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4.3 Attachment 7 - Fiscal Year 2020-21 Applications
City of Dublin 2020-2021 Human Services Grant Program Deadline: 1/13/2020 Association of the United States Army Education - Reading_ I ,programs at Frederiksen Elementary Schoo_ Jump to: Organization Information Questions Budget Documents $3,500.00 Requested Submitted: 1/10/2020 10:33:44 PM (EA_qLi_9)_ Project Contact Bo Rothchild bor72@comcast.net Tel: 925-963-3588 Additional Contacts leary_patrick@yahoo.com 6 4;"1 a 1 4 to] t I I- - 1. Business License Number BL-1 12089 LOHM4161 .. I- Association of the United States Army MG William Dean Chapter - Camp Parks 4847@A _Hopy r Rd,, Suite 4413 - Pleasanton,, CA 94588 President Jon Ellis 1. Select the category that best describes your organization: (Select only one.) Non -Profit --- Public Agency Other: Tele p hone925-963-3588 Fax Web www.ausa.org 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). The particular business of the Association of the United States Army shall be wholly educational, literary, scientific, fostering esprit de corps, dissemination of professional knowledge, and the promotion of the Army components of the Armed Forces of USA 3. Select the category that best describes the project: (Select only one.) -- Capital Project ✓ Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. ✓ Yes No, 5. Is this request for one-time, seed or operational funding? ✓ One-time funding Seed funding One-time and Seed funding Operational funding None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. AUSA Dean Chapter at Camp Parks has been asked to help support the Reading Programs, specifically One School One Book and One City One Book at Frederiksen Elementary School because many of the children at Frederiksen come from the military families at Camp Parks. The city is familiar with the One City One Book program and the teachers at Frederiksen have gone one step further and implemented their own One School One Book program. There are other scientific, writing, and environmental programs at Frederiksen that need funding which we would like to provide through the Dublin Grant. All the funds would be spent in the Dublin business community. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number ofservices received in a year.) The total number of students at Frederiksen Elementary School 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/9956/Application- Requirements-Process —' Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition -' Senior Services Youth Services -' Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the Above Please explain: . Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) Grant funds will be used to purchase the books for the Reading programs and to buy supplies for the scientific, writing, and environmental projects. The school administrators will oversee the use of these funds and ensure that they are cost effective. These funds will help the teachers by providing additional projects for the students. 10. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low -come, ESL persons, and/or disabled persons will access this project.Be sure to include your agencies marketing and outreach strategies and efforts. Not applicable. 11. If your agency is requesting Capital funding, will this project require implementation of Davis- Bacon/Fair Labor Standards Act requirements? NOTE.- Please contact City staff immediately ifyou have any questions regarding Davis -Bacon requirements. Not Applicable Yes No 12. ** QUESTIONS 13 THROUGH 25 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, check box here and answer questions 29 through 41. No. If no, check box here and enter Don't know. If you are unsure, please call City staff at (925) 833-6645. 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail Please enter "NIA "ifyou are not interested in qualifying for CDBG funding. N/A 14. CDBG ONLY - Identify at least.one HUD Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining -! Consolidate service delivery ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under - insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. -- C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. --` E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. ✓ F) Not Applicable. I am not interested in qualifying for CDBG funding. 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: --' Increase homeownership -- Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass -roots, faith -based, and other, community -based organizations ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 17. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority -serving institutions in HUD programs. -' End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 18. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. i Build on inter -jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service -enriched housing for persons with special needs. Not.Applicable. I am not interested in qualifying for CDBG funding. 19. CDBG ONLY- Select one HUD Objective that relates to your project: (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that l am seeking to address?') Creating a Suitable. Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 20. CD13G ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am l seeking?") Availability/Accessibility Affordability �3 Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. -- Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. -' Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. -' Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HN/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator, shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee -sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer -sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. J Not Applicable. I am not interested in aualifvine for CDBG fundiniz. 22. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) Persons Households %f Not Applicable, I am not interested in qualifying for CDBG funding. 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Disabled Women/Female Headed Households jseniors ---i _IYouth Homeless N/41 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.001 TOTAL 24. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ('AMP) information is available online at www.dublin,ca.govll956IApplication- Requirements-Process Low Income (50%-80% AMI) 1 Extremely Low Income (<30% AMI) N/,� Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) I== 25. CDBG ONLY- List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" White !White + HISPANIC Black/African American Black/African American HISPANIC Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White j Black/African American and White + HISPANIC ! American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC l Multi Racial + HISPANIC OR other Multi Racial. N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) i 0 00 TOTAL 26. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the agency's highest priority for funding. #2 - This program/project has the agency's 2nd highest priority for funding. #3 - This program/project has the agency's 3rd highest priority for funding. #4 - This program/project has the agency's 4th highest priority for funding. #5 - This program/project has the agency's 5th highest priority for funding. #6 - This program/project has the agency's 6th highest priority for funding. If you have more than 6 applications per organization, agency, district or entity, check here. Budget top _F,unftg Sources/Revenues BudgetAmount Amount Committed Dublin Grant 3,500.00 0.00 AUSA Dean Chapter donation $ 1,000.00 $ 1,000.00 Total $4,500 00 $1,000.00 Funding Uses/Expens.es BudgetAmount Amount Committed - -. - - - One School One Book Reading Program - 38 books @ 20 760.00 0.00 One City One Book - 38 books @ 20 760.00 760.00 Supplies for Scientific, Writing, and Environmental projects $22,980.00 0.00 Total4,500.00 $ 760.00 Budget Narrative Supporting the education of the children eof_the military families at Camp Parks is a high priority of the AUSA Dean Chapter. Funds from the revenues of the Dean Chapter are allocated each year to various educational activities. The .request from ateacher at Frederi:ksen Elementary came _as._a_n additional _item that the Dean Chapter needs help from the Dublin_ City, Grant. program to fulfill. Documents top Documents Requested * Requ.i.red?Attached Documents * Program Expense Budget forALLGrant Re nests download template Financial Information Form for ALL Grant download template List of Board of Directors(or overning_body) with agency contact information Program Expense Budget Financial Information Form Board of Directors Current Annual Budget for the Entire Agency Current Annual Budget Copy of most submitted IRS 990 form AUSA National IRS990 - Dean Chapter doe or Tax Return (include complete form) not have one. Board of Director's (or governing body's), Authorized Officer designation of authorized official Board of Director's.(pj_gpygrnjng_body's) Officer authorized to request funding, authorization to request funding_(pjqy be same document as one above) Proof of insurance carried, including bonding,, Certificate of Insurance liability and/or workers' compensation STATE AND FEDERAL NON-PROFIT IRS Exempt Status Letter DETERMINATION LETTER. All organizations MUST have approved .non-profit status from the State of California and Federal Tax Identification Number at time of aiDolication. Non-compliantpplicantdisqualified. Certified Audit and/or Certified Financial Certified Financial Statements for Dean Statements Chapter REQUIRED _FOR CIDBG ONLY - If requesting Capital Eun-g Lr)g,-PLea—se—upload —your Capital expenditure budget (your own format is acceptable) _ REQUIRED FOR CDBG ONLY - Personnel Policies Including Aff Affirmative Action Plan and Grievance Procedure REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy'-Pflast Audit Hgh,[ig". g."Findings" Section REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) REQUIRED FOR CDBG ONLY - AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEPLA ). Must include outreach to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used. REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) * ZoomGrantsTm is not responsible for the content of uploaded documents. Become a fan of ZoomGrants'' on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2020 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout I Browser City of Dublin ®1 Human Services Grant Program Deadline: 1/13/2020 Association of the United States Army Sea Cadets - Youth Leadership & Education _$5,QOO_,.00 Requested Submitted: 1/10/2020 10:21:13 AM Project Contact Bo Rothchild bor72,06gomcast,net Tel: 925-963-3588 Additional Contacts leary Patrick@yahoo.com . _ 1. Business License Number BL-1 12089 Association of the United States Army MG William Dean Chapter - Camp Parks 484711,Qpy Ar _ft, Suite 4413 Pleasanton, CA 94588 President Jon Ellis 1. Select the category that best describes your organization: (Select only one.) ./ Non -Profit Public Agency Other: Tele hone925-963-3588 Fax Web www.ausa.org 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). The particular business of the Association of the United States Army shall be wholly educational, literary, scientific, fostering esprit de corps, dissemination of professional knowledge, and the promotion of the Army components of the Armed Forces of USA 3. Select the category that best describes the project: (Select only one.) -! Capital Project ✓ Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes ✓ No S. Is this request for one-time, seed or operational funding? One-time funding Seed funding One-time and Seed funding ✓ Operational funding None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. The Sea Cadet program at Camp Parks recruits local area youths to participate in the restoration of historical military vehicles,to participate in leadership seminars, and to participate in physical education exercises. They are taught/trained in all areas of vehicle restoration such as bodywork, welding, vehicle painting, engine rebuilding/maintenance, wiring/electrical, brakes, clutches, and interior restoration. The cadets also learn and develop leadership skills as they are assigned specific tasks and they lead other cadets. The cadets also learn to work in a team environment and to be responsible for their assigned tasks. The vehicles are then used, or will be used, in the Dublin Parade and loaned to the Camp Parks Museum for public viewing. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 75 majority are from Dublin and the remainder are from Pleasanton, San Ramon, and Livermore 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.govll956/Application- Requirements-Process Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) ✓ Workforce Development Homelessness | | Transportation Services and Access LJ Domestic Violence and Child Abuse [� Disabilities Food and Nutrition Fl Senior Services ,/ Youth Services iChild Care, Early Childhood Development and Education L] Changing Demographics and Growing Diversity |] Financial Assistance [] None of the Above ~t Please explain: Youths are taught automotive vocational skills that can actually be used for a job in their adult life. 9.Describe indetail how Dublin grant funds will beused for this project. Inthis narrative, please include what measures are taken to ensure this project iscmsteffec1ive.andhomrthe budget meets the needs of the anticipated results. Uf capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What speofica8vwill the grant funds beused /br?) Dublin grant funds will be used to purchase tools, parts, and supplies for these vehicle restoration projects. Most items can and will be purchased from Dublin merchants. Occasionally, some special parts must be purchased on-line. The officers leading the projects areverysensitivetothecnstefhectiVenessofthevvorkandtheykeepe detailed Expense Report for each vehicle. Sometimes the officers will spend their own money to keep a project going. We can't always be sure of the budget for a new restoration, but the $5,000 that we are asking for will complete the restoration (already in progress) ofaViet Nam era jeep that vvewill drive inthe Dublin parade this year and will kick off in July the restoration of the next historical military vehicle that we already have nnthe premises. 10\Please list and briefly describe the outcome measures that are crucial tothe success mfthis project. What strategies or objectives will your agency use to track the progress mfmeeting the outcomme(s)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how Uom-commm,ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. There are approximately 75 current Sea Cadets in the program. They are from Dublin and other local area communities and the program is open to all area youths. New Cadets are recruited at Parades, Veterans' events, and speaking engagements bythe officers when the opportunity occurs. The success ofthe projects isseeingtheseyuuthsgrow\rnature,and|earnnem/ski||s—'eventhoughvveget restored historical vehicles in the process. The officers in charge volunteer for this duty, so they are very much committed tothe development ofthe Cadets. 11.N"your agency is requesting Capital funding, will this project require implementation of Davio- Bacon/peirLabor Standards Act requirements? NOTE., Please contact City staff immediately ifyou have any questions regarding Davis -Bacon requirements. wy Not Applicable Yes [] No 12. ** QUESTIONS 13 THROUGH 25 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes, If so, check box here and answer questions 29 through 41. ✓ No. If no, check box here and enter Don't know. If you are unsure, please call City staff at (925) 833-6645. 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail Please enter "NIA "ifyou are not interested in qualifying for CDBG funding. N/A 14. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive - Encourage community engagement and involvement Promote energy and resource efficiency -' Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery J Not Applicable. I am not interested in qualifying for CDBG funding. 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: -. A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under - insured residents with emphasis on activities that: Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. F) Not Applicable. I am not interestea in qualifying Tor c.uuu tunaing. 1. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing --` Strengthen communities Ensure equal opportunity in housing Promote participation of grass -roots, faith -based, and other community -based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 17. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority -serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 18. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. - Build on inter -jurisdictional cooperation to achieve housing and homeless needs. -' Increase the availability of service -enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 19. CDBG ONLY - Select one HUD Objective that relates to your project.. (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that l am seeking to address?') Creating a Suitable Living Environment - Providing Decent Affordable Housing Creating Economic Opportunities a/ Not Applicable. I am not interested in qualifying for CDBG funding. 20. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?') Availability/Accessibility —= Affordability Sustainability ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 21. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: - Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. _-_ Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. i - Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. - Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee -sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer -sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 22. CDBG ONLY - Please choose a common indicator that your agency will use to track.clients: (Select only ONE.) Persons - Households Not Applicable. I am not interested in qualifying for CDBG funding. 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Disabled Women/Female Headed Households Seniors - Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.001 TOTAL 24. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ('AMPinformation is available online at www.dublin.ca.govll956/Application- Requirements-Process Income (50%-80%AMI) Extremely Low Income (<30%AMI) N/A NotA Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) s pp q fY� g g• ( Yp Oooj TOTAL 25. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" White -.............. . ._ White + HISPANIC Black/African American j Black/African American + HISPANIC E .._.._...--.. ;Asian Asian + HISPANIC American Indian/Alaskan Native - - ( American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White [ American Indian/ Alaskan Native and White + HISPANIC Asian and White I Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC J - Multi Racial + HISPANIC OR other Multi Racial Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0 TOTAL 26. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY ✓ #1 - This program/project has the agency's highest priority for funding. #2 - This program/project has the agency's 2nd highest priority for funding. #3 - This program/project has the agency's 3rd highest priority for funding. #4 - This program/project has the agency's 4th highest priority for funding. #5 - This program/project has the agency's 5th highest priority for funding. #6 - This program/project has the agency's 6th highest priority for funding. If you have more than 6 applications per organization, agency, district or entity, check here. Budget toy? Funding Sources/Revenues Dublin City Grant AUSA additional funds Donations from outside sources Donations from Officers Total Budget Amount 5,000.00 $ 2,000 00 - 2,000.00 500.00 $ 9,500.00 Amount Committed 0.00 2,000.00 0.00 0.00 2,000.00 Funding Uses/Expenses Budget Amount Amount Committed Supplies sheet metal, welding, fabrication _paint, etc. $ 6,000.00, 0.00 Parts: headlights, tires, seat -gguggs,-gtc 13,000.00 Tools:jacks, sheet metal straiglLener, hammers, wrenches, etc, -500.00 Tota 1 $9,500.00 40get Narrative AUSA Dean Chapter has a limited budget to support the local military community. The Sea Cadet program wethin meets the criteria for Dublin Grant funding and the funds would be put to extremely gq-od-and,_needed,._use supporting a Youth Leadership and Work Skills_Trai ogra for local Documents -Re uested * Requirecl?Attached Documents Program Expense, Budget for ALL Grant Program Expense Budget icer Certificate of Insurance IRS Exempt Status Letter f�qqqests- download tempiate Financial Information Form for ALL Grant Financial Information For Requests download template List of Board of Directors -(gLgoverningbocly). WKh� agency contactinformation Current Annual Budget for the Entire Agency Cqpy-pf most recently .jgcgL submitted IRS 990 form , or Tax Return (include complete form) Board of Director's (or governing � _�y'§). designation of authorized official Board of Director's jpr�,govern I ing,bqdy15), authorization to request fund i ng,.(ffjay.,bq same document as one above) Proof of insurance carried, including bondi g, jjg� and/or workers' compensation STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of apolication. Non -comp Liant applicants will disqualified. Certified Financial Statements Certified Audit and/or Certified Financial for Dean Statements Chapter Board. of Directors Current Annual Budget not have one. Authorized Off 5-10—MMIMEMM I'M REQUIRED FOR CDBG ONLY - If requesting CapitalEu n ing,_pjpqsq _ _q[-_ _qpjpqd.yk4r-Ca.pjtgj expenditure budget (your own format is acceptable), E.EQUIRED FOR CDBG ONLY - Personnel Policies Including Affirmative Action Plan and Grievance Procedure I REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting, "Findings" Section, REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) REQUIRED,FOR CDBG _ONLY AGENCY'S, LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP). Must include outreach to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used. REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this is due with the 2nd quarter rgport_no.later than lanuary._1.5th, Supporting Documents such as Agency, Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) *ZoomGrants T" is not responsible for the content of uploaded documents. Application ID: 156313 Become a fan of ZoomGrants- on Facebook Problems? Contact us at,Questions@ZoomGrants.com 02002-2020 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout I Browser City of Dublin 2020-2021 Human Services Grant Program 1/13/2020 deadline Jump . Organization Information Questions Budget Documents _$9,0O0..00 Requested Submitted: 1/12/2020 2:20:09 PM (Pacific),, Project Contact Valerie Jonas yjonas,@axisheaIth.org Tel: 925.201.6068 Additional Contacts contracts@axishealth.org,scompt on@axishealth.org •. I a 1 0 go . 1. Business License Number --- ------- 112438 Axis Community Health 5925 W. Las Positas Blvd., Suite 100 Pleasanton, CA 94588 United States CEO Sue Compton scom:)ton@axishealth.org Select the category that best describes your organization: (Select only one.) ef Non -Profit Public Agency Other: Telephone, (925)_201 - 6068 x Fax (2�25)_417- 1503 x Web axishealth.orz 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Axis provides quality, affordable, accessible and compassionate health care services that promote the well- being of all members of the community. 3. Select the category that best describes the project: (Select only one.) Capital Project ✓ Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes ✓ No 5. Is this request for one-time, seed or operational funding? One-time funding Seed funding —` One-time and Seed funding J Operational funding None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. The goal of this project is to ensure access to affordable dental care for low-income Tri-Valley residents. Following a multi -year effort, in 2019 Axis opened a dental clinic staffed by two dentists and a hygienist to provide preventive care and treatment services. Prior to now, there has been a lack of such services in the Tri-Valley and pent-up need for care is enormous. There is already an 800 patient wait list for services. Only half of these patients are insured which means Axis must find the resources to provide this care. This project seeks to ensure that Axis can provide dental care to all low-income Tri-Valley residents in need of this essential health care. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 15 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.govll956/Application- Requirements-Process Behavioral Health (mental health and substance abuse) Affordable Housing ✓ Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities --! Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the Above Please explain: . Describe in detail hove Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. if capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) In early 2019, Axis Community Health opened a dental clinic in the Tri-Valley to serve low-income children, adults and seniors. Funding from Dublin, Livermore and Pleasanton was vital to helping launch this new dental service and enabled Axis to make necessary site improvements, including adding a sixth dental chair, upgrading existing dental equipment, and making interior improvements. The dental clinic is located at 7212 Regional Street in Dublin and is staffed with two dentists, a hygienist, and support staff. The clinic opened to patients on February 5, 2019. From that date until the end of 2019, Axis provided more than 2,500 dental visits for 800 unique patients. Of patients seen, 62% qualified for Medi-Cal, while 38% were uninsured. Axis has no source of funding to cover the cost of care provision for these uninsured dental patients. Additionally, given this is a new service that Axis is now able to offer patients, there is a tremendous backlog of patients in need of dental care. To date, we have a waiting list that has grown to more than 800 patients, of which 50% are uninsured. Other options for dental services for low-income and uninsured patients are extremely limited In the Tri- Valley, with only a few dentists providing services for a limited number of people. The only other option is to travel 20-plus miles to Alameda County's Highland Hospital in Oakland, where the wait time can be several months. Axis's goal is to make our local service accessible to low-income residents for essential preventive care and for acute dental needs in order to avoid unnecessary dental and health complications. Healthy People 2020, which describes Federal health standards for the U.S., states: "A growing body of evidence has linked oral health, particularly periodontal (gum) disease, to several chronic diseases, including diabetes, heart disease, and stroke. In pregnant women, poor oral health has also been associated with premature births and low birth weight. These conditions may be prevented in part with regular visits to the dentist." Axis estimates that an additional $600,000 in funding is needed during 2020 in order to provide dental services to uninsured patients. As noted there are 800 patients on the wait list and the list rate of growth is 100 patients per month, which will add an additional 1,200 patients in 2020. Therefore, we anticipate needing to serve 2,000 patients waiting for service during 2020, of which 50% (1,000 patients) are uninsured. Each patient has 2 to 3 visits in a year, which translates to providing 5,000 visits, of which 2,500 will be uncompensated. The average cost for a dental visit is $240, factoring in the range of visit types —from a dental exam with x-rays to anterior root canals. This care cost is very reasonable as compared to dental cost standards within the community health center environment, or as compared to dental services generally. Of the 1,000 uninsured patients that will be served by this project, an estimated 180 are Dublin residents. Dublin grant funds, in combination with funds from the cities of Livermore and Pleasanton, will help by providing 208 dental visits for 83 patients to help us achieve our goal of funding care for uninsured patients. This grant will fund 15 patients who are Dublin residents and who will receive 38 dental visits. Axis will use this funding to cover operational costs incurred --including staffing, x-rays, and dental supplies --in serving uninsured patients requiring preventive or general dentistry services. Services provided will include dental exams with x-rays, cleanings and fluoride application, fillings, sealants, complete and partial dentures, crowns, anterior root canals, extractions, and oral health education. Axis has already received $150,000 from Palo Alto Medical Foundation toward this project, and will be seeking additional grants and donations to support dental services for uninsured Tri-Valley residents. 10. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low -come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. A lack of access to dental services means low-income Tri-Valley residents do not receive essential preventive care, resulting in unnecessary dental and health complications. Based on our patient population and community data, we estimate 20-30,000 people in the Tri-Valley need access to dental services. Studies show that low-income people of all ages lack access to dental care and have disproportionately high rates of dental decay and disease that regular dental care prevents, including caries, gum disease and tooth loss. A survey of Axis patients showed that an estimated 34%, or 9,095 of 26,651 low-income Tri-Valley adults and children, did not access timely dental care. This project seeks to ensure access to dental services for all Tri-Valley residents, of all ages, in need of care. Outcome measures that are crucial to the success of this project are: • Reducing the number of low-income residents who lack access to preventive dental care and treatment services. • Improving the oral health of low-income patients and preventing other health complications due to a lack of dental care. • Providing oral health care education to low-income patients to achieve and maintain ongoing good oral health. Strategies and objectives that will be used to track the progress are: • Tracking wait list and appointment data to minimize wait times for treatment. • Ongoing review of patient oral health outcomes by Dental Director, Chief of Clinic Operations, and Quality Enhancement data team by utilization of our Electronic Health records system (Epic) to track data. Axis serves low-income and uninsured Tri-Valley residents of all ages with medical, mental health and dental services. This program serves Dublin families living below 200% of the federal poverty level (FPL)—Dublin's most impoverished residents. Many are the working poor who are struggling to maintain life's basic needs for their families. Dublin has experienced a substantial population growth and a growing poverty rate. The population jumped more than 53% over the past decade (Census 2010) and the number of Dublin residents in need of general assistance has doubled since 2003 (2011 Tri-Valley Needs Assessment). The past decade has seen growing diversity, with an increase of nearly 400% in the Asian population. Twenty-one percent of Dublin residents are foreign -born and 29% speak a language other than English at home. These demographics present cultural and linguistic barriers to attaining and maintaining good health. Axis continues to see a tremendous rise in the number of impoverished Dublin residents in need of our services. In fact, we have gone from providing services for 1,012 Dublin residents in 2010 to serving 2,046 in 2018, a 102% increase in just eight years (UDS Reports, 2010-2018). This project will benefit these residents by providing them access to dental services. Axis provides linguistically and culturally appropriate services throughout our organization, including with our dental services. One dentist and the hygienist are bilingual English/Spanish; the other dentist is bilingual English/Mandarin. All of our call center operators and front desk staff are bilingual (Spanish and English) and translation services for other languages are available as needed. Our employees are trained to recognize and respect differences among patients'values, expectations and experiences. Staff members represent the cultures and backgrounds of our patients, with care providers for all services fluent in many languages. Axis is the sole agency providing health care services for low-income and uninsured Dublin residents. Particular focus is put on reaching limited English speakers. These efforts have been successful and half our patients are limited English speakers. Axis promotes its services at community events, at organizations who serve low-income populations, and in media outlets. Activities include monthly outreach at the library, presentations at low-income housing communities, and coordination with school nurses. Our Enrollment Specialists and Community Relations Manager focus on reaching low-income limited English speakers and other challenged populations, such as those who have language or cultural differences, or a lack of knowledge of how to enroll in public insurance. Other multi-lingual referral mechanisms include the patient services specialists who field calls from the public and the CareMessage automated text appointment - reminders. In addition, Axis receives referrals form Alameda County's 211 agency, whose staff has the capacity to speak to callers in more than 150 languages. All Axis services are designed to accommodate individuals with disabilities and to comply with the Americans with Disabilities Act. Once enrolled as an Axis patient, these individuals benefit from the services offered through our dental clinic. 11. If your agency is requesting Capital funding, will this project require implementation of Davis- Bacon/Fair Labor Standards Act requirements? NOTE., Please contact City staff immediately if you have any questions regarding Davis -Bacon requirements. Not Applicable Yes - No COMMUNITY12. ** QUESTIONS 13 THROUGH 25 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FO FEDERAL DEVELOPMENT • ONLY. Are you are interested in applying Yes. If so, check box here and answer questions 29 through 41. No. If no, check box here and enter Don't know. If you are unsure, please call City staff at (925) 833-6645. 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). Hove does your agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail Please enter "NIA "ifyou are not interested in qualifying for CDBG funding. Axis's mission is to provide preventive and primary medical care to all members of the community, regardless of income, language, ethnicity or any other factor. Axis's services are designed to reach out to underserved and uninsured populations, including low-income racial and ethnic minority populations who otherwise lack access to health care. Our ability to effectively engage this population is evidenced by the increasing number of Dublin residents we serve. As the sole provider of medical services for the region's low-income and uninsured population, Axis serves a patient population that is ethnically and linguistically diverse. Because half of our medical patients are Spanish-speaking, all front-line staff (call center, case managers, enrollment staff, receptionists and medical assistants) are required to be bilingual in English and Spanish. Axis's medical staff speaks a variety of languages, including Spanish, Hindi, Farsi, Mandarin, and Urdu and also has expert multicultural health care skills and specific knowledge relevant to serving low- income, culturally diverse communities. This expertise successfully transcends cultural and other barriers, creating a bridge to health care and a medical home for Dublin's underserved residents. 14. CDBG ONLY . one HUD Consolidated Plan Guiding. - . your • - Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. -- *Promote fair housing and reduce housing discrimination. ✓ B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under - insured residents with emphasis on activities that: ✓ * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. ✓ * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. -- E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. F) Not Applicable. I am not interested in qualifying for CDBG funding. 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing ✓ Strengthen communities Ensure equal opportunity in housing Promote participation of grass -roots, faith -based, and other community -based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 17. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. ✓ Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority -serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 18. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: --- ' Increase the availability of affordable rental housing for extremely low income (31 very low income (50%) and low income (80%) households, Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter -jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service -enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 19. CDBG ONLY - Select one HUD Objective that relates to your project: (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that l am seeking to address?') Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 20. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am l seeking?') Availability/Accessibility Affordability Sustainability Not Applicable, I am not interested in qualifying for CDBG funding. r �: •ii- - Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. a/ Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star . qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. - Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. -' Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee -sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer -sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 22. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) / Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 11 Disabled Z Women/Female Headed Households � 21 Seniors 31 Youth Homeless Not Applicable, I am not interested in qualifying for CDBG funding. (Type N/A) 9,001 TOTAL 24. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMP9 information is available online at www.dublin.ca.gov/1956/Application- Requirements-Process 41 Low Income (50%-80% AMI) ill Extremely Low Income (<30% AMI) Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 15.001 TOTAL 25. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" 41, White 51 White + HISPANIC 11 Black/African American 01 Black/African American HISPANIC 41, Asian 01 Asian+ HISPANIC 01 American Indian/Alaskan Native oil American Indian/Alaskan Native + HISPANIC 01 Native Hawaiian/Other Pacific Islander 01 Native Hawaiian/Other Pacific Islander + HISPANIC 01, American Indian/ Alaskan Native and White 01 American Indian/ Alaskan Native and White+ HISPANIC 01 Asian and White 01 Asian and White + HISPANIC 01 Black/African American and White 0 Black/African American and White + HISPANIC - 0; American Indian/Alaskan Native and Black/African American _0 American Indian/Alaskan Native and Black/African American + HISPANIC 11 Multi Racial + HISPANIC OR other Multi Racial Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 15.001 TOTAL 26. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the agency's highest priority for funding. #2 - This program/project has the agency's 2nd highest priority for funding. #3 - This program/project has the agency's 3rd highest priority for funding. #4 - This program/project has the agency's 4th highest priority for funding. #5 - This program/project has the agency's 5th highest priority for funding. #6 -This program/project has the agency's 6th highest priority for funding. If you have more than 6 applications per organization, agency, district or entity, check here. Budget top- Fu nd.,ngnSources/Revenu..e.. s Budget Amount City of Dublin 9,000.00 City of Livermore $ 28,000.00 City of Pleasanton _$_13,000.00 Palo A1111.1lto Medical.. Foundation - $ 150,000.00 -- Foundation Grants 200,000.00 Community_ Donations 200,000.00 Total $MQ,000.00 Arg i.ng.Uses/Expenses Budget Amount Dental Visits for Uninsured Patients $ 600,000.00 Total 600,000.00 Amount Committed 0.00 0.00 0.00 $ 150,000 00 $ 0.00 $ 0.00 150,000.00 Amount Committed $ 150,000.00 150,000.00 Budget Narrative Project Cost: 5,000 dental visits at an average cost of $240 each. Tnl,s p_roject,., provides d,ental,..,services,,,fo,r1,.,000 uninsured Tri-Valley„_residents„whowi,l_Ineed an estimated ._,5,000_dental visits at a cost of $240.per visit, a total pro�ect_cost,of 600,000 Of the_1.,0.0,0, uninsured patients, 180 are Dublin residents. Funds from this grant, along with funding from the cities of Pleasanton and Livermore, will provide 208 dental visits for 83 patients. Of these, 15 patients will be Dublin residents who will receive 38 dental visits funded by this grant. The average cost of a dental visit is $240 and ranges from a dental exam with x-rays to anterior root canals. Services provided will be inclusive of h-ras.a,in s,flouric1e,aPP_..I.icati.on,fill,in s_,.._rt...i.al de.ntures,,,crowns,,_anterior rootcanalseacns,_ _, x-And ...o.ra,l _healt1.1111.1.1ducati. Fundin .som ,o....g.ouhf� Dublin, Pleasanton and Livermore for this project is in ratio to the number of patients served from each city by this, protect. Axis is seeking fund,i.ng f,,,rom other sources. for the reiing project costs.. Documents Requested Program Expense Budget for ALL Grant Requests download template. Financial Information Form for ALL Grant Requests download template List of Board of Directors (orgoverning body) with agency contact information Current ,Annual ,Budget for the. EntireAgency Copy of most recently„subm,itted IRS .990mform or Return (include complete, form) Board of Director's (or governing body's) designation_of authorized official Board of Director's (or governing body's), authorization to request funding -(may be same document as one above) Proof of insurance carried, including bonding,, liability and/or workers' compensation STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. All organizations MUST have approved non profit status_from the State of California and Federal Tax Identification Number at time of application. Non -compliant applicants will be disqualified. Certified Audit and/or Certified Financial Statements' REQUIRED FOR CDBG ONLY - If requesting Capital Funding,,.p,l,,eas,e_.u.p,load,your Capital, . expenditure, budget,_(yo_u_rownformat is acceptable) REQUIRED FOR CDBG ONLY _Personnel Policies Including Affirmative Action., Plan, and Grievance Procedure REQUIRED FOR CDBG ONLY -Agency Audit Requirements and Copy of Last Audit High lighting_°Find ,i_ngs"Section REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws REQ t ED,_FO_R CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) REQUIRED FOR CDBG ONLY -AGENCY'S Re„quired?Attached Documents * Axis Program Expense Budget f/ Axis Financial Information Axis Board of Directors Axis Current Budget far �,nire Agency_, Axis most recent IRS 990 form. Axis Authorized Official P/ Axis Board Authorization to Request Funding e Axis Proof of Insurance Axis Non -Profit Determination Letter Axis State Tax Letter ®/ Financials Axis Audited Fi e _ Axis Personnel Policies Axis Audited Financials Axis Articles of Incorporation Axis Bylaws 2018 Axis LEP LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP). Must include ou.treach.to_lim,itedEnglish,s,p.ea.ki_ng resi,de_nts, to encouragee access to services & housing, Include what access accommodations are used. REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this is due with_the 2nd quarter report no later than January 15th Supporting Documents such as Agency 5trategic_Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) * Zoom,Grants,Tm is not responsible, for the content uploaded,,,., d,,,,ocuments.. Application ID: 155044 Become a fan of ZoomGrantsTM' on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2020 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst,com, LLC. Logout I Browser City of Dublin 2020-2021 Human Services Grant Program 111312020 deadline Triage Call Nurse Jump to. Organization Information Questions Budget Documents ,135.00 Requested Submitted: 1/12/20201:34:40 PM (Pacific) Project Contact Valerie Jonas yjonas@gxishealth.org Tel: 925.201.6068 Additional Contacts contracts@la.xishealth.org,scompion@,gxishealth.org 1. Business License Number 112438 Axis Community Health 5925 W. Las Positas Blvd., Suite 100 Pleasanton, CA 94588 United States CEO Sue Compton scompton@LaLshealth.org _ 1. Select the category that best describes your organization: (Select only one.) ./ Non -Profit Public Agency Other: Telephone* (925)_201 - 6068 x Fax QU) 417- 1503 x Web axishealth.or2 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Axis provides quality, affordable, accessible and compassionate health care services that promote the well- being of all members of the community. 3. Select the category that best describes the project: (Select only one.) Capital Project ✓ Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes ✓ No S. Is this request for one-time, seed or operational funding? One-time funding Seed funding One-time and Seed funding ✓ Operational funding None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. This project ensures patients have phone access to a triage nurse to talk with about health symptoms and to guide them in accessing treatment. This ensures patients receive safe, timely and appropriate care and reduces risk for acute health problems. The role of the call center triage nurse is a vital part of the Axis care delivery system because it gives patients quick access to medical advice through our call center. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 1000 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application- Re q uirem en ts-Process Behavioral Health (mental health and substance abuse) Affordable Housing ✓ Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition 1 -= Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the Above Please explain: 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) Funds from this grant will address the need to provide quick phone access to a medical professional when patients are experiencing a health problem. It is also the link for parents/guardians of children who tend to require more frequent medical guidance. This funding will ensure Axis's ability to fund this critical position without a reduction in service hours. When a patient is experiencing symptoms, they can call our main phone line and be connected to the Triage Nurse, a licensed RN with specialized training in responding to patient calls, gathering information on . symptoms, and assisting patients with accessing appropriate care. The Triage Nurse is available during business hours to patients (Axis has an on -call phone service for after-hours care.) When a call center operator receives a call requiring a response from a licensed professional, the call is transferred to the Triage Nurse. The caller describes symptoms to the nurse and responds to the nurse's questions. The Triage Nurse uses a web -based decision -making tool, called Clear Triage, to assist in the process. Depending upon the severity of the symptoms and the patient's condition, the nurse advises on the appropriate next step. Options include having the patient proceed to emergency care, scheduling a same - day appointment with their Axis provider, scheduling a future appointment for the patient, or giving the patient advice for home care and follow-up. The nurse responds to patients of all ages, from newborns to geriatrics. As needed, the nurse brings a professional medical translator on the call to ensure clarity of information. The Triage Nurse is also the Specific Point of Contact (SPOC) for patients being discharged from the hospital. Through a dedicated phone line, area hospitals, including Stanford Health Care -Valley Care, Highland Hospital, and John George, call the Triage Nurse to arrange care for the patient after hospital discharge. This is a critical point of contact for ensuring continuity of care. During 2019, the Triage Nurse responded to 5,313 calls and assisted nearly 1,000 patients in discharge planning. The Dublin grant funds, in combination with funds from the cities of Livermore and Pleasanton, will help support a .5 FTE Triage Nurse, who will be available to 2,046 Axis patients who are Dublin residents. Axis was receiving an operational support grant annually for 10 years from Blue Shield of California Foundation (BSCF) which helped support the Triage Nurse position. However, BSCF has depleted this special fund for community health centers and is not providing any future support. In order to continue to have this critical role in the care delivery system, Axis must find sufficient funding. The provision of Triage Nurse call services is central to providing an appropriate standard of health care. Moreover, the project is targeted to reduce health care costs by ensuring that appropriate care levels are accessed in relation to patient symptoms, and further reduces health care costs by prioritizing care access in appropriate timeframes. Without this resource, patients may delay accessing treatment which can escalate health problems and cost of care. The salary cost for Triage Nurse services are reasonable in relation to the cost -savings realized when people are able to access health information that directs them appropriately. 10. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low -come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. Achieving appropriate levels of staffing that support a comprehensive system of care delivery is critical to the ongoing success of service delivery. The Triage Nurse is a position that, in many ways, is the backbone of medical serve delivery. Outcome measures that are crucial to the success of this project are: • Keeping patients who are experiencing symptoms safe by ensuring care that is timely and appropriate in relation to the symptoms. For example, directing a patient with chest pain or severe bleeding directly to emergency care which hastens access to essential care. • Preventing delay in care by promptly speaking with patients, or parents/guardians of patients, about the medical condition and facilitating appointments with care providers. • Assuring continuity of care for patients being discharged from an acute care setting by scheduling appropriate follow-up care with the patient's provider. • Addressing the needs of patients who are being discharged from other care settings. Strategies and objectives that will be used to track the progress are: • Tracking phone system data to monitor call volume and disposition. • Ongoing review by the Nurse Manager and Chief of Clinic Operations of workflows for calls coming into the Triage Nurse and their disposition. • Ongoing review of patient health outcomes by Nurse Manager, Chief of Clinic Operations,.and Quality Enhancement data team by utilization of our Electronic Health Records system (Epic) to track health data. Axis serves low-income and uninsured Tri-Valley residents of all ages with medical, mental health and dental services. This program serves Dublin families living below 200% of the federal poverty level (FPL)—Dublin's most impoverished residents. Many are the working poor who are struggling to maintain life's basic needs for their families. Dublin has experienced a substantial population growth and a growing poverty rate. The population jumped more than 53% over the past decade (Census 2010) and the number of Dublin residents in need of general assistance has doubled since 2003 (2011 Tri-Valley Needs Assessment). The past decade has seen growing diversity, with an increase of nearly 400% in the Asian population . Twenty-one percent of Dublin residents are foreign -born and 29% speak a language other than English at home. These demographics present cultural and linguistic barriers to attaining and maintaining good health. Axis continues to see a tremendous rise in the number of impoverished Dublin residents in need of our services. In fact, we have gone from providing services for 1,012 Dublin residents in 2010 to serving 2,046 in 2018, a 102% increase in just eight years (UDS Reports, 2010-2018). This project will benefit these residents by providing them access to medical advice by phone. Axis's mission is to provide quality, affordable, accessible and compassionate health care services that promote the well-being of all members of our community. To meet this goal, Axis provides linguistically and culturally appropriate services throughout our organization, including with our Triage Nurse calls. All of our call center operators and front desk staff are bilingual (Spanish and English) and translation services for other languages are available as needed. Our employees are trained to recognize and respect differences among patients'values, expectations and experiences. Staff members represent the cultures and backgrounds of our patients, with care providers fluent in many languages. Axis is the sole agency providing health care services for low-income and uninsured Dublin residents. Particular focus is put on reaching limited English speakers. These efforts have been successful and half our patients are limited English speakers. Axis promotes its services at community events, at organizations who serve low-income populations, and in media outlets. Activities include monthly outreach at the library, presentations at low-income housing communities, and coordination with school nurses. Our Enrollment Specialists and Community Relations Manager focus on reaching low-income limited English speakers and other challenged populations, such as those who have language or cultural differences, or a lack of knowledge of how to enroll in public insurance. Other multi-lingual referral mechanisms include the patient services specialists who field calls from the public and the CareMessage automated text appointment - reminders. In addition, Axis receives referrals form Alameda County's 211 agency, whose staff has the capacity to speak to callers in more than 150 languages. All Axis services are designed to accommodate individuals with disabilities and to comply with the Americans with Disabilities Act. Once enrolled as an Axis patient, these individuals benefit from the services offered through this Triage Nurse project. 11. If your agency is requesting Capital funding, will this project require implementation of Davis- Bacon/Fair Labor Standards Act requirements? NOTE., Please contact City staff immediately ifyou have any questions regarding Davis -Bacon requirements. Not Applicable Yes No QUESTIONS 13 THROUGHARE FOR THOSE ORGANIZATIONS INTE '.; • R. •I IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are .ntereste• in applyingfor • Yes. If so, check box here and answer questions 29 through 41. No. If no, check box here and enter Don't know. If you are unsure, please call City staff at (925) 833-6645. 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail Please enter "NIA "ifyou are not interested in qualifying for CDBG funding. Axis's mission is to provide preventive and primary medical care to all members of the community, regardless of income, language, ethnicity or any other factor. Axis's services are designed to reach out to underserved and uninsured populations, including low-income racial and ethnic minority populations who otherwise lack access to health care. Our ability to effectively engage this population is evidenced by the increasing number of Dublin residents we serve. As the sole provider of medical services for the region's low-income and uninsured population, Axis serves a patient population that is ethnically and linguistically diverse. Because half of our medical patients are Spanish-speaking, all front-line staff (call center, case managers, enrollment staff, receptionists and medical assistants) are required to be bilingual in English and Spanish. Axis's medical staff speaks a variety of languages, including Spanish, Hindi, Farsi, Mandarin, and Urdu and also has expert multicultural health care skills and specific knowledge relevant to serving low- income, culturally diverse communities. This expertise successfully transcends cultural and other barriers, creating a bridge to health care and a medical home for Dublin's underserved residents. 14. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your • • Be culturally accessible, appropriate and inclusive --- Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. - *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. ✓ B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under - insured residents with emphasis on activities that: ✓ * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. ✓ * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. F) Not Applicable. I am not interested in qualifying for CDBG funding. 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: -- Increase homeownership - Promote decent affordable housing ✓ Strengthen communities Ensure equal opportunity in housing Promote participation of grass -roots, faith -based, and other community -based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 17. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. ✓ Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority -serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 18. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. ®/ Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter -jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service -enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 19. CDBG ONLY - Select one HUD Objective that relates to your project: (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that l am seeking to address?") Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. . CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am l seeking?') .® Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. -- Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee -sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer -sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. -! Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 22. CDBG ONLY - Please choose a common indicator that your agency will use to,track clients: (Select only ONE.) ✓ Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 50 Disabled 1501 Women/Female Headed Households I am not interested in qualifying for CDBG funding. (Type N/A) 24. CDBG ONLY ® Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ('AMF) information is.available online at wwwdublin.ca.govll956IApplication- Requirements-Process 2201 Low Income (50%-80% AMI) 7201 Extremely Low Income (<30% AMI) Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 940.001 TOTAL 25. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above, If none, please enter "0" --275-1 White 39§, White + HISPANIC 391 Black/African American 11 Black/African American + HISPANIC 2281 Asian 21 Asian + HISPANIC 8-1 American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC 91 Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC 01 American Indian/ Alaskan Native and White 01 American Indian/ Alaskan Native and White + HISPANIC o Asian and White 01 Asian and White + HISPANIC 01 Black/African American and White Black/African American and White + HISPANIC 01 American Indian/Alaskan Native and Black/African American 01 American Indian/Alaskan Native and Black/African American HISPANIC 401 Multi Racial + HISPANIC OR other Multi Racial Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 1_,_000_._0d TOTAL 26. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the agency's highest priority for funding. #2 - This program/project has the agency's 2nd highest priority for funding. -' #3 - This program/project has the agency's 3rd highest priority for funding. #4 - This program/project has the agency's 4th highest priority for funding, #5 - This program/project has the agency's 5th highest priority for funding. #6 - This program/project has the agency's 6th highest priority for funding. If you have more than 6 applications per organization, agency, district or entity, check here. Budget to Funding Sources/Revenues Budget_Amo,unt Amount Committed City of Dublin 9,135.00 $ 0.00 City of Livermore, $.,,28,421 00 $ 0 00. City of Pleasanton $13,195.00 0.00 Foundation Grants $40,753.00 0.00 Community. Donations. $„10,000.00 $ Q00 Total. Eun,d,.ng;,U,ses/Expenses, Budget Amount Amount Committed Triage Call Nurse Salary $ 83,200.00 0.00 Triage Call Nurse Benefits Ll8,304.00 0.00 Tota.11. $ 101.504,,00 Budget Narrative This project is for the salary for a 1.0 FTE phone Triage Nurse at a rate of $40/hour plus 22% for benefits. Funding is sought from Dublin, which will be combined with grant funds from Livermore and Pleasanton, to fund .5 FTE. The request amounts for this funding is in ratio to the number of patients served from each city by this project. Axis is seeking funding from other sources for the remaining .5 FTE... for .this ,.,,.,..roiect....This critical service is in ro ortion to the overall staffin bud et for health services p 1_.... _.-- _ i?..__p..._._...._ .. ............_.., _ ... __g.._ ._.._.g _ ..__ ...._ a .the organ nation,, Documents Lop. Documents Requested * Program Expense Budget for ALL Grant Re_quests... download„te.mpia.te Financial Information Form for ALL Grant Requests_„ download template List of Board of Directors (o overning body,) with agency contact information Current Annual Budget for the Entire Agency Required?Attached Documents * Axis Program Expense Budget Axis Financial Information ,/ Axis Board of Directors �/ Axis Current Budget for Entire Agency �Copy of most recently submitted IRS 990 form or Tax Return (include comDlete form) complete - Board of Director 's (or governing body's), designation of authorized official Board of Director's (or governing body's) authorization to request funding -(may he same document as one above) Proof of insurance carried, including bonding,, Liability and/or workers' compensation STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of application. Non -compliant applicants will be disqualified, Certified Audit and/or Certified Financial Statements REQUIRED FOR CDBG ONLY - If requesti ng g Capi tal Funding, -please upload ,p y r Capital jo -Qu expenditure bu r ownjprmat is acceptable), REQUIRED FOR CDBG ONLY - Personnel Policies lncludinR Affirmative Action Plan and Grievance Procedure REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy ofLast Audit High�lightjjng "Findi gs" Section REQUIRED FOR CDBG ONLY - Articles of Incorporation and, Bylaws Axis most recent IRS 990 form Axis Authorized Official Axis Board Authorization to Request Funding - Axis Proof of IqSUrance ®/ Axis Non -Profit Determination Letter Axis State Tax Letter Axis Certified Audit Axis Personnel Policies Axis Audited Financials Axis Bylaws 2018 Axis Articles of Incorporation RE-Quil ED FOR CDBG ONLY - Conflict -of. Interest Statement (if not included in By Statement . . . .......... . REQUIRED FOR CDBG ONLY - AGENCY'S Axis LEP LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN LEP/LAP). Must include residents to encourage access to services & housing° Include what access accommodations are used. REQU1111 D FOR CDBG ONLY- LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency, Strategic Plan, geds Assessmen (Not, Required) Other Sup porting. Documents (Not Required), *Z6omGrantsTm is not responsible for the content of uploaded documents. Application ID: 156042 Become a fan ofZoomGrants- on Facebook Problems? Contact us at Questions@ZoomGrants.com 02002-2020 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout I Browser City of Dublin 2020-2021 Human Services Grant Program 1/13/2020 deadline, CALICO Center Dublin Child Abuse Intervention Jump _to: Organization Information Questions Budget Documents $15,000.00,Re uested Submitted: 1 /13/2020 4:56:01 PM (Pacific)_ Project Contact Erin Harper _ calicocenter@yahoo.com g_ Tel: 5108950702 Additional Contacts none entered 11111fr4, I IM a III R-11-11 Km • 524 Estudillo Ave San Leandro, CA 94577 United States Executive Director Erin Harper executive.di Z_calicocenteror 1. Select the category that best describes your organization: (Select only one.) of Non -Profit Public Agency Other: Telep.hpne(510) 895-0702 Fax (510) 895-0706 Web www.calicocenter.org 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). CALICO achieves justice and healing for abused children and adults with developmental disabilities, and promotes the safety and well-being of children everywhere. 3. Select the category that best describes the project: (Select only one.) Capital Project ✓ Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes ✓ No 5. Is this request for one-time, seed or operational funding? One-time funding Seed funding One-time and Seed funding ✓ Operational funding None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. CALICO proposes to conduct 10 forensic interviews with 7 Dublin children who have been sexually or physically abused, provide support services to 8 caregivers of the Dublin victims and facilitate a multi- disciplinary response to the allegations. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless ofnumber ofservices received in a year.) 18 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov11956/Application- Re quirem en ts-Process ✓ Behavioral Health (mental health and substance abuse) Affordable Housing - -' Health Care (including dental) -- Workforce Development ✓ Homelessness Transportation Services and Access ✓ Domestic Violence and Child Abuse ✓ Disabilities Food and Nutrition Senior Services �1 Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the Above --- Please explain: . Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) City of Dublin Community Grant funding would help offset the cost of our Child Interview Specialist (CIS) team. CALICO's services are crisis -oriented, meaning that an interview may be scheduled with little notice to accommodate the urgent needs of a particular case. In most situations, fewer than 24 hours elapse from the time we get the initial referral from the Dublin detective or child welfare worker to seeing the child at our center. In some cases, that time may shrink to under one hour. For that reason, we have a minimum of two CIS scheduled to work during normal business hours (we maintain a minimum staff of two because CALICO works simultaneously out of two locations, San Leandro and Oakland). In addition, all CIS are available by pager evenings and weekends for situations that require immediate attention. Please note that our Family Advocates (FA) are also available, but funding for those positions will be covered by other sources. The estimated cost to ensure that CALICO staff are available, when needed, to respond to the referrals of Dublin children and families is approximately $22,000 in FY20-21. Of that, the most significant expenses are staff salaries and benefits. City of Dublin funds would specifically offset a portion of staff salaries and benefits of the CIS team, which includes six part-time interviewers (including three bilingual Latinas who serve bilingual and mono -lingual Spanish-speaking families). When interviewers are not conducting interviews, they are performing other related tasks, including client intakes, data entry and quality control, observing and providing feedback to other interviewers, participating in trainings, planning and participating in monthly case review meetings and testifying in court, all necessary for the successful completion of our forensic interviewing services. 10. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low -come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts.. GOAL 1: Minimize trauma to abused children. 1 a. At least 75% of children interviewed will feel positive/neutral about their experience. 1 b. At least 75% of caregivers will indicate a favorable response to their child's treatment. GOAL 2: Improve coordination of child -abuse case investigations among multiple agencies. 2a. A multi -disciplinary team (comprised of a prosecutor, Dublin detective, and/or child welfare worker) will observe at least 75% of interviews. 2b. At least 70% of children eligible for a forensic medical exam will receive one. 2c. Monthly case Review meetings will be held at least 10 times per year to review select cases in depth from start to finish. GOAL 3: Improve the mental health of caregivers. 3a. An FA will conduct an on -site crisis assessment with at least 75% of families. 3b. An FA will initiate a California Victim Compensation Program (CaIVCP) application (or ensure one was already completed) on behalf of at least 50% of caregivers (to access funds for mental health services for the caregiver). 3d. By a second follow-up call, at least 35% of caregivers will be enrolled in counseling. Goal 4: Improve the mental health of victims. 4a. An FA will provide at least 75% of caregivers with psycho -education on the effects of trauma on children. 4b. An FA will assist at least 75% of families with a CaIVCP application on behalf of the child to provide funds for counseling. 4c. At least 35% of caregivers contacted will report their child is enrolled in counseling. CALICO tracks data for each child, family and case, including victim and offender demographics; data about the nature of the abuse, interview and multi -disciplinary team response; and extensive family support data, including caregiver demographics, services provided on site; referrals provided, outcome of follow-up calls and participation in counseling services. 11. If your agency is requesting Capital funding, will this project require implementation of Davis- Bacon/Fair Labor Standards Act requirements? NOTE., Please contact City staff immediately ifyou have any questions regarding Davis -Bacon requirements. ✓ Not Applicable -_' Yes No 12. ** QUESTIONS 13 THROUGH 25 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? ✓ Yes. If so, check box here and answer questions 29 through 41. No. If no, check box here and enter Don't know. If you are unsure, please call City, staff at (925) 833-6645. 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail Please enter "NIA "ifyou are not interested in qualifying for CDBG funding. CALICO is sensitive to the unique cultural and linguistic needs of each family served. At intake, we collect information about the race/ethnicity of the child, the child's primary language, and the caregiver's primary language. Three CALICO staff members are bilingual/bi-cultural Latinas who accommodate Spanish- speaking families as needed. Over the last five years, approximately 26% of the forensic interviews we conducted with Dublin victims were with children who identified as Latinx. If families speak a language other than English or Spanish (including ASQ, we work with the referring agency to arrange for a court -certified interpreter and may use the services of the county's language line, called Lionbridge. In addition, CALICO has translated all of our key documents into Spanish, and we can download select materials in other languages. 14. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: ✓ Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement ✓ Promote energy and resource efficiency ✓ Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery - Not Applicable. I am not interested in qualifying for CDBG funding. 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under - insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. ®/ * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. —' D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. F) Not Applicable. I am not interested in qualifying for CDBG funding. 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: - Increase homeownership Promote decent affordable housing %I Strengthen communities Ensure equal opportunity in housing Promote participation of grass -roots, faith -based, and other community -based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 17. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: --- Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. -` Participation of minority -serving institutions in HUD programs. --' End chronic homelessness within ten years. Removal of barriers to affordable housing. - Not Applicable. I am not interested in qualifying for CDBG funding. 18. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: -' Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. J Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter -jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service -enriched housing for persons with special needs. Not Applicable. 1 am not interested in qualifying for CDBG funding. 19. CDBG ONLY - Select one HUD Objective that relates to your project: (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that l am seeking to address?') Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 20. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am l seeking?') Availability/Accessibility Affordability Sustainability -' Not Applicable. I am not interested in qualifying for CDBG funding. 21. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. J Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. - Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS.- Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. -- Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness, jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee -sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer -sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 22. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 11, Disabled Women/Female Headed Households 0l Seniors 101 Youth 0 Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) --- 13 00 TOTAL 24. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ('AMI') information is available online at www.dublin.ca.gov11956IApplication- Requirements-Process 11 Low Income (50%-80%AMI) - 7= Extremely Low Income (<30%AMI) Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 18 001 TOTAL 25. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" -----�---7� White 41, White + HISPANIC �- 2? Black/African American Black/African American + HISPANIC 5' Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander - Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White - American Indian/ Alaskan Native and White + HISPANIC 9I Asian and White Asian and White+ HISPANIC Black/African American and White i ( Black/African American and White + HISPANIC [I American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) ' 18.001 TOTAL 26. If your ,•-- nt RAr priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the agency's highest priority for funding. #2 - This program/project has.the agency's 2nd highest priority for funding. #3 - This program/project has the agency's 3rd highest priority for funding. #4 - This program/project has the agency's 4th highest priority for funding. --'' #5 - This program/project has the agency's 5th highest priority for funding. #6 - This program/project has the agency's 6th highest priority for funding. If you have more than 6 applications per organization, agency, district or entity, check here. Funding Sources/Revenues Budget Amount Amount Committed Request from the City of Dublin 15,000.00 $ 0.00 Dublin Police Services, $ 4,500.00, $ 0.00 Alameda County DA's Office (in -kind), 3,000.00 U,000.00 Alameda County Social Services Agency $ 2,400.00 2,400.00 Community„Fundraising $ 5,000 00 $ 5,000 00, Total $29,900.00 $ 10,400.00 Funding Uses/Expenses Budget Amount Amount Committed Personnel Salary: Staff 12,195.00 0.00 Personnel Benefits: Staff $ 2,805.00 LQ.00 Personnel Salary & Benefits: ED (in kind) _ $ 3,000.00 _,551.00 _ $3,000.00 p Suplies 459.00 Printing $792.00 $250.00 Postage $, 240 00, 1 2- 00. Communications $ 1,547.00 200.00 Rent and Utilities $ 1,142.00 300.00 Audit and Accounting $ 583.00 $ 241.00 Outside Service $ 3,370_00 $ 3,9_ 5.00 Training $ 2,675.00 $ 2,675.00 Total 29,900.00 10,400.00 Budget Narrative The request of $15,000 from the City of Dublin will support slightly over one hour per week at the average pay of approximately $35 61-per hour of five members of the,. Child_Interview Specialist team to ensure there is full-time coverage to support Dublin children. Average pay is used to calculate the, request because, due to the crisis -oriented nature of our work, CALICO does not know ahead of time which Child Interview Specialist will conduct each interview. Child Interview Specialist, $35.61 x 68.4 hours x 1.23% benefits = $3,000 x 5 CIS - $15,000 CALICO's current benefit rate of 23% for employees includes payroll tax, workers comp, FICA, health,. Vision, dental, and 403b..._match_i.ng. ,i,. Documents top_ Documents Requested * Required?Attached Documents Program Expense Budget for ALL Grant Program Expense Budget Requests download template Financial Information Form for ALL Grant Requests download template List of Board of Directors (governing body) with agency contact information Current Annual .Budget., for the Entire Agency Copy of most recently,_sub_mltted_I_RS 990_form., -/ o.r..Tax,._RReturn ,(include complete for Board of Director's (or governing body's) des ignati o.n_o f authorized official Board of Director's or governing body's) authorization to request funding -(may be same document as one above) Proof of insurance carried, including bonding,, liability and/or workers' compensation STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of application. Non -compliant applicants will be disqualified. Certified Audit and/or Certified Financial v/ Statements REQUIRED FOR CDBG ONLY - If requesting Capital Funding, -please upload your Capital expenditure budget (your own format is acceptable) Financial Information i Insurance - - REQUIRED FOR CDBG ONLY__„_ Personnel Em ooyee Manual, Policies_ Including,Affirmative Action_ Plan, and, Grievance Procedure REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section REQUIRED FOR CDBG ONLY -Articles of Incorporation and Bylaws Audit - Articles of lncorporation Articles of Incorporation Amended Bylaws REQUIRED FOR CDBG ONLY - Conflict of Conflict of Interest Policy Interest Statement (if not included in„Bylaws) REQUIRED FOR CDBG ONLY - AGENCY'S LEP LAP LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP), Must „_include outreach to limited English speaking-resldents to encourage access to services & housing. Include what access accommodations are used. REQUIRED FOR CDBG ONLY -'LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc, (NN�ot Required) Other Supporting Documents (Not Required), * ZoomGrantsT"is not responsible_for the content of uploaded documents. Application ID: 155945 Become a fan of ZoomGrants- on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2020 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout I Browser Email This Preview Save as PDF Prim dose Window CAA V DUBLIN C A L I F 0 R N I A Powered by .ZoomGrantSTM City of Dublin 02 - 021 Human Services Grant Program 1/13/2020 deadline Jump to: Organization Information Questions Budaei Documents $ 9,9.00 Requested Submitted: 1/9/2020 9:38:21 AM (Pacific) Project Contact Sarah Holtzclaw sholtzclaK@Lcjpccd.org Tel: 925-560-9439 Additional Contacts none entered. 1. Business License Number BL 010043 Chabot -Las Positas Community College District/Tri-Valley Career Center 7600 Dublin Blvd Dublin, CA 94568 United States Interim Vice Chancellor for Business Services, designated signer Douglas Roberts droberts0cl ccd.org 1. Select the category that best describes your organization: (Select only one.) r Non -Profit Public Agency Other: . Telephone(925) 560-9431 Fax (925) 560-9457 Web trivalleycareercenter.org 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). As part of the CLPCCD Economic Development Department, our mission is to empower individuals and communities to thrive by creating career, education and economic opportunities. 3. Select the category that best describes the project: (Select only one.) F Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes ✓ No 5. Is this request for one-time, seed or operational funding? One-time funding Seed funding l_ One-time and Seed funding ✓ Operational funding None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Dublin Career & Employer Services will support TVCC's capacity to provide comprehensive career services to job seekers, recruitment services to local employers, and help to build the capability of local small business through a variety of workshops, events, and individual counseling. The program will focus on the human -centered design quality of our services and the/and increased awareness of the Career Center services in order to meet our goals. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 1,350 (450 through the daily Center activities and special events, 900 through social media and website). 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov11956/Application-Requirements-Process Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) ✓ Workforce Development F Homelessness F Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition Senior Services F Youth Services 'r Child Care, Early Childhood Development and Education F Changing Demographics and Growing Diversity F Financial Assistance F None of the Above r Please explain: 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) The Tri-Valley Career Center (TVCC) had been offering high -quality career services to the region for over 20 years. In the last 5 or five years, we have concentrated on professional izing our services and building our brand awareness in order to help more . job seekers connect with more local employers. Though the economy has grown stronger, we continue to increase or increasing the number of people we serve, the partners with which or with whom we collaborate, and the local businesses we help. We have increased our online presence, social media impact and our word-of-mouth referrals. Unfortunately, in that same amount of time, our main funding stream from the Department of Labor (DOL) via the Alameda County Workforce Development Board (ACWDB) has been cut in half. We are literally doing more with less. The partnership we have with our local cities is crucial to our success and vital to the local economy. It is in direct alignment with the Tri-Valley Needs Assessment to help job seekers find work and to help employers fill open positions. We strive to work with large companies as well as small businesses. We guide professional mid- to upper -level managers in search of employment, while helping low skilled workers secure good jobs also or simultaneously. We assist local businesses in their hiring practices or effectiveness so that they can continue to grow. Just last year, we helped add a minimum of $6.85 million back into our local economy. This figure accounts for or represents the documented earnings of job seekers enrolled in our WIOA program, who comprise just one-third of our overall traffic to or in or into the Career Center. Thus, the total financial (and social) impact could be or is likely much higher, making an investment in our employment services one the soundest the City of Dublin could make for or in its future. The Dublin grant will help fund both outreach and direct services. Career services are a highly personal process. It requires experienced staff to provide guidance to each job seeker. The Tri-Valley Career Center staff offers this guidance in both a 1-to- many workshop environment and in 1-on-1 counseling sessions. In order to reach more job seekers, staff also provides workshop facilitation at community partner locations such as the Dublin Library. Two-thirds of the funds sought from the City of Dublin will offset the staff costs to provide these services to Dublin residents. The remaining one-third of the requested funds are or will be allocated to outreach costs. This includes design and production of outreach materials as well as the placement costs for online advertising. We understand that the first place a newly unemployed person looks for work is often online. Thus, ads for the Tri-Valley Career Center concentrate on the online environment. Additionally, social media posts and ads remind people of the Career Center's services so that they can use us when they need us, and to refer others to use as needed or do the same. The timeline for this is ongoing. We have no hard start or stop dates other than events that are planned. Employers are continually looking to fill positions. Layoffs happen throughout the year. Job seekers can't take time off of or away from the search. Thus, our services are available 50 weeks a year (closing for the end of year holidays) and our brand awareness continues throughout the year. The events that we plan normally include job fairs, workshops, networking events and meet - ups with employers and/or other job seekers. Job fairs typically happen in the spring and fall. Other events happen or occur throughout the year, in an effort to continually assist both job seekers and employers. 10. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low -come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. The Tri-Valley Career Center's (TVCC) main funder is the Alameda County Workforce Development Board (ACWDB). Though the amount of funding has been cut in half over the last five years, the regulations or requirements of the Workforce Innovation & Opportunity Act (WIOA) have not changed. Since this funding is originally from the federal government, we must track and document much of our work. We track the number of people we see in our Dublin offices, the number of people attending events, the services we provide, the jobs secured by our enrolled job seekers and the number of people visiting our website and social media accounts. These are compared to similar time frames in previous years so that we know if we are growing our services as expected. Specifically, for this program, we will track and measure: • The number of Dublin and overall residents served; Percentage of Dublin residents to overall or total number of job seekers served; • The number of Dublin employers served; • New wages earned by Dublin residents; • Number of website visits; • Number of social media interactions; and ® Growth in social media interactions. TVCC is non-discriminatory in the people we serve. Our clients come from a wide variety of backgrounds, including: the newly unemployed, long-term unemployed, part-time or underemployed, experienced workers, new immigrants, college students, veterans, people with disabilities, ex -offenders, and people experiencing poverty. We actually seek out opportunities to help people facing barriers to employment through our outreach and partnerships with other Tri-Valley organizations, including CityServe of the Tri-Valley, the Department of Rehabilitation, and Alameda County Social Service Agency. These allow or this allows us to continue to serve our clients while, at the same time, helping job seekers who would not necessarily find their way to our offices. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE. Please contact City staff immediately if you have any questions regarding Davis -Bacon requirements. F Not Applicable r Yes V No 12. ** QUESTIONS 13 THROUGH 25 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for Yes. If so, check box here and answer questions 29 through 41. ✓ No. If no, check box here and enter F Don't know. If you are unsure, please call City staff at (925) 833-6645. 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 14. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: r- Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: F A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. F *Promote fair housing and reduce housing discrimination. F B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under -insured residents with emphasis on activities that: r * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. F Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. F C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. F E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. ✓ F) Not Applicable. I am not interested in qualifying for CDBG funding. 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: F Increase homeownership r Promote decent affordable housing f Strengthen communities Ensure equal opportunity in housing Promote participation of grass -roots, faith -based, and other community -based organizations ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 17. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: 1 Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. F Improving the quality of life for our Nation's communities r Encouraging accessible design features. r- Participation of minority -serving institutions in HUD programs. r End chronic homelessness within ten years. Not Applicable. I am not interested in qualifying for CDBG funding. 18. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). l Assist low and moderate income first-time homebuyers. i Reduce housing discrimination. r Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. r Build on inter -jurisdictional cooperation to achieve housing and homeless needs. r Increase the availability of service -enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 19. CDBG ONLY - Select one HUD Objective that relates to your project: (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?') Creating a Suitable Living Environment f— Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 20. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am / seeking?') Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 21. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. i Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. r Direct financial assistance to homebuvers: This indicator shows the number of homebuvers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. F Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee - sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. F Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer -sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. r Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 22. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) Persons Households ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Disabled Women/Female Headed Households Seniors Youth Homeless N/AI Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) TOTAL 24. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ('AMP) information is available online at www.dublin.ca.gov/9956/Application-Requirements-Process Low Income (50%-80% AM[) _-_....._]Extremely Low Income (<30% AMI) Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) .001 TOTAL 25. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. /f none, please enter "0" ............................. -......_.._._.............. -- White :] White + HISPANIC Black/African American Black/African American + HISPANIC [ Asian [ Asian + HISPANIC American Indian/Alaskan Native L _ ---]American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander } Native Hawaiian/Other Pacific Islander + HISPANIC j American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White ................ . Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American i American Indian/Alaskan Native and Black/African American + HISPANIC j Multi Racial + HISPANIC OR other Multi Racial N/A! Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) .00 TOTAL 26. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the agency's highest priority for funding. F #2 - This program/project has the agency's 2nd highest priority for funding. r #3 - This program/project has the agency's 3rd highest priority for funding. #4 - This program/project has the agency's 4th highest priority for funding. F #5 - This program/project has the agency's 5th highest priority for funding. r- #6 - This program/project has the agency's 6th highest priority for funding. I"- If you have more than 6 applications per organization, agency, district or entity, check here. Funding Sources/Revenues Budget Amount Amount Committed City of Dublin $ 9,952.00 $ 0.00 City of Livermore $ 9,844.00 $ 0.00 City of Pleasanton $ 9,899.00 $ 0.00 Alameda County -Oakland CAP $ 40,000.00 $ 40,000.00 Alameda County WDB _ $ 173,383.00 $ 173,383.00 CLPCCD $ 3,677.00 $ 3,677.00 Total $ 246,755.00 $ 217,060.00 Funding Uses/Expenses Salaries Benefits Supplies Printing Marketing Development Marketing Placement Travel Total Budget Amount $ 159,435.00 $ 77,395.00 $ 325.00 $ 950.00 $ 2,300.00 $ 5,800.00 - $ 550.00 - - - - $ 246,755.00 Amount Committed $ 143,651.00 $ 69,734.00 $ 120.00 $ 351.00 $ 852.00 $ 2,148.00 $ 204.00 $ 217,060.00 Budget Narrative TVCC is a program within the Economic Development Department of the Chabot -Las Positas Community College District (CLPCCD). Our core career services are primarily funded through the Alameda County Workforce Development Board (ACWDB) and the CLPCCD, with.additional help from the Tri-Valley cities. Recognizing that the overall budget of this program is much more or far greater than the three cities can or might collectively contribute, we have come up with an equitable amount for or from each of the three cities. Given that career services are heavily reliant on experienced staff, approximately 79% of this city -specific budget is or represents competitive wages and benefits. The remaining 21 % represents Dublin's share of the operating expenses, equal to the percentage of TVCC clients who are Dublin residents. Documents Lqp Documents Requested * Program Expense Budget for ALL Grant Requests download template Financial Information Form for ALL Grant Requests download template List of Board of Directors (or governing body) with agency contact information Current Annual Budget for the Entire Agency Copy of most recently submitted IRS 990 form or Tax Return (include complete form) -------- --------- Board of Director's (or governing body's) designation of authorized official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) Proof of insurance carried, including bonding, liability and/or workers' compensation STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of application. Non -compliant applicants will be disqualified. Certified Audit and/or Certified Financial Statements REQUIRED FOR CDBG ONLY - If requesting Capital Funding, please upload your Capital expenditure budget (your own format is acceptable) REQUIRED FOR CDBG ONLY - Personnel Policies Including Affirmative Action Plan and Grievance Procedure REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) REQUIRED FOR CDBG ONLY - AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP). Must include outreach to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used. Required? Attached Documents * ✓ CLPCCD-TVCC Program Expenses ✓ CLPCCD-TVCC Financial Information ✓ CLPCCD-TVCC Board of Trustees ✓ CLPCCD Adopted Budget 2019-2020 ✓ CLPCCD - No tax return - ✓ CLPCCD-TVCC Board Authorization ✓ CLPCCD-TVCC Board Authorization ✓ CLPCCD-TVCC Insurance Certificate - ✓ CLPCCD Tax Exempt Letter ✓ CLPCCD Most Recent Audit REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) * ZoomGrantsT"' is not responsible for the content of uploaded documents. Application ID: 155707 Become a fan of ZoomGranlsO` on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2020 GrantAnalysl.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Loaout I Browser Env ail This Preview Save as PDF Print Goss Window add V DUBLIN C A L I F 0 R N I A Powered by ZoomGrantsTM City of Dublin 2020-2021 Human Services Grant Program 1/13/2020 deadline Dublin VITA Program 2020-2021 Jump to: Organization Information Questions Budc et Documents $ 7,497.00 Requested Submitted: 1/9/2020 9:36:45 AM (Pacific) Project Contact Sarah Holtzclaw sho ltzclaw g clpccd. or Tel: 925-560-9439 Additional Contacts none entered 1. Business License Number BL 010043 Chabot -Las Positas Community College DistrictlTri-Valley Career Center 7600 Dublin Blvd Dublin, CA 94568 United States Interim Vice Chancellor for Business Services, designated signer Douglas Roberts droberts ..clracod.org 1. Select the category that best describes your organization: (Select only one.) Non -Profit F Public Agency F Other: Telephone(925) 560-9431 Fax (925) 560-9457 Web trivalleycareercenter.org 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). As part of the CLPCCD Economic Development Department, our mission is to empower individuals and communities to thrive by creating career, education and economic opportunities. 3. Select the category that best describes the project: (Select only one.) F Capital Project V Public Service Program or Project 4. Is this a "new" service, program, project or activity? "Flew" is identified as not yet started, implemented or in operation. Yes ✓ No 5. Is this request for one-time, seed or operational funding? One-time funding l� Seed funding F One-time and Seed funding ✓ Operational funding None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. For many people, taxes are scary, complicated and confusing. No one likes to face the federal government's threat of an audit. All this keeps paid tax preparers in business. However, when you are living paycheck to paycheck, you can't afford the cost of paying for tax preparation. The VITA program, sponsored by the IRS, is a powerful vehicle to deliver high -quality tax preparation that provides individual attention along the working poor's path to financial health. In fact, last year the average household income of the taxpayers served by Tri-Valley Career Center (TVCC) was just $28,152. TVCC stepped in several years ago to fill a gap for the low-income residents of the region. Over the years, the number of taxes e-filed by our certified volunteers has steadily risen. TVCC trains, certifies and manages 35 volunteers who work in three locations. These volunteers sit side -by -side with clients to prepare and a -file federal and state taxes. The impact of this service is both personal and widespread. Our clients are relieved and thankful for the service and speed in receiving their refunds. Jointly, the impact on the local economy is extensive, as hundreds of thousands of dollars are driven back into local businesses and families are stabilized each year. In the last 5 years, our taxpayers brought $4.1 million back into the Tri- Valley. The Dublin VITA program is a social service with an impressive and generous economic impact and return on the City's investment. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 72 unduplicated Dublin residents. For the 2019-2020 season, we believe we will serve 650 taxpayers, 11% of which will be from Dublin 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov11956/Application-Requirements-Process r— Behavioral Health (mental health and substance abuse) 1- Affordable Housing F Health Care (including dental) ✓ Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse F Disabilities Food and Nutrition Senior Services r Youth Services Child Care, Early Childhood Development and Education F Changing Demographics and Growing Diversity r Financial Assistance F None of the Above F Please explain: 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) The VITA Program offers its services for free. By law, we cannot take payment of any kind, including the occasional thank -you gift that a grateful client might later wish to bring back. Additionally, the taxes must be completed by volunteers. However, though the tax preparation services are free to the taxpayers, it is not without costs to operate. There is much planning, coordination and oversight that needs to happen or take place in the background. To ensure that this is done properly, the program is heavily reliant on its Program Coordinator. We rely on her expertise, planning, volunteer recruitment and operations oversight each year. She coordinates with the United Way and the IRS to ensure our volunteers are familiar not only with the software, but also all -new and altered tax laws each year. She manages the training of all volunteers as well as their schedules. Beginning in 2020, TVCC has used additional grant money to hire an Assistant Coordinator during the tax season in order to allow the program to grow further. Thus the City of Dublin grant will primarily pay for coordinating staff and benefits. This relatively small amount will cover printing and paper for the returns (which can reach 14 pages each), advertising, and travel for the coordinators. Dublin grant funds will be combined with other grants to cover all the costs associated with this program. These include federal, state, city and private donations. The City of Dublin funds are a critical piece to cover the costs associated with this vital, yet often overlooked, need. 10. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low -come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. Since this is a federally -regulated program, it is tracked meticulously by the IRS and United Way. At the end of the season, we should receive aggregated data on all of the clients we served. Each year, we track: ® Total number of clients served; • Percentage increase of clients served; • Total federal dollars returned to clients; • Average and Total Earned Income Tax Credits (EITCs) returned to clients served; • Average Adjusted Gross Income of clients served; and • The total number if ITIN applications filed From this, we can extrapolate Dublin data to know the above information specific to the City. VITA is a federal program, and thus is available or open to all qualified taxpayers. VITA is a service specifically for the working poor with low or moderate incomes. This year, the thresholds that we are bound or mandated to serve are single household incomes equal to or less than $66,000 a year, and married households earning $75,000 or less. Though this may seem or seems high, please note that in the Tri-Valley, a family of four is considered living in poverty with a household income of $89,000. Though Spanish is the most prevalent of second. languages that we serve, the program also has Tagalog-, Punjabi- and Chinese -speaking volunteers, allowing direct communication with/ to the taxpayers without the use of an interpreter. Additionally, our services as a Certified Acceptance Agency through the IRS allows us to streamline the process of obtaining an ITIN, for immigrant taxpayers without Social Security numbers. Our best marketing is that achieved through word-of-mouth, and through repeated business born of success and gratitude. A sizable number of our taxpayers return to us year after year. Their experience with and trust of the services/program is spread through recommendations and anecdotal word of mouth. More pinpointed marketing and outreach includes our website and that of our partner, the Pleasanton Library. It includes social media, both free and paid. Additionally, it includes flyers distributed through a network of social services and appropriate retailers in the region. These are produced in both English and Spanish. Our partners are a great resource in our outreach, as they provide additional services to the target population. Educating partner staff about the VITA services and how to access them is a critical outreach effort. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE. Please contact City staff immediately if you have any questions regarding Davis -Bacon requirements. F Not Applicable F Yes No 12. ** QUESTIONS 13 THROUGH 25 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? r Yes. If so, check box here and answer questions 29 through 41. ✓ No. If no, check box here and enter Don't know. If you are unsure, please call City staff at (925) 833-6645. 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 14. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: F Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement F Promote energy and resource efficiency Encourage networking and information sharing across service providers F Encourage process streamlining F Consolidate service delivery ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: i` *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. i= *Preserve and increase affordable rental housing opportunities for low and moderate income households. F *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. F Tromote fair housing and reduce housing discrimination. F B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under -insured residents with emphasis on activities that: F * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. F * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. r C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. ✓ F) Not Applicable. I am not interested in qualifying for CDBG funding. 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: F Increase homeownership F Promote decent affordable housing F Strengthen communities Ensure equal opportunity in housing - Promote participation of grass -roots, faith -based, and other community -based organizations ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 17. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: F Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. r Improving the quality of life for our Nation's communities 3- Encouraging accessible design features. r Participation of minority -serving institutions in HUD programs. F End chronic homelessness within ten years. F Removal of barriers to affordable housing. ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 18. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. F Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. I_. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. F Build on inter -jurisdictional cooperation to achieve housing and homeless needs. i- Increase the availability of service -enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 19. CDBG ONLY - Select one HUD Objective that relates to your project: (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?') F Creating a Suitable Living Environment F Providing Decent Affordable Housing r Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 20. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?') F Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 21. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. r Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. F Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. r Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. F Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. i Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in. subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. F Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. F Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. r Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. F Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee - sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. F Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer -sponsored health care benefits, and the types of jobs retained (using EDA classifications) 1-' Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 22. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) r Persons F Households ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". _ ---- Disabled Women/Female Headed Households Seniors J Youth Homeless N/Al Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) TOTAL 24. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ('AMI") information is available online at www.dublin.ca.gov/9956/Application-Requirements-Process _ Low Income (5011%-80% AMI) f Extremely Low Income (<30% AMI) N/Ai Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) .-....-....--..-....--.----... - -- 0,001 TOTAL 25. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" White White + HISPANIC Black/African American .- - Black/African American + HISPANIC Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander+ HISPANIC American Indian/ Alaskan Native and White 'American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC 1 Multi Racial + HISPANIC OR other Multi Racial - - N/Al Not Applicable. 1 am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 26. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY r- #1 - This program/project has the agency's highest priority for funding. #2 - This program/project has the agency's 2nd highest priority for funding. r #3 - This program/project has the agency's 3rd highest priority for funding. r #4 - This program/project has the agency's 4th highest priority for funding. F #5 - This program/project has the agency's 5th highest priority for funding. F #6 - This program/project has the agency's 6th highest priority for funding. r- If you have more than 6 applications per organization, agency, district or entity, check here. Funding Sources/Revenues - Budget Amount Amount Committed City of Dublin $ 7,497.00 $ 0.00 City of Livermore $ 9,495.00 $ 0.00 City of Pleasanton $ 9,995.00 $ 0.00 United Way of the Bay Area $ 16,500.00 $ 0.00 Alameda County -Oakland Community Action Partnership _ $ 20,000.00 $ 0.00 Wells Fargo $ 5,000.00 $ 0.00 Total $ 68,487.00 Funding Uses/Expenses Salaries Benefits Supplies Printing Rent/Utitlities Marketing Development Marketing Placement Travel - Total Budget Amount Amount Committed $ 28,373.00 -$ 0.00 $ 17,924.00 $ 0.00 $ 325.00 $ 0.00 $ 1,750.00 $ 0.00 $ 11,975.00 $ 0.00 $ 2,500.00 $ 0.00 $ 4,700.00 $ 0.00 $ 940.00 $ 0.00 $ 68,487.00 $ 0.00 Budget Narrative The VITA program is not the core business of the Community College District or TVCC. Thus the it must be fully funded through grants. As the only service of its kind (focused on the working poor) available to a large geographical area east of the Oakland Hills, and one of the only a few VITA programs expanding yearly in the Bay Area, we are fortunate to receive grants from United Way and the Alameda County -Oakland Community Action Partnership (AC-OCAP), as well as a small grant from the Wells Fargo Foundation. The Dublin funds are calculated to cover the percentage of taxpayers served who are Dublin residents, or 11 % of the total budget for 2020-2021. The VITA program relies heavily on volunteers and the Career Center staff to accomplish its goals. The "hard" costs include staff wages, benefits, and operational costs including rent, marketing, printing, and supplies. Of these hard costs: staff salaries = 41.4%; benefits = 26.2%; and operating expenses = 32.4%. The value of donated volunteer time, with which we could not carry out our VITA services, nearly matches the hard costs at more than $66,750. Documents t Documents Requested * Required? Attached Documents * Program Expense Budget for ALL Grant Requests ✓ CLPCCD-TVCC Program Expenses download template - - -- Financial Information Form for ALL Grant Requests ✓ CLPCCD-TVCC VITA Financial Information download template _ — -- List of Board of Directors (or governing body) with ✓ CLPCCD Board of Trustees agency contact information Current Annual Budget for the Entire Agency ✓ CLPPCD Budget Copy of most recently submitted IRS 990 form or Tax ✓ CLPCCD No Tax Return Return (include complete form) Board of Director's (or governing body's) designation ✓ CLPCCD Board Authorization of authorized official - Board of Director's (or governing body's) authorization ✓ CLPCCD Board Authorization to request funding (may be same document as one above) Proof of insurance carried, including bonding, liability ✓ CLPCCD Insurance Certificate and/or workers' compensation STATE AND FEDERAL NON-PROFIT ✓ CLPCCD IRS Nonprofit status letter DETERMINATION LETTER. All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of application. Non -compliant applicants will be disqualified. Certified Audit and/or Certified Financial Statements ✓ CLPCCD Most Recent Audit REQUIRED FOR CDBG ONLY - If requesting Capital Funding, please upload your Capital expenditure budget (your own format is acceptable) - REQUIRED FOR CDBG ONLY - Personnel Policies Including Affirmative Action Plan and Grievance Procedure REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws REQUIRED FOR CDBG ONLY - Conflict of Interest - Statement (if not included in Bylaws) REQUIRED FOR CDBG ONLY- AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP). Must include outreach to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used. REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) * ZoomGrantsT"^ is not responsible for the content of uploaded documents. Application ID: 156537 Become a fan of ZoomGrants- on Facebook Problems? Contact us al Questions@o oomGrants.com ©2002-2020 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. LoaoutI Browser Email This Preview Save as P®P Print Goss Window AA V City of Dublin 2020- 021 Human Services.Grant Program 1/13/2020 deadline CrisisCityServe of the Tri-Valley Dublin Prevention Jump to: i�rganization Information Questions Budget Documents $ 23,000.00 Requested Submitted: 1/13/2020 10:27:18 PM (Pacific) Project Contact Christine Beitsch data .cit servetrivalley.or Tel: 510-789-5443 Additional Contacts none entered 1. Business License Number BL-109916 CityServe of the Tri-Valley P.O. Box 1613 Pleasanton, CA 94566 United States CEO Christine Beitsch christine cx.cityservetrivalley.orq 1. Select the category that best describes your organization: (Select only one.) Non -Profit r Public Agency Other: Tel e phone925-223-6947 Fax Web . www.cityservetrivalley.org 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). CityServe exists to care for those in need: through direct service, coordinating resources with churches, fellow non -profits, businesses, schools, & government, & by connecting volunteers to human service needs to further mobilize mercy in our community. 3. Select the category that best describes the project: (Select only one.) r- Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. se ✓ No 5. Is this request for one-time, seed or operational funding? r- One-time funding Seed funding IF One-time and Seed funding ✓ Operational funding None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. CityServe is committed to Alameda County's Continuum of Care's goal to significantly reduce homelessness in our community by 2023. In the last two Point in Time counts, the data was clear: for every 2 people entering homelessness, only 1 person exits. In CA districts like the Tri-Valley, it is estimated that 6 out of 10 households are living paycheck to paycheck & that 53% of all families have no emergency fund to fall back on in the case of job loss or unexpected fiscal crisis. This makes these families susceptible to homelessness & ongoing instability, particular those living on fixed incomes such as seniors, veterans, & those with disabilities or other barriers to employment such as ESL residents or those without immigration paperwork. This means that the most cost-effective way to end homelessness is to prevent it in the first place. And preventing homelessness involves a multifaceted approach of providing safety -net emergency fiscal resources, individualized resourcing to connect those in need to existing infrastructures of support, & mobilizing the wider community, including churches, the business community, & individuals to provide volunteer assistance & support to those in crisis. In addition, the work of prevention requires a high level of coordination between service providers & communities that want to care for the residents of Dublin. These are the gaps that CityServe's Crisis Resource & Homelessness Prevention Program strives to fill & find solutions for. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 160 Dublin Residents — combined from receiving safety net fiscal assistance, individualized resourcing (aka case management), and workshops focused on education and skills training for stabilization 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov11956/Application-Requirements-Process ✓ Behavioral Health (mental health and substance abuse) ✓ Affordable Housing Health Care (including dental) ✓ Workforce Development ✓ Homelessness Transportation Services and Access Domestic Violence and Child Abuse ✓ Disabilities Food and Nutrition ✓ Senior Services Youth Services FChild Care, Early Childhood Development and Education Changing Demographics and Growing Diversity ✓ Financial Assistance None of the Above F Please explain: 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) The requested funding of $23,000 will go to three aspects of our Dublin -specific Prevention and Resource Program, including paying for a part-time Dublin -dedicated Resource Specialist (formerly known as Crisis Intervention Specialist/Case Managers) who wm De avaiiaDie Tor uuoun residents who need individualized action planning, resourcing, and help navigating existing support systems such as federal and state benefits. The average household caseload for a Full -Time Resource specialist is 20 at a time (with an average case turn -over of 4-6, times a year), which means that at .2 FTE, this Resource Specialist will be able to, conservatively, provide 20 households with highly individualized care, which amounts of an averaged total of 65 Dublin Residents served through $10,920, or $168 per resident served per year. This is an extremely cost-effective approach to case management as the distribution of impact in prevention and stabilization through individualized resource is far more efficient than intervention modalities which have been shown to have significantly lower beneficial outcomes for the population. In addition to this individualized care, nearly $12,000 from this grant application will go towards direct service safety -net fiscal. assistance (formerly known as Community Care funds) that specifically will serve to stabilize and keep Dublin residents housed. While rental assistance and eviction prevention is a critical piece of this (and often requires far more funding than a single grant or service provider can assist with), safety -net fiscal assistance also takes the form of utility payments to prevent lapses that can be grounds for eviction, gas cards and car registration payments (and back -payments) to allow individuals to access employment and services, transportation costs for those without vehicles, clothing and other necessary supplies for families and individuals for work or education, and other critical expenditures that help stabilize our participants and their families so they can continue working towards self-sufficiency. While there will be (based on historical program data) more requests for fiscal assistance and eviction prevention than this $12,000 can address in Dublin, we will also be pairing this safety -net funding with in -kind donations, leveraged donations from our supporting churches and individuals, and also utilizing our Regional HEAP direct -service dollars until they expire in Feb 2021. Lastly, a new aspect of our Prevention Program is our CityServe Workshops, designed to address some of the specific education and life skills gaps we see in the participant population we encounter. Workshops will be offered on a regular schedule with an understanding of the working adult's time constraints and targeted to be offered in both English and Spanish. Topics will range from on how to look for affordable housing (utilizing pre-existing tools such as the Tri-Valley Affordable Housing Guide, and housing search websites), fiscal literacy skills (basic budgeting, etc), resume and job search workshops (in partnership with Tri-Valley Career Center), and more. We are asking for a budget of $600 to help cover the material costs and resources for these workshops. While this request will also not cover our costs for these workshops, we are leveraging our collaborative partnerships to bring quality and customized content without incurring additional costs. Workshops will be held at partner facilities in the Tri-Valley and will be facilitated by topical industry experts who are generously donating their time and knowledge for the benefit of stabilization. We are requested nominal funding for these workshops from all three cities as we aim to create the most cost-effective and wide -reaching impact we can through these education opportunities. 10. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low -come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and . outreach strategies and efforts. CityServe has a robust client database framework that allows us to enroll participants in our programs, capture all critical demographic information (such as disability status, race/ethnicity, age, veteran status, self -reported income & income verification, and language translation needs), track progress towards the established action plan goal (a plan that is crafted between Resource Specialist and the participant), track all applicable expenses and time spent with participants, and finally track the measurable outcomes that CityServe and the participant have worked together to facilitate. Due to the diversity of needs, crises, and participants we work with, we have an equally diverse set of measurable outcomes that we aim for. For Prevention Program participants, these outcomes include eviction prevention, safety net fiscal assistance (utility bills), increased fiscal literacy, establishing sustainable transportation to and from work/school (in the form of auto repair, or license/registration fees), supporting the. participant's increase of legal income through better employment, enrollment in school or job training program, and accessing higher levels of services (such as critical mental health care or medical care). Our ultimate marker of success for all CityServe participants is demonstrated sustainable self-sufficiency. We serve all individuals that we can, who fall within the scope of our programs (low-income and residents of the Tri-Valley), and who are willing to comply with our need for documentation such as proof of identity, proof of need, etc. Our Resource Specialists are able to work with participants to attain documentation that is required but that they do not yet have. Additionally, in regard to accessibility, CityServe staff are available to go to individuals in need to capture our information and create action plans with them, or clients can call in to our offices for assistance. We are working on increasing our staff and volunteer pool of those who are bilingual (currently have 2 Spanish speaking team -members and are onboarding an additional), as well as widening our network with local churches and community groups that can translate on our behalf. CityServe markets primarily via our website and email/social media presence, our physical presence at local outreach events such as the Vineyard/Hope Van, Asbury Showers Program, Safe Parking Programs, and more, and also through our network of supportive churches and community groups and word-of-mouth from previous participants. We are a direct referral agency from 211 and we are a part of the Alameda County Continuum of Care which allows higher level of interagency collaboration for increased social impact. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE. Please contact City staff immediately if you have any questions regarding Davis -Bacon requirements. Not Applicable r Yes 12. ** QUESTIONS 13 THROUGH 25 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? F Yes. If so, check box here and answer questions 29 through 41. ✓ No. If no, check box here and enter F Don't know. If you are unsure, please call .City staff at (925) 833-6645. 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 14. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency F Encourage networking and information sharing across service providers F Encourage process streamlining F Consolidate service delivery ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: F_ A) Support.and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: F *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. F *Preserve and increase affordable rental housing opportunities for low and moderate income households. F *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. l B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under -insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. r * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. F C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. F D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. ✓ F) Not Applicable. I am not interested in qualifying for CDBG funding. 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing F Strengthen communities r Ensure equal opportunity in housing Promote participation of grass -roots, faith -based, and other community -based organizations ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 17. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: F Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. F Improving the quality of life for our Nation's communities F Participation of minority -serving institutions in HUD programs. r End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 18. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. r Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter -jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service -enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 19. CDBG ONLY - Select one HUD Objective that relates to your project: (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that 1 am seeking to address?') Creating a Suitable Living Environment Providing Decent Affordable Housing r Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 20. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am 1 seeking?') r Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 21, CDBG ONLY - Select one HUD Specific Indicator that relates to your project: F Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. 'Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. F Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. F Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. r Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. I Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. F Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. F Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. C- Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. F Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee - sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer -sponsored health care benefits, and the types of jobs retained (using EDA classifications) F Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 22. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) r- Persons F Households ✓ Not Applicable. ['am not interested in qualifying for CDBG funding. 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". —_ Disabled Women/Female Headed Households ---...... . .... ..._._ -- ------ -- Seniors Youth Homeless N/Al Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0,001 TOTAL 24. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ('AMI') information is available online at www.dublin.ca.gov11956/Application-Requirements-Process _ Low Income (50%-80% AMI) Extremely Low Income (<30% AMI) _ -- _N/A( Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) t) 00 TOTAL 25. CDBG ONLY - List the number of clients your agency anticipates serving in racelethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. if none, please enter "0" White White + HISPANIC i Black/African American j Black/African American + HISPANIC j Asian - j Asian + HISPANIC I American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC — Native Hawaiian/Other Pacific Islander —--------- Native Hawaiian/Other Pacific Islander + HISPANIC ? !American Indian/ Alaskan Native and White j American Indian/ Alaskan Native and White + HISPANIC Asian and White ( Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC - ( American Indian/Alaskan Native and Black/African American [ American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial ( N/Aj Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) --�OWITOTAL 26. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the agency's highest priority for funding. r- #2 - This program/project has the agency's 2nd highest priority for funding. #3 -This program/project has the agency's 3rd highest priority for funding. r- #4 - This program/project has the agency's 4th highest priority for funding. #5 - This program/project has the agency's 5th highest priority for funding. #6 - This program/project has the agency's 6th highest priority for funding. i If you have more than 6 applications per organization, agency, district or entity, check here. Fundinq Sources/Revenues Budqet Amount Amount Committed HEAP Crisis Intervention Regional Funding for Dublin $ 29,500.00 $ 29,500.00 In -Kind Donations/Facilities $ 2,000.00 $ 2,000.00 Leveraged Church/Individual Contributions $ 4,800.00 $ 4,800.00 City of Dublin HHSG 2020-2021 Grant $ 23,000.00 Total $ 59,300.00 $ 36,300.00 Funding Uses/Expenses Budget Amount Amount Committed Dublin -Specific Resource Specialist + Payroll Taxes & Health/Vision/Dental $ 10,920.00 Insurance Safety -Net Fiscal Assistance for Dublin Residents $ 11,480.00 Dublin Portion of CityServe Workshop Operating Cost $ 600.00 Resource Specialist Salary+ Benefits (funded by HEAP) $ 20,800.00 $ 20,800.00 HEAP Regional Safety Net Funding for Dublin $ 8,700.00 $ 8,700.00 Church/Individual Community Care $ 4,800.00 $ 4,800.00 In -Kind Donations (Facilities) $ 2,000.00 $ 2,000.00 Budget Narrative The $23,000 funding we are requesting will all be focused on homelessness prevention and crisis intervention (in order to maintain household stability) for extremely low, very low, and low income families in Dublin. It will go towards three critical aspects of prevention/stabilization -- individualized care and resourcing in the form of a Part -Time, Resource Specialist (formerly referred to as Case Manager/Crisis Stabilization Specialist) who will be dedicated to serving Dublin residents 7 hours a week, as well as Safety -Net Fiscal Assistance (formerly referred to as Community Care funding), and nominal operational funding for regional workshops focused on equipping Dublin residents with critical education and life skills to work towards their stability. As in the last funding cycle, we will also be providing homeless services in Dublin in this grant cycle, however, funding for both the Direct Expenditures for Homeless Client Needs and the Wages/Salaries for our Homeless Intervention Specialists working is provided by Alameda County HEAP funding. In our continually expanding role of providing critical safety net services for the three Alameda County Tri-Valley cities, we are in need of this funding in order to provide responsive, effective services to Dublin residents in crisis need. Our overall organization budget is designed to reduce homelessness, prevent homelessness, and increase housing security and household stability in Dublin and the Tri-Valley through our services. This project highlights our services for Dublin residents. Documents to Documents Requested * Required? Attached Documents Program Expense Budget for ALL Grant Requests ✓ Program Expense Budget download template Financial Information Form for ALL Grant Requests download template List of Board of Directors (or governing body) with agency contact information Current Annual Budget for the Entire Agency Copy of most recently submitted IRS 990 form or Tax Return (include complete form) Board of Director's (or governing body's) designation of authorized official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) Proof of insurance carried, including bonding, liability and/or workers' compensation STATE AND FEDERAL NON-PROFIT ✓ DETERMINATION LETTER. All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of application. Non -compliant applicants will be disqualified. Certified Audit and/or Certified Financial Statements REQUIRED FOR CDBG ONLY - If requesting Capital Funding, please upload your Capital expenditure budget (your own format is acceptable) REQUIRED FOR CDBG ONLY - Personnel Policies Including Affirmative Action Plan and Grievance Procedure REQUIRED FOR CDBG ONLY - Agency Audit ✓ Financial Information Form ✓ List of Board of Directors ✓ 2019 Budget ✓ 2018 IRS 990 ✓ Authorized Official Letter ✓ Authorized Funding Letter ✓ Proof of Insurance ✓ CityServe 2018 Profit & Loss CityServe 12.31.2018 Balance Sheet Letter of Intent Kequirements ana uopy of Last Auarc hignugnting "Findings" Section REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) REQUIRED FOR CDBG ONLY - AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP). Must include outreach to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used. REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) * ZoomGrantsTM is not responsible for the content of uploaded documents Application ID: 156002 Become a fan of ZoomGrants*" on Facebook Problems? Contact us at luesl nS(%ZOOmGrants ,corn ©2002-2020 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout ( Browser, City of Dublin 2020-2021 Human Services Grant Program 1/13/2020 deadline Jump to: Organization information Questions Budget Documents $14,779.0_Requested Submitted: 1/13/2020 11:47:04 AM Pacific Project Contact Michael Galvan Programs@crilhay ward.org aywarcl.org Tel: 510 881 5743 x31 Additional Contacts none entered Lndependent Living- 439 A Street Hayward, CA 94541 United States Interim Executive Director Michael Galvan Michael.GaivLan@crilliayw,grd.org 1. Select the category that best describes your organization: (Select only one.) %/ Non -Profit Public Agency Other: Telephone(510) 881-5743 Fax (510) 881-1593 Web www.crilhavward.orq 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). CRIL is a peer -based disability resource agency that provides advocacy, services and resources for people with disabilities to improve lives and make communities fully accessible. 3. Select the category that best describes the project: (Select only one.) E �, Capital Project ✓ Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes ✓ No 5. Is this request for one-time, seed or operational funding? One-time funding Seed funding One-time and Seed funding ✓ Operational funding -- None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. CRIL's Independent Living Services for Persons with Disabilities will provide low-income Dublin residents who have a disability with peer counseling, independent living skills & self -advocacy training, personal assistant/homecare worker referrals, benefits advocacy; travel training, housing search assistance and emergency preparation planning. The primary goals of the program are to: 1) Enhance the self -efficiency of low income Dublin residents with disabilities, including youth and seniors with functional limitations; 2) Increase the availability of resources to Dublin's most vulnerable residents; and 3) Improve the integration of existing social services in Dublin. 4) Assist people with disabilities who use life-saving to obtain alternative sources energy during Public Safety Power Shut -offs (PSPS). CRIL will directly serve 30 low-income Dublin residents, In addition, CRIL will indirectly serve 75 more individuals and businesses through disability education, technical assistance and information & referral. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 30 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/I956/Application- Requirements-Process Behavioral Health (mental health and substance abuse) Affordable Housing *r | � Health Care (including dental) [� Workforce Development wy Homelessness Transportation Services and Access L1 Domestic Violence and Child Abuse my Disabilities wy Food and Nutrition ~� Senior Services w' Youth Services [� Child [are. Early Childhood Development and Education [� Changing Demographics and Growing Diversity my Financial Assistance [] None ofthe Above wy Pleaseexplain: 10096 nf[R|Lconsumers have disabilities '30% are homeless ond4O% are seniors. Services most needed: Housing &Travel Training. 9. Describe in detail how Dublin grant funds will be used for this project. Umthismarrative,mWease include what measures are taken to ensure this project is cost effective, and how the budget meets the needs mfthe anticipated results. If capital funding hsbeing requested, this narrative should include detailed project scope and project timeline. (What specifically will the grant funds beused /or7 CRIL is requesting $14,779 in Dublin funding for FY 2020-21, which will allow us to increase Independent Living (IL), Housing Search Services, Youth Services, Travel Training, as well as, job Readiness support in the Tri4/a||eyarea. CRiL projects to serve30 }nvv income Dublin seniors and residents with disabilities (a 380% increase inconsumers since 2011),aswell asprovide |&Rto7Sother residents. [R|Lvvi||actively recruit youth to forma Disability Action Network for Youth (eroup advocacy) and to offer a Community Leadership Academy: Leaders Without Leaders which develops leadership skills and encourages participants to join community and government committees and commissions. FY2U2D-21 continues to see an increase in the number ofDublin consumers served. Funds will primarily cover 91.14% of the salary and benefits of the IL Coordinator with a small amount for shared indirect costs associated with necessary program admin and office operations (e.g., admin, telephone, supplies, insurance, Y0\Please list and briefly describe the outcome measures that are crucial tothe success mfthis project. What strat'enor objectives will your agency use tmtrack the progress mfmeeting the outcomme(a)?This should include the population your agency anticipates serving, how this project is culturally appropriate, and how Uow-cmmmm'ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. [R|L's Housing, Employment & }LServices for people with disabilities will provide 30 Dublin residents with improved access to affordable housing, peer counseling, employment & benefits counseling, travel training, I & R, assistive technology info & AT device loans & advocacy. Housing Search Counseling will include local resource info, application assistance, budgeting Q'credit counseling, landlord mediation and/or applications to Season ofSharing and Dept. ofRehabilitation's housing transition fund. [R/Lwill also provide indirect information 8' referral, technical &'assistivetechnology support, ADA & disability law education and community advocacy to 75 additional Dublin residents & businesses to increase their knowledge & independence. CRIL utilizes a national online database management system called CILSuite, which is specifically designed to track data and services for independent living centers. Data can be entered securely from any computer with internet access and CRIL management is able to monitor the timeliness and completeness of every consumer's service record. The structure of the online Intake form and data logs allows for uniformity and consistency in all consumer service records. CILSuite allows CRIL staff and management to regularly track and monitor each consumer's status with completing steps to achieve their personalized goals, as well as progress toward achieving the defined program outcomes: retention or placement in affordable, accessible housing & an increase in personal independence & self-sufficiency. Consumers complete an annual Satisfaction Survey which allows.us to evaluate the type & quality of services provided. Consumers provide management & the board of directors with feedback on the impact that our services & supports have had on their level of independence. 11. If your agency is requesting Capital funding, will this project require implementation of Davis- Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately ifyou have any questions regarding Davis -Bacon requirements. ✓ Not Applicable Yes No 12. ** QUESTIONS 13 THROUGH 25 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, check box here and answer questions 29 through 41. ✓ No. If no, check box here and enter Don't know. If you are unsure, please call City staff at (925) 833-6645. 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail Please enter "NIA "ifyou are not interested in qualifying for CDBG funding. CRIL offers it services in English, Spanish, Farsi and Dari. CRIL materials are available in English, Spanish, Chinese, Braille, in enlarged format, on CD, and electronically which is accessible. CRIL utilizes the County's Language Line for other language translations. CRIL's website (www.crilhayward.org) has a button which provides basic translation into many different languages. CRIL's website also can adjust size of text and brightness of page. 14. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: ✓ Be culturally accessible, appropriate and inclusive ✓ Encourage community engagement and involvement - Promote energy and resource efficiency ✓ Encourage networking and information sharing across service providers Encourage process streamlining ✓ Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: ✓, *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. e/ *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under - insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. F) Not Applicable. I am not interested in qualifying for CDBG funding. 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: -! Increase homeownership ./ Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass -roots, faith -based, and other community -based organizations Not Applicable. I am not interested in qualifying for CDBG funding. Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. J Participation of minority -serving institutions in HUD programs. J End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 18. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: J Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. ✓ Reduce housing discrimination. ✓ Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. ✓ Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter -jurisdictional cooperation to achieve housing and homeless needs. ✓ Increase the availability of service -enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 19. CDBG ONLY - Select one HUD Objective that relates to your project: (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that l am seeking to address?') Creating a Suitable Living Environment ✓ Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 20. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP. When selecting an outcome ask yourself, "What type of change or result am l seeking?') ✓ Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 21. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. ✓ Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. --' Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee -sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer -sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 22. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 301 Disabled 31 Women/Female Headed Households 121 Seniors i 51 Youth 5� Homeless N/Al, Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) ( 55.00E TOTAL 24. CDBG ONLY- Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ('AMP) information is available online at wwwdublin.ca.govll956/Application- Requirements-Process 25 Low Income (50%-80% AMI) 5; Extremely Low Income (<30% AMI) N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) E 30.001 TOTAL 25. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. if none, please enter "0" 121 White 5j White + HISPANIC 2 Black/African American j 01 Black/African American + HISPANIC 2 Asian + HISPANIC 0 American Indian/Alaskan Native j 11 American Indian/Alaskan Native + HISPANIC 21 Native Hawaiian/Other Pacific Islander 01 Native Hawaiian/Other Pacific Islander+ HISPANIC 01, American Indian/Alaskan Native and White ....... _ 01 American Indian/Alaskan Native and White + HISPANIC 01 Asian and White 0 Asian and White +HISPANIC -- -_ 01 Black/African American and White Black/African American and White + HISPANIC 0 American Indian/Alaskan Native and Black/African American -- 01 American Indian/Alaskan Native and Black/African American + HISPANIC 1 Multi Racial + HISPANIC OR other Multi Racial N//� Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 30.001 TOTAL 26. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the agency's highest priority for funding. #2 - This program/project has the agency's 2nd highest priority for funding. #3 - This program/project has the agency's 3rd highest priority for funding. #4 - This program/project has the agency's 4th highest priority for funding. #5 - This program/project has the agency's 5th highest priority for funding. #6 - This program/project has the agency's 6th highest priority for funding. If you have more than 6 applications per organization, agency, district or entity, check here. Funding S M@s/ v .n City of Dublin -City Funds City of Livermore -Federal City of Pleasanton .Federal Metropolitan Transportation Commision-Federal Department of Rehabilitataion-General Fund Total Budget Amount Amount Committed $ 14,779.00 $ 11,818.00 $_191501L00 $ 61,068.00 _$_61,070.00 13,298.00 13,299.00 _12,64.0 $741369.00 Funding Uses/Expenses Budget Amount Amount Committed ILC-Tri-Valley Coordinator-44.73% 53,888.00 ILC-Mobility Travel Trainer-37.27% $44,899.00 Executive Director-.81% g 979.00 Finance Director., 84%, 1,01000 _ - Supplies $928.00 565.00 Printing/Copying $399.00 361.00 Postage $276.00 _$__168.00 Telephone $..2,760 00 $ 2,1.52.00, Rent and Utilities $_221.00 134.00 Accounting and Audit $520.00 $ 318.00 Contracted „.Services $, 3,197.00 $„.„1,,95,0.,00 Books Dues and Publications _ $ 778.00 474.00 Insurance $�4,059.00 $ 3,728.00 Travel $._5,300.00 $ 5,300 00, Staff„Development $ 1,,250.00 $ 1-,250,.00, Total 12,464.00 16,400.00 Budget Narrative The_overall_operational_budget.for CRIL's_full service. Tri-Valley,bra.nch office _is_$120,464 which _covers 2.0FTE for _direct se_rv, ce,_provi,sion_- ILC-„Tri,Valley.Coordi,nator and ILC Mobility, Travel Trainer- Tri Valley. A small percentage is allocated to the Executive Director and Finance Director. Additional program expenses include essential, non -personnel, direct costs such as supplies,_printing,, telephone, occupancy,, insurance and outside contractors (computers and server) that are allocated to this_project,based. on a -federally approved Cost_ Allocation Plan. The City of Dublin's portion of $14,779 would cover 12.27% of the total project budget. The City of Dublin represents rougbly 1.33% of the proposed overall aggmy_budget for 2020-2021. Documents top Documents Requested * Program Expense Budget for ALL Grant Requests download ternpiate Financial Information Form for ALL Grant Requests download template List of Board of Directors or governing body) with agency contact information Current Annual Budget for the Entire Agency Required?Attached Documents Program Expense Budget Financeial Information Form List of Board of Directors Current Annual Budget for the Entire Agency_ Copy of most recently submitted IRS 990 form IRS 990 form or Tax Return (include_ complete form) Board, of.Dire.c or's.(or governing„body). v/ designation of authorized official Board of Director's (or governing body's), authorization to request funding -(may be same document as one above) Proof_ of, insurance carried, including bonding,, liability and/or workers' compensation STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. All organizations MUST have non„ -profit status from the State of California and Federal Tax Identification Number at time of application. Noncompliant applicants will be_ disqualified. Certified Audit and/or Certified Financial Statements REQUIRED FOR CDBG ONLY - If requesting Capital Funding, -please upload your Capital expenditure,budget,,,.(y_our..,,own_fo.rmatis acceptab,,le), REQUIRED FOR CDBG ONLY - Personnel Policies_ Including Affirmative Action Plan and Grievance Procedure REQUIRED FOR CDBG ONLY -Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws REQUIRED FOR CDBG_ONLY Conflict of Interest _Statement (if,not..,,i,ncluded„_in_Bylaws) IRS 990 form 2nd half Beard of Director's (or governing._tQjy's) designation of authorized official Board of Director's (or governing body's) authorization to request funding - General Liability. Workers Compensation IRS Letter • REQUIRED FOR CDBG ONLY - AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN_(LEP/LAP), Must include outreach to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used REQUIRED FOR CDBG ONLY_- LEVERAGING REPORT- this is due with the 2nd quarter report no later than.January, 15th Supporting Documents such as Agency Strategicment, etc Plan, Needs Assess. (Not Required) Other Supporting Documents( Required) * ZoomGrantsl is not responsible for the content of uploaded documents. Application,_I_D,.__1. 55919 Become a fan of ZoomGrants'"' on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2020 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout I Browser Email This Previews Save as PDr Print Goss Wind6wr AA V City of Dublin 2020-2021 Human Services Grant Program 1/13/2020 deadline Easterseals Bay Area I Jump to: Organization Information Questions Budget Documents 25,000.00 Requested Submitted: 1/13/2020 11:40:14 PM (Pacific) Project Contact Jennifer Kozicki iennifer.kozicki(@esba.org Tel: 510-414-1948 Additional Contacts none entered 1. Business License Number B L-005301 e Easterseals Bay Area 5601 Arnold Road Suite 104 Dublin, CA 94568 CEO Jim Kelleher connect(cD,esnorcal.org 1. Select the category that best describes your organization: (Select only one.) Non -Profit F Public Agency Other: Telephone510-414-1948 Fax 925-951-1307 Web www.esnorcal.org 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Our mission is to lead the way to ensure that individuals and families affected by disabilities and special needs can live, learn, work, and play to their full potential. 3. Select the category that best describes the project: (Select only one.) FCapital Project V Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. F Yes ✓ No 5. Is this request for one-time, seed or operational funding? r One-time funding Seed funding F One-time and Seed funding ✓ Operational funding F None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Kaleidoscope is a Community Adult Program based in Dublin, California that offers specific programming for adults with a developmental disability. This program helps adults integrate into the community and includes employment readiness and development, independent living skills, community inclusion, socialization, and many other beneficial activities. Participants work with Life Skills Coaches who help them pursue interests by helping them define their goals and become as independent as possible. Interest -based programming offered at Kaleidoscope includes: Community Access Recreation & Leisure Physical Fitness Pre -Employment Volunteering Life Skills & Employment Planning. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 27 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov11956IApplication-Requirements-Process Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) ✓ Workforce Development F Homelessness F Transportation Services and Access Domestic Violence and Child Abuse ✓ Disabilities F Food and Nutrition F Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance F None of the Above Please explain: 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) Grant funding from the City of Dublin would exclusively support the staffing expense for program staff. As the need for the Kaleidoscope program increases in the community, the need to hire the required number of Life Skills Coaches to successfully implement programmatic activities increases. Life Skills Coaches are community members with a desire to gain experience working with adults with diagnoses of Autism Spectrum Disorder, Down Syndrome or other disabilities. Kaleidoscope's design as a programmatic component of Easterseals allows cost-effective, comprehensive services for adults with disabilities without sacrificing quality. A cost -share model is used to offset daily expenses and share resources with other Easterseals programs. The program has been successful in meeting a need within the community and is challenged to meet the demand for increased participants. 10. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low -come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. Successful outcomes include the ability for participants to develop the skills necessary increase their integration within the community, satisfaction of participant families/caregivers, and the ability to reach capability of 1:3 supervision with coaches. Kaleidoscope works directly with the disabled population. As a vendor of the Regional Center of the East Bay, the program receives referrals for families who are low-income or limited English speakers whose children or wards are members of the developmentally disabled population. Kaleidoscope is committed to serving low-income families, limited English speaking families, single -parent households, as well as families with a disabled head of household. Kaleidoscope staff and participants and their accomplishments are regularly featured on all social media platforms, in direct mail marketing pieces, a quarterly newsletter, annual report, and via printed materials distributed throughout the Bay Area. An annual fundraising letter campaign is also coordinated to spread awareness of the program and its success. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE. Please contact City staff immediately if you have any questions regarding Davis -Bacon requirements. Not Applicable Yes No 12. ** QUESTIONS 13 THROUGH 25 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, check box here and answer questions 29 through 41. No. If no, check box here and enter Don't know. If you are unsure, please call City staff at (925) 833-6645. 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 14. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive l Encourage community engagement and involvement F Promote energy and resource efficiency F Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. F *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under -insured residents with emphasis on activities that: F * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. F * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. F D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. ✓ F) Not Applicable. I am not interested in qualifying for CDBG funding. 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: F Increase homeownership r Promote decent affordable housing F Strengthen communities F Ensure equal opportunity in housing F_ Promote participation of grass -roots, faith -based, and other community -based organizations ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 17. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: F Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. F Improving the quality of life for our Nation's communities r Encouraging accessible design features. Participation of minority -serving institutions in HUD programs. End chronic homelessness within ten years. F Removal of barriers to affordable housing. ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 18. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. i= Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). F Assist low and moderate income first-time homebuyers. F Reduce housing discrimination. F Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. F Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter -jurisdictional cooperation to achieve housing and homeless needs. r Increase the availability of service -enriched housing for persons with special needs. ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 19. CDBG ONLY - Select one HUD Objective that relates to your project: (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?') r- Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 20. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am l seeking?') F Availability/Accessibility F Affordability F Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 21. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: F Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this.indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. F Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. F Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. F Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. F Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. F Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. r Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee - sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer -sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 22. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, enter "0". Disabled Women/Female Headed Households Seniors Youth - — Homeless —N/Al Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) _ .001 TOTAL 24. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ('AMI') information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process Low Income (50%-80% AMI Extremely Low Income (<30% AMI) N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0 661 TOTAL 25. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" _ _White _— White + HISPANIC Black/African American Black/African American + HISPANIC Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC C American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC �- Asian and White _ Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American _ American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) a.oc) TOTAL 26. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY ✓ #1 - This program/project has the agency's highest priority for funding. 42 - This program/project has the agency's 2nd highest priority for funding. r #3 - This program/project has the agency's 3rd highest priority for funding. 1— #4 - This program/project has the agency's 4th highest priority for funding. 1 #5 - This program/project has the agency's 5th highest priority for funding. r- #6 - This program/project has the agency's 6th highest priority for funding. F_ If you have more than 6 applications per organization, agency, district or entity, check here. Funding Sources/Revenues Budget Amount Amount Committed Regional Center of the East Bay $ 481,509.00 $ 0.00 Total $ 481,509.00 $ 0.0 Funding Uses/Expenses Budget Amount Amount Committed Staffing $ 540,408.00 $ 0.00 Program Activity Supplies and Other Costs $ 3,000.00 Total $ 543,408.00 $ 0.00 Budget Narrative Kaleidoscope receives priority for funding within the overall organization budget as it is evident the need exists for increasing the number of participants. Easterseals' has acted on a commitment to individuals living with a disability since 1919 and has helped countless families. We wish to be able to continue offering quality programs and services to the adult disabled community. Documents Requested * Required? Attached Documents Program Expense Budget for ALL Grant Requests V Program Expense Form download template Financial Information Form for ALL Grant Requests Financial Information Form download tem late List of Board of Directors (or governing body) with V Board List agency contact information Current Annual Budget for the Entire Agency V Financial Summary Copy of most recently submitted IRS 990 form or Tax V 2018 990 Return (include complete form) Board of Director's (or governing body's) designation V Authorization Letter of authorized official Board of Director's (or governing body's) authorization V Authorization Letter to request funding (may be same document as one above) Proof of insurance carried, including bonding, liability V Proof of Insurance and/or workers' compensation STATE AND FEDERAL NON-PROFIT V 501 c 3 letter DETERMINATION LETTER. All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of application. Non -compliant applicants will be disqualified. Certified Audit and/or Certified Financial Statements V Certified Financial Statement REQUIRED FOR CDBG ONLY - If requesting Capital Funding, please upload your Capital expenditure budget (your own format is acceptable) REQUIRED FOR CDBG ONLY - Personnel Policies Including Affirmative Action Plan and Grievance Procedure REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) REQUIRED FOR CDBG ONLY -AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP). Must include outreach to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used. REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) * ZoomGrantsTM is not responsible for the content of uploaded documents Application ID: 155736 Become a fan of ZoomGrantsT^' on Facebook Problems? Contact us at Questions ar?ZoomGrants.com ©2002-2020 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout I Browser Email This Preview Save as PDF Print Goss Window AA V City of Dublin 2020-2021 Human Services Grant Program 1/13/2020 deadline hivelly Hively Behavioral Jump to: Organization Information Questions Budget Documents $ 25,000.00 Requested Submitted: 1/13/2020 7:12:02 PM (Pacific) Project Contact Kelly O'Lague Dulka kellbehively.org Tel: (925) 417-8733 Additional Contacts none entered 1. Business License Number BL-109890 Hively 6601 Owens Dr. Ste 100 Pleasanton, CA 94588 United States CEO Kelly O'Lague Dulka kelly @Aehively.org 1. Select the category that best describes your organization: (Select only one.) Non -Profit Public Agency F Other: Telephone(925) 417-8733 Fax (925) 730-4942 Web www.behively.org 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). At Hively, we believe that everyone should have the resources & support they need to feel supported, cared for, and able to thrive. For over 40 years, Hively has provided children & families throughout Alameda County access to high -quality social services 3. Select the category that best describes the project: (Select only one.) Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. ✓ No 5. Is this request for one-time, seed or operational funding? F One-time funding Seed funding F One-time and Seed funding ✓ Operational funding F None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. There has been a lack of affordable mental health services in the Tri Valley for over a decade. Every day in our work with parents, child care providers, and community members, we see firsthand the desperate need for and lack of accessible mental health services. At a recent trauma informed care workshop presented by Hively CEO Kelly O'Lague Dulka, an attendee, Julie, described how her husband suffers from anxiety, bipolar disorder type I, and PTSD from childhood trauma. He sought therapy, but was turned away from over 50 therapists, who would not accept his insurance despite being "in network" or were not accepting new patients. Julie has also sought, without success, intervention services for her 6-year-old daughter Mathilda, who suffers from separation anxiety and has trouble adjusting to new situations. Julie was so happy to hear that Hively is offering mental health services in the Tri Valley, stating, "I am desperately trying to hold my family together while I work full time and my husband is out on disability for mental health issues.... Please, please help connect me and my family." In 2019, Hively acquired a nonprofit mental health agency in San Leandro and has launched mental health services in the Tri Valley. Hively seeks grant funding to support the salary and benefits of a full-time, licensed clinician at Hively's Pleasanton office, who serves the residents of Dublin, Livermore, and Pleasanton. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) We aim to serve 300 distinct Dublin residents, who may come for mental health services, but who can then access Hively's other resources, like free clothing & shoes at our Community Closet; child care subsidies & referrals; & parent education classes. 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov11956/Application-Requirements-Process ✓ Behavioral Health (mental health and substance abuse) Affordable Housing F Health Care (including dental) r- Workforce Development F Homelessness Transportation Services and Access ✓ Domestic Violence and Child Abuse Disabilities Food and Nutrition r Senior Services ✓ Youth Services F Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity F Financial Assistance F None of the Above ✓ Please explain: By expanding mental health services in the Tri-Valley, this project aligns with Dublin's values of safety & customer service. 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) Grant funds (along with grant funds requested from the Cities of Pleasanton and Livermore) will be used to pay the salary and benefits of a full-time licensed clinician to serve the Tri-Valley community. The clinician will provide diagnostic assessments, conduct initial mental health screenings, and provide therapeutic services for children, teens, and their families. The clinician will also be able to supervise up to six interns and associates, thus maximizing grant dollars by providing the equivalent of four staff people. Grant funds will provide critical operational funds as we grow this new service in the Tri Valley. This project is cost-effective because our goal is for the grant -funded clinician to eventually bill enough in direct service and through services provided by interns/associates to pay for his/her own salary. Supporting a licensed clinician to serve Tri-Valley residents will help meet the stated need in the 2011 Eastern Alameda County Human Services Needs Assessment for more mental health care services, as there are "simply not enough services available to meet the demand." 10. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low -come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. [revise?] Hively will use the CANS structured assessment strategy for identifying youth and family actionable needs and useful strengths. It provides a framework for developing and communicating about a shared vision and uses youth and family information to inform planning, support decisions, and monitor outcomes. It provides a common language for multi -disciplinary settings for consensus building. The guiding principles of CANS: 1. Items are included because they are relevant for planning and decision making. 2. Item ratings translate into action levels. 3. Focus is on youth's needs, not interventions or services that could mask a need. 4. Consider culture and development before establishing action levels. 5. It's about the 'what,' not the 'why.' Don't explain away needs with what you think might be an underlying cause. 6. Specific ratings window (30 days) can be over -ridden based on action levels. The populations we provide mental health services for are the people that our agency serves every day: families with young children, low-income, and non-English speakers. For many of the families we serve, significant mental health issues impact the parent's ability to get and retain employment. Whether it's the parent's own mental health issues or the child's, many of our families face challenges that inhibit their ability to gain self sufficiency. By providing affordable, accessible mental health services, families can begin to mitigate some of the issues that keep them in poverty. Affordable, accessible mental health services have been extremely limited in the Tri Valley, with long wait times and providers who do not accept MediCal or are not accepting new patients. Increasing availability of mental health services will have an immediate impact for families in acute situations. Hively routinely engages with the community to provide programs that are culturally appropriate and cost effective. We have a . very diverse staff with fluency in 14 languages and will offer translation services to clients who need it. We are inclusive and strive to employ staff who reflect the communities we serve and who are experienced in providing support and resources to the target populations. Strategies are in place to increase the scope and scale of target marketing efforts by identifying where these populations live, schools their children attend, and locations they utiilize to access resources. Customized digital and printed educational and community resources will be distributed to Hively's low-income program participants. Hively will also reach out using Constant Contact, SurveyMonkey, social media, contests, community events, and the agency website. Hively actively pursues partnerships with Tri-Valley service organizations, businesses, nonprofits, and individuals to effectively and efficiently streamline service integration strategies, and reduce program costs to reach more low-income and Spanish- speaking families. Hively has rich partnerships with the Tri-Valley Anti -Poverty Collaborative; Axis Community Health; WIC; Community Care Licensing; CityServe; CAPE Head Start; Kaiser; the Dublin, Pleasanton, and Livermore school districts; First 5 Alameda County; California Child Care Initiative Project; and Livermore Community Needs. Hively will continue to seek new community partnerships and to target health care providers, school district social workers, and other community organizations who serve low-income families, limited English speakers, and youth. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis -Bacon requirements. Not Applicable 19 Yes F No 12. ** QUESTIONS 13 THROUGH 25 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? F Yes. If so, check box here and answer questions 29 through 41. ✓ No. If no, check box here and enter F Don't know. If you are unsure, please call City staff at (925). 833-6645. 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 14. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: 17_ Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement IF Promote energy and resource efficiency F Encourage networking and information sharing across service providers F Encourage process streamlining F Consolidate service delivery ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: i *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. F *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. F B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under -insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. F * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. I ` D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. ✓ F) Not Applicable. I am not interested in qualifying for CDBG funding. 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: F Increase homeownership Promote decent affordable housing F Strengthen communities Ensure equal opportunity in housing F Promote participation of grass -roots, faith -based, and other community -based organizations ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 17. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: r Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. F Improving the quality of life for our Nation's communities r- Encouraging accessible design features. Participation of minority -serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 18. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: F Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). r Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter -jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service -enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 19. CDBG ONLY - Select one HUD Objective that relates to your project: (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that 1 am seeking to address?') r Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 20. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?') F Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 21. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. F Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. F Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. F Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. r Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. r Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. F Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. r- Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee - sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer -sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses; and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 22. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) Persons r- Households ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Disabled . Women/Female Headed Households Seniors j Youth 1 J Homeless N/Al Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A - 0.001 TOTAL 24. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ('AMPS information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process C Low Income (50%-80% AMI) - Extremely Low Income (<30% AMI) N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0. t( i TOTAL 25. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" White White + HISPANIC Black/African American Black/African American + HISPANIC Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC Asian and White - Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American --------------------- American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial - N/A, Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) — it.,OO[TOTAL 26. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the agency's highest priority for funding. r- #2 - This program/project has the agency's 2nd highest priority for funding. r- #3 - This program/project has the agency's 3rd highest priority for funding. F #4 - This program/project has the agency's 4th highest priority for funding. F #5 - This program/project has the agency's 5th highest priority for funding. r #6 - This program/project has the agency's 6th highest priority for funding. F If you have more than 6 applications per organization, agency, district or entity, check here. = M Funding Sources/Revenues Budget Amount Amount Committed City of Dublin - $ 25,000.00 - $ 0.00 City of Pleasanton $ 25,000.00 $ 0.00 City of Livermore $ 25,000.00 $ 0.00 Client Fees $ 30,000.00 $ 25,000.00 Individual Donors $ 10,000.00 $ 10,000.00 Client Fees $ 0.00 $ 0.00 Total $ 115,000.00 $ 35,000.00 Funding Uses/Expenses Budget Amount Amount Committed Salary for licensed clinician(LCSW or LMFT) $ 75,000.00 Payroll taxes $ 5,738.00 Benefits $ 7,500.00 Retirement $ 3,750.00 Rent - - $ 4,500.00 Computer $ 900.00 Charting and office supplies $ 150.00 - Billing software $ 1,200.00 EHR software $ 1,200.00 Accounting/Audit $ 8,000.00 Clinical Director (5% FTE) $ 6,850.00 Total $ 115,388.00 $ 0.00 Budget Narrative Grant funds will be used to provide salary and benefits for a full-time, licensed clinician for one year. While the overall agency budget is nearly $23 million, approximately 95% of the funds are considered "pass through" dollars, which we use to pay subsidies for child care. The remainder of the operating budget is approximately $1 million. When combined with the services now being provided in the San Leandro clinic, mental health services will make up approximately 5% of the budget. Providing operating funds (through this grant and other funding sources) to support mental health services in the Tri-Valley will represent approximately 8% of the overall mental health operation. Documents #o Documents Requested * Required? Attached Documents * Program Expense Budget for ALL Grant Requests ✓ Program Expense for all grants download template Financial Information Form for ALL Grant Requests ✓ Financial Information form download template - -- - - - ------ - - - List of Board of Directors (or governing body) with ✓ Board of Dir. agency contact information Current Annual Budget for the Entire Agency ✓ Annual Budget Copy of most recently submitted IRS 990 form or Tax ✓ 990 Return (include complete form) ^- - - --- - -- Board of Director's (or governing body's) designation ✓ Designated Official of authorized official Board of Director's (or governing body's) authorization ✓ Authorization for funding to request funding (may be same document as one above) Proof of insurance carried, including bonding, liability ✓ Proof of Insurance and/or workers' compensation - STATE AND FEDERAL NON-PROFIT ✓ 501(c Letter DETERMINATION LETTER. All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of application. Non -compliant applicants will be disqualified. Certified Audit and/or Certified Financial Statements ✓ Financial Statements REQUIRED FOR CDBG ONLY - If requesting Capital Funding, please upload your Capital expenditure budget (your own format is acceptable) REQUIRED FOR CDBG ONLY - Personnel Policies Including Affirmative Action Plan and Grievance Procedure REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section REQUIRED FOR CDBG ONLY -Articles of Incorporation and Bylaws REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) - REQUIRED FOR CDBG ONLY - AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP). Must include outreach to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used. REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) * ZoomGrantsT"' is not responsible for the content of uploaded documents Application ID: 156547 Become a fan of ZoomGrantsT" on Facebook Problems? Contact us at Questions5ZoomGrants.com ©2002-2020 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout ( Browser Email This PreAevd Save as PDF Print Close Window AA City of Dublin 2020-2021 Human Services Grant Program 1/13/2020 deadline DiapermAively Hively Jump to: Organization Information Questions Sud et Documents $ 15,000.00 Requested Submitted: 1/13/2020 7:01:24 PM (Pacific) Project Contact Kelly O'Lague Dulka kelly(a.behively.or� Tel: (925) 417-8733 Additional Contacts none entered • . • Hively 6601 Owens Dr. Ste 100 Pleasanton, CA 94588 United States CEO Kelly O'Lague Dulka kelly@behively.org 1. Select the category that best describes your organization: (Select only one.) Non -Profit F Public Agency Other: Telephone(925) 417-8733 Fax (925) 730-4942 Web www.behively.org 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Hively's mission is to strengthen and support children and their families. At Hively, we believe that everyone should have the resources & support they need to feel supported, cared for, and able to thrive. 3. Select the category that best describes the project: (Select only one.) Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. F Yes W 5. Is this request for one-time, seed or operational funding? F One-time funding F Seed funding One-time and Seed funding ✓ Operational funding None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. "Give a man a fish and he will eat for a day. Teach a man how to fish and you feed him for a lifetime." - Italian proverb The Hively Diaper Pantry provides families in need with a month's supply of diapers and wipes, an age -appropriate children's book, and parent educational materials to promote children's literacy. In so doing, not only do we "feed the family for the day" by providing a crucial basic necessity, but we also "feed the family for a lifetime" by providing a path to break the cycle of poverty through the promotion of early childhood literacy. The Diaper Pantry serves families living significantly below the poverty line, like Marta's family. Marta is mom to 3-yr-old Jose and 1-yr-old Gabby and is one of the 436 families Hively served last fiscal year. Before coming to Hively, Marta was one of the 61 % of low-income households who did not have a single children's book in the house. When Marta ran short on diapers, out of desperation she'd scoop out the contents of a soiled diaper and put the dirty diaper back on Gabby, even though she knew it would probably lead to another ER visit for an infection or severe diaper rash. What other option did she have? Then she heard about the Diaper Pantry. 44% of children in Alameda County are not ready for Kindergarten. The books and resources provided allowed Marta to change the trajectory of her children's lives, build their critical literacy skills and improve their success rate in Kindergarten and beyond. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) We aim to serve 300 distinct Dublin residents, who may come for the free diapers, but who can then access Hively's other resources, like free clothing & shoes through our Community Closet; child care subsidies & referrals; & parent education classes. 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process F Behavioral Health (mental health and substance abuse) Affordable Housing ✓ Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse F Disabilities F Food and Nutrition F Senior Services ✓ Youth Services ✓ Child Care, Early Childhood Development and Education F Changing Demographics and Growing Diversity F Financial Assistance None of the Above ✓ Please explain: By helping to meet basic needs, the Diaper Pantry aligns with Dublin's values of safety & customer service. 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project 70 (What specifically will the grant funds be used for?) Grant funds will be used to help pay the partial salary of an employee who will staff the Diaper Pantry - including receiving, unpacking, organizing, and storing donated and purchased supplies; bagging diapers and wipes for distribution; literacy program development, and customer service on diaper distribution days. This project is cost effective because we are able get diapers donated and purchase diapers in bulk at the lowest possible price. Furthermore, Hively has partnered with several community organizations who have conducted diaper drives for the Diaper Pantry, including Kaiser, Dublin Unified School District, Boys Team Charity, National Charity League, Help A Mother Out, the Church of Jesus Christ of Latter -Day Saints, St. Raymond's Church, Safeway, and local child care providers. Through these community diaper drives, 40% of the diapers and wipes Hively distributed last year were donated at NO cost to our program. Last year, the Hively Diaper Pantry made over 1,200 diaper distributions which totaled over 135,000 diapers. 10. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low -come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. The outcome measures that are crucial to the success of this project are: 1) parent's ability to go to work or school by having an adequate supply of diapers to meet child care requirements; 2) an increase in the number of parents who are talking, singing, and counting with their babies during diaper changing time; and 3) an increase in parents reading age -appropriate books to their children. The number of diapers, age -appropriate books, and parent educational materials distributed, the number of program participants, and the frequency that parents are engaging with their children during diaper time will be tracked to measure the success of this project. The target populations for this project are families living well below the poverty line and limited English speaking families living in Dublin, Livermore, and Pleasanton. Participant data collected between Jan 2017 and Dec 2018 revealed that 67% of Diaper Pantry participants were Hispanic with limited English skills, 15% Caucasian, and 11 % African American..80% of participants reported an income level of <$24k/year and 19% reported an income level of <$48k/year. Therefore, 99% of Diaper Pantry participants are living significantly below the poverty line. Hively services and programming are culturally appropriate. We are inclusive and strive to employ staff who reflect the communities we serve and who are experienced in providing support and resources to the target populations. Our staff is very diverse with fluency in 14 languages, which ensures that we can communicate effectively with our families. The Diaper Pantry is culturally appropriate because we provide bilingual children's books and parent educational materials in Spanish. This not only meets the needs of our Spanish-speaking populations, it also provides an opportunity for parents and children to increase their dual -language literacy skills together. Hively has established successful partnerships with CityServe of the Tri-Valley, Axis Community Health, and WIC of Pleasanton, all of whom refer qualified clients to Hively's Diaper Pantry. In joining forces with these partners, Hively aims to deliver the most comprehensive services to its families. Our outreach efforts also include digital and printed community resource materials, Constant Contact, SurveyMonkey, social media, community events, and the agency website. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE. Please contact City staff immediately if you have any questions regarding Davis -Bacon requirements. Not Applicable F Yes F No 12. ** QUESTIONS 13 THROUGH 25 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? i Yes. If so, check box here and answer questions 29 through 41. e� No. If no, check box here and enter Don't know. If you are unsure, please call City staff at (925) 833-6645. 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail are N/A 14. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: F Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers F Encourage process streamlining Consolidate service delivery ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: F *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. F *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under -insured residents with emphasis on activities that: i * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. F C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. i- D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. r E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. ✓ F) Not Applicable. I am not interested in qualifying for CDBG funding. 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass -roots, faith -based, and other community -based organizations ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 17. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: i Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. r Improving the quality of life for our Nation's communities F Encouraging accessible design features. Participation of minority -serving institutions in HUD programs. F End chronic homelessness within ten years. Removal of barriers to affordable housing. ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 18. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: r Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. F Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). r- Assist low and moderate income first-time homebuyers. Reduce housino discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter -jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service -enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 19. CDBG ONLY - Select one HUD Objective that relates to your project: (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?') "- Creating a Suitable Living Environment FProviding Decent Affordable Housing F Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 20. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?') F Availability/Accessibility F Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding, 21. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. F Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. F Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIWAIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. F Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. F Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. r Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. F Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee - sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer -sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services, to meet the needs of the service area, neighborhood, or community, as determined by the grantee. ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 22. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) F Persons F Households ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Disabled Women/Female Headed Households Seniors iJ Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A ,t? TOTAL 24. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ('AMP) information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process _ Low Income (50%-80% AMI) Extremely Low Income (<30% AMI) N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0. 001 TOTAL 25. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" ------ White White + HISPANIC Black/African American Black/African American + HISPANIC Asian Asian + HISPANIC American Indian/Alaskan Native j — ( American Indian/Alaskan Native + HISPANIC _ ] Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander+ HISPANIC American Indian/ Alaskan Native and White - American Indian/ Alaskan Native and White + HISPANIC _ Asian and White Asian and White + HISPANIC Black/African American and White L___ _1 Black/African American and White + HISPANIC ( ] American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) I 0,001 TOTAL 26. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY F_ #1 - This program/project has the agency's highest priority for funding. #2 - This program/project has the agency's 2nd highest priority for funding. F #3 - This program/project has the agency's 3rd highest priority for funding. F #4 - This program/project has the agency's 4th highest priority for funding. r— #5 - This program/project has the agency's 5th highest priority for funding. F_ #6 - This program/project has the agency's 6th highest priority for funding. r If you have more than 6 applications per organization, agency, district or entity, check here. :VP[•T��P�Ti7 Funding Sources/Revenues Budget Amount Amount Committed City of Pleasanton $ 15,000.00 $ 0.00 City of Dublin -_ $ 15,000.00 $ 0.00 City of Livermore $ 15,000.00 $ 0.00 In -kind donations $ 30,000.00 $ 0.00 Other Grants _ $ 15,000.00_ Monetary Contributions - - $ 30,000.00 Total $ 120,000.00 $ 0.00 Funding Uses/Expenses 30% FTE Diaper Pantry Admin Benefits Supplies - Diapers Supplies - Books Supplies - Parent Educational Materials Elm Budget Amount - $ 30,000.00 $ 7,500.00 - - $ 89,000.00 $ 18,000.00 $ 8,000.00 $ 0.00 $ 152,500.00 Amount Committed $ 0.00 Budget Narrative The partial salaries of Hively employees comprise the bulk of this grant. Diapers were distributed over 1,200 times last year, with more than 135,000 diapers distributed. Therefore, customer service on diaper distribution days is an integral part of the success of this program. In addition, developing and maintaining community partnerships and executing successful fundraising strategies is vital to maximizing resources, securing diverse funding streams, and reducing program costs. Funding will cover staff salary and benefits, program materials, and supplies. Hively utilizes in -kind resources, community partnerships, fundraising and volunteers With participant data showing a dire need for low-income families to have access to free diapers/wipes and literacy materials, and despite an increase in the program's capacity over the last year, demand still exceeds supply. Hively is honored that the City of Dublin has contributed to the success of the Diaper Pantry and would be grateful for the City's continued support. Hively does not anticipate having any unspent grant funds at the end of the fiscal year. Documents Lop Documents Requested * Required? Attached Documents Program Expense Budget for ALL Grant Requests ✓ Program Expense for all grants download template - - Financial Information Form for ALL Grant Requests ✓ - Financial Information form download template List of Board of Directors (or governing body) with ✓ Board of Dir. agency contact information - Current Annual Budget for the Entire Agency ✓ Annual Budget Copy of most recently submitted IRS 990 form or Tax ✓ 990 Return (include complete form) - - Board of Director's (or governing body's) designation ✓ Designated Official of authorized official Board of Director's (or governing body's) authorization ✓ Authorization for funding to request funding (may be same document as one above) Proof of .insurance carried, including bonding, liability ✓ Proof of Insurance and/or workers' compensation - STATE AND FEDERAL NON-PROFIT ✓ 501 C Letter DETERMINATION LETTER. All organizations MUST - have approved non-profit status from the State of California and Federal Tax Identification Number at time of application. Non -compliant applicants will be disqualified. Certified Audit and/or Certified Financial Statements ✓ Financial Statements REQUIRED FOR CDBG ONLY - If requesting Capital Funding, please upload your Capital expenditure budget (your own format is acceptable) REQUIRED FOR CDBG ONLY - Personnel Policies Including Affirmative Action Plan and Grievance Procedure - REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section - REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) REQUIRED FOR CDBG ONLY - AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP). Must include outreach to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used. REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) * ZoomGrantsTM is not responsible for the content of uploaded documents. Application ID: 155617 Become a fan of ZoomGrants-M on Facebook Problems? Contact us at QuestlOnsnQ,Z00m(`i rantS,COm ©2002-2020 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logoul I Browser iamMi This Preview Save as PDF Pdrit Goss Window AA P DUBLIN C A L I F 0 R N I A Powered by ZoornCrants'M City of Dublin 2020- 0 1 Human Services Grant Program 1/13/2020 deadline Hope Hospice, Volunteer• Grief SupportProgram Jump to: Orc anization Information Questions Budget Documents $ 18,000.00 Requested Submitted: 1/13/2020 3:13:26 PM (Pacific) Project Contact Jennifer Pettley ienniferp(@hopehospice.com Tel: (925) 829-8770 Additional Contacts none entered 1. Business License Number B L-005299 Hope Hospice, Inc 6377 Clark Avenue Suite 100 Dublin, CA 94568 Chief Executive Officer Jennifer Hansen ienniferh@hopehospice.com 1. Select the category that best describes your organization: (Select only one.) Non -Profit r Public Agency Other: Telephone(925) 829-8770 Fax (925) 829-0868 Web www.hopehospice.com 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Since 1980, Hope's mission has been to provide compassionate in -home health care services for people at the end of life, and guidance and assistance to families who are caring for them. Hope is the leading non-profit hospice provider in Tri-Valley. 3. Select the category that best describes the project: (Select only one.) F Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is.identified as not yet started, implemented or in operation. rYes 5. Is this request for one-time, seed or operational funding? r One-time funding Seed funding One-time and Seed funding ✓ Operational funding i None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Hope's Grief Support and Volunteer Services are key components of Hope Hospice's patient care program which last year cared for 654 patients at the end of life and their families, a 21 percent increase over the previous year. Following the loss of their loved one, hospice family members receive one-on-one or group bereavement support as well as follow up contacts for up to 13 months to ascertain how they are coping. Members of the community are also welcomed into the program. Participants learn coping skills, how to connect with other community resources, and how to move successfully forward in their lives. The City of Dublin funding will allow Hope to offer 20 grief support groups throughout the year for adults, youth and children in the community at no charge. Volunteer Support Services provide cost-effective, high -quality support and companionship to Hope's patients, and vital respite for their caregivers. Unique to the hospice model of care, each patient care volunteer undergoes extensive training, including how to support patients with dementia conditions which create special challenges for families. These cases now comprise nearly 50 percent of Hope's admissions. Other volunteers serve on the board of directors, event committees, perform office work, assist at fundraising events, and help with our community outreach. This funding will allow Hope to recruit and train 30 new patient care volunteers and manage more than 150 volunteers agency -wide. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 147 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov11956/Application-Requirements-Process F Behavioral Health (mental health and substance abuse) F Affordable Housing ✓ Health Care (including dental) Workforce Development Homelessness r Transportation Services and Access Domestic Violence and Child Abuse ✓ Disabilities Food and Nutrition ✓ Senior Services F Youth Services Child Care, Early Childhood Development and Education ✓ Changing Demographics and Growing Diversity F Financial Assistance None of the Above Please explain: 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) While direct patient care at Hope is reimbursed by Medicare or other insurances, Hope's vital Grief Support and Volunteer Services Programs are funded with grants and community donations. These resources make it possible for Hope to provide services at no charge to all in the community who need them. Both programs complement Hope's direct medical care for patients, offering comprehensive support at a time when families need it most. Volunteers are utilized whenever possible, greatly enhancing the cost effectiveness of the programs. According to the Independent Sector, in 2019 the value of a volunteer hour was $25.43. Hope's volunteers logged 3,000 hours during FY 18/19, bringing a total value of $76,290 to the agency. Volunteers are vital to providing the range of support that patients, families and our events need. Not only do they bring a special service dimension to the Hope team but they help Hope save significantly in operational and staffing costs. We simply could not sustain these costs over the scope of care, support and service we provide. Grief Support Program Funding from the City of Dublin will allow Hope to offer 20 Grief Support Groups and recruit and train at least 30 patient care volunteers throughout the grant period. City of Dublin funds will be used to administer and operate Hope's Grief Support and Volunteer Services Programs, including staffing costs. Grief Support includes groups, individual sessions, telephone follow-up, and correspondence. In addition to general grief support, specific groups are offered for children and teens, and those who have lost a partner or child. Children meet in age - appropriate group sessions to express their feelings of grief through art projects, writing, music, games and discussions. Hope's new Mindfulness and Grief Group focuses on mindfulness meditation practice and deepening awareness relating to loss and change. Grief Support helps family members who have lost a loved one process their grief, learn healthy coping skills, and connect with a caring community. Hope staff and volunteers monitor and follow the progress of grieving individuals for up to 13 months. Hope's grief support team helps adults and youth learn healthy ways to process feelings and rebuild their lives in the aftermath of their loss. Our grief support groups and workshops offer an environment of hope, acceptance, and cooperative learning. We believe: ® Grief is a natural reaction to death. ® Everyone processes death and loss differently. Sharing one's story of pain and loss helps lessen suffering. ® Being in community with others helps process grief. Hope's Grief Support Center staff and volunteers hold memorial events and provide on -site support for local schools, senior centers, and other organizations. Volunteer Services Program Through Hope's Volunteer Services Program, trained volunteers provide support and companionship to patients and families through vigil at the bedside, reading, music, art, prayer, home repair, meal preparation, accompanying patients to medical appointments, and gentle touch (including massage, Reiki, and cosmetology). They also provide respite so family members can "take a break" to run errands, attend to their own health, or simply take some time away for themselves to recharge. In addition, volunteers provide support to families as their loved one is near death or at the time of death, and through bereavement, often helping them produce treasured mementos or write life reviews. Other volunteers at Hope provide vital office support, participate on committees or boards, offer fundraising assistance, and conduct community outreach. Some volunteers assist with outreach or fundraising events including registration and setting up or taking down equipment. Their assistance is invaluable to the hospice patient care experience and in assisting the organization in so many other ways. The Manager of Volunteers and staff conduct recruitment, training, scheduling and monitoring of our 150 volunteers who are working at many levels of the organization. Volunteers are initially interviewed to determine their area of interest and level of time commitment and then complete a registration and orientation process. Patient care volunteers undergo nearly 20 hours of extensive training and preparation to work in a home setting where someone is critically ill or who has a dementia -related condition. Volunteers are recognized frequently for their work, and we host an annual Volunteer Recognition Dinner at a casual location. 10. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low -come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. Strategies and Objectives Objectives include the following: Grief Support Objective: Hope Hospice will provide 20 Grief Support Groups during the grant period. Grief Support staff collects client satisfaction surveys following all of its programs, as well as evaluations from hospice families 13 months after their loss. The surveys and evaluations measure perceptions and assess how participants are coping in their grief experience. Service contacts and number of sessions are tracked in Hope's extensive database management system. The results help drive the development of new services and help to refine current services to ensure they continue to meet community needs. In addition, Grief Support staff make frequent follow up contacts with grief clients to ensure they are moving forward successfully in their grief journey or if they may need referrals to additional community services. Volunteer Services Objective: Hope Hospice will recruit and train at least 30 new volunteers during the grant period and provide 3,000 hours of volunteer services throughout the year. Volunteer hours and progress are carefully logged. Families complete satisfaction surveys which help us understand and respond to the ongoing and emerging needs of those in our care, including services provided by volunteers. In addition, our case managers, registered nurses, and medical social workers are in constant contact with our patients and families, regularly conduct needs assessments and measure levels of satisfaction. Population to be Served Hope Hospice served 654 patients last year, a 21% increase over the previous year. Hope also served 1,072 family members and members of the general public through Grief Support Services. Eighty-three percent of our hospice patients are aged 80 or more, a demographic group that is growing as our population ages. The increase in admissions has coincided with an increase in dementia -related cases, now outpacing cancer as the most common condition on admission. Hope Hospice serves primarily frail seniors with advanced illnesses who have received diagnoses limiting life to six months or less. Often their main caregiver is a spouse of equivalent age, also of frail condition. The hospice approach is to also support the needs of family caregivers as they cope with the care of their loved one at home. Case managers arrange visits by social workers, chaplains, or volunteers. Accessibility to Low -Income, ESL and Disabled Persons All Dublin residents who seek care from Hope Hospice are served. No one is turned away and all of these community - centered services are provided free of charge, enabling low-income residents to access all services. Hope Hospice is committed to serving families of diverse backgrounds. Patients are admitted for Hope Hospice services following a doctor's referral and after receiving a diagnosis that will limit their life to six months or less. Our patient care and support services are fully accessible since they are provided in the patient's home. Hope employs a diverse clinical team with multiple language and cultural capacity, including bilingual staff. We utilize a language translation service, including ASL, which is available 24/7/365. Our second -floor Grief Support Center is easily accessible by elevator and is fully able to accommodate the needs of disabled persons. We are walking distance to BART. Also, Hope's office and Grief Support Center are a block from the Dublin City Center and accessible by all major bus lines. Cultural Appropriateness All staff and patient care volunteers are trained in cultural sensitivity with special focus on the emotional, social and spiritual issues of the dying and bereaved, family dynamics and communication. In particular, they learn about beliefs held by many cultural and religious groups surrounding death and dying in the home setting and elsewhere. The experiences of caring for a dying loved one and grieving are unique to each individual. Our professionally trained hospice and grief support providers skillfully apply their experience and training in dealing with highly individualized cultural experiences. Marketing and Outreach To connect with the community, our Outreach staff conducts regular visits and presentations in senior centers, assisted living facilities, physicians' offices and medical groups, hospitals and health centers, elder care facilities, schools, government agencies, elder care nonprofits, and tables at numerous Chamber of Commerce events in the Tri-Valley region. Grief support staff often visit these offices and facilities and serve as members of the Critical Incident Stress Management team for local school districts. We also regularly send calendar notices and press releases to local newspapers and post information on our website and regularly to Facebook and Twitter. We also recently started a blog and post educational content there, as well as event and program informatio 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE. Please contact City staff immediately if you have any questions regarding Davis -Bacon requirements. ✓ Not Applicable Yes F No 12. ** QUESTIONS 13 THROUGH 25 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? so, check box here and answer questions 29 throu No. If no, check box here and enter F Don't know. If you are unsure, please call City staff at (925) 833-6645. 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 14. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: ( Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: F A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. I *Preserve and increase affordable rental housing opportunities for low and moderate income households. I *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. 11— *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under -insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. F) Not Applicable. I am not interested in qualifying for CDBG funding. 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: F Increase homeownership Promote decent affordable housing F Strengthen communities F Ensure equal opportunity in housing Promote participation of grass -roots, faith -based, and other community -based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 17. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority -serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. am not interested in qualifying for CDBG funding. 18. CDBG ONLY- Identify at least one HUD Consolidated Plan objective that relates to your project: r Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. F Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AW). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. F Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter -jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service -enriched housing for persons with special needs. ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 19. CDBG ONLY - Select one HUD Objective that relates to your project: (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?') F Creating a Suitable Living Environment F Providing Decent Affordable Housing Creating Economic Opportunities ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 20. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?') Availability/Accessibility F Affordability Sustainability ✓ Not Applicable. I am not interested in qualifying for CDBG funding 21. CDBG ONLY - Select one HUD -Specific Indicator that relates to your project: F Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. F Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. f Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. 1- Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIWAIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. r- Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. r Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. IF Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee - sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer -sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. F Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 22. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) i Persons F Households Not Applicable. I am not interested in qualifying for CDBG funding. 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". —] Disabled Women/Female Headed Households Seniors Youth Homeless N/Al Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0,00 TOTAL 24. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ('AMP) information is available online at www.dublin.ca.gov11956IApplication-Requirements-Process Low Income (50%-80% AMI) Extremely Low Income (<30% AMI) N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) TOTAL 25. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" White White + HISPANIC Black/African American — Black/African American + HISPANIC Asian ( Asian + HISPANIC i American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander j Native Hawaiian/Other Pacific Islander + HISPANIC j American Indian/ Alaskan Native and White _ American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC } American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) - - .00 TOTAL 26. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY ✓ #1 - This program/project has the agency's highest priority for funding. F_ #2 - This program/project has the agency's 2nd highest priority for funding. i= #3 - This program/project has the agency's 3rd highest priority for funding. F- #4 - This program/project has the agency's 4th highest priority for funding. r- #5 - This program/project has the agency's 5th highest priority for funding. 1 #6 - This program/project has the agency's 6th highest priority for funding. r= If you have more than 6 applications per organization, agency, district or entity, check here. Budget tc Funding Sources/Revenues Budget Amount Amount Committed Event Income $ 115,000.00 $ 115,000.00 Grants $ 46,000.00 $ 0.00 Individual Donations $ 440,000.00 $ 440,000.00 $ 0.00 Total $ 601,000.00 $ 555,000.00 Funding Uses/Expenses Budget Amount Amount Committed Grief Support Staffing $ 300,000.00 $ 300,000.00. Volunteer Services Program Staffing $ 301,000.00 $ 301,000.00 Total $ 601,000.00 $ 601,000.00 Budget Narrative Hope Hospice experienced a 20 percent increase in admissions over the last year. Due to our community's aging population, we expect this growth trajectory to continue. All programs are preparing, scaling and realigning to accommodate this increasing demand. While we are a Medicare -certified agency in which reimbursement for most direct patient care is received, many support services, which are unique to the hospice experience, have no reimbursement source and continue long after the patient has died. Hospice families are followed in their grief journey for up to 13 months after the passing of their loved one. In addition, we welcome anyone in the community who has experienced a loss. We do not charge for these services. They are available to anyone who needs them, thanks to community support through contributions and grants. In addition, our caregiving workshops and presentations on end of life care and planning at local facilities, senior centers and other locations in the community are free of charge. Documents Requested * Required? Attached Documents * Program Expense Budget for ALL Grant Requests V Program Expense Budget Form download template Financial Information Form for ALL Grant Requests V Financial Information download template List of Board of Directors (or governing body) with V Board of Directors agency contact information Current Annual Budget for the Entire Agency V Home Hospice Agency -Wide Budget FYI 9/20 Copy of most recently submitted IRS 990 form or Tax V Form 990 Return (include complete form) Board of Director's (or governing body's) designation V Designation of official of authorized official Board of Director's (or governing body's) authorization V resignation of official to request funding (may be same document as one above) Proof of insurance carried, including bonding, liability V Certificate of Liability Insurance and/or workers' compensation STATE AND FEDERAL NON-PROFIT V Tax Exempt Letters DETERMINATION LETTER. All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of application. Non -compliant applicants will be disqualified. Certified Audit and/or Certified Financial Statements V Current Audit REQUIRED FOR CDBG ONLY - If requesting Capital Funding, please upload your Capital expenditure budget (your own format is acceptable) REQUIRED FOR CDBG ONLY - Personnel Policies Including Affirmative Action Plan and Grievance Procedure REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) REQUIRED FOR CDBG ONLY - AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP). Must include outreach to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used. REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) Application ID: 155715 Become a fan of ZoomGrantOl on Facebook Problems? Contact us at Q�ZoomGrants.com ©2002-2020 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout I Browser Powered byZoomGrantsrm City of Dublin 2020-2021 Human Services Grant Progran-1 1/13/2020 deadline RMFM,� L Seniors Jump to: Information__ _Questions Budget Documents $ 7,500.00 Requested Submitted: 1/13/2020 4:56:1=LPM Project Contact James Tr ggiari A—reggLa —ri @-Las h —ica P_.org Tel: (.510) 832-3040 x302 Additional Contacts none entered L! 1-:11011117A ' Legal Assistance for Seniors 333.Begqrjberggr Road Sufte"118501, Oakland, CA 94621 United States Executive Director James Treggi_ar. i Lr _e g g La r—i a s —hi c a p —.o r g 1. Select the category that best describes your organization: (Select only one.) ./ Non -Profit Public Agency Other: (510) 832-3040 Tel h PPTe x302 Fax (510) 842-1080 Web www.lashicap.or9 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). The mission of Legal Assistance for Seniors is to ensure the independence and dignity of seniors by protecting their legal rights through education, counseling and advocacy. 3. Select the category that best describes the project: (Select only one.) Capital Project ✓ Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. - Yes ✓ No S. Is this request for one-time, seed or operational funding? One-time funding - Seed funding One-time and Seed funding ✓ Operational funding None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Legal Assistance for Seniors (LAS) will provide free legal services, community education, and health (Medicare) insurance counseling to Dublin seniors. LAS' legal program will serve elder abuse survivors and those needing legal assistance with guardianship, citizenship, public benefits, health law and housing. Legal services will include representation in court and at administrative hearings, legal advice and counsel, referrals to other community resources, and home visits for seniors with mobility or financial issues. LAS will also provide free community education and outreach on a variety of legal and health care related topics to seniors, seniors' families, and service providers. Community education is provided at locations within the Dublin community that are accessible and familiar to seniors. Presentations include How to Get Help with Health Care Costs, An Overview of Long Term Care Insurance, and Basic Housing Rights for Seniors, among other topics. Finally, the Health Insurance Counseling and Advocacy Program (HICAP) will provide free individual counseling on Medicare and related health insurance issues at the Dublin Senior Center. LAS' state - registered volunteer HICAP counselors help seniors and people with disabilities enroll in Medicare, supplemental and prescription drug plans and apply for cost -saving programs. Counselors also assist to resolve coverage issues, referring clients to LAS' legal program for further assistance if necessary. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 142 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov11956IApplication- Requirements-Process Behavioral Health (mental health and substance abuse) Affordable Housing -1 Health Care (including dental) Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition ®/ Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the Above Please explain: Senior services for elder abuse, eviction defense, health coverage. Culturally competent services, accessible for people with disabilities. 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) The proposed funds from the City of Dublin will be used to provide free legal services, community education, outreach, and HICAP counseling to Dublin seniors. Services will be focused on low or extremely low income seniors and will be provided not only at LAS' Oakland office, but several community locations throughout Dublin and the surrounding areas. Specifically, funds will contribute to salaries for LAS' program staff, including staff attorneys and advocates. Funds will also be used for postage, phones, rent, and outreach activities, plus materials expenses such as printing costs for legal cases and community education presentation handouts. Funding will also be used to support the cost of staff and volunteer travel for home visits, community education and outreach, and HICAP appointments. Legal home visits are essential for seniors who are home -bound or have difficulty traveling, who would otherwise be unable to access help for urgent issues such as elder abuse and public benefits. And providing community education and HICAP appointments directly in Dublin, in places where seniors live and spend their time, allows more seniors to be aware of and access these essential services. To ensure services are provided in a cost-effective manner, LAS works extensively with volunteers who provide both overall program support and direct services to clients, with supervision and support from program staff. For example, LAS currently has 33 extensively trained and state -registered volunteer HICAP counselors who provide hundreds of hours of service per year. Additionally, ten paid staff counselors provide supervision and support to the volunteers. In addition to providing individual health insurance counseling, a select number of LAS' HICAP counselors also provide community education and translation services. LAS also works with legal interns and summer law clerks to provide support to the legal program, including legal research, writing, and intake. Because LAS has provided legal, educational, and HICAP services in Dublin for manyyears, we are able to base the current year's budget on past results. This helps to ensure that the current budget will meet the needs of the anticipated results. Further, the project budget is also leveraged with additional county grants 10. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low -come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. LAS will provide legal services to seven Dublin seniors. LAS will also provide three community education presentations and/or outreach events in Dublin, reaching a minimum of 100 Dublin residents. LAS' HICAP will provide individual detailed counseling to 65 Dublin residents. While services are available to residents of any income, LAS focuses its efforts on serving low income clients, including conducting outreach in low income areas and partnering with other agencies that serve low income communities. LAS' legal services program will provide free services in the areas of elder abuse, health law, public benefits, guardianship, naturalization, housing, and general legal services for those needing assistance in other areas. Services will be provided to Dublin residents 60 and older, -or 50 and older for guardianship. In the area of elder abuse, LAS will assist seniors over the age of 65, or dependent adults of any age. Services range from legal counsel and advice to full representation in court, depending on the client's situation. This year, LAS will also be piloting a monthly housing clinic in Dublin, staffed by LAS' legal fellow. The clinic will be assessed based on effectiveness, available funding and client interest to determine long-term viability of the project. LAS will provide community education presentations and/or outreach events for Dublin seniors, pre - retirees, caregivers and senior and disability service providers. Presentations will be provided in community locations convenient and accessible to seniors on a wide variety of topics that are relevant to seniors' lives, including health care, public benefits, housing, and more. Finally, LAS will also provide free HICAP counseling, in -person or over the phone, to Dublin Medicare recipients, with in -person counseling done at the Dublin Senior Center. While most Medicare recipients are seniors, LAS will also provide HICAP counseling to younger individuals who are eligible for Medicare due to disability. To monitor the progress of these outcomes, LAS will utilize client databases that track client demographics and case outcomes. Periodic database reports will be generated and reviewed by LAS' management team to ensure LAS is on track to meet all project goals. If LAS notices a deficiency in one program area, adjustments will be made to ensure that all goals are met, including increasing outreach efforts in Dublin to make more seniors aware of LAS' services. LAS also distributes evaluation forms to all clients and community education participants to assess the quality of services provided. LAS' management team reviews all returned evaluations to ensure compliance with LAS' standards of service. LAS' services are designed to be easily accessible for seniors who are low income or have language barriers or disabilities. LAS makes home visits for legal clients who are unable to travel due to cost or mobility issues and provides HICAP and community education services at multiple community locations. LAS also accommodates seniors who prefer to receive assistance over the phone or have written materials mailed to them. To ensure seniors from isolated or underserved areas are aware of the services offered, LAS also conducts extensive outreach activities across the county. To make sure non-English speaking seniors can meaningfully access LAS' services, written materials are provided in multiple languages. LAS staff and volunteers can also provide services in several languages, and for all other language needs, a phone interpretation service is used. LAS' HICAP program currently has counselors providing services at the Dublin Senior Center that speak Cantonese, Mandarin and Dutch. Community education presentations are provided in multiple languages, including Cantonese, Mandarin, Korean, Spanish, Hindi and Punjabi. For court appearances, LAS attorneys arrange with the court to have an interpreter provided when needed. To ensure LAS' services are culturally appropriate, LAS collaborates with several cultural centers, including Multicultural Institute, Asian Health Services, and The Fruitvale Senior Center. LAS is also currently undertaking a comprehensive Equity, Diversity and Inclusion (EDI) initiative, including agency -wide staff training, to make our services as welcoming to all seniors as possible, regardless of ethnicity, sexual orientation, language, or disability. LAS' marketing and outreach strategies include distributing marketing communications at the Dublin Senior Center and throughout its robust network of partners. These marketing communications include event and service fliers, a quarterly newsletter, website links, Facebook posts, other publicity, and informative literature. The Dublin Senior Center is a primary source of outreach as HICAP services are delivered onsite. HICAP's state registered counselors are able to spot barriers to care first-hand and provide necessary intervention to seniors in at -risk situations. 11. If your agency is requesting Capital funding, will this project require implementation of Davis- Bacon/Fair Labor Standards Act requirements? NOTE. Please contact City staff immediately ifyou have any questions regarding Davis -Bacon requirements. Not Applicable Yes No interested12. ** QUESTIONS 13 THROUGH 25 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are in applying• %f Yes. If so, check box here and answer questions 29 through 41. No. If no, check box here and enter -' Don't know. If you are unsure, please call City staff at (925) 833-6645. 13. CD GONLY- Explain your Limited English Proficiency/Language Access Plan (L P/LAP). Hove does your agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail Please enter "NIA' ifyou are not interested in qualifying for CDBG funding. LAS does not allow language to be a barrier in its service delivery. Our Language Access Plan states that all program notices include a statement that translators will be available upon request for presentations, meetings and all in the field project activities. To encourage limited English speaking residents to access LAS' services, we coordinate with partnering agencies that specialize in serving monolingual seniors whenever possible. For example, we maintain Medicare counseling and community education sites at Fruitvale Senior Center, which serves predominately Hispanic seniors in Oakland, and Asian Health Services, serving many mono -lingual seniors, also in Oakland. LAS also outreaches to limited English speaking residents by making program materials available in various languages. We use translators to review any materials created and translated by LAS for linguistic accuracy. LAS also uses government documents for HICAP counseling that explain Medicare in multiple languages. In the past, we have provided written materials in Chinese, Farsi, Korean, Spanish, Tagalog, and Vietnamese. In addition, LAS recruits and trains HICAP counselors whose ethnicities reflect the diverse communities that we serve. It is common for LAS to have HICAP counselors that speak Cantonese, Mandarin, Spanish, Korean, Hindi, and Punjabi. LAS uses a telephone interpreter service (Language Line Solutions) for its legal and HICAP counseling services, which provides translators in 240 different languages including American Sign Language. LAS also arranges interpreter services with the courts in legal cases to ensure a translator is available. In addition, LAS uses bilingual staff and volunteers to provide translation for all its services. Bilingual staff are also available to attend home visits for clients who are unable to travel. 14. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: ✓ Be culturally accessible, appropriate and inclusive ✓ Encourage community engagement and involvement Promote energy and resource efficiency ✓ Encourage networking and information sharing across service providers ✓ Encourage process streamlining ✓ Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: ✓ A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. ✓ *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. ✓ *Promote fair housing and reduce housing discrimination. ✓ B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under - insured residents with emphasis on activities that: ✓ * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. ✓ * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. ✓ D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. ✓ E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. F) Not Applicable. I am not interested in qualifying for CDBG funding. 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: Increase homeownership -' Promote decent affordable housing ✓ Strengthen communities Ensure equal opportunity in housing Promote participation of grass -roots, faith -based, and other community -based organizations Not Applicable. I am not interested in qualifying for CDBG funding. WWI R r • . •. Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority -serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 18. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMP. Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Q/ Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter -jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service -enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 19. CDBG ONLY - Select one HUD Objective that relates to your project: (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?') ./ Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 20. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am l seeking?') Availability/Accessibility Affordability %/ Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 21. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: ,', Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. ✓ Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. --' Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the. number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired. with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other, emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee -sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer -sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 22. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0" i Disabled r Women/Female Headed Households _ 142I Seniors { Youth I Homeless ;Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 142.00` TOTAL 24. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMP) information is available online at www.dublin.ca.gov11956IApplication- Requirements-Process 571 Low Income (50%-80% AMI) 85� Extremely Low Income (<30% AMI) 0; Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 142 1 284.001 TOTAL 25. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" 53 White j 03 White + HISPANIC 181 Black/African American [ - 01 Black/African American + HISPANIC 3S Asian 0 Asian + HISPANIC 01 American Indian/Alaskan Native 01 American Indian/Alaskan Native + HISPANIC [ 9 Native Hawaiian/Other Pacific Islander ------ -_ . 0 Native Hawaiian/Other Pacific Islander + HISPANIC 0 American Indian/ Alaskan Native and White 0 American Indian/ Alaskan Native and White + HISPANIC I _ _0 Asian and White j 0 Asian and White + HISPANIC 0; Black/African American and White [ 01 Black/African American and White + HISPANIC 0 American Indian/Alaskan Native and Black/African American 01 American Indian/Alaskan Native and Black/African American + HISPANIC 27 Multi Racial + HISPANIC OR other Multi_Racial 0i Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 142,901 TOTAL 26. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the agency's highest priority for funding. #2 - This program/project has. the agency's 2nd highest priority for funding. #3 - This program/project has the agency's 3rd highest priority for funding. #4 - This program/project has the agency's 4th highest priority for funding. #5 - This program/project has the agency's 5th highest priority for funding. -' #6 - This program/project has the agency's 6th highest priority for funding. If you have more than 6 applications per organization, agency, district or entity, check here. Budget tQp.. Funding Sources/Revenues State of California, Office of Emergency Services - - g®y g _ - Alameda County —Social Services A enc Title III I I Svcs, Title TVII HICAP MIPPA Alameda County —Health Care Services Agency County of Contra,. Costa/HICAP Cities of Alameda, Dublin, Fremont, Hayward, Livermore, Pleasanton & Union City, State Bar of California: IOLTA, EAF, EAP & Bank Grant Foundations/Corporations: Berkeley Pilgrimafe, SAFE,. Biggl_esworth Family,,. Albert& Elaine Borchard, Van, Loben Sels/Rembe Rock, San Francisco, East Bay Foundation on Aging, Bernard E & Alba Witkin and others Pass through/contractual: Family Support Services & DayBreak Adult Care Centers Court Awarded Fees, Elder Abuse Conference Sponsorship & registration fees Budget Amount Amount Committed 120,000.00 120,000.00 990,271.00 954,909.00 337,115.00 $ 322,115.00 .$ 6,000 00_0 00 $80,939.00 247,108.00 123,554.00 371,076.00. 95,000.00 $ 15,000.00 0.00 $ 291,166.00 Individual_ Donations,. Annual Appeal & Fundraising Event 172,578,.00 -_ - --- - Total FundingUses/Expenses Budget Amount Amount Committed Personnel Salaries (see budget narrative) 1, 696, 892.00 1,109,181.00 Personnel Fringe Benefits $ UJ 61.00 $ 302,044.00 Operating.Expenses Supplies 11,000 00, $ 7,272eN00 Operating Expenses: Printing ",000.00 $ 9,007.00. Operating Expenses: Postage $3,000.00 $7,272.00 Operating Expenses: Telephone $ 15,000.00 _7,899.00 Operating Expenses Rent $m198,500 00 $,84,373,00, Operating Expenses: Accounting/Audit/Payroll/Bank Fees -23,000.00 $ 5,028.00 Operating Expenses: Contracted Services $ 24,000.00. $99,684.00 Operating Expenses:_ Insurance $ U,000.00 $ 19,433.00 Operating Expenses: Membership, Books & Dues 18,000.00 $ 9,974.00 Operating Expenses: Equipment Lease, Maintenance, Upgrades 14,200.00 $2,714.00 Operating Expenses: Staff & Volunteer Travel, Training, Recruitment,, $47000.00 $ 19,428.00 Support Operating Expenses:Conference & Annual Fundraising Food/Entertainment $17,000.00 $ 5,000.00 Operating„Expenses Client Costs, $ 27,500.00 $ 6,500.00 — _. Operating Expenses: Technology (on-line research/svcs $ 13,000.00 $ 7,588.00 Operating Expenses: Outreach $ 5,000.00 $ 3,181.00 Total udget Narrative The requested budget funds from the City for Salaries are as follows: Managing Attorney(1 %o @ $720);. Sr Staff Atto_rney_,(2% @ $1,279)" Sr Staff Attor01ey.(1% @_$624), Staff Attorney (2% @ $1,136),,,Staff At —to rney(2 6 $,1,084), Advocate (1 o @ $382) and, Advocate.(1_% Fringe Benefits include FICAer (7 5%), SUI & workers compensation (1 % each), health/dental/vision/life insurance (15%%) and retirement/benefit plan fees (3%) for a total of $1,373. Operating expenses include Rent ( 223), Telephone ( 30), Insurance ( 50), Office Supplies ( 40),. Printing/Copying_(50), Postage/Delivery (�G35). StaffNolunteer Travel @ .58 per/mile ( 100) will be underwritten, withadditional funds.The requested,grant amount _represe_ntsleKthan .3% of the total, L,AS„_agencybudget,. Our program services of legal assistance (guardianship, elder abuse prevention,, immigration/naturalization, housing & public assistance),.HICAP health insurance counseling and advocacy and community education presentation of these matters to the general public as well as assistance providers are all services that our agency provides to all Alameda County residents that enables their ability to live independently in safety and with dignity. In addition LAS recognized in fiscal year 2018/19 in kind volunteer services, attorneys (34 hours),, advocates (546 hours) with a value of $27,268 as recognized in our audited financial statement. In addition HICAP counselors provided 3,515 volunteer hours and presenters to our annual Elder Abuse Conference provided 179 volunteer hours. Documents Requested * Program Expense Budget for ALL Grant Requests download template Financial Information Form for ALL Grant Requests download template List of Board of Directors (orgoverning body,) with agency contact information CurreAnnuaBuet fthe Entire ............... ,,,g..g,y Copy of most recently submitted IRS 990 form or Tax Return (include complete form) Board of Director's_„(o,r,.governing,body's), designation_of authorized official. Board of Director's (or governing body's) authorization to request funding_(may be same document as one above) Proof of insurance carried, including bonding,, liability and/or workers' compensation STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of application. Non -compliant applicants will be disqualified. Certified Audit and/or Certified Financial Statements, REQUIRED FOR CDBG ONLY - If requesting Capital Fundingalease upload your Capital expenditure budge- (your own format is acceptable) REQUIRED FOR CDBG ONLY - Personnel Policies Including Affirmative Action Plan and Grievance Procedure REQUIRED FOR CDBG ONLY -Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section REQUIRED FOR CDBG _ONLY - Articles, of Inco(poration_ and_ Bylaws REQUIRED FOR CDBG ONLY - Conflict of Interest_ Statement (if not included in Bylaws) REQUIRED FOR CDBG ONLY -AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP). Must include Required?Attached Documents 2020/21 Dublin Program Expense Budget 2020/21 Dublin Financial Information Sources Staffing f List of a of Directors FY201920 General and Auto Insurance COI FY201920Workers _Compensation COlf._ FY201920 Professional Liability COI IRS Determination Letter State of CA-Deterrni_nation Letter PY201819 Audited Financial Statement LAS Employee Handbook Audit Requirements 201819 Audit Management Letter Articles of Incorporation ... LAS By Laws Conflict of Interest Policy® outreach to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used. REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency LAS 202e3 Strategic Plan Strategic Plan, Needs Assessment, etc, (Not Required), Other Supportirg Documents (Not Required). * Zoom.GrantsTM is not responsible forthe content. of uploaded documents,. Application ID: 155552 Become a fan of ZoomGrants" on Facebook Problems? Contact us at Questions ZoomGrants,com ©2002-2020 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout I Browser City of Dublin 2020-2021 Human Services Grant Program 1/13/2020 deadline • Open Heart Kitchen gpen Heart Kitchen Dublin Meal Progrik jump.to: Organization Information C uestions. Budget„_Documents_ 24,000.00 Requested Submitted: 12/26/2019 12:33:06 PM ,(Pacific)_ Project Contact Heather Greaux executivedirector@openheartkitchen.org Tel:.925-580-1616 ext 402 Additional Contacts none entered 1. Business License Number BL-009270 Open Heart Kitchen 1141 Catalina Drive #137 Livermore, CA 94550 United States Executive Director Heather Greaux executivedirector@openheartkitchen.org 1. Select the category that best describes your organization: (Select only one.) %t Non -Profit Public Agency Other: Telephone(925) 580-1616 Fax Web www.openheartkitchen.org 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Open Heart Kitchen serves prepared, nutritious meals free of charge to the hungry people of the Tri-Valley area. 3. Select the category that best describes the project: (Select only one.) Capital Project J Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes ✓ No 5. Is this request for one-time, seed or operational funding? One-time funding --- Seed funding One-time and Seed funding J Operational funding None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Open Heart Kitchen (OHK) is seeking funding for meal programs conducted in the City of Dublin. We serve meals to seniors 5 days a week at the Dublin Senior Center, we deliver bag lunch meals to 9 Dublin schools, and we serve hot meals every Saturday in Dublin. Our Hot Meal Program welcomes anyone in need. We serve homeless, senior citizens on a fixed income, and mostly the working poor. Meals can be eaten in our dining room or taken to -go. Many working mothers and fathers pick up meals for their families on their way home from work. We make every effort to make our meal service convenient for those who struggle with time, child care, and transportation. OHK's Senior Meal Program addresses the nutritional gap of low-income seniors. The program provides necessary nutrition as well as emotional support. Getting out of the house and interacting with everyone at the meal sites helps break the isolation that impacts many seniors. Their improved emotional well-being and access to nutrition helps keep them out of the emergency room and leads to a more balanced lifestyle. Our Weekend Bag Lunch Program addresses the nutritional gap of children who receive free or reduced school lunches during the week, but lack a secure source of nutrition over the weekend. By providing a stable source of nutrition to children over the weekend, the program helps mitigate the numerous physical and emotional impacts of hunger. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 700 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.govll956/Application-Requirements-Process Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development ✓ Homelessness -' Transportation Services and Access Domestic Violence and Child Abuse Disabilities ✓ Food and Nutrition J Senior Services ✓ Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the Above Please explain: 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) The grant funds will be used to purchase the food used in the Dublin meal programs. In an effort to provide a program based budget for Board Approval, OHK staff performs an extensive review of all program expenses and goals. The program budget includes an appropriate meal count growth and new program expansion goals established by the OHK Strategic Planning Committee. All organization budgets are approved by the Board of Directors annually. Budget performance is reviewed by the Board of Directors quarterly and by staff monthly. OHK utilizes donated food and holds food drives throughout the year in an effort to reduce the amount of purchased food. A contract with US Foods has also been established that takes advantage of their Manufacturer Cost Reduction Program. OHK is also a member of the local affiliate of Feeding America, the Alameda County Community Food Bank. As a member agency, OHK is able to purchase food from the Alameda County Community Food Bank in bulk below wholesale prices. The Alameda County Community Food Bank also provides fresh produce at no cost that OHK distributes directly to clients, as well as utilizes in the prepared meal programs and children's bag lunches. 10. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low -come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. Metrics Objective: End hunger by providing nutritious food. Activities: Work with the Alameda County Community Food Bank to distribute fresh produce. Follow nutrition guidelines for meal programs. Provide nutrition education to clients so they make healthy food choices. Timeline 07/01 /2020-06/30/2021 Outcomes Clients have access to fresh produce. Approximately 450 pounds of fresh produce per week is distributed in Dublin. Clients only receive food that is healthy and appealing. Nutrition education flyers will be included in bag lunches at least twice a year. (With permission from schools). Nutrition education outreach will be performed at the Dublin Senior Center quarterly. Measurement Pounds of produce delivered. Nutritional analysis by Registered Dietitian. Annual satisfaction surveys. Number of flyers. Number of outreach days. Number of people served. Given the vulnerability to diet -related diseases such as diabetes, people facing food insecurity deserve food that will not aggravate their existing medical predispositions. OHK focuses on distributing food that is high quality and healthful. A diet based on cheap foods of low nutritional value often leads to disease and increased work/school absenteeism. By distributing educational flyers focused on nutrition and access to safety net services, OHK provides families with the tools to better understand the implications of their food choices and how to navigate the food system. The number of flyers distributed in programs is tracked quarterly. Our Hot Meal Program welcomes anyone in need. Anyone who is struggling to make ends meet can rely on OHK for a source of nutrition for their families. We serve the homeless, senior citizens on a fixed income, and mostly the working poor. Low-income single -parent families, children and multi -generational families, the disabled, and veterans can find a free, healthy meal in an environment that upholds their dignity at our serving sites. Open Heart Kitchen's Senior Meal Program serves seniors 60 years and older. Food insecurity especially impacts our growing senior population. Our Senior Meal Program sees continual growth as the cost of housing, food, and health care continues to rise. According to Feeding America, one in six children in the United States do not have enough to eat. Sometimes school lunches, on which millions of kids rely, are the only meal they are sure to get during the day. Children need proper nutrition to grow and learn, making hunger an urgent problem that needs to be solved. Our Children's Weekend Bag Lunch Program serves low-income children who qualify for the Free/Reduced School Lunch Program. This specialized program provides the only weekend hunger relief geared specifically to at -risk children. OHK has made great efforts to improve the quality of the meals in our Hot Meal Program. We recognize that the low-income and homeless population that this program serves is considered an "at -risk" population. They are much more likely to suffer from many health problems such as obesity and diabetes. Many of our clients have severe dental problems from lack of access to dental care. Several of our homeless guests are seniors with special dietary needs. We have a responsibility to provide our guests with the.most nutritious meal as we possibly can. The meals for our Senior Meal Program are reviewed by a Registered Dietitian, then approved by the County of Alameda Area Agency on Aging. The senior meal menu is specifically designed to meet the special dietary needs of seniors. The food provided in our Children's Weekend Bag Lunch Program is reviewed by a Registered Dietitian and must meet dietary specifications for calories, saturated fat, and sodium. The items in the bags are appropriate for school age children and we provide at least three pieces of fresh produce in each bag. We find that many of our homeless and low-income guests utilize mobile devices to find services. Our website offers a daily calendar of our meal sites and hours of operation. We are also registered with City Serve and 211. We are a part of Alameda County Community Food Bank's referral system and we collaborate with several local churches and community service organizations. We distribute our meal program flyers in multiple languages and the flyers are distributed at our sites, in the bags of the Bag Lunch Program, we send them to schools who can email families, and other community based organizations. We work with area schools to identify children who can benefit from our Children's Weekend Bag Lunch Program. The Dublin Senior Center helps promote our Senior Meal Program to its visitors. We are always trying to recruit volunteers who speak languages other than English and encourage them to interact with our guests who speak the same language not only to tell them about our services, but to get to know them a little better. We also participate in several outreach events. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately ifyou have any questions regarding Davis -Bacon requirements. ✓ Not Applicable Yes No 12. ** QUESTIONS 13 THROUGH 25 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? ✓ Yes. If so, check box here and answer questions 29 through 41. No. If no, check box here and enter Don't know. If you are unsure, please call City staff at (925) 833-6645. 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail Please enter "N/A" ifyou are not interested in qualifying for CDBG funding. OHK is committed to making sure individuals with limited English proficiency have access to our programs. We recruit multilingual volunteers and offer our quarterly surveys and program flyers in multiple languages. We collaborate with agencies like the Alameda County Community Food Bank that provide translation services. All OHK program staff have been provided with "I Speak" cards to assist in identifying the language interpretation a guest may need should the occasion arise. The OHK staff are informally surveyed periodically on their experience concerning any contact with LEP persons during the year. This allows OHK to identify what translation services may need to be provided in the future. OHK takes reasonable steps to provide the opportunity for meaningful access to guests who have difficulty communicating in English, although a very low percentage of OHK clients are limited English speaking. 14.. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: ./ Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: -! A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under -insured residents with emphasis on activities that: a/ * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. ./ D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. a/ E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. F) Not Applicable. I am not interested in qualifying for CDBG funding. 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: --' Increase homeownership -' Promote decent affordable housing J Strengthen communities Ensure equal opportunity in housing J Promote participation of grass -roots, faith -based, and other community -based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 17. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority -serving institutions in HUD programs. J End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 18. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AM 1). - Assist low and moderate income first-time homebuyers. Reduce housing discrimination. ✓ Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services, ✓ Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter -jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service -enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 19. CDBG ONLY - Select one HUD Objective that relates to your project: (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?') ✓ Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 20. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am l seeking?') Availability/Accessibility Affordability ✓ Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 21. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. ✓ Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. - Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. _! Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness, jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee - sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job, jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer -sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 22. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) Persons -! Households Not Applicable. I am not interested in qualifying for CDBG funding: 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 481 Disabled 861 Women/Female Headed Households -3591 Seniors 435 Youth 10j Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 938.001 TOTAL 24. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ('AMP) information is available online at www.dublin.ca.govll956/Application-Requirements-Process 81 Low Income (50%-80%AMI) 6631 Extremely Low Income (<30% AMI) Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) --- 29, 700.001 TOTAL 25. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity; not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" 1871 White 261 White + HISPANIC 56 Black/African American -( Black/African American + HISPANIC 2091 Asian Asian + HISPANIC j 61 American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC 121 Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander+ HISPANIC _ American Indian/ Alaskan Native and White E American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White _.-.._...-- --- -- Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC 204[ Multi Racial + HISPANIC OR other Multi Racial Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 700.0Q TOTAL 26. if your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY ✓ #1 - This program/project has the agency's highest priority for funding. #2 - This program/project has the agency's 2nd highest priority for funding. #3 - This program/project has the agency's 3rd highest priority for funding. - #4 - This program/project has the agency's 4th highest priority for funding. #5 - This program/project has the agency's 5th highest priority for funding. #6 - This program/project has the agency's 6th highest priority for funding. - If you have more than 6 applications per organization, agency, district or entity, check here. Budget trap Funding Sources/Revenues Budget Amount Amount Committed Individual Contributions - - 415,879.00 _ - - City Grants $ 99,718.00 County Grants � 259,625.00 Federal Grants 14,000.00 Grants (non -Government). 318,500.00 Program Service Revenue, Special,.Events In -Kind Contributions Tota i Funding uses/Expenses Food and Supplies Food Delivery _(Auto) Personnel Facility and Equipment Information Technology and Communications Insurance (non -employee related) Office Supplies Postage_and Printing Program Outreach Supplies Rent.and Utilites Other Depreciation Total $ 78,743.000 100,000.00 _ $ 263,926.00 1,,391.00 .0 _udet Narrative Open Heart Kitchen is requesting24,000 to help support the Dublin meal program's food costs. OHK utilizes donated food and holds food drives throughout the year in an effort to reduce the amount of purchased food. A contract with US Foods has also been established that takes advantage of their Manufacturer Cost Reduction Program. 16 percent of the food that OHK serves is distributed in Dublin and we are requesting that Dublin cover 3 percent of our total food costs. Documents Requested * Required? Attached Documents Program Expense Budget for-ALL.Grant Requests Program Expense Budget download template Financial Information Form for ALL Grant Requests Financial Information download template List of Board of Directors (or governing body) with Board Roster agency contact information Current Annual Budget for the Entire Agency Copy of most recently submitted IRS 990 form or Tax Return (include complete form) _ - Board of Director's or governing _body's) designation of authorized official Board of Director's (or governing body's) authorization to. request funding_(may be same document as one above) Proof of insurance carried, including bonding, liability and/or workers' compensation STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. All organizations MUST have approved non- profit status from the State of California and Federal Tax Identification Number at time of application. Non -compliant applicants will be disqualified. ,/ Agency Budget %/ Form 990_ a/ Board Authorization Certified Audit and/or Certified Financial Statements ,f Audit REQUIRED FOR CDBG ONLY- If requestingapital C Funding,-please upload your Capital expenditure budget (your own format is acceptable) REQUIRED FOR CDBG ONLY - Personnel Policies Including Affirmative Action Plan and Grievance Procedure REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section REQUIRED FOR CDBG ONLY -Articles of Incorporation and Bylaws REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) REQUIRED FOR CDBG ONLY - AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP). Must include outreach to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used. REQUIRED FOR CDBG ONLY -LEVERAGING REPORT - this is due ,with the 2nd quarter report no later than January 15th Supporting_Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents Not Required) Employee Policy Handbook Conflict of Interest Policy_ LEP Plan Strategic Plan * Zoom Grants"" is not responsible, for the content, of unloaded documents, Application ID: 155600 Become a fan of ZoomGrants' on Facebook Problems? Contact us at Questions@ZoomGrants.com 02002-2020 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout I Browser Ernaii This Preview Save as PDP Print Goss Window AA V City of Dublin 2020- 0 1 Human Services Grant Program 1/13/2020 deadline C .. Case Management Jump to: OrganizationInformation Questions Budget Documents $ 16,604.00 Requested Submitted: 1/13/2020 2:35:27 PM (Pacific) Project Contact Robert Taylor rtayLor@sspty.org Tel: 925-931-5394 Additional Contacts none entered 1. Business License Number BL- 007038 e Senior Support Program of the Tri Valley 5353 Sunol Blvd Pleasanton, CA 94566 United States Executive Director Robert Taylor rtaylor@ssptv.org 1. Select the category that best describes your organization: (Select only one.) Non -Profit r- Public Agency Other: Telephone(925) 931-5379 Fax (925) 931-3499 Web www.ssptv.org 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Senior Support Program of the Tri-Valley's mission is to provide seniors in -home services, free of charge, to foster independence, promote safety and well-being, preserve dignity, and improve quality of life. 3. Select the category that best describes the project: (Select only one.) r Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes ✓ No 5. Is this request for one-time, seed or operational funding? ✓ One-time funding Seed funding One-time and Seed funding F Operational funding F None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Senior Support Program of the Tri-Valley (SSPTV) has 18 essential programs, serving as a "one -stop resource shop" for seniors in Livermore. SSPTV obtained our 501c3 in 2006 and ha operated as a nonprofit agency since. Currently, we have 24 employees (mainly part-time), giving us collectively over 130 years of experience with Senior markets. Since 1985, we have successfully managed the responsibilities and regulations of private, foundation, city, state, and county grants. The years of training, education, and experience from trained and vetted staff, compliance with contract requirements, accurate record - keeping, timely reporting and billing, strong Board and Executive Director, collaboration with other local CBO's and open lines of communication between service providers and funders are vital details qualifying SSPTV for this project. SSPTV Board of Directors is led by our Board President, who sits on multiple agency/county boards (i.e. Area Agency on Aging, etc..) working to improve the lives of Alameda County seniors. The head of our Fiscal Committee is a CPA and has experience managing large contracts in the nonprofit industry. SSPTV contracts with BayVap accounting professionals for accounting and payroll services. BayVap manages large accounts in addition to ours and has experience utilizing nonprofit bookkeeping practices. We have an annual audit prepared by Noe & Company(see attached documents) who complies with all audit standards and protocols. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 50 seniors 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov11956/Application-Requirements-Process F Behavioral Health (mental health and substance abuse) Affordable Housing F Health Care (including dental) r Workforce Development Homelessness i- Transportation Services and Access Domestic Violence and Child Abuse Disabilities Food and Nutrition ✓ Senior Services Youth Services F_ Child Care, Early Childhood Development and Education F Changing Demographics and Growing Diversity Financial Assistance None of the Above 1 Please explain: 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) Case Management services are provided directly in the senior's home after a phone intake determines the individual needs based on activities of daily living (ADLs) and indirect activities of daily living (IADLs) levels. An initial, in -home comprehensive assessment is made of the senior's living situation; the senior's physical, mental, environmental, spiritual, and emotional status as well as the need for assistance with ADLs are identified. After the initial visit, a care plan is formulated with the senior and family, if involved. Some of the services the Case Manager arranges, coordinates and supervises are: meals, transportation, home care, safety devices, social activities, medical/dental care, applying to government benefits when appropriate, bill paying, and living arrangements. One of the most critical parts of the program is the ongoing monitoring, reassessment and periodic follow up of each client. Follow-ups are done by phone calls (volunteers and interns assist in reducing the cost) and repeat home visits. The monitor checks to ensure implemented services are stable and sufficient. When basic physical, social and emotional needs are met, even in small increments, lives are changed and enhanced resulting in the senior's ability to engage and interact with their communities. Volunteers also help Case Managers with entering reports, copying information, printing documents, and various admin special projects keeping the costs as minimal as possible. Case Managers also utilize volunteers to assist with IT and data - entry related tasks keeping the expenses down. While we receive funding for Case Management from the cities of Pleasanton, Livermore, and Dublin, we keep city dollars separate from County (AAA -funded) dollars. County files are indicated with a different color sticker, and our Lead Case Manager designates County -funded clients after an initial phone screening; this helps us easily separate County and city funds. SSPTV is constantly expanding our network of local and regional partners, which includes senior housing facilities, senior centers, Kaiser, Stanford Valley Care Hospital, and Tri-Valley emergency responders. When Livermore -Pleasanton Police and Fire Departments respond to a 911 call and find a senior in crisis, they can directly refer the senior to SSPTV for comprehensive services. The past year, we worked closer than ever with Alameda County's Adult Protective Services (APS) to ensure referred seniors referred have a Case Manager to visit their home, assess, and assist. We have one-on-one relationships with Spectrum Community Services, HICAP (health insurance counseling), City Serve (faith -based community), Public Health, CRIL (Community Resources for Independent Living), Open Heart Kitchen, Tri-Valley Haven, Wiesner Foundation, Social Security, Alameda County's Senior Service Coalition, Behavioral Health, Tri-Valley Rotary groups, AXIS Community Health, In -Home Supportive Services, local transportation agencies, and food pantries. SSPTV has established referral procedures between agencies, eliminating delays and confusion. A simple phone call from these agencies is all that is needed for support to begin helping a senior remain independent. The timeline for clients varies greatly depending on the primary service needs but generally speaking, we provide case management services on a monthly basis (i.e. in -home visit plus phone follows) then re-evaluate each client within 12 months of service. During the re-evaluation period, we determine the next steps which could include continued service for an additional year, abbreviated service (quarterly), referrals to high-level service (i.e. Adult Protective Service) and/or discharge because clients have successfully completed case management program and are considered self-sufficient. 10. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low -come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. To ensure we continue to provide high quality programs, SSPTV employs a variety of evaluation measures. Outcomes in Case Management are defined by improvements in the quality of life of the seniors who have received our services. This improvement may be evident in a cleaner living environment, receiving a daily home delivered meal, taking advantage of referrals services provided, feedback from family or friends or the fact that the senior is able to successfully remain in their own home. Success may be evident when the fire department no longer is making repeat calls to lift a senior off the floor or no longer calling EMS for emergency services. Success may be found in that a trusting relationship has been forged with the Case Manager, and the senior is starting to accept the help that will improve their life. Improvement in ADLs and IADLs are recorded in the client file. Case Management is all about small successes. Our primary function is to give seniors the tools and support that will enable them to make the choices necessary to maintain their independence, improve their quality of life, and ensure their safety and well-being with dignity intact. Files are maintained for each client that include referrals, services implemented, outcomes, and reassessments. Care plans are updated and outcomes are recorded after each home visit. Staff and/or trained and supervised volunteers make phone calls to monitor the implementation of services and clients' well-being. Biweekly team meetings are held to discuss issues and problem solve. Data and statistics are kept, including the number of seniors served, units of services received, and seniors placed, relocated or discharged. The Case Manager maintains statistics and reports as required by the contract via quarterly Zoomgrant updates. SSPTV clients evaluate our programs annually by means of a questionnaire mailing. Family members or caregivers are included when appropriate. Since conception, SSPTV has been designed by the needs of the clients who have participated in programs, along with their caregivers and community members. SSPTV staff is continuously engaging in training sessions and asked to be a part of focus groups and needs assessments. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE. Please contact City staff immediately if you have any questions regarding Davis -Bacon requirements. ✓ Not Applicable F Yes No 12. ** QUESTIONS 13 THROUGH 25 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? F Yes. If so, check box here and answer questions 29 through 41. ✓ No. If no, check box here and enter Don't know. If you are unsure, please call City staff at (925) 833-6645. 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. na 14. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: F Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining T- Consolidate service delivery ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: F A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. F *Preserve and increase affordable rental housing opportunities for low and moderate income households. F *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. F B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under -insured residents with emphasis on activities that: r * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. r C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. ✓ F) Not Applicable. I am not interested in qualifying for CDBG funding. 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: Increase homeownership F Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing F Promote participation of grass -roots, faith -based, and other community -based organizations ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 17. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: r Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. F, Improving the quality of life for our Nation's communities !: Encouraging accessible design features. Participation of minority -serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 18. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: r Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. r Reduce housing discrimination. F Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter -jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service -enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 19. CDBG ONLY - Select one HUD Objective that relates to your project: (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?') F Creating a Suitable Living Environment F Providing Decent Affordable Housing F Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 20. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting.an outcome ask yourself, "What type of change or result am I seeking?') Availability/Accessibility Affordability F Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 21. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. I Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. F Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that. received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. F Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee - sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer -sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 22. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) f— Persons I Households ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 1 Disabled Women/Female Headed Households Seniors Youth - -- -J Homeless _ na Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.001 TOTAL 24. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ('AMP) information is available online at www.dublin.ca.gov11956IApplication-Requirements-Process Low Income (50%-80% AMI) Extremely Low Income (<30% AM[) [ nail Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) .001 TOTAL 25. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" White White + HISPANIC Black/African American - I Black/African American + HISPANIC _ Asian -- ( Asian + HISPANIC American Indian/Alaskan Native ( _ - American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander i Native Hawaiian/Other Pacific Islander + HISPANIC f American Indian/ Alaskan Native and White j American Indian/ Alaskan Native and White + HISPANIC j Asian and White Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC - Multi Racial + HISPANIC OR other Multi Racial na Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) - - 0,001 TOTAL 26. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY #1 - This program/project has the agency's highest priority for funding. r #2 - This program/project has the agency's 2nd highest priority for funding. F- #3 - This program/project has the agency's 3rd highest priority for funding. r- #4 - This program/project has the agency's 4th highest priority for funding. F- #5 - This program/project has the agency's 5th highest priority for funding. #6 - This program/project has the agency's 6th highest priority for funding. F- If you have more than 6 applications per organization, agency, district or entity, check here. Funding Sources/Revenues Budget Amount City of Pleasanton $ 25,000.00 City of Livermore $ 15,500.00 Total $ 40,500.00 Funding Uses/Expenses Budget Amount Case Manager 1 $ 4,750.00 Case Manager 2 $ 4,750.00 Case Manager 3 (part time) $ 2,150.00 Bookkeeper - $ 980.00 Director $ 1,200.00 ' Amount Committed $ 25,000.00 $ 25,000.00 Amount Committed Travel - mileage $ 700.00 Fringe Benefits $ 2,074.00 Total $ 16,604.00 $ 0.00 Budget Narrative Funds will be used for Case Management Direct Services. Robert Taylor is the Executive Director, who has been with the agency 3 years; attends all City of Dublin meetings and prepares all materials, represents Senior Support in all Dublin activities/services plus works as a manager. Mary McNamara and Jennifer Nelson are Case Managers with a vast experience in the fields of geriatrics plus one PT Case Manager with case management experience in the Tri-Valley. Our bookkeeper manages invoices and financial requirements with our accountant. Please note: The $13,830 amount requested covers direct salary costs. An additional $2,074 is proposed to cover benefits and fringe costs. Travel costs are only $700. This brings the total amount requested to: $16,604. Documents %p Documents Requested * Required? Attached Documents * Program Expense Budget for ALL Grant Requests ✓ Program Budget Spreadsheet download template Financial Information Form for ALL Grant Requests ✓ Senior Support - All Grants download template -_ ---- - --- List of Board of Directors (or governing body) with ✓ SSPTV Board of Directors Roster agency contact information — Current Annual Budget for the Entire Agency ✓ Agency Budget FY19'20 Copy of most recently submitted IRS 990 form or Tax ✓ 990 Return (include complete form) Board of Director's (or governing body's) designation ✓ Board Officers of authorized official Board of Director's (or governing body's) authorization ✓ Board Officers to request funding (may be same document as one --- above) Proof of insurance carried, including bonding, liability ✓ Insurance Cert and/or workers' compensation W- - _ --- orkmens Comp STATE AND FEDERAL NON-PROFIT ✓ NON-PROFIT DETERMINATION LETTER DETERMINATION LETTER. All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at time of a lication Non-com liant a licants will be pp p pp disqualified. Certified Audit and/or Certified Financial Statements REQUIRED FOR CDBG ONLY - If requesting Capital Funding, please upload your Capital expenditure budget (your own format is acceptable) REQUIRED FOR CDBG ONLY - Personnel Policies Including Affirmative Action Plan and Grievance Procedure REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section - REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) - REQUIRED FOR CDBG ONLY - AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ✓ FY'18°19 Audit to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used. REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) * ZoomGrantsT"' is not responsible for the content of uploaded documents. Application ID: 156744 Become a fan of ZoomGrantsT'' on Facebook Problems? Contact us at Questions on,ZoomGrants.com 02002-2020 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. L. ogout 1 Browser City of Dublin 2020-2021 Human Services Grant Program 1/13/2020 deadline 5pectrumCommunit , Services Meals on Wheels for Hornebound Dublin Seniors Jump to: Organization information Questions Budget Documents 1,5.0 Requested Submitted: 1/13/2020 12:51:02 PIVI (Pacific), Project Contact Lara Calvert LCglvert@sp9ctrurncs.or Tel: 510) 881-0300 ext. 243 Additional Contacts aclmin@spectrurncs.org, cold=es@pg �s Ctrumcs.org,, _ pherndon@spectrumcs.org 1. Business License Number 006992 Services 2621 Barrington Court Hayward, CA 94545 United States Executive Director Lara Calvert Icalvert@spectrumcs.org 1. Select the category that best describes your organization: (Select only one.) Non -Profit Telepbone(510) 881-0300 x243 Fax (510) 537-3340 Web www.spectrumcs.org Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Spectrum Community Services' mission is to improve the health and safety of seniors and low-income residents in Alameda County by enhancing their quality of life and helping them age at home with dignity. 3. Select the category that best describes the project: (Select only one.) Capital Project ✓ Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes ✓ No 5. Is this request for one-time, seed or operational funding? One-time funding Seed funding ---'. One-time and Seed funding ✓ Operational funding None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Spectrum Community Services' Meals on Wheels Program will deliver at least 8,000 nutritious, life -sustaining meals and a vital daily safety check to low/extremely low-income disabled and homebound seniors residing in Dublin. Spectrum's Meals on Wheels Program is one of two nutrition services provided through our Senior Nutrition Program, exclusively for Alameda County seniors. Our Spectrum Meals on Wheels Coordinator for Dublin is based in the Tri-Valley and implements day-to-day program activities, such as conducting in -home assessments, making appropriate referrals on behalf of participants, completing meal orders, and determining daily routes for drivers. They also confirms all volunteer drivers have reported in and routes will be covered. If necessary the Coordinator will deliver meals personally. Meals are planned by our partner Stanford Healthcare -Valley Care's Registered Dietitian, who strictly adheres to the Older Americans Act -Title IIIC. Spectrum's volunteer drivers pick up freshly prepared, nutritious meals each morning then deliver meals as well as provide safety checks and a warm smile with each delivery. They become a vital safety net for our seniors, combating their potential isolation and ensuring their well-being. Often, this special delivery is the only reason our senior participants get up in the morning. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) Spectrum's Meals On Wheels Program will provide daily meals to approximately 55 unduplicated Dublin senior residents. 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.govll956/Application- Requirements-Process Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) Workforce Development - -' Homelessness Transportation Services and Access Domestic Violence and Child Abuse f/ Disabilities Food and Nutrition Senior Services Youth Services Child Care, Early Childhood Development and Education Changing Demographics and Growing Diversity Financial Assistance None of the Above Please explain: 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) Spectrum is asking for $13,500 to support the Dublin Meals on Wheels Program. This request will fund a percentage of salaries and benefits for two positions: our Tri-Valley Supervisor ($5,819); and our Dublin Meals on Wheels Coordinator ($7,681). Our Dublin Meals on Wheels Coordinator is the backbone of the program. They are the main contact for each homebound Dublin senior, whether it is to register them for new service, complete their intake assessment,or talk to them about their meal schedule/preferences/other needs. The Coordinator completes personal, semiannual assessments with each senior in their home. This allows the Coordinator to provide a more personal touch and better assess each senior's needs/additional resources they might benefit from. The Dulbin Meals on Wheels Coordinator also assists with volunteer scheduling/planning routes to ensure all meals are delivered timely. Spectrum's Tri-Valley Supervisor recruits, trains, schedules, and manages the dedicated volunteers. Meals are delivered daily, primarily by volunteers, who are dedicated to the program and the seniors they serve. The Supervisor is an active participant in the community and expands Spectrum's outreach efforts. The Supervisor works to cultivate connections in Dublin with faith -based and cultural organizations at business and community venues where seniors and their families gather. Involvement in the community is not only important to raise awareness of services Spectrum's Dublin Meals on Wheels offers, it provides opportunities to support the program through recruiting new volunteers. Trained volunteers are an essential component of providing daily meals and safety -checks for homebound seniors. 10. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low -come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. The first and primary outcome measure crucial to Spectrum's Meals On Wheels Program success is to ensure all low and extremely low-income frail, homebound seniors, who reside in Dublin, have access to our program services. This guarantees we can meet their nutritional needs through our home delivered meals, as well as safeguard their wellbeing through daily safety checks. We want to ensure if a senior qualifies and wants or needs our support, we will be there to assist. Our goal is to meet or exceed our contracted outcome by providing home -delivered meals to 55 or more unduplicated Dublin in FY 2020-2021. Another outcome that measures the success of our Program is the number of meals we deliver each fiscal year. In FY 2020-2021, we will home -deliver 8,000 or more meals to Dublin seniors, sometimes the only meal they get each day. Finally, the Meals on Wheels Program can only be successful if, not only seniors served are happy with our meals and services, but we ensure Dublin seniors thrive by positively impacting their health through a well- balanced/nutrient-rich diet. To certify this outcome, our meals comply with the Dietary Guidelines for Older Americans, meeting 1/3 of the Dietary Reference Intakes for seniors, and meet strict food safety guidelines. We also guarantee seniors are happy with our meals through periodic Satisfaction Surveys filled out by our program seniors. Spectrum outcome data/demographics are collected daily through program meal orders and then input into the agency's database. Reports are generated monthly and Spectrum's management staff review these reports to confirm the program is on track to meet our stated goals, thus ensuring the success of Spectrum's Meals On Wheels Program. Spectrum continues to interact with other social agencies within Alameda County and the Tri Valley to ensure that seniors in need are directed to our program. Many doctor offices, senior apartments, social workers and churches direct clients to us. Both Meals on Wheels of Alameda County and Meals on Wheels America websites also direct potential clients in Dublin to Spectrum Community Services. 11. If your agency is requesting Capital funding, will this project require implementation of Davis- Bacon/Fair Labor Standards Act requirements? NOTE.• Please contact City staff immediately ifyou have any questions regarding Davis -Bacon requirements. - Not Applicable --! Yes ✓ No 12. ** QUESTIONS 13 THROUGH 25 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? ✓ Yes. If so, check box here and answer questions 29 through 41. No. If no, check box here and enter -! Don't know. If you are unsure, please call City staff at (925) 833-6645. 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services? What. access accommodations are used? Etc. Provide detail Please enter "NIA "ifyou are not interested in qualifying for CDBG funding. Spectrum conducts an Annual Language Survey with staff, volunteers, senior program participants and their families, and the community. Based on this survey, we are able to identify gaps in our current Limited English Proficiency/Language Access Plan, and address those gaps with the additional resources and. revised/enhanced protocols necessary to address these needs. Our LEP/LAP informs our ongoing staffing, outreach activities, informational materials, website, communications and operations. In combination with our Annual Language Survey, we periodically update our Internal Language Directory, which allows our agency team to quickly access non-English proficient speakers on staff (we update this document whenever there is a staff change). Our staff and volunteers include individuals fluent in English, Korean, Spanish, Hindi, Cantonese, Vietnamese, and Mandarin. When a staffer with certain language expertise is out sick or on vacation, Spectrum's management staff uses the Language Directory to identify a fluent speaker from another department who can assist if needed. We can also access Alameda County's Translation Line or Google Translate. Our goal is to always ensure our agency's cultural proficiency, so that all current and prospective senior participants and their families have access to Spectrum services in the language in which they are proficient, that they are treated with cultural sensitivity/respect and dignity, and that their questions are answered in a timely fashion. 14. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 15. CD G ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under - insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. ®i D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. -/ E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. r) Not Appucabie. i am not interestea in quautying Tor CDBU Tunaing. 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing ✓ Strengthen communities Ensure equal opportunity in housing ✓ Promote participation of grass -roots, faith -based, and other community -based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 17. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. J Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority -serving institutions in HUD programs. End chronic homelessness within ten years. - Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 18. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: i- Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. -' Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. ✓ Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service -enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 19. CDBG ONLY - Select one HUD Objective that relates to your project: (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that l am seeking to address?') ✓ Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities — Not Applicable. I am not interested in qualifying for CDBG funding. 20. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am l seeking?') Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the. number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving, TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. - Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have -- employee -sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer -sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 22. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) ✓ Persons Households Not Applicable. I, am not interested in qualifying for CDBG funding. 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". f 55 Disabled —_ --151 Women/Female Headed Households 5 Seniors Youth j Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 125.00 TOTAL 24. CDBG ONLY -Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ('AMP) information is available online at www.dublin.ca.gov11956/Application- Requirements-Process j 281 Low Income (50%-80%AMI) 271 Extremely Low Income (<30% AMI) Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 55 00; TOTAL 25. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" 21 White 61 White + HISPANIC 81 Black/African American Black/African American + HISPANIC 41, Asian Asian + HISPANIC 11 American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White I Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American+ HISPANIC 15, Multi Racial + HISPANIC OR other Multi Racial I Not Applicable. I am not interested in qualifying for CIDBG funding. (Type N/A) 55.00; TOTAL 26. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY %1 #1 - This program/project has the agency's highest priority for funding. #2 - This program/project has the agency's 2nd highest priority for funding. #3 - This program/project has the agency's 3rd highest priority for funding. #4 - This program/project has the agency's 4th highest priority for funding. #5 - This program/project has the agency's 5th highest priority for funding. #6 - This program/project has the agency's 6th highest priority for funding. If you have more than 6 applications per organization, agency, district or entity, check here. Fundine Sources/Revenues Area Agency on Aging Measure A MOWAC Citv of Livermore City of Pleasanton PrivateDonations Pro ram Revenue Volunteers Total Budget Amount Amount Committed $49,241.00 $49241.00 L37,500.00 37,500.00 ,7-5,000.00 a5&40.DQ $22,680.00 $37,500.00 $15,000.00 70,000.00 $�M,561.00 $_176,741.00 Funding_Uses/Expenses Budget Amount Amount Committed Salaries and Wages $ 1_67,826.00 Benefits 35,500.00- Supplies $ 2,500.00 - Postage - 750.00 - Telephone 2,700.00 Rent and Utilities Accounting/Audit Taxes & Licenses Contracted Services Travel & Company Vehicles In Kind Misc Ex ense P nsg Total - 990.00 �16,785.00 � 70,000.00 - - J 22,035.00 - 406,061.00 0.00 Budget Narrative Weare .._ a.s.ki_ng,for....$.1.3,500 from„_th.e.,._City _of.Dublin ,tofund , 3.5%qof,this , project. We will use this funding for the salaries of two key individuals in this life saving service to Dublin homebound seniors. These funds will help prevent us from going back to a wait list. Individual 1. - Meals on Wheels Coordinator who ensures that daily operations run smoothly - 24% of her salary and benefits which is_$615/mos,_V,681 annually. 2. Tri-Valley Supervisor establishes partnerships as well as trains,, recruits, and appreciates volunteers which is vital to our program - 9%o._of_her_salary_which, is.,...$485/mos,,.$,5,81,9,annually.,. Documents top. Documents Requested * Required?Attached Documents Program Expense Budget for ALL Grant q/ Program Expense Budget Requests -.. download template Financial Information Form for ALL Grant j/ Financial Information Form download template - List of Board of Directors (or governing body) with agency contact information Current Annual Budget for the Entire Agency, Copy of most recently submitted IRS 990 form / or Tax Return (include complete form). Board of Directo,r's,(orgoverning.body's) %/ designation of_authorized official Board of Director's (or governing body's) authorization to request funding_(may be same document as one above) Board Roster Agency Budget 990 Tax Return Authorized Official_ - Proof of insurance carried, including bonding,, liab_l,ity an,d/or workers' .compensation. STATE AND FEDERAL NON-PROFIT DETERMINATION _LETTER. All organizations MUST have approved non profit,statusfrom_ the State of California and Federal Tax _........ _...-� _.. Identification Number at time of application. Non -compliant applicants will be disqualified. Certified Audit and/or Certified Financial Statements REQUIRED FOR CDBG ONLY - If requesting Capital Funding, please upload your Capital expenditure, budget (your own_format,s ac,ce,ptab,le) REQUIRED FOR CDBG ONLY - Personnel Policies Including Affirmative Action Plan and Grievance Procedure REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section Insurance Certificate_ IRS Exempt Letter CA Statement of Information ®/ Financial Audit Affirmative Plan and Grievance Procedure REQUIRED FOR CDBG ONLY - Articles of Articles of Incorporation Incorporation and Bylaws Bylaws REQUIRED FOR CDBG ONLY - Conflict of Conflict of Interest Interest Statement (if not included in Bylaws) REQUIRED FOR CDBG ONLY - A_GENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP). Must include outreach to limited English speakl,ng residents to_en_courage,a,ccessto_services &,.housi,,ng,, Include what access accommodations are used. REQUIRED FOR CDBG ONLY - LEVERAGING REPORT, -.this is due with the 2nd_quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, NeedsAssessment, etc. (Not Required) Other Supporting Documents (Not Required), Language Access Plan * ZoomGrantsl is not responsible for the content of uploaded documents. Application ID: ,1._56247, Become a fan of ZoomGrants- on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2020 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout I Browser Email This Preview Save as PDF Print Close Window AA V DUBLIN C A L I F 0 R N I A Powered .bv Zoom GrantSTM City of Dublin 20 0- 0 1 Human Services Grant Program 1/13/2020 deadline Sunflower Program Support for Adults with Developmental Disabilties $ 25,000.00 Requested Submitted: 1/13/2020 1:54:43 PM (Pacific) Project Contact Pamela Zielske Kathvl .sunflowerhill.org Tel: 925-519-1.347 Additional Contacts none entered 1. Business License Number BL-110708 • Sunflower Hill P.O. Box 11436 Pleasanton, CA 94588 Executive Director Edie Nehls EdieCa7sunfiowerhill.org 1. Select the category that best describes your organization: (Select only one.) Non -Profit F Public Agency r Other: Telephone925-519-1347 Fax Web www.sunflowerhill.org 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Sunflower Hill is a nonprofit organization that develops places and spaces where adults with developmental disabilities thrive. We are committed to creating residential communities, along with educational and vocational programs that ensure a full life. 3. Select the category that best describes the project: (Select only one.) F Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes ✓ No 5. Is this request for one-time, seed or operational funding? F One-time funding F Seed funding F One-time and Seed funding ✓ Operational funding None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Sunflower Hill Garden has been actively providing educational and vocational horticulture training to individuals with developmental disabilities since April of 2015. Each week our team serves approximately 50 program participants from 16 different high school transition, adult -in -transition and adult day programs based in the Tri-Valley and beyond. We strive to serve a diverse population and have developed an engaging curriculum and setting to meet the needs of all learners. Our staffing ratio is based on each program participant's abilities and ranges from 1 staff member to 1 program participant to 1 staff member to 3 participants. The garden provides a unique backdrop to develop functional fitness, learn about nutrition and how food is grown, and practice social interaction skills, which are all critical elements that enable our program participants to lead rich and meaningful lives. Furthermore, we are honored to donate our produce to nonprofit organizations serving the needs of Tri-Valley families, such as Culinary Angels, Open Heart Kitchen, Tri-Valley Haven, and East Bay Stand Down. In 2019, Sunflower Hill donated 77% of our total produce, or 5,713 lbs., to these nonprofit partners. Additionally, Sunflower Hill Garden offers an employment program that provides individualized vocational coaching to moderate to high functioning adults with developmental disabilities. The goal of this 9-month program is for each individual to have a real - life work experience. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 48 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov11956IApplication-Requirements-Process Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) ✓ Workforce Development Homelessness Transportation Services and Access F Domestic Violence and Child Abuse ✓ Disabilities ✓ Food and Nutrition Senior Services 1 Youth Services Child Care, Early Childhood Development and Education l Changing Demographics and Growing Diversity I— Financial Assistance None of the Above Please explain: 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) The funds requested are to be used to support our Garden Teacher, Abby Lourenco, through funding 79% of her salary. Abby leads all classes each week in the garden. She is dedicated to creating an engaging, hands-on curriculum that enables each program participant to have the opportunity to experience the garden in a way that is unique and meaningful. Abby also has experience with Americorps/Foodcorps, and as a result, has been implementing new curriculum into our program, including simple cooking lessons and taste testing. Each session in the garden begins with an opening lesson where program participants explore the day's theme. Lessons will often include sensory exploration, a life science component, nutritional training, and therapeutic elements. Each lesson also includes an opportunity for each program participant to choose the task they wish to work on that day. Abby works collaboratively with our garden team to ensure that there are tasks for all abilities; table top activities for those who are unable to bend or squat, large muscle group activities for participants who like to be physically active, and close, hands-on work for those desiring to further develop fine -motor skills. The session is designed so that each program participant is able to successfully complete a task at the end of each session. Program participants end their session with a closing circle where they enjoy a snack of the produce they harvested, practice their social interaction skills and table manners, as well as learn about the importance of making healthy food choices. Sunflower Hill's Garden program is tremendously cost effective. Our garden team is comprised of a full-time teacher, program manager, program assistant, and farmer, as well as a part-time vocational coach, and volunteer assistant. We also have three adults with developmental disabilities participating in our employment program by working part-time as garden interns with the support of our vocational coach. Our team is highly skilled, and work collaboratively to ensure that the garden program runs smoothly and efficiently. We also have a team of dedicated and talented volunteers who work in the garden each week. These individuals are vital to our program and assist with directly supporting program participants, as well as with labor in the field, such as planting, harvesting, or weeding. All volunteers are trained and supervised by our garden teacher and farmer, and they are passionate about working withadults with developmental disabilities. We are also very fortunate to have a number of master gardeners and retired teachers regularly volunteering in the garden and sharing their knowledge with fellow volunteers and program participants. Under the leadership of our farmer, the Sunflower Hill Garden team has also taken significant efforts to ensure the garden's sustainability. The team sheet mulches using cardboard and organic. materials (wood chips and straw) between perennial beds. This practice conserves water, builds soil, and reduces weed pressure. The team has also streamlined our composting practices by using more of the green waste produced in the garden. Working in the compost area of the garden also provides an excellent educational opportunity for program participants. Furthermore, the Sunflower Hill Garden is on a three-year crop rotation in the main field to reduce pest pressure. We use both winter and summer cover crops between heavy feeding crop plants to recharge the soil with nutrients for the next season of crops. 10. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low -come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. This project is specifically designed to meet the unique needs of the local developmentally disabled population. The CDC estimates that 1 in 6 children, or approximately 15%, aged 3-17 have one or more developmental disabilities. These conditions begin early in childhood development, may impact day-to-day functioning, and usually continue throughout a person's lifetime. Locally, these numbers are consistent with national trends, with approximately 5,500 individuals with developmental disabilities living in Alameda County. Furthermore, it is estimated that roughly 395 Dublin residents, 471 Pleasanton residents, and 580 Livermore residents have a developmental disability. These members of our communities represent overlooked population groups in Eastern Alameda County in terms of services, living options, and job opportunities, as was reported in the 2011 Human Services Needs Assessment. It is critical for Tri- Valley cities to solicit and implement programs that address the diverse needs of the adult developmentally disabled population as programs and activities are significantly reduced once a person ages out of the public school system. In addition, individuals with developmental disabilities are considered extremely low income, living as adults on Social Security Income, or with assistance from family members, if available. Through an engaging, hands-on curriculum, and guidance from high skilled staff members and volunteers, program participants are able to achieve a number of objectives that lead to greater independence and empowerment. The Sunflower Hill team tracks their progress through the success of the lessons themselves. Lessons are designed so that program participants are able to achieve the following: • Working to stay focused on a task until completion; • Following step by step instructions and asking follow-up questions, as needed; e Executing against work activities discussed in circle time with hands-on activities in the field; ® Practicing simple math writing,and life science conce is as part of hands-on learning activities; • Improving social and communication skills with peers, Sunflower Hill staff, and volunteers; • Learning how food is grown from seed to harvesting; • Harvesting, washing, packing, and weighing food that is donated to local nonprofit organizations and ultimately distributed to low-income families throughout the Tri-Valley region. Support of our Garden Teacher will help to further enable the execution of the above objectives. Additionally, we are able to assess the success of our program by tracking programs that return to us year after year. Of our current programs, most of them are repeat groups who have been attending since we first began offering horticultural programming in April 2015. We have also increased the number of Adult Day programs we are serving by going from two Adult Day programs to five in the last year. This increase speaks to the need for local Adult Day programs to find quality, unique programming opportunities. Sunflower Hill is honored to be able to fill this need for adults with developmental disabilities in the Tri-Valley community. Our Garden Teacher and Programs Manager also gather information and feedback through program surveys of teachers, program participants, and volunteers. Donating a large portion of our produce to local nonprofit organizations, such as Culinary Angels, Open Heart Kitchen, and Tri- Valley Haven is an additional way that we measure our overall success. The Sunflower Hill team also actively engages in a variety of community outreach efforts. Our Communications Manager produces a regular monthly newsletter and maintains an active social media presence to encourage community engagement. Additionally, staff give presentations on the value of our programming to local school districts, clubs, organizations, and corporations. We also host tours in the garden to enable members of the public and elected officials to have the opportunity to see our programs in action. Our Programs Manager also actively builds relationships with new leadership in local Tri-Valley programs. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis -Bacon requirements. i . Not Applicable F Yes ✓ No 12. ** QUESTIONS 13 THROUGH 25 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? F Yes. If so, check box here and answer questions 29 through 41. ✓ No. If no, check box here and enter F Don't know. If you are unsure, please call City staff at (925) 833-6645. 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 14, CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: F Be culturally accessible, appropriate and inclusive F Encourage community engagement and involvement i— Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining F Consolidate service delivery ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and' homeless persons with emphasis on activities that: F *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. I "`Preserve and increase affordable rental housing opportunities for low and moderate income households. r *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. I' B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under -insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. t C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. F) Not Applicable. I am not interested in qualifying for CDBG funding. 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass -roots, faith -based, and other community -based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 17. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities F Encouraging accessible design features. Participation of minority -serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 18. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. F Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter -jurisdictional cooperation to achieve housing and homeless needs. F Increase the availability of service -enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 19. CDBG ONLY - Select one HUD Objective that relates to your project: (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?') F Creating a Suitable Living Environment t Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 20. CDBG ONLY - Select one HUD Outcome that relates to your (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?') Availability/Accessibility F Affordability Sustainability ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 21. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: r Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number .of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. F Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. F Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. r Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. F Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee - sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer -sponsored health care benefits, and the types of jobs retained (using EDA classifications) 1- Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 22. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) F Persons F Households V Not Applicable. I am not interested in qualifying for CDBG funding. 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Disabled Women/Female Headed Households F----]Seniors 'Youth Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0 MO I TOTAL 24. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ('AMP) information is available online at www.dublin.ca.gov11956IApplication-Requirements-Process I Low Income (50%-80% AMI) E Extremely Low Income (<30% AMI) F N/Al Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) - - - -- - ------------ - -- -------- - ----- ....... .. . -0.0-0-ITOTAL 25. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" White White + HISPANIC - -_Black/African American __ -_- - - -- - Black/African American + HISPANIC Asian Asian + HISPANIC American Indian/Alaskan Native A1 American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC ----=American Indian/ Alaskan Native and White —]American Indian/ Alaskan Native and White+ HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 26. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for only be one #1 PER AGENCY ✓ #1 - This program/project has the agency's highest priority for funding. I- #2 - This program/project has the agency's 2nd highest priority for funding. r #3 - This program/project has the agency's 3rd highest priority for funding. #4 - This program/project has the agency's 4th highest priority for funding. r #5 - This program/project has the agency's 5th highest priority for funding. r- #6 - This program/project has the agency's 6th highest priority for funding. f- If you have more than 6 applications per organization, agency, district or entity, check here. Budget to Fe Funding Sources/Revenues Budget Amount Amount Committed City of Dublin $ 25,000.00 $ 0.00 City of Pleasanton $ 30,000.00 $ 0.00 Clif Bar Family Foundation $ 3,500.00 $ 3,500.00 Whole Foods Kids Foundation $ 2,000.00 $ 0.00 City of Livermore $ 92,700.00 $ 0.00 Giving Tuesday campaign revenue $ 25,760.00 $ 25,760.00 Sunflower Fun Run - projected $ 100,000.00 $ 0.00 Total $ 278,960.00 $ 29,260.00 Funding Uses/Expenses - --- Budget Amount Amount Committed SFH Garden Teacher salary $ 31,680.00 $ 0.00 Total $ 31,680.00 $ 0.00 Budget Narrative Sunflower Hill's funding request of $25,000 will cover 79% of the salary for our Garden Teacher in FY 2020. The remaining budget required for both the Garden Teacher's salary as well as the Garden program will covered by contributed income from other city and private grants, as well as Sunflower Hill's robust fundraising efforts. Documents tQp Documents Requested * Required? Attached Documents Program Expense Budget for ALL Grant Requests ✓ Pro ram Expenses download template - - Financial Information Form for ALL Grant Requests ✓ Financial information download template - - - - - List of Board of Directors (or governing body) with ✓ SFH Board of Directors - 2020 agency contact information - - - - Current Annual Budget for the Entire Agency ✓ SFH Budget FY 2020 Copy of most recently submitted IRS 990 form or Tax ✓ SFH 990 Return (include complete form) — - - --- - --- Board of Director's (or governing body's) designation ✓ SFH Dublin authorization of authorized official --- Board of Director's (or governing body's) authorization ✓ - SFH Dublin authorization to request funding (may be same document as one above) - Proof of insurance carried, including bonding, liability ✓ Worker's comp insurance and/or workers' compensation SFH Liability Insurance STATE AND FEDERAL NON-PROFIT ✓ SFH Nonprofit determination have approved non-profit status from the State of California and Federal Tax Identification Number at time of application. Non -compliant applicants will be disqualified. Certified Audit and/or Certified Financial Statements REQUIRED FOR CDBG ONLY - If requesting Capital Funding, please upload your Capital expenditure budget (your own format is acceptable) REQUIRED FOR CDBG ONLY - Personnel Policies Including Affirmative Action Plan and Grievance Procedure REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) REQUIRED FOR CDBG ONLY - AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP). Must include outreach to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used. REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th CA nonprofit determination SFH 990 Supporting Documents such as Agency Strategic SFH Strategic Plan Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) Dublin business license SFH By the Numbers 2020 * ZoomGrantsTM is not responsible for the content of uploaded documents. Application ID: 155835 Become a fan of ZoomGrants'" on Facebook Problems? Contact us at Questions o�ZoomGrants.com ©2002-2020 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout ( Browser Email Time Preview Save as P®F Print Cioso Window Ada V City of Dublin 2020®1 Human Services Grant Program 1/13/2020 deadline Tri-Valley Haven Domestic mestic Violence Jump to: Organization Information Questions Budget Documents 25,000.00 Requested Submitted: 1/10/2020 2:04:34 PM (Pacific) Project Contact Cynthia Cunningham Morales cynthia@trivalleyhaven.org Tel: (925) 449-5845 Additional Contacts irina@trivalleyhaven.org,vicki@trivalleyhaven.org 1. Business License Number BL-007058 Questions to Tri-Valley Maven 3663 Pacific Avenue Livermore, CA 94550 United States Executive Director Ann King ann ontrivalleyhaven.oro 1. Select the category that best describes your organization: (Select only one.) Non -Profit F Public Agency F Other: Telephone(925) 449-5845 x Fax (925) 449-2684 x Web www.trivalleyhaven.org 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Tri-Valley Haven creates homes safe from abuse, contributes to a more peaceful society. One person, one family, one community at a time. Together we build a world without violence. 3. Select the category that best describes the project: (Select only one.) F Capital Project Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. r Yes ✓' No 5. Is this request for one-time, seed or operational funding? r One-time funding Seed funding One-time and Seed funding ✓ Operational funding None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Tri-Valley Haven's (TVH) Domestic Violence Services Program.is an existing project. Our 24-hour Crisis Line is the main point of entry for women seeking shelter. Clients are also referred to us via our website, law enforcement, hospitals, 211, shelter networks, and other social services agencies. Each client is screened via telephone to assess their needs, and if it is safe for them to stay at our shelter, and then, if appropriate, an in -person intake is conducted. Each client is assigned to a Case Manager and a Counselor is made available to her should she wish to participate in counseling. The following groups are available for adult clients: DV Support Group, Job Readiness Group, Parenting Group, Life Skills and Family Night. Goals are set for each client depending on their very specific needs during the first meeting with the Case Manager. Progress toward the goals will be reviewed on a weekly basis. The maximum length of stay at the Shelter is 105 days. Shiloh has its own vehicle which is used for client intakes and emergency transportation. While in the Shiloh program, bus passes/Clipper cards, BART tickets and gas cards are available to clients who need help getting to appointments, interviews or work. Domestic Violence Services Program will address Job Training, Food and Nutrition, Homeless Services, Behavioral Health, and Access priority needs identified by Human Services Commission. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 75 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov11956IApplication-Requirements-Process F Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) r Workforce Development F Homelessness F Transportation Services and Access ✓ Domestic Violence and Child Abuse Disabilities Food and Nutrition F Senior Services F Youth Services F Child Care, Early Childhood Development and Education F Changing Demographics and Growing Diversity Financial Assistance F None of the Above Please explain: 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) The funds requested from Dublin will be used to pay part of the Bilingual Case Manager's time, and part of the Overnight staffs time. These positions are essential for the shelter operations. Tri-Valley Haven's domestic violence services support Dublin's mission to have a high quality of life and a safe and secure environment for all residents through prevention and intervention services. Furthermore, we will make these services available to all residents through provision of services that are culturally sensitive and appropriate. Clients will benefit from our program or by creating a safety plan for themselves and their children, developing goals and plan of action towards achieving self-sufficiency, and connecting with the resources available in our community. In , we served 142 survivors of domestic violence from Dublin through our crisis line and shelter. The Domestic Violence Services Program utilizes in-house and donated services as much as possible to meet clients' needs and hold down costs. Residents are able to obtain food from the TVH Food Pantry, they are given clothing vouchers and referrals to our Thrift Store, they receive assistance applying for government services such as CAL Fresh, CalWORKS, and Linkages. We refer our clients to AXIS for their health related needs. Trained volunteers provide overnight crisis line coverage as well as (along with TVH staff) around the clock response to sexual assault calls and referrals from local police departments and hospitals, and volunteers provide childcare for shelter children while their parents participate in educational and support groups. All of this contributes to a very reasonable budget. 10. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low -come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. We have been required by our government funded contracts such as the Alameda County DVCA to use the Results Based Accountability (RBA) to measure the success of our program. Our performance measures include: a) at least 75% of participants will report that they are Satisfied or Very Satisfied on the satisfaction surveys; b) 75% of Shelter program participants will be safely housed upon exit. Last Fiscal Year we met or nearly met both performance measures. The success of the Program will be measured through evaluation of client surveys, statistical results, and the individual goals set by the program participant and her/his case manager. Those goals will be set up on a case -by -case basis and may include: reuniting with their children through completing their CPS Plan, finding housing or employment. Some clients will only stay one or two nights, and their goals will be very different such as safely relocating to a different county or a state. Client's progress will be tracked by the case manager during weekly meetings. It will also be monitored at weekly staff meetings during case review. Additionally Case managers consult with staff counselors or the Clinical Supervisor as needed in order to provide the best client services. We have multi -cultural staff members and volunteers who utilize their cultural backgrounds to enhance the services we provide to our clients. We presently have staff fluent in Spanish, Hindi, Punjabi and French and several African languages. Multi language fluency is always a consideration when hiring staff and recruiting volunteers, and wage differentials are given to those fluent in Spanish, Cantonese, Mandarin, Russian, Hindi or Tagolog. All of the written materials at Shiloh are in both English and Spanish, and some are in Chinese. We make sure that at Shiloh we have cooking utensils and dishes that are multi -culturally appropriate such as rice cookers, chopsticks, and new sets of pots and pans for Muslim clients whose religious practice requires that these not be shared with other families. Ethnic food is available for our shelter clients at the Food Pantry and grocery store gift cards are available to assist with purchasing items that aren't at the pantry. We continue educating our staff through participation in the Cultural Competence development projects. TVH staff maintains a good working relationship with CRIL, a local service provider for persons with disabilities and also is aware of key services such transportation for persons with disabilities and how to access them. Telephone screenings and intake processes include questions about needed accommodations (such as a bottom bunk, private room or special dietary needs). Our shelter is handicap -accessible. We conduct restraining order clinics at the Dublin library on the first and third Saturday of each month, which has increased our overall visibility in addition to making this service more accessible to those Dublin residents who need it. We conduct annual briefings at Dublin Police Services to update them about issues of domestic violence, sexual assault and homelessness, and our agency's activities. In addition, we ask all new staff and volunteers who attend our 70- hour domestic violence and sexual assault counselor training to ride along with one of the three Tri-Valley police departments in order to maintain a strong connection to local law enforcement. Officers regularly tell us during the annual briefings that this is a positive experience for them. We have participated for many years in the Family Violence Prevention Programs at Kaiser Permanente in Livermore and Pleasanton, and in November participated in the kick off meeting of their Family Violence Prevention Program. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE. Please contact City staff immediately if you have any questions regarding Davis -Bacon requirements. r- Not Applicable F Yes No 12. ** QUESTIONS 13 THROUGH 25 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, check box here and answer questions 29 through 41. No. If no, check box here and enter Don't know. If you are unsure, please call City staff at (925) 833-6645. 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. 14. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: F Be culturally accessible, appropriate and inclusive F Encourage community engagement and involvement Promote energy and resource efficiency F Encourage networking and information sharing across service providers f— Encourage process streamlining Consolidate service delivery ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. F *Promote fair housing and reduce housing discrimination. r B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under -insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. F E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. ✓ F) Not Applicable. I am not interested in qualifying for CDBG funding. 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: Increase homeownership F Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing F Promote participation of grass -roots, faith -based, and other community -based organizations ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 17. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: F Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. F Participation of minority -serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 18. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: r Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. J Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. F Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter -jurisdictional cooperation to achieve housing and homeless needs. r Increase the availability of service -enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 19. CDBG ONLY - Select one HUD Objective that relates to your project: (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address?') Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 20. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am / seeking?') r Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. 21. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. F Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of, affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. r Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. L Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee - sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. i Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer -sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. r Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 22. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) r- Persons Households ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. if none, please enter "0". 0 Disabled Women/Female Headed Households _ Seniors 0( Youth —�O Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) u CI t U TOTAL �-717 24. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ('AMP) information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 0 Low Income 50%-80%AMI - -- _ _ --- --- ( ) Vi Extremely Low Income (<30% AM[) N)A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0 00 1 TOTAL 25. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" 0 White ( vl White + HISPANIC ._. 0 Black/African American 0 Black/African American +HISPANIC 0 Asian 0 Asian + HISPANIC 0 American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC �— 0 Native Hawaiian/Other Pacific Islander _ Oj Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White 01 American Indian/ Alaskan Native and White + HISPANIC 0 Asian and White 01 Asian and White + HISPANIC ( 0 Black/African American and White 0 Black/African American and White + HISPANIC 0 American Indian/Alaskan Native and Black/African American 0 American Indian/Alaskan Native and Black/African American + HISPANIC 0; Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) I 0,00 TOTAL 26. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY r #1 - This program/project has the agency's highest priority for funding. 42 - This program/project has the agency's 2nd highest priority for funding. F #3 - This program/project has the agency's 3rd highest priority for funding. 44 - This program/project has the agency's 4th highest priority for funding. #5 - This program/project has the agency's 5th highest priority for funding. 17- 46 - This program/project has the agency's 6th highest priority for funding. r- If you have more than 6 applications per organization, agency, district or entity, check here. Funding Sources/Revenues Budget Amount Amount Committed Alameda County Domestic Violence Center Act $ 44,943.00 $ 0.00 Alameda County Family Justice Center $ 10,000.00 $ 0.00 Local/Dublin/Pleasanton/Livermore $ 61,974.00 $ 0.00 HCD Linkages $ 40,577.00 $ 0.00 CalOES DV $ 530,148.00 $ 0.00 CalWORKS $ 70,000.00 $ 0.00 Foundations $ 40,000.00 $ 40,000.00 Alameda CountySSA $ 33,033.00 $ 0.00 Total $ 830,675.00 $ 40,000.00 Funding Uses/Expenses Salaries Benefits Supplies Printing/Copying Telephone Rent and Utilities Accounting/Audit - Other Total Budget Amount Amount Committed $ 517,650.00 $ 34,050.00 $ 155,295.00 $ 5,950.00 $ 35,000.00 $ 0.00 $ 5,000.00 $ 0.00 $ 15,732.00 $ 0.00 $ 58,065.00 $ 0.00 $ 11,000.00 $ 0.00 $ 32,933.00 $ 0.00 $ 830,675.00 $ 40,000.00 Budget Narrative Revenue: The composition of revenue is our best estimate based on the previous year of operation. Expenses: personnel costs include salaries and benefits. Sick leave, vacation, and holidays are not included in the benefits calculation for staff that will be paid with the Dublin grant funds. Other operating expenses include:travel and mileage, portion of liability, property, D&O, and auto insurance, auto expense, and staff development. Domestic Violence Services budget is part of the overall agency budget that includes other programs and departments such as Homeless and Family Support Services, Sexual Assault Services, Finance, and Administration. thus only a portion of liability insurance, auto insurance, audit etc. are being charged to this program. Documents LQ2 Documents Requested * Required? Attached Documents Program Expense Budget for ALL Grant Requests V Program Expense Budget download template Financial Information Form for ALL Grant Requests V Financial Information download template List of Board of Directors (or governing body) with V Board of Directors agency contact information Current Annual Budget for the Entire Agency V Annual Budget Copy of most recently submitted IRS 990 form or Tax V IRS 990 Return (include complete form) Board of Director's (or governing body's) designation t/ BOD Resolution and Ault grit of authorized official Board of Director's (or governing body's) authorization t/ BO-D Resolution and Authority to request funding (may be same document as one above) Proof of insurance carried, including bonding, liability 6/ insurance and/or workers' compensation STATE AND FEDERAL NON-PROFIT V Non-profit Status. DETERMINATION LETTER. All organizations MUST State Non Profit Status. have approved non-profit status from the State of California and Federal Tax Identification Number at time of application. Non -compliant applicants will be disqualified. Certified Audit and/or Certified Financial Statements V Audit Part I Audit Part 2 Audit Part 3 REQUIRED FOR CDBG ONLY - If requesting Capital Funding, please upload your Capital expenditure budget (your own format is acceptable) REQUIRED FOR CDBG ONLY - Personnel Policies Including Affirmative Action Plan and Grievance Procedure REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) REQUIRED FOR CDBG ONLY - AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP). Must include outreach to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used. REQUIRED FOR CDBG ONLY - LEVERAGING REPORT —this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Strategic Plan Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) * ZoomGrantsTM is not responsible for the content of uploaded documents. Application ID: 156500 Become a fan of ZoomGrantOl on Facebook Problems? Contact us at Questions (a?ZoomGranls.com ©2002-2020 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoonnGrants logo are trademarks of GrantAnalyst.com, LLC. Loqout I Browser �City of Dublin 2020-2021 Human Services Grant Progr=arn .1,111.3/2020 deadline Tri-Vall y Raven Homeless Services jmplo; Organization Information Questions Budget Documents $_25,QOO.00 Requested Submitted: 1 /1012020 2:03:50 PM Project Contact Cynthia Cunningham Morales L fyntI:ia@Livalleyiaven.org _ _ Tel: 925) 449-5845 Additional Contacts irinp@b �triyalley aven.org,, - r_aIph@Lr_ivalleYhavLe--narg 1. Business License Number BL-007058 Tri-Valley Raven 3663 Pacific Avenue Livermore,CA 94550 United States Executive Director Ann King 2nr@L h -) rivalley aven.org 1. Select the category that best describes your organization: (Select only onej Non -Profit Public Agency IgLephone(925) 449-5845 x Fax (925) 449-2684 x Web www.trivalleyhaven.Qrg Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Tri-Valley Haven creates homes safe from abuse, contributes to a more peaceful society. One person, one family, one community at a time. Together we build a world without violence. 3. Select the category that best describes the project: (Select only one.) Capital Project ✓ Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes ✓ No S. Is this request for one-time, seed or operational funding? One-time funding Seed funding One-time and Seed funding ✓ Operational funding —' None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Funding will support TVH's Homeless and Family Support Services programs. TVH's family shelter, Sojourner House, provides homeless clients with support services while the Food Pantry (FP) provides nutritious food to low income & homeless Tri-Valley residents. Sojourner House will continue to provide homeless clients (women, women with children, two parent families with children, men with children) with shelter and support services to help them to overcome the barriers that led to their homelessness and to assist them in securing stable housing. Program participants are offered up to six months shelter residency. Shelter clients are provided case management, life skills classes, parenting groups and counseling services. The FP will continue to provide food.to low income, homeless, and "at risk of becoming homeless" Tri-Valley residents. On the second Friday of each month our Mobile Food Pantry distributes USDA items, meat and produce at three housing complexes in Dublin: Wexford and Carlow Court Apartments and Wicklow Sqare. The FP receives food through the Alameda County Community Food Bank, participation in the local Grocery Rescue program and membership in the FEED TRI-VALLEY (Give Local/Stay Local) project. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 425 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application- Requirements-Process L] Behavioral Health (mental health and substance abuse) Affordable Housing [] Health Care (including dental) i | Workforce Development wy Homelessness |�] Transportation Services and Access wy Domestic Violence and Child Abuse i | Disabilities %/ Food and Nutrition ij Senior Services |�) Youth Services [� Child Care, Early Childhood Development and Education [] Changing Demographics and Growing Diversity L| Financial Assistance None of the Above Please explain: 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. Ufcapital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds beused fhr?) The funds requested from Dublin will be used to pay a portion of the time of the following positions: a) Sojourner House Case Manager and b) Food Pantry Coordinator. VVeutilize multiple funding sources tosupport the staff positions and operating costs atboth Sojourner and the FP. The staffing atboth programs is sufficient to meet and exceed the anticipated results. The FP relies on a large number of volunteers to address the collection, sorting, shelving and distribution of food to clients, aswell asthe implementation ofthe Mobile Food Pantry. l0LPlease list and briefly describe the outcome measures that are crucial to the success wf this project. What strategies or objectives will your agency use twtrack the progress mfmeeting the outcome(m) This should include the population your agency anticipates serving, how this project ia culturally appropriate, and how Ummpcmmne'ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. The success ofthe Sojourner Housevvi||berneasuredthroughstatistica}resu|tsandthe|ndividua|gna|sset by the program participant and their case manager. Examples of those goals will include: a resident gaining employment, a family transitioning into a permanent living and feeling confident that it will be able to keep it, a family obtaining medical insurance etc. Long-term self-sufficiency achieved by a client would be a success. The population that we anticipate serving at S'ournerHnusevvi||cont|nuetnbedrasdca||y different from the population served in previous years. This is due to the County mandated Coordinated Entry System ([ES)which was initiated atSojourner HouseinDecennberZ018.|npreviousyearsTVHstaff provided screening for all its potential clients. With the [ES all potential clients gothrough an assessment process with a HUB agency. In the Tri-Valley Area the HUB agency is Abode. The more vulnerable the individual the higher the score, TVH contacts Abode when there are openings. Outreach is then provided by their staff. During the past year we have experienced a higher rate of individuals with mental health and/or substance abuse issues, conflicts arising between clients and a resistance to comply with shelter guidelines and expectations. Sojourner House and Food Pantry clients are almost exclusively extremely low through low income single parents with their children, two parent families, single women, disabled individuals and seniors. Clients will also benefit from our Food Pantry by receiving free groceries that in many cases they can't afford. Our clients in Dublin, most of them being seniors, will be getting their food from our Mobile Food Pantry, meaning that the transportation issues will be minimized. In FY 1819 Sojourner served 72 unduplicated clients, providing 5,177 bed nights, and the Food Pantry served 5,386 unduplicated clients. Statistics are maintained on the agency's O-Soft database which include individuals served at each program and services provided. We have multi -cultural staff members and volunteers who utilize their cultural backgrounds to enhance the services in the homeless program. We presently have multiple staff fluent in Spanish, Russian, Hindi, Punjabi, and French. Multi language fluency is always a consideration when hiring staff and recruiting volunteers. All of the Sojourner House and Food Pantry intake forms, paperwork and flyers are in English and Spanish, and some are in Chinese. We make sure that we have cooking utensils and dishes that are multi -culturally appropriate such as rice cookers, chopsticks, etc. Our Food Pantry has a capacity to offer ethnic food when needed. Every year our Holiday Program for low-income families from the Tri-Valley area brings new participants and spreads the word about our services. 160 Dublin residents participated in our 2019 Holiday Program. TVH staff maintains a good working relationship with CRIL, a local service provider for persons with disabilities and also is aware of key services such transportation for persons with disabilities and how to access them. Sojourner House was remodeled before it was opened in 2002 to include a ramp and a handicap accessible bathroom. Our Food Pantry has a portable ramp when needed. There are many ways we outreach to Dublin residents. Together with the Cities of Dublin, Livermore, and Pleasanton, Open Heart Kitchen and Interfaith Sharing, Tri-Valley Haven participates annually in FEED TRI- VALLEY. The mission of FEED TRI-VALLEY is to end hunger by educating and soliciting donations to feed our local community. We also participated in the Dublin Pride week and shared our programs and volunteer needs with the community through brochures and presentations. We have expanded our services to Dublin residents by bringing our Mobile Food Pantry to now three housing complexes in Dublin every second Friday of the month providing groceries to 70-80 residents, mostly seniors. In addition, we regularly conduct presentations to the Dublin Police Services on Domestic Violence, Sexual Assault and Homelessness issues and the programs that Tri-Valley Haven offers. Our Community Education Program reaches 2,454 students through Health Education classes that we teach in Dublin High School covering topics such as healthy relationships and teen dating violence. 11. If your agency is requesting Capital funding, will this project require implementation of Davis- Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately ifyou have any questions regarding Davis -Bacon requirements. ✓ Not Applicable Yes -' No 12. ** QUESTIONS 13 THROUGH 25 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? ✓ Yes. If so, check box here and answer questions 29 through 41. No. If no, check box here and enter —' Don't know. If you are unsure, please call City staff at (925) 833-6645. 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail Please enter "NIA "ifyou are not interested in qualifying for CDBG funding. NH is committed to providing services to limited English speaking clients. We presently have multiple staff fluent in Spanish. Additionally staff is available to provide assistance in Russian, Punjabi, Hindi, French, and Finnish. We seek out bilingual/bicultural staff, and provide a wage differential for those that speak Spanish. At Sojourner House and the Food Pantry we offer the use of Alameda County Social Services Agency's Language Line Solutions service for clients to access an on -demand interpreter. In Dublin, our largest LEP client group is Chinese -speaking. We make sure that our intake forms for the mobile food pantry are available in Chinese. In addition most flyers, client materials and other communications are created in both English and Spanish. We produce and distribute documents in other languages when available. 14. CDBG ONLY r; Consolidated project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency ®/ Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG funding. 1. CDBG ONLY e Identify at least HUD Consolidated Plan Goal that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: %/ *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under - insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. F) Not Applicable. I am not interested in qualifying for CDBG funding. 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing ✓ Strengthen communities Ensure equal opportunity in housing ✓ Promote participation of grass -roots, faith -based, and other community -based organizations - Not Applicable. I am not interested in qualifying for CDBG funding. 17. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. ✓ Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority -serving institutions in HUD programs. ✓ End chronic homelessness within ten years. ✓ Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG funding. 18. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. ✓ Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. ✓ Maintain and expand activities designed to prevent those currently housed from becoming homeless. - Build on inter -jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service -enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG funding. 19. CDBG ONLY - Select one HUD Objective that relates to your project: (TIP. When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that l am seeking to address?') ✓ Creating a Suitable Living Environment 1 Providing Decent Affordable Housing Creating Economic Opportunities Not Applicable. I am not interested in qualifying for CDBG funding. 20. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am l seeking?') Availability/Accessibility Affordability ✓ Sustainability Not Applicable. I am not interested in qualifying for CDBG funding. Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. ". Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. --! Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee -sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number otjobs with employer -sponsored health care benefits, and the types otjobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 22. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) ✓ Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 35 Disabled 120E Women/Female Headed Households 2251 Seniors 01 Youth 25; Homeless - Ol Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 405.0d TOTAL 24. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ('AMl'j information is available online at www.dublin.ca.govll956/Application- Requirements-Process _-- - — 25{ Low Income (50%-80% AMI) 4001 Extremely Low Income (<30%AMI) =_ - 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) ---- 425 00' TOTAL 25. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" 100j White i - 01 White + HISPANIC 50 Black/African American 1 Black/African American + HISPANIC j 200` Asian 01 Asian + HISPANIC 511 American Indian/Alaskan Native 01, American Indian/Alaskan Native + HISPANIC 51 Native Hawaiian/Other Pacific Islander 01 Native Hawaiian/Other Pacific Islander + HISPANIC 01 American Indian/ Alaskan Native and White 01 American Indian/ Alaskan Native and White HISPANIC 01 Asian and White Asian and White + HISPANIC 01, Black/African American and White 0, Black/African American and White + HISPANIC '0 American Indian/Alaskan Native and Black/African American 01 American Indian/Alaskan Native and Black/African American + HISPANIC 651 Multi Racial + HISPANIC OR other Multi Racial 01, Not Applicable. I am not interested in qualifying for CIDBG funding. (Type N/A) 425.001 TOTAL 26. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY %/ #1 - This program/project has the agency's highest priority for funding. #2 - This program/project has the agency's 2nd highest priority for funding. #3 - This program/project has the agency's 3rd highest priority for funding. #4 - This program/project has the agency's 4th highest priority for funding. #5 - This program/project has the agency's 5th highest priority for funding. #6 - This program/project has the agency's 6th highest priority for funding. If you have more than 6 applications per organization, agency, district or entity, check here. I:rm M-ama .Funding _$Q_Vrc g$,IRevenues Alameda County SSA HCD Linkages Local/Dublin/Pleasanton/Livermore Individual Donations/Foundations EFSP Alameda County IESG Total Budget Amount 212,693.00 $ 40,577.00 98,449.00 1j21000.00 $-U,500.00 $97601.00 $-49U-ZU-0 Amount Committed $-0-00 0.00 $-Q---00 $-0.00 1-9m $97,601.00 $-97M1,0-0. F , -4-ing.,V,$g;s9xpgMPA Budget Amount Amount Committed Salaries L286,934.00 I 46,241.00 Benefits 84,876.00 $,8160.00 Supplies $29,280.00 17,280.00 Printing/Copying $-1,20-0.00 $-0---00 Telephone 8,250.00 0.00 - Rent and Utilities U2,100.00 0 00 co Acunting/Audit - $_3,260.00 _ 0. 00 Other $72,920.00- 25,920.00 Total 488,820.00 �,601.00 Budget Narrative Revenue: The composition of revenue is our best estimate based on the previous year of operation and also -includes a.,_ contract ,from WAlameda eCou,ntyESG which began 1/1/2020.. Expenses: personnel costs include salaries and benefits. Sick leave, vacation, and holidays are not included in the benefits calculation for staff that will be paid with the Dublin grant funds. Other operating expenses include:travel and mileage,aportion of liability.,®property,, D&O, and auto insurance,, auto expense, staff development, and client assistance. The Homeless Services,,_budget is,,,pa.rt..of„the overall agency,budget that, Includes Other„p,rograms,.and departments such as Domestic Violence„ Services,, Sexual Assault Services, Finance, and Administration. thus only a port onof liability insurance, auto insurance, audit etc. are being charged to this program. Documents Lop D.ocume,n,ts..,.Reauested„_* Required?Attac,hed.,,,,,Docume,nts *. Program,,Expe.ns.e.B.udget.for_AL.L,_G.r..apt ./ Program Expense Budget_ Requests download template Financial Information Form for ALL Grant Requests . dowload_template List of Board of Directors (orgoverning body,) with agency„_contact information Current Annual Budget for the Entire Agency Copy of most recently submitted JRS 990 form or Tax Return (include complete form), Bo_ard.of.Director's (or,governing body's) designation of authorized official Board of Director's or governing body's) authorization to request funding..(may_be. same.,_ document as one above) Proof of insurance carried, including bonding,, liability and/or workers' compensation STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number of, ap.p ... .,licati.on,, No.n-co,mplia,nt,_,ap,p,lica.ntswill ,be disqualified.. - Certified Audit and/or Certified Financial Financial Information Board of Directors Annual Budget IRS 990 BOD Resolution and Authority. OD Resolution and Authority Insurance Non-profit Status State Non -Profit Status �/ Audit Part Statements Audit Part 2 Audit Part 3 REQUIRED FOR CDBG ONLY - If requesting Capital Funding, -please upload your Capital expenditure buclget (yourownformat is acceptable) REQUIRED FOR CDBG ONLY - Personnel Personnel Policies Policies Including Affirmative Action Plan and Grievance Procedure REQUIRED FOR CDBG ONLY - Agency Audit Audit Requirement Requirements and CopyofLast Audit Highlighting "Findings" Section IRED FOR CDBG ONLY - Articles,, of By -Laws.. Incorporation and Bylaws Articles of Incorporation REQUIRED FOR CDBG ONLY - Conflict of By -Laws Interest Statement (if not included in Bylaws) _ REQUIRED FOR CDBG ONLY - AGENCY'S LEP Access Plan LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN LEP/LAP). Must include outreach to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used. REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this is due with the 2nd quarter Supporting Documents such as Agency Strategic Plan Strategic_ Plan, Needs Assessment,, etc. (Not Other Supporting Documents Not Required) ZoomGrants' is not responsible for the content of uploaded documents, Appjic-qtiorj IPJ556031 Become a fan of ZoomGrants- on Facelbook Problems? Contact us at _Questions@ZoomGrants.com @2002-2020 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Loggut I Browser City of D u bI i r! 2020-2021 Human Services Grant Program Deadline: 1/13/2020 valley iWrerVs Museum Elay • STEA Jump to: Organization Information Questions Budget Documents $ 6,000.00 Requested Submitted: 1/13/2020 9:52:37 AM (Pacific)_ Project Contact Edward Duarte inLo@yalleychildrensmuseum.org Tel; _(225)_998-1151 Additional Contacts none entered Ygfty Ch�lldrefV�s Museum Lelephone(925) 786-2833 P.O. Box 2102 Fax Dublin, CA 94568 Web https://www.vallevchildrensmuseum.org/ President Edward "Ed" Duarte eddieross57 1. Business License Number 1. Select the category that best describes your organization: (Select only one.) Non -Profit Public Agency Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). The Valley Children's Museum (VCM) mission is to engage children's intellectual curiosity and nurture their social, emotional and cognitive development through the wonders of creative play and hands-on education. 3. Select the category that best describes the project: (Select only one.) Capital Project ✓ Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. Yes ✓ No S. Is this request for one-time, seed or operational funding? One-time funding Seed funding —' One-time and Seed funding ✓ Operational funding None 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Valley Children's Museum currently provides children ages 0-12 in the Tri-Valley area an opportunity to explore science, math and engineering concepts through a play -based approach. All play based STEAM programming is aligned with both the Next Generation Science Standards and Common Core Science standards. This non- traditional, unmediated approach allows learners to participate in open-ended exploration that supports K-12 public school achievement. Participants are exposed to an evidence based three-dimensional learning experience in their local community. The K-12 public school funding environment is experiencing shrinking resources that limit STEAM -focused field trips and hands on content instruction. In contrast, Valley Children's Museum allows children to achieve a deep knowledge of concepts through their own self -directed exploration in a non-academic setting. As they engage in self -directed play with interactive manipulatives, they acquire STEAM vocabulary and concepts and exercise their creativity. In essence, the children guide their own learning. All of this is achieved without the use of worksheets or the direct instruction of adults. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 7/1/18- 6/30/19 Attendance at Super Saturday/Farmer's Market events adults & kids= 4573. Attendance at City festivals Eggstravaganza, Splatter= 1644. Approx. 100 high school & adult corporate/non profit organization volunteers. 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin,ca.gov/1956/Application-Requirements- Process Behavioral Health (mental health and substance abuse) Affordable Housing Health Care (including dental) ✓ Workforce Development —' Homelessness Transportation Services and Access Domestic Violence and Child Abuse [] Disabilities | ] Food and Nutrition [] Senior Services Youth Services *' Child Care, Early Childhood Development and Education |_| Changing Demographics and Growing Diversity [� Financial Assistance [] None of the Above Please explain: 9. Describe indetail how Dublin grant funds will beused for this project. In this what measures are taken tmensure this project iocost effective, and how the budget meets the needs mfthe anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds beused for?) If successful in receiving the requested Dublin grant, Valley Children's Museum (VCM) will use the funds to continue a play based STEAM programming initiative that has been proven to be both popular and effective. This program occurs seasonally Thursdays in conjunction with the Dublin Farmers Market. The program is also offered one Saturday a month. At these sessions, up to 100 adults and children participate in meaningful STEAM -centric play and exploration. Past programs have included themes such as: the 50th Anniversary of the Lunar Landing, The Great Camp Out,UnderThe Sea and P|antaat|c. In spring 2019, VCM hired a creclentialed teacher as the Program Coordinator to design all activities. All play based STEAM curriculum are aligned with both the Next Generation Science Standards and Common Core Science standards, The funding will be used for materials, program design and implementation and outreach. Interactive technology exhibits and manipulative learning tools will be purchased to enable children to discover through their own exploration. |norder tobecost effective, all activities are prepared and supervised by teen volunteers. Adult volunteers from the National Charity League or local companies assist in the set up and clean up of equipment, and collect entry admissions. Materials and supplies are purchased in bulk and re -used as much as possible, In kind donations are pursued and used for project suppli es, Periodic reviews of operations are conducted to analyze potential reductions in overhead expenditures. As a result, in 2019, off site storage of supplies and equipment was consolidated from the rental of two smaller storage units to one larger unit to save monthly rent. Current VCM marketing efforts are cost free. The anticipated results are that children will learn science, technology, engineering, art and math concepts inafun, unstructunad'hoUsticnoannecForexamp|e.the"Up'UpandAway"thennedprograminSeptemberofferedchi|dnen the opportunity tomake hot air balloons, glider airplanes, and DIY barometers. Teen mentors explained the underlying science concepts while children built their own gadgets using everyday materials such as cardboard, glue, straws, and household liquids. Participants were exposed toabstract ideas while making practical use of their motor and model building skills. In a typical school setting, this kind of extensive,one onone learning isnot possible, Funding to VCM also has a significant positive impact on the community by providing a venue for families tosupport the education oftheir children and enjoy |earninXtogether. 10. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)?This should include the population your agency anticipates serving, how this project Umculturally appropriate, and how lom-cmmme.ESL persons, and/or disabled persons will access this project. Bemuretoindudmyour agencies marketing and outreach strategies and efforts. The outcome measure crucial to the success of the project is increased attendance of children. The impact of this grant can be measured and verified through our attendance database and revenues from admission ticket sales. We anticipate our attendance figures will first remain stable at current levels and then grow in response to expanded marketing and programming inthe coming year. VCM intentionally strives to serve the diverse population of the Tri Valley and beyond. The admission price is currently $5 per child and $2 for additional child. Families who receive CalFresh benefits are eligible for a reduced admission price of $2 per family. Children under 3 and adults are always free. VCM's site at the centrally located Emerald Glen Park, with ample free parking, further reduces the cost burden on families. The museum has installed a specially equipped ADA compliant access lift for visitors with disabilities. Our play -based approach allows children with disabilities the freedom to explore STEAM concepts on their own terms. Suggested directions for activities are visually based and not dependent on English language skills. VCM's Teen Leadership Council volunteers are representative of the diverse local population. They possess the basic foreign language skills to welcome and assist ESL visitors. Marketing of VCM events is achieved through a comprehensive approach. This effort consists of: an organizational website which is updated regularly; monthly newsletters to its database of visitors, donors, and supporters; postings on social media such as Facebook, Twitter, NextDoor; postings on local news outlets such as The Patch, Bay Area Parent, Eventbrite; and notices in print edition newspaper such as The Independent. VCM does outreach by hosting activity booths at local festivals such as the City of Dublin's St Patrick's Day, Splatter, and Eggstravaganza events. Future marketing plans consist of expanding outreach efforts at festivals in neighboring Tri Valley cities and exploring targeted paid advertising. Marketing efforts always include images that reflect the diversity of the VCM target audience. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE., Please contact City staff immediately ifyou have any questions regarding Davis -Bacon requirements. J Not Applicable - Yes No 12. ** QUESTIONS 13 THROUGH 25 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? Yes. If so, check box here and answer questions 29 through 41. J No. If no, check box here and enter Don't know. If you are unsure, please call City staff at (925) 833-6645. 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail Please enter "N/A" ifyou are not interested in qualifying for CDBG funding. N/A 14. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service providers Encourage process streamlining Consolidate service delivery ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. *Preserve and increase affordable rental housing opportunities for low and moderate income households. *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low-income, uninsured and under -insured residents with emphasis on activities that: * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low- income and underserved populations. F) Not Applicable. I am not interested in qualifying for CDBG funding. 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass -roots, faith -based, and other community -based organizations Not Applicable. I am not interested in qualifying for CDBG funding. 17. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate -income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority -serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. J Not Applicable. I am not interested in qualifying for CDBG funding. 18. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. Build on inter -jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service -enriched housing for persons with special needs. ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 19. CDBG ONLY - Select one HUD Objective that relates to your project: (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that l am seeking to address?') Creating a Suitable Living Environment Providing Decent Affordable Housing Creating Economic Opportunities ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 20. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am l seeking?') Availability/Accessibility Affordability Sustainability ✓ Not Applicable. I am not interested in qualifying for CDBG funding. 21. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. -- Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate -income persons and households served, slum/blight demolition, number of acres of brownfields remediated, etc. in a targeted area. Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied bythe elderly, and those units designated for chronically homeless persons and persons with HIV/AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with. H IWAI DS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and/or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied bythe elderly, number of units designated for persons with HIV/AIDS, and number of units for the chronically homeless. J Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIWAIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short-term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee - sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer -sponsored health care benefits, and the types of jobs retained (using EDA classifications) Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. ---'! Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. Not Applicable. I am not interested in qualifying for CDBG funding. 22. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) --' Persons Households Not Applicable. I am not interested in qualifying for CDBG funding. 23. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Disabled Women/Female Headed Households Seniors - -- Youth ( Homeless - — - N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) TOTAL 24. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ('AM/') information is available online at www.dublin.ca.govII956/Application-Requirements- Process - Low Income (50%-80% AMI) Extremely Low Income (<30%AMI) N/Al Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00J TOTAL 25. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above, if none, please enter "0" White - _ White + HISPANIC Black/African American — Black/African American + HISPANIC - _ J Asian Asian + HISPANIC American Indian/Alaskan Native 3 American Indian/Alaskan Native + HISPANIC - Native Hawaiian/Other Pacific Islander _ Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC - —� Asian and White _ Asian and White + HISPANIC �..--- ................ -� Black/African American and White Black/African American and White + HISPANIC - American Indian/Alaskan Native and Black/African American I - American Indian/Alaskan Native and Black/African American + HISPANIC .. _. .............. ._. ................... -- Multi Racial + HISPANIC OR other Multi Racial N/Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.00 TOTAL 26. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY ✓ #1 - This program/project has the agency's highest priority for funding. #2 - This program/project has the agency's 2nd highest priority for funding. #3 - This program/project has the agency's 3rd highest priority for funding. -' #4 - This program/project has the agency's 4th highest priority for funding. #5 - This program/project has the agency's 5th highest priority for funding. #6 -This program/project has the agency's 6th highest priority for funding. -' If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding,Sou rces/Revenues Program.._ a_dmission_fees PG&E grant EBCC grant Safeway grant Other grants Individual__gifts LLNS_grant Budget Amount $ 19,500.00 1-5,000.00 $2,500.00 $ 22,300.00 $ 15,000.00 12,000„00 2,500.00. Amount Committed $. 19,500.00 5,000.00 122,500.00 $ 2,300.00 .$ 2,500.00 Sandia exhibit grant _t 7 7,500.00 Tota 1 -$-66,300.00 $39,300.00 Funding Uses/Expenses Budget Amount Amount Committed Program Director contract fees $24,000.00 _$24,000.00 Museum Op rations Director contract fees 7,200.00 $7,200.00 P.L9gg_Msu_ pplies es 7200.00 , J7__200.00 Advertising $4,000-00 14,000.00 Printing $ 900.00 900.0 Program equipment JA,000.00 $ 4,000.00 Rentofstorage unit, utilities $185/month t2,220.00 $2,220.00 Museum insurance L4,800.00 $4,800.00 Total $-_ 4�,320.00 -$..54,12 Q0 A Q Audget Narrative VCM is funded by grants from local organizations, corporate and individual donors, and paid admissions. Play based STEAM-piogramming is the core focus of the budget.,_ Operatingexpensesinclude: ntin _r:p igLc g, — -qpyin- -rent and utilities, insurance, and contracted services of Program Director and Museum Operations Director. Both adult and teen volunteers contribute their time and talents to the core operations of VCM. The grant funds from the City of Dublin will be used for sup project lies which are reusable, educational -p manipuLlatives such as Robotics/coding kit, Light Up Math activity centers, Healthy Heart & Brains kit. Targeted paid advertising will be on social media such as Facebook and in school newsletters such as Peachjar. Programming -equipment includes: a shed for outdoor "Imagination BIocks",-p-Qp-qp-canopies to allow for outdoor activity centers, and a printer, �. Mf Documents- Requested Required? Attached Documents* Program Ex Requests R Budget Req=-- Program Expense Budget j— download template Financial Information Form for ALL Grant Requests download template — List of Board of Directors (Q[_governing body), with agency contact information Current Annual Budget for the Entire Agency Financial Information Form Board of Directors Current annual budget Copy of most recently submitted IRS 990 form or IRS 990 Tax Return (include complete form) Board of Director's (or governing body's) Designated repfor VCM designation of authorized official Board of Director's or governing body's) I BOD funding authorization request funding -(maybe same document as one above) Proof of insurance carried, including bonding, I Insurance liability and/or workers' compensation STATE AND FEDERAL NON-PROFIT Non profit letter DETERMINATION LETTER. All organizations MUST Non profit letter 2 have approved non-profit status from the State of California and Federal Tax Identification Number at time of application. Non -compliant appligLts,will be disqualified_ Certified Audit and/or Certified Financial Statements - REQUIRED FOR CDBG ONLY - If requesting Capital Funding,_please upioad..°your Capital expenditure budget (your own format is acceptable) REQUIRED FOR CDBG ONLY- Personnel Policies Including Affirmative Action Plan and Grievance Procedure REQUIRED, FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting_"Findi_ngs" Section REQUIRED FOR CDBG ONLY -Articles of Incorporation and Bylaws REQUIRED FOR CDBG ONLY - Conflict of Interest Statement fff.flpt included.,in Bylaws) REQUIRED FOR CDBG ONLY -AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP). Must include outreach to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used. ----------- REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this ...i_s_due with the 2nd quarter report no later than January 15th S.u,pport nng Documents such as Agency Strategic Plan, Needs Assessment,, etc. (Not Required) Qther Su,pportingot Req _Documents_,(Nuired) V/ Financial statements *ZoomGrants is not responsible for the content of uploaded documents. Application ID: 155819 Become a fan of ZoomGrants' on Facebook Problems? Contact us at Questions@ZoomGrants.com 02002-2020 GrantAnalyst.com. All.rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. LogoutI Browser