one of the CDBG Program s three broad National Objectives: Benefit low and moderate-income persons (24 CFR 570.208(a)). Aid in the prevention or elimination of slum or blight (24 CFR 570.208(b)). Meet community development needs having a particular urgency (major catastrophes or emergencies due to natural or manmade disasters such as floods, tornadoes, terrorist acts, etc.) (24 CFR 570.208(c)). Eligible Applicants: Private Nonprofits Governmental Agencies, Departments Private For-Profit entities: A limited number can qualify as subrecipients when facilitating economic development by assisting microenterprises under 24 CFR 570.201(o)(1). Eligible Activities: Housing Services Homelessness Services Public Facilities, Infrastructure and Real Property Improvements o Neighborhood Facilities, o Parks, Recreational Facilities o Educational Child Care Centers o Transportation Infrastructure Public Services o Abused and Neglected Children o Battered and Abused Spouses o Educational Childcare Programs o Employment Training o Food Securities o Health Services o Mental Health Services o Senior Services o Youth Services Ineligible Activities: Political activities Religious-oriented activities/programs Income payments

2 of 20 APPLICATION REVIEW CRITERIEA 1. Organization Information Grants Administration staff will evaluate the proposed project/activity and organization s capacity to administer a HUD grant using guidelines specified in OMB Circulars, grant regulations, and Uniform Administrative Requirements. Although no points will be assigned for this part of the review, grant applications may not be recommended for funding if an organization cannot meet the requirements under this section to demonstrate organizational capacity. Applications will also be reviewed and scored by a review board consisting of City Staff who do not participate in the program. 2. Project and Activity Information Proposed project/activity meets a CDBG National Objective or grant-specific objective Cleary defined and supported the need for the project/activity. Thoroughly described program activities, project scope, and outcomes for the target population. Organization has previous experience in operating the program or delivering similar services. Clearly defined how the program/project success will be measured in qualitative and quantitative measurements (i.e. defined short-term goals that are specific, measurable, attainable, relevant, and time-bound). Presented realistic long-term expectations and outcomes. Organization has experienced staff with previous HUD grant experience, adequate program/project staff, and adequate financial/fiscal staff to operate the propose program or complete the proposed project. 3. Budget and Financial Information Provided justification for the program/project funding request. A financial rationale was provided and included credible and realistic costs. Provided a realistic timeframe on how funds will be spent. Described how the program/project will be sustained past the grant cycle. Budget included accurate calculations Provided documentation to verify leveraged funds that are specific to support the program/project.

3 of 20 SECTION 1: APPLICANT INFORMATION Agency: Chief Executive Officer/Department Director: Street Address: Direct Telephone #: City, Zip: Email: Federal Tax ID#: Contact Person: DUNS #: Title: SAMS #: Direct Telephone #: EIN # : Email: I certify that this Community and/or agency possesses the legal authority to proceed with this project if it is awarded, a copy of the authorizing documentation is attached, that the information contained herein is true and correct and that the submittal of this application has been duly authorized. Type Name of Chief Executive Officer/Department Director: Signature: Date:

4 of 20 SECTION 2: ACTIVITY/PROJECT INFORMATION Name of Activity/Project Physical Address of Activity/ Location Requested CDBG Funding *Minimum amount of $5,000* Total Cost of Activity/Project The proposed activity is: A new activity The continuation of an existing CDBG activity A quantifiable increase in the level of service of an existing CDBG activity To be eligible for CDBG funding, activities must meet a national objective identified in 24 CFR 570.201. Which of the following national objectives would your organization s proposed activity satisfy? Check one. Benefit to low-and moderate-income families; or Aid in the prevention or elimination of slums or blight; or Activities designed to meet other community development needs having particular urgency How many unduplicated/new persons/households do you expect to serve with your activity? *If your organization offers services such as childcare, emergency assistance, health services, etc., report beneficiaries as individuals. If your organization provides housing, residential rehabilitation or homeownership assistance, report beneficiaries as households. Please state the cost per service or cost per unit, if applicable. If your activity includes funding salaries please provide, pay per hour. Include a description of the unit or service. For example, $50 per meal. A meal is a hot lunch provided once a day to Mesquite residents.

5 of 20 Which criteria does your activity meet? Check one. a. Area benefit: At least 51% of residents within the targeted activity area are low to moderate income (LMI), see map in Appendix 2 b. At least 51% of clientele to be served will documented as LMI. c. Job Creation: At least 51% of jobs for LMI persons: Number of FTE jobs to be created. d. Elimination of Slums and Blight e. Urgent Need f. Limited clientele/special needs group (Please select subgroup below) (i) Abused children (ii) Elderly persons (Age 62 or older) (iii) Survivors of domestic violence (iv) Severely disable adults (v) Persons living with HIV/AID (vi) Migrant Farm Workers (vii) Homeless persons (viii) Other: Please Specify 1. Provide a detailed description of your proposed activity. Describe the work to be performed. Including activities to be undertaken or the services to be provided, the goals and objectives of the activity and the method of approach.

6 of 20 2. What needs or issues identified in Mesquite s most recent Consolidated Plan are addressed by your activity? 3. What are the eligibility requirements for your activity? 4. CDBG regulations require grantees and subrecipients to collect and report demographic information, as well as to document income. How will your organization collect the required information?

7 of 20 5. How does your organization identify perspective clients and make them aware your services are available to all eligible persons, including those with disabilities, on a non-discriminatory basis? 6. Is your organization faith-based? Yes No 7. If you checked Yes to Question 6, briefly explain how your agency will demonstrate compliance with 24 CFR 570.200(j) which prohibits inherently religious activities. 8. Describe your agency s experience administering federal, state, local and/or private grants.

8 of 20 9. How does your organization/department leverage resources by coordinating services with other community organizations? SECTION 3: BUDGET AND FINANCIAL INFORMATION 1. Does your organization spend more than $750,000 in federal awards during its most recent fiscal year? Yes No 2. Is CDBG the primary source of cash funding for the proposed activity? Yes No 3. How will the organization cover program/project costs until reimbursed by the grant? Not applicable to city departments.

9 of 20 4. Provided the projected number of beneficiaries served and the estimated amount of CDBG funds to be expended each quarter in the table below. Projected # of beneficiaries Estimated CDBG Expenditures 1st Quarter (Oct-Dec) 2nd Quarter (Jan-Mar) 3rd Quarter (April- June) 4th Quarter (July-Sept) $ $ $ $ $ Total 5. If salaries and fringe benefits are included in the grant budget for the program/project provide the employee s name, job title and brief summary of job duties each person will perform for the program/project. Please attach additional documents if necessary. Job Title Duties and Responsibilities Salary

10 of 20 6. Please complete the budget form below. Cost Categories CDBG Funds Requested (A) Other Committed Funding Sources (Leverage) (B) Other Pending Funding Sources (C ) Salaries/Fringe General Expenses Utilities Rent Equipment Equipment Lease Insurance Communications Materials and Supplies Reproduction and Printing Consultants Mileage Travel/Training Expenses Other Total Budget $ $ $ $ Total Project Costs A+B+C=D (D) SECTION 4: CONSTRUCTION BUDGET 1. Construction Budget: If your project is a specific construction project, identify the total costs of the project, the amount to be funded by CDBG and a narrative as to how the agency can meet additional operating costs if any resulting from construction. *Please respond using N/A is not applicable.

11 of 20 2. Total Construction Cost $. *Please respond using N/A is not applicable. 3. Sources of funds (list all sources financing the construction budget including other government funds, agency cash, private funds, CDBG). *Please respond using N/A is not applicable. 4. Will this project be fully funded once CDBG is in place? *Please respond using N/A is not applicable. 5. How long will it take to complete the construction project? *Please respond using N/A is not applicable.

12 of 20 6. Pre-development soft costs (legal, A&E, survey, environmental, etc.) a. Completed already $ b. Funded by this CDBG Request $ c. Funded by other sources $ d. Expected soft costs $ e. Total development costs $ (construction and soft costs ) 7. Briefly discuss the impact of the project, if any on the operating expenses of agency. Identify any additional operational expenses.

13 of 20 SECTION 5: ATTACHMENTS ATTACHMENT 1: PY19 PROPOSED ACTIVITY TIMELINE Project Title: Activities/Milestones Oct 19 Nov 19 Dec 19 Jan 20 Feb 20 Mar 20 April 20 May 20 June 20 July 20 Aug 20 Sept 20 1. 2. 3. 4. 5. 6.

14 of 20 ATTACHMENT 2: PERFORMANCE MEASURES Performance Measures: Provide the SMART (Specific, measureable, attainable, relevant and time bound) goals for the proposed project/activity in the chart below. Attach Additional Pages if necessary. ACTIVITY/PROJECT LONG- TERM GOALS ACTIVITY/PROJECT SHORT- TERM GOALS OBJECTIVES PERFORMANCE INDICATORS/MEASURES OUTCOMES

15 of 20 ATTACHMENT 3: Sources of Leveraged Funds: Attach supporting documentation for committed funding sources for this proposed project/activity, if necessary. City, County, State, or Federal Funds Source Grant Name Amount Date funds will be available (mm/dd/yyyy) $ $ $ $ $ $ $ $ Sub Total $ Private Funds (Attach additional pages, if necessary) Source Amount Date funds will be available Loans Loans Loans Grants Grants Grants Private Donations/Fundraising Sub Total $

16 of 20 ATTACHEMNT 4: CONFLICT OF INTEREST CERTIFICATION FORM The standards in 2 CFR 200.318 provide that no employee, officer, or agent shall participate in the selection, award, or administration of a contract supported by Federal funds if a real or apparent conflict of interest would be involved. Such a conflict would arise when an employee, officer, or agent, any member of his or her immediate family, his or her partner, or an organization which employs or is about to employ any of the parties indicated herein, has a financial or other interest in the firm selected for an award. The CDBG regulations at 24 CFR 570.611 provide that no person who is an employee, agent, consultant, officer, or elected official or appointed official of the recipient or subrecipient that are receiving CDBG funds and (1) who exercises or has exercised any functions or responsibilities with respect to activities assisted with CDBG funds; or (2) who is in a position to participate in a decision-making process or gain inside information with regard to these activities, may obtain a financial interest from a CDBG-assisted activity, or have any interest in any contract, subcontract, or agreement with respect thereto, or the proceeds there under, either for themselves or those with whom they have family or business ties, during their tenure or for one (1) year thereafter. Are any employees, agents, consultants, officers, family members, or elected officials of the organization requesting funds in a position to participate in the decision making process for approval of this application? Yes No Are any employees, agents, consultants, officers, family members, or elected officials of the organization requesting funds in a position to gain inside information with regard to approval of this application? Yes No Will any employees, agents, consultants, officers, family members, or elected officials of the organization requesting funds obtain a financial interest or substantial benefit from this activity? Yes No Will any employees, agents, consultants, officers, family members, or elected officials of the organization requesting funds have an interest in any contract, subcontract or agreement with respect to funding this application, either for themselves or those with whom they have family or business ties during the program year and one year thereafter? Yes No If you answered YES to any of the above questions, a letter must be submitted with the application that includes a disclosure of the nature and extent of the conflict. Date Signature/Authorized Official of Board Title Printed Name : Date Signature/Authorized Representative of Organization Title Printed Name:

17 of 20 ATTACHMENT 5: CDBG Board Signature Authorization Form The Board of Directors of (Name of organization requesting CDBG funds) does hereby resolve that on (mm/dd/yyyy), the Board reviewed the Application for Community Development Block Grant Funds to be submitted to the City of Mesquite Grants Administration for funding consideration for the upcoming program year and in a proper motion and vote approved this application for submission. The Board further certifies that the organization making this application has complied with all applicable laws and regulations pertaining to the application and is a non-profit organization, tax exempt, and incorporated. (Name of organization requesting CDBG funds) hereby proposes to provide the program services or complete the project identified in this application in accordance with this application for Community Development Block Grant Funds. If this application is approved and this organization receives CDBG funding from the City, this organization agrees to adhere to all relevant Federal, State and local regulations and other assurances as required by the City. In addition, the content of the application shall be incorporated as part of the written agreement and, as such, will be used to monitor performance. Activities, commitments, and representations offered in the application that are not subsequently made a part of the program/project as funded, shall be considered a material contract failure, and may result in a repayment of all CDBG funds and/or suspension from Program participation. Furthermore, as the duly authorized representative of the organization, I certify that the organization is fully capable of fulfilling its obligation under this application as stated herein. I further certify that this application and the information contained herein are true, correct and complete. I authorize the following person(s) to have signatory authority regarding this grant: Name: Title: Name: Title: Date Signature/Authorized Official of Board Printed Name: PENALTY FOR FALSE OR FRAUDULENT STATEMENT - U.S. Code Title 18, Section 1001, provides that a fine of up to $10,000 or imprisonment for a period not to exceed five years, or both, shall be the penalty for willful misrepresentation and the making of false, fictitious statements, knowing same to be false.

18 of 20 SUPPLEMENTAL DOUCMENTS REQUIRED. Please provided one copy of the following supplemental documents along with the application. Not Required for City Departments. 1. IRS Status: Non-profit organizations must submit tax-exemption determination letters from the Federal Internal Revenue Service and the State Department of Revenue Services. 2. Incorporation/Bylaws: Include the length of time the agency has been in operation, the date of incorporation, the purpose of the agency, and the type of corporation. Describe the type of services provided, the agency's capabilities, the number and characteristics of clients served, and license to operate (if necessary). Include copies of the agency's Articles of Incorporation and Bylaws. A brief paragraph with the agency s mission should also be included. 3. Organizational Chart: An organizational chart must be provided which describes the agency's administrative framework and staff positions, which indicates where the proposed project will fit into the organizational structure and which identifies any staff positions of shared responsibility. 4. List of Board of Directors: Please include name, telephone, email, and occupation or affiliation. 5. Proof of Liability Insurance: State whether or not the agency has liability insurance coverage, in what amount and with what insuring agency. State whether or not the agency pays all payroll taxes and worker's compensation as required by Federal and State law. State whether or not the agency has fidelity bond coverage for principal staff who handle the agency's accounts, in what amount and with what insuring agency. 6. Most recent Financial Statement and Audit: Submit most recent copy

19 of 20 Appendix 1: APPLICATION CHECKLIST Completed Application Attachment 1: Proposed Activity Timeline Attachment 2: Performance Measures Attachment 3: Sources of Leveraged Funds Attachment 4: Conflict of Interest Form * Not required for City Departments* Attachment 5: Board Authorizations Form * Not required for City Departments* IRS Status Form * Not required for City Departments* Incorporation/Bylaws * Not required for City Departments* Organization Chart * Not required for City Departments* List of Board of Directors * Not required for City Departments* Proof of Liability Insurance * Not required for City Departments* Authorized Official Signature:

Appendix 2: CDBG AREAS 20 of 20