Spreadsheet: 056436bb-aa82-4993-91b2-956ddda1e843
Sheet: Sheet1

CITY OF IRVINE
2014 Application for CDBG Funding
PUBLIC SERVICES
 | Part 1. Agency Requesting Funding:
 | Name of Agency:
 | Agency Address:
 | Name of Program:
 | Program Address:
 |  |  |  |  |  |  | New Program |  |  |  |  | Existing Program to be Enhanced and/or Expanded
 | Amount Requested:
 | Prior Years City of Irvine CDBG/HOME Capital Funding:
 |  |  |  |  |  |  |  | 2010 |  | - |  |  |  | - |  |  |  |  |  | - |  |  | -
 | CDBG Funds Awarded
 | Amount Spent
 | Agency Type: |  |  |  |  | Nonprofit* |  |  | For-profit |  |  |  | Public/Quasi Public
 | (check one) |  |  |  |  | (*If nonprofit, attach verification of 501 c3 status)
 | Faith-based Organization? |  |  |  |  |  |  |  |  | Yes |  |  | No
 | Employer Federal ID#: |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]#:
 | Contact Person for application (name, title, phone and email):
 |  |  |  | Name:
 |  |  |  | Title:
 |  |  |  | Phone:
 |  |  |  | [NAME]:
 | Contact person for administration of the project (name, title, phone and email):
 |  |  |  | Name:
 |  |  |  | Title:
 |  |  |  | Phone:
 |  |  |  | [NAME]:
 | Two officials authorized to sign contracts and expend funds for the organization (name and title):
 |  |  |  | Name:
 |  |  |  | Title:
 |  |  |  | Name:
 |  |  |  | Title:
 | Part 2. Statement of Applicant
 | The undersigned acknowledges the following:
 | 1. |  | That, by submission of this application, the organization agrees that the application will become a public document.
 | 2. |  | That, to the best of its knowledge and belief, all information provided is true and correct and all estimates are reasonable.
 | 3. |  | That no revised proposals/applications may be made in connection with this application once the deadline for applications has passed.
 | 4. |  | That the City of Irvine may request or require changes in the information submitted which it deems reasonable for any and all information provided.
 | 5. |  | That the applicant will cooperatively assist in the application review process.
 | 6. |  | That, if the program is recommended and approved by the City Council, the City reserves the right to fund less than the full amount requested. The City also reserves the right to reduce and/or cancel allocation if federal entitlements are cancelled, reduced, or rescinded.
 | 7. |  | That the City of Irvine reserves the right not to fund any submittals received.
 | 8. |  | By submission of this application, the organization agrees to abide by the federal regulations applicable tot his program.
 | 9. |  | That past program and financial performance will be considered in reviewing this application.
 | 10. |  | That services are to be provided only to eligible [NAME] residents at no cost during the grant period.
 | 11. |  | That, if the program is funded, the City or a designated agency may conduct an accounting system inspection to review internal controls, including procurement and uniform administrative procedures, prior to issuance of payments for program expenditures.
 | 12. |  | That, if the program is funded, the City will perform an environmental review prior to the obligation of funds.
 | 13. |  | That, if the program is funded, a written agreement will be required that includes, among other matters, a statement of work, records retention and reporting, local and federal requirements, and circumstances that would trigger grant suspensions and terminations.
 | 14. |  | That a program's funding does not guarantee its continuation in subsequent program years.
 | 15. |  | That proof of insurance (general comprehensive public liability insurance with a company licensed to do business in California, and in the aggregate naming the City, its employees and agents as additional insured) will be submitted to the City prior to receiving funds.
 | 16. |  | That written signature authority from the organization's governing body indicating who can execute contracts and amendments on its behalf will be submitted to the City prior to receiving funds.
 | 17. |  | That the organization agrees to abide by the City of Irvine's Conflict of Interest Policy. Items of concern would include Board of Directors or staff members families having a monetary interest in any contract made by the City, and other matters that may give the appearance of a conflict of interest.
 |  | By signing below, the applicant acknowledges the above.
Name: |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Title:
Signature: |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date:
 | Part 3. Program Description
 | Please describe the program and how the CDBG funds will be used. Describe how your program meets the goals of the Irvine CDBG program, as detailed in the Consolidated Plan and outlined in the Notice of Funding Availability for this application. If the program is a continuation of a currently funded activity, please explain how the services will be expanded and/or modified.
 | (Be concise in stating the nature and eligibility of the project, reasonable start and end dates, program costs, positions, and operating expenses to be funded. Do not exceed space provided for all narrative responses).
 | Please describe the target population and number of unduplicated Irvine residents to be served from July 1, 2014 through June 30, 2015. Describe how the expected number of clients was determined. Explain why this program is needed for this target population. Cite specific, independent data explain and document need.
 | Describe the program marketing/outreach and service delivery method.
 | (Please describe how you will reach your target population and how your program will be carried out, what service(s) will be provided and who will deliver those services.)
 | State the program outcomes and objectives. Indicate how the outcomes and objectives will be measured.
 | (Outcomes and objectives must be results-oriented, specific, and measurable. For example, if the program is a workshop, list the number of workshops, how many participants are expected to attend, and how the benefit(s) to the participants will be demonstrated.)
 | Part 4 Operating Budget
 | (Provide a summary of operating expenses for the Agency as a whole and for the Public Service Program. The Public Service Program Budget must reflect only those costs of serving CDBG-eligible [NAME] residents. Please round up to the nearest dollar.)
 |  |  |  |  |  |  |  | Proposed CDBG Budget
 |  |  |  |  |  |  |  | [NAME] |  |  |  | Leveraged Funds** |  |  |  | Total CDBG Program Budget |  |  |  |  | Total Agency Budget*
 | Personnel Services
 | Salaries |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | Benefits |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | Other |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | Personnel Services Subtotal
 | Supplies
 | Office Supplies |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | Postage |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | Other |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | Supplies Subtotal
 | Direct Client Service Expenses
 | a. |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | b. |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | c. |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | Client Service Expenses Subtotal
 | Operating Expenses
 | Telephone |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | Utilities |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | Rent (Facility) |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | Liability Insurance |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | Printing |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | Training |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | Travel |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | Audit |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | Other |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | Operating Expenses Subtotal
 | Other Operating Expenses
 | a. |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | b. |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | c. |  |  |  |  |  |  | 0 |  |  |  | 0 |  |  |  |  |  |  |  |  | 0
 | Other Operating Expenses Subtotal
 | Total Operating Budget
 | *   Attach a copy of the Agency's most recent audited financial statement, or, if your organization is not required to perform audits, copies of your most recent balance sheet and income statement.
 | **  Leveraged Funds are not required for Public Service Programs, but will enhance your proposal. Leveraged Funds are the other non-CDBG funds that will be used in conjunction with the CDBG request to complete the program. Leveraged Funds can be a blend of cash, gifts, in-kind gifts, or volunteer labor. These funds must be firmly assigned to the program and immediately available.
 | If Leveraged Funds will be used, please describe.
 | Part 5. Agency Experience
 | [NAME] and briefly describe similar programs your Agency has previously undertaken.
 | [NAME] the outcomes of the programs mentioned above in measurable terms.
 | [NAME] how the Agency will verify that clients are eligible for CDBG assistance.
 | d. |  | Describe the Agency's experience in working with CDBG and other federal funds in communities other than [NAME], including outcomes.
 | e. |  | Describe the Agency's experience in working with City of Irvine CDBG and other funds, including outcomes.
 | f. |  | List the Agency's personnel, consultants, and/or volunteers who will be carrying out the program and their qualifications.
 | g. |  | For each person listed above, please provide their salary, cost of benefits, and the percentage of their time that will be charged to the program. For each position to be funded under this application, please attach a current job description.
 | h. |  | Identify and describe any audit findings, liens, investigations, or probation by any oversight agency in the past five (5) years. If none, please state none.
 | Please attach a letter from your Executive Director or Board President describing the need for your program and how the program will meet that need.