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03-28-2019 HSC Agenda Packet
March 28, 2019 Dublin Human Services Commission AgendaPage 1 of 2 SPECIAL MEETING Thursday, March 28, 2019, 5:30 PM Dublin Civic Center, 100 Civic Plaza DUBLIN HUMAN SERVICES COMMISSION REVISED A G E N D A • Agendas and Staff Reports are posted on the City’s Internet Website (www.dublin.ca.gov) • A complete packet of information containing Staff Reports and exhibits relate to each item is available of public review at least 72 hours prior to a Human Services Commission Meeting or, in the event that it is delivered to Human Services Commission members less than 72 hours prior to a Human Services Commission Meeting, as soon as it is so delivered. SPECIAL MEETING 5:30 PM 1. CALL TO ORDER 2. PLEDGE OF ALLEGIANCE 3. ORAL COMMUNICATIONS 3.1. Public Comment At this time, the public is permitted to address the Human Services Commission on non-agendized items. Please step to the podium and clearly state your name for the record. COMMENTS SHOULD NOT EXCEED THREE (3) MINUTES. In accordance with State Law, no action or discussion may take place on any item not appearing on the posted agenda. The Human Services Commission may respond to statements made or questions asked, or may request Staff to report back at a future meeting concerning the matter. Any member of the public may contact the Recording Secretary’s Office related to the proper procedure to place an item on a future Human Services Commission agenda. The exceptions under which the Human Services Commission MAY discuss and/or take action on items not appearing on the agenda are contained in Government Code Section 54954.2(b)(1)(2)(3). 4. CONSENT CALENDAR Consent Calendar items are typically non-controversial in nature and are considered for approval by the Human Services Commission with one single action. Members of the audience, Staff or the Human Services Commission who would like an item removed from the Consent Calendar for purposes of public input may request the Chair to remove the item. 4.1. Minutes of the January 24, 2019 Meeting The Commission will consider approval of the January 24, 2019 meeting minutes. STAFF RECOMMENDATION: Approve the January 24, 2019 meeting minutes. 5. NEW BUSINESS 5.1. Human Services Grant Program Recommendations for Fiscal Year 2019-20 On an annual basis, the Human Services Commission reviews Human Services Grants Program applications for the upcoming Fiscal Year. The Commission will receive presentations from staff and the community non-profit organizations applying for grant program funding; discuss the grant applications; review Staff’s recommendations and make funding recommendations to the City Council. STAFF RECOMMENDATION: Receive Staff recommendation on funding levels, receive organization presentations, deliberate, and make funding recommendations to the City Council for their March 28, 2019 Dublin Human Services Commission Agenda Page 2 of 2 consideration at the April 16, 2019 City Council meeting. At this meeting, all applicants are required to give a brief presentation to the Commission. The order of the presentations is based on the date and time that the completed application was submitted. Attachment 5 provides a chart listing the order in which applications will be presented, along with each grant application. 6. OTHER BUSINESS Brief information only reports from City Council and/or Staff, including committee reports and reports by City Council related to meetings attended at City expense (AB1234). 7. ADJOURNMENT This AGENDA is posted in accordance with Government Code Section 54954.2(a) If requested, pursuant to Government Code Section 54953.2, this agenda shall be made available in appropriate alternative formats to persons with a disability, as required by Section 202 of the Americans with Disabilities Act of 1990 (42 U.S.C. Section 12132), and the federal rules and regulations adopted in implementation thereof. To make a request for disability-related modification or accommodation, please contact the City Clerk’s Office (925) 833 - 6650 at least 72 hours in advance of the meeting. Mission The City of Dublin promotes and supports a high quality of life, ensures a safe and secure environment, and fosters new opportunities. Vision Dublin is a vibrant city committed to its citizens, natural resources and cultural heritage. As Dublin grows, it will balance history with progress, to sustain an enlightened, economically balanced and diverse community. Dublin is unified in its belief that an engaged and informed community encourages innovation in all aspects of City life, including programs to strengthen our economic vitality, and preserve our natural surroundings through environmental stewardship and sustainability. Dublin is dedicated to promoting an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. Page 1 of 1 STAFF REPORT HUMAN SERVICES COMMISSION DATE: March 28, 2019 TO: Honorable Chair and Commissioners FROM: La Shawn Butler, Parks & Community Services Director SUBJECT: Approval of Minutes Prepared by: Suzanne Iarla, Management Analyst II EXECUTIVE SUMMARY: The Commission will consider approval of the January 24, 2019 meeting minutes. STAFF RECOMMENDATION: Approve the January 24, 2019 meeting minutes. FINANCIAL IMPACT: N/A DESCRIPTION: The Commission will consider approval of the January 24, 2019 meeting minutes. NOTICING REQUIREMENTS/PUBLIC OUTREACH: N/A ATTACHMENTS: Minutes of the January 24, 2019 Human Services Commission Meeting 4.1 Packet Pg. 3 HUMAN SERVICES COMMISSION MINUTES Thursday, January 24, 2019 Human Services Commission January 24, 2019 Regular Meeting P a g e | 1 A Regular Meeting of the Dublin Human Services Commission was held on Thursday, January 24, 2019, in the Human Services Commission Council Chamber. The meeting was called to order at 7:00 PM., by Commissioner Janet Songey. 1. Call to Order Chair Songey called the meeting to order. Attendee Name Title Status Janet Songey Commission Chair Present Alan Brown Commissioner Present Shawn Costello Commissioner Present Ankita Sharma Commissioner Present Candy Velasco Commissioner Present 2. Pledge of Allegiance - Chair Songey led the Pledge of Allegiance. 3. Oral Communications 3.1. Introduction of New Commissioner Chair Songey welcomed new Commissioner Candy Velasco, who introduced herself; Ms. Velasco works in the home healthcare industry. 3.2. Employee Introduction - Bridget Amaya Ms. Amaya introduced herself and shared some of her public service career. 3.3. First 5 Informational Presentation Ms. Iarla introduced Page Tomblin, Senior Policy Administrator with First 5, who gave an informational presentation. The slide deck is included as an attachment to the minutes. Ms. Tomblin shared a brief history of First 5 and an overview of their services to children ages 0 to 5 and their families, including programs such as: • perinatal home visiting program • "Help Me Grow" program for children with special needs • Quality Counts program related to quality early care site and education to providers • Training and capacity building Ms. Tomblin also mentioned First 5's role as a catalyst and collaborator and policy advocate. Cmr. Costello asked if First 5 has services for children's whose disability occurs after birth; Ms. Tomblin said yes and mentioned a program for families with children who have severe special needs. Cmr. Costello asked if First 5 facilities guest speakers to share their personal 4.1.a Packet Pg. 4 Attachment: Minutes of the January 24, 2019 Human Services Commission Meeting (SR for HSC Minutes Jan 2019) Human Services Commission January 24, 2019 Regular Meeting P a g e | 2 experiences; Ms. Tomblin said yes, they do bring in speakers who can share their family's experience. Cmr. Brown asked if First 5 has their own board; Ms. Tomblin said yes, they have their own board of directors, and have one representative from the Alameda County Board of Supervisors on the board. Cmr. Brown asked about outreach; Ms. Tomblin said First 5 serves all of Alameda County and their primary outreach is through pediatric offices and other partners. Cmr. Brown mentioned Camp Parks in Dublin might be able to benefit from their services. Cmr. Velasco asked about the home visits; Ms. Tomblin explained the home visits are conducted by First 5 staff. Cmr. Sharma asked about First 5's connection to hospitals; Ms. Tomblin explained that First 5 has staff at Highland Hospital and works with other medical offices, especially Medi-Cal providers. Cmr. Brown asked about First 5's participation in community events such as Dublin's St. Patrick's Day Festival; Ms. Tomblin explained First 5 attends less events now due to limits on staff resources, but they are interested in being involved at events that particularly are focused on families with children ages 0 to 5. Cmr. Velasco asked about children over age 5; Ms. Tomblin explained that they hope those children are receiving services through their school and other agencies. Chair Songey thanked Ms. Tomblin for the presentation. 4. Public Comment None. 5. Consent Calendar 5.1. Approve the November 15, 2018 meeting minutes. Chair Songey asked about the discussion regarding 5.1 and noted it was not on the January agenda; Ms. Butler explained this month's meeting was focused on the grants program. Chair Songey summarized that the discussion did not resolve if Commissioners visiting agencies in their leisure time would: • just visit grant-recipients or any locally serving organization • conduct visits individually or in pairs • self-select which agencies to visit or have staff assist with scheduling Ms. Butler reminded the Commission that more than two Commissioners conducting a visit together would be a violation of the Brown Act and answered some other questions. It was moved (Brown/Costello) to adopt the minutes of the last meeting. The motion passed 4-0- 1 with Cmr. Velasco abstaining. 4.1.a Packet Pg. 5 Attachment: Minutes of the January 24, 2019 Human Services Commission Meeting (SR for HSC Minutes Jan 2019) Human Services Commission January 24, 2019 Regular Meeting P a g e | 3 RESULT: Adopted [Unanimous] MOVED BY: Brown SECOND: Costello AYES: Alan Brown, Shawn Costello, Ankita Sharma, Janet Songey ABSTAIN: Candy Velasco 6. New Business 6.1. Election of Officers Staff liaison Iarla provided information on the term and duties of the Chair and Vice- Chair. Chair Songey said she felt it is beneficial for the Chair to be someone who has served on the Commission for at least a year; Cmr. Costello expressed interest in serving as Chair. Chair Songey nominated Cmr. Brown to serve as Chair. By consensus, it was moved (Songey/Sharma) to select Cmr. Brown as Chair and Cmr. Costello as Vice-Chair for 2019. Chair Brown presided over the rest of the meeting. RESULT: AGREE BY CONSENSUS - VOTE [UNANIMOUS] MOVED BY: Songey SECOND: Sharma AYES: Costello, Sharma, Brown, Songey, Velasco 6.2. Overview of Human Services Grants Process for Fiscal Year 2019-2020 Staff liaison Iarla provided an overview of the Human Services Grants Program, including the grant application process, the priority areas for funding, and the sources of funding for the Program. In response to a question from Cmr. Sharma, Ms. Butler confirmed that it would be okay for an individual commissioner to visit organizations to learn more about that organization. Commissioners received the “Organization Affiliation Worksheet” and were instructed to return the completed form to Staff by February 1, 2019. 6.3. Fiscal Year 2017-18 Human Services Grant Program: Grant Recipient Year-End Reports Ms. Butler provided information on the year-end reports from Fiscal Year 2017-18 Human Services Grant Program participants. 4.1.a Packet Pg. 6 Attachment: Minutes of the January 24, 2019 Human Services Commission Meeting (SR for HSC Minutes Jan 2019) Human Services Commission January 24, 2019 Regular Meeting P a g e | 4 7. Other Business Cmr. Songey reported participating in Everyone Counts, a homeless point-in-time survey on January 30, 2019 in the morning. Cmr. Costello reported he plans to attend the Consumer Advisory Committee of the California. Department of Developmental Services meeting next month. He enjoys serving on Committee. Chair Brown reminded the Commission about the ethics training being held on January 31. Iarla stated that if a Commissioner cannot attend, they should inform the City Clerk's office to make other arrangements as attendance is mandatory. Cmr. Costello asked if there were plans to take a group photo of the Commissio n to display on the City’s webpage about the Commission. 8. Adjournment The meeting was adjourned at 8:30 P.M. 4.1.a Packet Pg. 7 Attachment: Minutes of the January 24, 2019 Human Services Commission Meeting (SR for HSC Minutes Jan 2019) Page 1 of 9 STAFF REPORT HUMAN SERVICES COMMISSION DATE: March 28, 2019 TO: Honorable Chair and Commissioners FROM: La Shawn Butler, Parks & Community Services Director SUBJECT: City of Dublin Fiscal Year 2019-20 Human Services Grants Program Funding Recommendations Prepared by: Suzanne Iarla, Management Analyst II EXECUTIVE SUMMARY: On an annual basis, the Human Services Commission reviews Human Services Grants Program applications for the upcoming Fiscal Year. The Commission will receive presentations from staff and the community non-profit organizations applying for grant program funding; discuss the grant applications; review Staff’s recommendations and make funding recommendations to the City Council. STAFF RECOMMENDATION: Receive Staff recommendation on funding levels, receive organization presentations, deliberate, and make funding recommendations to the City Council for their consideration at the April 16, 2019 City Council meeting. At this meeting, all applicants are required to give a brief presentation to the Commission. The order of the presentations is based on the date and time that the completed application was submitted. Attachment 5 provides a chart listing the order in which applications will be presented, along with each grant application. FINANCIAL IMPACT: The Human Services Grants Program is supported by several funding sources including the Federally-funded Community Development Block Grant (CDBG) Fund, the General Fund, and the Affordable Housing Fund. Table 1 shows the estimated Fiscal Year 2019- 20 Program funding by source: Table 1: Estimated Human Services Grants Program Funding by Source Source Amount CDBG (Estimated) $ 91,462 5.1 Packet Pg. 8 Page 2 of 9 City General Fund $130,000 City Affordable Housing Fund $ 8,000 Total $229,462 The CDBG amount is estimated to be the same as the allocation received in Fiscal Year 2018-19 since the final allocations from the Department of Housing and Urban Development (HUD) are currently not known. On May 15, 2018, the Dublin City Council adopted the Fiscal Years 2018-19 and 2019- 20 Budget, which included $130,000 to the Program from the General Fund and $8,000 from the Affordable Housing Fund, a restricted fund, to the Program for each operating year of the biennial budget. DESCRIPTION: Fiscal Year 2019-20 marks the 15th year of Dublin’s Human Services Grants Program which provides financial support to local non-profit organizations serving the Dublin community. Between December 5, 2018 and January 14, 2019, the City accepted applications via an online platform, ZoomGrants. The City received 21 applications by the deadline. Prior to the deadline, in November and December 2018, Staff conducted a number of outreach and education efforts as part of the Human Services Grants Program application process. Staff: Provided notice of funding availability and upcoming community workshops to non-profit organizations. Advertised the funding availability in The Valley Times newspaper on November 30 and December 7, 2018. Provided information on the City website. Held two Grant Application Workshops to review the online application process and discuss program guidelines for the upcoming Fiscal Year. (Attendance at one of these workshops was a requirement of applicants.) Human Services Grant Program Priorities: Each year, the Commission provides a recommendation to the City Council which then awards funding to organizations that best meet the community’s needs in support of the City’s adopted Mission and Vision (Attachment 1), needs identified in the Tri-Valley Needs Assessment (Attachment 2) and previously identified priorities. At the October 20, 2015 City Council Meeting, the City Council discussed the funding priorities for future grants cycles. The discussion resulted in City Council direct ion that the Grants Program should emphasize funding programs specifically directed towards human service needs. The City Council decided that, going forward, grants would not 5.1 Packet Pg. 9 Page 3 of 9 be awarded to arts or school-based programming or events, but would be focused on the most critical human services needs such as health care, food and nutrition, homelessness, child care, etc. CDBG Funding: The Community Development Block Grant fund is provided by the U.S. Department of Housing and Urban Development (HUD). The City of Dublin works with Alameda County’s Urban County CDBG Program to allocate funds and to assure that all CDBG - funded activities are in compliance with Federal regulations. The City of Dublin has participated in Alameda County’s Urban-County CDBG Program since 1982. The City of Dublin, along with the cities of Albany, Emeryville, Newark, and Piedmont (cities with a population below or near 50,000 residents), are called the “Urban County Cities,” along with the unincorporated areas of Alameda County. Estimated CDBG Funding Allocation and Committed Uses: The City’s total estimated CDBG funding allocation for Fiscal Year 2019 -20 is estimated at $116,112. This is the projected amount available to the City for a number of distinct community programs or uses as shown in Table 2. Table 2: Dublin Use of CDBG Funds Program Fiscal Year 2019-20 Estimated Amount Minor Home Repair Program (administered by Alameda County) $18,050 Human Services Grant Program AND Existing Facility Project Loan Obligation (Axis Community Health - Health Center) $91,462 Administration fees (to support the City’s administration of the CDBG program) $6,600 Total estimated CDBG allocation $116,112 Existing Facility Project Loan Obligation (Axis Community Health - Health Center): The City has an existing Facility Project Loan Obligation for Axis Community Health’s Health Center. The Axis Community Health Facility Project Loan Obligation agreement was executed in July 2015 and is a 20-year loan repayment commitment, through 2035, with payment remitted annually with CDBG funds. The funding allocation for repayment of the loan is identified as part of the Staff recommendation since it is a project funded with CDBG funds. Background on Facility Project Loan Obligation: On May 6, 2014, the City Council approved a resolution authorizing the City to enter into a Public Participating Jurisdiction Agreement (PPJ) with the cities of Pleasanton, 5.1 Packet Pg. 10 Page 4 of 9 Livermore, and the County of Alameda for repayment of a HUD loan to support Axis Community Health’s Health Center expansion in Pleasanton. The Health Center opened in May 2016. The PPJ allowed the agencies, with City of Pleasanton acting as lead agency, to borrow $1.25 million to support Axis Community Health’s facility construction. As a result of the agreement, the City of Dublin is required to repay its portion of the loan. In Fiscal Year 2019-20, the estimated payment due is $16,852. Dublin’s total obligation (through 2035) is estimated at $233,590 based on the latest projection of interest rates. CDBG Project Type: Public Service Project vs. Capital Project: Each year, the County limits the use of CDBG funds by each Urban County City to approximately 12% of the CDBG allocation for service-based organizations and projects, with the remaining 82% for capital projects. The County’s past practice has been to review all applications received from each Urban County City to determine if the overall request for service-based projects exceeds the 12% limit. In recent years, the County has requested that the City adjust the service-based project allocation when the County was projected to exceed the 12% limit. If adjustments are needed for Fiscal Year 2019-20, Staff will work with eligible grant applicants and the County to make adjustments as necessary, including implementation of a prorated reduction for all CDBG awards, if necessary. This year the City did not receive any capital project applications. The City typically receives far more service project requests than capital project requests. Analysis of Grant Applications: For the past nine years, the City Council has emphasized basic life needs such as food, shelter, health care and mental health services in their grant funding decisions. Further, the Human Services Commission’s preference in recent years has been to address needs in the areas of Behavioral Health (mental health and substance abuse), Health Care (including dental), and Senior Services. With this guidance, Staff reviewed all of the applications and considered a number of factors to determine the Staff rating and recommended funding amounts. Factors considered (not in any order) include: Grant Rating Criteria Worksheet (Attachment 3). Determination if the request meets the adopted Program guidelines and qualifications. Compliance with Program’s request limits ($3,500 minimum to $25,000 maximum). Whether the project addresses one or more of the 14 Key Areas of Concern identified in the 2011 Tri-Valley Needs Assessment Report. 5.1 Packet Pg. 11 Page 5 of 9 Whether the project addresses basic life needs such as food, shelter, health care and mental health services. Past performance of projects that received grant funds in prior years. Whether City funds are used to leverage other funding sources. The number of Dublin residents served and cost per participant. The eligible uses for each of the three funding sources. City funding for homeless services (due to anticipated requirement for City to spend local funds in Fiscal Year 2019-20 on homeless services as part of match for receiving in State Homeless Emergency Aid Program (“HEAP”) funding) For CDBG only: Compliance of proposed programs and service providers to ensure the activities comply with HUD/CDBG guidelines. During this year’s application period, the City of Dublin received 21 applications from 18 organizations (three organizations each submitted applications for two different projects). Table 3 summarizes the total funding requests and Staff recommendations for the Fiscal Year 2019-20 Human Services Grants Program by funding source: Table 3: Funding Requests and Staff Recommendations by Source FY 2019-20 Funding Source Funding Requests Available Funds and Staff Recommendation CDBG Fund* $122,010 $91,462 General Fund $253,046 $130,000 Affordable Housing Fund $8,000 $8,000 Total $375,056 $229,462 * Includes allocation to the Axis Community Health Facility Project Loan Obligation. Staff Recommendations: Once again this year, grant applicants requested more funds than are available in the Program. The overall funding amount requested e xceeded the amount available by approximately 60%, making it a very competitive process. Staff’s recommendations are based on the factors identified previously in this report and summarized in Attachment 4. This year, of the 21 applications received: Seven applicants qualified and indicated they were willing to meet the strict federal guidelines for use of CDBG funds including to meet the CDBG program’s 5.1 Packet Pg. 12 Page 6 of 9 national objectives of benefiting income qualified persons, homeless persons or persons with disabilities. One organization is being recommended for funding through the City’s Affordable Housing Fund: Tri-Valley Haven Domestic Violence Program. Housing services are allowable expenses per the City’s Zoning Ordinance, Section 8.68.080A as long as income verification is collected. This program has been supported through this City funding source in prior years. One project is not being recommended for funding, and another is recommended to only receive funding for a portion of the proposed services d escribed in the application. The Program is a competitive grant process. Since requests far exceeded the funds available, this year, the City is unable to fund all of the application requests. Dublin High School PFSO’s Every 15 Minutes Program is not being recommended for funding as the project does not provide direct human service needs, and the school-based project may be eligible for educational related grants from other sources. Association of the United States Army/Dean Chapter’s application for Military Community Youth Activities and Support Project included activities that Staff determined where not direct human service needs, with the exception of funds to be used to provide low-income military families with supplemental child care support. Table 4: STAFF RECOMMENDATIONS FOR FISCAL YEAR 2019-20 GRANT PROGRAM Organization Name and Proposal Title Requested Amount Recommended Amount Recommended Source(s) Association of the United States Army/Dean Chapter - Dublin Military Community Youth Activities and Support Project $25,000 $2,500 General Fund Axis Community Health - Ensuring Appropriate and Timely Access to Care with Triage Call Nurse $9,135 $ 6,000 CDBG Axis Community Health - Loan Obligation * $16,852 $16,852 CDBG CALICO Center - Dublin Child Abuse Intervention $15,000 $10,000 CDBG Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin Career & Business Services $12,847 $ 9,000 General Fund 5.1 Packet Pg. 13 Page 7 of 9 Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin VITA Program $7,185 $6,000 General Fund Child Care Links - Child Care Links Diaper Pantry $12,000 $6,000 General Fund Child Care Links - Behavioral Health Care Services $25,000 $10,000 General Fund Children's Emergency Food Bank - Support for Food Expense $15,000 $8,000 General Fund CityServe of the TriValley - Homelessness Prevention/Crisis Intervention Services $24,900 $24,900 General Fund Community Resources for Independent Living - Housing and Independent Living Skills $11,523 $8,250 CDBG Deaf Counseling Advocacy and Referral Agency - Deaf Access Services $25,000 $10,000 General Fund Dublin High School PFSO - Every 15 Minutes Program $10,000 DECLINE - Easter Seals Bay Area - Kaleidoscope Community Adult Program $15,000 $9,050 General Fund Hope Hospice, Inc - Grief Support Center and Hospice Volunteer Program $18,000 $15,000 General Fund Legal Assistance for Seniors - Legal Services, Medicare Counseling and Education for Dublin Seniors $7,500 $6,000 CDBG & General Fund Open Heart Kitchen - Dublin Meal Programs $24,000 $21,260 CDBG & General Fund Senior Support Program of the Tri Valley - Case Management $22,114 $13,500 General Fund Spectrum Community Services - Meals on Wheels for Dublin's Homebound Elderly $13,000 $11,500 CDBG Sunflower Hill - Client Centered Vocational Coaching & Training $16,000 $4,700 General Fund Tri-Valley Haven - Domestic Violence Services Program $25,000 $18,000 General Fund & Affordable Housing Fund Tri-Valley Haven - Homeless Services Program $25,000 $12,950 CDBG & General Fund Total $375,056 $229,462 5.1 Packet Pg. 14 Page 8 of 9 *The Axis Community Health Facility Project Loan Obligation a greement was executed in July 2015 and is a 20-year loan repayment commitment, through 2035, with payment remitted annually with CDBG funds. Should the CDBG allocation be less than anticipated, Staff will apply the percentage of the decrease evenly across all the organizations (with allowance for rounding and compliance with grant guidelines). If adjustments are necessary to comply with the 12% service-based project cap, Staff will work with the organizations and the County to bring grant allocations into compliance. Additional adjustments may also be necessary once the City receives guideline on the local match requirements for State Homeless Emergency Aid Program (“HEAP”) funding. Should this be necessary, Staff may adjust General Fund amounts to eligible homeless services projects and may apply the decrease in funds to other organizations evenly across those organizations (with allowance for rounding and compliance with grant guidelines). Next Steps: After the Commission deliberates and make a recommendation, Staff will present the Commission’s recommendation to the City Council for their consideration at the April 16, 2019 City Council meeting. Final consideration of the City Council’s grant funding decision is scheduled for May or June 2019 as part of the Fiscal Year 2019-20 budget approval. After the City Council has adopted the budget, all organizations who are awarded a grant by the City Council, will be required to enter into an agreement with the City of Dublin. Organizations receiving funds will be required to submit insurance documents, timely invoices and quarterly (if CDBG-funded) or twice-yearly reports on their progress in reaching the goals. CDBG-funded organizations will also be required to participate in annual site monitoring visits. ATTACHMENTS: 1. City of Dublin Mission and Vision 2. Tri-Valley Needs Assessment 14 Areas of Concern 3. Grant Rating Criteria Worksheet 4. Staff Funding Recommendations Summary 5. Grant Applicant Presentation Order 6. Association of the United States Army/Dean Chapter - Dublin Military Community Youth Activities and Support Project Application 7. Axis Community Health - Ensuring Appropriate and Timely Access to Care with Triage Call Nurse Application 8. CALICO Center - Dublin Child Abuse Intervention Application 9. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin Career & Business Services Application 5.1 Packet Pg. 15 Page 9 of 9 10. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin VITA Program Application 11. Child Care Links - Child Care Links Diaper Pantry Application 12. Child Care Links - Behavioral Health Care Services Application 13. Children's Emergency Food Bank - Support for Food Expense Application 14. CityServe of the TriValley - Homelessness Prevention/Crisis Intervention Services Application 15. Community Resources for Independent Living - Housing and Independent Living Skills Application 16. Deaf Counseling Advocacy and Referral Agency - Deaf Access Services Application 17. Dublin High School PFSO - Every 15 Minutes Program Application 18. Easter Seals Bay Area - Kaleidoscope Community Adult Program Application 19. Hope Hospice, Inc - Grief Support Center and Hospice Volunteer Program Application 20. Legal Assistance for Seniors - Legal Services, Medicare Counseling and Education for Dublin Seniors Application 21. Open Heart Kitchen - Dublin Meal Programs Application 22. Senior Support Program of the Tri Valley - Case Management Application 23. Spectrum Community Services - Meals on Wheels for Dublin's Homebound Elderly Application 24. Sunflower Hill - Client Centered Vocational Coaching & Training Application 25. Tri-Valley Haven - Domestic Violence Services Program Application 26. Tri-Valley Haven - Homeless Services Program Application 5.1 Packet Pg. 16 5.1.a Packet Pg. 17 Attachment: 1. City of Dublin Mission and Vision (HS Grant Program FY19 Recommendations) Page 14 of 17 – Grant Application Instructions 2011 Tri ‐Valley Needs Assessment Findings by Area of Concern * 1 Behavioral health (mental health and substance abuse) 8 Disabilities 2 Affordable housing 9 Food and nutrition 3 Health care 10 Senior services 4 Workforce development 11 Youth services 5 Homelessness 12 Child care,early childhood development and education 6 Transportation services and access 13 Changing demographics and growing diversity 7 Domestic violence and child abuse 14 Financial assistance *Page 33 Eastern Alameda County Human Services Needs Assessment 5.1.b Packet Pg. 18 Attachment: 2. Tri-Valley Needs Assessment 14 Areas of Concern (HS Grant Program FY19 Recommendations) 1 H:\GRANTS\Funding Year 2013-2014\Criteria Rating Sheet FY 13-14.doc Organization: ______________________________ Program: _______________________________ PROPOSAL SCORE Maximum of 15 points RECOMMEND FUNDING Yes No FUNDING SOURCE CDBG Comm. Grant Incl. Fund Total Requested Total Recommended IF RECOMMENDING CDBG FUNDING, NOTE THAT CDBG FUNDS MAY ONLY BE USED FOR THE FOLLOWING ACTIVITIES AS DEFINED BY THE U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (CHECK ONE). CAPITAL PROJECTS PUBLIC SERVICE HOUSING ECONOMIC DEVELOPMENT THE WORD “PROGRAM” IS USED BELOW ON THIS FORM TO INCLUDE SERVICES, ACTIVITIES OR IMPROVEMENTS. 1. Organization/Management The organization previously received funding from Dublin, and has fully complied with the City’s management procedures, including invoice and report deadlines. The organization, as presented in the application, is able to achieve the stated goals and outcomes. The organization and their staff are qualified and have the capacity to provide for the program. (i.e. non-profit status, resumes for staff, a Board of Directors, information on clients served). The organization has completed all required aspects of the application process. The proposed program has a successful proven track record (not a new program). (Maximum of 5) ______ 2. Needs/Benefit The beneficiaries are an appropriate target group (lower income residents, handicapped, elderly, youth, etc.) The organization provides an activity to Dublin residents that other organizations do not provide. Applicant’s activity: (choose a or b) a. benefits a majority of Dublin residents by meeting the City’s Mission, Vision and Values OR b. meets at least one of the U.S. Department of Housing and Urban Development’s Strategic Goals or Policy Priorities. The organization’s program meets one of the 14 Areas of Concern as identified in the 2011 Eastern Alameda County Needs Assessment Report The organization collaborates with other agencies to enhance services. (Maximum of 5) ______ City of Dublin Universal Grant Rating Sheet TO BE FILLED OUT BY CITY STAFF 5.1.c Packet Pg. 19 Attachment: 3. Grant Rating Criteria Worksheet (HS Grant Program FY19 Recommendations) 2 H:\GRANTS\Funding Year 2013-2014\Criteria Rating Sheet FY 13-14.doc 3. Funding/ Budget The amount of funding requested compared to the number of Dublin residents served is reasonable. Fiscal responsibility - evaluation of the most current audit does not reveal one or more *material weaknesses* (or equivalent) that could jeopardize other funding. Program and administrative budget covers the cost to provide for the program. The organization leverages other funding sources to provide activities/services/improvements. The organization charges a fee and/or produces other income that may be used to support this program (review submitted fee schedule if applicable). (Maximum of 5) ______ *Standardized accounting audit statements 1. A “Control Deficiency”, which is the lowest of the three deficiencies, exists when the design or operation of a control does not allow management or employees, in the normal course of performing their assigned functions, to prevent or detect misstatements on a timely basis. 2. A “Significant Deficiency” is a control deficiency or a combination of control deficiencies, that adversely effects the organization’s ability to initiate, authorize, record, process or report financial data in accordance with the Generally Accepted Accounting Principles, and that the likelihood of a misstatement of the organization’s financial statement that is more than inconsequential which will not be prevented or detected by the organization’s established internal controls. 3. A “Material Weakness”, is a significant deficiency or a combination of significant deficiencies, that results in more than a remote likelihood that a material misstatement of the financial statements which will not be prevented or detected by the organization’s established internal controls. Rating Criteria is subject to change from time to time to reflect the current industry or to address the type of applications received. 5.1.c Packet Pg. 20 Attachment: 3. Grant Rating Criteria Worksheet (HS Grant Program FY19 Recommendations) City of Dublin Fiscal Year 2019-20 Human Services Grant Program Staff Funding Recommendations Summary Organization Name Proposal Title FY18 Funded Amount FY19 Requested Amount Staff Recommendation CDBG Funds General Fund Affordable Housing Fund Total Staff Rating Reported Number of Areas of Concern Addressed Association of the United States Army/Dean Chapter Dublin Military Community Youth Activities and Support Project *N/A $ 25,000 $ 2,500 $ 2,500 $ 2,500 8*3 Axis Community Health Ensuring Appropriate and Timely Access to Care with Triage Call Nurse N/A $ 9,135 $ 6,000 $ 6,000.0 $ 6,000 15 1 Axis Community Health Loan Obligation $ 15,962 $ 16,852 $ 16,852 $ 16,852.00 $ 16,852 15 1 CALICO Center Dublin Child Abuse Intervention $ 10,000 $ 15,000 $ 10,000 $ 10,000.0 $ 10,000 14 5 Chabot-Las Positas Community College District/Tri-Valley Career Dublin Career & Business Services 2019- 2020 $ 12,025 $ 12,847 $ 9,000 $ 9,000 $ 9,000 14 1 Chabot-Las Positas Community College District/Tri-Valley Career Dublin VITA Program 2019-2020 $ 6,700 $ 7,185 $ 6,000 $ 6,000 $ 6,000 15 2 Child Care Links Child Care Links Diaper Pantry $ 8,525 $ 12,000 $ 6,000 $ 6,000 $ 6,000 12.5 3 Child Care Links Behavioral Health Care Services N/A $ 25,000 $ 10,000 $ 10,000 $ 10,000 13.5 5 Children's Emergency Food Bank Support for Food Expense N/A $ 15,000 $ 8,000 $ 8,000 $ 8,000 12.5 1 CityServe of the TriValley Homelessness Prevention/Crisis Intervention Services $ 14,360 $ 24,900 $ 24,900 $ 24,900 $ 24,900 13.5 5 Community Resources for Independent Living Housing and Independent Living Skills $ 9,360 $ 11,523 $ 8,250 $ 8,250.0 $ 8,250 14 5 Deaf Counseling Advocacy and Referral Agency (DCARA) Deaf Access Services $ 9,025 $ 25,000 $ 10,000 $ 10,000 $ 10,000 12 5 Dublin High School PFSO Every 15 Minutes Program N/A $ 10,000 $ - $ - DECLINE DECLINE 2 Easter Seals Bay Area Kaleidoscope Community Adult Program $ 12,695 $ 15,000 $ 9,050 $ 9,050 $ 9,050 12 4 Hope Hospice, Inc Grief Support Center and Hospice Volunteer Program $ 14,860 $ 18,000 $ 15,000 $ 15,000 $ 15,000 15 3 Legal Assistance for Seniors Legal Services, Medicare Counseling and Education for Dublin Seniors $ 7,000 $ 7,500 $ 6,000 $ 5,550.0 $ 450.0 $ 6,000 14 5 Open Heart Kitchen Dublin Meal Programs $ 22,500 $ 24,000 $ 21,260 $ 20,810.0 $ 450.0 $ 21,260 14 2 Senior Support Program of the Tri Valley Case Management $ 13,200 $ 22,114 $ 13,500 $ 13,500 $ 13,500 13.5 1 Spectrum Community Services Meals on Wheels for Dublin's Homebound Elderly $ 13,000 $ 13,000 $ 11,500 $ 11,500.0 $ 11,500 15 3 Sunflower Hill Client Centered Vocational Coaching & Training N/A $ 16,000 $ 4,700 $ 4,700 $ 4,700 11 3 Tri-Valley Haven Domestic Violence Services Program $ 17,625 $ 25,000 $ 18,000 $ 10,000 $ 8,000 $ 18,000 14 3 Tri-Valley Haven Homeless Services Program $ 10,625 $ 25,000 $ 12,950 $ 12,500.0 $ 450 $ 12,950 14 5 CDBG Total ($91,462)0.0 91462.00 General Fund Total ($130,000)0.0 130000.00 Affordable Housing Fund Total ($8,000)0.0 8000.00Red number is value Affordable Housing Funds Awards over/under (should be 0) *Staff recommendation for AUSA is based on limiting grant funds to emergeny childcare support only, not the full scope of the project proposed. Red number is value CDBG Awards over/under (should be 0) Red number is value General Fund Awards over/under (should be 0) 5.1.d Packet Pg. 21 Attachment: 4. Staff Funding Recommendations Summary (HS Grant Program FY19 Recommendations) CITY OF DUBLIN HUMAN SERVICES GRANTS PROGRAM ORDER OF APPLICANT PRESENTATIONS ON MARCH 28, 2019 As part of the Human Services Grants Program application process, applicants are required to make a brief presentation to the Human Services Commission. The order of the presentations is based on the date and time that the completed application was submitted in ZoomGrants. Order Organization Project Title 1 Dublin High School PFSO Every 15 Minutes Program 2 Chabot-Las Positas Community College District/Tri-Valley Career Center Dublin Career & Business Services 2019-2020 3 Chabot-Las Positas Community College District/Tri-Valley Career Center Dublin VITA Program 2019-2020 4 Open Heart Kitchen Dublin Meal Programs 5 Children's Emergency Food Bank Support for Food Expense 6 Hope Hospice, Inc Grief Support Center and Hospice Volunteer Program 7 Tri-Valley Haven Homeless Services Program 8 Legal Assistance for Seniors Legal Services, Medicare Counseling and Education for Dublin Seniors 9 CALICO Center Dublin Child Abuse Intervention 10 Tri-Valley Haven Domestic Violence Services Program 11 Sunflower Hill Client Centered Vocational Coaching & Training 12 Deaf Counseling Advocacy and Referral Agency (DCARA) Deaf Access Services 13 Senior Support Program of the Tri Valley Case Management 14 Community Resources for Independent Living Housing and Independent Living Skills 15 Axis Community Health Ensuring Appropriate and Timely Access to Care with Triage Call Nurse 16 Child Care Links Child Care Links Diaper Pantry 17 Child Care Links Behavioral Health Care Services 18 CityServe of the TriValley Homelessness Prevention/Crisis Intervention Services 19 Association of the United States Army/Dean Chapter Dublin Military Community Youth Activities and Support Project 20 Easter Seals Bay Area Kaleidoscope Community Adult Program 21 Spectrum Community Services Meals on Wheels for Dublin's Homebound Elderly 5.1.e Packet Pg. 22 Attachment: 5. Grant Applicant Presentation Order (HS Grant Program FY19 Recommendations) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline Association of the United States Army/Dean Chapter Dublin Military Community Youth Activities and Support Project Jump to: Questions Budget Documents USD$ 25,000.00 Requested Submitted: 1/14/2019 6:56:44 PM (Pacific) Project Contact Douglas Miller dougmiller94566@gmail.com Tel: 925.998.9905 Additional Contacts leary_patrick@yahoo.com Association of the United States Army/Dean Chapter 4847 Hopyard Road #4413 Pleasanton, CA 94566 Chapter President Jon Ellis renegadelongbow@gmail.com Telephone925.998.9905 Fax Web https://www.ausa.org/chapters/mg- william-f-dean-chapter Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). The Dean Chapter of AUSA provides financial assistance to military personnel and their families primarily based and/or working at Camp Parks. Primary focus involves family and youth activities at Camp Parks. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding 5.1.f Packet Pg. 23 Attachment: 6. Association of the United States Army/Dean Chapter - Dublin Military Community Youth Activities and Support Project 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. For the activities described in this "project", Camp Parks Morale, Welfare and Recreation (MWR) typically receives about $2000 each year from Installation Management Command. These funds are severely inadequate for these planned events. In the current fiscal year, without any funds from this grant request, Dean Chapter/AUSA will supplement expected MWR funds in the amount of $3,000. 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). Camp Parks Morale, Welfare and Recreation (MWR) Center is the primary partner for these "project" activities. MWR had adequate staff to competently plan and conduct these events, but never has sufficient funds. For the past 20 years, Dean Chapter/AUSA as supplied additional funding and volunteers. 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. To provide a set of youth services events and support at Camp Parks to offset the high cost of living for basic human services such as child care and support to military service members and their families. 9. 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 who live and work at Camp Parks plus 25,000 military service members who come to Camp Parks annually for training and reside in Dublin during their training. 10. 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 Concern. 11. How will this project will be implemented, administered, and operated? Camp Parks Morale, Welfare and Recreation (MWR) Center, an established function at all military bases around the world, will implement, administer and operate the events and programs being described in this project. https://www.armymwr.com/ The Major General William F. Dean Chapter of the Association of the United States Army acts on behalf of Camp Parks MWR to solicit additional funds. Dean Chapter/AUSA also provides volunteers under the direction of MWR personnel. Dean Chapter/AUSA will be responsible for overseeing, distributing and reporting to the City of Dublin on grant money expenditures. 12. Describe in detail how Dublin grant funds will be used for this project. (What specifically will the grant funds be used for?) Please see attached Dean Chapter/AUSA Project Application Narrative. Populated in this field several times and would not save. gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services ✔✔✔✔ Youth Services ✔✔✔✔ Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity ✔✔✔✔ Financial Assistance gfedc None of the above gfedc Please explain: 5.1.f Packet Pg. 24 Attachment: 6. Association of the United States Army/Dean Chapter - Dublin Military Community Youth Activities and Support Project 13. 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)? Action After Reviews will capture number of attendees for each event along with a survey completed by a sample of attendees. This information will help define further improvements for future events. 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. 700 Dublin based military family members and approximately 25,000 members of the military services who come to Camp Parks for training on an annual basis. 1. Provides youth with a positive environment to connect with family and peers. 2. Supports low-income military families with supplemental child care support. 3. Provides local veterans and service members with emergency funding relief. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? This project will focus on the local military community, more specifically the youth who face multiple social challenges with their ever changing environment. Financial support will also be provided to lower income military members to help offset the higher cost of child care in the Bay Area. Emergency Financial support will also be provided to military members and veterans in the Dublin area that have short term needs. This project represents a renewed opportunity to better connect the City of Dublin with the Dublin Military Community. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? AUSA has a direct and ongoing communications with all Camp Parks residents and with all military community members who work on the Camp Parks military reservation through MWR and local veteran organizations(VFW, American Legion). Through formal project request managed by AUSA. 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Dean Chapter/AUSA has several local significant partners beside Camp Parks MWR. A City of Dublin agreement with Dean Chapter/AUSA provides Camp Parks based military organizations with the free use of city buildings, including conference centers, and parks for military meetings and events. Most recently, in December 2018, the Dublin Shannon Center was made available at no charge for a Camp Parks based unit for their annual Christmas party. A similar agreement exists with the City of Pleasanton. Dean Chapter/AUSA works in partnership with Veterans of Foreign Wars Post 6298 and American Legion Post 237, both based in Pleasanton on many projects in support of the local military community. Through those partnerships, we frequently host the Annual Army Birthday Ball at the Pleasanton Veterans Memorial Building in Pleasanton. Dean Chapter/AUSA has about a dozen local corporate partners who provide additional goods and services(Donations-in-kind) to our events, this mitigating event costs. Several local hotels and restaurants are Dean Chapter corporate partners. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. Dean Chapter/AUSA is a member of the Dublin Chamber of Commerce. Our members attend monthly chamber meetings. The grant application was the result of attending a recent chamber meeting where a Dean Chapter/AUSA member met city employee Suzanne Larla who suggested that we should investigate this grant opportunity. In addition, previous chamber meetings have resulted in donations to the general fund of more than $3,000 in the past two years. In addition, informal partnership exist with local Rotary clubs, Las Positas College and several churches, especially Cornerstone Fellowship in Livermore. Dean Chapter/AUSA board members are members of other veterans service organizations such as, VFW, American Legion, Vietnam Veterans of Diablo Valley and Vietnam Helicopter Pilot Association. 5.1.f Packet Pg. 25 Attachment: 6. Association of the United States Army/Dean Chapter - Dublin Military Community Youth Activities and Support Project 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. With a primary targeted population of 700, the cost per person is $36 per year. With a potential secondary targeted population of 25,000 military personnel at Camp Parks for short term training, the cost per person of this program could be considerably less. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Camp Parks MWR events would continue at a lower quality and some events would be cut. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 25. 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. 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process Camp Parks has been a major part of the Dublin Community history for over 75 years. A healthy and vibrant Camp Parks Community encourages the residents to contribute to the active lifestyle of the greater Dublin Community. 28. ** QUESTIONS 29 THROUGH 41 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? ✔✔✔✔ No gfedc Yes: If yes, please explain: gfedc Yes ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. ✔✔✔✔ Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc Yes. If so, check box here and answer questions 29 through 41. ✔✔✔✔ No. If no, check box here and enter gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. 5.1.f Packet Pg. 26 Attachment: 6. Association of the United States Army/Dean Chapter - Dublin Military Community Youth Activities and Support Project 29. 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 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *Promote fair housing and reduce housing discrimination. gfedc 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: gfedc * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. gfedc * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. gfedc C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. gfedc D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. gfedc 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. gfedc Increase homeownership gfedc Promote decent affordable housing gfedc Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. gfedc Improving the quality of life for our Nation's communities gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. 5.1.f Packet Pg. 27 Attachment: 6. Association of the United States Army/Dean Chapter - Dublin Military Community Youth Activities and Support Project 35. 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?") 36. 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?") 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc Reduce housing discrimination. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. 5.1.f Packet Pg. 28 Attachment: 6. Association of the United States Army/Dean Chapter - Dublin Military Community Youth Activities and Support Project 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 39. 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". 40. 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 41. 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" gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. Disabled Women/Female Headed Households Seniors Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL 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) 0.000.00 TOTAL White White + HISPANIC Black/African American Black/African American + HISPANIC Asian Asian + HISPANIC 5.1.f Packet Pg. 29 Attachment: 6. Association of the United States Army/Dean Chapter - Dublin Military Community Youth Activities and Support Project 42. 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 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). In 2017, Dean Chapter/AUSA took over responsibility for a major golf fundraising tournament that was established in 2009. With the addition of our first title sponsor (The Cooper Companies), 2018 Bay Area Military Classic raised significantly more money than ever before. This event will become our primary fundraising event each year. https://birdeasepro.com/bamc/ In addition, Dean Chapter/AUSA has received grants from local companies such as Walmart and Graham Hitch. 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. bl-112089 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) 0.000.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed Dublin City Grant USD$ 25,000.00 USD$ 0.00 MG Dean/AUSA USD$ 3,000.00 USD$ 3,000.00 US Army IMCOM USD$ 2,000.00 USD$ 0.00 Total USD$ 30,000.00 USD$ 3,000.00 Funding Uses/Expenses Budget Amount Amount Committed Dublin Military Community Youth Activities and Support Project USD$ 30,000.00 USD$ 3,000.00 Total USD$ 30,000.00 USD$ 3,000.00 5.1.f Packet Pg. 30 Attachment: 6. Association of the United States Army/Dean Chapter - Dublin Military Community Youth Activities and Support Project Budget Narrative See Program narrative document that is the last uploaded document. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Financial Information Form for ALL Grant Requests download template ✔✔✔✔ MG Dean Financial Information List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ MG Dean Board Current Annual Budget for the Entire Agency ✔✔✔✔ MG Dean Current Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ MG Dean IRS 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ MG Dean Board Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ MG Dean Board Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ MG Dean Insurance 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. ✔✔✔✔ MG Dean Federal Tax Exempt Letter MG Dean State Tax Exempt Form 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 Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) Dean Chapter/AUSA Project Application Narrative 5.1.f Packet Pg. 31 Attachment: 6. Association of the United States Army/Dean Chapter - Dublin Military Community Youth Activities and Support Project Application ID: 133158 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 5.1.f Packet Pg. 32 Attachment: 6. Association of the United States Army/Dean Chapter - Dublin Military Community Youth Activities and Support Project Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline Axis Community Health Ensuring Appropriate and Timely Access to Care with Triage Call Nurse Jump to: Questions Budget Documents USD$ 9,135.00 Requested Submitted: 1/14/2019 5:19:19 PM (Pacific) Project Contact Valerie Jonas vjonas@axishealth.org Tel: 925.201.6068 Additional Contacts contracts@axishealth.org,scompton@axishealth.org Axis Community Health 5925 W. Las Positas Blvd., Suite 100 Pleasanton, CA 94588 United States CEO Sue Compton scompton@axishealth.org Telephone(925) 201-6068 x Fax (925) 417-1503 x Web axishealth.org Questions top 1. Select the category that best describes your organization: (Select only one.) 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.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding 5.1.g Packet Pg. 33 Attachment: 7. Axis Community Health - Ensuring Appropriate and Timely Access to Care with Triage Call Nurse Application (HS Grant 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. N/A - This project has not received any government funding in the last three years. 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). Axis Community Health is a non-profit Federally Qualified Health Center (FQHC) that provides medical, behavioral health, and WIC nutrition services to more than 14,000 Tri-Valley residents. We are the sole provider of care for low-income and uninsured residents enrolled in Medi-Cal or the county health program (HealthPac). Axis has been serving Tri-Valley residents since 1972 and presently has a staff of 175 which includes physicians, nurse practitioners, behavioral health professionals, registered dieticians, and support personnel. Axis is governed by a Board of Directors comprised of users of Axis services, Tri-Valley residents, and business leaders. Axis’s executive team is led by Sue Compton, CEO, and is comprised of the following roles: CFO, Chief Medical Officer, Chief Administrative Officer, Chief Development Officer, Chief Quality & Transformation Officer, Chief of Behavioral Health, and Chief of Clinic Services. Axis's fiscal department uses a robust accounting system (Sage) and the agency has annual financial audits as well as extensive monitoring and oversight by state and federal agencies. The Axis infrastructure meets federal regulatory requirements for provision of services. We’ve maintained contracts with the State, the County and the cities of Pleasanton, Livermore and Dublin for more than two decades. We have fulfilled contractual requirements and passed all audits without findings. Financial records are maintained to standard accounting procedures and annual audits are conducted by an independent CPA firm. 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text 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. 9. 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.) 1841 10. 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 Concern. 11. How will this project will be implemented, administered, and operated? 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. 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. Based on symptom severity and the patient’s condition, the nurse advises on the appropriate next step. gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing ✔✔✔✔ Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above gfedc Please explain: 5.1.g Packet Pg. 34 Attachment: 7. Axis Community Health - Ensuring Appropriate and Timely Access to Care with Triage Call Nurse Application (HS Grant 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 onto 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-ValleyCare, 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 2018, the Triage Nurse responded to 7,020 calls and assisted nearly 1,000 patients in discharge planning. 12. Describe in detail how Dublin grant funds will be used for this project. (What specifically will the grant funds be used for?) Funds from this grant will help 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 frequently need medical. This funding will ensure Axis’s ability to fund this critical position without a reduction in service hours. 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 1,841 Axis patients who are Dublin residents. Axis was receiving an operational support grant annually for the last 10 years from Blue Shield of California Foundation (BSCF) from 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. 13. 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)? 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 service 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. 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. Axis serves low-income and uninsured Tri-Valley residents of all ages with medical and mental health 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 medical services for 1,012 Dublin residents in 2010 to serving 1,841 in 2017, an 83% increase in just seven years (UDS Reports, 2011-2018). This project will benefit these residents by providing them access to medical advice by phone. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? 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 5.1.g Packet Pg. 35 Attachment: 7. Axis Community Health - Ensuring Appropriate and Timely Access to Care with Triage Call Nurse Application (HS Grant 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. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? 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, organizations who serve low-income populations, and media outlets. Activities include monthly outreach as the library, presentations at low-income housing communities, and coordination with school nurses. Our Enrollment Specialists and Community Relations Coordinator 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 from 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. 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Axis coordinates services on a number of levels. For patient care, we have cooperative agreements with partners regarding specific needs, such as Stanford Health Care – ValleyCare for obstetrics services and Highland Hospital for specialty medical services. Additionally, Axis is part of the Alameda Health Consortium and works with the other community health centers in our county to assess community needs, identify new opportunities for collaboration, coordinate patient advocacy, delineate effective continuums of care and prevent duplication of services. Among our safety-net partners are Tri-Valley Haven, which provides a food bank and shelter services for homeless families and victims of domestic violence, Open Heart Kitchen, which offers a hot-meal program; and CAPE/Head Start, which provides early intervention and educational services for low-income children. Axis partners with the Alameda County Community Food Bank to distribute food monthly at one of our clinic sites, which helps to ensure access to healthy food for patients. Axis is also active in the Tri-Valley Non-Profit Alliance and Tri-Valley Anti-Poverty Collaborative, which provides new opportunities for collaborative activities with other providers. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. Axis’s Community Outreach Coordinator and Enrollment Specialists perform regular outreach at health fairs, community forums and faith-based events and work closely with Head Start, school-based services, parent-education programs and other human services providers to identify prospective clients. Axis also alerts underserved populations to its services through its own client-friendly website; through 211.org, a free information and referral service; and through ACHealthcare.org, a website that enables Alameda County residents to locate the nearest health care provider, with special emphasis on programs that can assist non-English speakers. Because one-third of clients rely on public transportation, Axis sites are located near bus lines. Our enrollment specialists have been providing services at the Dublin library on a regular basis and attend school parent events. With the start of the Affordable Care Act in 2010, Axis has increased its outreach and marketing throughout the Tri- Valley. In Dublin, Axis has presented at Dublin library, at Covered California information nights, at low-income housing meetings, and many other places. We are are constantly providing informational sessions in Dublin in order to reach people eligible for Medi-Cal and coverage through the health exchange, particularly since our demographic studies indicate that Dublin has a large number of eligible families. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. 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. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Axis is seeking funding for Triage Nurse services from all three Tri-Valley Cities. Securing $9,135 from the City of Dublin will 5.1.g Packet Pg. 36 Attachment: 7. Axis Community Health - Ensuring Appropriate and Timely Access to Care with Triage Call Nurse Application (HS Grant greatly improve our ability to seek other public funding as it demonstrates the continued collaborative effort within the Tri- Valley to meet the health care needs of low-income residents. Since we no longer have annual support for this service from Blue Shield of California Foundation, Axis must seek other resources. Without this grant funding from Dublin, we will be less well-positioned in our efforts, and will also need to find other sources for the $9,135 we are seeking. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 25. 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. 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process This project meets a number of the City of Dublin’s Mission, Vision, Values and Strategies. The project aligns with the Mission statement “promotes and supports a high quality of Life, which ensures a safe and secure environment and fosters new opportunities.” This project provides services to meet the needs of the increasing number of low-income and uninsured Dublin residents in need of health services. Access to health care directly impacts the quality of life of these families. 28. ** QUESTIONS 29 THROUGH 41 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? 29. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your ✔✔✔✔ No gfedc Yes: If yes, please explain: gfedc Yes ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. ✔✔✔✔ Yes. If so, check box here and answer questions 29 through 41. gfedc No. If no, check box here and enter gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. 5.1.g Packet Pg. 37 Attachment: 7. Axis Community Health - Ensuring Appropriate and Timely Access to Care with Triage Call Nurse Application (HS Grant 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. 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. 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: ✔✔✔✔ Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *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. gfedc C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. gfedc D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. gfedc E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low-income and underserved populations. gfedc F) Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase homeownership gfedc Promote decent affordable housing ✔✔✔✔ Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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 5.1.g Packet Pg. 38 Attachment: 7. Axis Community Health - Ensuring Appropriate and Timely Access to Care with Triage Call Nurse Application (HS Grant 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: 35. 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?") 36. 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?") 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Availability/Accessibility gfedc Affordability gfedc Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. 5.1.g Packet Pg. 39 Attachment: 7. Axis Community Health - Ensuring Appropriate and Timely Access to Care with Triage Call Nurse Application (HS Grant 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 39. 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". 40. 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 41. 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" gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 92 Disabled 276 Women/Female Headed Households 239 Seniors 423 Youth 36 Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 1,066.001,066.00 TOTAL 386 Low Income (50%-80% AMI) 1344 Extremely Low Income (<30% AMI) Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 1,730.001,730.00 TOTAL 515 White 5.1.g Packet Pg. 40 Attachment: 7. Axis Community Health - Ensuring Appropriate and Timely Access to Care with Triage Call Nurse Application (HS Grant 42. 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 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). Axis continually seeks funding from private foundations and donations from individuals to cover operational costs that are not covered by reimbursements from public health insurance, such as Medi-Cal, Medicare and HealthPac. 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. bl-112019 718 White + HISPANIC 74 Black/African American 0 Black/African American + HISPANIC 424 Asian 0 Asian + HISPANIC 18 American Indian/Alaskan Native 0 American Indian/Alaskan Native + HISPANIC 18 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 0 Asian and White 0 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 74 Multi Racial + HISPANIC OR other Multi Racial Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 1,841.001,841.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed City of Dublin USD$ 9,135.00 USD$ 0.00 City of Livermore USD$ 28,421.00 USD$ 0.00 City of Pleasanton USD$ 13,195.00 USD$ 0.00 Foundation Grants USD$ 40,753.00 USD$ 0.00 Community Donations USD$ 10,000.00 USD$ 0.00 5.1.g Packet Pg. 41 Attachment: 7. Axis Community Health - Ensuring Appropriate and Timely Access to Care with Triage Call Nurse Application (HS Grant Total USD$ 101,504.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Triage Nurse Salary USD$ 83,200.00 USD$ 0.00 Triage Nurse Benefits USD$ 18,304.00 USD$ 0.00 Total USD$ 101,504.00 USD$ 0.00 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 project. This critical service is in proportion to the overall staffing budget for health services at the organization. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Axis Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Axis Financial Information List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ Axis Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ Axis Current Budget for Entire Agency Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ Axis most recent IRS 990 form Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Axis Designation of Authorized Official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Axis Board Authorization to Request Funding Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Axis Proof of Insurance 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. ✔✔✔✔ Axis Non-Profit Determination Letter 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 Axis Personnel Policies REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section Axis Audited Financials REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws Axis Articles of Incorporation Axis Bylaws 2018 REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) REQUIRED FOR CDBG ONLY - AGENCY'S Axis LEP 5.1.g Packet Pg. 42 Attachment: 7. Axis Community Health - Ensuring Appropriate and Timely Access to Care with Triage Call Nurse Application (HS Grant Application ID: 132007 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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) 5.1.g Packet Pg. 43 Attachment: 7. Axis Community Health - Ensuring Appropriate and Timely Access to Care with Triage Call Nurse Application (HS Grant Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline CALICO Center Dublin Child Abuse Intervention Jump to: Questions Budget Documents USD$ 15,000.00 Requested Submitted: 1/11/2019 3:35:34 PM (Pacific) Project Contact Erin Harper calicocenter@yahoo.com Tel: 5108950702 Additional Contacts nadia@calicocenter.org CALICO Center 524 Estudillo Ave San Leandro, CA 94577 United States Executive Director Erin Harper executive.director@calicocenter.org Telephone(510) 895-0702 Fax (510) 895-0706 Web www.calicocenter.org Questions top 1. Select the category that best describes your organization: (Select only one.) 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.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding 5.1.h Packet Pg. 44 Attachment: 8. CALICO Center - Dublin Child Abuse Intervention Application (HS Grant Program FY19 Recommendations) 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. • City of Dublin: $10,000 (awarded for FY18-19), $9,778.75 (FY17-18), $8,313.60 (FY16-17). Funding for core services. • City of Pleasanton: $8,500 (awarded for FY18-19), $7,000 (FY17-18), $7,000 (FY16-17). Funding for core services. • City of Livermore: $15,270 (awarded for FY18-19), $11,565 (FY17-19), $12,000 (FY 16-17). Funding for core services. • City of Hayward: $20,000 (awarded for FY18-19), $20,000 (FY17-18), $21,000 (FY16-17). Funding for core services. • City of San Leandro: $22,260 (FY18-19), $20,537 (FY17-18), $19,400 (FY16-17). Funding for core services. • City of Fremont: $22,500 (awarded for FY18-19), $18,496.59 (FY17-18), $15,244.58 (FY16-17). Funding for core services. • City of Union City: $3,573.11 (FY17-18). Funding for core services. • State of California (CalOES): $281,000 (awarded for FY17-19). Funding for program expansion. 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). CALICO is governed by a 12-member Board of Directors that oversees finances, operations and fundraising and a 29-member advisory committee (comprised of representatives from each partner agency agency) which creates and monitors program activities. With an annual operating budget of over $890,000 (for county-level services) CALICO supports two interviewing sites, eight full-time staff and three part-time staff (including staff for interviewing, family support services, training, team coordination, fund development/communications and finance/administration). The District Attorney’s Office provides significant support by assigning a full-time Executive Director (ED), who reports to the CALICO Board of Directors, and a District Attorney Liaison to observe interviews and ensure the integrity of investigations. 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. CALICO proposes to conduct 20 forensic interviews with 18 Dublin children who have been sexually or physically abused, provide support services to 12 caregivers of the Dublin victims and facilitate a multi-disciplinary response to the allegations. 9. 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 10. 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 Concern. 11. How will this project will be implemented, administered, and operated? CALICO proposes to conduct 20 forensic interviews with 18 children from Dublin and provide support services to 12 caregivers. Children will be referred to CALICO primarily by Dublin Police Services (DPS) and Children and Family Services (CFS). Forensic interviews are the cornerstone of a child-abuse investigation. A child’s statement may be the only evidence to determine if a crime occurred or if the child is safe at home. For many children, their CALICO interview is the first time they fully describe what happened to them. This is an essential first step toward healing. At CALICO, children are welcomed into a gfedc None ✔✔✔✔ Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development ✔✔✔✔ Homelessness gfedc Transportation Services and Access ✔✔✔✔ Domestic Violence and Child Abuse ✔✔✔✔ Disabilities gfedc Food and Nutrition gfedc Senior Services ✔✔✔✔ Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above gfedc Please explain: CALICO's primary services are geared toward child abuse victims. As such,also it provides referrals to mental health and housing services. 5.1.h Packet Pg. 45 Attachment: 8. CALICO Center - Dublin Child Abuse Intervention Application (HS Grant Program FY19 Recommendations) comfortable setting. The interviewing room is painted in warm colors and the family waiting areas are equipped with art supplies, toys, videos and books, in multiple languages. Skilled interviewers meet individually with each child, asking non- leading, developmentally appropriate questions to elicit the child’s account of the abuse. CALICO records the interview onto a DVD so that investigators may refer to it moving forward, rather than re-questioning the child. Further, the investigating team (a DPS detective, CFS worker and prosecutor) observes from another room, providing supplemental questions through an earpiece. Each child leaves with a stuffed animal, book and blanket donated by community partners. CALICO believes that to support an abused child, we must ensure s/he has the full and appropriate support of his/her caregiver. Family Advocates (FAs) meet with the caregiver, conducting a crisis assessment to learn more about the child, the traumatic experience, and the child’s living environment. The FA supports the parent with psycho-education, referrals, resources and more, as appropriate. The FA then follows up with the family by phone to provide further support. Through these services, CALICO is in a unique position to intervene at a pivotal moment, which may be the only opportunity to put that child on a path to healthy adulthood. 12. Describe in detail how Dublin grant funds will be used for this project. (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 support staff 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 FY19-20. 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. 13. 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)? GOAL 1: Minimize trauma to abused children. 1a. At least 75% of children interviewed will feel positive/neutral about their experience. 1b. 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. Dublin cases will be reviewed at a least 2 of the case reviews. GOAL 3: Improve the mental health of caregivers. 3a. An FRS will conduct an on-site crisis assessment with at least 75% of families. 3b. An FRS will initiate a California Victim Compensation Program (CalVCP) 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 FRS will provide at least 75% of caregivers with psycho-education on the effects of trauma on children. 4b. An FRS will assist at least 75% of families with a CalVCP 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. 5.1.h Packet Pg. 46 Attachment: 8. CALICO Center - Dublin Child Abuse Intervention Application (HS Grant Program FY19 Recommendations) 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. The target population for this grant is Dublin children, ages 2-17, as well as adults with developmental disabilities who are victims of sexual abuse, physical abuse, neglect, sexually trafficked and/or who have been exposed to severe violence in their homes and communities. Over the past 5 years, CALICO has conducted 70 interviews with abused Dublin children. Most victims were girls (66% of client) and who had been sexually abused (84% of clients). The majority were referred to CALICO by Dublin Police Services or Children and Family Services, although a few cases involved children who were Dublin residents but had been abused in other cities in Alameda County, including Livermore and Pleasanton. In 2017-18, we conducted 18 forensic interviews of Dublin children. Children benefit from CALICO services because the services are child-focused, evidence-based and facilitated by staff who are specially trained to talk to children of all ages and developmental levels. In that way, child who come to CALICO are not caused further trauma by participating in a child-abuse investigation. This project also targets the caregivers of those children, which typically includes a mother, step-mother, foster mother or other related caretaker. Caregivers of victims experience a range of emotions (sadness, anger, confusion, and shame) and are typically unaware of how their reactions affect their child’s long-term healing. CALICO services benefit caregivers by engaging a team of professionals to support them through every step in the process, including attending to their medical, mental health and legal needs; providing crisis intervention, as needed; and explaining the investigative process and what to expect moving forward in terms of their case, their child’s response to trauma, and their own response. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? 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 22% 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 ASL), 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. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? For this project, CALICO will accept referrals primarily from Dublin Police Services officers and child welfare workers. Families cannot directly refer a child to CALICO, but we will help them make an official report if they contact us instead of the police or child-abuse hotline. Given the nature of our work, CALICO has little control over which children get brought to the center. Yet through training and community outreach, we are able to help patrol officers, detectives, child welfare workers, and youth- serving professionals understand their respective roles in reporting and investigating child abuse. By doing so, we hope to increase the number of victims identified and improve the appropriateness of each agency’s response. In addition, we provide information about which children are more at risk and how professionals can be more sensitive and aware in their interactions with these groups. For adult victims, CALICO receives referrals from Adult Protective Services (APS). In order to assist our partners in helping victims understand and be comfortable participating with CALICO, we recently developed – with input from our partner agencies – a brochure that detectives can give caregivers when they schedule a CALICO interview. The brochure explains what CALICO is and how a caregiver can support their child prior to coming to CALICO. CALICO has created copies of this brochure in both English and Spanish. The text is written at a 5th grade reading level to increase its accessibility. Last, CALICO periodically meets with agencies serving clients with disabilities, including the Regional Center, Stepping Stones, the Center for Early Intervention on Deafness and more to ensure its services are culturally appropriate for clients with disabilities. Both of its office locations are physically accessible and comply with ADA requirements. 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. CALICO facilitates a unique collaborative partnership among 29 agencies that includes the following: Dublin Police Services (and eighteen other law enforcement agencies), six county agencies that respond to Dublin children (Behavioral Health Care Services, County Counsel, District Attorney’s Office, Probation, Social Services, and the Family Justice Center), two local hospitals (Children’s and Highland) that provide forensic medical exams for Dublin victims, and the state child-care licensing organization. CALICO signs an annual operating agreement with Chief Garrett Holmes and other county leaders. Sgt. Daniel McNaughton is 5.1.h Packet Pg. 47 Attachment: 8. CALICO Center - Dublin Child Abuse Intervention Application (HS Grant Program FY19 Recommendations) the Dublin Police representative on CALICO’s Program Advisory Committee, (which meets monthly to guide policy and programming), and DPS detectives participate in monthly case-review meetings. Sgt. McNaughton recently stated that, “Dublin Police Services could not complete our mission to protect and serve all members of our community, often the very young and vulnerable, without the professional, competent, and caring support of CALICO.” For CALICO, collaboration extends well beyond facilitating joint child-abuse investigations between Dublin Police Services and the child-welfare system. CALICO has strategically crafted joint staffing positions to further advance its mission and better aid children. For example, CALICO is one of few non-profits that co-locates with a government partner – a prosecutor is assigned full-time to CALICO. She observes interviews, advises on investigations and assists with case charging recommendations. In addition, CALICO has built a unique collaborative partnership with UCSF Benioff Children’s Hospital Oakland (CHO). CALICO’s FAs each spend one day a week at CHO, following up with and supporting families whose investigations necessitate treatment or examination at CHO. This ensures that wherever a child or family presents – CALICO or CHO – they receive a continuity of services. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. CALICO has strong working relationships with many community-based organizations based in the Tri-Valley area that provide legal, medical and therapeutic services to Dublin children and families that come through CALICO. CALICO’s Family Advocates routinely refer families to the following agencies: Tri-Valley Haven (families are referred for restraining orders for domestic violence, legal custody issues, sexual assault and domestic violence counseling services, and for basic needs such as food, shelter and clothing), Horizons Family Services (counseling), Axis Clinic (for counseling services); and individual mental-health clinicians who are approved to accept California Victim Compensation Program reimbursement. As noted previously, CALICO does not do direct marketing to families; all referrals must come via law enforcement officers or child welfare workers. However, we host quarterly trainings for new investigators so that all detectives and child welfare workers (as well as other professionals such as prosecutors, victim advocates and medical personnel) are aware of CALICO services, the Alameda County protocol for how we work together across agencies, and the process for referring families. Approximately 100 professionals attend these annually. CALICO also offers a child sexual abuse prevention workshop geared toward parents of children in grades K-3 about situations that put children at risk of sexual abuse and about behaviors of adults and older youth that may suggest that the individual intends to sexually offend against a child. Trainings are scheduled throughout the county upon request, and we have reached hundreds of parents through these outreach efforts. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. CALICO services cost-effective as they eliminate duplication while raising quality. Prior to CALICO, Dublin detectives and child welfare workers would conduct independent, overlapping investigations, which raised the overall costs. In addition, high-quality investigations require professionals who are adequately trained. Given the dozens of patrol officers, detectives and child welfare workers who could be assigned to investigate a child-abuse allegations in Dublin, there are considerable costs to ensure each professional understands the dynamics of child abuse, how to interact and develop rapport with children (particularly children in crisis), and how to minimize bias when questioning children. With CALICO, that expertise rests in a skilled staff team who has participated in hundreds (in some cases, thousands) of child-abuse investigations. A national cost-benefit analysis found that investigations in counties that followed the child advocacy center (CAC) model implemented at CALICO, child abuse investigations proved to be 36% less expensive than in counties that did not utilize centers like CALICO. The benefits do not end with cost. CAC counties show significantly more evidence of coordinated investigations, authorize more forensic medical examinations (which can provide important evidence for the investigation and provide the child with a heightened sense of well-being), provide three times more referrals to mental health services and result in increased caregiver satisfaction with the investigation. If CALICO did not exist, child abuse allegations would still need to be investigated and that responsibility would fully return to law enforcement officers and child welfare workers. In that case, the City of Dublin would incur considerably more costs by taking on those tasks themselves and would get less value for that investment than they do by engaging CALICO services. Further, children would experience increased trauma and families would be less supported 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? CALICO aims to provide services to all children referred to us from Dublin detectives and child welfare workers. In fact, in our over 22 year history, CALICO has never turned a child away due to a lack of resources. CALICO aims to ensure we have the infrastructure and resources to continue to interview 100% of children referred. Funds from the City of Dublin would contribute significantly to making that possible. Without these funds, we will need to look elsewhere to fill the gap, possibly to private foundations (which are often highly competitive and restrictive in terms of how funds can be expended) or appeals to individual donors. If we were unable to secure funds, we would need to reduce expenditures, starting with “non-essential” expenditures 5.1.h Packet Pg. 48 Attachment: 8. CALICO Center - Dublin Child Abuse Intervention Application (HS Grant Program FY19 Recommendations) (e.g., trainings, equipment upgrades, outreach to partner agencies, etc.). We would then consider scaling back personnel so that each staff member would be required to take on a larger caseload. Given the emotionally difficult nature of our work, there are concerns such an option could result in significant vicarious trauma and burnout. Finally, if left with no other options, we would be forced to reduce services to a child or family (meaning we may have to triage cases and not offer timely services for every referral). 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 25. 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. 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process CALICO directly serves the City's mission of creating a safe and secure environment and its value regarding public safety resources. CALICO's close partnership with DPS helps hold offenders accountable, making Dublin safer for all children. DPS recently wrote CALICO to say how they, "appreciate all that you and the rest of the CALICO team members do for us and our victims, and how much we appreciate the partnership and support." 28. ** QUESTIONS 29 THROUGH 41 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? 29. 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 ✔✔✔✔ No gfedc Yes: If yes, please explain: gfedc Yes ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. ✔✔✔✔ Yes. If so, check box here and answer questions 29 through 41. gfedc No. If no, check box here and enter gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. 5.1.h Packet Pg. 49 Attachment: 8. CALICO Center - Dublin Child Abuse Intervention Application (HS Grant Program FY19 Recommendations) accommodations are used? Etc. Provide detail Please enter "N/A" if you 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 22% 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 ASL), 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. 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: ✔✔✔✔ Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement ✔✔✔✔ Promote energy and resource efficiency ✔✔✔✔ Encourage networking and information sharing across service providers ✔✔✔✔ Encourage process streamlining ✔✔✔✔ Consolidate service delivery gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *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. gfedc 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. gfedc F) Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase homeownership gfedc Promote decent affordable housing ✔✔✔✔ Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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 gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 5.1.h Packet Pg. 50 Attachment: 8. CALICO Center - Dublin Child Abuse Intervention Application (HS Grant Program FY19 Recommendations) 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: 35. 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?") 36. 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?") 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc Reduce housing discrimination. gfedc 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. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Availability/Accessibility gfedc Affordability gfedc Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. 5.1.h Packet Pg. 51 Attachment: 8. CALICO Center - Dublin Child Abuse Intervention Application (HS Grant Program FY19 Recommendations) 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 39. 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". 40. 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 41. 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" gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 1 Disabled 5 Women/Female Headed Households Seniors 18 Youth Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 24.0024.00 TOTAL 18 Low Income (50%-80% AMI) 12 Extremely Low Income (<30% AMI) Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 30.0030.00 TOTAL 8 White 16 White + HISPANIC 2 Black/African American Black/African American + HISPANIC 5.1.h Packet Pg. 52 Attachment: 8. CALICO Center - Dublin Child Abuse Intervention Application (HS Grant Program FY19 Recommendations) 42. 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 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). CALICO pieces together many small grants and donations (from government, private foundations, corporations, civic groups and individuals) to meet its operating expenses each year. Our board and staff continually look for ways to leverage new funds. Additionally, CALICO is working to increase gifts from individual donors (which are important sources of unrestricted funds) yielding funds for FY19-20 that can be used to support Dublin families if other sources of funding are not secured. These strategies include participating in the Oakland Running Festival, hosting CALICO's annual One Child at a Time benefit in the early fall and conducting a direct-mail campaign. Finally, CALICO has been working closely with the California Office of Emergency Services to create a state-level funding stream for CALICO and centers like it. 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. BL-109881 2 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 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 28.0028.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed Request from the City of Dublin USD$ 15,000.00 Dublin Police Services USD$ 4,500.00 Alameda County DA's Office (in-kind) USD$ 3,000.00 USD$ 3,000.00 Alameda County Social Services Agency USD$ 2,400.00 USD$ 2,400.00 Community Fundraising USD$ 5,000.00 USD$ 5,000.00 Total USD$ 29,900.00 USD$ 10,400.00 5.1.h Packet Pg. 53 Attachment: 8. CALICO Center - Dublin Child Abuse Intervention Application (HS Grant Program FY19 Recommendations) Funding Uses/Expenses Budget Amount Amount Committed Personnel Salary: Staff USD$ 12,195.00 USD$ 0.00 Personnel Benefits: Staff USD$ 2,805.00 USD$ 0.00 Personnel Salary & Benefits: ED (in kind) USD$ 3,000.00 USD$ 3,000.00 Supplies USD$ 1,551.00 USD$ 459.00 Printing USD$ 792.00 USD$ 250.00 Postage USD$ 240.00 USD$ 200.00 Communications USD$ 1,547.00 USD$ 200.00 Rent and Utilities USD$ 1,142.00 USD$ 300.00 Audit and Accounting USD$ 583.00 USD$ 241.00 Outside Service USD$ 3,370.00 USD$ 3,075.00 Training USD$ 2,675.00 USD$ 2,675.00 Total USD$ 29,900.00 USD$ 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 matching. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ List of Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Board Authorization Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Board Authorization2 Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Insurance 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. ✔✔✔✔ 501(c)(3) IRS Determination Letter State Determination Letter Certified Audit and/or Certified Financial Statements 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 Employee Manual 5.1.h Packet Pg. 54 Attachment: 8. CALICO Center - Dublin Child Abuse Intervention Application (HS Grant Program FY19 Recommendations) Application ID: 131321 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. Procedure REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section Audit REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws Bylaws Articles of Incorporation Amended Articles of Incorporation REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) Conflict of Interest Policy 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. LEP_LAP 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) 5.1.h Packet Pg. 55 Attachment: 8. CALICO Center - Dublin Child Abuse Intervention Application (HS Grant Program FY19 Recommendations) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline Chabot-Las Positas Community College District/Tri-Valley Career Center Dublin Career & Business Services 2019-2020 Jump to: Questions Budget Documents USD$ 12,847.00 Requested Submitted: 1/8/2019 9:34:04 AM (Pacific) Project Contact Sarah Holtzclaw sholtzclaw@clpccd.org Tel: 925-560-9439 Additional Contacts none entered Chabot-Las Positas Community College District/Tri-Valley Career Center 7600 Dublin Blvd Dublin, CA 94568 United States Vice Chancellor for Business Services, designated signer Ronald Gerhard rgerhard@clpccd.org Telephone(925) 560-9431 Fax (925) 560-9457 Web trivalleycareercenter.org Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). The mission of the Tri-Valley Career Center (TVCC) (formerly the Tri-Valley One-Stop Career Center/ TVCC) is to provide high- quality, integrated, seamless, accessible and professional employment services for employers and job seekers. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? gfedc Non-Profit ✔✔✔✔ Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No ✔✔✔✔ One-time funding gfedc Seed funding gfedc One-time and Seed funding gfedc Operational funding 5.1.i Packet Pg. 56 Attachment: 9. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin Career & Business Services Application (HS 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. The following funding amounts pertain specifically to our career services. As can be seen from the figures below, our largest grant from the Alameda County Workforce Development Board (ACWDB) has shrunk nearly 30% over the last three years. Our operational budget is augmented by the Chabot-Las Positas Community College District (CLPCCD). These figures do not include the fees for service that employers are charged for participation in recruitment events. 2018-2019 ACWDB, $250,255 City of Dublin, $12,025 City of Pleasanton, $5,000 City of Livermore, $7,000 2017-2018 ACWDB, $374,197 ACWDB Special Projects, $40,000 City of Dublin, $13,500 City of Pleasanton, $7,000 City of Livermore, $5,000 2016-2017 ACWDB, $328,402 Career Pathways Trust Grant, $25,000 City of Dublin, $15,000 City of Pleasanton, $7,000 2015-2016 ACWDB, $348,402 City of Dublin, $9,600 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). We have the capacity to conduct career services and small business advisement, as described below and has been demonstrated over the years, by our organizational structure, staff expertise and proven adherence to federally-related operational requirements. Operational Structure: TVCC is a self-funded service of the CLPCCD, operating under the District’s Economic Development office. CLPCCD has an elected board, complete fiscal staff and experience with grants. This relationship with CLPCCD guarantees that we have management, fiscal and governing board oversight of our operations. Additionally, we are partnering with Ohlone College and Las Positas College (LPC) to provide small business development services in the coming years, through the Alameda County Small Business Development Center (SBDC). Together, the three of us have the capacity and expertise to serve the region’s small business. Staff Expertise: The Career Center is staffed with seven workforce development specialists, who, together have over 65 years of experience offering career services to the public. The career center has been in operation since 1998 and continues to make adjustments to the modern job search process. Staff is trained, and keeps up-to-date on current hiring trends in order to pass this knowledge to our clients. We have an 92% placement rate with our job seekers. On average, our Dublin job seekers spend 6 months with us, and earn an average wage of $37.63/hour at their new jobs. Local, State and Federal Operational Rules: Additionally, our career services program is regulated by the state and federal workforce law – Workforce Innovation & Opportunity Act (WIOA). The staff must adhere to certain standards, keep certain records and report specific data to the state and local boards. We continually strive to add new services to our repertoire while still adhering to these standards. Our added SDBC services will adhere to its state-wide system standards as well. 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. Dublin Career & Business Services 2019-2020 will increase TVCC’s capacity for provide comprehensive career services to job gfedc None 5.1.i Packet Pg. 57 Attachment: 9. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin Career & Business Services Application (HS seekers and to build the capacity of local small business through workshops and individual counseling. 9. 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 plan to reach 2100 unduplicated Dublin residents and/or businesses during the 2019-2020 fiscal year. This will be done through a variety of touch points including in our Career Center, at partner locations, online and at events. 10. 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 Concern. 11. How will this project will be implemented, administered, and operated? Our services target both the job seeker and the employer: For the Job Seekers We will continue to provide high-quality, integrated career services on two levels. These include teaching self-directed job seekers to learn new search techniques via workshops and offering our available facilities and equipment. These job seekers need little or no assistance from our staff. Those looking for staff-assisted help, move to next tier of our services. These clients may also meet with staff 1-on-1 to develop individualized employment plans. Our counselors meet with clients to address barriers to employment the clients may be experiencing and to help put a plan together. When appropriate, our employment specialist connects the job-ready applicants to open positions in the area. These, more engaged job seekers, also have an opportunity for additional training to be more competitive in the job market. We will also be targeting job seekers who cannot meet in person or come to the center. Through the use of technology, we will reach out to job seekers via webinars, social media, e-newsletters, blogs and other means using available technology. For Employers Currently, our employer services include recruitment assistance, hiring events, customized training and on-the-job training reimbursements. Our services, however, will expand to include many more options for employers and small businesses. It will include classes and workshops to improve a knowledge base and build capacity. It will also include 1-on-1 advising by the Small Business Development Center. Will offer events and classes at our Career Center, at partners such as the Chambers, and at Las Positas College/ 12. Describe in detail how Dublin grant funds will be used for this project. (What specifically will the grant funds be used for?) Our services, both for the job seeker and the employer, rely heavily on the time and expertise of our staff. Our staff salaries and benefits are 75% of the overall Career Center annual budget. However, our ever-diminishing ACWDB grant pays for only about half of these costs, and does not cover any additional operating expenses. We are left to find additional resources for the remaining. Thus, this grant, if fully funded, will pay for a portion of our staff salary. However, more importantly, it will help pay for marketing, outreach, travel and operating expenses. The marketing and outreach will include the development of online campaigns, as well as placement costs on Google and Facebook. Operational costs include a portion of rent, utilities, supplies and printing costs. The amount requested from the City of Dublin is proportional to that being asked of the cities of Livermore and Pleasanton. This particular project is equal to 10% of the over staff hours throughout the year at the Career Center. We are requesting that each of the three cities contribute 10% of the staff salaries and benefits for the project, or 1% of our annual staff salaries and benefits. Additionally, we are requesting that each city contribute an amount toward the operating expenses equal to the gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) ✔✔✔✔ Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above gfedc Please explain: 5.1.i Packet Pg. 58 Attachment: 9. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin Career & Business Services Application (HS percentage of clients we serve from that particular city. In the case of the City of Dublin, that would be 21.53%. The full requested amount from the City of Dublin is 11.11% of the overall project budget, or less than 2% of our over annual budget. 13. 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)? It is a strong belief of the Career Center’s manager, that you cannot manage what you do not track. Therefore, we track many aspects of our business. As a federally-funded program through WIOA, we are mandated to track all of the services we offer to our second-tier job seekers. Per the WIOA-regulations, for those clients enrolled in our second tier of services, we track: • What services we provide the client • Placement rate, or employment found • Hourly wage and benefits the client will make at their new job • Job title and company of the new position • Whether they are still employed 6 months and a year later For all job seekers, we track: • Number of unduplicated individuals visiting to the Career Center • Job Seeker age and gender • Frequency of visits • City of residence • Workshops attended • Website visits • Social media engagement For our business and employer clients, we will track similar data • Business location • Business size • Business service provided (Ie: on-site recruitment, job fair, job board listing, employee placement, recruitment assistance, workshop) 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. The TVCC office is open to the public, without regard to income, ability or experience. Per our contract with the ACWDB, we serve adults 18 years of age and over who are legally able to work in the U.S. Our average client is a 42-year old woman, with the gender split being 60% women, 40% men. Our enrolled, 2nd tier clients are broken into two categories of Dislocated Workers (i.e.: those who have been recently laid off), and Adults (i.e.: those long term unemployed or parents coming back into the workforce). Unlike similar career centers, we offer a wide array of workshops that meet the needs our particular job seekers. This includes workshops ranging from soft skills to LinkedIn to tips for the mature worker who may be facing ageism in the job market. Our ongoing partnerships include state, county and local agencies serving people with disabilities, veterans, basic skill deficient, formerly incarnated, low-income, and English language learners. We also work with the Tri-Valley ROP, regional highs schools and youth providers of job services. If there is a population who needs job search services, we likely work with them or partner with an agency that does. On average, the businesses we assist tend to be smaller in size, without a human resources staff. Our recruitment assistance is welcomed by those owners who do not have that expertise. That said, we do seek out and work with the region’s largest employers as well. With the addition of the SBDC services, we will be serving new entrepreneurs as well as established employers. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? 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. Services in our offices are done on individually or in a small group environment. We pride ourselves on the diversity of both the people we serve and the breadth of the jobs available at any given time. Clients can access information as they prefer: on their own, using our office equipment and/or space; small groups where clients access workshops to help in their search or small group counseling and networking opportunities; or one-on-one career counseling where staff spends time with them individually to work on resumes, interview skills and job search strategies. Our more-intensive clients create individual 5.1.i Packet Pg. 59 Attachment: 9. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin Career & Business Services Application (HS employment plans (IEP) with the help of staff. The IEP is individualized to meet the needs of the client and ensure success in reaching their employment goals. Goals may include such things as learning English, going to an adult school for basic skills, attending training courses, expunging a record, targeting companies, improving interview skills or simply networking more. Additionally, we have three Spanish-speaking staff who can assist clients if their native language is preferred. One of these staff members is a Career Counselor who can offer workshops and career guidance in Spanish. We have a third-party language service should the job seeker need other language interpretation. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? The WIOA law requires job centers such as TVCC to specifically work with job seekers who have barriers to employment. The intent is to spend additional time and funding for those harder to employ. This focus includes, but is not limited to, people with disabilities, ex-offenders, low-income, low-skilled and English language learners. We are outreaching to these populations but also have plans in place to work with partners who already serve these populations. We have three Spanish-speaking staff members at TVCC, including a Career Counselor. We have translated our materials into Spanish and have outreach to Spanish-speaking populations in the region. For those who speak other languages, we have a third-party translation service available to us. Additionally, we partner with the regional adult schools and the Tri-Valley ROP to offer the services of a Transition Specialist who guides mostly ELL students to trainings, community college or the Career Center for jobs. We have auxiliary aids and services available upon request to individuals with disabilities including software installed on computers to aid visually and auditory impaired individuals. We also partner with the Department of Rehabilitation to co-enroll and help their clients with disabilities. We have a partner who works with Santa Rita Jail inmates prior to their release so they can be ready for their job search or training once they return to the community. This staff member sits in our TVCC office. Our outreach efforts include community partners who also serve low-income adults, such as Axis Community Health, Open Heart Kitchen, the three regional cities and the public libraries and the housing authority. We have opened opportunities to not only teach clients but staff of partner agencies so that they can better serve their clients in our absence. 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. TVCC continually seeks out partnerships with other community organizations across the region. Lack of employment is often a reason for the need of other services. The following are organizations with which we currently work. Over the coming year, this list is sure to expand as there are many organizations doing great work and helping people find employment. • Las Positas Community College: educating students for the workforce. Work w/ staff & faculty, coordinate job fairs, partner with small business offerings • Ohlone College: with the SBDC services and workshops • Cities/Chambers of Dublin, Livermore & Pleasanton: co-hosting job fairs, outreach to businesses and clients • DOR: offer space for their staff and clients. We co-enroll clients when appropriate. • EDD: Veteran services is co-located at TVOS once month. We are working, as well, to bring EDD unemployment services to the area. • SSA: serve CalWorks clients, offer space and applications for public benefit enrollments. • Dublin & Livermore Libraries: offer our workshops and career counseling onsite 3x a month. • Pleasanton Public Library: offer our tax services once a week at the Library during tax season. • Santa Rita Jail & FCI Dublin: offer resources and pre-release counseling and workshops for inmates. • Tri-Valley ROP/Adult School Cooperative: work with the adult schools and ROP to host a Transition Specialist at TVOS and to develop programs that will benefit mutual clients. ROP staff teach computer and Microsoft Office classes at TVOS. • Tri-Valley Educational Cooperative: bring employers to the table for high school students to learn career paths & skills development. • City Serve of the Tri-Valley: offer services to City Serve clients as they are needed. We also attend meetings to learn of other resources in the region and to outreach to other organizations. • Tri-Valley Anti-Poverty Collaborative: attend meetings and sit on committees where appropriate. • Various CBOs: cross refe 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. Marketing and outreach is a part of this grant request. Our TVOS Program Manager, who took over in 2015, makes a concerted effort to continually expand the Center’s marketing and outreach efforts. From our annual survey, we know 50% of our clients found TVCC through a referral by a friend, family member or other agency. Another 20% learned about our services online. These results show that the marketing and outreach efforts that have been done in the last years are working. Unfortunately, the TVCC is still a secret to many job seekers and employers alike. We still hear too many people saying “I 5.1.i Packet Pg. 60 Attachment: 9. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin Career & Business Services Application (HS wish I knew you were here”, or “where have you been all this time”. That is a testament that the marketing and outreach must continue to expand. Given our diminishing budgets, we rely heavily on low-cost outreach such as our website, SEO, Yelp and Facebook posts. We have also built our network of partner organizations and keep them informed of events and opportunities. However, we know from 1) best practices and 2) our past marketing efforts with job fairs our biggest “bang of the buck” is online. Jobs are online and thus the job seekers are there as well. Fully funded by all three cities, this project and grant request will allow us to pay for online marketing that we otherwise would not be able to afford. We are also increasing outreach to employers in the region. Though we have built an excellent relationship with employers over the years, the growth of the region means that more employers are joining the Tri-Valley economy. The robust economy also means that employers are more desperate to find qualified staff. We are working with the Chambers and Cities, using our website and SEO as well as partners to reach them. The addition of SBDC services will also expand this outreach. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Fully funded by all three cities, this project will help build the capacity of the TVCC primarily through marketing. The budget includes staff salaries and benefits as the services of the Career Center are heavily reliant of the expertise of the staff. This line item, however is but 10% of the project and 1% of our annual budget. The larger portion of the budget covers operating expenses such as printing, rent and marketing development. The amount requested from the City of Dublin is proportional to that being asked of the cities of Livermore and Pleasanton. This particular project is equal to 10% of the over staff hours throughout the year at the Career Center. We are requesting that each of the three cities contribute 10% of the staff salaries and benefits for the project, or 1% of our annual staff salaries and benefits. Additionally, we are requesting that each city contribute an amount toward the operating expenses equal to the percentage of clients we serve from that particular city. In the case of the City of Dublin, that would be 21.53%. The full requested amount from the City of Dublin is 11.11% of the overall project budget, or less than 2% of our over annual budget. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? The budget for TVCC is very tight. The staff are CLPCCD employees and thus have relatively secure positions. However, since the Career Center is not a core service of the District, CLPCCD leadership seeks to have the TVCC budget fully funded through grants or fees for service. Unfortunately, the federal funding through ACWDB has decreased 30% over the last 4 years, which can be seen in question 6 of this applications. In fact, TVCC has lost nearly $100,000 of funding over that period. Thus, the need for the city funding as well as additional support is ever greater this year. That said, should the funding be less than anticipated, we would first cut back on the marketing and other operating expenses, which will then affect the program growth. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not applicable. N/A ✔✔✔✔ No gfedc Yes: If yes, please explain: gfedc Yes ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 5.1.i Packet Pg. 61 Attachment: 9. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin Career & Business Services Application (HS 25. 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. 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process Our work is one of economic development that directly corresponds with the City’s vision of a high quality of life. By helping Dublin residents secure employment, we are increasing disposable income that will be spent in the region. We are also helping employers to grow by finding qualified employees for their businesses. Both sides of this coin help the region grow, and bring security to the City. 28. ** QUESTIONS 29 THROUGH 41 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? 29. 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 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. ✔✔✔✔ Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc Yes. If so, check box here and answer questions 29 through 41. ✔✔✔✔ No. If no, check box here and enter gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *Promote fair housing and reduce housing discrimination. gfedc 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: 5.1.i Packet Pg. 62 Attachment: 9. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin Career & Business Services Application (HS 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: 35. 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?") 36. 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?") 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. gfedc * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. gfedc C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. gfedc D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. gfedc 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. gfedc Increase homeownership gfedc Promote decent affordable housing gfedc Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. gfedc Improving the quality of life for our Nation's communities gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc Reduce housing discrimination. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. 5.1.i Packet Pg. 63 Attachment: 9. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin Career & Business Services Application (HS 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 39. 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". gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. 0 Disabled 0 Women/Female Headed Households 5.1.i Packet Pg. 64 Attachment: 9. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin Career & Business Services Application (HS 40. 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 41. 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" 42. 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 0 Seniors 0 Youth 0 Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL 0 Low Income (50%-80% AMI) 0 Extremely Low Income (<30% AMI) N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL 0 White 0 White + HISPANIC 0 Black/African American 0 Black/African American + HISPANIC 0 Asian 0 Asian + HISPANIC 0 American Indian/Alaskan Native 0 American Indian/Alaskan Native + HISPANIC 0 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 0 Asian and White 0 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) 0.000.00 TOTAL gfedc #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. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. 5.1.i Packet Pg. 65 Attachment: 9. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin Career & Business Services Application (HS 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). TVCC is a service of the CLPCCD. Our core career services are primarily funding through the ACWDB and the CLPCCD, with additional help from the Tri-Valley cities. We are not completely dependent on the any one entity. That said, CLPCCD leadership requests that TVCC’s budget be fully-funded through grants or fees for service. Unfortunately, the ADWDB funding is dwindling rather than increasing over time. Center management is continuing to seek additional grants and funding opportunities through private and public entities to make this happen. In the meantime, CLPCCD will help pay staff salaries and management will continue to tightly monitor expenses. 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. BL 010043 gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed City of Dublin USD$ 12,847.00 USD$ 0.00 City of Livermore USD$ 12,556.00 USD$ 0.00 City of Pleasanton USD$ 12,703.00 USD$ 0.00 Alameda County Workforce Development Board USD$ 44,675.00 USD$ 0.00 Chabot-Las Positas Community College District USD$ 14,891.00 USD$ 14,891.00 USD$ 0.00 USD$ 0.00 Total USD$ 97,672.00 USD$ 14,891.00 Funding Uses/Expenses Budget Amount Amount Committed Salaries USD$ 46,834.00 USD$ 7,141.00 Benefits USD$ 24,126.00 USD$ 3,678.00 Supplies USD$ 325.00 USD$ 50.00 Printing/Copying USD$ 950.00 USD$ 145.00 Rent/Utilities USD$ 9,387.00 USD$ 1,431.00 Contracted Marketing Services USD$ 15,500.00 USD$ 2,362.00 Other - Travel USD$ 550.00 USD$ 84.00 USD$ 0.00 USD$ 0.00 USD$ 0.00 Total USD$ 97,672.00 USD$ 14,891.00 Budget Narrative 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 such as rent, marketing, printing and supplies. Of these hard costs: staff salaries = 43.3%; benefits = 31.3%; and operating expenses = 25.4%. Together they are less than 40% of our over budget, while our donated volunteer time is over 60% of the budget. The VITA program is a small portion of our overall budget. In fact, the staffing costs alone is just 5.47% of our annual staff and benefits costs. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ CLPCCD-TVCC Career & Business Services 19-20 Program Expenses Financial Information Form for ALL Grant Requests download template ✔✔✔✔ CLPCCD-TVCC Career & Business Services 19-20 Financial Info List of Board of Directors (or governing body) with ✔✔✔✔ CLPCCD Board of Directors 5.1.i Packet Pg. 66 Attachment: 9. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin Career & Business Services Application (HS Application ID: 132890 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. agency contact information Current Annual Budget for the Entire Agency ✔✔✔✔ CLPCCD Annual Adopted Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ CLPCCD No 990 or Tax Return Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ CLPCCD Board Authorization Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ CLPCCD Board Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ CLPCCD Proof of Insurance 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. ✔✔✔✔ CLPCCD IRS 501c3 Letter 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) 5.1.i Packet Pg. 67 Attachment: 9. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin Career & Business Services Application (HS Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline Chabot-Las Positas Community College District/Tri-Valley Career Center Dublin VITA Program 2019-2020 Jump to: Questions Budget Documents USD$ 7,185.00 Requested Submitted: 1/8/2019 9:38:33 AM (Pacific) Project Contact Sarah Holtzclaw sholtzclaw@clpccd.org Tel: 925-560-9439 Additional Contacts none entered Chabot-Las Positas Community College District/Tri-Valley Career Center 7600 Dublin Blvd Dublin, CA 94568 United States Vice Chancellor for Business Services, designated signer Ronald Gerhard rgerhard@clpccd.org Telephone(925) 560-9431 Fax (925) 560-9457 Web trivalleycareercenter.org Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). The mission of the Tri-Valley Career Center (TVCC) (formerly the Tri-Valley One-Stop Career Center/ TVCC) is to provide high- quality, integrated, seamless, accessible and professional employment services for employers and job seekers. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? gfedc Non-Profit ✔✔✔✔ Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No ✔✔✔✔ One-time funding gfedc Seed funding gfedc One-time and Seed funding gfedc Operational funding 5.1.j Packet Pg. 68 Attachment: 10. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin VITA Program Application (HS Grant Program 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. 2018-2019 United Way, $13,000 Alameda County Community Actions/City of Oakland, $10,000 City of Dublin, $6,700 City of Pleasanton, $5,000 Wells Fargo Foundation, $5,000 2017-2018 United Way, $11,500 City of Dublin, $7,000 2016-2017 United Way, $10,000 City of Dublin, $6,000 2015-2016 United Way, $6,000 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). We have the capacity to run the VITA program as described below and demonstrated over the years by our organizational structure, staff expertise and proven adherence to federally-related operational requirements. Operational Structure: TVCC is a self-funded service of the Chabot-Las Positas Community College District (CLPCCD), operating under the District’s Economic Development office. CLPCCD has an elected board, complete fiscal staff and experience with grants. This relationship with CLPCCD guarantees that we have management, fiscal and governing board oversight of our operations. In addition to providing quality career services to our community, we offer other services that are within the workforce development scope. One of those services is to offer free tax preparation. The 2019 tax season will be the 7th season that we offer this service. Each year, it has grown in the number of volunteers and the clients we have served. We are definitely filling a service gap in the Tri-Valley region. Staff Expertise: Program Coordinator, Alexandra Gallegos has been facilitating the program since its inception in 2013. She has grown the program from 68 tax returns to 500 a year since we began the program. She facilitates the entire program and is the reason for its success. Program Manager, Sarah Holtzclaw, also has a background of developing and expanding a free tax preparation program in Oregon. She assists with marketing, fund raising and working with partners. IRS Operational Rules: Additionally, the program is highly regulated by the Internal Revenue Service. The program and volunteers must adhere to specific training and certifications, as well as operational standards and procedures. Taxes are completed by certified volunteers on a nationally-used software platform. The program is audited on-site by both the United Way and the IRS at least once during the season. 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. The VITA program increases access to free tax preparation for the working poor. State and federal taxes are e-filed by certified volunteers, so taxpayers avoid unnecessary costs, while bringing federal refund monies back to the local economy. 9. 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.) 111 unduplicated Dublin residents. For the 2019-2020 season, we believe we will serve 675 taxpayers, 16.5% of which will be from Dublin. 10. 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 Concern. gfedc None gfedc Behavioral Health (mental health and substance abuse) 5.1.j Packet Pg. 69 Attachment: 10. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin VITA Program Application (HS Grant Program 11. How will this project will be implemented, administered, and operated? The IRS develops guidelines and operational standards to which we must adhere, and to which our networks monitor, including the paperwork that is completed, the scope for which we can help, and the follow-through that needs done. In order for the season to go well, our Coordinator spends 4-5 months recruiting volunteers, training on the new procedures, setting up the processes and training the volunteers. Volunteers are trained in January, on three consecutive Saturdays. This training teaches volunteers both the tax law and the software. We will offer the VITA services weekly at our Dublin offices and at the Pleasanton Public Library. Clients make 45-minute appointments and are told what paperwork must be bought to their session. At the appointment, the client completes some paperwork, talks with a volunteer to be sure they qualify and have all the necessary paperwork to complete the taxes in that session. If so, the client meets with a tax preparer, sitting beside the volunteer as they complete the tax forms. Once completed, a third volunteer administers a quality review to be sure all information has been input correctly. The client walks out with a copy of their federal and state returns. We keep only their signed approval to submit form. At the end of the day, we will electronically submit all returns completed that day. Any errors are fixed as needed. If the pilot program at Las Positas College (LPC) is successful in 2019, we will again offer guided “do-it-yourself” services at the College. In these facilitated sessions, students and the public are offered a chance to complete their taxes on their own. This not only offers TVCC a chance to help many people at once, but gives the clients the confidence to complete their taxes themselves. The session is facilitated by our certified volunteers who will be trained in taxes above the regular constrictions, including international student issues. 12. Describe in detail how Dublin grant funds will be used for this project. (What specifically will the grant funds be used for?) Though the tax preparation services are free to the tax payers, it is not free to operate. The largest expense is staff salary and benefits, 43.3 and 31.3 percent, respectively. This program is heavily reliant on the expertise, planning, volunteer recruitment and operations oversite by our Program Coordinator. She coordinates with the United Way and the IRS to ensure our volunteers are familiar not only with the software and all new tax law each year. She works with the Library and LPC to ensure the space is ready and all equipment and supplies are available. She attends Coordinator meetings that help raise her level of expertise. She personally files each completed return electronically. She recruits, trains, schedules and oversees 40 volunteers throughout the season. By federal statute, the taxes must be prepared by volunteers. However, they cannot do their job effectively without all the work done ahead of time and during the season to support them and to make the systems run smoothly. As an added service, two staff at TVCC are Certified Acceptance Agents (CAA) with the IRS. This allows us to fast-track Individual Tax ID Numbers (ITIN) applications for those tax payers without a social security number. We are now the only CAA office in the far east and southern part of Alameda County. In the past 3 years, we have prepared 26 tax returns with ITIN applications. A smaller portion of the grant will pay for supplies (25.4) such as paper, toner, and office supplies; printing; facilities rent; low- cost marketing; and volunteer appreciation. The overall budget for the program is $110,299, of which $43,549 is hard costs. The remaining $66,750 is the value of our volunteers. Dublin’s share of this budget is 16.5%, or $7,185, which reflects the percentage of clients served from Dublin. 13. 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)? gfedc Affordable Housing gfedc Health Care (including dental) ✔✔✔✔ Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity ✔✔✔✔ Financial Assistance gfedc None of the above gfedc Please explain: 5.1.j Packet Pg. 70 Attachment: 10. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin VITA Program Application (HS Grant Program Since this is a federal-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. For the Tri-Valley VITA program, we will track: 1) Total number of clients served 2) Percentage increase of client served 3) Total federal dollars returned to clients 4) Average and Total Earned Income Tax Credits (EITCs) returned to clients served 5) Average Adjusted Gross Income of clients served 6) The total number if ITIN applications filed From this, we can extrapolate Dublin data to know the above information specific to the City. 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. VITA is a service specifically for the working poor with low or moderate incomes. This year, the thresholds that we are bound to serve are household incomes equal to or less than $65,000 a year, whether they are single, head of household or married couples. Though this sounds like a living wage, it is important to note that the average household income for our Dublin clients during the past tax season was just over $28,300, which far below the living wage for our region ($16.52/hour for a single person, no children or $34,362 full time). This includes all our clients: singles, single parents and married couples with or without children. Though the Tri-Valley is a very high average household income, there are obviously a significant number of families living at or just above the poverty line. The VITA program is also offered to counter the high cost of paid, and sometimes predatory, tax preparation services. It can cost $350-$500 for simple tax return at the national tax preparation chains, or half of our average refund. Though national tax preparing franchises, such as H&R Block and Liberty Tax Services, advertising free tax preparation, it is not truly free. Their two-page federal 1040 is free with a single W-2. However, any additional W-2’s and all forms there-after, such as the EITC, Child Tax Credit, College Credit worksheets, etc. cost money. Additionally, it costs to file a state return at the same time. The costs can equal the average refund, which means the tax payer does not benefit from their refund at all. Add to that the high interest rates of a refund anticipation loan, and the low-income tax payer can actually be in debt from filing their taxes. VITA and TVCC are intending to mitigate those costs and helping hard working families keep and save as much of their money as possible, so they can pay rent, buy new shoes and clothing, pay daycare bills, put food on the table and the like. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? VITA is a federal program, and thus is open all qualified tax payers. The program is intended to help working families file their taxes for free. The program has strict policies as to the tax situations that qualify for the free service or if they need to be referred to a paid preparer. We can help with simple returns all the way to mortgages and capital gains. However, if their income or tax situation fall outside our parameters, we are not able help them. This guarantees that we serve only those the program is intended to serve – the most vulnerable. The truly working poor. VITA is a service that offers one-on-one tax preparation with a certified volunteer. The volunteer completes the client’s state and federal tax returns while that tax payer sits beside them. We have Spanish-, Tagalog-, and Chinese-speaking volunteers, which allows them to communicate directly with the tax payer, without the use of an interpreter. For other languages, often the client will bring an English-speaking relative, or we will use our third-party language service. Additionally, our services as a Certified Acceptance Agency through the IRS, allows us to streamline the process of obtaining an ITIN, for immigrant tax payers without a Social Security number. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? As the intended clients of VITA are low- to moderate-income working families, we need to use non-traditional methods for our outreach and marketing. Of course, word of mouth and returning clients are our best method of marketing. We offer “refer a friend” cards to each client after we’ve served them. Our current outreach efforts include community partners who also serve low-income adults. We start marketing in English and Spanish during the holidays so we can capture the Christmas food box deliveries. We market through partners such as City Serve, the Tri-Valley Anti-Poverty Collaborative, Axis Community Health, thrift stores, the school district counselors and social workers, the public libraries and the housing authorities. We will also be marketing to LPC students heavily again in 2020. For those who look for the services online, we have a section of the TVCC site dedicated to the services and are listed on the United Way of the Bay Area’s site. If our budget is fully-funded, we will also use a portion of the funds for online advertising through Google and Facebook. 5.1.j Packet Pg. 71 Attachment: 10. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin VITA Program Application (HS Grant Program Our marketing efforts are all in English and Spanish. Additionally, we strive to have Spanish-, Tagalog-, and Chinese-speaking volunteers so that families feel comfortable in an already-stressful situation. Additionally, TVCC’s services as Certified Acceptance Agency through the IRS is one of the only such services in the region – beyond the Tri-Valley. The IRS often sends clients to us for their applications. This is important for foreign-born tax payers who are paying taxes for the first time. They must apply for the ITIN at the time of the tax preparation and send the taxes with their applications. An ITIN number can be used for paying taxes only, which is one step in the process of becoming a citizen of this country. 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. The TVCC is continually seeking partnerships with other community organizations across the Tri-Valley and beyond. Currently, we have five main partners in this program, each of which contribute to its success. They include: • United Way of the Bay Area – the United Way is both a funder and a partner. They are the lead agency in the Bay Area for the VITA program. In addition to funding, they provide oversite and training for our site coordinators, marketing materials, volunteer recruitment help and ongoing support. • Internal Revenue Service – the IRS provides the tax law, software and technical support, training materials and ongoing support. IRS employees also volunteer as tax preparers during the season. • Alameda County Community Action Coalition/City of Oakland – Our newest partner is the ACCAC which is a funder and marketing partner. The ACCAC is promoting the California Earned Income Tax Credit (EITC) throughout the county along with funding several VITA programs. • Pleasanton Library – The Pleasanton Library is our second site for tax preparation. The Library assists in taking appointments for the Saturday sessions as well as offers us their space, technology and printing capabilities. • Las Positas College – Las Positas College (LPC) is a new location for us in our tax sites in the 2019 season. The LPC site offers students and the public an opportunity to complete their taxes themselves for free, under the facilitation of certified volunteers. We use a particular software for this service that allows for clients to complete the taxes themselves, gaining confidence to do their own taxes in future years, in they wish. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. Marketing and outreach is a critical component to growing this program and serving more Tri-Valley residents. Unfortunately, it is also the line item that is cut first when our budget is not met. Therefore, we often are left with low cost options such as: • Word of Mouth/Refer a Friend: Word of mouth from our past clients is the best form of advertising. As we have grown over the past years, our repeat client base has also grown. We offer every client a “Refer a Friend” card at the end of their appointment. This offers them an opportunity to formally refer our services. Even if these are never used, they put the idea of referral in their head and often leads to the suggestion to friends and family. • Social Media: We use our social media accounts as well as our partner organizations’ to post the services and link to our website. • Flier/Poster Distribution: Fliers and posters are designed each year for distribution in holiday gift baskets, to partners’ clients, to LPC students and the public. These are created both in Spanish and English. They are widely distributed where low-income residents shop and frequent as well as the school districts, the cities and other community nonprofits serving similar populations. • TV 30: The local community cable channel interviews our staff and volunteers once or twice a season to remind the community of the service and the documents to bring. With additional funds, the budget includes paid online advertising through Google and Facebook. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. 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 such as rent, marketing, printing and supplies. These total $43,549 for this 2019- 20 year. This represents 39.5% of the overall budget. The value of the volunteers’ time is an additional $66,750, bringing the total budget $110,299. The VITA program is extremely cost efficient and delivers a substantial return on investment (ROI) for the City of Dublin. State and federal tax returns are spent directly in the tax payer’s community. Research on the Earned Income Tax Credit (EITC), in particular, shows that there is 1) a multiplier effect on the refund in the community of 1.5-2.0%; and 2) the EITC is an actually encouragement to employment by single mothers, in particular. The following is the City of Dublin’s return on their investment of $7,185. • We anticipate the “hard” program budget for the 2019-20 fiscal year to be $48,549. • City of Dublin’s $7,185 grant is 16.5% of the total budget 5.1.j Packet Pg. 72 Attachment: 10. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin VITA Program Application (HS Grant Program • We anticipating serving over 675 clients during the tax season • 16.5% (111) of these, we believe, will be Dublin residents • The average refund last season was $1,890 • $1,890 x 111 taxpayers = $176,490 in refunds to Dublin tax payers • 1.5% multiplier effect (conservatively) > $264,735 specifically to the Dublin economy The City of Dublin should see an ROI of $264,735 or 3,584% for the small investment of $7,185. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? VITA programs across the country are primarily grant funded. In fact, the U.S. Congress appropriates funding each year to promote and support the service in all 50 states. The United Way of the Bay Area and its network is a large recipient of this federal grant funding for the entire Bay Area, dividing it among all of the regional programs. Though our United Way grant has grown over the years, it still does not come close to covering all of our costs. TVCC is limited to what services it can provide due to the limited funding it receives. The budget provided is a minimal one for the services provided. There is no cushion in the budget other than marketing. Much of the program coordination needs to be done whether we have one site open or three. We still need to plan, recruit and train volunteers, coordinate and control the quality of the services provided. That said, should the funding be less than anticipated, we would first cut back on the marketing and other operating expenses, which will then affect the program growth. Should this not be enough, we will need to cut back on the number of hours we are open as to limit the staff time in the coordination of the site. This, of course, then directly correlates with the number of clients we are able to help, and the City’s ROI. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 25. 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. 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) ✔✔✔✔ No gfedc Yes: If yes, please explain: gfedc Yes ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. ✔✔✔✔ Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 5.1.j Packet Pg. 73 Attachment: 10. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin VITA Program Application (HS Grant Program 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process The VITA program helps the City of Dublin fulfill its mission supporting a high quality of life by returning money to the pockets and bank accounts of its most vulnerable residents. It allows for those living on the edge to remain in Dublin by offering services for free and returning federal refunds to the clients to spend in the community, which only multiplies its effect on additional residents and businesses. 28. ** QUESTIONS 29 THROUGH 41 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? 29. 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 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: gfedc Yes. If so, check box here and answer questions 29 through 41. ✔✔✔✔ No. If no, check box here and enter gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *Promote fair housing and reduce housing discrimination. gfedc 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: gfedc * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. gfedc * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. gfedc C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. gfedc D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. gfedc 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. gfedc Increase homeownership gfedc Promote decent affordable housing gfedc Strengthen communities gfedc Ensure equal opportunity in housing 5.1.j Packet Pg. 74 Attachment: 10. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin VITA Program Application (HS Grant Program 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: 35. 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?") 36. 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?") 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc Promote participation of grass-roots, faith-based, and other community-based organizations ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. gfedc Improving the quality of life for our Nation's communities gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc Reduce housing discrimination. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. 5.1.j Packet Pg. 75 Attachment: 10. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin VITA Program Application (HS Grant Program 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 39. 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". 40. 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 gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. 0 Disabled 0 Women/Female Headed Households 0 Seniors 0 Youth 0 Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL 0 Low Income (50%-80% AMI) 0 Extremely Low Income (<30% AMI) N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 5.1.j Packet Pg. 76 Attachment: 10. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin VITA Program Application (HS Grant Program 41. 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" 42. 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 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). TVCC is a service of the CLPCCD. Our core career services are primarily funding through the ACWDB and the CLPCCD, with additional help from the Tri-Valley cities. We are not completely dependent on any one entity. That said, the VITA program is completely grant-funded, with “last-dollar” financial support from the CLPCCD. Though an extremely valuable services to the client, it is not our core business, and thus must be grant funded each year. As can be seen from question 6, our funding has increased over the years to include other entities, both private and public. This allows us to continually grow the service. In order to continue to offer the services and to grow the program, we continue to search for additional or increased funding sources. We continue to request funding from each of the three cities, as well as increase our United Way grant. This year, we added funding sources that we hope will continue in the 2019-20 fiscal year and will seek additional ones as well. 0.000.00 TOTAL 0 White 0 White + HISPANIC 0 Black/African American 0 Black/African American + HISPANIC 0 Asian 0 Asian + HISPANIC 0 American Indian/Alaskan Native 0 American Indian/Alaskan Native + HISPANIC 0 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 0 Asian and White 0 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) 0.000.00 TOTAL gfedc #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. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. 5.1.j Packet Pg. 77 Attachment: 10. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin VITA Program Application (HS Grant Program 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. BL 010043 Budget top Funding Sources/Revenues Budget Amount Amount Committed City of Dublin USD$ 7,185.00 USD$ 0.00 City of Livermore USD$ 8,274.00 USD$ 0.00 City of Pleasanton USD$ 9,145.00 USD$ 0.00 United Way of the Bay Area USD$ 14,000.00 USD$ 0.00 Wells Fargo USD$ 5,000.00 USD$ 0.00 Volunteer Time Donation USD$ 66,750.00 USD$ 0.00 Total USD$ 110,354.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Salaries USD$ 18,836.00 USD$ 0.00 Benefits USD$ 13,647.00 USD$ 0.00 Supplies USD$ 325.00 USD$ 0.00 Printing/Copying USD$ 750.00 USD$ 0.00 Postage USD$ 312.00 USD$ 0.00 Rent/Utilities USD$ 2,890.00 USD$ 0.00 Contracted Marketing Services USD$ 6,000.00 USD$ 0.00 Other: Volunteer Appreciation/Travel USD$ 790.00 USD$ 0.00 Volunteer Time USD$ 66,750.00 Total USD$ 110,300.00 USD$ 0.00 Budget Narrative 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 such as rent, marketing, printing and supplies. Of these hard costs: staff salaries = 43.3%; benefits = 31.3%; and operating expenses = 25.4%. Together they are less than 40% of our over budget, while our donated volunteer time is over 60% of the budget. The VITA program is a small portion of our overall budget. In fact, the staffing costs alone is just 5.47% of our annual staff and benefits costs. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ CLPCCD-TVCC 19-20 VITA Program Expenses Financial Information Form for ALL Grant Requests download template ✔✔✔✔ CLPCCD-TVCC 19-20 VITA Financial Info. List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ CLPCCD Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ CLPCCD Annual Adopted Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ CLPCCD No 990 or Tax Return Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ CLPCCD Board Authorization Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ CLPCCD Board Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ CLPCCD Proof of Insurance 5.1.j Packet Pg. 78 Attachment: 10. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin VITA Program Application (HS Grant Program Application ID: 131657 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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. ✔✔✔✔ CLPCCD IRS 501c3 Letter 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) 5.1.j Packet Pg. 79 Attachment: 10. Chabot-Las Positas Community College District/Tri-Valley Career Center - Dublin VITA Program Application (HS Grant Program Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline Child Care Links Child Care Links Diaper Pantry Jump to: Questions Budget Documents USD$ 12,000.00 Requested Submitted: 1/14/2019 5:41:54 PM (Pacific) Project Contact Kelly O'Lague Dulka kdulka@childcarelinks.org Tel: (925) 417-8733 Additional Contacts none entered Child Care Links 6601 Owens Dr. Ste 100 Pleasanton, CA 94588 United States CEO Kelly O'Lague Dulka kdulka@childcarelinks.org Telephone(925) 417-8733 Fax (925) 730-4942 Web www.childcarelinks.org Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Child Care Links is a multi-faceted social service agency with a 43 year history of improving the lives of low income families in the Tri-Valley. Our mission is to provide resources that strengthen and support children and families. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding 5.1.k Packet Pg. 80 Attachment: 11. Child Care Links - Child Care Links Diaper Pantry Application (HS Grant Program FY19 Recommendations) 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. In the last two years, the Child Care Links Diaper Pantry received funding from the City of Pleasanton and the City of Dublin. In 2017, the City of Pleasanton funded Child Care Links $6182.00 and the City of Dublin funded Child Care Links $8000.00 to provide low income families a month supply of diapers, as well as free literacy material. In 2018, the City of Pleasanton funded Child Care Links $7041.00 and the City of Dublin funded Child Care Links $8525.00 to again provide low income families a month supply of diapers, as well as free literacy material. 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). Child Care Links has been providing crucial early childhood resources and services to children, families, and the community throughout Alameda County for over 40 years. These services include subsidized child care, child care referrals, professional development trainings for Parents and Child Care Providers, and community outreach programs like car seat safety checks, and distributing free car seats to low-income families. Child Care Links staff has extensive experience in managing and executing programs through various Private, Federal, State, County and City grant awards. Effective processes are in place to insure policies, procedures, tracking, and reporting requirements are met in a timely manner, and funds provided to the agency are expended in accordance with state and federal law. In-kind services, equipment and personnel will be provided by the Community Services Director and administrative staff. After conducting a six month research-based needs assessment in 2016, Child Care Links opened a Diaper Pantry as a pilot program in January 2017 with a goal to distribute 50,000 diapers to 333 children. In 2017, the Diaper Pantry distributed 157,000 diapers to 1,136 children. In 2018, that number grew to 196,000 diapers to 1,314 children. In addition to diapers, we have distributed over 6,000 books to the very low income families who come in seeking diapers. We provide parents with resources to encourage reading to and with their little ones. Most of the books we distribute are bilingual in Spanish and English. 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. Child Care Links provides diapers for low income families in Dublin and the other Tri-Valley cities of Pleasanton and Livermore. Families often have to choose between food or diapers. We want to ensure that parents aren't forced to make that choice. 9. 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.) 300 10. 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 Concern. gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing ✔✔✔✔ Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services ✔✔✔✔ Youth Services ✔✔✔✔ Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above 5.1.k Packet Pg. 81 Attachment: 11. Child Care Links - Child Care Links Diaper Pantry Application (HS Grant Program FY19 Recommendations) 11. How will this project will be implemented, administered, and operated? The Child Care Links Diaper Pantry was developed with an infrastructure to support and evaluate participant engagement, collaborate with community partners, and track short and long-term impacts. The agency has designated staff members for program implementation, data collection, marketing, reporting, training, and fundraising. A variety of tools are used to research and collect data to evaluate strategies that will better reach and serve the needs of target populations identified as low-income and limited English speaking families. Program participants will be eligible to receive up to a one month supply of diapers and literacy materials six times in a twelve month period. Parents will be required to complete an Impact Needs Assessment questionnaire to measure and track: income level, ethnicity, city of residence, number of children in diapers, quantity of resources received, frequency of visits, diapering activities (talk, read, sing), financial impact, hours spent reading, and level of parent engagement. The Diaper Pantry will be open to low-income families during regular business hours two days a week. No appointment is necessary. The agency will evaluate the program on a quarterly basis to ensure the needs of the community are being met. When appropriate, Child Care Links will add additional days of operation to meet the high demand. 12. Describe in detail how Dublin grant funds will be used for this project. (What specifically will the grant funds be used for?) Dublin Grant funds will play a critical role in bridging the income-related academic achievement gap, facilitating early literacy skills, and ensuring the safety and well-being of children being transported in and around Dublin and the Tri-Valley. These funds will ensure that key systemic service needs are met. Funding from the City of Dublin represents an investment in a partnership rooted in shared values, and a genuine commitment to foster new opportunities for children and their families to improve and sustain a high quality of life. A funding commitment from the City of Dublin will also help leverage a variety of resource streams that will help the agency build a diversified revenue model for program sustainability. Specifically these funds will be used towards staff salary and benefits, the purchase of diapers, literacy materials, and resources for parent engagement. Resident data collected between 1/1/18 – 12/31/18revealed that nearly 25% of Diaper Pantry recipients resided in Dublin. This data was used to identify a strategic funding request based on the program’s total budget and direct costs allocated to serving Dublin families. In order for Child Care Links to build a solid foundation of diversified funding streams the agency must have a designated staff member who can contribute their efforts to securing these partnerships. In addition, staff and volunteers provide the labor to purchase and organize diapers for distribution, serve clients of the diaper pantry on distribution days and ensure that diaper drives are ongoing throughout the Tri-Valley. 13. 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)? The success of this project will be measured by tracking the number of hours and the frequency that parents are engaging with their children during diaper time, as a result of receiving free educational materials and information about the affects these interactions have on closing the achievement gap between affluent and low-income families. An astounding 42% of Diaper Pantry recipients reported not knowing the direct effects that talking, reading and signing to their child every day has on their child’s academic success. The number of age-appropriate books, literacy materials, diapers, and car seats distributed to each child and family will be tracked to measure community need and program reach. Outcomes will also measure parent’s ability to go to work, or school, by having access to an adequate supply of diapers in order to meet child care program requirements. 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. The target populations this project will serve are families living well below the poverty line, limited English speaking families living in Dublin and the Tri-Valley. Participant data collected between 1/1/17 – 12/13/18 revealed that 67% of Diaper Pantry participants are Hispanic with limited English skills, 15% are Caucasian, and 11% are African American. A humbling 80% of participants reported an income level of < $24K a year, and 19% reported an income level of < $48K a year. gfedc Please explain: 5.1.k Packet Pg. 82 Attachment: 11. Child Care Links - Child Care Links Diaper Pantry Application (HS Grant Program FY19 Recommendations) Based on the 2018 California Income Limits for Alameda County released in July 2018 using an average household size of four, 99% of the participants are living significantly below the poverty line. Based on these facts, the target populations will benefit from the implementation of this project as detailed in questions #12 and #29. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? Child Care Links actively engages with the community on a regular basis to provide programs that are culturally appropriate and cost effective. Interviews and questionnaires were conducted with representatives of the intended target audience to create a program that would be effective and culturally appropriate. Their input was invaluable to the planning and development of the Diaper Pantry, including the decision to distribute literacy materials in both English and Spanish. Families receive a one-month supply of diapers, bilingual books, and educational materials that inform parents how to maximize diaper time to nurture brain development through stories, pictures, songs, and counting toes. The majority of the Hispanic participants are Spanish speaking families who greatly benefit from receiving children’s books and educational materials in both Spanish and English. This not only meets the needs of the Spanish speaking Hispanic population, it provides opportunities for parents and their children to increase their dual-language literacy skills together. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? Child Care Links uses a variety of innovative strategies to consistently collect data, and evaluate objectives on how to best reach low income families, limited English speakers and/or disabled children needing a specialized car seat. Using the participant data outlined in question #14 relating to the populations this project will serve, 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 utilize to access resources. Customized digital and in-print educational and community resources will be distributed to program participants. The agency will also outreach using Constant Contact, SurveyMonkey, social media, contests, community events and the agency website. Child Care Links employs staff who speak many of the languages that are spoken by residents in the City of Dublin and are experienced in providing support and resources to these individuals living in suburban poverty within an affluent community. Child Care links initiates new community partnerships through purposeful engagement and outreach initiatives, targeting low- income housing facilities, such as Camellia Place, Wexford Way and Oak Grove Apartments. Other outreach efforts targets health care providers, school district social workers, social service agencies, and collaborating with community organizations who serve low-income, limited English speaking families, and disabled youth. 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Child Care Links 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. The agency has rich partnerships with the Tri-Valley Anti-Poverty Collaborative, Axis Health, WIC, Community Care Licensing, CityServe, CAPE Head Start, Kaiser, Hacienda Helping Hands, Food Bank of Alameda County, Dublin, Pleasanton and Livermore School Districts, First 5 Alameda County, California Child Care Initiative Project, and Livermore Community Needs. Additional partnerships are currently being developed with WorkDay, John Muir Health, Costco, and the City of Livermore. Currently, CityServe of the Tri-Valley, Axis Community Health, and WIC of Pleasanton refer qualified clients on a consistent basis to the Diaper Pantry. Axis Community Health has five sites serving more than 14,000 East Alameda County residents, 800 of those children between the ages of 0-3 years old and a majority of their patients living below the poverty line. WIC of Pleasanton serves 500 infants and toddlers a month and CityServe of the Tri-Valley serves over 2,000 low-income families a year. Collaborations such as these are key in meeting the unique and changing needs of Tri-Valley families living in suburban poverty, and for building a self-sustaining program that does not require annual funding from repeat funders. Child Care Links will enlist the aid of these partners in order to deliver the most comprehensive services to Dublin families. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. Child Care Links actively collaborates with the Dublin Unified School District’s Community Liaison and Student Services to 5.1.k Packet Pg. 83 Attachment: 11. Child Care Links - Child Care Links Diaper Pantry Application (HS Grant Program FY19 Recommendations) collaborate in outreach events for the Annual Health Fair, SeeDubRun and family resource fairs held at below-market housing facilities. Locations include Camellia Place, Wexford Way and Oak Grove Apartments. The agency works closely with the Dublin CAPE facility to bring resources, trainings, and services on site to CAPE families. The agency conducts car seat safety checks and brings free car seats on site to distribute to families with old, damaged or expired car seats. In 2017, Child Care Links collaborated twice with Marilyn Avenue School, the Food Bank of Alameda County, Axis Community Health, Las Positas College, and Stanford Health to provide parents with information and a tool kit on choices they can make every day to raise successful, healthy children. Child Care Links use a wide variety of marketing and outreach strategies to expand the reach of services. The agency publishes in-print and digital media content for the Child Care Links website and social media pages, community calendars, and monthly newsletters. The Child Care Links website and social media pages allow parents, Child Care Providers, and the community the ability to download forms, receive and share information, and register for events through the agency’s online calendar. Child Care Links anticipates expanding the agency’s reach in the community by providing youth volunteer opportunities for Dublin students wanting to volunteer in their community. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Funding will cover expenses including staff salary and benefits, program materials, and supplies. Please see the budget for specific line item information. Staff identified a community need and developed a program using a root-cause solution approach while implementing cost effective strategies. Child Care Links utilizes in-kind resources, community partnerships, fundraising strategies, and volunteers to help minimize costs. With participant data showing a dire need for low-income families to have access to free diapers, age-appropriate literacy materials, and car seats, the program’s capacity has tripled in twelve months. Running it as a pilot program last year on a shoestring budget, Child Care Links was able to distribute 157,000 diapers and 32 car seats in the first twelve months. The retail price for that amount of diapers would cost $100,000 but as a member of the National Diaper Bank Network (NDBN) the agency is able to purchase diapers for a third of that cost. Additionally, having a membership with the NDBN allows the agency to connect with a network of over 3,500 partner agencies and access to reduced purchasing agreements for car seats. In order to increase the cost effectiveness of this program, a higher percentage is being requested for salaries. This is a crucial step for the program to become self-sufficient as outlined in question #45. Developing community partnerships and innovative fundraising strategies is vital to streamlining resources, securing diverse funding streams, and reducing program costs. This type of expertise warrants the expenditure and integrity it takes to build a successful program with a significant impact. Child Care Links is honored to have the City of Dublin as a founding contributor to the program’s success during the pilot last year. Child Care Links does not anticipate having any unspent grant funds at the end of the fiscal year. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Child Care Links is committed to serving low-income, limited English speaking families, and disabled youth throughout the Tri- Valley in partnership with the cities of Dublin, Pleasanton and Livermore. If this project is not funded, or receives reduced funding, it will have a significant impact on the number of families who are able to buy food and pay bills with the money they save on receiving free diapers and car seats. Currently the demand for diapers is so great that Child Care Links has to limit the number of times families can visit the Diaper Pantry to six times a year in order to accommodate the high demand and serve more families. As the agency continues to reach out to the targeted populations in community, the demand for car seats will continue to rise. Without funding, the agency will have to turn families away, resulting in parents not being able to work due to lack of supply of diapers, children not being transported safety, and closing the achievement gap for low income children. If Child Care Links receives reduced funding, or no funding, it will limit the scope and reach of the project and it’s impact on bridging the income-related achievement gap. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 5.1.k Packet Pg. 84 Attachment: 11. Child Care Links - Child Care Links Diaper Pantry Application (HS Grant Program FY19 Recommendations) 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 25. 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. 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process This grant addresses three of the priorities articulated in the Eastern Alameda County Human Services Needs Assessment: Early Learning and Child Care, Workforce Development and Health Care. Diapers are an essential supply for keeping kids healthy. They are also required for children enrolled in child care. Without diapers, parents are unable to leave their children in child care. Without child care, parents can't work. Literacy materials help prepare children for academic success. 28. ** QUESTIONS 29 THROUGH 41 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? 29. 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 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: ✔✔✔✔ No gfedc Yes: If yes, please explain: gfedc Yes ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. ✔✔✔✔ Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc Yes. If so, check box here and answer questions 29 through 41. ✔✔✔✔ No. If no, check box here and enter gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement 5.1.k Packet Pg. 85 Attachment: 11. Child Care Links - Child Care Links Diaper Pantry Application (HS Grant Program FY19 Recommendations) 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *Promote fair housing and reduce housing discrimination. gfedc 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: gfedc * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. gfedc * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. gfedc C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. gfedc D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. gfedc 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. gfedc Increase homeownership gfedc Promote decent affordable housing gfedc Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. gfedc Improving the quality of life for our Nation's communities gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc Reduce housing discrimination. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. 5.1.k Packet Pg. 86 Attachment: 11. Child Care Links - Child Care Links Diaper Pantry Application (HS Grant Program FY19 Recommendations) 35. 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?") 36. 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?") 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc Increase the availability of service-enriched housing for persons with special needs. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs 5.1.k Packet Pg. 87 Attachment: 11. Child Care Links - Child Care Links Diaper Pantry Application (HS Grant Program FY19 Recommendations) 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 39. 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". 40. 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 41. 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" with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) gfedc 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. gfedc 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. gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. Disabled Women/Female Headed Households Seniors Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL 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) 0.000.00 TOTAL 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 5.1.k Packet Pg. 88 Attachment: 11. Child Care Links - Child Care Links Diaper Pantry Application (HS Grant Program FY19 Recommendations) 42. 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 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). The Child Care Links Diaper Pantry does not have a way to generate any kind of revenue through fees from the clients served. We have turned to family and friends of staff and board members, we work with corporate and church groups to host diaper drives, we seek donations from community members and we still have trouble keeping the diaper pantry stocked. The need is great and the more diapers and books we are able to secure, the more families we can serve. This program might be viewed as optional or extra; but, to low income families in the Tri-Valley it really is the difference between being able to feed their kids or diaper them. We are able to help them do both. 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. BL-109890 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) 0.000.00 TOTAL gfedc #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. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed City of Dublin USD$ 12,000.00 City of Pleasanton USD$ 12,000.00 City of Livermore USD$ 24,000.00 Share the Spirit Grant USD$ 7,500.00 USD$ 7,500.00 Rotary Clubs USD$ 7,500.00 USD$ 7,500.00 Individual Donors USD$ 30,000.00 USD$ 15,000.00 Corporate and Church Diaper Drives USD$ 40,000.00 Total USD$ 133,000.00 USD$ 30,000.00 Funding Uses/Expenses Budget Amount Amount Committed Program Staff Diaper Pantry (.25 FTE) USD$ 12,000.00 Payroll Taxes USD$ 960.00 Benefits USD$ 1,850.00 Supplies - Diapers USD$ 60,000.00 Supplies - Books USD$ 48,000.00 Supplies - Parent Education Materials USD$ 12,000.00 Total USD$ 134,810.00 USD$ 0.00 5.1.k Packet Pg. 89 Attachment: 11. Child Care Links - Child Care Links Diaper Pantry Application (HS Grant Program FY19 Recommendations) Budget Narrative The cost of diapers and books are the bulk of this grant. Funding will cover expenses including staff salary and benefits, program materials, and supplies. Please see the budget for specific line item information. Staff identified a community need and developed a program using a root-cause solution approach while implementing cost effective strategies. Child Care Links utilizes in-kind resources, community partnerships, fundraising strategies, and volunteers to help minimize costs. With participant data showing a dire need for low-income families to have access to free diapers, age-appropriate literacy materials, and car seats, the program’s capacity has tripled in twelve months. Running it as a pilot program last year on a shoestring budget, Child Care Links was able to distribute 157,000 diapers and 32 car seats in the first twelve months. The retail price for that amount of diapers would cost $100,000 but as a member of the National Diaper Bank Network (NDBN) the agency is able to purchase diapers for a third of that cost. Additionally, having a membership with the NDBN allows the agency to connect with a network of over 3,500 partner agencies and access to reduced purchasing agreements for car seats. In order to increase the cost effectiveness of this program, a small percentage is being requested for salaries. This is a crucial step for the program to become more self-sufficient as outlined in question #45. Developing community partnerships and innovative fundraising strategies is vital to streamlining resources, securing diverse funding streams, and reducing program costs. This type of expertise warrants the expenditure and integrity it takes to build a successful program with a significant impact. Child Care Links is honored to have the City of Dublin as a founding contributor to the program’s success during the pilot last year. Child Care Links does not anticipate having any unspent grant funds at the end of the fiscal year. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Expense Budget for all grant Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information form List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ Board of Dir. Current Annual Budget for the Entire Agency ✔✔✔✔ Annual Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ Tax Return Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Designated Official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Funding Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Certificate of Insurance 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. ✔✔✔✔ Letter 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 5.1.k Packet Pg. 90 Attachment: 11. Child Care Links - Child Care Links Diaper Pantry Application (HS Grant Program FY19 Recommendations) Application ID: 133266 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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) 5.1.k Packet Pg. 91 Attachment: 11. Child Care Links - Child Care Links Diaper Pantry Application (HS Grant Program FY19 Recommendations) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline Child Care Links Behavioral Health Care Services Jump to: Questions Budget Documents USD$ 25,000.00 Requested Submitted: 1/14/2019 5:42:24 PM (Pacific) Project Contact Kelly O'Lague Dulka kdulka@childcarelinks.org Tel: (925) 417-8733 Additional Contacts Vdilks@childcarelinks.org Child Care Links 6601 Owens Dr. Ste 100 Pleasanton, CA 94588 United States CEO Kelly O'Lague Dulka kdulka@childcarelinks.org Telephone(925) 417-8733 Fax (925) 730-4942 Web www.childcarelinks.org Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Child Care Links is a multi-faceted social service agency with a 43 year history of improving the lives of low income families in the Tri-Valley. Our mission is to provide resources that strengthen and support children and families. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project ✔✔✔✔ Yes gfedc No gfedc One-time funding ✔✔✔✔ Seed funding gfedc One-time and Seed funding gfedc Operational funding 5.1.l Packet Pg. 92 Attachment: 12. Child Care Links - Behavioral Health Care Services Application (HS Grant Program FY19 Recommendations) 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. N/A - Child Care Links has not received funding for this particular service in the past. 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). Child Care Links has been providing a wide array of supportive resources and services to children, families, and the early learning and care community in the Tri-Valley cities of Dublin, Livermore and Pleasanton and throughout Alameda County for over 40 years. These services include parent education and support, subsidized child care for families on CalWORKS, child care referrals, professional development training and coaching for child care providers and others who care for children, and a variety of community outreach programs. Child Care Links staff has extensive experience in managing and executing programs in partnership with various private, federal, state, county and city funding partners. Effective processes are in place to insure policies, procedures, tracking, and reporting requirements are met in a timely manner, and funds provided to the agency are expended in accordance with state and federal law. Our agency has a strong organizational culture including a committed board of directors, a dynamic leadership team with a combined fifty years of service to the organization, strong fiscal management systems and a staff of 32 that go above and beyond to provide resources that strengthen the children and families we serve. There is a strong commitment to professional development and staff are encouraged to continue to strengthen their skills through ongoing training and education. Our fiscal management systems have resulted in excellent audits from both state and county funders as well as from our external auditor. The merger/acquisition with Family Services Counseling and Community Resource Center will only serve to strengthen our fiscal position and increase our ability to provide the resources and support families in our community need to thrive. 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. Child Care Links has acquired a nonprofit mental health agency and we are expanding services to the Tri-Valley. Funds from this grant will be used to hire a spanish-speaking clinician to serve residents of Dublin, Livermore and Pleasanton. 9. 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.) 96 10. 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 Concern. gfedc None ✔✔✔✔ Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access ✔✔✔✔ Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services ✔✔✔✔ Youth Services ✔✔✔✔ Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity ✔✔✔✔ Financial Assistance gfedc None of the above gfedc Please explain: 5.1.l Packet Pg. 93 Attachment: 12. Child Care Links - Behavioral Health Care Services Application (HS Grant Program FY19 Recommendations) 11. How will this project will be implemented, administered, and operated? For more than 10 years there has been an identified need in the Tri-Valley for an increase in the availability of mental health services for children and teens and their families. Axis Community Health has an extensive waiting list and the limited private services available are often too expensive for the families we serve. In July 2019, Child Care Links will begin providing mental health services for residents of Dublin, Livermore and Pleasanton. With the acquisition of Family Services Counseling and Community Resource Center in San Leandro on February 1, 2019, Child Care Links will have the capacity and infrastructure to offer individual, family and couples therapy, in addition to group therapy and support groups. Being a Medi-Cal provider, Child Care Links will be able to offer services to the low income families we currently serve. In addition, we hope to serve children and adults who are low income but might not qualify for CalWORKS or Medi-Cal by offering a sliding scale fee structure. To be able to provide services for low income families, Child Care Links is currently seeking funding from the Cities of Dublin, Livermore and Pleasanton and exploring other potential funding partners. When families face mental health challenges, it can have far-reaching consequences. This is especially true when a family is living in poverty. Living in a poor or low-income household has been linked to poor health and increased risk for mental health problems in both children and adults that can persist across the life span. Despite their high need for mental health services, children and families living in poverty are least likely to be connected with high-quality mental health care. At Child Care Links, we see every day the urgent need for mental health services for the low income children and families we serve. It is often described as the critical "missing puzzle piece" in the services we offer to help lift families out of poverty. 12. Describe in detail how Dublin grant funds will be used for this project. (What specifically will the grant funds be used for?) In combination with funding from a variety of sources, Dublin grant funds will be used to hire a full-time bilingual licensed clinician to serve the Tri-Valley community. The licensed clinician will be able to provide diagnostic assessments, do initial mental health screenings and will provide therapeutic services for children and teens and their families. The licensed clinician will also be able to supervise up to six interns and associates; thus, we will, in essence, be able to add one full-time staff person but will get the full-time equivalent of four staff people. Grant funds will provide critical seed money to get the program going. Gradually, the grant-funded staff person will be able to bill enough in direct service and through services provided by interns and associates to pay for his/her own salary. 13. 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)? Like other providers working within the framework of Alameda County Behavioral Health Care Services, Child Care Links 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 multidisciplinary 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 the 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. 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. Child Care Links serves the lowest income, most vulnerable families in the Tri-Valley. The majority of families served by Child Care Links are eligible for CalWORKs (cash aid benefits). They are referred through the Department of Social Services to receive subsidized child care, through an alternative payment program (CalWORKs Stages 1, 2 and 3 or CAPP). To be eligible, children must be, according to the DSS criteria, be "deprived" by having at least one parent who is unemployed, disabled, continuously absent, in jail, or has died. We anticipate that grant funds will be used to address the mental health needs of this population, the population we serve every day in the Tri-Valley. 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, a high number of our families face challenges that inhibit 5.1.l Packet Pg. 94 Attachment: 12. Child Care Links - Behavioral Health Care Services Application (HS Grant Program FY19 Recommendations) 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 are extremely limited in the Tri- Valley. Providers who accept Medi-Cal often have long waiting lists, with wait times reportedly as long as 6 to 12 months. Being able to expand services will have an immediate impact on the accessibility of services for families in acute situations. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? Child Care Links actively engages with the community on a regular basis to provide programs that are culturally appropriate and cost effective. We have a very diverse staff with fluency in 14 languages. We value inclusion and strive to hire and retain staff who reflect the communities we serve. To determine the best way to serve the behavioral health care needs of our constituents, Interviews and questionnaires were conducted with representatives of the intended target audience to create a program that would be effective and culturally appropriate. Input was invaluable to the planning and development of the behavioral health care services we plan to offer to families. Over 50% of the families we serve are Spanish speaking. By investing in Spanish speaking clinical staff, we will be able to improve the effectiveness of the services we provide. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? Child Care Links uses a variety of innovative strategies to consistently collect data, and evaluate objectives on how to best reach target populations including low income families, limited English speakers and youth/disabled youth needing a properly fitted or specialized car seat. Using the participant data outlined in question #22, 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 utilize to access resources. Customized digital and in-print educational and community resources will be distributed to Child Care Links’ low income program participants. Child Care Links will also outreach using Constant Contact, SurveyMonkey, social media, contests, community events and the agency website. The agency employs staff who speak many of the languages that are spoken by residents in the City of Pleasanton and are experienced in providing support and resources to these individuals living in suburban poverty within an affluent community. Child Care Links initiates new community partnerships through purposeful engagement and outreach initiatives, targeting low- income housing facilities, schools, and Social Service Agencies. Other outreach efforts target health care providers, school district social workers, and collaborating with community organizations who serve low-income, limited English speaking families, and disabled youth. 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Child Care Links 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. The agency has rich partnerships with the Tri-Valley Anti-Poverty Collaborative, Axis Health, WIC, Community Care Licensing, CityServe, CAPE Head Start, Kaiser, Hacienda Helping Hands, Food Bank of Alameda County, Dublin, Pleasanton and Livermore School Districts, First 5 Alameda County, California Child Care Initiative Project, and Livermore Community Needs. Additional partnerships are currently being developed with WorkDay, John Muir Health, Costco, and the City of Livermore. Currently, CityServe of the Tri-Valley, Axis Community Health, and WIC of Pleasanton refer qualified clients on a consistent basis to the Diaper Pantry and car seat program. Axis Community Health has five sites serving more than 14,000 East Alameda County residents, 800 of those children between the ages of 0-3 years old and a majority of their patients living below the poverty line. WIC of Pleasanton serves 500 infants and toddlers a month and CityServe of the Tri-Valley serves over 2,000 low-income families a year. Collaborations such as these are key in meeting the unique and changing needs of Tri- Valley families living in suburban poverty, and for building a self-sustaining program that does not require annual funding from repeat funders. Child Care Links will enlist the aid of these partners in order to deliver the most comprehensive services to Dublin families. 5.1.l Packet Pg. 95 Attachment: 12. Child Care Links - Behavioral Health Care Services Application (HS Grant Program FY19 Recommendations) 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. Child Care Links actively collaborates with the Dublin Unified School District’s Community Liaison and Student Services to collaborate in outreach events for the Annual Health Fair, SeeDubRun and family resource fairs held at below-market housing facilities. Locations include Camellia Place, Wexford Way and Oak Grove Apartments. The agency works closely with the Dublin CAPE facility to bring resources, trainings, and services on site to CAPE families. The agency conducts car seat safety checks and brings free car seats on site to distribute to families with old, damaged or expired car seats. In 2017, Child Care Links collaborated twice with Marilyn Avenue School, the Food Bank of Alameda County, Axis Community Health, Las Positas College, and Stanford Health to provide parents with information and a tool kit on choices they can make every day to raise successful, healthy children. Child Care Links use a wide variety of marketing and outreach strategies to expand the reach of services. The agency publishes in-print and digital media content for the Child Care Links website and social media pages, community calendars, and monthly newsletters. The Child Care Links website and social media pages allow parents, Child Care Providers, and the community the ability to download forms, receive and share information, and register for events through the agency’s online calendar. Child Care Links anticipates expanding the agency’s reach in the community by providing youth volunteer opportunities for Dublin students wanting to volunteer in their community. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Funds will be used to hire and employee a full time licensed clinician who is bilingual in English and Spanish for one year. The overall agency budget is $18 million but approximately 80% of the funds are considered "pass through" dollars which we use to pay subsidies for child care. The remainder or the operating budget is approximately $3 million. When combined with the services now being provided in the San Leandro clinic, mental health services will make up approximately 15% of the budget. Bringing services to the Tri-Valley through seed funding from the Cities and other funding sources will represent approximately 18% of the overall mental health operation. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Child Care Links is committed to serving low-income, limited English speaking families, and disabled youth throughout the Tri- Valley in partnership with the cities of Dublin, Pleasanton and Livermore. If this project is not funded, or receives reduced funding, it will have a significant impact on the number of families we will be able to serve. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 25. 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. ✔✔✔✔ No gfedc Yes: If yes, please explain: gfedc Yes ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 5.1.l Packet Pg. 96 Attachment: 12. Child Care Links - Behavioral Health Care Services Application (HS Grant Program FY19 Recommendations) 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process The Eastern Alameda County 2011 Human Services Needs Assessment specifically addresses the need for and importance of increased behavioral health care services for the Tri-Valley area. Stakeholders reported that behavioral health is one of the greatest social concerns in Eastern Alameda County. There are significant barriers that exist in regard to accessing services. Our project directly addresses the need for additional behavioral health care services in the Tri-Valley area. 28. ** QUESTIONS 29 THROUGH 41 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? 29. 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 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. ✔✔✔✔ Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc Yes. If so, check box here and answer questions 29 through 41. ✔✔✔✔ No. If no, check box here and enter gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *Promote fair housing and reduce housing discrimination. gfedc 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: gfedc * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. gfedc * Increase outreach and access for underserved populations including limited English speaking persons, youth, 5.1.l Packet Pg. 97 Attachment: 12. Child Care Links - Behavioral Health Care Services Application (HS Grant Program FY19 Recommendations) 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: 35. 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?") 36. 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?") 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: disabled, seniors and homeless persons. gfedc C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. gfedc D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. gfedc 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. gfedc Increase homeownership gfedc Promote decent affordable housing gfedc Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. gfedc Improving the quality of life for our Nation's communities gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc Reduce housing discrimination. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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 5.1.l Packet Pg. 98 Attachment: 12. Child Care Links - Behavioral Health Care Services Application (HS Grant Program FY19 Recommendations) 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 39. 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". 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. Disabled Women/Female Headed Households Seniors 5.1.l Packet Pg. 99 Attachment: 12. Child Care Links - Behavioral Health Care Services Application (HS Grant Program FY19 Recommendations) 40. 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 41. 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" 42. 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 Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL 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) 0.000.00 TOTAL 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) 0.000.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. 5.1.l Packet Pg. 100 Attachment: 12. Child Care Links - Behavioral Health Care Services Application (HS Grant Program FY19 Recommendations) 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). This specific program/project should gradually become self-funding. We are seeking seed monies to get the staff hired that will grow the program. By the end of year one, the program should be able to generate enough revenue through Medi-Cal reimbursement and client fees to be able to begin to support staff salaries. 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. BL-109890 gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed City of Dublin USD$ 25,000.00 USD$ 0.00 City of Pleasanton USD$ 25,000.00 USD$ 0.00 City of Livermore USD$ 25,000.00 USD$ 0.00 Sunlight Giving Foundation USD$ 5,000.00 USD$ 5,000.00 East Bay Community Foundation USD$ 5,000.00 USD$ 5,000.00 Client Fees USD$ 30,000.00 USD$ 0.00 Total USD$ 115,000.00 USD$ 10,000.00 Funding Uses/Expenses Budget Amount Amount Committed Salary for licensed clinician (LCSW or LMFT) USD$ 75,000.00 USD$ 10,000.00 Payroll taxes USD$ 5,738.00 Benefits USD$ 7,500.00 Retirement USD$ 3,750.00 Rent USD$ 4,500.00 Computer USD$ 900.00 Phone USD$ 600.00 Charting and office supplies USD$ 150.00 Billing software USD$ 1,200.00 EHR software USD$ 1,200.00 Accounting/Audit USD$ 8,000.00 Clinical Director (5% FTE) USD$ 6,850.00 Total USD$ 115,388.00 USD$ 10,000.00 Budget Narrative Funds will be used to hire and employee a full time licensed clinician who is bilingual in English and Spanish for one year. The overall agency budget is $18 million but approximately 80% of the funds are considered "pass through" dollars which we use to pay subsidies for child care. The remainder or the operating budget is approximately $3 million. When combined with the services now being provided in the San Leandro clinic, mental health services will make up approximately 15% of the budget. Bringing services to the Tri-Valley through seed funding from the Cities and other funding sources will represent approximately 18% of the overall mental health operation. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense for all grants Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information form List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ Board of Dir. Current Annual Budget for the Entire Agency ✔✔✔✔ Agency Budget 5.1.l Packet Pg. 101 Attachment: 12. Child Care Links - Behavioral Health Care Services Application (HS Grant Program FY19 Recommendations) Application ID: 132502 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ Tax Return Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Designated Official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Funding Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Certificate of Insurance 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. ✔✔✔✔ Non Profit Letter 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 Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) 5.1.l Packet Pg. 102 Attachment: 12. Child Care Links - Behavioral Health Care Services Application (HS Grant Program FY19 Recommendations) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline Children's Emergency Food Bank Support for Food Expense Jump to: Questions Budget Documents USD$ 15,000.00 Requested Submitted: 1/11/2019 11:10:39 AM (Pacific) Project Contact Rick Snowden rick.snowden@att.net Tel: 602-625-9928 Additional Contacts none entered Children's Emergency Food Bank 7421 Amarillo Road Dublin, CA 94568 United States President Rick Snowden rick.snowden@att.net Telephone925-828-5363 Fax Web childrensemergencyfoodbank.org Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Our mission is to provide canned and packaged food and gift certificates to obtain fresh foods. We try to give each family enough for one week up to six times per year. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding 5.1.m Packet Pg. 103 Attachment: 13. Children's Emergency Food Bank - Support for Food Expense Application (HS Grant Program FY19 Recommendations) 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. We have not received any funding from any other governments. However, we did receive a $7,000.00 grant from The City of Dublin in 2015 to help replace our old building. That project was completed in October 2016. 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). Children's Emergency Food Bank (CEFB) is a 501c3 non-profit organization that has been in continuous operation as it is today since 1969. The Food Bank is located on the campus of John Knox Presbyterian Church in Dublin, California. The earliest beginning was in 1966 and only included Christmas distributions of food. We supply a week's worth of food to each client up to six times a year. We have an experienced staff of volunteers and a Board of Directors that meets quarterly, more often if necessary. Some current volunteers have well over fifteen years experience and we gain several new volunteers each year. 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. Our mission to to provide food to our clients. Clients call 925-828-5363 to request food. They are asked a few qualifying questions and connected to a volunteer who makes an appointment to meet with them to distribute the food. 9. 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.) The number of unduplicated Dublin clients from Dublin in 2018 was 105 or 57% of the total. In 2017 it was 112 or 58%. Please know that almost every client has some amount of family members so the actula number of one time residents is much higher. 10. 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 Concern. 11. How will this project will be implemented, administered, and operated? The project is run from our building at 7421 Amarillo Rd in Dublin. The building is on the campus of John Knox Presbyterian Church. Clients call our number and are put in touch with the volunteer on duty who makes an appointment for them to come and receive about a week's worth of food. When the client arrives they fill out a registration sheet showing proof of residence in Dublin, Pleasanton, San Ramon or Danville which is our serving area. In addition to the food they are given a $10.00 gift card from a local supermarket to purchase fresh food or milk. We are an all volunteer organization. There is no paid staff. We have a different volunteer on duty each day of the week. The answering service has the list of volunteers and the schedule. We buy the food and stock it in our building and distribute is as calls come in. Our expenses, other than for food and gift cards are minimal and include: $47.00 per month for the answering service, $27.00 per month for the phone along with insurance and a few miscellaneous items. gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities ✔✔✔✔ Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above gfedc Please explain: 5.1.m Packet Pg. 104 Attachment: 13. Children's Emergency Food Bank - Support for Food Expense Application (HS Grant Program FY19 Recommendations) 12. Describe in detail how Dublin grant funds will be used for this project. (What specifically will the grant funds be used for?) Every dollar that Children's Emergency Food Bank receives from this Grant will be used to purchase food to be distributed to our clients during the Grant period. As stated earlier, we are an all volunteer organization with very low expenses. Our main expense is the cost of the food we distribute to our clients. Which brings me to the reason we find it necessary to file this Application for Grant at this particular time. For over thirty five years our Food Bank has been supported by the Raley's Food for Families Program. The Program supported 71 Food Banks within the Raley's Family of Fine Food Stores serving area. The member Food Banks bought food from Raley's at or near cost. In addition, each Food Bank accrued credits to be used to buy food. During March 2017 Raley's notified each Food Bank separately that they were restructuring the program to stop supporting the Food Banks and to divert all those resources to Feeding America a national charity which gives food to County Food Banks. Raley's feels that this arrangement will get food to more people in need. For many years we benefitted from buying food at low cost and, for the past several years, a large portion of our food was actually free due to accrued Raley's credits. Now we are paying retail for everything we buy. This change makes it necessary for us to find more cash very quickly. We anticipate spending over $20,000 on food in 2019 and we currently only have about $25,000 in our checking account. Please don't misunderstand. We are forever grateful to Raley's for their support for so many years and we wish them well in their new endeavor. Their generosity has greatly benefitted many residents in our serving area. Again, every dollar we may receive from this Grant will be spent on food to support our clients. 13. 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)? The only measure of success will be the fact that we are able to buy enough to support those who request food from us this year. This will be measured by the number of requests we receive and our ability to buy the amount of food necessary to support that demand. 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. The Children's Emergency Food Bank is a local 501c3 non profit organization serving Pleasanton, Dublin, San Ramon and Danville since 1966. Traditionally, 55% to 60% of our clients are Dublin residents. The Food Bank provides food for families in emergency or temporary situations, rather than ongoing support. Our clients include senior citizens, some are disabled. We also serve families in need that are identified by other organizations such as the Dublin Unified School District or City Serve of the Tri Valley. Many clients are low income folks that just need a hand once in a while. Some are single parents. Some are from minority ethnic groups. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? I think helping those in need is culturally appropriate at any time. Our service is simple it helps those in need of food when they need a hand. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? Because the Food Bank has been in operation in the same location for so many years there is little need to advertise. So many school employees, religious organizations and other public service groups are aware of what we do and can recommend us to those in need. We do have a website that explains our organization and the service we provide and how to approach us for help. The website address is www.childrensemergencyfoodbank.org Please log on to the website and you will be able to read our: Mission Statement By-Laws Schedule of Volunteers Excel Telemessaging (The answering service) Eligibility requirements Registration Sheet Food Assortment Annual Report 5.1.m Packet Pg. 105 Attachment: 13. Children's Emergency Food Bank - Support for Food Expense Application (HS Grant Program FY19 Recommendations) Christmas Basket Distribution Report Ways to Support Us Friends of the Food Bank Financial Summary 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. There is really no need to partner directly with other organizations to accomplish our goal but we are in contact with Gloria Gregory and City Serve of the Tri Valley. We refer clients who need prepared meals to Open Heart Kitchen and we work with the food distribution operation at St. Raymond Catholic Church in Dublin. We were awarded the Martin Luther King Jr. Legacy Award by The YMCA of the TRI Valley in January of 2017. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. As I stated, we have a website, www.childrensemergencyfoodbank.org. We also communicate with other organizations during the year as opportunities arise such as City Serve of the Tri Valley, DUSD Parent Partnership Program, and St. Raymond Catholic Church's food distribution program and Open Heart Kitchen. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. I have uploaded a copy of the 2019 Operations Budget under the tab Current Annual Budget for the Entire Agency. Please see that document while reviewing this narrative. We are a very small non profit organization with no paid staff. Our expenses, other than for the purchase of food and gift cards, is minimal. The top part of the uploaded document is Sources of Funds. The bottom portion is Uses of Funds. Please see the line titled Donations. I show $2,500.00 in January because we often receive a cash donation from a company named Crown Castle early in the year. They collect cash from their employees to donate to us and the company matches what they raise. The donation is usually less than $2,500.00 but we usually receive small cash donations from a few others so I estimated $2,500.00. We are asked to apply for a small grant each year by the Fremont Bank Foundation to help with our annual Christmas Basket Distribution. For the past few years we have been awarded $2,500.00 so I am assuming we will receive it again this year in November. Every other year the ladies of The Women's Organization of John Knox Presbyterian Church put on a Holiday Tea to help support the Food Bank. The event is well attended and I am anticipating that we could receive about $8,000.00 this year. On the bottom of the page you can see that food and gift cards make up 88% of our expenses. Remember that with each food donation of about a weeks worth of food we give the client a $10.00 gift card for fresh food or milk. Once in a while we give them two cards if there is a special reason. The remaining expenses are for the answering service, the phone bill, insurance and a few minor miscellaneous items. I think you will agree that this is cost effective and reasonable. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? If we do not receive funding it will make it much more difficult to buy the amount of food we need to distribute to our clients this year. As I stated earlier, we lost the support of the Raley's Food for Families Program during 2018. All money received from this Grant award will be spent on food to be distributed to our clients. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] ✔✔✔✔ No gfedc Yes: If yes, please explain: gfedc Yes ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 5.1.m Packet Pg. 106 Attachment: 13. Children's Emergency Food Bank - Support for Food Expense Application (HS Grant Program FY19 Recommendations) Enter "N/A" if not applicable. N/A 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 25. 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. 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process The one way this organization helps Dublin residents is that we help them with food expenses when they need a hand. I mentioned earlier that Dublin residents traditionally make up 55% to 60% of our clients. 28. ** QUESTIONS 29 THROUGH 41 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? 29. 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 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc Yes. If so, check box here and answer questions 29 through 41. ✔✔✔✔ No. If no, check box here and enter gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. 5.1.m Packet Pg. 107 Attachment: 13. Children's Emergency Food Bank - Support for Food Expense Application (HS Grant Program FY19 Recommendations) 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: 35. 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?") 36. 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?") gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *Promote fair housing and reduce housing discrimination. gfedc 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: gfedc * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. gfedc * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. gfedc C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. gfedc D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. gfedc 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. gfedc Increase homeownership gfedc Promote decent affordable housing gfedc Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. gfedc Improving the quality of life for our Nation's communities gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc Reduce housing discrimination. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. 5.1.m Packet Pg. 108 Attachment: 13. Children's Emergency Food Bank - Support for Food Expense Application (HS Grant Program FY19 Recommendations) 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. 5.1.m Packet Pg. 109 Attachment: 13. Children's Emergency Food Bank - Support for Food Expense Application (HS Grant Program FY19 Recommendations) 39. 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". 40. 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 41. 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" 42. 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 Disabled Women/Female Headed Households Seniors Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL 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) 0.000.00 TOTAL 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) 0.000.00 TOTAL 5.1.m Packet Pg. 110 Attachment: 13. Children's Emergency Food Bank - Support for Food Expense Application (HS Grant Program FY19 Recommendations) only be one #1 PER AGENCY 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). Since losing the support of the Raley's Food for Families Program as I described earlier it will be necessary for us to approach corporations within the area for financial support. There are a number of corporations who donate to us on a semi-regular basis but we will be looking for larger and more regular commitments. The preparation for this work in in process and will begin in early February 2019. 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. BL 005278 ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed Beginning Balance USD$ 26,380.00 USD$ 26,380.00 Total USD$ 26,380.00 USD$ 26,380.00 Funding Uses/Expenses Budget Amount Amount Committed Food USD$ 20,000.00 USD$ 20,000.00 Gift Cards for fresh food or milk USD$ 4,970.00 USD$ 4,970.00 Insurance USD$ 500.00 USD$ 500.00 JKPC Administrative Services USD$ 600.00 USD$ 600.00 Telephone & Answering Service USD$ 921.00 USD$ 921.00 Business Licence USD$ 4.00 USD$ 4.00 Postage USD$ 80.00 USD$ 80.00 Trailer Rental USD$ 100.00 USD$ 100.00 Supplies & Bags USD$ 580.00 USD$ 580.00 Print Charges USD$ 375.00 USD$ 375.00 Misc USD$ 250.00 USD$ 250.00 Total USD$ 28,380.00 USD$ 28,380.00 Budget Narrative I have listed the components of our Operations Budget for 2019 again here. A copy of the Operations Budget has been uploaded as an attachment as well. I listed some possible additional sources of revenue on our budget and uploaded them as possible additional sources of income in the upload section. Those additional revenue possibilities are not shown here but they could total more or less than $13.000. I explained in Tab 2 question 19 that we lost our sponsor of 35 years during 2018. The Raley's Food for Families Program stopped supporting 71 local food banks and those dollars now go to Feeding America a national charity that funds County Food banks. During 2018 we received over $15,000 of food free from the Food for Families Program. If we spent the budget as shown without receiving any of the $13,000 of possible additional income we would exceed our current checking account by over $2000. If we spent the budget and received the $13,000 we would end the year with about $11,000 with which to enter 2020. This is why we are asking for a grant of $15,000 to be used to buy food. Together the cost of food and gift cards to buy food is 98% of our budget or $24,970. A grant of $15,000 would equal about 60% of the cost of food and gift cards. Traditionally Dublin residents make up 55% to 60% of our clients so it seems that this figure is reasonable. 5.1.m Packet Pg. 111 Attachment: 13. Children's Emergency Food Bank - Support for Food Expense Application (HS Grant Program FY19 Recommendations) Given our budget forecast and our cash on hand it seems as though we would make it through 2019 without much help but that would leave us totally unprepared to enter 2020. This is why we are asking the City of Dublin for this grant. Children's Emergency Food bank has been operational in Dublin for well over 50 years. I have uploaded several additional documents that show some of our accomplishments over the years. Please take a look at them and our website to see a few things that I haven't mentioned here. Thank you very much for this opportunity, Rick Snowden Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ Operations Budget 2019 Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ IRS 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Auth. to Request Funding Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Auth. to Request Funding Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Proof of Insurance 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. ✔✔✔✔ Fed. Non-Profit Letter State Non-Profit Info. 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 5.1.m Packet Pg. 112 Attachment: 13. Children's Emergency Food Bank - Support for Food Expense Application (HS Grant Program FY19 Recommendations) Application ID: 132014 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) 45 Years Business Success Dublin Org of the Year 1993 Congressional Recog. 2016 & 2017 MLK Jr. Legacy Award Cert. of Appreciation 2018 5.1.m Packet Pg. 113 Attachment: 13. Children's Emergency Food Bank - Support for Food Expense Application (HS Grant Program FY19 Recommendations) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline CityServe of the TriValley Homelessness Prevention/Crisis Intervention Services Jump to: Questions Budget Documents USD$ 24,900.00 Requested Submitted: 1/14/2019 6:33:14 PM (Pacific) Project Contact Gloria Gregory info@cityservetrivalley.org Tel: 925-223-6947 Additional Contacts none entered CityServe of the TriValley P.O. Box 1613 Pleasanton, CA 94566 United States Executive Director Gloria Gregory gloria@cityservetrivalley.org Telephone925-223-6947 Fax Web www.cityservetrivalley.org Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). We serve people in the Tri-Valley by 1) Caring for people in crisis, 2) Coordinating resources and volunteers between the faith- based community, non-profits, schools, businesses & government agencies 3) Connecting community volunteers to local non- profits 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding 5.1.n Packet Pg. 114 Attachment: 14. CityServe of the TriValley - Homelessness Prevention/Crisis Intervention Services Application (HS Grant Program FY19 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. 1) Alameda County contract, 2018/2019, $100,000 for homeless services in the Tri-Valley 2)) City of Pleasanton grant funds, 2018/2019, $13,300 for crisis intervention services 3) City of Livermore grant funds, 2018/2019, $8,000 for crisis intervention services 4) City of Pleasanton grant funds, 2017/2018, $8,000 for crisis intervention & operations 5) City of Livermore grant funds, 2017/2018, $5,000 for crisis intervention 6) City of Pleasanton grant funds, 2016/2017, $5,000 for operations 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). We are governed by an eight member Board of Directors, qualified to make decisions re: the organization, strategy and operations of our organization.The board includes a diverse group of individuals currently employed in business, government, and faith-based leadership roles. Four of our board members are Dublin residents. Our organization's management, programs and projects are led by Executive Director, Gloria Gregory. Gloria holds a Bachelor's degree in Education and is a 34 year Tri-Valley resident with 33 years of professional business experience. Her past positions include Vice-President of Sales & Marketing, Pulte Home Corporation and Vice-President of Operations and Training, Kaufman & Broad Mortgage. Gloria is Co-Founder of CityServe of the Tri-Valley. Our financial statements are prepared by our Board Treasurer, Patrice Van Dussen, who has 25 years experience as controller in the public sector. Our staff consists of a very capable Administrative Manager, Marielle Evans (Marielle holds a Master's Degree and is extremely qualified), a very effective Homeless Services Crisis Intervention Specialist, Aaron Horner (Aaron holds a Bachelor's degree in Human Services Management, and Aaron is Spanish speaking), and Graciela Pena and Natessa Martinez, 2 part time (20 hours per week) Crisis Intervention Specialists. Graciela is Spanish speaking. Our capacity is expanded through the volunteer administrative/client services support team we have built over the last 5 years and continue to build. We have 9 very capable volunteers in established roles (the group includes a CPA, who handles our weekly input of financial data and a retired Clorox data management specialist who helps manage our client data records and produces our monthly data reports). We have all needed information technology resources, a robust human services database, and a well-maintained website, which serves as a valued community resource/directory re: solutions to human services 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. We provide needed solutions to Dublin residents/families in crisis, including emergency motel nights for the homeless, rent assistance to prevent eviction, funds for auto repair to sustain employment, deposit/initial rent assistance to gain housing. 9. 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.) 370 people 10. 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 Concern. ✔✔✔✔ Operational funding gfedc None ✔✔✔✔ Behavioral Health (mental health and substance abuse) ✔✔✔✔ Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development ✔✔✔✔ Homelessness ✔✔✔✔ Transportation Services and Access gfedc Domestic Violence and Child Abuse ✔✔✔✔ Disabilities ✔✔✔✔ Food and Nutrition ✔✔✔✔ Senior Services ✔✔✔✔ Youth Services 5.1.n Packet Pg. 115 Attachment: 14. CityServe of the TriValley - Homelessness Prevention/Crisis Intervention Services Application (HS Grant Program FY19 11. How will this project will be implemented, administered, and operated? This project is on-going, and it will continue to be administered and operated as in previous successful years. Our crisis intervention process includes completion of a thorough intake phone or in-person interview with each Dublin resident who contacts us, or who we are asked to contact (via the school district, police department, or other community organizations) or who we discover through our community outreach efforts, regarding their urgent human services need. We will provide immediate connection to established resources available to remedy the situation. If the interview is done via phone, we will schedule at in-person meeting with one of our Crisis Intervention Specialists for the client to provide documentation re: the urgent need (i.e. ID, copy of lease if rental assistance is required, copy of pay stubs, other income sources, copy of bank statements for income verification, etc). If financial assistance is warranted, we will work with the client to determine how much of the need they can provide, and, if the needed balance is more than we can provide, we will work with the client to engage other local organizations to assist (local churches are the most likely to respond quickly to requests for urgent financial help). Upon resolution of the urgent need, we will work with the client to address other needs affecting their future household stability (budgeting, employment search assistance, and other life skills training is needed to avoid future similar crisis situations. Our Homeless Services Crisis Intervention Specialists spend as much time in the field as possible engaging with the homeless in Dublin, Livermore, and Pleasanton. We equip these Specialists with database equipped iPads so the intake can be completed upon connection with a homeless client. We were recently donated a used van, and that van allows us to provide transportation to a San Leandro detox center for homeless clients needing detox and/or to a Hayward social services offices 12. Describe in detail how Dublin grant funds will be used for this project. (What specifically will the grant funds be used for?) $14,500 of the Dublin grant funds will be used to provide crisis intervention through direct financial help for Dublin residents who have proven a legitimate, urgent need that puts in jeopardy their housing security or household stability. The most clear example is provision of rental assistance for a family who has received a 3 day notice to pay rent or move from their apartment. Each month we receive calls from Dublin residents in affordable housing locations as well as market-rate apartment locations in such need. Our ability to assist them is critical & is a key homelessness prevention measure. Another example is funds for auto repair so transportation to work and other necessary destinations (medical, schooling, etc) are not interrupted, which can lead to job loss, which can lead to loss of housing and homelessness. Payment of delinquent utility bills will be another use, in order to restore service (such requests often comes from Dublin seniors in affordable housing). We also can assist with purchasing perishable food items or personal hygiene items not available at most food pantries (items like milk, bread, meat, toothpaste, toilet paper, laundry detergent). Often CalFresh monthly food allowances are not enough to cover the family needs, and personal hygiene items are not allowable for CalFresh purchases. The remaining $10,400 of the Dublin grant funds will be used for wages and salaries of a non-homeless services Crisis Intervention Specialist who will devote 10 hours per week to directly serving Dublin residents in need. These funds are needed because our Crisis Intervention staff dedicated to homeless services in Dublin are funded through the Alameda County Contract we now have (7/1/18-6/30/19) and will continue to be funded by the anticipated Alameda County HEAP funds we anticipate receiving to cover 7/1/19-12/31/21. Our urgent need will be for homeless prevention/crisis intervention staff funding. 13. 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)? Our outcome measures are clearly identified through the Social Solutions client data management software system we have been using since April 2018. This system captures all data we maintain on each client, including initial request, analysis of contributing factors to the crisis situation, and all of our intervention efforts and the results. We measure outcomes that include the achievement of eviction prevention for a resident/family, provision of clothing, food, or transportation (transportation involves solutions from BART/bus tickets to transferring a donated car to our client), payment of delinquent utility charges, and more. We publish a monthly report of all client related data/matters. Our staff and Board review those reports to evaluate the requests for assistance we have received and the effectiveness of our service(s) provided. We identify and celebrate major outcomes! gfedc Child Care, Early Childhood Development and Education ✔✔✔✔ Changing Demographics and Growing Diversity ✔✔✔✔ Financial Assistance gfedc None of the above ✔✔✔✔ Please explain: Our work involves 10 of these categories because we assist Dublin residents navigate complex crises that involve many areas of concern. 5.1.n Packet Pg. 116 Attachment: 14. CityServe of the TriValley - Homelessness Prevention/Crisis Intervention Services Application (HS Grant Program FY19 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. We anticipate serving the same population we have provided with crisis intervention services over the past 5-6 years. Consistent with those years, our 2018 data records the Dublin population we served in these groups: 1) 88% Extremely Low Income 2) 8% Very Low Income 3) 4% Low Income 4) 42% Female Head of Household (many single mothers with Dublin school age children) 5) 25% Homeless 6) 15% Disabled 7) 11% Youth 8) 7% Seniors 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? We understand culture to refer to the diversity of experiences within groups including gender, race, national origin, class, or religion. We strive to understand cultural differences and the need for culturally sensitive and informed care. We strive to make clients from various cultures feel comfortable in communicating details of their crisis situations to us and being comfortable in understanding and accepting our strategies in assisting them. Regarding clients of various national origins: We employ two Spanish speaking staff members (one male and one female) to ensure we are able to effectively communicate with Latino clients. A testimony to our effectiveness in assisting local Latinx clients is the $10,000 grant we received in December from the local Latina Giving Circle. We collaborate with the Muslim Community Center (MCC) located in Pleasanton to engage Farsi and Arabic speakers in order to more effectively communicate with clients of Middle Eastern origin. Our data details 3 clients over the last 18 months who we partnered with the MCC based on the need for Farsi translation. Two of those clients were Dublin residents – one client had school age children and lived at Wexford Way, a Dublin below market apartment community. In that instance we actually partnered financially with the MCC to support the families’ need for rent assistance and initial deposit for the move that was necessary within the Dublin community. Additionally, we have volunteers from the Indian, Portuguese, Chinese, and Russian cultures available who have assisted us in translation as needed. We are continually learning from our clients and partners as we strive to be culturally-informed and reduce language and cultural barriers for those in need of help. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? Our strongest outreach to low-income, limited English speakers and disabled occurs through our close working relationship with the property and resident services managers at Dublin’s low income apartment communities. Each year we participate in the National Night Out events at these locations and connect with residents and distribute information on our services and relevant resources. There are over 1,000 low-income apartments in Dublin (including those designated for seniors), and virtually every week we receive contact from at least one of the managers at those locations or a resident they have referred to us for crisis intervention. We also work closely with the Dublin Unified School District Student Services Director and Community Liaison to ensure our outreach to low-income, limited English speakers, and disabled persons. The school district organizes events at each of the largest low income housing locations (separate from the National Night Out events), and we partner with the school district in coming to their low-income housing events to display our collaboration with them and to provide needed services. We also work closely with La Familia (a local non-profit primarily focused on serving low-income Latino Individuals and families), CRIL (Community Resources in Independent Living that serves disabled people), HomeStretch (an Alameda Co. assisted housing program for those with mental/physical disabilities), and the Senior Support Program of the Tri-Valley to be sure they contact us when their clients need the crisis intervention services we provide. Referrals and collaborations between our organization and theirs occur regularly. We also outreach to these population groups through our working relationship with the Dublin Police Department. In December 2018 we began “ride-alongs” with Dublin Police officers to ensure we are connecting to Dublin homeless individuals and families and engaged in providing services to them to end their homelessness 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Core to our mission at CityServe is collaboration and partnering with other agencies to ensure unduplicated efforts and the most effective community impact. We do this through our robust referral program, having over 3120 collaborations with other local agencies in 2018 alone. 5.1.n Packet Pg. 117 Attachment: 14. CityServe of the TriValley - Homelessness Prevention/Crisis Intervention Services Application (HS Grant Program FY19 We work closely with agencies such as Abode Services to ensure our homeless clients are entered into the Alameda County Coordinated Entry Program. Additionally, we frequently partner with Axis Community Health by complementing one another’s services. We receive calls from Axis personnel when their client has urgent need of motel lodging to recovery from a medical issue, or needs other crisis intervention services we provide. In turn, we connect our clients to Axis Community Health (often delivering them directly to the clinic), helping them enroll in MediCal, and sometimes paying for essential medical tests/equipment not covered by MediCal. Similarly, we partner with the Emergency Room Social Work staff at Stanford Health/Valley Care hospital to providing services for patients being discharged. One example from 2018 was a Dublin man, wife, and daughter who were without permanent housing, living in the Dublin Extended Stay. The man suffers from several health issues and was hospitalized for more than a week. It was time for discharge, but he did not have the funds to pay for the needed prescription at the pharmacy in order to allow for it. The hospital social worker called our office and one of our Crisis Intervention Specialists went to the pharmacy, paid for the prescription, and delivered it to the hospital. It is this ability to respond quickly and creatively that allows CityServe to be a complementary partner agency with so many others in the area. We also partner with Camp Parks in Dublin, by serving families there and connecting those families and Camp Parks to services and volunteer needs in Dublin and the Tri-Valley. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. Our marketing outreach has included participation in the National Night Out and Dublin School District events at the Dublin low-income rental communities. We have consistently participate in these events for the last 4 years. Our outreach has also included visits by the Executive Director as well as Crisis Intervention Specialists to Dublin’s low-income apartment community managers to ensure they are aware of our services, our monthly newsletter, resource guides, and our website as solutions to their residents’ crisis situations (rental assistance needed, delinquent utility bill payment, gas for travel to employment, food, clothing for children, auto repair for sustained transportation to work and school, medical appointments). We originated and continue to update and publish helpful human services related guides for Dublin and Tri-Valley residents. These guides include our contact information and are a continual form of outreach. Our new “Resource Field Guide” is organized topically such as Homelessness and Employment and provides more details on Tri-Valley specific agencies. “Tri- Valley Food Resource, Shower, and Laundry Guide” lists the many food resources, including food pantries maintained by churches as well as non-profits, Open Heart Kitchen serving sites and times, Tri-Valley Haven senior mobile food pantry schedule, and times and locations of showers and laundry facilities available at no cost. In addition to the “Tri-Valley Food Resource, Shower, and Laundry Guide”, at appropriate times of the year we publish “A Tri- Valley Guide to Resources for School Backpacks/Supplies” and “A Tri-Valley Guide to Holiday Resources”. These Guides have been published for over 4 years and are actively used by Dublin and Tri-Valley school district staff, low-income housing managers, city departments, including the police departments, many non-profits, and community businesses and individuals. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. This project is cost effective because we leverage collaboration with other organizations and community volunteers in providing services to our clients. In 2018 our data base recorded 585 instances of individual, specific collaboration with other local organizations in serving specific clients. We recorded 2,882 total instances of individual, specific collaboration in our service to Tri-Valley clients. This extensive collaboration and knowledge of human services resources allows us to provide significant and effective services with a very cost effective and reasonable budget. This project will serve 370 Dublin residents with homelessness prevention and crisis intervention services at a cost of $24,900 or $67.30 per resident. That is cost effective and reasonable. $14,500 of this project’s cost will provide direct remedies to crisis situations in the form of such expenditures as rental assistance, delinquent utility bill payment, auto repair costs; funds are never disbursed to the client rather always disbursed to the landlord, utility provider, auto repair business or other appropriate party. $10,400 of this project’s cost will pay for the wages of a Homeless Prevention & Crisis Intervention Specialist to devote 10 hours per week to serving Dublin residents. This is in addition to the significant hours our Homeless Services Crisis Intervention Specialists will devote to serving Dublin clients provided through funding from Alameda County and the State of California HEAP funding in this grant period. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Our work in serving crisis human service needs for the residents of Dublin has grown each year for the last 9 years. Our goal is to continue to expand our role as a key safety net provider for the City of Dublin and the City’s residents. We have worked to establish trusted and respected relationships with Dublin’s city staff, Dublin’s low-income housing managers, Dublin’s school district child welfare and student services staff, the police department, and other segments of the community through 5.1.n Packet Pg. 118 Attachment: 14. CityServe of the TriValley - Homelessness Prevention/Crisis Intervention Services Application (HS Grant Program FY19 our consistent delivery of solutions to resident’s crisis situations. If this application does not receive funding or receives reduced funding our level of service to Dublin residents will be reduced, and our ability to respond quickly and effectively will be significantly reduced. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 25. 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. 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process Our project will help the City of Dublin provide great customer service for Dublin residents. Our project will serve the community by preventing homelessness and remedying crisis living situations for many Dublin residents. All Dublin residents will benefit from our services because of that reduced homelessness and crisis stress reduction in the city. As noted, our monthly newsletters, website, CityServe Community Meetings and Resource Guides provide customer service to all residents. 28. ** QUESTIONS 29 THROUGH 41 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? 29. 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 ✔✔✔✔ No gfedc Yes: If yes, please explain: gfedc Yes ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc Yes. If so, check box here and answer questions 29 through 41. ✔✔✔✔ No. If no, check box here and enter gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. 5.1.n Packet Pg. 119 Attachment: 14. CityServe of the TriValley - Homelessness Prevention/Crisis Intervention Services Application (HS Grant Program FY19 accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *Promote fair housing and reduce housing discrimination. gfedc 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: gfedc * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. gfedc * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. gfedc C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. gfedc D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. gfedc 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. gfedc Increase homeownership gfedc Promote decent affordable housing gfedc Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. gfedc Improving the quality of life for our Nation's communities gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). 5.1.n Packet Pg. 120 Attachment: 14. CityServe of the TriValley - Homelessness Prevention/Crisis Intervention Services Application (HS Grant Program FY19 35. 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?") 36. 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?") 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc Assist low and moderate income first-time homebuyers. gfedc Reduce housing discrimination. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. 5.1.n Packet Pg. 121 Attachment: 14. CityServe of the TriValley - Homelessness Prevention/Crisis Intervention Services Application (HS Grant Program FY19 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 39. 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". 40. 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 41. 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" gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. N/A Disabled N/A Women/Female Headed Households N/A Seniors N/A Youth N/A Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL N/A Low Income (50%-80% AMI) N/A Extremely Low Income (<30% AMI) N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) N/A 0.000.00 TOTAL N/A White N/A White + HISPANIC N/A Black/African American N/A Black/African American + HISPANIC N/A Asian N/A Asian + HISPANIC N/A American Indian/Alaskan Native N/A American Indian/Alaskan Native + HISPANIC N/A Native Hawaiian/Other Pacific Islander 5.1.n Packet Pg. 122 Attachment: 14. CityServe of the TriValley - Homelessness Prevention/Crisis Intervention Services Application (HS Grant Program FY19 42. 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 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). Our sources of funding and amount of funding continue to grow each year. In 2018 we received increased funding from the cities of Livermore & Pleasanton. In 2018 we also received an Alameda County contract in the amount of $100,000 to provide homeless services in the Tri-Valley (our first county contract). We anticipate receiving HEAP (Homeless Emergency Assistance Program) funding for homeless services for 7/1/19-6/30/20 of $247,500 Facts about our services for the most vulnerable in the Tri-Valley are more & more well-known, &, in 2018, resulted in new donations from public foundations, local family foundations, and community individuals. Financial support from Tri-Valley churches show a growing trend each year. In the fall of 2018 our opportunities to speak to local Rotary groups and other community service groups developed, and we anticipate receiving support from those groups in 2019. Our Board of Directors actively strategizes fundraising efforts. 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. BL-109916 N/A Native Hawaiian/Other Pacific Islander + HISPANIC N/A American Indian/ Alaskan Native and White N/A American Indian/ Alaskan Native and White + HISPANIC N/A Asian and White N/A Asian and White + HISPANIC N/A Black/African American and White N/A Black/African American and White + HISPANIC N/A American Indian/Alaskan Native and Black/African American N/A American Indian/Alaskan Native and Black/African American + HISPANIC N/A Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed Direct Expenditures for Client Needs USD$ 14,500.00 USD$ 0.00 Wages USD$ 10,400.00 USD$ 0.00 Total USD$ 24,900.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Homelessness Prevention -Rental Assistance USD$ 7,500.00 Homelessness Prevention -Initial Apt. Deposit/Initial Rent Assistance USD$ 3,000.00 5.1.n Packet Pg. 123 Attachment: 14. CityServe of the TriValley - Homelessness Prevention/Crisis Intervention Services Application (HS Grant Program FY19 Crisis Intervention-Delinquent utility bill payment USD$ 1,000.00 Crisis Intervention-Vehicle repair USD$ 1,500.00 Crisis Intervention-gas cards for transportation to employment, school, medial appts. USD$ 500.00 Crisis Intervention-gift cards for perishable food items/personal hygiene items USD$ 600.00 Crisis Intervention-clothing for low-income Dublin school chldren, or youth/adults beginning employment USD$ 400.00 Wages for Homeless Prevention/Crisis Intervention Specialist (average 10 hours/week Dublin services USD$ 10,400.00 Total USD$ 24,900.00 USD$ 0.00 Budget Narrative The $24,900 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. As noted in the grant application, 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 Crisis Intervention Specialists working with the homeless will be provided by Alameda County funding. In our 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 top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ 2019 Program Expenses Financial Information Form for ALL Grant Requests download template ✔✔✔✔ 2019 Financials List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ CityServe Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ 2019 CityServe Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ 990 2017 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Board Authorization Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Board Funding Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Liability Insurance Insurance Proof 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. ✔✔✔✔ Federal Non-Profit Status 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 5.1.n Packet Pg. 124 Attachment: 14. CityServe of the TriValley - Homelessness Prevention/Crisis Intervention Services Application (HS Grant Program FY19 Application ID: 132721 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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) Dublin Q1-2 Update Food Resource Grid Holiday Resources Thanksgiving Resources 2018 Brochure January 2019 Newsletter Field Resource Guide 5.1.n Packet Pg. 125 Attachment: 14. CityServe of the TriValley - Homelessness Prevention/Crisis Intervention Services Application (HS Grant Program FY19 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline Community Resources for Independent Living Housing and Independent Living Skills Jump to: Questions Budget Documents USD$ 11,523.00 Requested Submitted: 1/14/2019 4:13:58 PM (Pacific) Project Contact Michael Galvan Programs@crilhayward.org Tel: 510 881 5743 x31 Additional Contacts none entered Community Resources for Independent Living 439 A Street Hayward, CA 94541 United States Executive Director Ron Halog Ron.Halog@crilhayward.org Telephone(510) 881-5743 Fax (510) 881-1593 Web www.crilhayward.org Questions top 1. Select the category that best describes your organization: (Select only one.) 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.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding 5.1.o Packet Pg. 126 Attachment: 15. Community Resources for Independent Living - Housing and Independent Living Skills Application (HS Grant Program FY19 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. City of Livermore-2018-2019 $10,689, 2017/2018 $10,000, 2016-2017-$7,500-- IL Skills, Housing Services in Livermore-City Funding City of Pleasanton- 2018-2019 $15,000, 2017/2018 $0.00, 2016-2017-$15,617--IL Skills, Housing Services in Pleasanton-City Funding Department of Rehabilitation- 2018-2019 estimated$21,740, 2017/2018 $25,302, 2016-2017-$8,983- Federal Funding Funding specifically supports the Tri Valley office with salaries/benefits and operational costs to support IL- Skills, Housing, Employment and travel training CIL-2016-2017-$11,014- Federal funds through ACTC grant and a subcontract under CIL 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). For 39 years, Community Resources for Independent Living (CRIL) has been providing comprehensive life skills training, including housing assistance & job readiness to southern & eastern Alameda County residents with all types of disabilities. The majority of CRIL's service providers are peers - individuals who have a disability - who are uniquely qualified to offer peer support and empowering guidance to lower income residents who face physical and societal barriers to employment , self- sufficiency, self-determination and access to goods & services. Since opening a full-service Tri-Valley branch office in 2001, CRIL has also been readily accessible to Dublin residents with disabilities and seniors with functional limitations. The Independent Living philosophy is one of self-directedness and self-determination. With support, encouragement, self- advocacy skills and equal access to resources, people with significant disabilities can achieve their goals and prosper as active members of their community. CRIL's board of directors and management are also community members with disabilities who are role models, for both our consumers and the larger community. Though we are a small organization, CRIL is fiscally sound and well managed organizationally. We serve a larger number of consumers, offer more diverse wrap-around services and effect more social & policy systems change through our community advocacy than many larger independent living centers in CA. CRIL's staff & management are highly trained and educated in the fields of social service, education, psychology, sociology, counseling, community organizing & theology. All services providers are cross trained by their peers. 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. Provide Housing Assistance, Employment Counseling, Advocacy Training, Travel Training, Leadership Development and Independent Living Support Services for under-served, low income Dublin residents with disabilities and seniors with functional limitations. 9. 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 directly, 75 indirectly 10. 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 Concern. gfedc None gfedc Behavioral Health (mental health and substance abuse) ✔✔✔✔ Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development ✔✔✔✔ Homelessness ✔✔✔✔ Transportation Services and Access gfedc Domestic Violence and Child Abuse ✔✔✔✔ Disabilities gfedc Food and Nutrition ✔✔✔✔ Senior Services ✔✔✔✔ Youth Services gfedc Child Care, Early Childhood Development and Education ✔✔✔✔ Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above gfedc Please explain: 5.1.o Packet Pg. 127 Attachment: 15. Community Resources for Independent Living - Housing and Independent Living Skills Application (HS Grant Program FY19 11. How will this project will be implemented, administered, and operated? CRIL's Tri-Valley staff are quite familiar with the resources and services available in Dublin and the surrounding cities. With our Tri-Valley office located in the Livermore Multi-Service Center, we have developed strong relationships with service providers at ECHO, Abode Services, the Livermore Housing Authority, Dublin's Housing Services Department and other local agencies that provide housing & social services. CRIL will actively expand its housing search resources since affordable housing continues as the major need of Dublin consumers. CRIL's Tri-Valley Independent Living Coordinator is a bilingual woman with a disability, and provides disability peer support and role modeling to both English and Spanish speaking residents of Dublin. She is also a certified work incentive coordinator (CWIC) and is able to help consumers who return to work how this will affect their benefits. CRIL is a subcontractor with the Season of Sharing program and has access to funding to assist qualifying low-income residents with one-time delinquent mortgage or rent payments, security deposits, modifications or other costs associated with retaining housing or moving into a new home. CRIL's Housing, Employment & IL Services will be administered through the following comprehensive service methods: 1. Monthly Housing Workshops - topics include individual housing needs, eligibility for Section 8 & other subsidized programs, credit reports & repair, housing research, applications, interviews, tenant rights & responsibilities. 2. Monthly Job Club & 1:1 Employment Counseling 3. Individualized Travel Training Excursions on WHEELS, BART & AC Transit 4. Monthly Peer Support Groups 5. Individual Independent Living Plan development & coordination - CRIL's IL Coordinator meets individually with each consumer to develop a plan with specific steps & timelines for meeting goals 6. IL Coordinators check in with each consumer every 30 - 60 days to see how they're doing with meeting goals 12. Describe in detail how Dublin grant funds will be used for this project. (What specifically will the grant funds be used for?) CRIL is requesting $11,523 in Dublin Community Grant funding for FY 2019-20, which will allow us to increase Independent Living (IL), Housing services, Youth Services, Mobility and Travel Training, as well as, Job Readiness support in the Tri-Valley area. CRIL projects to serve 30 low income Dublin seniors and residents with disabilities (a 380% increase in consumers since 2011), as well as provide I & R to 75 other residents. CRIL will actively recruit youth to form a Disability Action Network for Youth (group 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. FY 2019-20 continues to see a dramatic increase in the number of Dublin consumers served. Funds will primarily cover (April please add %) of the salary and benefits of the IL Coordinator with a small amount for shared indirect costs associated with necessary program and office operations (e.g., admin, telephone, supplies, insurance, etc.). 13. 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)? CRIL's Housing, Employment & IL Services 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 & credit counseling, landlord mediation and/or applications to Season of Sharing and Dept. of Rehabilitation's housing transition fund. CRIL will also provides indirect information & referral, technical & assistive technology support, ADA & disability law education and community advocacy to 75 additional Dublin residents & businesses to increase their knowledge & independence. With Livermore & Pleasanton youth, a youth advocacy group (DANY) will be formed. 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. 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. This program will serve low and very low income Dublin residents of all ages who have a disability or disabling condition, including youth and seniors. Dublin residents will benefit by being able to retain or obtain affordable, accessible and safe housing through their work with 5.1.o Packet Pg. 128 Attachment: 15. Community Resources for Independent Living - Housing and Independent Living Skills Application (HS Grant Program FY19 CRIL's IL Coordinator, which in turn decreases the City's homeless population and minimizes the possibility of unnecessary institutionalization of this at-risk population. Those seeking employment will have guidance and assistance from CRIL's IL Coordinator who is an SSA Certified Work Incentives Counselor (CWIC), specially trained on counseling consumers on the integration of work incentives and other tools to achieve self-sufficiency through employment. CRIL's providers will also assist consumers with navigating the job readiness resources available through the American Job Centers, and prepare consumers for their job hunt through the CRIL Job Club which addresses creating cover letters, resume writing, interviewing skills, dressing for success and more. Moreover, with CRIL's travel training program consumers will attain the skills needed to use public transportation for greater independence, to have the ability to get to school and work. Others will receive assistance to attain and maintain their benefits. Other Dublin residents with disabilities will obtain needed information, support, counseling and training which will help them maintain or gain greater independence and well being, thereby decreasing the likelihood of emergency intervention or institutional care. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? CRIL's IL services are directed specifically toward low-income Dublin residents with disabilities & older seniors who are typically underserved and extremely vulnerable. Since the majority of CRIL's staff are also people with disabilities who live in Alameda County, we are in a uniquely credible & powerful position to provide peer counseling, personal support, an array of local resources and peer role modeling with this population. Having a full service branch office at the Livermore Multi-Service Center also allows CRIL staff & management to develop and maintain strong partnerships & collaborations with other Dublin area social service agencies. For example, we have presented workshops on personal assistance services, assistive technology, disaster preparedness & healthy living at the Dublin Senior Center and to residents who live at local HUD apartment complexes. We have also partnered with the Livermore Hindu CCC annually since 2012 to sponsor a Mega Health Fair for low-income Tri-Valley residents. With grant funding, CRIL has provided hundreds of low income residents with free flu vaccines through Sutter At-Home Healthcare. CRIL also participates in the Tri- Valley Affordable Housing Committee as we collaborate with others to address the severe housing crisis in Dublin and the East Bay. CRIL’s Tri-Valley Coordinator is also bilingual & bicultural in Spanish/English and is therefore able to provide culturally appropriate, direct outreach & services to the 14.5% Hispanic population of Dublin. Not only are individual services provided in Spanish for these consumers, but many of our classes, workshops and trainings are also separately conducted in Spanish or with simultaneous translations provided. We also have a contract with Hands On and a list of certified independent ASL interpreters that we utilize for County residents who are deaf. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? CRIL has 3 offices strategically located in southern and eastern Alameda County to provide optimum access to everyone who can benefit from CRIL's services. All three offices (Hayward, Livermore, and Fremont) are on, or close to, bus routes and other forms of public transit. Facilities are also completely accessible to people with mobility and sensory disabilities and include automatic doors, accessible parking and restrooms, TTY phones, and materials in other languages and alternate formats. All 3 offices are open Monday through Friday with drop-in hours on Tuesdays & Thursdays. Services are also provided via phone, in the community, or at the person’s home for those who cannot readily travel to one of the offices. CRIL provides services in English, Spanish, Dari and Farsi. All CRIL informational materials are available in large print, Braille, on CD and in Spanish and Chinese. CRIL utilizes the County's Language Line for other language translations. In addition, 82% of CRIL staff have a disability and are thus able to provide peer counseling and peer mentoring. 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. CRIL’s Tri-Valley branch is located in the Livermore Multi-Resource Center, allowing CRIL to work closely with several other service agencies co-located at the Center. CRIL staff often bring a consumer over to work with a colleague at Department of Social Services, Department of Rehabilitation, ECHO Housing or EBI in order to address the person’s comprehensive needs, especially in relation to housing assistance. We have closely collaborated with the Livermore Housing Authority, Abode, ECHO and Season of Sharing (SOS) a number of times in order to improve the probability of reaching the desired outcome of a housing placement. 5.1.o Packet Pg. 129 Attachment: 15. Community Resources for Independent Living - Housing and Independent Living Skills Application (HS Grant Program FY19 Various Tri-Valley workshops are often co-facilitated with staff from Alliance Health, Senior Services Coalition, the Public Authority of Alameda County, the Alameda County Public Health Department, Social Security and the Alameda County Food Bank. Some are held at the Livermore Multiservice Center and others at Tri-Valley area senior centers, libraries or housing complexes. Other social service agencies with which CRIL staff routinely coordinates services include Eden Housing, BACS, BOSS, FESCO, HACA, Tri-Valley Senior Support Services, CIWP, the Center for Independent Living (CIL), Spectrum, Season of Sharing and the Tri-Valley Haven. CRIL partners with TheCIL (formerly CIL Berkeley) and the Alameda County Area Agency on Aging (AAA) in the county’s Aging & Disability Resource Connection or ADRC. This core team of CRIL, TheCIL and AAA is working with over 20 other agencies that serve seniors and persons with disabilities to improve the access to and coordination of Long Term Services and Supports for these populations to maintain their health, independence and activity within the community. CRIL also participates in Alameda County's Council for Age-Friendly Communities. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. CRIL participates in or co-sponsors over 50 outreach events annually with several located in the Tri-Valley cities and in Dublin specifically. Many of these outreaches are targeted toward youth, seniors, families, people with disabilities or communities with health concerns and Spanish-speaking groups. CRIL has participated in the Dublin Senior Health Fair, the Tri-Valley youth transition fair, as well as the Hindu Temple Health Fair and several community and senior fairs in Livermore and Pleasanton. Our staff often attend community meetings and events in the Tri-Valley, including visiting residents and resident managers at Dublin housing complexes, such as The Groves and Emerald Vista. We also advertise in the Alameda County print and online telephone directories, with Eden 211, local newspapers, Spanish language channel 14, Chinese World News, Alameda County Senior Directory, Livermore Hindu Center, Livermore Chamber news, Hayward Chamber news, Fremont FRC news, at local senior centers, libraries and city halls, and on CRIL's own website and Facebook page, as well as in our monthly e-newsletters and periodic event mailings. Our website is fully W3C accessibly-compliant (www.crilhayward.org), has a large print access feature, and has a Google button for immediate, basic translation into other languages. CRIL’s listserv has 1,334 consumers who regularly (twice a month at least) receive emails from CRIL concerning the disability community. CRIL Staff, Board, Disability Action Network for Youth (DANY) members also serve on number of boards, commissions and advisory councils throughout Alameda County. Therefore, we are involved in a variety of social and economic justice activities with other local agencies, and are well known in the community. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Since the majority of CRIL's consumers are extremely low income, it is vital & significant that CRIL does not charge consumers for any program costs & does not limit the amount of services they can receive. The cities of Livermore & Pleasanton, Hindu CCC, Dept. of Rehabilitation and Alameda County Transportation Commission (ACTC) funding for travel training all contribute to the overall costs of operating CRIL’s Housing, Employment & IL Services program and supporting our full-service branch office in the Tri-Valley. The city of Dublin's portion to support CRIL's Tri-Valley services is 10.5%. CRIL provides more than one dozen programs & services to residents in the Dublin community, including education, training, employment services, benefits counseling & peer support groups. We also provide ADA materials to businesses & non- disabled Dublin residents, which improve the accessibility & inclusiveness of the Dublin community. Housing placement services are extremely time intensive and often, especially for very low income residents who can only afford subsidized housing units, take a longer period of time to achieve. Typically hours & hours of direct service time and networking are involved in helping people with disabilities locate an affordable and accessible long-term home -- even when they already have a rare Housing Choice voucher. This project is very cost effective for the City because with a limited investment that leverages other funding, CRIL is able to maintain a level of knowledgeable, caring, and culturally proficient service providers to assist the City with reducing homelessness & meeting the housing needs of its most vulnerable residents, assist others in obtaining employment & moving out of poverty, and to improve the lives of many other low income residents with disabilities through peer support groups, IL & advocacy skills training, mobility/travel training, community I&R. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Funds contributed by the City of Dublin help leverage funds from the other two cities in the Tri-Valley area, as well as private foundation & other government support. The diversity of Tri-Valley funding specifically allows CRIL to maintain a local presence in the Tri-Valley area, serving the entire community with a full-time, full service capacity branch office. Though Dublin funding is only (APRIL ADD %) of the total program budget, CRIL strongly relies on the City's support to 5.1.o Packet Pg. 130 Attachment: 15. Community Resources for Independent Living - Housing and Independent Living Skills Application (HS Grant Program FY19 maintain our presence in the Tri-Valley. Without Dublin funding, CRIL would not be able to continue operating a full service branch office in the Tri-Valley area. CRIL has sustained significant cuts to its operating budget since the great recession of 2008 and the slow economic recovery. Some of these cuts have resulted in decreased staffing and loss of individual services availability. Further reductions would result in diminished office hours or complete office closure. Without CRIL's local presence in the Tri-Valley, it would be extremely difficult for Dublin residents with disabilities to receive personalized, in-depth services. For those who are in jeopardy of losing their housing, Dublin would see an increase in homelessness and institutionalization among its most vulnerable residents - a significantly threatening reality in this current environment of high rents and low vacancies. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 25. 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. 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process With self-advocacy & equal access, people with disabilities achieve prosper. CRIL consumers having a high quality of life which fosters new opportunities in a safe and secure environment. This is done by supporting independence and self- determination by the use of assistive technology, increased accessibility of transportation and housing, better understanding of the relationship between employment and benefits. CRIL's advocacy work encourages active civic engagement and leadership development. 28. ** QUESTIONS 29 THROUGH 41 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? ✔✔✔✔ No gfedc Yes: If yes, please explain: gfedc Yes ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. ✔✔✔✔ Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. ✔✔✔✔ Yes. If so, check box here and answer questions 29 through 41. gfedc No. If no, check box here and enter 5.1.o Packet Pg. 131 Attachment: 15. Community Resources for Independent Living - Housing and Independent Living Skills Application (HS Grant Program FY19 29. 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. 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. 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. ✔✔✔✔ Be culturally accessible, appropriate and inclusive ✔✔✔✔ Encourage community engagement and involvement gfedc Promote energy and resource efficiency ✔✔✔✔ Encourage networking and information sharing across service providers ✔✔✔✔ Encourage process streamlining ✔✔✔✔ Consolidate service delivery gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ 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. gfedc *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. gfedc F) Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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 gfedc 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. ✔✔✔✔ Participation of minority-serving institutions in HUD programs. ✔✔✔✔ End chronic homelessness within ten years. ✔✔✔✔ Removal of barriers to affordable housing. 5.1.o Packet Pg. 132 Attachment: 15. Community Resources for Independent Living - Housing and Independent Living Skills Application (HS Grant Program FY19 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: 35. 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?") 36. 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?") 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ 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). gfedc 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. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Creating a Suitable Living Environment ✔✔✔✔ Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Availability/Accessibility gfedc Affordability gfedc Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. 5.1.o Packet Pg. 133 Attachment: 15. Community Resources for Independent Living - Housing and Independent Living Skills Application (HS Grant Program FY19 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 39. 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". 40. 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 41. 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" gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 30 Disabled 5 Women/Female Headed Households 10 Seniors 5 Youth 5 Homeless 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 55.0055.00 TOTAL 35%Low Income (50%-80% AMI) 55%Extremely Low Income (<30% AMI) Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL 10 White 5 White + HISPANIC 3 Black/African American 0 Black/African American + HISPANIC 5.1.o Packet Pg. 134 Attachment: 15. Community Resources for Independent Living - Housing and Independent Living Skills Application (HS Grant Program FY19 42. 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 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). As an accredited Center for Independent Living by the federal Rehabilitation Services Administration, CRIL’s federal revenues (68%) include ACL funding and CA State Department of Rehabilitation IL funding to provide 7 core IL services within our geographic area. The rest of our revenue is from local social service & CDBG grants, other competitive government grants, private foundations, fee-for-service contracts, fundraising activities & individual donations. Diversified government and private funding allows CRIL to provide additional services that meet the specific needs of our community (e.g., employment assistance, benefits counseling, PAS services, mobility/travel training, disaster preparedness training) and maintain full- service branch offices in the Tri-Cities and Tri-Valley. CRIL often partners with other local organizations on grant applications and projects (e.g., TheCIL, AC AAA, ACPHD, Senior Services Coalition, LAS-HICAP, CFILC) to maximize effectiveness of funding. 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. BL-009274 8 Asian 2 Asian + HISPANIC 0 American Indian/Alaskan Native 0 American Indian/Alaskan Native + HISPANIC 2 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 0 Asian and White 0 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 Multi Racial + HISPANIC OR other Multi Racial Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 30.0030.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed Department of Rehabilitation-Federal USD$ 15,799.00 USD$ 15,799.00 Alameda County Transportation Commission-State USD$ 50,773.00 USD$ 0.00 City of Livermore-Federal USD$ 14,275.00 USD$ 0.00 City of Dublin-City Funds USD$ 11,523.00 USD$ 0.00 City of Pleasanton-Federal USD$ 16,025.00 USD$ 0.00 5.1.o Packet Pg. 135 Attachment: 15. Community Resources for Independent Living - Housing and Independent Living Skills Application (HS Grant Program FY19 Hindu Temple-Foundation USD$ 1,000.00 USD$ 1,000.00 Total USD$ 109,395.00 USD$ 16,799.00 Funding Uses/Expenses Budget Amount Amount Committed ILC- Mobility Travel Trainer-Tri Valley-30% USD$ 32,806.00 USD$ 0.00 ILC- Tri Valley Coordinator-35% USD$ 38,429.00 USD$ 10,376.00 Executive Director-1% USD$ 1,084.00 USD$ 158.00 Finance Director-1% USD$ 920.00 USD$ 134.00 Salaries and Benefits USD$ 22,115.00 USD$ 3,127.00 Supplies- Program and office USD$ 1,645.00 USD$ 142.00 Printing and Postage USD$ 511.00 USD$ 75.00 Telephone USD$ 2,487.00 USD$ 340.00 Accouting and Audit USD$ 616.00 USD$ 89.00 Contacted Services USD$ 4,570.00 USD$ 520.00 Insurance USD$ 949.00 USD$ 138.00 Travel/ mileage USD$ 1,524.00 USD$ 505.00 Dues, Books and Publications USD$ 883.00 USD$ 128.00 Occupancy- Rent and Other USD$ 456.00 USD$ 67.00 Staff Development-Training USD$ 400.00 USD$ 0.00 Total USD$ 109,395.00 USD$ 15,799.00 Budget Narrative The overall operational budget for CRIL's full service Tri-Valley branch office is $109,395 which covers 2.0 FTE for direct service provision - ILC- Tri Valley Coordinator 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 $11,523 would cover 10,5% of the total project budget. The City of Dublin represents roughly 1% of the proposed overall agency budget for 2019-2020 Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget for ALL Grant Requests Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information Form for ALL Grant Requests List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ List of Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ Current Annual Budget for the Entire Agency Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ Copy of most recently submitted IRS 990 form Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ 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) ✔✔✔✔ Board of Director's (or governing body's) authorization to request funding Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Workers Compensation Liability Insurance STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. All organizations MUST have approved non-profit status from the State of ✔✔✔✔ STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER 5.1.o Packet Pg. 136 Attachment: 15. Community Resources for Independent Living - Housing and Independent Living Skills Application (HS Grant Program FY19 Application ID: 132087 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. California and Federal Tax Identification Number at time of application. Non-compliant applicants will be disqualified. Certified Audit and/or Certified Financial Statements 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 Personnel Policies Including Affirmative Action Plan and Grievance Procedure REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section Copy of Last Audit REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws Bylaws REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) Conflict of Interest Statement 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. AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP 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) 5.1.o Packet Pg. 137 Attachment: 15. Community Resources for Independent Living - Housing and Independent Living Skills Application (HS Grant Program FY19 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline Deaf Counseling Advocacy and Referral Agency (DCARA) Deaf Access Services Jump to: Questions Budget Documents USD$ 25,000.00 Requested Submitted: 1/13/2019 11:46:04 AM (Pacific) Project Contact DCARA Grants grants@dcara.org Tel: 510-343-6676 Additional Contacts debbybuchan@gmail.com Deaf Counseling Advocacy and Referral Agency (DCARA) 14895 East 14th Street Suite 200 San Leandro, CA 94578 United States Executive Director Raymond Rodgers raymond.rodgers@dcara.org Telephone(510) 343-6676 Fax (510) 483-2526 Web www.dcara.org Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). DCARA promotes and advocates for the rights of full access to American Sign Language, English, education, employment, and cultural identify of, by for, and with Deaf, DeafBlind, Hard of Hearing and Late-Deafened people. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding 5.1.p Packet Pg. 138 Attachment: 16. Deaf Counseling Advocacy and Referral Agency - Deaf Access Services Application (HS Grant Program FY19 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. DCARA has received funding from the City of Fremont for the past 23 years. Funding has been from the City of Fremont’s Human Services program: FY 16/17 for $15,000, FY 17/18 for $15,000 and FY18/19 for $15,450. Services have included Communication Assistance, Advocacy, Peer Counseling, Independent Living Skills training, Employment services, Information and Referral and Community Education, all focusing on access to basic social services through linkage to city and government services, educating both service providers and the Deaf and hard of hearing community of their rights and means of accessing services. State funding has included the Department of Social Services, Deaf Access Program for which DCARA has received funding since 1980 including: FY 16/17 for $1,135,887, FY17/18 for $1,135,887 and FY 18/19 for $1,869,501. Funding is to cover a 14 county area of northwestern California providing Deaf Access Services to Deaf and hard of hearing residents. Services include educating service providers on the most effective and efficient means of serving the Deaf and hard of hearing community and working with the Deaf and hard of hearing community to access services. DCARA has received funding to co-located DCARA staff in five designated EDD offices to provide access to employment services since 1986 including: FY 16/17, 17/18 and 18/19 for $558,135 each fiscal year. Through the Department of Rehabilitation DCARA has received funding for a new fee-for-service program, Job and Literacy Training. For the first year, start up, DCARA received $1,650 for FY 17/18. 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). DCARA is a community-based nonprofit agency, serving the greater Bay Area, providing social services to the Deaf and hard of hearing (D/HH) community since 1962. DCARA manages a $2.6 million budget providing over 26,000 services to more than 11,000 people annually. As a multi-service agency DCARA has a demonstrated track record for providing linkage and direct services to the D/HH community with wrap around services including employment services, academic and job readiness training programs, literacy and ASL classes, and Deaf mentoring for families with Deaf children, preventing clients from “falling between the cracks” in the maze of traditional services. DCARA has over 40 years of funding from state and local governments, foundations, fees for service and fund raising including submitting financial, statistical and narrative reports monthly, quarterly and annually. DCARA has a state of the art database system and IT staff to ensure secure client service information and reporting. Our accounting department is experienced and efficient in the budgetary, accounting and reporting aspects of funders. DCARA’s Board oversees annual financial audits conducted by outside auditors. The Board of Directors, all of whom are D/HH, represent the community and provide feedback and guidance on programs, services and community needs. They supervise the Executive Director who is also Deaf and who provides agency oversight and develops and maintains collaborative relationships with community organizations. DCARA has established policies and procedures to maintain the day-to-day operations of the agency and its services including: Bylaws, Articles of Incorporation, Employee Handbook, Operations Manual, Health & Safety Standards, Accessibility Policies, client satisfaction surveys and program evaluations. Monthly reports on programs are submitted to administration and the Board to monitor progress in meeting goals. 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. DCARA enables access to services for the Deaf and hard of hearing community in Dublin through linkage and direct services including communication services, peer counseling, advocacy, I&R and community education and training. 9. 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.) DCARA's goal is to serve 25 unduplicated residents of Dublin for the full requested amount of funding. 10. 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 Concern. gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing ✔✔✔✔ Health Care (including dental) gfedc Workforce Development ✔✔✔✔ Homelessness ✔✔✔✔ Transportation Services and Access 5.1.p Packet Pg. 139 Attachment: 16. Deaf Counseling Advocacy and Referral Agency - Deaf Access Services Application (HS Grant Program FY19 11. How will this project will be implemented, administered, and operated? DCARA currently is providing basic access services to Deaf and hard of hearing (D/HH) residents of Dublin, so there will be no start up time to implement services in FY 19/20. The goal is to improve and ensure overall access to services for D/HH residents, many of whom are not currently able to access needed services. DCARA proposes the following in FY 19/20: Provide more Deaf Awareness training to service providers to ensure the Deaf community has access to services; Initiate story telling in American Sign Language at local bookstore for families; Outreach to Kaiser, which will be expanding to Dublin area to ensure Deaf access to their services. DCARA will continue to administer the funding and program including supervision, invoicing and reporting from the HQ office. One-on-one services are provided in-person or via Video Phone in a Deaf-centered model of service delivery, acknowledging the client’s culture and language and include: Document Translation provides assistance comprehending and filling out forms; translation of written information into ASL or other communication modes used by the consumer. Counseling Assistance includes support for living with hearing loss and peer counseling situations. Independent Living Skills (ILS) training on housing, public transportation, telephone mentoring, self-advocacy and navigating the traditional services system. Advocacy Assistance includes both Individual and system advocacy to ensure accessibility of all public services, compliance with Americans with Disabilities Act, other non-discrimination laws and special education laws. Information and Referral provides local, state, and national information and resources related to the Deaf community, and information and referrals to community events and local resources. Community Education promotes public awareness through sensitivity trainings, exhibit booths, workshops and presentations for educating both our clientele and the general public. 12. Describe in detail how Dublin grant funds will be used for this project. (What specifically will the grant funds be used for?) The City of Dublin funds help us leverage funding from other public and private sources by emphasizing the support DCARA receives from local cities. We have found this to be advantageous, when applying for funding, to show support from a variety of sources such as the City of Dublin. DCARA services are an efficient use of the City of Dublin’s funding. If DCARA did not exist, and traditional agencies with hearing non-signing staff had to provide services directly to D/HH people, these agencies would have to contract with sign language interpreters in order to communicate with their D/HH clients. Traditional agencies would then have to pay $95 per hour or more (plus mileage) for each sign language interpreter in addition to the salary and fringe benefits of their non-signing staff. By funding DCARA, the City of Dublin’s funding serves more individuals than would be true for a non-Deaf organization. Funding will be used to pay for staff to work 1.5 days a week (30% time) with Dublin residents enabling legally required “access” to city and local services. Deaf access is an ongoing daily process, unlike building a ramp for wheelchair access, communication access requires addressing barriers faced in all manner of daily life. For example: A client with a traffic ticket was required to attend traffic school. New policy requires individuals to apply online for traffic school and to pay fines. The client was unable to follow the online process without assistance. Advocate contacted several traffic schools to arrange for interpreters but none would provide interpreters for communication access. Advocate then assisted client to take an online course. This required 6 two-hour sessions translating the English information into ASL. After many meetings the client passed the test and met the requirements of the court ordered traffic school. 13. 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)? For FY 19/20 the following outcome measures and objectives are: • Increase D/HH resident’s access to services in the community; • Increase D/HH resident’s knowledge of information on community resources and how to access them; and • Increase Dublin City service providers’ knowledge to improve services to the D/HH community. Strategies/Objectives for 19/20: Progress in meeting the outcomes will be measured by the number of services provided and the number of unduplicated clients served. DCARA tracks, by funders, services to individual clients through an online database which documents services ✔✔✔✔ Domestic Violence and Child Abuse ✔✔✔✔ Disabilities gfedc Food and Nutrition ✔✔✔✔ Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above ✔✔✔✔ Please explain: DCARA’s Deaf Access Project identifies with many of the Areas of Concern identified in the 2011 Needs Assessment Report. The Deaf and hard o 5.1.p Packet Pg. 140 Attachment: 16. Deaf Counseling Advocacy and Referral Agency - Deaf Access Services Application (HS Grant Program FY19 provided, goals identified by the client, and achievement of goals through provision of service. Community Education workshops are evaluated through feedback from participants on what they have learned, with the number of participants documented in the database. 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. An estimated 15% of the population, according to national statistics , are Deaf or hard of hearing (D/HH), which affects all races, ethnicities, and socio-economic classes. Individuals with severe hearing loss tend to require the most specialized services. Most of these individuals eventually learn and use American Sign Language and self-identify as a linguistic and cultural communnity. The major challenge facing the D/HH community is that of communication and language access. Approximately 95% of Deaf children are born Deaf or become Deaf before acquiring spoken language. Due to lack of early identification and exposure to a visual and accessible language, this segment of the community represents some of the highest levels of illiteracy, unemployment, and dependency on governmental assistance. This population is largely disenfranchised because they do not have access to basic information, education and services. Accessibility is a daily issue determining their quality of life and often their basic civil rights. DCARA serves the whole D/HH community including Deaf, DeafBlind, Deaf with disabilities, hard of hearing, and late- deafened. The majority of DCARA clients are low-income, receive government assistance and require assistance in accessing basic services and written materials. DCARA’s goal for FY 19/20 is to continue to provide Dublin D/HH residents access to community services and programs that enable them to live productive and independent lives. For many D/HH residents DCARA’s access services are the only means of benefiting from community services. Examples of DCARA’s assistance: D/HH Seniors have access to Senior Citizen Center; Deaf resident could have lost his job after 12 years; Deaf worker disabled at work would not have full access to attorney. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? DCARA is a strong advocate of communication and language access to bridge barriers and open up access to information and resources. We acknowledge and respect the Deaf community’s linguistic and cultural identity and align our services to compliment this philosophy. DCARA’s staff are open and accommodating to the client’s preference, and respectful of cultural identities, educational experiences and levels of comfort. Consumers are informed of their right of choice of language and accommodations. For Deaf individuals that includes American Sign Language and for many hard of hearing individuals it may include access to assistive listening devices. DCARA also works with foreign born Deaf individuals, many who not have developed ASL skills and may not know written English. To successfully work with these clients, DCARA’s staff will incorporate ASL with gestures, body language, printed pictures, role-playing and/or mime while communicating with clients. We offer special ASL classes for these clients in our San Leandro location. In 1978, DCARA, in collaboration with two other service agencies, received funding as a research and demonstration project from the Department of Social Services. The results of this historic research project demonstrated that the most efficient and effective service delivery model for the D/HH population was an "of, by and for the Deaf" philosophy of direct, one-on-one services provided by people skilled in the various modes of communication used by this population. This Deaf-centered model of service delivery continues to be used by DCARA to provide services and assess the needs of the community. DCARA’s staff and board represent the spectrum of the D/HH communities, with a majority D/HH. All staff members are fluent in American Sign Language (ASL) and experienced in communicating with individuals who rely on other accommodations used by D/HH people, which makes the agency environment fully accessible at all times to the target populatio 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? The majority of the consumers served by DCARA are low-income, limited English speakers, Deaf and hard of hearing. Staff are skilled in adapting to the client’s preferred means of communication and, when required, there is a budget to hire other spoken language interpreters when meeting with family members or translating flyers into a language other than English. DCARA utilizes multiple venues of outreach including social media, Facebook, DCARA website and email newsletters. Each office maintains a bulletin board announcing all DCARA events, community education workshops, and community events. DCARA also posts Vlogs, announcements in ASL, of community events, services and information. The Vlogs are posted on social media along with captions, written transcript, and image descriptions. DCARA’s staff are available to do document translation in real time ASL to optimize the client’s comprehension. Each venue as described offers accessibility to all individuals based on their preferred choice of access. All Community Education events provide full communication access and language access by arranging for professional American Sign Language interpreters, certified Deaf Interpreters, DeafBlind interpreters, Support Service Professionals for DeafBlind clients, Oral/Speech reading interpreters, real time captioning services, and written English documents as may be requested. Contact will be made with local agencies and service providers, including audiologists, senior centers, libraries, disability service agencies and service providers, to let them know of our services available to Dublin City residents. 5.1.p Packet Pg. 141 Attachment: 16. Deaf Counseling Advocacy and Referral Agency - Deaf Access Services Application (HS Grant Program FY19 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. DCARA works closely with the Bay Area Coalition of Deaf Seniors, National Deaf Seniors, Fremont Oak Gardens, Carlton Plaza (both Fremont and San Leandro facilities), Deaf Community Counseling Services, Family and Children Services, California School for the Deaf, Fremont, and Center for Independent Living Centers. We collaborate with many service organizations to enable Deaf and hard of hearing individuals access to their services, this often includes sensitivity training on how to ensure access that is linguistically and culturally sensitive. We also offer our services to agencies that are serving Deaf or hard of hearing clients so that those clients may learn of the resources and assistance that DCARA’s services can provide. For example, seniors who may be losing their hearing as they age may not be aware of the assistive devices or coping strategies that DCARA is able to share with them that will enable them to live more full and independent lives. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. DCARA advertises its programs, services and community education workshops and trainings through its social media and network of community providers including California School for the Deaf in Fremont, Ohlone College, and a range of Deaf community groups. DCARA’s goal is to make its outreach and advertising visual and Deaf-friendly by using Vlogs on social media to advertise our services and announce funding from the City of Dublin. DCARA’s Advocates also provide outreach with each of their clients connecting them with opportunities to receive additional information and resources that may be relevant to their needs. DCARA has contacted local audiologists to inform them of DCARA’s services, however we have not received any responses. This will be followed up on during FY 19/20. For FY 19/20 we want to expand our outreach to include other agencies and groups that may have contact with this population including audiologists, senior centers, nursing homes, schools and social service agencies. We look forward to collaborating with other service providers to both educate them on how to improve access to their services for our community and to expand our knowledge of resources in the area. We understand that Kaiser Permanente will be adding new facilities in the Dublin area so we plan to make contact with them to advocate for Deaf-friendly access as well as partnering on basic health information made available to the D/HH community. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. DCARA’s request for funding for a part-time staff position to serve Dublin D/HH residents is a cost effective way of ensuring access for the city’s D/HH residents. Existing social service organizations, often facing limited funding, rarely have a line item in their budget specifically geared towards access accommodations for the D/HH community. While they may initially accept such clients and provide interpreters for client appointments, as mandated by the Americans with Disabilities Act, these service organizations quickly realize the expense related to accommodation requirements. Without DCARA’s ability to provide linkage services these clients may go without the services they need. DCARA services are an efficient and cost effective use of funding that provides accommodation on a 1:1 basis, avoiding a third party payment. DCARA eliminates the need to deny services by being readily available to address barriers and provide access to information and services. DCARA employs staff who are fluent in American Sign Language and competent in the provision of a wide range of social services. Further, DCARA’s staff have years of experience in working with other service organizations thus encouraging a collaborative relationship between the organizations. By DCARA administering this program from its San Leandro HQ office, we are saving on overhead, staffing and supervision costs. DCARA’s goal is to keep the project as cost-effective as possible. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? DCARA’s services are focused on optimizing services within the community for the D/HH population. Without funding from the City of Dublin, services to Dublin residents will be greatly restricted due to limited resources and that many D/HH residents who are low income are not able to travel to DCARA’s HQ office in San Leandro to receive services. As identified in the Eastern Alameda County 2011 Human Services Needs Assessment Findings Report, “public transportation limitations present a significant barrier to residents seeking human services.” By funding the DCARA Access Services Project more residents will be able to access services needed by addressing the barriers to services and information. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? ✔✔✔✔ No gfedc Yes: If yes, please explain: gfedc Yes 5.1.p Packet Pg. 142 Attachment: 16. Deaf Counseling Advocacy and Referral Agency - Deaf Access Services Application (HS Grant Program FY19 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 25. 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. 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process By providing “access” to community services DCARA supports a high quality of life ensuring a safe and secure environment for D/HH residents. An example is a client with a traffic ticket was required to attend traffic school, but none would provide an interpreter. DCARA assisted client to take an online course requiring 6 two-hour sessions translating the English information into ASL. After many meetings the client passed the test and met the requirements of the court ordered traffic school. 28. ** QUESTIONS 29 THROUGH 41 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? 29. 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 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. ✔✔✔✔ Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. ✔✔✔✔ Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc Yes. If so, check box here and answer questions 29 through 41. ✔✔✔✔ No. If no, check box here and enter gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. 5.1.p Packet Pg. 143 Attachment: 16. Deaf Counseling Advocacy and Referral Agency - Deaf Access Services Application (HS Grant Program FY19 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: 35. 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?") gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *Promote fair housing and reduce housing discrimination. gfedc 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: gfedc * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. gfedc * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. gfedc C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. gfedc D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. gfedc 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. gfedc Increase homeownership gfedc Promote decent affordable housing gfedc Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. gfedc Improving the quality of life for our Nation's communities gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc Reduce housing discrimination. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. 5.1.p Packet Pg. 144 Attachment: 16. Deaf Counseling Advocacy and Referral Agency - Deaf Access Services Application (HS Grant Program FY19 36. 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?") 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. 5.1.p Packet Pg. 145 Attachment: 16. Deaf Counseling Advocacy and Referral Agency - Deaf Access Services Application (HS Grant Program FY19 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 39. 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". 40. 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 41. 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" ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. Disabled Women/Female Headed Households Seniors Youth Homeless 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL Low Income (50%-80% AMI) Extremely Low Income (<30% AMI) 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL 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 5.1.p Packet Pg. 146 Attachment: 16. Deaf Counseling Advocacy and Referral Agency - Deaf Access Services Application (HS Grant Program FY19 42. 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 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). DCARA has continued its pursuit to increase the organization’s financial self-sufficiency. We have added two fee-for-service programs to expand services as well as develop new sources of revenue: DCARA Interpreting Services was initiated in March of 2017 to provide communication access to our clients and community as well as with the goal of generating new income to help cover overhead costs; the Job and Literacy Training Program (JLTP) is also a new program to expand employment readiness services as well as establish a new funding stream through the Department of Rehabilitation. The JLTP was vendorized and began taking referrals from DOR in January 2018. We have also purchased a food truck to be part of the employment program for training and work experience as well as developing new fundraising opportunities for the agency. Our Deaf Community Center has expanded its rental program to earn revenue to cover overhead expenses also. 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. #BL-110837 Multi Racial + HISPANIC OR other Multi Racial 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed City of Dublin USD$ 25,000.00 California Department of Social Services, Office of Deaf Access43 USD$ 43,884.00 USD$ 43,884.00 Total USD$ 68,884.00 USD$ 43,884.00 Funding Uses/Expenses Budget Amount Amount Committed Salaries USD$ 36,609.00 USD$ 18,910.00 Benefits USD$ 9,540.00 USD$ 5,114.00 Supplies USD$ 710.00 USD$ 610.00 Printing/Copying USD$ 750.00 USD$ 750.00 Postage USD$ 100.00 USD$ 100.00 Telephone USD$ 1,500.00 USD$ 1,500.00 Rent and Utilities USD$ 6,900.00 USD$ 6,900.00 Accounting/Audit USD$ 10,700.00 USD$ 10,000.00 ASL Interpreters USD$ 2,075.00 USD$ 0.00 Total USD$ 68,884.00 USD$ 43,884.00 Budget Narrative Funds will be used as leverage to support funding from California Office of Deaf Access. Salaries: Advocate (30%), Deputy Director (10%), Program Developer (5%), and Finance Director (5%) Benefits: 10.04% based on current cost for FICA & Medicare (7.65%) + Workers comp (1.05%) + Unemployment (1.34%), and Insurance for employees. Premium varies based on employees’ age. These figures are average costs for current staff. 5.1.p Packet Pg. 147 Attachment: 16. Deaf Counseling Advocacy and Referral Agency - Deaf Access Services Application (HS Grant Program FY19 Supplies: Office supplies such as paper, forms, copy machine supplies, program supplies, folders, pens, pencils for offices. Also includes operating supplies for trainings, workshops and events. Printing/Copying: Printing and photocopying for program. Includes printing agency brochures, stationary, envelopes, business cards, general agency and special interest newsletters, flyers about services offered and upcoming events, etc. and handouts used in trainings and workshops. Postage: Postage costs for newsletters, flyers, business mailing, etc. Also overnight shipping costs for items that are sent via Express Mail. Telephone/Internet: Phone lines include fax lines, and DSL & Internet & VP Rent/Utilities: Office, meeting and workshop space required to provide services. Accounting/Audit: Auditing and preparation of 990 IRS form services by CPA Firm and Payroll Services - by TraxPayroll Other: Interpreters/CART: ASL interpreters and CART to facilitate communication at community events, meetings, etc. We will use both interpreting and real captions services, as well as individual interpreters and CART. Cost of Interpreters ranges from $95 - $150 hour and for CART from $100 - $155 per hour. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ Organization Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ IRS 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Board Resolution Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Board Resolution Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Insurance 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. ✔✔✔✔ Non Profit Status 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. 5.1.p Packet Pg. 148 Attachment: 16. Deaf Counseling Advocacy and Referral Agency - Deaf Access Services Application (HS Grant Program FY19 Application ID: 132726 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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) 5.1.p Packet Pg. 149 Attachment: 16. Deaf Counseling Advocacy and Referral Agency - Deaf Access Services Application (HS Grant Program FY19 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline Dublin High School PFSO Every 15 Minutes Program Jump to: Questions Budget Documents USD$ 10,000.00 Requested Submitted: 1/7/2019 4:03:22 PM (Pacific) Project Contact Rochelle Gilmour DHSE15@gmail.com Tel: 8473408354 Additional Contacts rochellegilmour@gmail.com,andyjenmay@comcast.net Dublin High School PFSO 8151 Village PKWY Dublin, CA 94568 United States President Teretha Allaway president@dhspfso.com Telephone925-833-3300 Fax Web www.dhspfso.com Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Supporting the students and faculty at Dublin High School 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project ✔✔✔✔ Yes gfedc No ✔✔✔✔ One-time funding gfedc Seed funding gfedc One-time and Seed funding gfedc Operational funding 5.1.q Packet Pg. 150 Attachment: 17. Dublin High School PFSO - Every 15 Minutes Program Application (HS Grant Program FY19 Recommendations) 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. No funds received in the past 3 years. This program runs every 4 years and was last funded by the City of Dublin through the 2015-2016 Community Grants program. 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). The Every 15 Minutes project is staged every 3 years as a collaboration between Dublin High School and Valley High School to serve the needs of all 10th-12th graders in our city. We have a proven track record of successfully presenting this program. We have an extensive volunteer network, committee chairpersons in place, and very detailed notes from the prior three stagings of this event on which to draw. The chairpersons from the last event (held in the spring of 2016) not only turned over binders filled with every detail of a very successful program, complete with contact names and information, minute-to-minute timelines, and detailed expense reports, but they have indicated that they remain available to consult with this year's chairpersons to ensure that the program is a success. 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. "Every 15 Minutes" is a dramatic enactment of a fatal car accident and it's aftermath, designed to instill in teen drivers the consequences of driving under the influence. It also covers distracted driving and offers tools for making better choices. 9. 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.) "Every 15 Minutes" will be presented to approximately 2600 10th-12th grade students (2480 from Dublin high School; 120 from Valley High School) and up to 100 other community members. 10. 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 Concern. 11. How will this project will be implemented, administered, and operated? A committee of volunteers, led by 4 co-chairs, will coordinate all aspects of this very intensive 2-day program. On Day 1, before students come to school, two wrecked cars are brought to the campus and staged as if they had been in a collision. Bleachers are rented and brought in to provide seating in a semi-circle around the cars. Student actors are made-up to look as if they have been in an accident. One student is designated as a drunk driver; two are designated as DOA; 5 others are designated as injured. These students are placed in the vehicles shortly before the main student body is released from class to sit on the bleachers. The enactment consists of 911 tapes being played, police and fire responding to the scene, the drunk driver being "arrested" and taken to jail, injured students being taken away by ambulance, and the DOA being taken out in the coroners van. The student body is informed that the students have died. Video is taken at the hospital, the morgue, parent notifications, the jail, etc. The second day, there is an assembly (formatted to look like a funeral, complete with coffin), where the video is played for the student body. Guest speakers are brought in to describe the impact that drunk/distracted driving has had on their lives. Grief gfedc None ✔✔✔✔ Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services ✔✔✔✔ Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above gfedc Please explain: 5.1.q Packet Pg. 151 Attachment: 17. Dublin High School PFSO - Every 15 Minutes Program Application (HS Grant Program FY19 Recommendations) counselors are made available to the students during these two days. In addition, there is an intensive retreat for the students who are "actors" in the cars, as well as students who are pulled out of class on Day 1 as "walking dead" to serve as a reminder to the general student body that drunk/distracted driving can affect any of them. The committee is responsible for coordinating with the Dublin PD, Fire Department, CHP, hospitals, jail officials, bleacher rental company, videographer, florist etc. to ensure that all pieces are in place. This is a proven program, developed by the California Highway Patrol, with supporting materials to ensure success. 12. Describe in detail how Dublin grant funds will be used for this project. (What specifically will the grant funds be used for?) This is a very expensive project. The City Grant funds may be used for: -Bleacher rentals (our largest expense, with a student body this size). -Professional Videographer Services, the second most expensive, and one of the most important pieces of this project. Every stage of the program is videotaped: the staged "party" where the students get "drunk" before driving, the accident scene, the hospital scene, the parental death notifications, the "drunk" student's booking and arraignment, etc. The entire video is professionally edited and then shown to the entire student body. -Audio/Visual equipment to provide the sounds and effects for the crash scene, as well as the sound and projection system for the "funeral" assembly. -Hotel fees for the retreat for student participants (approximately 25 students and their chaperones). -Luncheon for volunteers, students, and their parents -Mock-tombstone supplies for the "walking dead" and those students designated as "DOA" in the accident. -Supplies for the retreat. -Printing costs. 13. 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)? 1. Reduce traffic accidents caused by teen drivers under the influence. If even one accident is prevented, this program will be a success. 2. Reduce the number of teens texting while driving, thus leading to fewer accidents by distracted teen drivers. If even one accident is prevented, this program will be a success. 3. Raise awareness of drunk/distracted driving among teens, and empower them to make better choices and to speak up when they see their peers about to make a poor choice. If even one student feels emboldened to take an impaired student's keys or ask a friend to put away the phone while driving, the program will have been a success. It is hard for us to give specific strategies that we can use to measure the success of the program, but we know programs such as these work. We do know historically that students continue to discuss and implement the strategies they learn for years after the program. According to the CHP's website, "The [Every 15 Minutes] program’s name was derived from the fact that in the early 1990’s, every fifteen minutes someone in the United States died in an alcohol-related traffic collision. However, with the implementation of new laws, grass roots programs like Mother’s Against Drunk Drivers (MADD), Students Against Destructive Decisions SADD, Friday Night Live (FNL) and programs such as [Every 15 Minutes], the death rate is now every thirty minutes, a figure which continues to be unacceptable." 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. This program will benefit every single high school student (10-12th) in Dublin, as Dublin High School coordinates with Valley High School on this program. Because this program is so expensive, we only run Every 15 Minutes every 3 years, thereby ensuring that each student sees it one time in their high school career. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? The entire program has been designed by the CHP to be most impactful to teens. The actors are students from the 2 high schools, chosen by the administration to ensure all social groups are equally impacted by the program, and the audience can relate to the situation they find themselves in. Because we use students, local PD, local fire department, take the "injured" students to the local hospital, etc., we are making the enactment as realistic as possible. Further, the speakers that come to the assembly on the second day are local, as opposed to those from the national speaking circuit, and they are very good at connecting with the students. We have found in the past that this program is extremely impactful to our local teens, and find that they still talk about their experiences with it many years later. 5.1.q Packet Pg. 152 Attachment: 17. Dublin High School PFSO - Every 15 Minutes Program Application (HS Grant Program FY19 Recommendations) This population (high school students) are within a year or so of getting their driver's licenses or already have it, and therefore the information that is presented is extremely timely. Teens may think they are invincible, but when they see a video of a coroner informing the mother of one of their classmates that the classmate died in a drunk driving accident, they don't soon forget it. Likewise, they get to see a video of the "drunk driver" being booked into Santa Rita Jail and having an initial appearance before a judge. These things leave a lasting impression on even the most cynical of teens. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? All high school students participate in this program. The students that are designated as the "walking dead" are chosen by the administration to come from all demographic groups at the high school, thereby ensuring that as many students as possible know someone who has been removed from class and designated as "deceased." Further, all students, regardless of income level, language spoken at home, or disability level, come to the accident scene. Even those students who are English Language Learners, while they may not understand all the words that are said on the 911 recording over the loud speaker, understand what they are seeing when the police department and the ambulances take their classmates away from the crash scene. This program truly reaches all students at both of our high schools 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. We partner with: Dublin PD - to provide officers to assist with the crash enactment and to "arrest" our DUI suspect Dublin Fire Department - to assist with the crash enactment and to use the "jaws of life" to extract students from the car and transport students from the crash scene to the ambulance CHP - to provide the medivac helicopter to evacuate the most seriously wounded student Local hospitals - to receive the wounded students and allow us to film their "treatment" and the notification of their parents Alameda Sheriff's Department and Santa Rita Jail - to "book" our DUI suspect Alameda County Courthouse - to "arraign" our DUI suspect 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. The public is welcomed to attend this event. While we do try to keep the details, and the date, a secret from the kids as much as possible to preserve the impact of the program, we do put out a press release prior to the event inviting the public to come to the crash enactment and the subsequent assembly. We find (regretably in the global context, fortunately for this event) that most students don't read the paper, and so putting out a press release doesn't tend to lessen the impact or the surprise for our students too much. Because the program is run during the school day and students are excused from classes, we have a built-in strategy for ensuring participation. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. This is an expensive program. It requires the coordination of multiple municipal agencies, vendors, and volunteers. For this reason, we only run the program every 3 years, thereby ensuring that each high school student in Dublin has the opportunity to benefit from the program, but not become numb to it. By directly serving 2500+ residents, and indirectly serving the entire City of Dublin, the value of the program is immeasurable. We anticipate that the total cost of the program will be approximately $35,000. In 2008@$22,000; in 2012@$25,000, 2016@$29,000 With the population growth at our high schools, and inflation, we believe the cost will be closer to $35,000 for 2020. However, because the program is only run every 3 years, and has the potential to save untold thousands of dollars in emergency response fees, medical fees, and lives, we believe that the benefits far outweigh the costs. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? If the City of Dublin is unable to fund this project, or is unable to fund the entire requested $10,000, we will still proceed with the project. We are requesting approximately $20,000 from the CHP to provide the bulk of our funding, and we will be attempting to make up the difference with outside donations. If the City of Dublin is unable to help, or doesn't fully fund our request, we will hold fundraisers, look to corporate sponsors, do everything in our power to ensure that this program goes 5.1.q Packet Pg. 153 Attachment: 17. Dublin High School PFSO - Every 15 Minutes Program Application (HS Grant Program FY19 Recommendations) forward. There are a limited number of corporate sponsors in Dublin, and many already donate heavily to the schools, but we will do our best to secure the funding outside of the grant process. Unfortunately, if the city is not able to fully fund our request, while the program will still go forward, it will likely have to be scaled back, thereby blunting the impact for our students. For example, one of the most powerful aspects of the program is the retreat for the "walking dead" and the crash participants. If we don't receive city funding, we will have to find another way to quarantine those students (who have no contact with the outside world, because of course they are "dead," from the time of the crash enactment until the assembly on the second day). Other cost cutting measures would have to be explored, but since much of the services for this program are already donated, we would be hard pressed to cut enough corners to make up the difference. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 25. 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. 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process In alignment with the city's vision the Every 15 minute program reaches 2500 students of Dublin as well as their immediate families. By reaching these community members and educating them on the dangers of drinking and driving, we can help with the city's mission of providing a safe environment for its residents to live in. By promoting the program, we are aligning ourselves with the city's efforts to better connect and inform residents of public safety matters. 28. ** QUESTIONS 29 THROUGH 41 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? ✔✔✔✔ No gfedc Yes: If yes, please explain: gfedc Yes ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 5.1.q Packet Pg. 154 Attachment: 17. Dublin High School PFSO - Every 15 Minutes Program Application (HS Grant Program FY19 Recommendations) 29. 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 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: gfedc Yes. If so, check box here and answer questions 29 through 41. ✔✔✔✔ No. If no, check box here and enter gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *Promote fair housing and reduce housing discrimination. gfedc 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: gfedc * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. gfedc * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. gfedc C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. gfedc D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. gfedc 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. gfedc Increase homeownership gfedc Promote decent affordable housing gfedc Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. gfedc Improving the quality of life for our Nation's communities gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. 5.1.q Packet Pg. 155 Attachment: 17. Dublin High School PFSO - Every 15 Minutes Program Application (HS Grant Program FY19 Recommendations) 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: 35. 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?") 36. 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?") 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc Reduce housing discrimination. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. 5.1.q Packet Pg. 156 Attachment: 17. Dublin High School PFSO - Every 15 Minutes Program Application (HS Grant Program FY19 Recommendations) 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 39. 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". 40. 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 41. 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" gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. Disabled Women/Female Headed Households Seniors Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL 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) 0.000.00 TOTAL White White + HISPANIC Black/African American Black/African American + HISPANIC 5.1.q Packet Pg. 157 Attachment: 17. Dublin High School PFSO - Every 15 Minutes Program Application (HS Grant Program FY19 Recommendations) 42. 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 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). We constantly hold fundraisers (dining outs, product sales), an annual gala/auction, and donation drives. 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. BL105768 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) 0.000.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed CHP Grants Dublin High School USD$ 9,999.99 CHP Grants Valley High School USD$ 9,999.99 Donations from local businesses and individuals USD$ 2,000.00 City of Dublin community grant USD$ 10,000.00 Dublin Rotary Club USD$ 1,500.00 Dublin Partners in Education USD$ 1,500.00 Total USD$ 34,999.98 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Videographer (throughout project) USD$ 5,200.00 Bleacher Rentals USD$ 19,000.00 Audio / Video services (crash day and assembly) USD$ 2,500.00 5.1.q Packet Pg. 158 Attachment: 17. Dublin High School PFSO - Every 15 Minutes Program Application (HS Grant Program FY19 Recommendations) DVD copies USD$ 100.00 Hotel for student retreat USD$ 3,000.00 Printing brochures USD$ 1,200.00 supplies USD$ 500.00 postage USD$ 80.00 flowers for funeral USD$ 120.00 chair rental for funeral USD$ 540.00 food USD$ 600.00 makeup (crash victims, and 'walking dead') USD$ 1,000.00 towing fees USD$ 320.00 forklift USD$ 1,000.00 Total USD$ 35,160.00 USD$ 0.00 Budget Narrative The Every 15 Minutes program, while administered by the Dublin High School PFSO, is completely dependent on outside funding sources. Because it is only run every 3 years, it is not part of either the DHS or Valley High School PFSO budgets. To that end, we rely on outside fundraising to run the program. The CHP has grants specifically for this program that we anticipate receiving for both Dublin High and Valley that will make up the bulk of the funding. The remaining funding will come from the City of Dublin Grant, hopefully, with supplemental money coming from individual donations from local service organizations, corporations, and citizens. Our expenses include the following: Videographer - this is the key to the entire program. Every piece is professionally taped and edited, from the staged party where the students get "drunk" and get behind the wheel, to the hospital emergency room, to the parental death notifications, to the jail, and everything in between. It is all edited into a final video that is shown at the "funeral" assembly. Bleachers - The largest expense, but critical for putting 2500 students up close and personal to the crash site. A/V Services - Sound systems and effects during the simulated crash and during the "funeral" assembly. DVD - copies of the finished video. Hotel Retreat - For the 25 student participants and their chaperones. Printing - Programs, shirts, tombstones, obituaries, press releases, etc. Supplies - For the retreat and 2 luncheons. Flowers - To enhance the "funeral" assembly. Postage - For invitations, contracts, thank you notes, and such. Chair rental - for adults and staff at the "Funeral" assembly. The students sit in the bleachers inside the school gym. Food - For the two lunches - one for the student participants on day 1, one for a wide variety of participants on day 2. Make-up - to make the students look sufficiently injured or dead. Towing fees - to get the wrecked cars on and off campus. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ e15min program expense budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ e15min financial information form List of Board of Directors (or governing body) with ✔✔✔✔ Board of directors 5.1.q Packet Pg. 159 Attachment: 17. Dublin High School PFSO - Every 15 Minutes Program Application (HS Grant Program FY19 Recommendations) Application ID: 132460 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. agency contact information Current Annual Budget for the Entire Agency ✔✔✔✔ e15min pfso budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ e15min IRS 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ e15min designation of official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ e15min request funding Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ insurance 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. ✔✔✔✔ federal non profit e15min state tax letter 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 Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) impact statement Ryan Josey impact statement Seth Schwindt impact statement Jenny Dyer 5.1.q Packet Pg. 160 Attachment: 17. Dublin High School PFSO - Every 15 Minutes Program Application (HS Grant Program FY19 Recommendations) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline Easter Seals Bay Area Kaleidoscope Community Adult Program Jump to: Questions Budget Documents USD$ 15,000.00 Requested Submitted: 1/14/2019 7:09:32 PM (Pacific) Project Contact Abigail Guerdat zlupton@esba.org Tel: 925-266-8670 Additional Contacts none entered Easter Seals Bay Area 2730 Shadelands Drive Building 10 Walnut Creek, CA 94598 United States Associate Director of Marketing & Communications Abigail Guerdat abigail.guerdat@esba.org Telephone(925)849-8999 Fax (925)849-8966 Web www.eastersealsbayarea.org Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Providing services to people with disabilities to help them live, learn, work and play to their full potential. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No ✔✔✔✔ One-time funding gfedc Seed funding gfedc One-time and Seed funding gfedc Operational funding 5.1.r Packet Pg. 161 Attachment: 18. Easter Seals Bay Area - Kaleidoscope Community Adult Program Application (HS Grant Program FY19 Recommendations) 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. Funding from the Cities of Livermore and Pleasanton have been received in support of this project, the Kaleidoscope Community Adult Program, since FY2018/19. Funding awards from both governments has totaled $15,635. 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). The Kaleidoscope Community Adult Program (KCAP) is a subsidiary of Easterseals Bay Area, which has a governing Board of Directors, executive leadership, experienced Finance staff, clinical leadership and practitioners; a team of experienced direct care providers, a program manager and a program director oversee KCAP to ensure best practices. 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. KCAP provides community-based daytime care for adults with developmental disabilities with a focus on independence, workforce development and social integration, while providing meaningful employment to Tri-Valley residents working in behavioral health. 9. 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.) 5 10. 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 Concern. 11. How will this project will be implemented, administered, and operated? The KCAP program will continue to be implemented, administered and operated by Easterseals Bay Area as a subsidiary. The program is open 5 days per week, with 5 hours per day spent out in the community. Working with various community partners (i.e. local businesses and volunteer opportunities for job training, fitness trainers and sports facilities for health, celebrations with similar adult day programs, etc.) has allowed the program to flourish in diversity of activities, and provides participants with new skills to help them further their independence. 12. Describe in detail how Dublin grant funds will be used for this project. (What specifically will the grant funds be used for?) Grant funding from the City of Dublin would exclusively support the salary supplementation of the Life Skills Coaches (6). These Coaches are Tri-Valley residents, and many of them have worked in the behavioral health field for over a decade. Working with adults with diagnoses of autism spectrum disorder, Down syndrome or other developmental disabilities is very rewarding; it is also challenging and a true labor of love for our Coaches. As Tri-Valley residents and loyal providers of direct care to people and families with disabilities, we feel it is imperative to ensure they receive financial support for the work they do and the care they provide in the community. We have been fortunate to have community partners donate in support of programming materials and equipment, which allows us the ability to support the salaries of those providing the direct services within the program. gfedc None ✔✔✔✔ Behavioral Health (mental health and substance abuse) gfedc Affordable Housing ✔✔✔✔ Health Care (including dental) ✔✔✔✔ Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse ✔✔✔✔ Disabilities gfedc Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above gfedc Please explain: 5.1.r Packet Pg. 162 Attachment: 18. Easter Seals Bay Area - Kaleidoscope Community Adult Program Application (HS Grant Program FY19 Recommendations) Supporting these staff costs is critical as KCAP continues to grow as one of the strongest adult day programs in Alameda County. Regional Center of the East Bay continues to refer individuals, with several participants having transitioned from other existing programs in the community. Under the guidance of the Life Skills Coaches, the participants learn life skills (cooking, cleaning, placing/taking food orders, counting money, etc.), self-care skills (hygiene, oral care, etc.), leisure skills (recreational trips to the movies, bowling, lunch with friends, etc.), pre-vocational skills (job searching, volunteering, interview preparation, etc.), and transportation skills. This mentorship stays with the participants throughout their lives, ensuring that they can be healthy, active members of the workforce and community, and reach their full potential. 13. 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)? The Life Skills Coaches at KCAP will continue to work closely with parents and caregivers to ensure that the goals and interests listed in each participant’s in-take binder are met. Such goals and interests include various activities, such as volunteerism, art, grocery shopping, office exposure/etiquette, cooking, sports and exercise, customer service, money counting and more. Through repetition and practice, many of our participants end up meeting these goals and even exceed them. Occasionally, participants, parents and caregivers may have other goals not listed on the intake binder, which are taken into account and addressed via programming. When these goals and interests are shared with the KCAP staff, the Life Skills Coaches diligently integrate them into the monthly calendars of activities, and provide a stigma-free learning environment in which the participants can succeed. 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. The population that will be served ultimately is the participant population, consisting of adults 18 and up with developmental disabilities, via care provided by Life Skills Coaches supported by City of Dublin funds. These funds would provide our Life Skills Coaches with salary supplementation to ensure that they can continue living and supporting their own families in the Tri- Valley while providing the highest quality direct care to make the most impact on the lives of our participants. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? The Kaleidoscope Community Adult Program (KCAP) serves individuals with developmental disabilities and special needs starting at age 18 through end of life by exposing participants to familiar and new goals and interests that will enhance their independence and overall quality of life. Such goals include working on interest-based or vocational tasks, social skills, and life skills training, while still maintaining an appropriate level of peer interaction. For aging adults with developmental disabilities and special needs, being prepared to transition into a group home setting, gain employment, develop secure social support systems, and become productive members of their communities is critical to reducing isolation, depression and poverty. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? KCAP works directly with the disabled population. As a vendor of the Regional Center of the East Bay, KCAP receives referrals for families who are low-income or limited English speakers whose children or wards are members of the developmentally disabled population. KCAP is committed to serving low-income families, limited English speaking families, single-parent households, as well as families with a disabled head of household. 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Easterseals Bay Area and KCAP are continuously working on building and enhancing relationships with other organizations to assist our participants in transitioning to group homes, training for and placement in promising careers, and in receiving exposure to new interests. KCAP has had participants volunteer at local animal shelters and gardens, and recently worked with Region 68 of CVS (Dublin) to host a fundraiser which provided the participants with customer service and money handling experience. Promising pursuits for community partnerships and integration in 2019 include Puzzle Piece Athletics, Sunflower Hill, and a continued co-hosted social skills program with the Enjoy Life More adult day program in Livermore. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. Easterseals Bay Area has had a constant presence of promotion and outreach for the program since before its opening in August 2018. A fundraiser was held in October 2018 to celebrate the program’s successful opening, and had a reporter from the Dublin patch, as well as Dublin Vice Mayor Melissa Hernandez in attendance. A short documentary-style video that highlights KCAP’s program and participants was also produced and has been shared on social media and viewed over 1,600 times. Our participants and their accomplishments are also occasionally featured on Easterseals Bay Area’s social media platforms, in direct mail marketing pieces, and on the Easterseals Bay Area website to showcase their skills and development. Attendance at various resource fairs and local Autism Speaks walks is used to promote KCAP, and a webpage devoted to the program serves as informational outreach for the public. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. KCAP's design allows us to offer cost-effective, comprehensive services for adults with developmental disabilities without 5.1.r Packet Pg. 163 Attachment: 18. Easter Seals Bay Area - Kaleidoscope Community Adult Program Application (HS Grant Program FY19 Recommendations) sacrificing quality. By offering the program as a programmatic component of Easterseals Bay Area (ESBA), we are able to share expenses and resources based on a pro-rated share between programs. The majority of the program occurs within the community so that participants are given the opportunity to apply the functional skills they obtain in a real-world setting while simultaneously building the relationships needed for independent living in their home: the Tri-Valley. Necessary and standard operating expenses for the project include rent, utilities, and phone lines; supplies include materials to be distributed to partnering community-based organizations on persons with disabilities and inclusionary practices, as well as training materials that are used for providing direct services to participants. Activity fees represent costs like eating in the community and admittance to community recreation programs. Direct service salaries for the Life Skills Coaches represent the entire cost of the project. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? If the City of Dublin is unable to provide funding, or provides reduced funding, we will seek contributions from other organizations and ESBA-hosted fundraisers and campaigns to cover program/supply costs in order to restrict a portion of the budget to salaries. However, the support from the City of Dublin would go far in helping us provide the level of quality programming our participants and their families need, and would also demonstrate local community support for Tri-Valley residents working in the behavioral health field. Easterseals Bay Area is very thankful for being able to leverage City Grant funding from the City of Dublin to raise additional awareness and support, and to cultivate life-long champions of KCAP since the transition from the after-school program. We would not be as successful as we are without the help of the Dublin community. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 25. 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. 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its ✔✔✔✔ No gfedc Yes: If yes, please explain: gfedc Yes ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. ✔✔✔✔ Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. ✔✔✔✔ Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 5.1.r Packet Pg. 164 Attachment: 18. Easter Seals Bay Area - Kaleidoscope Community Adult Program Application (HS Grant Program FY19 Recommendations) vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process KCAP serves Dublin residents with innovation by giving participants the chance to explore their interests via a low-to-high rating system at intake. Also, by teaming up with local businesses to give participants exposure to facets of various careers, we are simultaneously exposing the public at large to the talents of our participants and their innate desire for meaningful social interactions. With every activity and encounter in Dublin, we are building a more educated and inclusive community. 28. ** QUESTIONS 29 THROUGH 41 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? 29. 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 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: gfedc Yes. If so, check box here and answer questions 29 through 41. ✔✔✔✔ No. If no, check box here and enter gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *Promote fair housing and reduce housing discrimination. gfedc 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: gfedc * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. gfedc * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. gfedc C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. gfedc D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. gfedc 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. gfedc Increase homeownership gfedc Promote decent affordable housing gfedc Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations 5.1.r Packet Pg. 165 Attachment: 18. Easter Seals Bay Area - Kaleidoscope Community Adult Program Application (HS Grant Program FY19 Recommendations) 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: 35. 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?") 36. 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?") 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. gfedc Improving the quality of life for our Nation's communities gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc Reduce housing discrimination. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number 5.1.r Packet Pg. 166 Attachment: 18. Easter Seals Bay Area - Kaleidoscope Community Adult Program Application (HS Grant Program FY19 Recommendations) 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 39. 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". 40. 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 of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV/AIDS. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. Disabled Women/Female Headed Households Seniors Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL 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) 5.1.r Packet Pg. 167 Attachment: 18. Easter Seals Bay Area - Kaleidoscope Community Adult Program Application (HS Grant Program FY19 Recommendations) 41. 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" 42. 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 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). Easterseals Bay Area's Kaleidoscope Community Adult Program is a non-profit program that relies on grant funding, individual donors, and Easterseals Bay Area-hosted fundraisers throughout the year to support the program. At Easterseals Bay Area headquarters, we are continuously working on developing solutions that both address the growing need for KCAP within the community and the need for increased fiscal support. 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. BL-005301 0.000.00 TOTAL 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) 0.000.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top 5.1.r Packet Pg. 168 Attachment: 18. Easter Seals Bay Area - Kaleidoscope Community Adult Program Application (HS Grant Program FY19 Recommendations) Funding Sources/Revenues Budget Amount Amount Committed Program Service Fees (Regional Center revenue) USD$ 22,956.00 USD$ 22,956.00 City of Livermore HHSG USD$ 7,635.00 USD$ 7,635.00 City of Pleasanton HHSG USD$ 8,000.00 USD$ 8,000.00 Safeway Foundation People with Disabilities Campaign USD$ 150,000.00 USD$ 150,000.00 Fundraiser/event revenue USD$ 3,154.00 USD$ 3,154.00 Donations USD$ 18,069.00 USD$ 18,069.00 Client tuition (activity fees) USD$ 3,198.00 USD$ 3,198.00 City of Dublin HSG USD$ 12,695.00 USD$ 12,695.00 Other grants USD$ 12,635.00 USD$ 12,635.00 Total USD$ 238,342.00 USD$ 238,342.00 Funding Uses/Expenses Budget Amount Amount Committed Program Activity Supplies & Other Costs USD$ 2,727.00 USD$ 2,727.00 Program Food Supplies USD$ 384.00 USD$ 384.00 Vehicle Maintenance USD$ 1,207.00 USD$ 1,207.00 Office Supplies USD$ 1,641.00 USD$ 1,641.00 Postage & Shipping USD$ 30.00 USD$ 30.00 Printing USD$ 154.00 USD$ 154.00 Facility Repair & Maintenance USD$ 2,970.00 USD$ 2,970.00 Legal Services USD$ 7,684.00 USD$ 7,684.00 Office Move Expense USD$ 4,646.00 USD$ 4,646.00 Professional Training & Education USD$ 10.00 USD$ 10.00 Bank Service Charges USD$ 514.00 USD$ 514.00 Total USD$ 21,967.00 USD$ 21,967.00 Budget Narrative The above numbers are pulled from the program budget for Easterseals Bay Area's Kaleidoscope Community Adult Program. The HHSG funds are funds from the HHSG funds from the Cities of Livermore and Pleasanton, as well as the Safeway Foundation's People with Disabilities Campaign during Summer 2018. A fundraiser campaign was also held to raise funds for KCAP equipment/program supplies. When necessary, ESBA uses general donations and funds from general operating to support Kaleidoscope. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financials List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ Board Roster Current Annual Budget for the Entire Agency ✔✔✔✔ Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Authorization Letter Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Authorization Letter Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Insurance 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 ✔✔✔✔ IRS Letter 5.1.r Packet Pg. 169 Attachment: 18. Easter Seals Bay Area - Kaleidoscope Community Adult Program Application (HS Grant Program FY19 Recommendations) Application ID: 133491 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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 Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) 5.1.r Packet Pg. 170 Attachment: 18. Easter Seals Bay Area - Kaleidoscope Community Adult Program Application (HS Grant Program FY19 Recommendations) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline Hope Hospice, Inc Grief Support Center and Hospice Volunteer Program Jump to: Questions Budget Documents USD$ 18,000.00 Requested Submitted: 1/11/2019 11:17:13 AM (Pacific) Project Contact Jennifer Pettley jenniferp@hopehospice.com Tel: (925) 829-8770 Additional Contacts none entered Hope Hospice, Inc 6377 Clark Avenue Suite 100 Dublin, CA 94568 Chief Executive Officer Jennifer Hansen jenniferh@hopehospice.com Telephone(925) 829-8770 Fax (925) 829-0868 Web www.hopehospice.com Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Hope Hospice provides compassionate, home nursing care and support services residents at the end of life, and supportive services for families who are caring for their loved one at home. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding 5.1.s Packet Pg. 171 Attachment: 19. Hope Hospice, Inc - Grief Support Center and Hospice Volunteer Program Application (HS Grant Program FY19 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. Hope Hospice has in the last three years received the following government funding for its patient care and family support services: FY18/19 City of Livermore ($5,000) Hospice Volunteer Program. Curriculum development, resource materials, training, supervision and evaluation, scheduling of volunteers, consultants and staff.. City of Pleasanton ($9,000) Grief Support Center and Hospice Volunteer Program. Implementation of various grief support services, groups, one-on-one counseling sessions. Curriculum development, training, resource materials, supervision and evaluation, scheduling of volunteers, consultants and staff. City of Dublin ($14,860) Grief Support Center and Hospice Volunteer Program. Implementation of various grief support services, groups, one-one-one counseling. Training and resource materials, supervision and evaluation, scheduling of volunteers, consultants and staff. FY17/18 City of Pleasanton ($5,000) Grief Support Center; Capital Grant ($15,000) United Communications Phone System to modernize phone system. City of Livermore ($5,000) Grief Support Center; Capital Grant ($15,000) United Communications Phone System to modernize phone system. City of Dublin ($15,000) Grief Support Center and Hospice Volunteer Program FY2016/17 City of Pleasanton ($5,000) Grief Support Program; Volunteer Support $5,000) City of Dublin ($15,000) Grief Support Services and Volunteer programs. 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). Founded in 1986, Hope Hospice, Inc. is a 501(c)(3) nonprofit organization that is governed by a nine-member volunteer Board of Directors. These professionals meet monthly and bring leadership experience in the healthcare, financial, business and public service sectors. Our Chief Executive Officer reports to the Board. The Chief Financial Officer reports to the CEO. The organization has 113 paid, licensed clinical staff, administrators and managers, many of whom with advanced degrees. Our 158 trained volunteers assist with patients and families, in the office, in governance roles, or with special events. In addition, Hope has a nine-member volunteer community advisory committee of professionals in business, public service, clergy, non-profit and higher education. The advisory committee meets periodically with Hope leadership to provide community perspectives on Hope activities and initiatives. Our clinical team includes a Medical Director and three Associate Medical Directors, all hospice-certified physicians; numerous Registered Nurses, Licensed Vocational Nurses, Licensed Clinical Social Workers, Licensed Marriage and Family Therapists, Spiritual Care Counselors, Home Health Aides, a Dietitian, Quality and Compliance professionals, and hospice- trained volunteers. Our Grief Support Services Manager and Director of Volunteer Services (DVS) both have long careers in the hospice industry and in managing and developing programs that meet community needs. The DVS is a Registered Nurse and is certified as a trainer by the Alzheimer's Association and by Teepa Snow, a nationally renowned specialist in dementia care practices and occupational therapy. The Hope Hospice team brings a wealth of experience, expertise, and specialized education to each patient and family. Each team member contributes to an environment that offers patients customized care, symptom management and peacefulness, and is focused on protecting their dignity and choices at the end of 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. The Grief Support Services Center and Volunteer Services program work collaboratively to deliver a range of grief experience and volunteer support services to patients and families in the home and in our Dublin center. 9. 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 gfedc None 5.1.s Packet Pg. 172 Attachment: 19. Hope Hospice, Inc - Grief Support Center and Hospice Volunteer Program Application (HS Grant Program FY19 10. 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 Concern. 11. How will this project will be implemented, administered, and operated? The Grief Support Center and Volunteer Services programs are key components of the Hope Hospice patient care program. The Grief Support Center is administered by a highly experienced grief services professional with a long history of managing and developing programs that meet the needs of community members who have lost a loved one. The Bereavement Support Manager oversees a team of trained volunteer facilitators who provide grief support for groups and individuals in multiple sessions, in one or two-day classes, or on a drop-in basis as people feel they need help throughout the year. In addition, in collaboration with East Bay Hospice, Hope's Grief Support Dept. has in the last year added a children's bereavement group. Other sessions help people who have lost a child or spouse and some incorporate art therapy. These programs are free of charge to all. They are designed for hospice families for 13 months after a loss or longer, if needed, as well as for members of the community who otherwise don't have access to grief support help. The Volunteer Services department administers the recruitment, training, supervision and scheduling of volunteers for the support of hospice patients and families, as well as for other functions throughout the organization. To meet the growing and diverse needs for community support for dementia-related cases, Volunteer Services now trains volunteers who wish to work with patients with these conditions. These volunteers provide support, guidance and assistance to family members who need help with the care of their loved one. "Living with Dementia" is administered by Jill Smith, RN, Director of Volunteers who is certified by the National Council of Dementia Practitioners, the Alzheimer’s Association, and Positive Approach to Care by Teepa Snow. Our volunteers use successful, research-based communication techniques and alternative activities that are sensitive and respectful to the dementia patient. 12. Describe in detail how Dublin grant funds will be used for this project. (What specifically will the grant funds be used for?) These funds will in part support the expenses associated with administering and operating both the Grief Support and Volunteer Support services programs, including staffing costs, facilities overhead, IT and communications costs, transportation costs, materials development and printing costs, marketing and outreach. All Medicare-certified hospices are required by federal law to have a grief support program and a volunteer program but these services are not billable or reimbursable through insurance or other means. Therefore, they are supported by contributed funds. Both programs require many hours of planning, preparation, participation, and follow-up by the directors and staff to deliver needed and excellent care to our patients and families, and services to the general public. Grief Support helps people learn healthy coping skills in processing their grief and how to connect with a caring community. The 13-month program includes personal consultation, elective participation in ongoing support groups or in one-on-one sessions, and scheduled telephone follow-up. Children meet in age-appropriate group sessions to express their feelings through art projects, writing, music, games and discussions. The Grief Support Center also conducts memorial events and provides on-site support for local schools, senior centers, and other organizations. gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing ✔✔✔✔ Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse ✔✔✔✔ Disabilities gfedc Food and Nutrition ✔✔✔✔ Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above gfedc Please explain: 5.1.s Packet Pg. 173 Attachment: 19. Hope Hospice, Inc - Grief Support Center and Hospice Volunteer Program Application (HS Grant Program FY19 Volunteers provide high-quality support and companionship to patients and families through vigil, reading, music, art, prayer, home repair, meal preparation, and gentle touch. They also provide respite so family members can "take a break" to run errands or take some time away for themselves to recharge. Volunteers also provide support to families as their loved one is near death or at the time of death, and through bereavement, helping them produce treasured mementos or write life reviews. Other volunteers provide vital help in the office, on committees or boards, or help plan and staff fundraising and outreach even 13. 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)? Service contacts and sessions are tracked in a comprehensive database management system. Grief Support Services collects client satisfaction surveys following all of its programs, as well as evaluations from hospice families 14 months after their loss. The surveys and evaluations measure perceptions and assess how participants are coping in their grief experience. The results help drive the development of new services, such as those for teens and young adults and a drop-in support program, and help to refine current services to ensure they continue to meet community needs. As vital members of the hospice patient care and family support team, volunteers help with fundraising events, in the office and elsewhere in the organization. Among their many patient care services are sitting with the patient while the family takes some respite time, visiting/companionship, driving patients to the doctor, and vigil when patients are near death. Others assist in event registration-setting up and taking down equipment, or serve as a board or community advisory committee member. Patient care volunteers undergo nearly 20 hours of extensive training and preparation to work in a home setting where someone is critically ill. . All Hope volunteers are initially interviewed to determine their area of interest and level of time commitment and then complete a registration and orientation process. Their progress, hours and interests are carefully logged. Volunteers are recognized frequently for their work, and we host an annual Volunteer Recognition Dinner at a local residence. Families complete satisfaction surveys which help us understand and respond to the ongoing and emerging needs of those in our care, including the volunteer services. In addition, our case managers, registered nurses, and medical social workers are in constant contact with our patients and families, and regularly conduct needs assessments and measure levels of satisfaction. 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. Hope Hospice served 503 patients during CY2018, a 4% increase over the previous year. In addition, we served 1,500 family members and members of the general public through the Volunteer Program and 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 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 a diagnosis 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, whether its to arrange for visits by social workers, chaplains, or volunteers. Free services of the Volunteer Program benefit patients and their families by providing valuable companionship for patients, respite time for caregivers, home support (chores, errands), specialized patient physical care (massage, Reiki, cosmetology) and music, arts or pet therapy, and other volunteer services. All Dublin residents who seek care from Hope Hospice are served, regardless of income status, religion, age or any other demographic descriptor. No one is turned away and all of these community-centered services are provided free of charge. While most services are not demographic-specific, Hope's Grief Support Center does offer a support group for teens, and one- on-one counseling is available to anyone who seeks it at no charge. These emotional and practical support services are possible only because of community support and contributions. . 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? All staff and patient care volunteers are trained in cultural sensitivity and in multi-cultural issues, especially as they relate to the emotional, social and spiritual issues of the dying and bereaved, family dynamics and communication. In particular, they learn about the beliefs held by some cultural groups surrounding death and dying in the home setting and elsewhere. When necessary, we employ a translation service and have a number of multi-lingual staff members on hand when translation is needed or to address cultural beliefs as they relate to a patient's care. The nature of loss influences the complexity and depth of the grief response. Our professionally trained grief support providers 5.1.s Packet Pg. 174 Attachment: 19. Hope Hospice, Inc - Grief Support Center and Hospice Volunteer Program Application (HS Grant Program FY19 skillfully apply their experience and training in dealing with highly individualized grief experiences. Those same skills have resulted in thoughtfully designed programs and grief support sessions that help various individuals process their grief. For example, our "Bridge" program for children aged 5 to 18 makes use of non-verbal methods of expressing grief, such as through art projects. For some adults, grief is a very personal matter, so we offer one-on-one or drop-in sessions. Other programs are tailored for the those who have lost a spouse or a parent. We also offer telephone support for up to 14 months after loss and continue follow-up through correspondence. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? In general, Hope Hospice is committed to serving families of diverse background, culture, language, learning style, and disabled conditions. Patients are admitted for Hope Hospice services following a doctor's referral and after receiving a diagnosis that will most likely limit their life to six months or less. Our patient care and support services are provided in the patient's home, wherever that may be, and include nursing, physician, home health aide, social worker, chaplain, volunteer and grief support services. As a service agency, we are sensitive and responsive to the needs of all individuals and our services reflect that compassion. We have: - A diversified clinical team with multiple language and cultural capacity. - We utilize a language translation service, including ASL, which is available 24/7/365. - Our second-floor Grief Support Center is easily accessed by elevator and is fully able to accommodate the needs of disabled persons. The services are available to the community at no cost and we have bi-lingual facilitators for those with limited English. - 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 a Critical Incident Stress Management team for local school districts. 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Hope Hospice has an ongoing partnership with Hospice East Bay, contracting for its Manager of Grief Support (MGS) to administer and manage Hope's program. The Manager of Grief Support is on-site at Hope Hospice twice per week and oversees a Grief Support staff and trained volunteer group facilitators. As a full team member, the MGS is always accessible by phone and email, always participates in Hope management and staff meetings as well as staff trainings. The MGS brings a strong background and capability in Grief Support management and keeps abreast of community needs in the Tri-Valley region and beyond. Hope also has ongoing partnerships/contractual relationships with residential care facilities, such as Valle Verde Care Home II, and with Stanford Health ValleyCare, San Ramon Regional Medical Center, Kaiser Permanente, Castlewood Country Club, Dublin Senior Center, the University of San Francisco, Heritage Estates, Stoneridge Creek, Reutlinger Jewish Community. Such partnerships enhance access to those who need services, and help increase awareness about end-of-life issues, hospice, and bereavement care. We serve patients wherever they call "home." In some locations, facility staffs provide ongoing care for the patient while Hope Hospice nurses, home health aides, volunteers and other hospice team members visit as often as the patient needs. The Family Caregiver Education Series of workshops held at our Dublin office features speakers from Horizon Elder Care, Tri- Valley Personal Home Care, the National Institute on Aging, Senior Support of Tri-Valley, and Graham Hitch to present topics that educate and support participants who are caregivers to a seriously ill family member.. We work with local schools to educate and provide specialized grief support activities for youth. We partner with ARF to provide pet therapy to children grieving the loss of a loved one, and with Valley Humane Society to provide canine comfort visits to hospice patients. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. Hope Hospice regularly publicizes and advertises its services in local newspapers and on social media, and distributes flyers and other marketing materials to senior centers, assisted living facilities, physicians' offices and medical groups, hospitals and health centers, elder care facilities, schools, government agencies, elder care nonprofits, and at numerous Chamber of Commerce events in the Tri-Valley region. We are Chamber members in the cities of Livermore, Dublin, San Ramon and in Walnut Creek and have a marketing table at all of their major showcase and member events. We are also members of the Tri- Valley Nonprofit Allilance, a group of more than 100 local nonprofits that meets monthly to network and meet other agency representatives, and to reach out and learn about nonprofit issues. Hope staff regularly make presentations to health, senior and social service agencies to ensure their constituencies and clients are aware of Hope's programs and services. Hope also conducts numerous mailings several times per year, reaching thousands of current, former and prospective clients with email announcements, newsletters, direct mail appeals and other mailings. 5.1.s Packet Pg. 175 Attachment: 19. Hope Hospice, Inc - Grief Support Center and Hospice Volunteer Program Application (HS Grant Program FY19 Specific activities include: Sending direct mail and email to Dublin area residents announcing events Sending printed copies of Hope Hospice's VOICES newsletter or Annual Report to Dublin area residents 3 times per year Announcing Grief Support Center programs in local media, schools, churches, fire departments, police departments and senior centers; Hosting the annual Service of Remembrance at the Shannon Center where families can come to celebrate the memory of a loved one. Participating regularly in Dublin, San Ramon, Livermore, and Walnut Creek Chambers of Commerce events to showcase and publicize our services. Attending regular meetings of the Tri-Valley Nonprofit Alliance to network with other nonprofits and agencies. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. The $18,000 grant request covers just 3% of the $537,510 combined expenditures for the Grief Support Center and the Volunteer Program, while Dublin residents are projected to account for approximately 10% of unique individuals served by Hope Hospice in FY19/20. This is a service demand increase of 4% over FY18/19. Funds granted by the City of Dublin will be allocated to cover a portion of the salaries for the Directors of Grief Support and Volunteer Services and the program staff who implement the services provided to Dublin residents. Cash donations to help support these programs are also received from other Dublin sources - individuals, families, organizations and businesses. These programs are free to the public so Hope relies on community donations and grants to support them. Volunteers also provide staffing help to Hope Hospice in these programs. The Independent Sector estimates that the value of an hour of volunteer time in California is $29.09 (2017). Last fiscal year our 158 volunteers logged 4,860 hours, creating an in- kind value of $141,377. The actual cost of staffing to provide the wide range of services provided by volunteers would far exceed this value. By leveraging the leadership skills of our Director of Volunteers and the philanthropic intentions of local residents, businesses and institutions, Hope Hospice is able to provide a diverse array of trained volunteer support services to hospice patients in the Dublin area which would otherwise not be possible. Likewise, by maximizing the variety and availability of the services offered in the Grief Support Center by relying on a combination of staff, interns, and community partners to meet the needs of grieving individuals, the community's support of the Director of Grief Support and the Children's Grief Support staff and programs is highly leveraged. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? These programs will continue with other sources of funding, such as philanthropic support from members of the community, local service clubs, and/or private or corporate foundation grants. Since the level of philanthropic support can never be certain, Hope Hospice utilizes a mix of funding resources, including individual and business contributions, community and foundation grants, corporate sponsorships of fundraising events and city grants to help support these services. The needs for these services are ongoing and on the rise. We have seen a 4% increase in admissions in the last year so we will continue to pursue this funding mix to meet the growing and diverse needs in our community. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not ✔✔✔✔ No gfedc Yes: If yes, please explain: gfedc Yes ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 5.1.s Packet Pg. 176 Attachment: 19. Hope Hospice, Inc - Grief Support Center and Hospice Volunteer Program Application (HS Grant Program FY19 applicable. N/A 25. 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. 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process Hope Hospice operates primarily within the city's vision for its business, safety and innovation goals. As the community thrives and grows, the diverse needs of its residents also grow in times of good health and in times of declining health. A local, non-profit business for nearly 40 years, Hope has been helping Dublin families manage the care of a critically ill loved one. Operational and clinical excellence, Innovation, safety and even history are at the core of our service delivery. 28. ** QUESTIONS 29 THROUGH 41 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? 29. 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 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc Yes. If so, check box here and answer questions 29 through 41. ✔✔✔✔ No. If no, check box here and enter gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *Promote fair housing and reduce housing discrimination. 5.1.s Packet Pg. 177 Attachment: 19. Hope Hospice, Inc - Grief Support Center and Hospice Volunteer Program Application (HS Grant Program FY19 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: 35. 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?") 36. 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?") gfedc 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: gfedc * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. gfedc * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. gfedc C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. gfedc D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. gfedc 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. gfedc Increase homeownership gfedc Promote decent affordable housing gfedc Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. gfedc Improving the quality of life for our Nation's communities gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc Reduce housing discrimination. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability 5.1.s Packet Pg. 178 Attachment: 19. Hope Hospice, Inc - Grief Support Center and Hospice Volunteer Program Application (HS Grant Program FY19 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 39. 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". ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. 5.1.s Packet Pg. 179 Attachment: 19. Hope Hospice, Inc - Grief Support Center and Hospice Volunteer Program Application (HS Grant Program FY19 40. 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 41. 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" 42. 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 Disabled Women/Female Headed Households Seniors Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL 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) 0.000.00 TOTAL 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) 0.000.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. 5.1.s Packet Pg. 180 Attachment: 19. Hope Hospice, Inc - Grief Support Center and Hospice Volunteer Program Application (HS Grant Program FY19 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). As a Medicare-certified nonprofit agency, Hope Hospice receives reimbursement to help cover the delivery of hospice care. Other services are provided at no charge to patients and families so require external funding to support them. It is these services that define the full breadth of the hospice experience, including the family supportive services through the grief program and volunteer services. Hope prudently manages investment income and uses a mix of resources to help fund these services and meet the needs. We also conduct fundraising direct mail appeals, receive individual and business contributions, organize two major fundraising events-the Hope 100 Golf Marathon at Castlewood Country Club--and the Hike for Hope, a memorial hike at Del Valle Regional Park, and solicit funding from corporate and private family foundations. In addition to Dublin, we also submit grant requests to the cities of Livermore and Pleasanton. 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. BL-005299 gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed Event Income USD$ 212,209.44 USD$ 212,209.44 Municipal and Organizational Grants USD$ 48,000.00 USD$ 0.00 Individual Donations USD$ 268,627.44 USD$ 268,627.44 Total USD$ 528,836.88 USD$ 480,836.88 Funding Uses/Expenses Budget Amount Amount Committed Grief Support Center Staffing, Supplies, Taxes USD$ 337,574.14 USD$ 337,574.14 Volunteer Services Program Staffing, Supplies, Taxes USD$ 192,246.36 USD$ 192,246.36 USD$ 0.00 Total USD$ 529,820.50 USD$ 529,820.50 Budget Narrative The Funding Sources/Revenues and committed figures shown here reflect the allocation for the Grief and Volunteer Support programs from Hope Hospice's current overall operational budget. Dublin residents comprise approximately 5 percent of our region's service delivery, a rate that is expected to double in 2019/20. In CY18 Hope Hospice served 503 patients, a record number, reaching an average daily census of 154 in November, up from 115 the previous year. In addition to serving our patients' families, Hope provided grief support to 1,500 members in the community. For FY 19/20, we expect a 4 to 5 percent growth trend and demands for care and support to continue across our services. In total, Hope Hospice income is derived from various sources: Medicare reimbursements for patient care operations, investment income, and revenues from fundraising events, grants and individual and business donations. As a Medicare provider, Hope Hospice is required by law to provide volunteer and grief support services but these are not reimbursed nor do we bill for them. Hope provides these services free of charge to the community, so we must seek outside sources to fund them. These programs require many hours of staff time to prepare, promote, outreach and implement and Hope's grant request to the City of Dublin covers only a portion of that overall time. Hope Hospice commits community donations and grants to cover these expenses, including the $18,000 grant we are requesting from the City of Dublin for help in funding the Volunteer Services and Grief Support Services programs. We understand municipal grant funding is not guaranteed so we do not show this category as committed funding at this point in time. 5.1.s Packet Pg. 181 Attachment: 19. Hope Hospice, Inc - Grief Support Center and Hospice Volunteer Program Application (HS Grant Program FY19 Application ID: 131243 * ZoomGrants™ is not responsible for the content of uploaded documents. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget Form Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ Hope Hospice Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ Annual Budget FY18-19 Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ Form 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Authorization to Request Funding Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Designation of official Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Certificate of Liability Insurance Certificate of Liability Insurance - Gen 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. ✔✔✔✔ Nonprofit Determination - State Nonprofit Determination - Fed 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) 5.1.s Packet Pg. 182 Attachment: 19. Hope Hospice, Inc - Grief Support Center and Hospice Volunteer Program Application (HS Grant Program FY19 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser 5.1.s Packet Pg. 183 Attachment: 19. Hope Hospice, Inc - Grief Support Center and Hospice Volunteer Program Application (HS Grant Program FY19 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline Legal Assistance for Seniors Legal Services, Medicare Counseling and Education for Dublin Seniors Jump to: Questions Budget Documents USD$ 7,500.00 Requested Submitted: 1/11/2019 3:26:44 PM (Pacific) Project Contact James Treggiari jtreggiari@lashicap.org Tel: (510) 832-3040 x302 Additional Contacts none entered Legal Assistance for Seniors 333 Hegenberger Road Suite 850 Oakland, CA 94621 United States Executive Director James Treggiari jtreggiari@lashicap.org Telephone(510) 832-3040 x302 Fax (510) 842-1080 Web www.lashicap.org Questions top 1. Select the category that best describes your organization: (Select only one.) 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.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding 5.1.t Packet Pg. 184 Attachment: 20. Legal Assistance for Seniors - Legal Services, Medicare Counseling and Education for Dublin Seniors Application (HS Grant 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. In the last three years, LAS has received contracts from multiple government sources. In fiscal year 16/17, LAS received the following: (1) $45,000 from the State of California for immigration services; (2) $140,464 in federal Title III and VII funds; (3) $818,148 from the County of Alameda for general operating expenses and elder abuse, guardianship, and HICAP; (4) $13,000 from Contra Costa County for HICAP; and (5) a total of $70,450 from the cities of Pleasanton, Livermore, Hayward, Alameda and Fremont for general program support. In fiscal year 17/18, LAS received: (1) $16,500 from the State of California for immigration services; (2) $152,695 in federal Title III and VII funds; (3) $746,011 from the County of Alameda for general operating expenses and elder abuse, guardianship, and HICAP; (4) $13,000 from Contra Costa County for HICAP; and (5) a total of $86,469 from the cities of Pleasanton, Livermore, Hayward, Alameda, Fremont, Union City and Dublin for general program support. In fiscal year 18/19, LAS received: (1) $268,827 from the State of California for elder abuse services; (2) $292,759 in federal Title III and VII funds; (3) $619,426 from the County of Alameda for general operating expenses and elder abuse, guardianship, and HICAP; (4) $6,000 from Contra Costa County for HICAP; and (5) a total of $84,855 from the cities of Pleasanton, Livermore, Hayward, Alameda, Fremont, Union City and Dublin for general program support. 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). Through over forty-two years of service to seniors, Legal Assistance for Seniors (LAS) has a proven track record for providing quality services that improve the lives of thousands of seniors each year. LAS has a dedicated team of staff, volunteers, and board members who are all committed to fulfilling LAS’ mission of promoting the independence and dignity of seniors. Many LAS team members have been with the agency for over 10 years, enhancing the services LAS provides through their years of expertise and institutional knowledge. LAS is overseen by a board of directors from a broad range of professional backgrounds related to the needs of seniors, including elder law attorneys, fiduciaries, home care experts and financial professionals. LAS’ board meets bimonthly and is closely involved in the governance of the agency, including strategic planning and fundraising efforts. In addition to the Executive Director, LAS’ management team consists of the Managing Attorney, Office Manager, Development Director, Chief Financial Officer (CFO), and HICAP Manager. Nearly all members of the management team have been with LAS for a minimum of five years, and the Chief Financial Officer and HICAP Manager have both been with LAS for 25 years. The management team works together to ensure that all of LAS’ departments are running smoothly, meeting weekly to discuss any agency concerns and department updates. LAS’ fiscal staff consists of the CFO, Development Director, and LAS’ Accounting Associate and Contract Administrator. Together, the fiscal team maintains LAS’ comprehensive fundraising plan consisting of a variety of funding sources. These include foundation and government grants, contracts with Alameda County, many Alameda County cities, the State Bar of California, events held throughout the year, and individual giving campaigns. It should be noted that LAS’ fiscal audits have noted no deficiencies in internal controls for as long as we have had financial statements. 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. LAS will provide legal services, individual health insurance counseling, and community education to Dublin seniors free of charge. Assistance will be provided on a broad range of legal and health care issues including housing eviction prevention. 9. 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 10. 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 Concern. gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing ✔✔✔✔ Health Care (including dental) gfedc Workforce Development ✔✔✔✔ Homelessness gfedc Transportation Services and Access 5.1.t Packet Pg. 185 Attachment: 20. Legal Assistance for Seniors - Legal Services, Medicare Counseling and Education for Dublin Seniors Application (HS Grant 11. How will this project will be implemented, administered, and operated? The legal services program provides free legal advice and full representation on a variety of legal issues, including housing, a new practice area added last year. Once a senior contacts LAS’ legal program, either directly or through an agency referral, they will be scheduled to meet with an attorney or advocate for a consultation if we can assist. Depending on the senior’s ability to travel, the appointment will take place at LAS’ office, in the senior’s home, or another community location convenient for the senior. LAS’ community education program provides hundreds of free presentations each year at various locations across the county. Presentations are given to seniors, service providers, and interested community members to teach seniors to make informed choices and advocate for themselves. Presentation topics include Low Income Assistance, Basic Housing Rights for Seniors, and Know Your Medicare Rights, among others. Attendees are also connected with LAS staff if they need further assistance. The community education program also conducts extensive outreach throughout the county, including participating in outreach events such as senior fairs, to raise awareness of LAS’ services. LAS’ Health Insurance Counseling and Advocacy Program (HICAP) assists with Medicare issues through individual counseling. Counseling is provided by state-registered volunteer counselors at the Dublin Senior Center and many other county locations. In a counseling session, a senior can enroll in Medicare, supplemental and Part D plans, and be screened for and get help applying for cost-saving programs. When a senior has a Medicare issue, HICAP counselors and staff coach the senior on how to self-advocate to resolve it. If the issue goes beyond HICAP’s scope, the case will be referred to LAS’ health law department. All services are free and offered in multiple languages, either through interpretation provided by staff or volunteers, or by using a phone interpretation service. 12. Describe in detail how Dublin grant funds will be used for this project. (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, and HICAP counseling to Dublin seniors, focusing on low or extremely low income seniors. Specifically, funds will contribute to salaries for LAS’ staff attorneys and advocates, as well as photocopies for legal cases and community education presentation handouts, postage, phones, rent, and outreach activities. Funding will also be used to support travel for home visits to Dublin clients, community education presentations, and HICAP appointments. 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. When an attorney visits a senior, they are also able to identify additional needs that would otherwise remain unseen and can provide support to address these issues even if not legal in nature. Just as home visits are vital to connecting with vulnerable seniors, 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. Funding from the City of Dublin is crucial to support LAS’ programs. LAS receives funding from Alameda County and other funders for all three programs (legal services, community education and HICAP) but this funding does not cover the entire budgetary need in any of the programs, and LAS is required to match these funds. Funding from Dublin and other cities within Alameda County helps LAS match the funding from Alameda County and also helps defray the cost of providing services in Dublin. 13. 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)? LAS’ legal services program will provide free legal services to seven seniors in the areas of elder abuse, health law, public benefits, guardianship, naturalization, housing, and general legal services for those needing assistance in other areas. ✔✔✔✔ Domestic Violence and Child Abuse ✔✔✔✔ Disabilities gfedc Food and Nutrition ✔✔✔✔ Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above ✔✔✔✔ Please explain: Services for elder abuse victims, eviction defense, and securing affordable health care. Most clients are seniors, many have disabilities. 5.1.t Packet Pg. 186 Attachment: 20. Legal Assistance for Seniors - Legal Services, Medicare Counseling and Education for Dublin Seniors Application (HS Grant Services will be provided to Dublin residents 60 and older, or 50 and older for guardianship, and will range from legal counsel and advice to full representation in court, depending on the client’s situation and legal issue. LAS will also provide a minimum of three community education presentations and/or outreach events in Dublin for seniors, caregivers and senior service providers, reaching a minimum of 60 Dublin residents. Community education gives seniors the information they need to be informed consumers, with the goal of preventing the need for more intensive services in the future. Finally, LAS will also provide free HICAP counseling, in-person or over the phone, to 75 Dublin Medicare recipients, with in- person counseling done at the Dublin Senior Center, saving seniors money on their health care costs and ensuring they have the best coverage for their individual needs. To monitor the progress of these outcomes, LAS will utilize its client databases that program staff use to 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, it will make any necessary adjustments 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 recipients of all its programs to assess the quality of services provided. LAS’ management team reviews every returned evaluation form to ensure compliance with LAS’ standards of service. Through this review, LAS is also able to evaluate emerging trends or areas of unmet need identified by clients. 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. LAS will provide legal services to Dublin seniors age 60 and older, with the exception of guardianship, which will serve clients 50 and older. Based on recent data, an estimated 60% of these clients will be extremely low income, 40% will be low to very low income, and 45% will have a disability. Through LAS’ free legal services, Dublin seniors and adults with disabilities will be able to obtain elder abuse restraining orders to protect themselves from further abuse. Seniors will also be able to obtain guardianships of minors in their care, maintaining stable homes for these children. They will be able to obtain US citizenship, public benefits, and health care. Seniors will also be able to obtain assistance for eviction and other housing problems. All of these outcomes provide increased independence, safety and security for seniors and their families. While the majority of its clients are seniors, HICAP provides counseling to clients of any age who receive or are eligible for Medicare, either through age or disability. HICAP counseling will benefit Dublin Medicare beneficiaries by ensuring they have the best health care coverage for their needs at the lowest cost. If a client is at risk of losing coverage due to an issue with their insurance, HICAP can advise the client on how to preserve their appeal rights while referring the case to LAS’ legal department for further assistance. Community education programs are tailored to seniors, senior caregivers, and service providers, although most presentations are open to the public, meaning interested community members of any age may attend. Community education will benefit Dublin residents by providing helpful information on areas of critical importance in seniors’ lives, such as advanced health care directives and long term care insurance. Through education, seniors will be armed with the knowledge they need to make informed decisions and will also be aware of where to turn when they need more assistance. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? LAS’ services are specifically tailored for the unique needs of seniors, especially those who are traditionally underserved such as low-income and disabled seniors, those living in isolated areas, and those from multi-cultural and linguistically diverse backgrounds. To reach isolated seniors and those with difficulty traveling due to physical or financial issues, LAS makes home visits for legal clients 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 areas are aware of the services offered, LAS also conducts extensive outreach activities across the county. To ensure non-English speaking seniors benefit from LAS’ services, written materials are provided in multiple languages. LAS staff and volunteers can provide translation services in Spanish, Cantonese, Mandarin, French, Korean, Farsi, Hindi, Punjabi, Vietnamese, Tagalog, Russian, Kashmiri, and American Sign Language. LAS’ HICAP program currently has counselors providing services at the Dublin Senior Center that speak Cantonese, Mandarin and Dutch. Community education presentations are also provided in multiple languages, including Cantonese, Mandarin, Korean, Spanish, Hindi and Punjabi. For all other language needs, LAS utilizes a phone interpreter service. Attorneys also make arrangements with the courts to ensure an interpreter will be provided during hearings if needed. LAS also collaborates with several cultural centers to ensure that LAS’ services are reaching these communities and are culturally appropriate. Some of these community partners include the Multicultural Institute, Asian Health Services, and The Fruitvale Senior Center. 5.1.t Packet Pg. 187 Attachment: 20. Legal Assistance for Seniors - Legal Services, Medicare Counseling and Education for Dublin Seniors Application (HS Grant 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? LAS has a 42-year history of providing services that have been deeply rooted throughout all of the cities in which it serves, including Dublin. We are the only nonprofit legal services agency specifically designed to reach and provide seniors, many who are low-income, disabled and limited in English, with legal representation, advocacy and referral, Medicare counseling and community education in Alameda County. This unique niche affords LAS an incredibly high volume of daily referrals from all over the county and because we specialize in serving seniors, many of those seeking services are low-income. In periods of open enrollment or other times of Medicare required consumer action, it is common for LAS to receive over 100 calls and/or referrals per day. Services are highly accessible to seniors with barriers to care such as income, disability and linguistics. Services are delivered in the homes and service agencies in which these seniors live, receive healthcare and socialize, including the Dublin Senior Center. These service delivery centers not only provide accessibility, they serve as a coordinated network for outreach and referrals with agencies such as senior affordable housing sites, government agencies including Adult Protective Services, the Dublin Senior Center, and healthcare providers with high rates of Medi-Cal consumers. LAS distributes marketing communications at the Dublin Senior Center and throughout its robust network of partners, which 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 LAS’ Health Insurance Counseling and Advocacy Program (HICAP) is delivered onsite. HICAP’s state registered counselors provide outreach as they are able to spot barriers to care for seniors in at-risk situations and provide necessary intervention. 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. As mentioned in question 16, LAS has formed close partnerships in Dublin and throughout the county resulting in integration with the Dublin Senior Center, senior housing, and health and human service agencies. These partnerships ensure accessibility to legal counseling and representation, healthcare access and education on issues relevant to social welfare. LAS also collaborates with public and private agencies whose consumers are those seeking abuse assistance, services for attaining guardianship of minor children, resolution of denials of government benefits, and housing and health insurance enrollment. Those agencies include but are not limited to: (1) Alameda County Kinship Collaborative, a group of service providers focused on families headed by kin caregivers; (2) Adult Protective Services Multi-Disciplinary Team, a collaboration between service providers and Adult Protective Services to foster the coordination of community resources for the benefit of elders and dependent adults; (3) Community Projects Committee, a group of nonprofit legal service providers that share information and trainings to better serve indigent clients; (4) Senior Services Coalition, nonprofit and public senior service providers collaborating to coordinate services and support; (5) Council on Age Friendly Communities, a county-led working group supporting local age-friendly initiatives; and (6) Acute Care for Elders Multi-Disciplinary Team, a collaboration between local government and nonprofit agencies and hosted by the District Attorney’s Office, to learn best practices and address gaps in service. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. One of LAS’ successful strategies for marketing and outreach to seniors in specific geographic areas is its delivery of community education programs and participation in outreach events. In FY18-19 we’ve reached 392 people in Dublin via education and outreach events alone. LAS’ community education department provides presentations at many Dublin, Pleasanton and Livermore locations each year, including senior centers, senior housing sites, libraries, Palo Alto Medical Foundation, and John Muir Health to name a few. By having LAS maintain this visible presence in the community, we aim to create top of mind awareness as the leader in senior health and welfare education, Medicare counseling and legal representation. LAS’ collaboration with the Pleasanton Senior Center is also a source of marketing as LAS makes appointments for its legal clients there. These appointments are available to senior residents of all Tri-Valley cities. Providing services at these locations is especially important for Dublin and Tri-Valley seniors with mobility barriers because transportation is either accessible by senior transportation services or, transportation is not needed because these programs are delivered onsite in locations where seniors live such as senior housing and assisted living centers. Coordination of these education and legal programs also allows LAS to develop relationships with service and outreach coordinators at senior provider agencies, which results in increased access to LAS for the seniors they serve. LAS promotes these community engagement efforts with its website, community education calendar, a quarterly newsletter, Facebook posts, fliers, and brochures. Finally, LAS has become known as a leader in elder abuse prevention through its annual Conference on Elder Abuse Conference in partnership with UC Hastings College of Law, which brings together senior service professionals from all over the Bay Area. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the 5.1.t Packet Pg. 188 Attachment: 20. Legal Assistance for Seniors - Legal Services, Medicare Counseling and Education for Dublin Seniors Application (HS Grant anticipated result. It is commonly known that Bay Area law firms charge hundreds of dollars per hour. A 2011 United States Consumer Law Attorney Fee Survey Report study notes that the average attorney rate for a small firm in California is $350 per hour. The Alameda County Bar website notes that the average hourly rate for a lawyer in Alameda County is between $200 and $400. LAS legal services are free of charge. This is made possible because LAS programs are well leveraged with diverse funding. They utilize volunteers, legal fellows and pro-bono attorneys. If funded, LAS will provide legal services, including full representation to seven seniors in Dublin. LAS’ Medicare counseling program, HICAP, utilizes a large team of state registered volunteer counselors that if funded in fiscal year 2019-2020, will provided counseling to 75 Dublin seniors. LAS’ community education is also free and accessible and reaches a large number of seniors annually. If funded in FY2019-2020, LAS’ community education and/or outreach events will serve 60 seniors in Dublin. Our ability to travel to multiple site locations throughout Dublin reaching seniors where they live, socialize and receive services, make this a highly cost-efficient program. LAS can prioritize educational sites based on the size of the target audience. Based on these three program outcomes, LAS will serve a total of 142 seniors for a budget of $7,500 . That’s $52.82 per senior served, including those receiving legal services. It should be noted that many of the seniors in the legal and HICAP program will require several hours of service to resolve the legal or Medicare issue in question. For example, an uncontested guardianship case is 12-15 hours of staff time. This will further reduce the rate per senior served. LAS is the only agency in Alameda County that can specifically serve the needs of seniors free of charge, with such a high level of professional legal, Medicare and educational services via a nonprofit business model. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? LAS will still continue to provide services to Dublin seniors if it were not to receive funding, however, it will create limitations. All of LAS programs are funded by multiple sources and should Dublin funds be eliminated, services would have to be scaled back in accordance with the program’s overall reduced budget. This would include reducing the number of seniors LAS could serve in Dublin with legal services, community education programs and Medicare counseling via the HICAP program. Federal funding for HICAP has recently been reduced, and this, coupled with any loss of City funds would likely reduce the numbers of Dublin seniors served. In addition, the City of Dublin would likely need to implement an intervention to redirect seniors, many who rely heavily on LAS, to other agencies for assistance in managing their Medicare plans. LAS would continue to seek funding in order to try and maintain service levels as we would not like to see any reduction in an area where we have an established presence and so many relying on our services. We would continue to collaborate with our advocacy partners Senior Services Coalition of Alameda County, the council of Age Friendly Communities, and California Alliance for Retired Americans (CARA) for protecting funding to every extent possible. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 25. 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. ✔✔✔✔ No gfedc Yes: If yes, please explain: gfedc Yes ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 ✔✔✔✔ Not Applicable gfedc Yes gfedc No 5.1.t Packet Pg. 189 Attachment: 20. Legal Assistance for Seniors - Legal Services, Medicare Counseling and Education for Dublin Seniors Application (HS Grant 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process In accord with Dublin’s vision, the project ensures a safe and secure environment and fosters new opportunities by supporting seniors’ safety and wellbeing. LAS’ innovative services protect seniors from elder abuse and eviction and help to secure necessities seniors need for a safe and healthy lifestyle, including health insurance and basic income. LAS is known as a reliable resource for seniors in need, contributing to the City’s vision of maintaining excellent public safety resources. 28. ** QUESTIONS 29 THROUGH 41 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? 29. 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. LAS has a language access plan as we do not allow language to be a barrier in its service delivery. This 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 that end, LAS outreaches to a diverse population of seniors by making its 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 its Medicare counseling program (HICAP) 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 state registered 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 through Alameda County, 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 bi-lingual staff and volunteers to provide translation for all its services. It should be noted that those staff are also available for home visits for those with transportation barriers. Finally, culturally appropriate services are also ensured through coordination with partnering agencies that specialize in serving mono-lingual 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 Asian seniors also in Oakland. 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. ✔✔✔✔ Yes. If so, check box here and answer questions 29 through 41. gfedc No. If no, check box here and enter gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. ✔✔✔✔ Be culturally accessible, appropriate and inclusive ✔✔✔✔ Encourage community engagement and involvement gfedc Promote energy and resource efficiency ✔✔✔✔ Encourage networking and information sharing across service providers ✔✔✔✔ Encourage process streamlining ✔✔✔✔ Consolidate service delivery gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 5.1.t Packet Pg. 190 Attachment: 20. Legal Assistance for Seniors - Legal Services, Medicare Counseling and Education for Dublin Seniors Application (HS Grant 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: 35. 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?") ✔✔✔✔ 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: gfedc *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. gfedc *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. gfedc 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. gfedc F) Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase homeownership gfedc Promote decent affordable housing ✔✔✔✔ Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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 gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc 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. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment 5.1.t Packet Pg. 191 Attachment: 20. Legal Assistance for Seniors - Legal Services, Medicare Counseling and Education for Dublin Seniors Application (HS Grant 36. 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?") 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Availability/Accessibility gfedc Affordability ✔✔✔✔ Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 5.1.t Packet Pg. 192 Attachment: 20. Legal Assistance for Seniors - Legal Services, Medicare Counseling and Education for Dublin Seniors Application (HS Grant 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 39. 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". 40. 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 41. 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" ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 0 Disabled 0 Women/Female Headed Households 142 Seniors 0 Youth 0 Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 142.00142.00 TOTAL 57 Low Income (50%-80% AMI) 85 Extremely Low Income (<30% AMI) Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 142.00142.00 TOTAL 57 White White + HISPANIC 2 Black/African American Black/African American + HISPANIC 40 Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC 2 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 41 Multi Racial + HISPANIC OR other Multi Racial 5.1.t Packet Pg. 193 Attachment: 20. Legal Assistance for Seniors - Legal Services, Medicare Counseling and Education for Dublin Seniors Application (HS Grant 42. 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 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). LAS has and continues to increase and diversifying government, individual and foundation support along with implementing publicity for bolstering these efforts. To increase service to donors and for better outreach analytics and implementation, LAS continues to develop its proprietary donor database application that manages donation data from multiple platforms (Mailchimp and Evenbrite) making campaign and event management faster and accurate. LAS has also delivers a quarterly electronic newsletter and maintains Facebook activity. To increase foundation, corporate and government support, LAS conducts ongoing research and maintains a robust annual grant submission calendar. These efforts continue to result in increased interest, sustainable program budgets and new program development. To that end, LAS was awarded first time grants from the Bigglesworth Family Foundation and The San Francisco Foundation to support its recently launched housing program. 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. BL-110718 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 142.00142.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed Alameda County (Title III & VII), HICAP/MIPPA, APS, General Funds, DCFS) USD$ 865,722.00 USD$ 652,797.00 State of California (Dept.of OES (VOCA) USD$ 119,479.00 USD$ 119,479.00 County of Contra Costa USD$ 6,000.00 Cities of Dublin, Alameda, Fremont, Hayward, Livermore, Pleasanton & Union City USD$ 85,169.00 The State Bar of California: IOLTA, EAF, EAP & Bank Grant USD$ 111,510.00 USD$ 111,510.00 Corporations/Foundations (Bigglesworth, Thomas J. Long, Van Loben Sels/Rembe Rock, West Davis & Bergard, San Francisco Foundations, East Bay Fdn on Aging, Stern Memorial Trust, Family Support Svcs., Calif Health Advocates & Hindu Comm. & Cultural Center USD$ 584,123.00 USD$ 156,500.00 Court Awarded Fees USD$ 150,000.00 Elder Abuse Conference sponsorships & registration fees USD$ 90,000.00 Individual Donations, Fundraising Event, Annual Appeal, Board Contributions & Client Donations USD$ 158,000.00 Total USD$ 2,170,003.00 USD$ 1,040,286.00 Funding Uses/Expenses Budget Amount Amount Committed Personnel Salaries (See Budget Narrative) USD$ 1,342,538.00 USD$ 660,122.00 5.1.t Packet Pg. 194 Attachment: 20. Legal Assistance for Seniors - Legal Services, Medicare Counseling and Education for Dublin Seniors Application (HS Grant Personnel Fringe Benefits (See Budget Narrative) USD$ 362,486.00 USD$ 180,003.00 Operating Expenses: Printing/Copying USD$ 17,000.00 USD$ 5,704.00 Operating Expenses: Postage & Delivery USD$ 9,000.00 USD$ 1,263.00 Operating Expenses: Office Supplies & Minor Equipment USD$ 8,000.00 USD$ 7,143.00 Operating Expenses: Rent USD$ 209,129.00 USD$ 95,481.00 Operating Expenses: Telephone USD$ 12,000.00 USD$ 4,506.00 Operating Expenses:Technology (OnLine Access & Research) USD$ 8,000.00 USD$ 4,829.00 Operating Expenses: Insurance USD$ 30,000.00 USD$ 13,212.00 Operating Expenses: Membership, Book & Dues USD$ 11,000.00 USD$ 8,045.00 Operating Expenses: Audit & Payroll USD$ 16,500.00 USD$ 16,855.00 Operating Expenses: Consultant (Computer, General, Dbase, Translation, Development) USD$ 28,000.00 USD$ 13,886.00 Operating Expenses: Equipment Lease/ Maintenance USD$ 8,350.00 USD$ 3,984.00 Operating Expenses: Equipment (Computers, Software & Upgrades) USD$ 17,500.00 Operating Expenses: Client Costs & Outreach USD$ 23,000.00 Operating Expenses: Conference & Annual Fundraising Costs USD$ 25,000.00 USD$ 5,000.00 Operating Expenses: Staff & Volunteer Training/Travel, Recruitment & Support USD$ 38,500.00 USD$ 20,253.00 Operating Expenses: Bank/Processing Fees USD$ 4,000.00 Total USD$ 2,170,003.00 USD$ 1,040,286.00 Budget Narrative The requested budget funds from the City for Salaries are as follows: Managing Attorney (1% @ $690); Sr Staff Attorney (2% @ $1,140), Staff Attorney (3% @ $1,520); Staff Attorney (2% @ $1,032), Advocate (2% @ $665) and Advocate (1% @ $318). Fringe Benefits include FICAer (7.65%), SUI & workers compensation (1% each), health/dental/vision/life insurance (15%) and retirement/benefit plan fees (3%) for a total of $1,488. Operating expenses include Rent ($350), Telephone ($40), Insurance ($50), Office Supplies/Minor Equipment ($35), Printing/Copying ($50), Postage/Delivery ($40). Staff/Volunteer Travel @ $.55 per/mile ($82) will be underwritten with additional funds. 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 2017/18 in kind volunteer services, attorneys (127 hours), advocates (653 hours) with a value of $45,310 as recognized in our audited financial statement. In addition HICAP counselors provided 4,211 volunteer hours and presenters to our annual Elder Abuse Conference provided 199 volunteer hours. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ 2019/20 Dublin Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ 2019/20 Dublin Financial Information List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ 2018/19 LAS agency budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ 2016-2017 Tax Return Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Board Resolution Board of Director's (or governing body's) authorization to request funding (may be same document as one ✔✔✔✔ Board Resolution 5.1.t Packet Pg. 195 Attachment: 20. Legal Assistance for Seniors - Legal Services, Medicare Counseling and Education for Dublin Seniors Application (HS Grant Application ID: 131403 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. above) Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ GL/Auto COI Workers Compensation COI 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. ✔✔✔✔ IRS Determination Letter State of CA-Determination Letter Certified Audit and/or Certified Financial Statements 1718 Audited 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 LAS Employee Handbook REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section Audit requirements 1718 Audit Management Letter REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws Articles of Incorporation LAS By Laws REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) Conflict of Interest Policy 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. LAS Language Access Plan 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) LAS 2023 Strategic Plan Other Supporting Documents (Not Required) 5.1.t Packet Pg. 196 Attachment: 20. Legal Assistance for Seniors - Legal Services, Medicare Counseling and Education for Dublin Seniors Application (HS Grant Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline Open Heart Kitchen Dublin Meal Programs Jump to: Questions Budget Documents USD$ 24,000.00 Requested Submitted: 1/11/2019 10:00:11 AM (Pacific) Project Contact Heather Greaux executivedirector@openheartkitchen.org Tel: 925-580-1616 ext 402 Additional Contacts none entered Open Heart Kitchen 1141 Catalina Drive #137 Livermore, CA 94550 United States Executive Director Heather Greaux executivedirector@openheartkitchen.org Telephone(925) 580-1616 Fax Web www.openheartkitchen.org Questions top 1. Select the category that best describes your organization: (Select only one.) 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.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding 5.1.u Packet Pg. 197 Attachment: 21. Open Heart Kitchen - Dublin Meal Programs Application (HS Grant Program FY19 Recommendations) 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. Fiscal Year 18/19 City of Dublin: $22,500 Dublin meal programs City of Livermore $10,000 Livermore meal programs City of Pleasanton $13,000 Pleasanton Hot Meal and Bag Lunch Program City of Pleasanton $47,818 Pleasanton Senior Meal Program County of Alameda $215,625 Senior Meal Program (Dublin, Livermore, Pleasanton) Fiscal Year 17/18 City of Dublin: $15,979 Dublin meal programs City of Livermore $10,000 Livermore meal programs City of Pleasanton $13,500 Pleasanton Hot Meal and Bag Lunch Program City of Pleasanton $47,500 Pleasanton Senior Meal Program County of Alameda $186,175 Senior Meal Program (Dublin, Livermore, Pleasanton) FEMA $14,000 Hot Meal Program (Dublin, Livermore, Pleasanton) Fiscal Year 16/17 City of Dublin: $13,579 Dublin meal programs City of Livermore $10,000 Livermore meal programs City of Pleasanton $10,000 Pleasanton Hot Meal and Bag Lunch Program City of Pleasanton $40,905 Pleasanton Senior Meal Program County of Alameda $135,471 Senior Meal Program (Dublin, Livermore, Pleasanton) FEMA $15,000 Hot Meal Program (Dublin, Livermore, Pleasanton) 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). Open Heart Kitchen has been providing hot meals in the Tri-Valley since 1995. We have a proven record of managing quality nutrition programs for vulnerable populations. Last year Open Heart Kitchen served over 330,000 meals to over 5,400 un- duplicated clients. Our meal programs are designed to be sensitive to our clients’ specific needs, including specialized nutrition for seniors, children, and people who are likely to have diet-related diseases such as diabetes. OHK is governed by a Board of Directors composed of a group of individuals with diverse skills and extensive experience in fiscal oversight, business management and development, and marketing. OHK employs management personnel such as the Executive Director and Operations Director as well as a Volunteer Coordinator, Program Coordinator, Production Chefs, and several part time program staff. The combined skills and experience of the staff, Board of Directors, and key volunteers allow Open Heart Kitchen to provide over 5,000 meals to people in need every week. 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. Open Heart Kitchen serves meals to seniors 5 days a week at the Dublin Senior Center, delivers bag lunch meals to 7 Dublin schools, and serves hot meals to anyone in need every Saturday at Valor Crossing in Dublin. 9. 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 10. 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 Concern. gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development ✔✔✔✔ Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities 5.1.u Packet Pg. 198 Attachment: 21. Open Heart Kitchen - Dublin Meal Programs Application (HS Grant Program FY19 Recommendations) 11. How will this project will be implemented, administered, and operated? Open Heart Kitchen chefs prepare the meals for the Senior Meal and Hot Meal Programs every day with the help of volunteers in its main kitchen located in Pleasanton. The meals are transported in insulated hot and cold portable cambro units to each meal site by Open Heart Kitchen staff drivers. Site Supervisors along with volunteers serve the diners of the Dublin Senior Center Monday - Friday from 11:30am-12:15pm and at Valor Crossing on Saturdays from 12:00pm-2:00pm. Bag lunches for the Children’s Weekend Bag Lunch Program are assembled by staff and volunteers and delivered to 7 schools in Dublin every week. Every Friday, children pick up bag lunches at a convenient location within the schools with no need to rely on an adult to assist them with this service. Menus are prepared by the Operations Director who has a B.S. in Holistic Nutrition. A Registered Dietitian performs a nutritional analysis (sodium, fiber, protein, vitamin A and vitamin C) of our senior meal menu. The Volunteer Coordinator schedules and manages all of the volunteers. Production Chefs maintain menus, prepare food, and direct volunteers. The Program Coordinator works with management and staff to keep programs on task, provide outreach, and administrative support. Site Supervisors direct volunteers and provide meal service. Log sheets are maintained daily at each meal site to track the number of meals served, volunteer hours, and food temperatures. All of the staff involved with serving or preparing food are Serv-Safe certified in food handling and they train and oversee the volunteers. 12. Describe in detail how Dublin grant funds will be used for this project. (What specifically will the grant funds be used for?) Open Heart Kitchen is requesting $24,000 to help support the Dublin meal program’s food costs. Our average cost for food is $2/meal and we anticipate serving 56,000 meals in Dublin during the grant period. The grant funds will cover 21% of the cost of food for the Dublin meal programs. 13. 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)? Initiative: End Hunger by Providing Nutritious Food Strategy: Provide high quality, healthy food. OHK clients are vulnerable to diet related diseases and deserve nutritionally balanced meals. • Establish, monitor, and follow nutrition guidelines for meal programs. • Adopt donation acceptance guidelines that prohibit the acceptance of food that is of poor quality, is unhealthy, or would harm the dignity of our clients. • Provide nutrition education to our clients so they make healthy food choices. • Distribute fresh produce through a partnership with the Alameda County Community Food Bank. Strategy: Connect vulnerable populations to the nutrition safety net. • Outreach to homeless population to connect them with immediate food. • Connect families and individuals who are under-utilizing services with the nutrition safety net. • Educate newly or marginally food-insecure families about OHK’s services. • Food delivery to locations where clients are gathered in groups receiving other services. Key Performance Indicators: Number of meals served, number of people served, nutritional analysis of menus, meal service channels/locations, pounds of donated food used in programs vs. disposed, pounds of fresh produce distributed, number of education materials distributed, attendance rates for educational outreach, percent of clients who feel they have regular access to food. 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. The Eastern Alameda County 2011 Human Services Needs Assessment cited insufficient availability of meals for the homeless and the working poor as a specific gap in human services. Our programs strive to help our clients move toward self- ✔✔✔✔ Food and Nutrition ✔✔✔✔ Senior Services ✔✔✔✔ Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above gfedc Please explain: 5.1.u Packet Pg. 199 Attachment: 21. Open Heart Kitchen - Dublin Meal Programs Application (HS Grant Program FY19 Recommendations) sufficiency by providing help with access to nutritionally adequate, prepared meals. The Tri-Valley has no other seven day a week hot meal program. 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 throughout the week 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 continue to rise. Some seniors are forced to choose between paying for medicine or food, housing or food, and utilities or food. Food is a basic human need and no senior should ever have to question where their next meal is coming from. 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. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? 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 minimized the amount of sugary, empty calorie, and high sodium donated foods that we use in the program. We have a responsibility to provide our guests with the most nutritious meals that 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. In designing the menus, Open Heart Kitchen often struggles to find the balance between culturally appropriate food and nutritious food that is enjoyed by the diners. Types of foods, and ways of preparing and consuming food, have vastly different meanings in different cultural contexts. Ethnic and class divisions are often visible through dietary habits. Many of our senior diners developed their food consumption habits in the era of casseroles prepared with highly processed foods. Other diners are used to eating foods prepared with fresh, local produce. Food that is understood as nutritious by one group of diners may be viewed as inappropriate by others. Open Heart Kitchen attempts to maintain a balance of food that is palatable to all of the diners while remaining highly nutritious. Open Heart Kitchen relies on guest satisfaction surveys in menu development. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? We find that many of our homeless and low-income guests utilize mobile devices to find services. Our new website offers a daily calendar of our meal sites and hours of operation. We are also registered with City Serve and 2-1-1. We are a part of The 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 participate in several outreach events in the community throughout the year in an effort to promote our services to potential guests and to recruit volunteers. 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. We host our Senior Meal Program at the Dublin Senior Center. Our partnership with the Senior Center allows us to leverage both of our staffs to provide greater outreach and service to the senior guests. We have also partnered with Valor Crossing to host our Hot Meal Program on Saturdays. This site provides the residents of Valor Crossing as well as members of the 5.1.u Packet Pg. 200 Attachment: 21. Open Heart Kitchen - Dublin Meal Programs Application (HS Grant Program FY19 Recommendations) greater community with a stable source of food every week. Several local corporations provide volunteer grants or pay their employees to volunteer during work hours. This expands our volunteer workforce and exposes the corporate workforce to our work, the greater community, and its needs. These corporations include Workday, Clorox, Boeing, Salesforce, Ross, Gap, Kaiser Permanente, and Target. Workday and Shaklee donate items for, and help assemble, our Holiday Bags for our homeless guests which we distribute over the holidays. All of these collaborations play a role in providing services to our guests and reducing the costs of doing so. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. We have found that the Dublin residents who utilize our services and volunteer at our sites provide an invaluable resource for outreach in the local community in addition to the outreach described in question 16. We collaborate with several community service organizations in the Tri-Valley. The following agencies provide fresh produce for our meal programs: The Alameda County Community Food Bank provides more than 4 pallets of fresh produce weekly, Fertile Groundworks provides a source of organic produce, and Sunflower Hill provides over 2,000 pounds of fresh produce every year. We provide meals for the Partners for Change Program in Livermore and the Mariachi Program in Pleasanton. We deliver meals once per week to the residents of Hillcrest Gardens, The Groves, Vineyard Village, and Arbor Vista. Upon request, we provide meals for the Livermore Homeless Refuge. The Valley Humane Society distributes pet food at our meal sites once per month. We coordinate outreach with Abode, Tri-Valley Haven, Axis, and Spectrum. Asbury United Methodist Church coordinates a shower and laundry program in conjunction with our Hot Meal service. We are a founding member of Feed Tri-Valley, and Committee Members of the Tri-Valley Anti-Poverty Collaborative. We work with several churches who help with outreach to their congregations. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Open Heart Kitchen is requesting $24,000 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. 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. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? If the Dublin Meals Program does not receive funding, we will pull funding from other sources. Lack of funding from this particular grant will not have a direct impact on the Dublin programs, but it will cause OHK to re-evaluate the program next fiscal year to determine the availability of funding sources and the scope of the program. OHK only receives 7% of its revenue from City grants. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 25. 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. ✔✔✔✔ No gfedc Yes: If yes, please explain: gfedc Yes ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 5.1.u Packet Pg. 201 Attachment: 21. Open Heart Kitchen - Dublin Meal Programs Application (HS Grant Program FY19 Recommendations) 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process Our meal programs serve Dublin residents by providing a higher quality of life to its more vulnerable populations. We serve a diverse community by providing them with a safe and secure environment where they can enjoy healthy meals served by a community of engaged volunteers. Our meal sites become a place where our volunteers and guests come together to build a stronger community that promotes diversity and understanding. 28. ** QUESTIONS 29 THROUGH 41 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? 29. 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. OHK is committed to making sure individuals with limited English proficiency have access to our programs. We recruit multi- lingual 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 is informally surveyed periodically on their experience concerning any contact with LEP persons during the year. This allows OHK to identify what translation services may be needed 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. 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. ✔✔✔✔ Yes. If so, check box here and answer questions 29 through 41. gfedc No. If no, check box here and enter gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. ✔✔✔✔ Be culturally accessible, appropriate and inclusive ✔✔✔✔ Encourage community engagement and involvement gfedc Promote energy and resource efficiency ✔✔✔✔ Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. 5.1.u Packet Pg. 202 Attachment: 21. Open Heart Kitchen - Dublin Meal Programs Application (HS Grant Program FY19 Recommendations) 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: 35. 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?") 36. 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?") gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *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. gfedc 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. gfedc F) Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase homeownership gfedc Promote decent affordable housing ✔✔✔✔ Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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 gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc 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. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 5.1.u Packet Pg. 203 Attachment: 21. Open Heart Kitchen - Dublin Meal Programs Application (HS Grant Program FY19 Recommendations) 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) gfedc Availability/Accessibility gfedc Affordability ✔✔✔✔ Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 5.1.u Packet Pg. 204 Attachment: 21. Open Heart Kitchen - Dublin Meal Programs Application (HS Grant Program FY19 Recommendations) 39. 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". 40. 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 41. 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" 42. 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 12 Disabled 30 Women/Female Headed Households 300 Seniors 400 Youth 5 Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 747.00747.00 TOTAL 160 Low Income (50%-80% AMI) 540 Extremely Low Income (<30% AMI) Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 700.00700.00 TOTAL 175 White 12 White + HISPANIC 61 Black/African American Black/African American + HISPANIC 203 Asian Asian + HISPANIC 3 American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC 11 Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC 2 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 233 Multi Racial + HISPANIC OR other Multi Racial Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 700.00700.00 TOTAL 5.1.u Packet Pg. 205 Attachment: 21. Open Heart Kitchen - Dublin Meal Programs Application (HS Grant Program FY19 Recommendations) only be one #1 PER AGENCY 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). OHK strives to find ways to identify new funding sources. We utilize donated food and supplies whenever appropriate and operate with a minimal staff and almost 20,000 volunteers to keep our expenses down. OHK has been financially stable for over a decade. OHK only receives 7% of its overall income from City grants. 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. BL-009270 ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed Foundations USD$ 241,800.00 Corporations USD$ 45,000.00 City Grants USD$ 93,319.00 County Grant USD$ 215,625.00 Other Federal Grant USD$ 14,000.00 Special Events USD$ 90,000.00 Individual Contributions USD$ 529,098.00 In-Kind Contributions USD$ 681,720.00 Total USD$ 1,910,562.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Personnel USD$ 563,877.00 Rent / Occupancy USD$ 33,912.00 Office Supplies USD$ 4,137.00 Equipment and Facility Expenses USD$ 16,279.00 Communications (Telephone, Internet, etc.) USD$ 14,716.00 Travel / Mileage USD$ 1,241.00 Audit / Other Professional Fees USD$ 10,982.00 Auto (Gas, Insurance, License) - Food Delivery USD$ 30,100.00 Food and Supplies USD$ 539,100.00 Printing and Marketing USD$ 8,319.00 Permits, Other Fees USD$ 635.00 Insurance USD$ 5,544.00 Volunteer Services (In-Kind) USD$ 539,520.00 Donated Food USD$ 124,200.00 Donated use of Facilities USD$ 18,000.00 USD$ 0.00 Total USD$ 1,910,562.00 USD$ 0.00 Budget Narrative Open Heart Kitchen is requesting $24,000 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. 17 percent of the food that OHK serves is distributed in Dublin and we are requesting that Dublin cover 4 percent of our total food costs. 5.1.u Packet Pg. 206 Attachment: 21. Open Heart Kitchen - Dublin Meal Programs Application (HS Grant Program FY19 Recommendations) Application ID: 131715 * ZoomGrants™ is not responsible for the content of uploaded documents. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget Form Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information Form List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ OHK BOD Roster Current Annual Budget for the Entire Agency ✔✔✔✔ OHK Budget FY1819 Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ OHK Tax Return Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ BOD Authorization Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ BOD Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ General Liability Auto and Worker's Comp 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. ✔✔✔✔ Federal Determination Letter CA Entity Status Letter Certified Audit and/or Certified Financial Statements Audited Financials 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 Employee Handbook (Personnel Policies) REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section Audited Financials Agency Audit Requirements from By-Laws REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws Bylaws Articles of Incorporation REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) Conflict of Interest Policy 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. LEP Plan 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) Strategic Plan Other Supporting Documents (Not Required) 5.1.u Packet Pg. 207 Attachment: 21. Open Heart Kitchen - Dublin Meal Programs Application (HS Grant Program FY19 Recommendations) Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser 5.1.u Packet Pg. 208 Attachment: 21. Open Heart Kitchen - Dublin Meal Programs Application (HS Grant Program FY19 Recommendations) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline Senior Support Program of the Tri Valley Case Management Jump to: Questions Budget Documents USD$ 22,114.00 Requested Submitted: 1/14/2019 8:31:46 AM (Pacific) Project Contact Robert Taylor rtaylor@ssptv.org Tel: 925-931-5394 Additional Contacts none entered Senior Support Program of the Tri Valley 5353 Sunol Blvd Pleasanton, CA 94566 United States Executive Director Robert Taylor rtaylor@ssptv.org Telephone(925) 931-5379 Fax (925) 931-3499 Web www.ssptv.org Questions top 1. Select the category that best describes your organization: (Select only one.) 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.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No ✔✔✔✔ One-time funding gfedc Seed funding gfedc One-time and Seed funding gfedc Operational funding 5.1.v Packet Pg. 209 Attachment: 22. Senior Support Program of the Tri Valley - Case Management Application (HS Grant Program FY19 Recommendations) 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. NA 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). Senior Support Program has 17 essential programs, serving as a one-stop resource shop for seniors. Since 1981, we have successfully managed the responsibilities and regulations of private, foundation, city, and county grants. Senior Support Program obtained our 501c3 in 2006 and have operated as a nonprofit agency since. Currently, we have 25 employees (mainly part-time), giving us collectively over 135 years of experience with Senior Support. The years of education and experience from reliable staff, compliance with contract parameters, accurate record keeping, timely reporting and billing, strong Board and Executive Director, and open lines of communication between service providers and funders are vital ingredients qualifying Senior Support Program for this project. Board of Directors is led by our Board President, who sits on multiple agency/county boards working to improve the lives of Alameda County seniors. The head of our Fiscal Committee is a Certified Public Accountant and has experience managing large contracts. Other board members are professionals from government, legal, and business sectors. Senior Support contracts with BayVap accounting professionals for accounting and payroll services. BayVap manages large accounts in addition to ours and has experience using nonprofit bookkeeping practices. Our Board of Director’s Finance Committee meets monthly with the Executive Director and BayVap to review all fiscal activities and proposed expenditures. The Finance Committee reports monthly to the Board of Directors. The system of checks and balances we adhere to protect awarded funds. We have an annual audit prepared by Noe & Company(see attached documents). In this audit, our internal controls and protocols are scrutinized in accordance with auditing standards generally accepted in the U.S. in addition to Government Auditing Standards 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. Case Management ensures all needs in a senior’s life are being met. For each client, case managers develop and execute a plan, which involves implementing, coordinating, monitoring, and evaluating cost-effective resources to improve quality of life. 9. 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.) If full funding is awarded, we anticipate serving 70 unduplicated Dublin clients. 10. 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 Concern. 11. How will this project will be implemented, administered, and operated? Case Management is the critical link between seniors in need and assistance available in the community. The initial contact with a senior is typically an urgent request for help and/or information. Many seniors have never required assistance before, do not know what their needs are, and are unaware of the types of services available in the community. Hence, referrals come from a variety of sources, including: Adult Protective Services, police/fire departments, medical discharge planners, senior gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition ✔✔✔✔ Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above gfedc Please explain: 5.1.v Packet Pg. 210 Attachment: 22. Senior Support Program of the Tri Valley - Case Management Application (HS Grant Program FY19 Recommendations) center/housing facility staff, concerned citizens, or the senior in need. A referral is as simple as a phone call to a case manager, available 5 days a week. Case Management is provided directly in the senior’s home, after a phone intake. An initial, comprehensive assessment is made of the senior's living situation; physical, mental, environmental, spiritual and emotional status; as well as need for assistance with Activities of Daily Living (ADLs). Together, the senior and case manager create a comprehensive, practical plan identifying available resources for the senior’s many needs. 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 bill paying, and living arrangements. Weekly Case Management team meetings for staff help to problem solve complex needs and ensure the best resources are provided to help the senior maintain their independence. Volunteers help case managers with entering reports, copying information, printing documents and various special projects. One of the most critical parts of the program is ongoing monitoring, reassessment and periodic follow-up of each client. Follow-ups are done by phone calls and repeat home visits. The monitor ensures implemented services are stable and sufficient. When basic physical, social and emotional needs are met, even in small increments, lives are changed and enhanced. 12. Describe in detail how Dublin grant funds will be used for this project. (What specifically will the grant funds be used for?) The City of Dublin grant funds will be used for direct Case Management services for seniors. The primary costs with this program comes from Case Managers' salaries, materials, travel expenses associated with driving to a senior's home and driving a senior to other needed services. These funds will allow Case Managers to conduct: initial intakes, home visits (assessments of seniors' needs), creation of care plans and implementation of services, monitoring on a regular basis, resource referrals (i.e. food stamps, Meals on Wheels, PG&E HEAP discounts, CalFresh, internal services, senior living options, etc.. ), referrals of volunteers, and acquisition of resources necessary to assist clients. Senior Support is fortunate to operate in the Pleasanton Senior Center rent and utility free, which reduces overhead expenses and allows us to provide these free, direct services to seniors. Expenses for copying, office supplies, accounting, insurance and auditing are minimal, as they are spread among all Senior Support contracts and largely paid through private donations. Case Management is provided on a one-on-one basis and is personalized; therefore, the exact time and cost for each client varies significantly. Senior Support is diligent in utilizing Case Managers' time as efficiently and effectively as possible. 13. 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)? Outcomes in Case Management are measured by the improvement in the quality of life and safety for the seniors who received our services. During the initial assessment, the Case Manager assists the senior in setting goals and putting services in place. The care plan for each client is thoroughly documented and filed. Through telephone monitoring and repeat home visits, the Case Manager tracks and documents progress and modifies the care plan as needed. A strong indicator of progress is improvement in scores for Activities of Daily Living (ADLs) and Indirect Activities of Daily Living (IADLs), which are documented. Success can be different for each senior. Goals may be evident in better nutrition and mobility and access to mental and medical health services. Success may be evident in the fact that the senior can remain safely and self-sufficient at home with improved quality of life. Positive impacts may be evident when the fire department/EMS no longer needs to make repeat visits to lift a senior off the floor. Case Management revolves around taking many small steps, leading to self-sufficiency at home. Our primary desired outcome is for seniors to have the information, support, and resources enabling them to maintain independence, improve physical and mental health, and remain at home with dignity intact. From over 34 years of delivering Case Management, we know when basic physical, social, and emotional needs are met, even in small increments, lives are improved. 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. All program recipients are age 60+ living in Dublin; this population of seniors is growing exponentially. In fact, Alameda County’s Needs Assessment predicts the number of residents age 60+ will increase 60% from 2010 to 2020; furthermore, this population is expected to increase by 99% from 2010 to 2030. The demand for Case Management is greater than ever before. Consequently, priority is given to seniors who are living in the greatest economic need, functionally impaired, or minority. Senior Support is the only nonprofit agency providing free Case Management, specifically tailored to older adults, for Dublin residents. We have been serving Dublin's seniors for over 34 years. 5.1.v Packet Pg. 211 Attachment: 22. Senior Support Program of the Tri Valley - Case Management Application (HS Grant Program FY19 Recommendations) Case Management benefits Dublin seniors by enabling them to remain living independently and safely in their own community, with familiar surroundings, and an improved quality of life. For instance, Mr. M is 82-year-old Dublin resident. He called the Dublin Senior Center, who referred him to Senior Support Case Management. Maintaining on a fixed income (less than$895/month), Mr. M was feeling very worried he would no longer be able to afford his needed medications for chronic health conditions, since he was notified his apartment rent was being increased. Our Case Manager helped him with lowering non-essentials expenses, allowing him to better control expenses. The Case Manager contacted Meals on Wheels plus CalFresh (food stamps) on his behalf and was able to stabilize his benefits. We also schedule a HICAP (Health Insurance Counseling) appointment, to ensure he has the most cost-effective prescription drug coverage. Prior to SSPTV, Mr. M. planned to reduce taking medications, to pay his monthly rent. Now, Mr. M is pleased he can still afford to meet his basic costs of living, including medications; he feels comfort knowing he can call Senior Support when a need arises. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? Senior Support clients receive our full suite of services regardless of ethnicity, nationality, sex, religion or any other differences. Many seniors receiving Case Management experience a series of losses, from friends and family, to mobility and the ability to complete daily activities. Beyond providing resources, Case Management supports the senior through every step of the process to obtain the assistance they need. Our staff works tirelessly to understand each senior’s complex needs. We hold weekly staff meetings, where cases are discussed and problem-solved. In-services provide staff and volunteers education on mental and physical health, finance/benefits, safety and adaptive devices and other geriatric specialties. Case Managers attend trainings, such as Behavioral Health seminars, throughout the county and receive in-service education from groups, such as the Afghan Elderly Association. Senior Support has staff and volunteers with language capabilities in English, Spanish, Mandarin, Cantonese, Japanese, Farsi, Hindi, and American Sign. We have numerous programs, especially our health education programs, available in English and Mandarin/Cantonese. Especially this last year, Senior Support expanded training and efforts to accommodate the growing population of Mandarin-speaking Dublin seniors. Through case management, we discovered many of these seniors, typically living on less than $800/month, lacked the financial means to purchase enough food. Hence, we constantly learn about the needs of specific populations to ensure we can effectively assist seniors maintain a healthy, independent life. Furthermore, Senior Support works with many community and faith-based groups that volunteer to help seniors in need. These groups help us further understand the customs and needs of seniors who have limited English, are non-English speaking, or are from other areas. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? Senior Support staff partakes regularly in outreach events to seniors and the community at large. Besides one-on-one outreaches, we try to do a minimum of one community outreach monthly. Some outreach efforts are held at senior apartment complexes and mobile home parks, enabling us to reach seniors who are homebound and unable to get out on their own. Our case manager is also present as needed at the Dublin Senior Center for case management services. We conduct presentations to groups in the community, such as clubs, churches, service groups and caregiver workshops.We have multilingual staff and volunteers who can present as needed. Senior Support is able to provide information to Dublin's limited-English speakers through our handouts and brochures available in English, Spanish and Chinese. Senior Support staff is very sensitive to and aware of different cultural needs. We work well with seniors' families and friends to make sure proper services are in place. Many seniors learn about case management through our wellness, fitness, and fall prevention classes, hosted at senior housing sites, churches, senior centers, etc. Staff develops a relationship with the participants; our staff is trained to assess concerns that arise and can easily provide a referral to case management. The majority of seniors served through our program are visited in their homes, where a complete assessment is made of their needs. If they should need to come to the offices, we are conveniently located at the Pleasanton Senior Center in an area originally designed for an adult day care program; our office is wheelchair accessible and has three handicap accessible restrooms. Senior Support has a volunteer transportation program available to Case Management clients who need transportation to access services and resources put in place by the Case Manager. 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. We are grateful to constantly expand our network of community partners throughout the Tri-Valley and Alameda County. We have established referral procedures between agencies, eliminating delays and confusion. The past year, we worked closer 5.1.v Packet Pg. 212 Attachment: 22. Senior Support Program of the Tri Valley - Case Management Application (HS Grant Program FY19 Recommendations) than ever with Alameda County’s Adult Protective Services(APS) to ensure seniors referred from APS have a Case Manager in their community who can visit their home to assess and establish needed assistance. We have a strong collaboration with Spectrum Community services. A client who needs meals brought to them can have the meals started with one simple phone call. We have partnerships with many faith-based and Rotary groups that join us to provide home clean-up and support. To reach shut-ins in crisis, we developed a strong partnership with the Dublin police and EMS paramedics. When they find a senior in crisis, they call us. This past year, we expanded this effort by being a partner agency for a county pilot program, STEADI, where paramedics responding to 911 calls assess seniors for various needs; if needs exist, the senior can be directly referred to our case management team. Our case manager responds by working with the client or family to provide essential services. This has helped to eliminate repeat 911 calls. We have worked closely with the Dublin Senior Center for many years. Their staff refers clients they are concerned about. Our nurses provide Health Screenings at the Senior Center and use of the Senior Center is often part of Case Managers' care plans. In addition, we have developed strong relationships with local hospital staff, including Valley Care/Stanford and Kaiser social workers. Other agencies we work with are City Serve, HICAP, LAS, Public Health, CRIL, Open Heart Kitchen, Tri- Valley Haven, Wiesner Foundation, Salvation Army, Social Security, IHSS, AXIS Community Health and local transportation agencies. A simple phone call from these agencies is all that is needed for support to begin. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. Senior Support provides outreach to Dublin residents through media, community fairs, local events, and presentations to local organizations, clubs and groups. We always enjoy participating in Dublin's annual Senior Info Fair, which is very popular. We have had newspaper articles in the Independent, Pleasanton Weekly and Tri-Valley Times. We have a website, Facebook page, LinkedIn profile and various social media coverage. Once a year, the staff works closely with the City of Dublin and the Dublin Police Department, assisting seniors with cleaning their homes, gardening and minor home maintenance. We work with the Dublin Police Department and city for holiday giving events, St. Raymond's Church for Thanksgiving meal deliveries, and City Serve to address community needs. We also collaborate with Tri-Valley Rotary Organizations, providing them with referrals of seniors who need home clean-ups or minor home repair. Several Dublin residents were included in this project. We also work with local community colleges, providing opportunities for student internships. The interns provide record keeping, assistance with classes, accounting help, and health screenings. We partner with and are a recipient of Hacienda Park Helping Hands. Senior Support Case Management is not a standalone program. It is one part of our services encompassing In-Home Counseling, Family Caregiver Support, Friendly Visiting, In-Home Caregiver Registry, door-through-door Senior Transportation, Exercise & Nutrition Programs, Partners in Safety, Medication Safety, Health Services, alcohol and other drug prevention, and Information and Referral Service. All these services are available to Dublin seniors. With the diversity of programs and staff backgrounds, there is constant collaboration within our organization as we work to meet the needs of older adults effectively and efficiently, ultimately improving their quality of life. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Each new client costs approximately $630 per year; the services provided to the seniors include but are not limited to: Initial intake/consult; Home/Health visit (assessment of senior’s needs); Senior Care plan and implementation of services; Monitoring on a regular (min. monthly) basis; Resource referral (Meals on Wheels, PG&E discounts, etc.); and Referral of volunteers To serve 30 clients with complete Case Management services would cost about $18,000. We respond to approximately 500 information and referral calls per year and serve at least 40 one-time service clients, requiring a Case Manager to gather information and offer limited coordination of services. These costs, compared to an average of $90,000 per year per client for institutionalization, that often becomes the taxpayers’ responsibility, are very cost effective. Senior Support strives to keep costs at a minimum. We are grateful for the many volunteers who assist with office support and telephone reassurance. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? The demand for Case Management this past year has grown exponentially in the senior population; requests for service already exceed our capacity to provide them, making it necessary to prioritize services to those most at risk. We will continue to provide very limited Case Management to Dublin seniors, as allowed through our Area Agency on Aging funding. If full funding is not received, we will have to significantly decrease the number of seniors that will be served in Dublin. However, if no funding is received we would only be able to serve approximately 15 seniors with the funds we receive through our Case Management Program funded by the Area Agency on Aging. These are not counted in the 65 we propose to serve through this grant. Having each city in the Tri-Valley provide funding is crucial to maintain the level of service we have been privileged to provide 5.1.v Packet Pg. 213 Attachment: 22. Senior Support Program of the Tri Valley - Case Management Application (HS Grant Program FY19 Recommendations) for the past 34 plus years. If funding is not received, seniors who have needs that can quickly be solved, allowing them to return to an active life, will fall through the cracks, resulting in costly and less than desired results, in most cases. Senior Support continuously looks for more funding to provide all necessary services. We look to foundations, fundraisers, donations, businesses and the county to provide these monies. We continually look for volunteers from the community and partnerships with other CBO’s to expand our services. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. NA 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not applicable. NA 25. 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. 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process **** Case Management promotes and supports a high quality of life for Dublin seniors. Often, seniors referred to Case Management no longer have any friends, relatives, or social connections in the area; Case Managers often provide the only form of support the senior may have. Through in-home assessments, the Case Manager can ensure seniors are living as safely as possible and address areas of concern. 28. ** QUESTIONS 29 THROUGH 41 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? 29. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your ✔✔✔✔ No gfedc Yes: If yes, please explain: gfedc Yes ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc Yes. If so, check box here and answer questions 29 through 41. ✔✔✔✔ No. If no, check box here and enter gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. 5.1.v Packet Pg. 214 Attachment: 22. Senior Support Program of the Tri Valley - Case Management Application (HS Grant Program FY19 Recommendations) 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 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *Promote fair housing and reduce housing discrimination. gfedc 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: gfedc * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. gfedc * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. gfedc C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. gfedc D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. gfedc 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. gfedc Increase homeownership gfedc Promote decent affordable housing gfedc Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. gfedc Improving the quality of life for our Nation's communities gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. 5.1.v Packet Pg. 215 Attachment: 22. Senior Support Program of the Tri Valley - Case Management Application (HS Grant Program FY19 Recommendations) 35. 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?") 36. 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?") 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc Reduce housing discrimination. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency 5.1.v Packet Pg. 216 Attachment: 22. Senior Support Program of the Tri Valley - Case Management Application (HS Grant Program FY19 Recommendations) 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 39. 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". 40. 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 41. 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" housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. 0 Disabled 0 Women/Female Headed Households 0 Seniors 0 Youth 0 Homeless 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL 0 Low Income (50%-80% AMI) 0 Extremely Low Income (<30% AMI) 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL 0 White 0 White + HISPANIC 0 Black/African American 0 Black/African American + HISPANIC 0 Asian 0 Asian + HISPANIC 0 American Indian/Alaskan Native 0 American Indian/Alaskan Native + HISPANIC 5.1.v Packet Pg. 217 Attachment: 22. Senior Support Program of the Tri Valley - Case Management Application (HS Grant Program FY19 Recommendations) 42. 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 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). **** Senior Support constantly looks for more funding to provide necessary services. We look to foundations, fundraisers, donations, businesses and city governments to provide these monies. Particularly, this past year, volunteers have been an incredible asset to the ever-increasing need for Case Management. We feel very fortunate to have volunteers who not only understand the complex needs of an aging population, but they are dedicated to helping our Case Managers with various tasks, maximizing the amount of direct service time Case Managers can provide to seniors. Thus, we will continue to look for additional volunteers to expand our services. 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. BL- 007038 0 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 0 Asian and White 0 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 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed City of Pleasanton USD$ 45,000.00 USD$ 45,000.00 City of Livermore USD$ 15,280.00 Total USD$ 60,280.00 USD$ 45,000.00 Funding Uses/Expenses Budget Amount Amount Committed Case Manager 1 USD$ 6,338.00 Case Manager 2 USD$ 6,338.00 Case Manager 3 PT USD$ 3,905.00 Bookkeeper USD$ 1,328.00 Director USD$ 3,605.00 Travel Miles USD$ 600.00 Total USD$ 22,114.00 USD$ 0.00 5.1.v Packet Pg. 218 Attachment: 22. Senior Support Program of the Tri Valley - Case Management Application (HS Grant Program FY19 Recommendations) Budget Narrative *** Funds will be used for Direct Services. Robert Taylor is the Executive Director, who has been with the agency 2 years; he 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. Our bookkeeper manages invoices and financial requirements with our accountant. Please note: The $18287 amount requested covers direct salary costs. An additional $3227 is proposed to cover benefits and fringe costs. This brings the total amount requested to: $21,514. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget Form Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ Board of Directors FY'18-19 SSPTV Current Annual Budget for the Entire Agency ✔✔✔✔ SSPTV Agency Budget FY18.19 Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ 990 Fy'17-18 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Designation Memo Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Board Designation Memo Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Insurance cert - city of Dublin 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. ✔✔✔✔ 501c3 Certified Audit and/or Certified Financial Statements Audited Financials Fy16.17 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 5.1.v Packet Pg. 219 Attachment: 22. Senior Support Program of the Tri Valley - Case Management Application (HS Grant Program FY19 Recommendations) Application ID: 132409 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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) Dublin Business License 5.1.v Packet Pg. 220 Attachment: 22. Senior Support Program of the Tri Valley - Case Management Application (HS Grant Program FY19 Recommendations) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline Spectrum Community Services Meals on Wheels for Dublin's Homebound Elderly Jump to: Questions Budget Documents USD$ 13,000.00 Requested Submitted: 1/14/2019 10:07:21 PM (Pacific) Project Contact Lara Calvert JSchafer@spectrumcs.org Tel: (510) 881-0300 ext. 243 Additional Contacts lcalvert@spectrumcs.org Spectrum Community Services 2621 Barrington Court Hayward, CA 94545 United States Executive Director Lara Calvert lcalvert@spectrumcs.org Telephone(510) 881-0300 x243 Fax (510) 537-3340 Web www.spectrumcs.org Questions top 1. Select the category that best describes your organization: (Select only one.) 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.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding 5.1.w Packet Pg. 221 Attachment: 23. Spectrum Community Services - Meals on Wheels for Dublin's Homebound Elderly Application (HS Grant Program FY19 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. Spectrum Community Services has received funding supporting our five different programs from multiple cities, the County, State and Federal Government for many years. Funding through the sources listed below are for home-delivered meals to frail/disabled seniors, many who are low/extremely low income. In the last three years, funding from these sources include: City of Pleasanton – CDBG funds – FY 16/17 $7,000, FY 17/18 $8,000, FY 18/19 $11,000 City of Livermore – CDBG funds – FY 16/17 $12,000, FY 17/18 $12,565, FY 18/19 $18,324 Alameda County Area Agency on Aging– FY 16/17 $17,073, FY 17/18 $14,329, FY 18/19 $26,319 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). Spectrum demonstrates its capacity to conduct our Meals On Wheels Program through its successful provision of meals/safety checks to Dublin seniors for almost 40 years. Spectrum’s management structure is program/function-driven. We are governed by a community Board of Directors who hired our Executive Director of five years, to carry out the policies and day-to-day administration of the agency. Our CFO has over 25 years of experience in finance and has been with Spectrum for 4 years. Spectrum is Dublin’s only Meals on Wheels provider, a suburban area where homebound seniors face serious issues of food insecurity as they age. Our staff/volunteers have a passion to serve along with a basic understanding of the needs/problems of the elderly and have been trained in subjects such as food safety/protecting health information/mandated reporting. To safeguard the security of our senior participants, all staff must pass a full background check and volunteers must pass one annually. This is a requirement for anyone to work in the program. Our Senior Nutrition Program Manager manages all Spectrum meal programs, including Meals On Wheels, and reports to Spectrum’s Executive Director. She/he supervises our Tri-Valley Supervisor, who recruits/trains/maintains volunteers, provides outreach/engagement in the community and supervises our Dublin Meals On Wheels Coordinator. The Coordinator holds a Food Handlers Certification that has provided the education needed to conduct in-home assessments/make appropriate referrals on behalf of participants/complete meal orders/determine daily routes for drivers, and be the primary contact for our staff/volunteers/seniors. The program has 10 weekly volunteer drivers supporting 2 routes dedicated to Dublin seniors. Drivers pick up freshly prepared meals each morning from Stanford Health Care/Valley Care Hospital and deliver them to our homebound Dublin seniors. In addition, they provide a daily safety check to ensure each senior’s wellbeing. 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text 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 10,000 nutritious, life-sustaining meals and a vital daily safety check to low/extremely low-income disabled and homebound seniors residing in Dublin. 9. 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 50 unduplicated Dublin senior residents. 10. 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 Concern. gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse ✔✔✔✔ Disabilities ✔✔✔✔ Food and Nutrition ✔✔✔✔ Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above 5.1.w Packet Pg. 222 Attachment: 23. Spectrum Community Services - Meals on Wheels for Dublin's Homebound Elderly Application (HS Grant Program FY19 11. How will this project will be implemented, administered, and operated? 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. She/he also confirms all volunteer drivers have reported in and routes will be covered. If a volunteer is unable to drive their assigned route on a given day, and there is no other volunteer available, 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 from Stanford Health Care/Valley Care Hospital in Livermore and deliver them to our homebound Dublin seniors. In addition to delivering meals at the same time each weekday, volunteers 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 wellbeing. Often, this special delivery is the only reason for our senior participants to get up in the morning, have something to look forward to, and provide a reminder to our frail seniors to take good care of themselves. 12. Describe in detail how Dublin grant funds will be used for this project. (What specifically will the grant funds be used for?) Spectrum is asking for $13,000 to support its Meals on Wheels Program. A portion of this request will fund a percentage of salaries for two positions: our Tri-Valley Supervisor ($3,276); our Dublin Meals on Wheels Coordinator ($3,286). It will also fund a proportional share of the benefits ($1,443) for these positions. Our Dublin Meals on Wheels Coordinator is the backbone of the program. She/he is the main contact for each of our seniors, whether it is to register them for new service/complete their intake assessment/talk to them about their meal schedule/preferences/other needs. The Coordinator completes semiannual in-home assessments with each senior in their home. This allows she/he to provide a more personal touch and better assess each senior’s needs/additional resources they might benefit from. The 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/manages volunteers. Meals are delivered daily, primarily by volunteers, who are dedicated to the program/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/cultural organizations/business/ community venues where seniors and their families gather. Involvement in the community is not only important to raise awareness of services 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/safety-checks for homebound seniors. Due to the limited number of meals funded through the Alameda County Area Agency on Aging, we must have additional funds to meet the needs of all eligible homebound Dublin seniors. We are asking for direct funding of $5.35 per 934 meals to pay for the direct food costs of additional meals. 13. 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)? The first and primary outcome measure crucial to Spectrum’s Meals On Wheels Program success is to ensure all low/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/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 50 or more unduplicated Dublin in FY2019-2020. Another outcome that measures the success of our Program is the number of meals we deliver each fiscal year. In FY2019- 2020, 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 gfedc Please explain: 5.1.w Packet Pg. 223 Attachment: 23. Spectrum Community Services - Meals on Wheels for Dublin's Homebound Elderly Application (HS Grant Program FY19 track to meet our stated goals, thus ensuring the success of Spectrum’s Meals On Wheels Program. 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. Spectrum’s Meals On Wheels Program will serve disabled and ailing homebound seniors residing in Dublin, most of whom are low/extremely low-income. These individuals are unable to leave their home on their own, prepare meals for themselves, and/or need assistance with other activities of daily living. The seniors we serve are considered an “at-risk” and vulnerable population by the Centers for Disease Control. Their infirm, homebound, and often low-income status means Meals on Wheels is one of the few free services that enables them to remain in their homes as they age. To qualify for the Meals On Wheels Program, seniors must meet various criteria, and based on their responses, they are assigned an A, B, or C priority level. Eighty percent of our current Dublin seniors are designated as Level A, meaning the senior has an urgent need for our program. An urgent need means a senior is meeting at least two risk factors. Some risk factors include living alone, recent discharge from the hospital, confined to a bed, no access to meals, or impairments with numerous activities of daily living. These homebound seniors benefit from the Meals on Wheels Program by receiving a nutritious meal, delivered by a friendly face up to 5 times per week. They also receive a safety check on each day their meal is delivered and can count on a trained volunteer from our program to look out for their best interest and wellbeing. Based on the Dietary Guidelines for Americans, our nutritious meals meet 1/3 of the Dietary Reference Intakes for an older adult. We also offer therapeutic meals, including renal diets and altered textures, such as puree or soft meals. Both the nutritional meals and safety checks are vital benefits to all of the Meals on Wheels seniors we serve in Dublin. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? To ensure our Meals On Wheels Program is culturally appropriate, we are very pleased to have the ability to offer numerous meal options for our Dublin senior participants. Stanford Health Care - ValleyCare Hospital, the agency who prepares our daily meals, offers both tortillas and rice as a substitute for bread, as well as a vegetarian menu option. There are also special meals for traditional and ethnic holidays. Seniors tastes are taken into account by the Registered Dietitian for menu development. Meals are also available to address medical needs including soft mechanical, puree, renal, dairy and gluten free. We Also, ensuring this Program is culturally appropriate, Spectrum maintains a diverse workforce that reflects the communities we serve. Our staff and volunteers include individuals who are fluent in English, Spanish, Hindi, Cantonese, Vietnamese, and Mandarin. They assist our Meals on Wheels Coordinator and drivers to better communicate with the Dublin seniors we serve. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? Spectrum’s Wheels On Wheels Program is available and welcoming to seniors of all racial/ethnic/ cultural groups residing in Dublin. As stated in Questions 15, Spectrum is fortunate to have numerous staff members who are bilingual, which supports our ability to outreach to individuals of multiple ethnicities. If an individual, who is a limited or non-English speaker, calls seeking information, a staff member who speaks their language will answer their questions/provide support. If there is no one available who speaks the person’s language, we can utilize Alameda County’s Translation Line. Our website is compliant with Americans With Disabilities Act and can be fully translated into all major languages, breaking down barriers to information needed by non-English literate seniors in Dublin. Our website also supports families, who search for the well-known Meals On Wheels online, and find Spectrum as the only local provider. We continue to expand our outreach in Dublin/Alameda County, through ensuring materials/referral information are provided in multiple languages. When participating in outreach activities, a Spectrum employee, who speaks the primary language of those attending, will be present to answer questions prospective new seniors and/or their families have (most new clients have help from a family member, friend or medical provider to get set up for services). Our Meals on Wheels staff work to cultivate connections with faith-based/cultural organizations/businesses/community venues, to assist us in providing referrals and bringing awareness to seniors who currently or will need these services. We perform outreach regularly to the Chamber of Commerce/public library/senior housing facilities/ churches/business establishments, places where seniors and/or their families frequent. With a sustained presence in the community we will continue recruitment in multiple languages to attract bilingual volunteers to help us better serve more seniors in need. 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Stanford Health Care1 – ValleyCare Hospital – Daily prepares and packs our nutritious meals, while Spectrum provides all administration for delivery and overall operations 5.1.w Packet Pg. 224 Attachment: 23. Spectrum Community Services - Meals on Wheels for Dublin's Homebound Elderly Application (HS Grant Program FY19 Senior Support Program of the Tri-Valley – Provides a broad range of social services and care management for Spectrum’s seniors, and makes regular referrals to our Meals on Wheels Program. Alameda County Area Agency on Aging – Provides countywide services, a 1-800 number assistance line, and is the primary contractor for Spectrum’s Senior Nutrition (congregate meals) and Meals and Meals On Wheels Programs focused on seniors Eden Information & Referral - Alameda County’s 2-1-1 line that provides a free, non-emergency, confidential, 3-digit phone number and service that provides easy access to housing information, and critical health and human services for all Alameda County residents. Spectrum’s coordinated service network - Enables our Dublin Meals on Wheels Coordinator to effectively provide access to needed supportive services, such as the Senior Support Program of the Tri-Valley. In addition, seniors are often referred to Spectrum’s Low-Income Home Energy Assistance Program and Weatherization services. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. Spectrum’s community marketing/outreach efforts have built awareness of our Meals On Wheels Program among seniors, their families, and the Dublin community. We have and continue to attend City Council meetings, monthly Chamber meetings, present at Dublin Rotary Club meetings, collaborate with local churches, and attend meetings for Tri-Valley Community Service Providers at Axis Community Health, the Anti-Poverty Collaborative, City Serve, the Non-Profit Alliance, and the nonprofit, 1000 Mothers Against Violence, all in an effort to keep Spectrum ‘s Meals On Wheels Program visible as a vital provider of home delivered meals to low/extremely low-income frail, homebound seniors residing in Dublin. Many of these organizations have members who are also volunteers with our program. We partner with the Valley Humane Society to provide pet food to low-income seniors. Pets are important companions for the seniors we serve and ensuring that both the senior and pet have enough food to eat is good for the health of all. Spectrum works closely with the Senior Support Program of the Tri-Valley, which provides a broad range of social services and care management for our senior participants. They refer ailing and disabled Dublin seniors in need to our Meals On Wheels Program. Due to our marketing/outreach efforts, most of the new seniors registering with Spectrum’s Meals On Wheels Program are referrals from Tri-Valley hospitals, doctors offices, and clinics. In addition, each delivery driver has a magnetic sign on his or her car, which helps identify our staff/ volunteers and promotes our program while on the road for delivery routes. The magnets include the Wheels On Wheels Program name and phone number. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. A $13,000 grant award from the City of Dublin will support Spectrum’s Meals On Wheels Program deliver approximately 8,000 meals to 50 unduplicated homebound Dublin seniors in FY 2019-2020. Total cost of a delivered meal is only $9.00 each. No other agency provides this type of service in Dublin. We are part of a greater safety net for the frail homebound elderly in Dublin and, without this service, they would often need substantially more expensive care in nursing homes. Our proposed budget, based on actual program costs, also supports a portion of the salaries and benefits of our Tri-Valley Supervisor and Dublin Meals On Wheels Coordinator, two positions critical to the success of this vital program. Government and private funding sources cover only a portion of the Program’s operating expenses. Given the constraints that Alameda County’s Area Agency on Aging Title III-C and USDA funding imposes on operations for our Meals On Wheels Program, Spectrum has become adept at leveraging these funds to maximum efficiency. We feel the cost-effectiveness of Spectrum’s Meals On Wheels Program is evident in our attached budget. The funding we have requested from the City of Dublin will ensure Spectrum has adequate, highly trained staffing to meet the increased demand in Dublin among homebound seniors, respond promptly to requests for Meals on Wheels services, maintain the high quality of meals and services currently provided to our senior participants, and train/recruit local, diverse volunteers. It will also help ensure the City’s mission to promote/support a high quality of life and ensure a safe and secure environment (for frail homebound seniors). 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Without a full award of requested funds to cover a portion of staff salaries/benefits and meals, it will be extremely difficult to continue serving all of the low/extremely low-income, homebound seniors who vitally need Meals On Wheels in Dublin. Without adequate funding, Spectrum may be forced to cap services, decrease hours for our Tri-City Supervisor and Meals on Wheels Coordinator, making it difficult to effectively provide the high quality services needed by Dublin seniors. We request 5.1.w Packet Pg. 225 Attachment: 23. Spectrum Community Services - Meals on Wheels for Dublin's Homebound Elderly Application (HS Grant Program FY19 the Human Service Commission strongly consider the harmful impact reducing this life-sustaining service will have on seniors who find themselves homebound, unable to prepare meals, or shop for or afford food. Without accessible Meals On Wheels services, homebound seniors recuperating from an illness may be at risk for re-hospitalization and those who are frail elderly with chronic conditions and/or mobility limitations may not be able to receive the nutrition they require. If this service is reduced, it will also put Dublin’s homebound seniors at risk for decreased quality of life and increases their safety risks, which is the City’s primary mission. Spectrum’s FY2019-2020 full funding request will enable Spectrum’s Meals On Wheels Program continue to be responsive to the needs of our vulnerable seniors in the Dublin community. We have been successful in the past year in raising more funds for meals from individuals/foundations/businesses and we will continue our productive efforts to seek new/more diversified revenue sources/increase outreach for more volunteers/in-kind support. However, we need full City funding support in order to effectively deliver quality meals to Dublin seniors. Not funding our personnel costs will mean less funding for meals to our senior participants. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 25. 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. 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process Spectrum’s Meals on Wheels Program helps Dublin carry out its mission by providing nutritious meals/ safety checks to low- income/disabled/homebound seniors. Our services support a higher quality of life and ensures they are safe/secure. We help Dublin achieve its vision through bilingual staff/volunteers, a multi-language/ADA compliant website and information materials, and culturally sensitive meals. Spectrum will continue to help ensure the Dublin community remains happy/healthy/well- balanced. ✔✔✔✔ No gfedc Yes: If yes, please explain: gfedc Yes ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 5.1.w Packet Pg. 226 Attachment: 23. Spectrum Community Services - Meals on Wheels for Dublin's Homebound Elderly Application (HS Grant Program FY19 28. ** QUESTIONS 29 THROUGH 41 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? 29. 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. 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, 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. 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: ✔✔✔✔ Yes. If so, check box here and answer questions 29 through 41. gfedc No. If no, check box here and enter gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. ✔✔✔✔ Be culturally accessible, appropriate and inclusive ✔✔✔✔ Encourage community engagement and involvement gfedc Promote energy and resource efficiency ✔✔✔✔ Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *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. gfedc 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. gfedc F) Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase homeownership gfedc Promote decent affordable housing 5.1.w Packet Pg. 227 Attachment: 23. Spectrum Community Services - Meals on Wheels for Dublin's Homebound Elderly Application (HS Grant Program FY19 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: 35. 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?") 36. 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?") 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: ✔✔✔✔ Strengthen communities gfedc Ensure equal opportunity in housing ✔✔✔✔ Promote participation of grass-roots, faith-based, and other community-based organizations gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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 gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc Reduce housing discrimination. gfedc 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. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Availability/Accessibility gfedc Affordability gfedc Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. 5.1.w Packet Pg. 228 Attachment: 23. Spectrum Community Services - Meals on Wheels for Dublin's Homebound Elderly Application (HS Grant Program FY19 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 39. 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". 40. 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 gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 50 Disabled 15 Women/Female Headed Households 50 Seniors Youth Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 115.00115.00 TOTAL 25 Low Income (50%-80% AMI) 5.1.w Packet Pg. 229 Attachment: 23. Spectrum Community Services - Meals on Wheels for Dublin's Homebound Elderly Application (HS Grant Program FY19 41. 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" 42. 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 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). Spectrum enters each fiscal year with a Board approved/balanced budget, ensuring sustainability/self-sufficiency. A diverse government/private funding base is paramount and we continue to identify new funding sources. We are building our individual giving through a direct mail campaign, specifically focused on individuals concerned about senior hunger. Efforts have been fruitful, including new funds from East Bay Foundation on Aging/Whole Foods/Workday/Service Champions, and several churches in garnering new support. In light of market demand for higher staff wages, we are now using only volunteer drivers, greatly reducing staff costs. However, City funding is vital in safeguarding quality services to current/future Dublin seniors and meeting escalating personnel/food costs. Spectrum will do its share as well, through its continued efforts to guarantee Spectrum’s long-term sustainability/greater self-sufficiency and ensure its capacity to forward its mission to support Dublin 25 Extremely Low Income (<30% AMI) Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 50.0050.00 TOTAL 20 White 4 White + HISPANIC 8 Black/African American Black/African American + HISPANIC 2 Asian Asian + HISPANIC 1 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 15 Multi Racial + HISPANIC OR other Multi Racial Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 50.0050.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. 5.1.w Packet Pg. 230 Attachment: 23. Spectrum Community Services - Meals on Wheels for Dublin's Homebound Elderly Application (HS Grant Program FY19 seniors. 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. BL-006992 Budget top Funding Sources/Revenues Budget Amount Amount Committed Area Agency on Aging USD$ 26,319.00 USD$ 26,319.00 MOWAC USD$ 55,000.00 USD$ 55,000.00 Measure A USD$ 75,000.00 USD$ 75,000.00 City of Livermore USD$ 35,640.00 City of Pleasanton USD$ 22,680.00 Private Donations USD$ 34,000.00 Program Revenue USD$ 50,000.00 Volunteers (In-Kind) USD$ 47,840.00 Total USD$ 346,479.00 USD$ 156,319.00 Funding Uses/Expenses Budget Amount Amount Committed Salaries and Wages USD$ 156,457.00 Benefits USD$ 31,247.00 Supplies USD$ 2,400.00 Postage USD$ 550.00 Telephone USD$ 2,650.00 Rent and Utilities USD$ 1,300.00 Accounting/Audit USD$ 630.00 Contracted Services USD$ 99,664.00 Taxes/Licenses USD$ 1,850.00 Travel & Company Vehicle USD$ 7,200.00 Misc Expense USD$ 7,690.00 In-Kind (Volunteers) USD$ 47,840.00 Total USD$ 359,478.00 USD$ 0.00 Budget Narrative We are asking for $13,000 from the City of Dublin to fund 4% of this project. We will use this funding for the salaries of two key individuals in this life saving service to Dublin residents as well as to continue to try to meet the needs of all of the Dublin 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 - 26% of her salary which is $273.78/mos, $3,286 annually. Individual 2. Tri-Valley Supervisor establishes and fosters partnerships in the Tri-Valley as well as trains, recruits, and appreciates volunteers which is vital to our program - 7% of her salary which is $272.98/mos, $3,276 annually. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information Form List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ Board Roster Current Annual Budget for the Entire Agency ✔✔✔✔ Agency Budget Copy of most recently submitted IRS 990 form or Tax ✔✔✔✔ Form 990 5.1.w Packet Pg. 231 Attachment: 23. Spectrum Community Services - Meals on Wheels for Dublin's Homebound Elderly Application (HS Grant Program FY19 Application ID: 132913 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. Return (include complete form) Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Board Designation Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Board Designation Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Insurance Certificate 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. ✔✔✔✔ Non Profit Determination Letter Certified Audit and/or Certified Financial Statements 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 Affirmative Action REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section Audit REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws Articles of Incorporation By Laws REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) Conflict of Interest Policy 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. LEP/LAP 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) 5.1.w Packet Pg. 232 Attachment: 23. Spectrum Community Services - Meals on Wheels for Dublin's Homebound Elderly Application (HS Grant Program FY19 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline Sunflower Hill Client Centered Vocational Coaching & Training Jump to: Questions Budget Documents USD$ 16,000.00 Requested Submitted: 1/12/2019 10:31:49 AM (Pacific) Project Contact Kathy Layman Kathyl@sunflowerhill.org Tel: (925) 963-9675 Additional Contacts none entered Sunflower Hill P.O. Box 11436 Pleasanton, CA 94588 Executive Director Edie Nehls Edie@sunflowerhill.org Telephone(925) 231-6003 Fax Web www.sunflowerhill.org Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Sunflower Hill's mission is to create sustainable residential communities for individuals with special needs, similar to senior living, which would not only support life-long living opportunities, but also social, vocational and recreational activities. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project ✔✔✔✔ Yes gfedc No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding 5.1.x Packet Pg. 233 Attachment: 24. Sunflower Hill - Client Centered Vocational Coaching & Training Application (HS Grant Program FY19 Recommendations) 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. City of Pleasanton, Youth Commission - $5,881, Grant award, Special Needs Curriculum and Lessons Plan Development City of Pleasanton - $10,000, 2018 grant award, Special Needs Teaching Support City of Livermore - $5,000, 2018 grant award, Special Needs Horticulture Teaching Program City of Livermore - $5,000, 2017 grant award - SFH Gardens teacher and curriculum development for special needs students and interns City of Pleasanton - $5,000, 2017 grant award - SFH Gardens teacher and curriculum development for special needs students and interns $500,000 from Alameda County Board of Supervisors in 2016, towards development of our Residential Communities for Developmentally Disabled adults $5,000 from Alameda County Board of Supervisors in 2016, towards the Sunflower Hill Gardens 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). In April 2019, our Sunflower Hill Gardens will have been successfully in operation for 4 full years, providing horticulture training to high school special day / transition programs, adult day programs, family work days plus vocational training for our Gardens Field Technicians. The students, field technicians and families are residents from the various cities in the Tri-Valley area. The SFH Gardens Horticulture program is lead by two part-time employees. Lina is our horticulture expert for the garden design, planting, irrigation, pest control, etc. and provides horticulture knowledge and tasks for the curriculum and skills training. Rebecca is our horticulture program teacher for the 14 groups from local high school special day and transition classes plus many local adult day programs. We additionally have 2 volunteer Master Gardeners that advise and participate with SFH on a regular basis. Our horticulture program focuses on three main objectives: Horticulture knowledge, Life Skills training and practice, and Healthy Quality of Life. In our classes, we emphasize trying new foods and making healthy food choices. In November, we hired a part-time Vocational Coach to create and provide client centered coaching to our employees and Field Technicians, helping them develop in areas where they would like to grow and encouraging them to learn a new set of skills to add to their life skills tool kit and enabling their success in other future jobs. Our Vocational Coach has worked with individuals with autism for the past 11 years and is a licensed marriage and family therapist who has worked in schools and private practice. From her experience, she has learned that working with these individuals in a community based setting opens up a variety of opportunities to increase their independence and self-esteem which are important elements to their ultimate success in the workforce and contributing to the community. 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. With the hiring of our Vocational Coach, we want to evolve our vocational program to implement focused training, coaching and mentoring needed to enable individual success based on their capabilities, skills and goals. 9. 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.) 37 10. 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 Concern. gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) ✔✔✔✔ Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse ✔✔✔✔ Disabilities ✔✔✔✔ Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity 5.1.x Packet Pg. 234 Attachment: 24. Sunflower Hill - Client Centered Vocational Coaching & Training Application (HS Grant Program FY19 Recommendations) 11. How will this project will be implemented, administered, and operated? Sunflower Hill Gardens operates in Livermore. Horticultural classes for neurodiverse individuals meet three times a week; class is in session 45 weeks out of each calendar year. Our garden is staffed and open to volunteers 49 Saturdays a year. We host three family work days as a way for the DD community to come together. All of these programs are provided to our community at no cost. Our staffing plan requires that we have 1 neurotypical individual for every 3 neurodiverse individuals working in the garden. As you can imagine this takes many volunteers and staff to implement. This year, SFH committed to deepening our client centered curriculum by hiring a part-time Vocational Coach, Allison Arons. Allison is tasked with assessing how our program currently operates as a therapeutic garden and to make recommendations to better serve our clients. Allison is formalizing our internship program for both neurotypical and neurodiverse individuals, and will work closely with our special needs gardens employee. She will coach garden staff on best practices for working with autistic individuals. Allison’s work will impact all of the classes as we build upon the life skills and vocational curriculum our SN Teacher developed last year. She will ensure a client centered focus on tasks and activities by developing individual goals which will build skills and experiences necessary for future employment. She will work with them on decision making, communication, task completion, and basic life skills. With each individuals goals and objectives in mind, she will coach them on job preparation, planning and execution skills and will supervise, direct tasks, monitor progress and initiative with next activities, etc. She will work with our neurotypical interns teaching them how to adapt communication, activities, and interactions to be more effective and less frustrating for our population group. Our hope is that our client-focused coaching will prepare them for future employment. 12. Describe in detail how Dublin grant funds will be used for this project. (What specifically will the grant funds be used for?) The award from the City of Dublin grant will help fund our newly hired part-time Vocational Coach and soon-to-be-hired neurodiverse Gardens employee. Our Coach will work with our employee, interns and program staff to ensure all clients are furthering their training, education and experiences with job skills such as teamwork, work stamina, time management, following directions, asking questions and interpreting answers, receiving feedback and everyday communication clues while at the garden. Gaining these skills will improve our client's confidence and adaptability in their current and future jobs or careers. As a first step, this coaching and mentoring will enable our clients to independently start work upon arrival at their Gardens, check job boards and ask questions if something is confusing plus gain leadership skills to help others with tasks. As part of this program, we also want to offer our summer Interns a small stipend at the end of the Internship for their hard work, participation and dedication to working with and learning about this diverse group of individuals and getting personal experience with the complexities, joy and adaptations that make working with the diverse group so rewarding and meaningful as they seek to find a place to lead successful, productive lives in our community. 13. 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)? As Sunflower Hill has newly created this role within the organization, the first year will be an important time for Allison Arons, our Vocational Coach, to assess areas where we can adapt our gardens program to more successfully support our constituents. This will include working closely with employees and fields technicians to set their individual goals, hiring and coaching on workplace expectations, i.e., adhering to a schedule, tracking time in/out, accomplishing tasks, and setting goals. We do not anticipate this to be easy to quantify, but that measurable results will be the daily successes achieved as our students, employees and field technicians develop life skills and work place skills needed in the workforce on a daily basis. These will be small wins, a little at a time. 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. There are two population groups that are served by SFH Gardens with our horticulture classes and donations. The first group are the neurodiverse youths and adults that attend the horticulture classes from the local high school special day programs (14 - 22 years old), local high school transition programs (18 -22 years old), adult day programs (22 years and older) and Gardens employees / Field Technicians (22 years and older). These groups are all considered disabled and low-income. The vocational coaching contributes to their continued learning of life and job skills that will help them in other vocational programs, college classes or jobs. The second group are the low-income individuals and families that receive the donations from the local kitchens and food pantry, with harvest from SFH Gardens. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? The city of Livermore owns Hagemann Ranch and leases part of that Ranch - a one-acre farm - to SFH Gardens with the requirement that we service low-income and disadvantaged individuals and families in our local communities. We are also gfedc Financial Assistance gfedc None of the above gfedc Please explain: 5.1.x Packet Pg. 235 Attachment: 24. Sunflower Hill - Client Centered Vocational Coaching & Training Application (HS Grant Program FY19 Recommendations) required to donate at least 51% of the produce grown to local food kitchens for distribution to low-income families and individuals. We serve individuals with developmental disabilities (neurodiverse) in our horticulture programs and low-income individuals in our donations of food. In the US, 1 in 6 children are diagnosed with one or more developmental disabilities (15% of children ages 3 - 17). These disabilities begin during the childhood developmental period and usually continue throughout adulthood. This population is important to our communities and represent an overlooked population in terms of services, living opportunities, job choices, social interactions, community participation, etc. It is important for cities to solicit and implement programs that can address this population and their specific needs in the communities just as was done in the 80's for the senior/elderly population group. The SFH Gardens horticulture program is our first program created to provide educational and vocational opportunities to individuals that have limited options, particularly with vocational jobs. There aren't many vocational jobs available to neurodiverse individuals, unpaid or paid. By implementing the vocational coaching, we will continue to reinforce and work on life skills and job skills that are crucial to this group in their everyday lives and future jobs. We are also developing a program at Stable Cafe at the Alameda County Fairgrounds that could develop a different set of job skills and opportunities for our population group. We feel that this approach will make a tremendous difference with vocational, job skills and life skills training that is essential to the success of this population group 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? SFH Gardens currently has 14 different school or adult daycare programs and 2 summer programs attending the horticulture classes on a regular basis. These programs were initially started via direct contact with school districts, transition programs and adult programs in the area plus word of mouth from one teacher or aide to another, soliciting their interest in outside programs to continue educational, voacational and life skills training and experience opportunities. Our classes enable outreach to parents, guardians, conservators and teacher across the Tri-Valley areas via special needs events, community events and of course teacher discussions with others in their network of contacts. Our Gardens staff continually reach out and respond to questions about the program with other local school districts and adult programs who have heard about us and potentially want to be involved. In some ways, the special needs community is small and families interact with other special needs families via Special Olympics events, community sponsored events, school functions, outreach events sponsored by agencies offering services to special needs individuals and families. Sunflower Hill gets discussed at these events because of the communities in development and because of the SFH Gardens activities. Family work days occur 3 times per year where special needs families, friends and local community members visit the Gardens to volunteer or participate in Gardens events (Spring planting, summer harvesting, pumpkin festival, winter celebration, etc.). This is another sort of outreach that identifies new groups for our classes, internship program and food donation agencies. We also regularly post information and solicit participation via our website, Facebook, Twitter and publish a monthly Newsletter. 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Sunflower Hill Gardens partners with the following organizations: 1. School Districts to provide horticulture students - Dublin, Pleasanton, Livermore, San Ramon - Students in Special Day classes - Students in Transition classes 2. Adult day programs to provide horticulture students - RES - Danville - Futures Explorer - SVS - ELM (Enjoy Life More) - Kaleidoscope (future - disussions in progress!) 3. Providing meals via kitchens and shelters - Open Heart Kitchens - provides 300,000 meals a year, adding healthy choices from SFHG - Tri-Valley Haven - Carmen Avenue Apartments - Shepherd's Gate - Marilyn Avenue School - Meals on Wheels 5.1.x Packet Pg. 236 Attachment: 24. Sunflower Hill - Client Centered Vocational Coaching & Training Application (HS Grant Program FY19 Recommendations) 4. Community Service participation and volunteer community services hours: - Livermore Valley Rotary - Rotary Club of Livermore - Pleasanton North Rotary - Rotary Club of Pleasanton - Rotary Club of Danville / Sycamore Valley Community Foundation - Pleasanton Boys Team Charity - Pleasanton Girls National Charity League - Local Boy Scout troops - Eagle Scout Projects - Community Church program and missions - Fundraising events at local businesses and wineries 5. Corporate Community Support - team building and volunteer day in the Gardens - Sandia National Laboratories - Salesforce - Sensiba San Filippo 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. As stated above, we continually reach out to school districts, special day classroom teachers and aides, adult day programs, special olympics coaches and volunteers to provide information about our SFH Gardens program as the opportunities for neurodiverse individuals to comfortably and ably participate in are limited. Our Gardens is a safe environment that appeals to all ages and abilities. Additionally the food donations to local food banks and kitchens also provide outreach opportunities for additional volunteers, ideas for possible new program attendance to our classes, and new agencies for donations. We take every opportunity with volunteers, our fundraising events, community events where we participate, family work days in the Gardens, etc. to discuss SFH and our mission with the Developmentally Disabled community. We also regularly post on Twitter and Facebook to provide updates and photos of interest and to provide recent information about progress with the communities and activities at the Gardens. In addition, we publish a monthly newsletter to provide updates on what's happening and upcoming future events. Family work days in the Gardens (3 times per year) are also an opportunity for outreach where families and local community members come to volunteer in the Gardens and the garden events. This allows us to learn about local corporations that might be interested in our cause and that might have corporate matching processes in place that could be set up for additional benefit to SFH. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. We are thrilled to have hired our Vocational Coach as she is highly skilled with working with the neurodiverse population and has a license in Marriage and Family Counseling where she has worked in school and private settings. She will be working 12 hours per week over 45 weeks which takes into account the school sessions, holidays, etc. so we don't waste her hours when we don't have clients or employees in the Gardens. We planned our Gardens employee at 10 hours per week spread over the same 45 weeks of the year. We feel the hourly rates are reasonable and have budgeted $5 per hour for benefits which applies to our other SFH employees as well. We have also included in our program details a cell phone plan for her job use plus have included her continuing education class cost to keep her license current as we feel it is critical to her role and responsibilities to this program. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? If we don't receive funding or receive reduced funding, we will continue to solicit other grants to help fund this client-centered individual focused program approach but we may not be able to do as much coaching/mentoring for as many clients in our programs and with our employees as we would like. Depending on the level of reduced funding decisions, we would use the reduced funds first to partially support our vocational teacher which is critical creating the client focused approach to training, learning life skills and acquiring job skills. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for ✔✔✔✔ No gfedc Yes: If yes, please explain: 5.1.x Packet Pg. 237 Attachment: 24. Sunflower Hill - Client Centered Vocational Coaching & Training Application (HS Grant Program FY19 Recommendations) construction, equipment, furniture, fixtures)? 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 25. 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. 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process Our client centered Vocational Coaching seeks to enable the neurodiverse community to have a high quality of life by enabling them to acquire and retain jobs that provide meaning to their lives and allows them to contribute to the community via the donations to food banks and kitchens. Our SFH Gardens also promotes an active lifestyle through the Gardens activities / tasks - digging, planting, weeding, post harvest preparations, etc. We have many community members volunteering on Saturdays 28. ** QUESTIONS 29 THROUGH 41 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? 29. 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 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: gfedc Yes ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. ✔✔✔✔ Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. gfedc Yes. If so, check box here and answer questions 29 through 41. ✔✔✔✔ No. If no, check box here and enter gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers 5.1.x Packet Pg. 238 Attachment: 24. Sunflower Hill - Client Centered Vocational Coaching & Training Application (HS Grant Program FY19 Recommendations) 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *Promote fair housing and reduce housing discrimination. gfedc 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: gfedc * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. gfedc * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. gfedc C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. gfedc D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. gfedc 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. gfedc Increase homeownership gfedc Promote decent affordable housing gfedc Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. gfedc Improving the quality of life for our Nation's communities gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc Reduce housing discrimination. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. 5.1.x Packet Pg. 239 Attachment: 24. Sunflower Hill - Client Centered Vocational Coaching & Training Application (HS Grant Program FY19 Recommendations) 35. 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?") 36. 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?") 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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 5.1.x Packet Pg. 240 Attachment: 24. Sunflower Hill - Client Centered Vocational Coaching & Training Application (HS Grant Program FY19 Recommendations) 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 39. 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". 40. 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 41. 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" new businesses that remain operational for three years after assistance. gfedc 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. gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. Disabled Women/Female Headed Households Seniors Youth Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL 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) 0.000.00 TOTAL 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 5.1.x Packet Pg. 241 Attachment: 24. Sunflower Hill - Client Centered Vocational Coaching & Training Application (HS Grant Program FY19 Recommendations) 42. 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 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). We write grants and get financial and infrastructure support from many local charities, corporations and businesses that have a passion for our cause - to help the neurodiverse population have a safe and affordable place to live and job/program opportunities to enrich their lives. We also have private and anonymous donors that donate on a regular basis. Additionally we conduct a very successful fundraiser each year in July which raises quite a bit of money that goes to our operational budget which ended on a very positive note this year. This year we are also kicking off a capital campaign to help fund items (commercial kitchen, equipment and furniture, etc.) and personnel costs for our Irby Ranch community in Pleasanton which will start construction around March 2019 with move-in planned for June 2020. We have also begun investing in an endowment fund and are committed to growing that for the future of the organization. 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. BL-110708 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) 0.000.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed SFH Operations Budget USD$ 14,200.00 USD$ 14,200.00 City of Dublin USD$ 16,000.00 USD$ 0.00 Total USD$ 30,200.00 USD$ 14,200.00 Funding Uses/Expenses Budget Amount Amount Committed Employee Salaries USD$ 18,450.00 USD$ 4,950.00 Employee Benefits USD$ 4,950.00 USD$ 4,950.00 Supplies and Materials USD$ 5,000.00 USD$ 2,500.00 Employee Cell Phone USD$ 300.00 USD$ 300.00 Intern Stipends USD$ 1,250.00 USD$ 1,250.00 Other - Continuing Education classes USD$ 250.00 USD$ 250.00 Total USD$ 30,200.00 USD$ 14,200.00 Budget Narrative Funding Request of $16,000 to cover Vocational Coach 540 hours at $25/hr rate in 2019/2020 city fiscal year which amounts to $13,500. Additionally requesting $2,500 in the grant to cover materials and supplies needed as part of the vocational coaching activities specific to the needs of each individual client. 5.1.x Packet Pg. 242 Attachment: 24. Sunflower Hill - Client Centered Vocational Coaching & Training Application (HS Grant Program FY19 Recommendations) Remaining budget required for the program is to be covered by SFH operational budget ($14,200) which includes the neurodiverse Gardens employee 450 hours at $11/hr rate ($4950), benefits for the Vocational Coach and Gardens employee ($4950), cell phone plan for Vocational coach ($300), stipend for 2 interns in the summer ($1250) and continuing education credit dollars for Vocational Coach ($250) to keep her license current. We are forecasting at this time contributed income from grants, annual giving, corporate and trustee giving to be just over $100,000 so feel we have the funds to make up the difference to operate the program with the funds received from the city of Dublin. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Form_2019-2020_Sunflower Hill Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Program Finance Information_2019-2020_Sunflower Hill List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ SFH Directory Current Annual Budget for the Entire Agency ✔✔✔✔ SFH_2018_Balance Sheet Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ SFH 990 Tax Return_2017 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ SFH Bylaws Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ SFH Bylaws Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ SFH Proof of Insurance 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. ✔✔✔✔ SFH - Federal Tax Exempt Status Letter SFH CA State Tax Exempt Status Letter Certified Audit and/or Certified Financial Statements SFH 990 Tax Return_2017 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 SFH Moonlight in the Vines Fundraising event video 5.1.x Packet Pg. 243 Attachment: 24. Sunflower Hill - Client Centered Vocational Coaching & Training Application (HS Grant Program FY19 Recommendations) Application ID: 131597 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. Plan, Needs Assessment, etc. (Not Required) SFH - Vocational programs video SFH Gardens By the Numbers Other Supporting Documents (Not Required) SFH - Dublin Business License 5.1.x Packet Pg. 244 Attachment: 24. Sunflower Hill - Client Centered Vocational Coaching & Training Application (HS Grant Program FY19 Recommendations) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline Tri-Valley Haven Domestic Violence Services Program Jump to: Questions Budget Documents USD$ 25,000.00 Requested Submitted: 1/11/2019 3:56:00 PM (Pacific) Project Contact Irina Milinevskaya irina@trivalleyhaven.org Tel: (925) 449-5845 Additional Contacts cynthia@trivalleyhaven.org Tri-Valley Haven 3663 Pacific Avenue Livermore, CA 94550 United States Executive Director Ann King ann@trivalleyhaven.org Telephone(925) 449-5845 x Fax (925) 449-2684 x Web www.trivalleyhaven.org Questions top 1. Select the category that best describes your organization: (Select only one.) 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.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding 5.1.y Packet Pg. 245 Attachment: 25. Tri-Valley Haven - Domestic Violence Services Program Application (HS Grant Program FY19 Recommendations) 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. Tri-Valley Haven's funding portfolio is intentionally diverse. Our programs receive funding from local jurisdictions (Dublin, Livermore, Pleasanton), Alameda County, the State and the Federal Government. Below please see the funding sources for the Domestic ViolenceServices Program for the past three years: FY 18/19 Local Dublin/Livermore/Pleasanton $57,625 Alameda County DVCA $44,943 Alameda County Family Justice Center $10,000 CalWORKS $44,017 EFSP $12,000 HCD Linkages $40,577 Individual Donations/Foundations $30,000 CalOES DV $339,380 FY 17/18 Local Dublin/Livermore/Pleasanton $50,600 Alameda County DVCA $44,943 Alameda County Family Justice Center $10,000 CalWORKS $44,017 EFSP $14,000 HCD Linkages $40,577 Individual Donations/Foundations $25,208 CalOES DV $326,410 FY 16/17 Local Dublin/Livermore/Pleasanton $32,000 Alameda County DVCA $44,943 Alameda County Family Justice Center $10,000 CalWORKS $44,017 EFSP $16,000 HCD Linkages $40,577 Individual Donations/Foundations $48,518 CalOES DV $325,374 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). Founded in 1977, Tri-Valley Haven is the premier provider of shelter and support services for victims of domestic violence, sexual assault, homelessness and hunger. What began as a crisis hotline run out of a founding Board Member’s garage, the Haven has grown to be the most comprehensive safety net program in the Tri-Valley. Today our programs include: Shiloh, our 30 bed domestic violence safe house, 24/7 crisis hotline for domestic violence and sexual assault, Rape Crisis Center, Violence Prevention Education, Legal Clinic, Individual and Group Therapy, Sojourner House 16 Bed Family Shelter, Food Pantry, and a Thrift Store. Notably, both our shelters are the only shelters locally that allow teen boys to stay with their families and our family shelter is the only local shelter to admit two parent families as well as single fathers with their children. Through innovation and dedication, the Haven has developed the resources to confront domestic violence, homelessness and hunger. Tri-Valley Haven's major governing body is the Board of Directors. Each Board Member's term is two years. Our Management team consists of the Executive Director and five managers. Tri-Valley Haven has its own Finance and Compliance Department. All of our Direct Service staff such as Case Managers, Life Skills Instructors etc. are required to have a Bachelors Degree or equivalent life experience. Direct Service staff all complete 65-hour State approved training. The Director of Homeless and Family Support Services overseeing Sojourner House has 34 years of experience managing residential programs and the Food Pantry Coordinator has 18 years of experience managing community Food Programs. gfedc None 5.1.y Packet Pg. 246 Attachment: 25. Tri-Valley Haven - Domestic Violence Services Program Application (HS Grant Program FY19 Recommendations) 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. Shiloh is a 30 bed confidential shelter and support services for women and children fleeing family violence. Adult male victims receive short term shelter at motels or longer term shelter at Sojourner House, our family shelter. 9. 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 10. 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 Concern. 11. How will this project will be implemented, administered, and operated? Tri-Valley Haven's 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, 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. 12. Describe in detail how Dublin grant funds will be used for this project. (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 staff's time. These positions are essential for the shelter operations. 13. 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)? 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. gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development ✔✔✔✔ Homelessness gfedc Transportation Services and Access ✔✔✔✔ Domestic Violence and Child Abuse gfedc Disabilities ✔✔✔✔ Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above gfedc Please explain: 5.1.y Packet Pg. 247 Attachment: 25. Tri-Valley Haven - Domestic Violence Services Program Application (HS Grant Program FY19 Recommendations) 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. Shiloh serves women survivors of Domestic Violence and their children due to the communal living layout of the shelter. Male victims can utilize our crisis line, counseling and legal services. Short term shelter for male survivors is provided through motel vouchers funded by donations. Male victims requiring longer term shelter may be housed at Sojourner House, our homeless family shelter, where they have access to all of the services available through Shiloh. 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 FY 17/18, we served 91 survivors of domestic violence from Dublin through our crisis line and shelter. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? 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. 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, 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 the Shelter 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. The most recent projects were focused on serving the needs of African-American and Asian/Pacific Islander communities. 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 will be expanding the scope of the Bilingual Case Manager funded by this grant to include a domestic violence support group in Spanish for community clients, and providing additional outreach to the Spanish-speaking community to increase awareness of our services. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? We conduct outreach through many of our programs such as the Food Pantry, 24-hour crisis line and social media. We also participate in community health fairs and outreach events such as Dublin Pride week, we attend monthly meeting with CityServe, where local providers can share their needs, volunteer opportunities and program updates. 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 in- person intake processes include questions about needed accommodations (such as a bottom bunk, private room or special dietary needs). Our shelter is handicap-accessible. All of our agency literature is available in Spanish. 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. We have developed partnerships with many local businesses and community organizations, that support our programs. Particularly, the Trader Joe's and Walmart in Pleasanton donate food to our Food Pantry twice a week, every year Harvest Park Middle school collects non-perishable food items for our Holiday Program, Castlewood Country Club supports our program with multiple drives every year. We truly appreciate those partnerships. In addition to that, we have Operational Agreements with over 60 organizations including Police Departments from Livermore, Dublin and Pleasanton, District Attorney's Offices, local school Districts, other domestic violence and homeless shelters, hospitals, and social service agencies. The Haven's community linkages go beyond the Tri-Valley area via collaborations with agencies throughout the Alameda County, including the Alameda County Family Violence Council, the CalWORKS Domestic Violence Advisory Board, and the Alameda County Everyone Home. The Haven, together with five other agencies participates in the Alameda County Housing-Jobs Linkages Program to help clients obtain long-term housing, and achieve self-sufficiency. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. In 2017 we began offering 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 5.1.y Packet Pg. 248 Attachment: 25. Tri-Valley Haven - Domestic Violence Services Program Application (HS Grant Program FY19 Recommendations) 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 teams at Kaiser Permanente in Livermore and Pleasanton, and look forward to also partnering with the staff at the new Dublin Kaiser Permanente facility which will be opening this year. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. 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. All of this contributes to a very reasonable budget. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Our goal would be not to reduce staff hours, as these positions are essential to our program. We will work diligently to increase our fundraising throughout the grant period. We will be bringing back a very popular fundraiser, “The Vagina Monologues” in April, and in October, we hold our annual Pace for Peace 5K/10K walk run. We also reach out to foundations and private donors to increase our revenue. We conduct at least three mail appeals to donors every year, and network in the community to develop connections with service clubs, houses of worship and local businesses who support our efforts. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 25. 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. 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. ✔✔✔✔ No gfedc Yes: If yes, please explain: gfedc Yes ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 5.1.y Packet Pg. 249 Attachment: 25. Tri-Valley Haven - Domestic Violence Services Program Application (HS Grant Program FY19 Recommendations) Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 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. 28. ** QUESTIONS 29 THROUGH 41 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? 29. 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 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: gfedc Yes. If so, check box here and answer questions 29 through 41. ✔✔✔✔ No. If no, check box here and enter gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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: gfedc *Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *Promote fair housing and reduce housing discrimination. gfedc 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: gfedc * Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. gfedc * Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. gfedc C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. gfedc D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. gfedc 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. gfedc Increase homeownership gfedc Promote decent affordable housing gfedc Strengthen communities gfedc Ensure equal opportunity in housing gfedc Promote participation of grass-roots, faith-based, and other community-based organizations ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. 5.1.y Packet Pg. 250 Attachment: 25. Tri-Valley Haven - Domestic Violence Services Program Application (HS Grant Program FY19 Recommendations) 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: 35. 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?") 36. 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?") 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc Provide increased homeownership and rental opportunities for low and moderate-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. gfedc Improving the quality of life for our Nation's communities gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. gfedc End chronic homelessness within ten years. gfedc Removal of barriers to affordable housing. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc Reduce housing discrimination. gfedc 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. gfedc Maintain and expand activities designed to prevent those currently housed from becoming homeless. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. 5.1.y Packet Pg. 251 Attachment: 25. Tri-Valley Haven - Domestic Violence Services Program Application (HS Grant Program FY19 Recommendations) 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 39. 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". 40. 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 gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. 0 Disabled 0 Women/Female Headed Households 0 Seniors 0 Youth 0 Homeless N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL 0 Low Income (50%-80% AMI) 0 Extremely Low Income (<30% AMI) N/A Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0.000.00 TOTAL 5.1.y Packet Pg. 252 Attachment: 25. Tri-Valley Haven - Domestic Violence Services Program Application (HS Grant Program FY19 Recommendations) 41. 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" 42. 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 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). We actively fundraise throughout the year and reach out to both corporate and private donors. We hold donor appreciation events annually including last year’s bay area tour: Peace on the Potomac. We have recently been successful in securing support from foundations, such as Pinpoint whose criteria categories match the services provided in our programs. In 2013 Tri-Valley Haven opened a Thrift Store, with the expectation of generating ample revenue to put back funds, i.e. revenue over expenses, in support of program services offered the community. This has been a reality since March 2017. 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. BL-007058 0 White 0 White + HISPANIC 0 Black/African American 0 Black/African American + HISPANIC 0 Asian 0 Asian + HISPANIC 0 American Indian/Alaskan Native 0 American Indian/Alaskan Native + HISPANIC 0 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 0 Asian and White 0 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) 0.000.00 TOTAL gfedc #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. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed 5.1.y Packet Pg. 253 Attachment: 25. Tri-Valley Haven - Domestic Violence Services Program Application (HS Grant Program FY19 Recommendations) Alameda County Domestic Violence Service Center Act USD$ 44,943.00 USD$ 0.00 Alameda County Family Justice Center USD$ 10,000.00 USD$ 10,000.00 Local Dublin/Pleasanton/Livermore USD$ 79,000.00 USD$ 0.00 HCD Linkages USD$ 40,577.00 USD$ 0.00 CalOES DV USD$ 533,257.00 USD$ 0.00 CalWORKS USD$ 44,017.00 USD$ 0.00 Individual Donations/Foundations USD$ 40,000.00 USD$ 40,000.00 Total USD$ 791,794.00 USD$ 50,000.00 Funding Uses/Expenses Budget Amount Amount Committed Bilingual Case Manager, 27% of Salary and Benefits USD$ 13,745.00 USD$ 0.00 Overnight Staff, 25% of Salary and Benefits USD$ 11,255.00 USD$ 0.00 Other Program Staff USD$ 615,900.00 USD$ 0.00 Supplies USD$ 35,000.00 USD$ 0.00 Printing/Copying USD$ 5,000.00 USD$ 0.00 Telephone USD$ 15,000.00 USD$ 0.00 Rent and Utilities USD$ 55,300.00 USD$ 0.00 Accounting/Audit USD$ 11,000.00 USD$ 0.00 Other Operating Expenses USD$ 29,594.00 USD$ 0.00 Total USD$ 791,794.00 USD$ 0.00 Budget Narrative Revenue: The composition of revenue is our best estimate based on the previous years 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 etc. thus only a portion of Liability Insurance, Auto Insurance, Audit etc. being charged to this Program. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ TVH Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ TVH Financial Information Form List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ TVH List of Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ TVH Agency Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ TVH 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ TVH Board of Directors designation of authorized official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ TVH Board of Director's authorization to request funding Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ TVH Proof of Insurance 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 ✔✔✔✔ TVH State Non-Profit Letter TVH Federal Non-Profit Letter 5.1.y Packet Pg. 254 Attachment: 25. Tri-Valley Haven - Domestic Violence Services Program Application (HS Grant Program FY19 Recommendations) Application ID: 131161 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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 Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) 5.1.y Packet Pg. 255 Attachment: 25. Tri-Valley Haven - Domestic Violence Services Program Application (HS Grant Program FY19 Recommendations) Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin 2019-2020 Human Services Grant Program 1/14/2019 deadline Tri-Valley Haven Homeless Services Program Jump to: Questions Budget Documents USD$ 25,000.00 Requested Submitted: 1/11/2019 3:16:42 PM (Pacific) Project Contact Irina Milinevskaya irina@trivalleyhaven.org Tel: (925) 449-5845 Additional Contacts cynthia@trivalleyhaven.org Tri-Valley Haven 3663 Pacific Avenue Livermore, CA 94550 United States Executive Director Ann King ann@trivalleyhaven.org Telephone(925) 449-5845 x Fax (925) 449-2684 x Web www.trivalleyhaven.org Questions top 1. Select the category that best describes your organization: (Select only one.) 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.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding 5.1.z Packet Pg. 256 Attachment: 26. Tri-Valley Haven - Homeless Services Program Application (HS Grant Program FY19 Recommendations) 6. Please describe any funding received from other Cities, County, State or Federal government within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N/A" if the project has not previously received any government funding. Tri-Valley Haven's funding portfolio is intentionally diverse. Our programs receive funding from local jurisdictions (Dublin, Livermore, Pleasanton), Alameda County, the State and the Federal Government. Below please see the funding sources for the Homeless Services Program for the past three years: FY 18/19 Local Dublin/Livermore/Pleasanton $99,625 Alameda County SSA $166,977 EFSP $20,000 HCD Linkages $42,820 Individual Donations/Foundations $12,500 FY 17/18 Local Dublin/Livermore/Pleasanton $91,578.75 Alameda County SSA $161,330 EFSP $20,000 HCD Linkages $42,820 Individual Donations/Foundations $12,000 FY 16/17 Local Dublin/Livermore/Pleasanton $40,000 Alameda County SSA $149,487 EFSP $20,000 HCD Linkages $42,820 Individual Donations/Foundations $10,000 7. Please provide information to demonstrate your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). Founded in 1977, Tri-Valley Haven is the premier provider of shelter and support services for victims of domestic violence, sexual assault, homelessness and hunger. What began as a crisis hotline run out of a founding Board Member’s garage, the Haven has grown to be the most comprehensive safety net program in the Tri-Valley. Today our programs include: Shiloh, our 30 bed domestic violence safe house, 24/7 crisis hotline for domestic violence and sexual assault, Rape Crisis Center, Violence Prevention Education, Legal Clinic, Individual and Group Therapy, Sojourner House 16 Bed Family Shelter, Food Pantry, and a Thrift Store. Notably, both our shelters are the only shelters locally that allow teen boys to stay with their families and our family shelter is the only local shelter to admit two parent families as well as single fathers with their children. Through innovation and dedication, the Haven has developed the resources to confront domestic violence, homelessness and hunger. Tri-Valley Haven's major governing body is the Board of Directors. Each Board Member's term is two years. Our Management team consists of the Executive Director and five managers. Tri-Valley Haven has its own Finance and Compliance Department. All of our Direct Service staff such as Case Managers, Life Skills Instructors etc. are required to have a Bachelors Degree or equivalent life experience. Direct Service staff all complete 65-hour State approved training. The Director of Homeless and Family Support Services overseeing Sojourner House has 34 years of experience managing residential programs and the Food Pantry Coordinator has 18 years of experience managing community Food Programs. 8. Provide a concise summary of the project (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. Funding will support Tri-Valley Haven’s Homeless and Family Support Service programs. TVH’s family shelter provides homeless clients with support services while the Food Pantry provides nutritious food to low income & homeless Tri-Valley residents. 9. 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 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your gfedc None 5.1.z Packet Pg. 257 Attachment: 26. Tri-Valley Haven - Homeless Services Program Application (HS Grant Program FY19 Recommendations) project identify with? Please explain how your project meets the selected Areas of Concern. 11. How will this project will be implemented, administered, and operated? Tri-Valley Haven’s Homeless and Family Support Services program offers assistance to Dublin residents through Sojourner House, our family homeless shelter, and at our Food Pantry. Both programs have been in operation since 2002. TVH’s family shelter provides homeless clients (women, women with children, men with children, and two parent families 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. Adult shelter clients are provided case management, life skills classes and counseling services. Assessments are made on each client with regards to individual needs, i.e. health, mental health, housing, employment, public entitlements. Weekly Parenting Classes and Life Skills groups are held. Counseling services are available to shelter clients at TVH’s community building. Food Pantry provides nutritious food to low income, homeless, and “at risk of becoming homeless” Tri-Valley residents. The FP is open afternoons on Monday through Friday. On average 35-50 households are provided assistance day. In addition to government food items clients are provided donated food, including fresh bread, eggs, meat and produce donated from local stores such as Whole Foods, Trader Joe’s, Walmart, the Walmart Neighborhood Store, Target, Raley’s/Nob Hill, Grocery Outlet and Safeway. On the second Friday of each month our Mobile FP distributes food to three housing complexes in Dublin (Carlow Court/Wexford/ Wicklow Apartments). These efforts assist individuals who are not able to travel to the food pantry site. On average 60-70 households are assisted monthly through this endeavor. We are very thankful for our dedicated volunteers that make TVH’s Food Pantry a reality. Over twenty volunteers assist each week to pick up and sort food donations, stock shelves and provide counter assistance. 12. Describe in detail how Dublin grant funds will be used for this project. (What specifically will the grant funds be used for?) The funds requested from Dublin will be used to pay part of the Sojourner House Case Manager's time and part of the Food Pantry Coordinator's time. 13. 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)? We believe that our Homeless and Family Support Services continue to be a success. We define success in terms of both the quality of our services and in our ability to meet, and hopefully exceed, the needs of our program participants from the Tri- Valley community. The success of our programs will be measured through evaluation of client surveys, statistical results, and at the shelter the individual goals set by the program participant and their Case Manager. Those goals will include the securing of employment, permanent housing and addressing health and mental health needs. Long-term self-sufficiency achieved by our clients would be a success. The Food Pantry will continue to provide households with an abundance of nutritious foods. 14. Describe the population your agency anticipates serving with these funds and how clients/customers will benefit from the implementation of this project, i.e. seniors, youth, disabled, low-income, etc. Our Homeless Shelter 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 benefit from receiving case management, job and housing search coaching. They will be connected to the housing resources locally and county wide. Our staff will make sure that every possible opportunity is being utilized for the local families to obtain permanent housing. Clients will also benefit from our Food Pantry by receiving free groceries that in many cases they are not able to afford. In addition to serving Dublin residents at our Food Pantry, we also offer a monthly mobile pantry in Dublin for households that are unable to visit our Livermore Pantry site due to mobility and/or transportation issues. gfedc Behavioral Health (mental health and substance abuse) ✔✔✔✔ Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development ✔✔✔✔ Homelessness ✔✔✔✔ Transportation Services and Access ✔✔✔✔ Domestic Violence and Child Abuse gfedc Disabilities ✔✔✔✔ Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the above gfedc Please explain: 5.1.z Packet Pg. 258 Attachment: 26. Tri-Valley Haven - Homeless Services Program Application (HS Grant Program FY19 Recommendations) Last Fiscal year our Homeless Shelter served 72 unduplicated clients, providing 5451 bednights, while the Food Pantry served 5230 unduplicated clients. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client/customer population served)? We have multi-cultural staff members and volunteers who utilize their cultural backgrounds to enhance the services in the Homeless and Family Support Services Program. We presently have multiple staff fluent in Spanish. Additionally staff is available to provide assistance in Russian, Punjabi, Hindi, French, and Finnish. Multi language fluency is always a consideration when hiring staff and recruiting volunteers, and wage differentials are given to those fluent in Spanish. All of the Sojourner House (Homeless Shelter) and the Food Pantry intake forms, paperwork and flyers are in English and Spanish, and at the Food Pantry flyers are available 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 the capacity to offer ethnic food when needed. 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How will each of these groups access the project for which your agency is requesting funding? We conduct outreach to low income, limited English speakers and disabled individuals through many of our programs such as the Food Pantry, counseling services and 24-hour crisis line. We also utilize community resources as much as we can; we participate in community health fairs and outreach events. We attend meetings with CityServe and the Tri-Valley Anti-Poverty Collaborative, where local providers can share their services, needs and volunteer opportunities. Every year our Holiday Gift and Food Distribution Event for low-income families from the Tri-Valley area brings new participants and spreads the word about our services. 235 Dublin residents participated in the Program this year. 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. The Sojourner House client intake process includes questions about needed accommodations (such as a bottom bunk, private room or special dietary needs). 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 appropriate to access the counter. The Food Pantry provides a monthly mobile Food Pantry program to locations in Dublin, Pleasanton, and Livermore. These efforts assist individuals who are unable to travel to the Food Pantry site. To further address transportation, our sites are near bus routes. 17. Identify other organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. The Food Pantry receives a monthly food delivery from the Alameda County Community Food Bank consisting of USDA and Emergency Food Box allocations. Our involvement in the local Grocery Rescue Program includes weekly pickups at Whole Foods, Trader Joe’s, Walmart, the Walmart Neighborhood Store, Target, Raley’s/Nob Hill, Grocery Outlet and Safeway. TVH’s FP is a member of the FEED TRI VALLEY (Give Local/Stay Local) project along with other Tri-Valley food pantries. This allows our agency to encourage the Tri-Valley Community to end local hunger by giving locally. A group of local churches funds the ESTA (Emergency Short Term Assistance) Program, administered by TVH’s FP Coordinator, which allows our agency to provide emergency motel vouchers and gas coupons for homeless and/or near homeless clients that utilize the FP. Tri-Valley Haven’s Food Pantry benefits from food drives sponsored by local churches, businesses and schools. Numerous long-term volunteers pick up food donated from local stores and manage the counter, welcome clients and distribute food during Food Pantry hours. Private donors provide gift cards to local stores which allow the Food Pantry Coordinator to purchase items in low supply or items to meet special dietary needs. We also assist the Valley Humane Society with their “AniMeals” program to provide community members free pet food once a month. We have developed partnerships with many local businesses and community organizations that support our programs. Eden Housing helps us coordinate our Mobile FP in Dublin, while CityServe provides a venue for sharing our programs and volunteer opportunities with the other local providers. We truly appreciate those partnerships. In addition, we have Operational Agreements with over 60 organizations including Police Departments from Livermore, Dublin and Pleasanton, District Attorney's Offices, local school Districts, other domestic violence and homeless shelters, hospitals, and social service agencies. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific outreach collaboration with other service organizations in the City of Dublin or Tri-Valley. There are many ways we outreach to Dublin residents. Last year together with the Cities of Dublin, Livermore, and Pleasanton, Open Heart Kitchen, CityServe, and Interfaith Sharing, Tri-Valley Haven participated 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 have expanded our services to a third venue to Dublin residents by bringing our Mobile Food Pantry to Dublin every second Friday of the month providing groceries to 60 - 70 residents, mostly seniors. In 2017 we began offering restraining order clinics at the Dublin Library on the first and third Saturday of each month. This offers additional opportunities for Dublin residents who have difficulty accessing our weekday clinics in Livermore and Pleasanton to receive restraining order assistance and learn about our other programs. We regularly conduct presentations to the Dublin Police Department on Domestic Violence, Sexual Assault and Homelessness issues and the programs that Tri-Valley Haven offers. Our Community Education Program reaches 385 5.1.z Packet Pg. 259 Attachment: 26. Tri-Valley Haven - Homeless Services Program Application (HS Grant Program FY19 Recommendations) students through Health Education classes that we teach in Dublin High School covering topics such as healthy relationships and teen dating violence. This year 235 Dublin residents received holiday foods and gifts through the Holiday Gift and Food Distribution Event in Livermore. This Program is helping low and very low income families in the Tri-Valley area to prepare Thanksgiving dinner and shop for Christmas presents for their loved ones. 19. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. Homeless 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. We try to minimize expenses for outside services whenever possible. Use of volunteers and donated goods is also a major factor in helping hold the costs down. 20. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? If this application does not receive funding, we most likely have to reduce the hours of our Case Management staff. With the current implementation of coordinated entry we believe the potential exists for our clients served to change drastically. Local families in need won't necessarily be eligible to stay at our shelter and will be placed somewhere else in the county. We feel very strongly that with enough support from the cities of Dublin, Pleasanton, and Livermore we can continue to offer the same level of support services to our shelter clients. 21. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? 22. CAPITAL PROJECTS: Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? 23. If your agency is requesting Capital funding, describe the detailed scope of work for the project. Include a timeline/schedule. [Attach project budget, photos, designs, site plans, specs, needs assessment, etc. later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 24. If your agency is requesting Capital funding, describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). [Attach relocation plan (if needed) and other supporting documents later in the "Documents" tab.] Enter "N/A" if not applicable. N/A 25. 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. 26. PERFORMANCE MEASURES: Select AT LEAST ONE of the following statements that best describes the project: (You may choose more than one.) 27. The City Council updated and modified Dublin's Vision statement in 2018 as part of the City's Strategic Plan. Describe one way the project serves Dublin residents and will help the City carry out its mission and achieve its ✔✔✔✔ No gfedc Yes: If yes, please explain: gfedc Yes ✔✔✔✔ No. If no, check box here and enter N/A for questions 23, 24 and 25 ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. gfedc Balance history with progress, to sustain an enlightened, economically balanced and diverse community. gfedc Encourages innovation of City life, including programs to strengthen our economic vitality, supports environmental stewardship and sustainability through the preservation of our natural surroundings. gfedc Promotes residents engaging in an active and healthy lifestyle through the creation of first-class recreational opportunities, facilities and programs. 5.1.z Packet Pg. 260 Attachment: 26. Tri-Valley Haven - Homeless Services Program Application (HS Grant Program FY19 Recommendations) vision for the The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process Tri-Valley Haven’s Homeless & Family Support Services provides Dublin residents with a safe and secure environment at Sojourner House and fosters new opportunities for Dublin residents to secure nutritious food for their families through TVH’s Food Pantry and Mobile Food Pantry. 28. ** QUESTIONS 29 THROUGH 41 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? 29. 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. We at TVH are committed to continuously improving our 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/customers 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. 30. CDBG ONLY - Identify at least one HUD Consolidated Plan Guiding Principle that relates to your project: 31. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: 32. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: ✔✔✔✔ Yes. If so, check box here and answer questions 29 through 41. gfedc No. If no, check box here and enter gfedc Don't know. If you are unsure, please call City staff at (925) 833-6650 immediately for assistance. ✔✔✔✔ Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency ✔✔✔✔ Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ 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. gfedc *Preserve and increase affordable rental housing opportunities for low and moderate income households. gfedc *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing that maintains affordability. gfedc *Promote fair housing and reduce housing discrimination. gfedc 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: gfedc * 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. gfedc C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. gfedc 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. gfedc F) Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase homeownership gfedc Promote decent affordable housing 5.1.z Packet Pg. 261 Attachment: 26. Tri-Valley Haven - Homeless Services Program Application (HS Grant Program FY19 Recommendations) 33. CDBG ONLY - Identify at least one HUD Policy Priority that relates to your project: 34. CDBG ONLY - Identify at least one HUD Consolidated Plan objective that relates to your project: 35. 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?") 36. 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?") 37. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: ✔✔✔✔ Strengthen communities gfedc Ensure equal opportunity in housing ✔✔✔✔ Promote participation of grass-roots, faith-based, and other community-based organizations gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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 gfedc Encouraging accessible design features. gfedc Participation of minority-serving institutions in HUD programs. ✔✔✔✔ End chronic homelessness within ten years. ✔✔✔✔ Removal of barriers to affordable housing. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Increase the availability of affordable rental housing for extremely low income (30%), very low income (50%) and low income (80%) households. gfedc Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). gfedc Assist low and moderate income first-time homebuyers. gfedc 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. gfedc Build on inter-jurisdictional cooperation to achieve housing and homeless needs. gfedc Increase the availability of service-enriched housing for persons with special needs. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Availability/Accessibility gfedc Affordability gfedc Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. 5.1.z Packet Pg. 262 Attachment: 26. Tri-Valley Haven - Homeless Services Program Application (HS Grant Program FY19 Recommendations) 38. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 39. 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". 40. 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 gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. I am not interested in qualifying for CDBG funding. 25 Disabled 85 Women/Female Headed Households 135 Seniors 0 Youth 15 Homeless 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 260.00260.00 TOTAL 175 Low Income (50%-80% AMI) 5.1.z Packet Pg. 263 Attachment: 26. Tri-Valley Haven - Homeless Services Program Application (HS Grant Program FY19 Recommendations) 41. 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" 42. 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 43. Please describe actions your organization is taking to become financially self-sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). We actively fundraise throughout the year and reach out to both corporate and private donors. We hold donor appreciation events annually including last year’s bay area tour: Peace on the Potomac. We have recently been successful in securing support from foundations, such as Kaiser Permanente, Alameda County Waste Management Authority (StopWaste) and Pinpoint whose criteria categories match the services provided in our homeless and family support services programs. In 2013 Tri-Valley Haven opened a Thrift Store, with the expectation of generating ample revenue to put back funds, i.e. revenue over expenses, in support of program services offered the community. This has been a reality since March 2017. 250 Extremely Low Income (<30% AMI) 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 0 425.00425.00 TOTAL 75 White 5 White + HISPANIC 50 Black/African American 0 Black/African American + HISPANIC 160 Asian 0 Asian + HISPANIC 2 American Indian/Alaskan Native 0 American Indian/Alaskan Native + HISPANIC 3 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 0 Asian and White 0 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 130 Multi Racial + HISPANIC OR other Multi Racial 0 Not Applicable. I am not interested in qualifying for CDBG funding. (Type N/A) 425.00425.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. 5.1.z Packet Pg. 264 Attachment: 26. Tri-Valley Haven - Homeless Services Program Application (HS Grant Program FY19 Recommendations) 44. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. BL-007058 Budget top Funding Sources/Revenues Budget Amount Amount Committed Alameda County Social Services Agency USD$ 166,977.00 USD$ 0.00 HCD Linkages USD$ 42,820.00 USD$ 0.00 Local Dublin/Pleasanton/Livermore USD$ 185,000.00 USD$ 0.00 Individual Donations/Foundations USD$ 12,500.00 USD$ 0.00 EFSP (Emergency Food and Shelter Program) USD$ 20,000.00 USD$ 0.00 Total USD$ 427,297.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Case Manager, 25% of Salary and Benefits USD$ 12,143.00 USD$ 0.00 Food Pantry Coordinator, 20% of Salary and Benefits USD$ 12,857.00 USD$ 0.00 Other Program Personnel USD$ 341,087.00 USD$ 0.00 Supplies USD$ 12,000.00 USD$ 0.00 Printing/Copying USD$ 1,200.00 USD$ 0.00 Telephone USD$ 8,250.00 USD$ 0.00 Rent and Utilities USD$ 21,000.00 USD$ 0.00 Accounting/Audit USD$ 3,260.00 USD$ 0.00 Other USD$ 15,500.00 USD$ 0.00 Total USD$ 427,297.00 USD$ 0.00 Budget Narrative Revenue: The composition of revenue is our best estimate based on the previous years 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, Insurance, Portion of Liability, Property, D&O, and Auto Insurance, Auto Expense. Homeless Services Program Budget is part of the overall agency budget that includes other programs and departments such as Domestic Violence Services, Sexual Assault Services, Finance etc. thus only a prorated portion of Liability Insurance, Auto Insurance, Audit etc. is being charged to this Program. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ TVH Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ TVH Financial Information Form List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ TVH List of Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ TVH Annual Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ TVH Form 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ TVH Board of Directors designation of authorized official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Board of Directors authorization to request funding Proof of insurance carried, including bonding, liability ✔✔✔✔ TVH Proof of Insurance 5.1.z Packet Pg. 265 Attachment: 26. Tri-Valley Haven - Homeless Services Program Application (HS Grant Program FY19 Recommendations) Application ID: 131472 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2019 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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. ✔✔✔✔ TVH State Non-Profit Letter TVH Federal Non-Profit Letter 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 TVH Personnel Policies REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section TVH Audit requirements TVH Audit Part 1 TVH Audit Part 2 REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws TVH Artucles of Incorporation TVH 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. TVH LEP Access Policy 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) 5.1.z Packet Pg. 266 Attachment: 26. Tri-Valley Haven - Homeless Services Program Application (HS Grant Program FY19 Recommendations)