HomeMy WebLinkAboutHRC - Homeless Prevention 2022HUMAN RELATIONS COMMISSION AGREEMENT FOR
GRANTS-IN-AID AWARD
THIS AGREEMENT, dated _________________ for the convenience of the parties hereto, is
between the City of San Luis Obispo, a chartered municipal corporation (referred to herein as
CITY), and Community Action Partnership of San Luis Obispo County, Inc. (CAPSLO) (referred to
herein as GRANTEE).
WITNESSETH:
WHEREAS, GRANTEE, has requested CITY to contribute to Homeless Prevention / Housing Stability
as submitted in its application to the CITY on January 25, 2022 (the “Service” or “Services”).
WHEREAS, the Services will be available to residents of the City, thereby serving both a public
and municipal purpose.
NOW, THEREFORE, CITY and GRANTEE for and in consideration of the mutual benefits,
promises and agreements set forth herein, do agree as follows:
1.GRANTEE will make its Services, as described in its Application (the
“Application”), incorporated by reference and attached as Exhibit A, available
to CITY residents from July 1, 2022 through June 30, 2023.
2.GRANTEE will provide CITY with a mid-year report, due January 31, 2023, and
final program report, due July 31, 2023, summarizing administrative, financial,
and client Service activities. Said reports shall be in the form of "Exhibit B",
attached hereto.
3.GRANTEE and all its agents, representatives, or participants in any manner in
the performance of its obligations and duties hereunder, shall be employees,
or volunteers for GRANTEE. They shall not for any purpose be considered
employees or agents of the CITY.
4.GRANTEE agrees to hold CITY harmless, and to defend CITY against, from, and
in any claim, action, proceeding, or hearing wherein there is an allegation
charging liability on the part of the CITY as a result of any act or omission,
negligent or otherwise, by GRANTEE.
5.CITY agrees to pay GRANTEE a one-time only grant, in the sum of $10,000,
to be used for the Services as described in the Application. The grant will be
paid in one installment when a signed contract is received.
6.The Department Head – Administration may terminate this agreement at
his sole discretion, after a public hearing and upon ten (10) days written notice
to GRANTEE. Said termination shall be effective thirty (30) days after CITY
mails notice of termination of agreement to GRANTEE. Any funds not paid
pursuant to paragraph 5 above shall revert to CITY upon said
DocuSign Envelope ID: C4B2E59A-4103-46DA-AA77-DBD202EB92EF
9/7/2022 | 9:52 PM PDT
termination.
7. GRANTEE hereby certifies and agrees that it will comply with the Human
Relations Committee “Bylaws” which creates an environment within the City in
which all persons can enjoy equal rights and opportunities regardless of race,
religion, sex, national origin, sexual orientation, age, physical, mental, or
economic status.
8. For purposes of notice under this agreement, all notices shall be
considered effective upon being sent by certified mail to the following
addresses:
CITY:
City of San Luis Obispo 919
Palm Street
San Luis Obispo, CA 93401
Attn: Greg Hermann, Department Head - Administration
GRANTEE:
Community Action Partnership of San Luis Obispo County, Inc. (CAPSLO)
1030 Southwood Drive
San Luis Obispo, CA 93401
esteinberg@capslo.org
IN WITNESS WHEREOF, the parties hereto have executed this agreement by their proper officers
duly authorized:
Grantee
By:
CITY OF SAN LUIS OBISPO, A MUNICIPAL CORPORATION
By:
Greg Hermann, Department Head – Administration
APPROVED AS TO FORM:
By:
Christine Dietrick, City Attorney
DocuSign Envelope ID: C4B2E59A-4103-46DA-AA77-DBD202EB92EF
City of San Luis Obispo HRC Grants-in-Aid j 2022-23
! ./ I One (1) signed application, including all attachments as a completepackage, in PDF format, submitted via email to ogoode@slocity.org .
• �!lri EJ1s OBISPO
HUMAN RELATIONS COMMISSION
2022-23 GRANTS-IN-AID APPLICATION
AGENCY: Community Action Partnership of San Luis Obispo County, Inc.
PROJECT/PROGRAM NAME: Homeless Prevention/Housing Stability
ADDRESS: 1030 Southwood Drive
CONTACT: Elizabeth "Biz" Steinberg
E-MAIL ADDRESS: esteinberg@capslo.org
PHONE: 805-544-4355
WEBSITE: www.capslo.org
(This person will receive notifications regarding grant decisions, contract execution, and reporting requirements)
WHO PREPARED THIS APPLICATION: Donna Fioravanti PHONE: (80 5) 712-7879
FEDERAL TAX ID NUMBER: 95-2410253
AMOUNT OF GRANT REQUEST: $1 0,000
DATE AGENCY ESTABLISHED: 121911965����������-
�������������������������
1.Please provide your agency's core mission statement on one attached page (maximum 50 words)
labeled Attachment 1.
2.Please answer the following questions on one attached page labeled Attachment 2:
a.Briefly describe the program/project or reason you are requesting funds (max 150 words).
b.Please describe your grant request in detail (max 250 words).
c.Itemize how your agency would use the GIA award (refer back to "Funding Decisions"Section on page 1 on the directions).
3.Please answer the following questions on one attached page labeled Attachment 3:
a.Please describe creative approaches your agency takes to achieve the Agency's mission.
b. Please describe the interaction or collaboration between your Agency and other localnon-profits who serve similar clientele.
Exhibit ADocuSign Envelope ID: C4B2E59A-4103-46DA-AA77-DBD202EB92EF
City of San Luis Obispo HRC Grants-in-Aid I 2022-23
c.How will your program and the citizens of San Luis Obispo benefit as a result of this
grant?
4.The HRC has identified their main funding priority as: Homeless prevention including affordable
and alternative housing, supportive services and transitional housing. Does your grant request
meet this funding priority?
[Z]ves
0No
5.Which other priority of the non-ranked HRC funding priorities does your request support? Please
check the appropriate boxes:
[ZJ Hunger and malnutrition prevention
! I !supportive physical and mental health services for those in need
Oservices for seniors and/or people with disabilities in need
Osupportive and developmental services for children and youth in need
Oservices encouraging diversity, equity, and inclusivity in marginalized communities
6.What is the project's total budget?_$:....1_0....:.,_0_00 ________________ _
7.What is your agency's entire total annual budget? --'$_9_8-'-,7_2_1_.,'--8_8_9 _________ _
(for the local chapter if a widespread organization)
8.What percentage of your agency's entire total annual budget comes from private (non-
governmental) donations ?_4_0
;,,.:Yo _____________________ _
a.What are those private funding sources? Corporate and foundation grants,
individual donations, fundraising events, Friends of 40 Prado
9.What percentage of your agency's entire total annual budget comes from public
(governmenta I) donations?_9_6_0_Yo _____________________ _
a.What are those public funding sources? Federal agencies such as Dept of HHS &
USDA for Head Start, Dept of Energy, State of CA, SLO County, local city govt
10.Have you seen growth or decline in your funding sources over the past year?
a.If so, how much? From what type of sources? Growth of 4.8% as a result of
CARES Act funding across several divisions.
b.Did you receive any funds to mitigate financial impacts associated with COVID-19? If so,
how much? From what type of sources? Yes, from State and Feds thru the County.
11.Will this grant satisfy a match grant requirement, or leverage funding from another grantor?
Yes
DocuSign Envelope ID: C4B2E59A-4103-46DA-AA77-DBD202EB92EF
City of San Luis Obispo HRC Grants-in-Aid I 2022-23
a.If so, how much? From what funding sources? 100% of funds will be used as a
match for the HUD Coordinated Entry Program through the County.
12.Is this grant request for a new program, or continuation of an existing program? ____ _
Continuation of existing program.
13.In the table below briefly list 1-3 methods of evaluation and indicators of success.
Methods of Evaluation Indicators of Success
Tracking Attendance (Sample answer) 100 Attendees Per Session (Sample answer)
Document# able to retain/obtain stable housinq 7 individuals or families obtain/retain housinq
Follow up 3 months after assistance provided 90% remain stably housed at 3 months later
14.Using the chart below briefly explain if your agency plans to collaborate with other agencies
and partners on this project. Give specific examples and specify other collaborators:
Name of Partner Activity/Service They Provide for This Project
ABC Dance Club (Sample answer) Free Use of Dance Hall (Sample answer)
5Cities Homeless Coalition; ECHO coordinate, co-manage eviction prevention services
Transitions Mental Health Association Meet weekly to discuss services; cross-refer
County of SLO Dept Social Services Meet weekly to discuss services; cross-refer
SLO Legal Assistance Foundation cross refer for client services
15.What is the total number of residents served by your agency and program?
# of residents served # of residents served Projected# of residents Projected# of
by your program by your� your program will serve residents your�
July 2020-July 2020-July 2021-will serve July 2021-
June 2021 June 2021 June 2022 June 2022
City of San Luis Obispo 6 3,247 15 4,000
Outside City limits 1 23, 120 0 24,000
Total Served 7 26,367 15 28,000
16.If your agency is submitting more than one application for a grant, please rank the
applications in the order of priority.
a.Homeless Prevent.
b.FCSS -SAFE
c.
d.
17.Eligibility Checklist: (Please review the checklist at the beginning of this application and make
sure you have followed all guidelines and included all required documents)
DocuSign Envelope ID: C4B2E59A-4103-46DA-AA77-DBD202EB92EF
City of San Luis Obispo HRC Grants-in-Aid ) 2022-23
Signatures:
I certify that the information contained in this application is, to the best of my knowledge, true and accurate; that our agency
subscribes to the Human Relations Commission's "Statement of Purpose and Bylaws" which creates an environment within
the City in which all persons can enjoy equal rights and opportunities regardless of race, religion, sex, national origin, sexual
orientation, age, physical, mental or economic status; and that this application is submitted with the Board of Director's full
knowledge and endorsement.
Dee Lacey
Print Name
D L Oigilall.y signed by Dee Lacey ee acey Da1e; 2022.01.2511:44:44
-08'00'
Signature
Elizabeth Steinberg
Print Name
Elizabeth "Biz"
Steinberg
Signature
Digitally signed by Elizabeth "Biz"
Slei11l..1t:1ry
Date: 2022.01 25 11 :45:15 ·OB'OO'
Board President
Title (Board President or Designee)
January 25, 2022
Date
Chief Executive Officer
Title (Executive Director/CEO or Designee)
January 25, 2022
Date
DocuSign Envelope ID: C4B2E59A-4103-46DA-AA77-DBD202EB92EF
Attachment 1
Mission Statement:
City of San Luis Obispo Grants in Aid I 2022-23
CAPSLO -Homeless Prevention/Stable Housing Program
Community Action Partnership of San Luis Obispo County addresses the causes of poverty,
empowering low-income people to achieve self-sufficiency through community-based
collaborations and programs.
DocuSign Envelope ID: C4B2E59A-4103-46DA-AA77-DBD202EB92EF
Attachment 2 City of San Luis Obispo Grants in Aid I 2022-23
CAPSLO -Homeless Prevention/Stable Housing Program
a.Briefly describe the program, project or other reason you are requesting funds.
The Homeless Prevention/Stable Housing Program provides emergency financial assistance to City
of San Luis Obispo households that are at risk of being evicted and need assistance with a rental
payment, or who need assistance securing housing with first month's rent and/or a security deposit.
Only those assessed individuals who can demonstrate their ability to maintain rent beyond the
assistance and are willing to participate in case management for 6 months (to further ensure
continued success) are accepted into the program. Case managers work with candidates to develop
and maintain a realistic post-housed budget and connect them to community resources to obtain
additional assistance (i.e., food, clothing, job training). In addition, individuals are encouraged to
stretch their dollars further by utilizing services at 40 Prado, including free laundry, meals, primary
medical care and other supportive services offered during the day.
b.Please describe your grant request in detail.
This program is part of the existing Case Management program, providing immediate financial
assistance to prevent individuals from falling into homelessness or assist them out of homelessness
and into stable housing. Since rents continue to increase and landlords are requiring up to three
month's rent to move in, additional funding is needed. Although Cares Act housing assistance
received by the County can be applied lo those who have been affected by COVID-19, this grant will
provide assistance for those individuals whose homelessness or risk of homelessness is not due to
COVID-19.
Clients are screened to establish which individuals have the greatest need. For example, individuals
who experience unexpected setbacks caused by illness, loss of a job, or other sudden circumstances
beyond their control are considered qualified if they are also income-eligible (under 120% of the
Federal Poverty Income Guidelines). For eviction prevention assistance (one month's rent), clients
must provide proof of emergency need: either their rent payment is in arrears or due within five
days, or they must provide an eviction notice from the landlord. To secure housing through a first
month's rent or security deposit, the household is living in an emergency shelter, a car, or a motel.
They must participate in the Case Management program and must show that they can afford the
monthly rent once housed. Checks are mailed directly to the landlord or given to the case manager
to personally deliver to the landlord.
c.Itemize how your agency would use the GIA award.
The majority of the funding ($9,200) will be used for financial assistance payments to cover rent or
security de12osits for low�income (Jty of San Luis Obj�Q.9 households who are homeless or atrisk of
homelessness. As mentioned above, payments will be made directly to the landlord. The remaining
funds ($800) will be used for agency indir-ecl costs al a federally approved 8% rJle.
DocuSign Envelope ID: C4B2E59A-4103-46DA-AA77-DBD202EB92EF
Attachment 3 City of San Luis Obispo Grants in Aid I 2022-23
CAPSLO -Homeless Prevention/Stable Housing Program
a.Please describe any creative approaches your agency takes to achieve the Agency's mission.
CAPSLO's 40 Prado Homeless Services Center in San Luis Obispo achieves the agency's mission of
empowering individuals to attain self-sufficiency through strategic programming to meet community
needs, integrated services and collaboration. This year CAPSLO was able to complete construction of the
new Medically Assisted Withdrawal Treatment Center, 34 Prado, for individuals who are low-income or
MediCal beneficiaries, and for whom there are few other options for the treatment of opioid and other
addictions in SLO County.
40 Prado offers 24/7 emergency shelter services, meals, showers, laundry, health screenings at the CHC
on-site clinic, services to dual diagnosed individuals, recuperative care for those recently released from
the hospital, a warming center, animal kennels, a community garden, internet access, a mail and
message center to facilitate job and housing searches, and safe parking to homeless individuals and
families. CAPSLO's Head Start program offers the "Home Based" family education and support pr ogram
for parents of toddlers. These comprehensive on-site services are provided by agency staff, volunteers
(pandemic guidelines permitting), and community partners.
b.Please describe the interaction or collaboration between your Agency and other local nonprofits
who serve similar clientele.
An example of collaboration that exists with CAPSLO's Homeless Services Case Management is the
Coordinated Entry Program with SCities Homeless Coalition (SCH() and El Camino Homeless
Organization (ECHO). CAPSLO focuses on serving individuals and families in the City of San Luis Obispo,
while SCHC serves the South County and ECHO serves the North County. The three agencies enter client
data into CAPSLO's shared database using a common screening form to avoid service duplication. The
entire county is covered through this partnership, and homeless individuals as well as those at risk of
homelessness have access to services regardless of their location, and are appropriately referred. Other
local agencies collaborating with CAPSLO at 40 Prado are Dignity Health, Tenet Health, Community
Counseling Center, CenCal Health, Restorative Partners, Legal Assistance Foundation, Middlehouse, and
Casa Solana.
c.How will your program and the citizens of San Luis Obispo benefit as a result of this grant?
Benefits to Homeless Prevention/Stable Housing Program:
Grants-in-Aid (GIA) funding is essential to house or keep housed individuals and families who would
otherwise end up on the street. GIA funds will be used to provide rental assistance to individuals and
families at immediate risk of losing their housing, or those who are ready to obtain housing but don't
have the funds needed for a security deposit and/or first month's rent, through case management.
Although CARES Act funding is available for those who have been directly affected by the COVID-19
pandemic, there are individuals and families whose imminent homelessness was not caused by COVID-
19, and who are not eligible for federal relief. Additionally, funding fr om the City of San Luis Ob ispo is
utilized to leverage grants and donations from other cities within the county, private foundations,
businesses, individual donations, and the County of SLO.
Benefits to Citizens of San Luis Obispo:
GIA funds will only be used for residents of the City of San Luis Obispo who are at imminent risk of
homelessness. Last year, 488 of the 686 individuals (71%) who obtained services through 40 Prado were
residents of the City of San Luis Obispo. Although participants come to 40 Prado Homeless Services
Center from all areas of the county, the majority are residents of the City of San Luis Obispo.
CAPSLO is currently responding to increased numbers of individuals and families now in economic crisis
because of job loss and job reduction caused by the pandemic. Funding for homeless prevention to keep
individuals and families stably housed has never been more crucial to the health and quality of life for £.ll
residents of the City of San Luis Obispo.
DocuSign Envelope ID: C4B2E59A-4103-46DA-AA77-DBD202EB92EF
COMMUNl�Y ACTON PARTNERSHIP BOARD OF DIRECTORS and TERMS DATES -2021
Dee Lacey -President
Private Representative -Director A
1195 Beaver Creek Lane
Paso Robles, 'CA 93446
(H) 238-1482 (C) (805) 440-4977
jdlacey1963@gmail.com
Carlos Sosa -Vice President
Low Income Representative -C,:>ast
433 Manzanita Drive District II
Los Osos, CA 93402
(O) 528-5098 :c) (805) 550-4747
csosa1950@aol.com
(12/2020)
(1212020)
Mical W. Bovee, Secretary/Trea�1urer (1212020)
Private Representative -Director B
1150 Palm Street
San Luis Obis::io, CA 93401
(0) 544-1441 '.F) 593-1231
mical.bovee@qlennburdette.com
Debbie Arnold, Public Representative (NIA)
County Government Center/Boad of Su1liervisors
1055 Monterey Street, Room 0430
San Luis Obis::io, CA 93408
(0) 781-5450 '.F) 781-1350
darnold@co.slo.ca.us
Chuck Cesena
Public Representative
2122 9th Street, Suite 102
Los Osos, CA 93402
(0) 528-9435 '.C) (805) 801-8183 (=) 5W-9377
clcesena@charter.net
(12/2022)
Lan George
City of Arroyo Grande
300 E. Branch Street
Arroyo Grande, CA 93420
(PC) (805) 459-6212
lgeorge@arroyogrande.org
Gary Jordan
Low-Income Representative -North County
208 Cardinal Way District I
Paso Robles, CA 93446
(H) 239-3798 (0) 451-3841
gdaiordan@yahoo.com
Diane "Dee" Limon
Low-Income Representative -North County
22410 J Street
Santa Margarita, CA 93453
(C) 464-9999
dlimon@cuesta.edu
Sandee Menge
Low-Income Representative -South County
P.O. Box 2228 District Ill
Avila Beach, CA 93424
(H) 595-7315 (C) (661) 203-6030
sandeemng@gmail.com
Margie Perez-Sesser
Private Representative -Director D
5495 Oakhurst
Cambria, CA 93428
(H) 927-4998 (C) (805) 909-7298
margiesesser@sbcglobal.net
Maria Garcia (1212022) Anneka Scranton
City of Paso Robles
1000 Spring Street
Paso Robles, CA 93446
(0) 237-3888
rngarcia@prcity.com
Rob Garcia
Private Representative -Director E
613 South Main Street
Templeton, CA 93465
(0) 434-2608
rob@garciawealth.com
(12/2022)
Private Representative -Director C
2590 San Dominico
Los Osos, CA 93402
(C) (310) 872-9088
annekamarina@gmail.com
Lisa Sperow
Low-Income Representative -South County
370 Canyon Way District IV
Arroyo Grande, CA 93420
(H) 489-8844 (C) (805) 709-9299
esperow@calpoly.edu
(12/2020) Erica A. Stewart, Public Representative
City of San Luis Obispo
990 Palm Street
San Luis Obispo, CA 93401
(PC) (805) 540-1154
estewart@slocity.org
(NIA)
(1212020) I Board Consultants I
(12/2021)
(1212022) [ Early Head Start/Head Start Policy Council I Wendy Morales (1012020)
HS/EHS PC President
648 Felton Way, Apt. B-3
San Luis Obispo, CA 93405
(C:, (760) 670-9173
(1212022) Pamela McKiernan
HS/EHS PC Vice President
1845 El Cajon Ln.
Ramona, CA 92065
(C;, (760) 822-1047
(10/2020)
(1212021) I Migrant & Seasonal Head Start Policy Council I
Blanca Arroyo (6/2020)
MSHS President
261 Natividad Road
Salinas, CA 93906
(C} (831) 613-2714
(1212021) Angeles Bustamante
MSHS Vice President
309 Cypress Street #B
Lodi, CA 95240
(C; (209) 747-6030
(6/2020)
Updated: January 27, 2020 by: RA
DocuSign Envelope ID: C4B2E59A-4103-46DA-AA77-DBD202EB92EF
... '1..0 !if U,{ D..� 0. c .� u .,:
DocuSign Envelope ID: C4B2E59A-4103-46DA-AA77-DBD202EB92EF
• :;.-�:·i 11 n S 11,·1 .. :111i.c .. : ._.:- ,11., i-1 _. ., ... ,. :· ld1} Ii"\....._ l,i<,·111:d RlYl'llllL' St·rri�·,·
l9993
P.O. Box 2508 Cincinnati OH 45201 In reply refer to: 0248226129 Aug. 18, 2009 LTR 4168C ED 95-2410253 000000 00
00012792
BODC: TE
COMMUNITY ACTION PARTNERSHIP OF SAN
LUIS OBISPO COUNTY INC 1030 SOUTHWOOD DR
SN LUIS DBISP CA 93401-5813
Employer Identification Number:
Person to Contact:
Toll Free Telephone Number:
Dear Taxpayer:
95-2410253
Ms. K. Hilson
1-877-829-5500
This is in response to your request of Aug. 07, 2009, regarding your tax-exempt status.
Our records indicate that a determination letter was issued in May 1966, that recognized you as exempt from Federal income tax, and discloses that you are currently exempt under section 50l(c)(3l of the Internal Revenue Code .
Our records also indicate you are not a private foundation within the
meaning of section 509Ca) of the Code because you are described in
section(s) 509(a)(l) and 170Cb)Cl)CA)Cvi). ·
Donors may dedL1ct contributions to you c1s provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes
it they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code.
If you have any questions, please call us at the telephone number s h o ,,m i n t Ii e h e a d i n g o f t td s 1 e t t e r .
Sincerely yours,
Michele M. Sullivan, Oper·. Mgr . Accounts Management Operations I
DocuSign Envelope ID: C4B2E59A-4103-46DA-AA77-DBD202EB92EF
COMMUNITY ACTION PARTNERSHIP OF SAN LUIS OBISPO COUNTY, INC.
City of San Luis Obispo -Human Relations Commission
2022 -2023 Grants-In-Aid Application
Case Management Homeless Prevention/Stable Housing Project
Total
REVENUE
City of San Luis Obispo GIA $ 10,000
TOTAL REVENUE $ 10,000
NON-PERSONNEL
Financial Assistance Payments $ 9,259
Total Non-P ersonnel 9,259
OTHER PROGRAM EXPENSES
Indirect Expense @ 8% 741
Total Other 741
TOTAL EXPENSES $ 10,000
DocuSign Envelope ID: C4B2E59A-4103-46DA-AA77-DBD202EB92EF
DocuSign Envelope ID: C4B2E59A-4103-46DA-AA77-DBD202EB92EF
Exhibit B
Grants-In-Aid Program
MID-YEAR REPORT
Organization:
Program:
Administrator’s Report: (A brief synopsis of the activities of the reporting period, including a statement
of the activities, service or programs provided as described in Exhibit B (your grant application) using the
Grants-In-Aid provided, and any changes that have occurred during the reporting period. If
operations have changed due to COVID-19, please disclose briefly here.)
Statistical Report: (This section should include the number of clients served, their cities of origin, the
nature of services provided, as well as any other statistics which are kept by the agency. The total number
of clients served also should be broken down by the type of service received.)
Financial report: (A financial statement detailing how the City’s grant money has been expended or plan
to be expended.)
Name Title Phone
Signature Date E-mail
Please limit to no more than 2 pages. Once signed, please scan and e-mail to Beya Makekau, Diversity Equity
Inclusion Manager (bmakekau@slocity.org)
Due: January 31, 2023
]
DocuSign Envelope ID: C4B2E59A-4103-46DA-AA77-DBD202EB92EF
Grants-In-Aid Program
YEAR-END REPORT
Organization:
Program:
Administrator’s Report: (A brief synopsis of the activities of the reporting period, including a statement
of the activities, service or programs provided as described in Exhibit B (your grant application) using the
Grants-In-Aid provided, and any changes that have occurred during the reporting period. If
operations have changed due to COVID-19, please disclose briefly here.)
Statistical Report: (This section should include the number of clients served, their cities of origin, the
nature of services provided, as well as any other statistics which are kept by the agency. The total number
of clients served also should be broken down by the type of service received.)
Financial report: (A financial statement detailing how the City’s grant money has been expended or plan
to be expended.)
Name Title Phone
Signature Date E-mail
Please limit to no more than 2 pages. Once signed, please scan and e-mail to Beya Makekau, Diversity Equity
Inclusion Manager (bmakekau@slocity.org)
Due: July 31, 2023
DocuSign Envelope ID: C4B2E59A-4103-46DA-AA77-DBD202EB92EF