HomeMy WebLinkAboutItem 3_ 2017 CDBG Draft RecommendationsMeeting Date: December 7, 2016
Item Number: 2
2
HUMAN RELATIONS COMMISSION AGENDA REPORT
SUBJECT: 2017 CDBG Funding Recommendations
PROJECT ADDRESS: Citywide BY: Jenny Wiseman, Acting Housing Programs Manager
Phone Number: 781-7010
e-mail: jwiseman@slocity.org
FILE NUMBER: GENP-4175-2016
BACKGROUND
The City received a total of five 2017 CDBG applications requesting a total of $560,290. Estimated
funding for the 2017 Program Year is $442,462. Of the total estimated allocation, 20% of the funds are
reserved for administrative costs. Since the County has taken over the main portion of each
jurisdiction's administrative duties, 65% of the total administrative funds for the City are claimed by
the County and only 35% of the total administration funds stay with the City. Therefore, of the City’s
$442,462 estimated allocation, the City will receive $30,972 for administration purposes and $57,520
goes to the County.
In addition, the City has $31,200 in additional CDBG funds to award in the 2017 CDBG cycle from
the unsuccessful 2014 CDBG award to the Women’s Shelter Program for renovations to their facility.
In late 2015, the Women’s Shelter Program returned the funds as they were unable to proceed with the
project due to funding and prevailing wage limitations.
FUNDING PRIORITIES
On October 18, 2016, the City Council endorsed the HRC’s recommended CDBG funding priorities
for 2017. The ranked priorities established by the HRC and City Council are:
1. Provide emergency and transitional shelter, homelessness prevention and services.
2. Develop and enhance affordable housing for low and very-low income persons.
3. Promote accessibility and/or removal of architectural barriers for the disabled and elderly.
4. Enhance economic development (to include seismic retrofit, economic stability, low and
moderate income jobs).
PROGRAMS RECOMMENDED FOR FUNDING
The above priorities are used as the basis for making recommendations regarding the 2017 CDBG
applications. Staff is recommending funding three of the five applications, as shown in Attachment A,
these three programs are further described below. The recommendations were previously reviewed and
approved by the City’s Capital Improvement Plan Committee on November 7th. A copy of each of the
2017 CDBG applications is provided for HRC review (Attachment B).
GENP-4175-2016 (Citywide)
Page 2
Project Overview and Funding Recommendations
1. CAPSLO (Maxine Lewis Homeless Shelter): CAPSLO has requested $125,000 in CDBG funds to
assist with operational costs of the Maxine Lewis Memorial Homeless Shelter (MLMS). The City
typically chooses to fund 100% of the public services allocation of CDBG funds (15% total) to the
MLMS. The estimated public services allocation is $66,369 and therefore the City is recommending
funding $66,369 to CAPSLO. The City also helps fund MLMS with General Fund money. Should
CAPSLO have remaining funds when 40 Prado opens, those funds will be use to operate 40 Prado.
2. Transitions Mental Health Association (Bishop Street Studios): TMHA and the Housing Authority
of San Luis Obispo are partnering to develop Bishop Street Studios, a 34-unit affordable housing
development which will house clients participating in TMHA mental health programs. They have
requested $200,000 in CDBG funds to cover site acquisition and offsite improvements. Staff is
recommending funding the entire request of $200,000 to this very important affordable housing
project. The project has received full entitlements and will be applying for Low Income Housing
Tax Credits in March 2017. Should the HRC support funding this project, a reservation letter will
be sent to the City Council prior to the March 2017 hearing to ensure CDBG funding will be
included in their tax credit application. Any CDBG funds will be contingent upon a successful tax
credit application.
3. Family Care Network, Inc. (Estelita Court Supported Housing Rehabilitation): FCNI has
requested $125,290 in CDBG funds to renovate their existing four-unit apartment building which
houses up to seven transitional aged youth residents. These individuals are transitioning out of foster
care and are extremely or very-low income. The supported housing complex is in need of a wide
range of repairs including: replacing walkways and driveway asphalt, repairing the roof and
flooring, installing energy efficiency windows and appliances, installing increased security doors
and lighting, and bathroom renovations. Staff is recommending to fund $118,801 towards this
project.
PROGRAMS NOT RECOMMENDED FOR FUNDING
In addition, staff is recommending not funding two of the five 2017 CDBG Applications. These
programs and recommendation reasoning are further described below.
4. Lifesteps Foundation, Inc. (Senior Homemaker Program): Lifesteps Foundation, Inc. (LFI) has
requested $5,000 to provide additional caregiving support to seniors through their Senior
Homemaker Program. Typically, the City recommends all public service funds be awarded to the
Homeless Shelter as that is the number one funding priority from Council. Since this program is
also categorized as a public service, funding the project would reduce available funding to the
Homeless Shelter, which is a higher priority. The County has also requested a minimum of $8,000
for all CDBG applications. Staff recommends the applicant apply to the City’s Grants-In-Aid grant
program to potentially fund the project.
5. City of San Luis Obispo (Curb Ramps): The City of San Luis Obispo Public Works Department
has requested $105,000 for curb ramp replacement projects to remove architectural barriers for
disabled and elderly persons. Staff had previously recommended the project receive $58,000 in
CDBG funding; however, at the CIP Meeting on November 7th, the City Engineer and Public
Works Director both stated that the proposed funding recommendation would not be enough to
GENP-4175-2016 (Citywide)
Page 3
justify prevailing wage for the entire project and decided to allocate those funds to a higher priority
project.
HRC Role
These recommendations are provided for the benefit of the public and HRC. The HRC’s role is to
consider these recommendations in light of public testimony and either, (1) accept the allocations
proposed if the HRC concurs, or (2) make changes so that the recommendation reflects the views o f a
majority of the Commission. The adopted priorities should guide the Commission throughout the
discussion.
The HRC’s recommended allocations will be forwarded to the County for incorporation into the Draft
Action Plan for the 2017 CDBG program year. The entire Draft Action Plan will be considered by the
Council in March 2017.
Attachments
A. 2017 CDBG Funding Recommendations
B. 2017 CDBG Applications
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A
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM
APPLICATION FOR THE 2017 PROGRAM YEAR
SAN LUIS OBISPO COUNTY DEPARTMENT OF P LANNING AND BUILDING
976 O SOS STREET R OOM 200 S AN L UIS O BISPO CALIFORNIA 93408 (805) 781-5600
Promoting the Wise Use of Land Helping to Build Great Communities
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 1 OF 10
APPLICATION FOR FUNDING DURING 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
The County of San Luis Obispo is pleased to announce the availability of funds for the Community
Development Block Grant (CDBG) program. The CDBG program is a flexible program that provides
communities with resources to address a wide range of unique community development needs.
Applicants seeking CDBG funds MUST address one of the three national objectives, as provided by the
Department of Housing and Urban Development (HUD) (see question 10 for detailed information on the
objectives). Applications that do not address one of the objectives will NOT be considered for CDBG
funding. Furthermore, completed applications should provide the necessary exhibits, budgets, or
requested information on targeted populations.
Applications must be received by the County of San Luis Obispo. Please email grant applications to
ActionPlan@co.slo.ca.us by the application deadline of 5:00 P.M., Friday, October 21, 2016.
Please label your email subject by adding the grant program name and the agency name (Example:
CDBG – CAPSLO).
CONTACT INFORMATION
1. Qualifying Information
Organization Name: _________________________________DUNS number: _________________
Contact person/title/________________________________________________________________
Phone:____________________ Fax:____________________Email:________________________
Address (mailing and physical address requested if different):________________________________
__________________________________________________________________________________
Is your agency currently participating in Homeless Management Information System (HMIS)?
For more information see note #2 at the end of the application.
Yes No If not currently participating, does your agency have the capacity to participate
in HMIS? If yes, how so?
Total amount of CDBG funds requested: $____________________________________
Note:Please attach additional sheets for more detailed information of your proposed project or program for any of
the questions below.
PROJECT DESCRIPTION
2. Title/name/address of proposed project or program:
City of San Luis Obispo 829742431
David Athey/Supervising Civil Engineer
805-781-7108 805-781-7198 dathey@slocity.org
919 Palm Street, San Luis Obispo, CA 93401
105,000
2018 Curb Ramp Project/ Curb ramps on Marsh and Higuera Streets, between Archer and
California Streets.
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 2 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
3. Please describe the proposed project or program.Include a brief project/program description. For
projects, describe the location of the project (be as specific as possible, e.g. street address). For programs,
state the location from which the program will be operated, and describe the geographic area served by the
program.
4. Please attach a timeline of the project/program milestones.
5. Who are the clients of your organization and who will benefit from the CDBG funding?
(Example: low- to moderate-income persons, elderly persons, severely disabled persons, migrant
farm workers, battered spouses, etc.) Please explain how they will directly benefit from the
project or program.
6.Which of the 2015-2019 Consolidated Plan goal(s) does your project plan to address?Check
all that apply.
____ Create housing opportunities for residents
____ Preserve and maintain existing affordable housing
____ Reduce and end homelessness
____ Create suitable living environment through public services
____ Stabilize and revitalize diverse neighborhoods (Public facility improvements)
____ Improve educational and job readiness
7. Will the services offered by your organization increase or expand as a result of the CDBG
assistance? If yes, please answer the following questions:
a. What new programs or services will be provided?
b. Describe how existing programs or services will be expanded and what percentage of an
increase is expected?
The City of San Luis Obispo originally constructed street and sidewalk network impedes
access to those who have physical disabilities. The major impediment is the elevation
difference between the street and the sidewalk. Installation of corner curb ramps and crossing
points provide the needed transition between the street and sidewalk. A project map is
attached
Under federal rules, the removal of such impediments (architectural barriers) is considered to
meet national objectives for low- and moderate income persons, since it benefits elderly and
disabled persons. The elderly and disabled will benefit by being able to access and use the
same facilities as able bodied persons. This will provide equal access.
✔
✔
Not applicable.
Not applicable
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 3 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
8. Check any of the following eligible activity categories that apply to the proposed project or
program:(Refer to CDBG regulations and the Guide to Eligible CDBG Activities).
____ Acquisition of real property*
____ Disposition of real property
____ Public facilities and improvements (may include acquisition, construction, reconstruction,
rehabilitation or installation)* and/or **
____ Privately owned utilities
____ Public services
____ Relocation of individuals, families, businesses, non-profit organizations, and/or farms
____ Removal of architectural barriers
____ Housing rehabilitation**
____ Homeownership assistance
____ Technical assistance to businesses/micro-enterprise development
____ Administrative technical assistance and planning studies (specified)
9. Describe the need and the degree of urgency for the proposed project or program.
What would the consequences be if the proposed project or program is not funded in the
next year?
8. Please describe your organization’s capacity to implement the proposed project/program.
Who will be involved in the project/program? (In-house employees, contractors, other agency
partners, etc.)
9. Does the project require the issuance of a permit (from local, state or federal agencies)?
Yes No
a. If yes, please identify the permits necessary to complete the project.
b. Have the necessary permits been issued? Please provide proof of permit issuance.
* Relocation
** Lead-Based Paint
(See note 7 and 8 on page 10)
✔
✔
City policy is to coordinate accessibility projects with the Pavement Management Program. The
Pavement Management Program cycles through various areas of the City over an eight year
period with work in the downtown core and arterial roadways completed in coordination with
other work as needed. This project is in the downtown core. The next paving project for this
area is scheduled for 2019. Therefore, failure to fund this application will require the use of City
General Fund monies, thereby reducing funds for essential public facilities and services.
The City of San Luis Obispo Public Works Department oversees the design and construction of
curb ramps throughout the City. The Capital Division staff consisting of project managers,
Supervising Civil Engineer, Construction Supervisor and the City Engineer oversee and
manage these projects. The project will be publicly bid and constructed under procedures
adopted by the City and State of California in conjunction with federal requirements.
A City of San Luis Obispo Encroachment Permit.
No, Permits are issued just prior to construction.
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 4 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
c. If permits are required but not yet obtained, when will the permits be issued?
NATIONAL OBJECTIVES CRITERIA
10. Please identify the appropriate CDBG objective that applies to the proposed project/program
by choosing A, B, or C. Provide a corresponding explanation of how the proposed activity
meets the national objective.
A.Objective One – Low/Moderate Income (check one):
Note: To meet this national objective, the proposed activity must benefit a specific clientele or residents
in a particular area of the County or participating city, of which at least 51 percent of who are low- and
moderate-income persons.
Select one:
Area Benefit – The project serves only a limited geographic area which is proven by 2010
Census data or survey to be a predominately (51% or more)low/moderate-income area.
Applicants choosing this category must be able to prove their project/activity primarily benefits
low/moderate-income households.
Clientele – The project benefits a specific group of people,at least 51% of whom are
low/moderate-income persons. Note: Income verification for clients must be provided for this
category. The following groups are presumed to be low/moderate-income: abused children; elderly
persons; battered spouses; homeless persons; illiterate adults; adults meeting census definition of
severely disabled; persons living with AIDS; and migrant farm workers.
Housing – The project adds or improves permanent residential structures that will be/are
occupied by low/moderate-income households upon completion.
Jobs – The project creates or retains permanents jobs, at least 51% of which are taken by
low/moderate-income persons or considered to be available to low/moderate-income persons.
Explain:
B.Objective Two – Slums or Blight
Assists in the prevention or elimination of slums or blight. Note:To meet this national objective, the
proposed activity must be within a designated slum or blighted area and must be designed to address
one or more conditions that contributed to the deterioration of the area.
Select one:
Addressing Slums or Blight on an Area Basis
Addressing Slums or Blight on a Spot Basis - This project will prevent or eliminate
specific conditions of blight or physical decay. Activities are limited to clearance, historic
The City of San Luis Obispo Public Works Department will issue the ramp installation
contractor an Encroachment Permit after the sidewalk ramp installation construction
contract is awarded.
✔
Under federal rules, the removal of barriers is considered to meet national objectives for
low- and moderate income persons, since it benefits elderly and disabled persons,
"limited clientele" groups generally presumed to meet income standards.
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 5 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
preservation, rehabilitation of buildings, but only to the extent necessary to eliminate
conditions detrimental to public health and safety.
Explain:
C.Objective Three – Urgent Need
Meets community development needs having a particular urgency where existing conditions
pose a serious and immediate threat to the health or welfare of the community, and no other
funding sources are available, i.e., a major catastrophe such as a flood or earthquake.Note: To
meet this national objective, the proposed activity must deal with major catastrophes or emergencies
such as floods or earthquakes.
Explain:
11. If the project or program is designed specifically to provide benefit to low- and moderate-
income persons, please estimate the number of unduplicated persons (or households)to
benefit from the project, and break that estimate down by income group. Note:Unduplicated
means the number who are served, i.e., the grant will allow 25 children to participate in preschool – not 25
children x 5 days x 52 weeks = 6,500.
a.Total number of persons or households who will benefit from the project or program
(regardless of income group):
Persons/households (circle the applicable unit)
b.Of the total number of persons or households entered above, how many will be
low-income (earning 51% - 80% or less of the County median-income)?
Persons/households (circle the applicable unit)
c.Of the total number of persons or households entered above, how many will be
very low-income (earning 50% or less of the County median-income)?
Persons/households (circle the applicable unit)
#
#
#
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 6 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
12. If your project serves homeless households, please describe how your program coordinates
with other Continuum of Care projects and entities, and how it aligns with the San Luis
Obispo Countywide 10-Year Plan to Homelessness.
BENEFICIARY DATA
Note:Organizations will be asked to provide detailed data regarding race, ethnicity, gender, income,
etc. If they cannot provide data, they may not be eligible for funding.
13. How do you collect demographic data on the beneficiaries of the proposed project or
program?(Example: racial/ethnic characteristics)Please provide a sample of your intake process
as an attachment if possible.
14. How do you document and maintain income status of each client in compliance with HUD
regulations?(Example: very low ($0, , low ($0,) and moderate-income $0, )
Area Median Income (AMI)Please provide a sample of your intake process as an attachment if
possible.
15. Provide the following information for the persons in your organization responsible for the
preparation and submittal of the quarterly reports and for collecting and reporting the
beneficiary data to the Urban County.
Jenny Wiseman/Acting Housing Programs Manager
Contact Person/Title:__________________________________________________________
Phone/email:________________________________________________________________
FINANCIAL INFORMATION
For CDBG applications to the County of San Luis Obispo involving acquisition, construction, or
rehabilitation projects, the County will require additional information on financial source and
use of funds and other budget details prior to the draft Action Plan funding recommendations.
16. Attach a timeline of total expenditures.
Not applicable.
N/A - Access is for all.
N/A - Access is for all.
(805) 781-7010, jwiseman@slocity.org
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 7 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
17. Please identify the jurisdictions to which you are applying. If you are applying to one or
more jurisdictions, please provide a copy of the application to the County by the application
deadline. If you are requesting CDBG funds from more than one city, please break down the
amount shown above by the city listed below.The minimum requested CDBG amount is
$8,000 for public services per jurisdiction.
City of Arroyo Grande: $_______________ City of Paso Robles: $______________
City of Pismo Beach: $_______________ City of San Luis Obispo: $______________
City of Atascadero: $_______________ County of San Luis Obispo: $______________
City of Morro Bay: $_______________
Total amount of CDBG funds requested: $____________________________________
18. Please describe the budget for the proposed project or program. Itemize all sources of
funding expected to be available and used for this project (please include commitment
letters if available):
a. Revenues: Please identify funding sources for each category, if applicable.
1. CDBG Funds requested $ _________________
2. Other Federal fund(s): ___________________ $ _________________
3. State source(s): _______________________ $ _________________
4. Local source(s): _______________________ $ _________________
5. Applicant’s matching fund(s) $ __________________
6. Other funds: __________________________ $ _________________
_____________________________________ $ _________________
Total Revenues $ _________________
b. Expenditures under CDBG: List below by item or cost category.
$
$
$
$
$
$
$
$
$
TOTAL: $ ____________
105,000
105,000
105,000
105,000
Construction 105,000
105,000
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 8 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
19. How do you plan to fund the operation and maintenance costs (if any)associated with this
project? Are these funds available now? If not, when will they be available? And from what
sources?
20. Will CDBG funds be used to match/leverage other funds from other sources? List below
funding sources and amounts and identify award dates of these sources.
21. Federally funded projects/programs must comply with the following regulations. Please
explain how your organization will comply with the following requirements:
a. Civil Rights:
b. Section 504:
c. Fair Housing:
d. Limited English Proficiency:
I certify that the information in this application is true and accurate to the best of my knowledge and
ability.
___________________________________________________________
Signature Date
___________________________________________________________
Printed or typed name Title
There are no operation or maintenance costs associated with this project.
No
This project is intended to serve disabled and elderly citizens by
providing access to sidewalk and public facilities.
This project is intended to serve disabled and elderly citizens by
providing access to sidewalk and public facilities.
Not applicable
Not applicable
9/26/16
David M. Athey
9/26/16
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 9 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
Notes to applicant:
The County and cities require all of the grant recipients to maintain general liability, automobile and
workman’s compensation insurance with limits of not less than $1 million. If you are successful in
obtaining an award, you will be asked to provide documentation regarding ability to provide the required
coverage.
Prior to HUD’s release of grant funds for the CDBG-funded project, a review of the project’s potential
impact on the environment must be conducted and approved by the County of San Luis Obispo prior
to obligating or incurring project costs. The County must certify to HUD that it has complied with all
applicable environmental regulations and requirements. If project costs are obligated or incurred prior
to the completion of the necessary environmental review, the project shall not benefit from the grant
funds. The level of environmental review required depends on the nature of the project. Tilte 24 CFR
Part 58 is available at http://www.hud.gov/offices/pih/ih/codetalk/onap/docs/24cfr58.pdf.
1.Please review the CDBG regulations and guidelines and the Request for Proposals before
completing your proposal. The CDBG regulations, under 24 CFR 570, are available at
www.sloplanning.org under “Federal HUD Grants.”
2.HMIS Reporting for 2015 homeless services, housing and shelter - All homeless service providers
applying for ESG funds to assist, house or shelter the homeless must identify and demonstrate its
capacity to participate in the County of San Luis Obispo Homeless Management Information
System (HMIS) to provide: personnel for data entry, user licensing, and hardware and software
necessary for compatibility with HMIS. HMIS is an electronic data collection system that stores
client level information about persons who access the homeless services system in a Continuum of
Care, and reports aggregate data for the County as per the U.S. Department of Housing and Urban
Development’s (HUD) Data Standards. HUD updated its data standards in 2014, and the new
standards are in effect starting October 1, 2014. More information can be found at
https://www.hudexchange.info/resources/documents/HMIS-Data-Standards-Manual.pdf and
https://www.hudexchange.info/resources/documents/HMIS-Data-Dictionary.pdf.
3.Affirmative Marketing: Quarterly and annual reports shall be submitted by the project/program
manager to the County for only CDBG-funded public services and housing projects. Each report
shall report the total number of project/program applicants and clients served with respect to race,
ethnicity, gender, and disability status. Affirmative marketing efforts shall be taken to increase the
participation of any underserved groups.
4.Section 504 of the Rehabilitation Act of 1979: The County does not discriminate on the basis of
disability in admission to, access to, or operation of its federally assisted programs and activities.
The Section 504 Coordinator maintains a Grievance Procedure that receives and responds to
Section 504 grievances / complaints. However, it applies only to County programs and activities
that are funded by HUD. You can reach the ActionPlan@co.slo.ca.us, at the beginning of this
application, if you would like more information or wish to contact the Section 504 Coordinator.
5.The Project Proposal submitted to the County of San Luis Obispo shall be examined in relation to
the County’s community development goals and funding priorities as presented in the Urban County
of San Luis Obispo 2015-2019 Consolidated Plan. The Housing and Economic Development team
will make draft funding recommendations using the rating criteria stated in the updated Request for
Proposals as well as other information including but not limited to: the County Board of Supervisors,
recommendations from the Homeless Services Oversight Council, online “needs” survey, other
participating jurisdictions of the Urban County of San Luis Obispo, identified needs that could be
addressed by the grant funds, consistency with goals and priorities in the 2015-2019 Consolidated
Plan and the Ten Year Plan to End Homelessness, results of the Needs Workshops, working
knowledge of the project and organization, and availability of limited funds.
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 10 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
6.Those awarded grants are required to provide beneficiary data at the end of each quarter and year
end data of the fiscal year.
7.* Relocation: Any project that involves the acquisition of property and/or rehabilitation and is funded
in whole or in part with federal funds, even if the federal funds are not used for the acquisition itself,
is subject to federal requirements related to acquisition and relocation. A project cannot be broken
into separate “projects” in order to avoid the federal requirements concerning property acquisition
and relocation. Any questions regarding the relocation regulations for a specific property
acquisition project should be directed to the County Housing and Economic Development staff
before any action is taken on the project.
If HUD funded project will cause a household or a business to move, evenly temporarily, the relocation
regulations will apply. Please submit the following:
x Estimate of relocation cost (moving costs, subsidy amount for suitable replacement dwelling).
x Letter to owner of voluntary acquisition and proof of delivery to owner.
x General Information letter to tenants (both business and residential tenants) and proof of
delivery to all.
x List of tenants (both business and residential tenants) at the time of application submittal.
x Refer to http://www.slocounty.ca.gov/planning/Housing_and_Economic_Development/ura.htm
for sample relocation letters under the downloadable manuals.
8.** Lead-Based Paint (LBP): LBP regulations apply if HUD funded project involves acquisition or
rehabilitation of a residential units that was built in 1978 or earlier. Please submit the following:
x Estimate of costs for LBP work prepared by certified LBP consultant. Or a statement letter by
LBP consultant explaining that the project is exempt.
x Include any temporary housing costs.
Attachment B
Attachment 1
Project Area Map
2017 CDBG Project
September 4, 2016
Community Development Block Grant (CDBG)
Program Application for the 2017 Program Year
San Luis Obispo County Planning and Building
Attachment B
Attachment 2
Project Time Line, Milestones and Expenditures
2017 CDBG Project
September 4, 2016
Community Development Block Grant (CDBG)
Program Application for the 2017 Program Year
San Luis Obispo County Planning and Building
Project Time Line, Milestones, and Expenditures:
June 2017 – City Budget approved authorizing the 2017 CDBG Project
July 2017 to March 2018 – Ramp design is completed.
May 2018 – Project Approved for bid by City Council.
July 2018 – Project awarded and authorized for construction
August 2018 – Project constructed, the funding will be spent during this phase of the project.
September to October 2018 – Project close out.
October to November 2018 – Final Billing provided to County of San Luis Obispo
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM
APPLICATION FOR THE 2017 PROGRAM YEAR
SAN LUIS OBISPO COUNTY DEPARTMENT OF P LANNING AND BUILDING
976 O SOS STREET R OOM 200 S AN L UIS O BISPO CALIFORNIA 93408 (805) 781-5600
Promoting the Wise Use of Land Helping to Build Great Communities
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 1 OF 10
APPLICATION FOR FUNDING DURING 2017 PROGRAM YEAR A UGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING & BUILDING WWW .SLOPLANNING.ORG
The County of San Luis Obispo is pleased to announce the availability of funds for the Community
Development Block Grant (CDBG) program. The CDBG program is a flexible program that provides
communities with resources to address a wide range of unique community development needs.
Applicants seeking CDBG funds MUST address one of the three national objectives, as provided by the
Department of Housing and Urban Development (HUD) (see question 12 for detailed information on the
objectives). Applications that do not address one of the objectives will NOT be considered for CDBG
funding. Furthermore, completed applications should provide the necessary exhibits, budgets, or
requested information on targeted populations.
Applications must be received by the County of San Luis Obispo. Please email grant applications to
ActionPlan@co.slo.ca.us by the application deadline of 5:00 P.M., Friday, October 21, 2016.
Please label your email subject by adding the grant program name and the agency name (Example:
CDBG – CAPSLO).
CONTACT INFORMATION
1. Qualifying Information
Organization Name: _________________________________ DUNS number: _________________
Contact person/title/ ________________________________________________________________
Phone: ____________________ Fax: ____________________ Email: ________________________
Address (mailing and physical address requested if different): ________________________________
__________________________________________________________________________________
Is your agency currently participating in Homeless Management Information System (HMIS)?
For more information see note #2 at the end of the application.
Yes No If not currently participating, does your agency have the capacity to participate
in HMIS? If yes, how so?
Total amount of CDBG funds requested: $____________________________________
Note: Please attach additional sheets for more detailed information of your proposed project or program for any of
the questions below.
PROJECT DESCRIPTION
2. Title/name/address of proposed project or program:
City of San Luis Obispo 09-899-2407
Jenny Wiseman, Acting Housing Programs Manager
(805) 781-7010 (805) 781-7173 jwiseman@slocity.org
919 Palm Street, San Luis Obispo
CA 93401
30,972
City of San Luis Obispo CDBG Program Administration
919 Palm Street, CA, San Luis Obispo, CA 93401
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 2 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
3. Please describe the proposed project or program.Include a brief project/program description. For
projects, describe the location of the project (be as specific as possible, e.g. street address). For programs,
state the location from which the program will be operated, and describe the geographic area served by the
program.
4. Please attach a timeline of the project/program milestones.
5. Who are the clients of your organization and who will benefit from the CDBG funding?
(Example: low- to moderate-income persons, elderly persons, severely disabled persons, migrant
farm workers, battered spouses, etc.) Please explain how they will directly benefit from the
project or program.
6.Which of the 2015-2019 Consolidated Plan goal(s) does your project plan to address?Check
all that apply.
____ Create housing opportunities for residents
____ Preserve and maintain existing affordable housing
____ Reduce and end homelessness
____ Create suitable living environment through public services
____ Stabilize and revitalize diverse neighborhoods (Public facility improvements)
____ Improve educational and job readiness
7. Will the services offered by your organization increase or expand as a result of the CDBG
assistance? If yes, please answer the following questions:
a. What new programs or services will be provided?
b. Describe how existing programs or services will be expanded and what percentage of an
increase is expected?
This application is made consistent with HUD regulations that allow up to 20% of a
jurisdiction's CDBG funding to be used for program administration. Per the City/County
2015-17 Cooperation Agreement, the City will use 7% of program funding for administration.
Activities accomplished with this funding include community outreach, application review and
recommendation staff reports public hearings and project monitoring reporting and tracking
The project is a continuation of administration activities for the City's CDBG program.
Administrative costs for the City's program will be a result of awarding several CDBG grants to
organizations which serve low or moderate income persons, elderly persons, disabled
persons, migrant farm workers etc.
The request for administrative funding is to continue the City's CDBG program.
Program administration is vital to an effective CDBG program. Meeting HUD
requirements requires the City to assign sufficient staff resources to administration.
Administration funding for CDBG programs allows growth for new CDBG funded
projects throughout the City.
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 3 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING & BUILDING WWW .SLOPLANNING.ORG
8. Check any of the following eligible activity categories that apply to the proposed project or
program: (Refer to CDBG regulations and the Guide to Eligible CDBG Activities).
____ Acquisition of real property*
____ Disposition of real property
____ Public facilities and improvements (may include acquisition, construction, reconstruction,
rehabilitation or installation)* and/or **
____ Privately owned utilities
____ Public services
____ Relocation of individuals, families, businesses, non-profit organizations, and/or farms
____ Removal of architectural barriers
____ Housing rehabilitation**
____ Homeownership assistance
____ Technical assistance to businesses/micro-enterprise development
____ Administrative technical assistance and planning studies (specified)
9. Describe the need and the degree of urgency for the proposed project or program.
What would the consequences be if the proposed project or program is not funded in the
next year?
10. Please describe your organization’s capacity to implement the proposed project/program.
Who will be involved in the project/program? (In-house employees, contractors, other agency
partners, etc.)
11. Does the project require the issuance of a permit (from local, state or federal agencies)?
Yes No
a. If yes, please identify the permits necessary to complete the project.
b. Have the necessary permits been issued? Please provide proof of permit issuance.
* Relocation
** Lead-Based Paint
(See note 7 and 8 on page 10)
✔
Program administration is vital to an effective CDBG Program. HUD requires extensive record
keeping, monitoring and community outreach. Meeting these requirements requires the City to
assign sufficient staff resources to program administration.
CDBG program administration is accomplished by the Housing Programs Manager, a full-time
position in the Community Development Department.
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 4 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING & BUILDING WWW .SLOPLANNING.ORG
c. If permits are required but not yet obtained, when will the permits be issued?
NATIONAL OBJECTIVES CRITERIA
12. Please identify the appropriate CDBG objective that applies to the proposed project/program
by choosing A, B, or C. Provide a corresponding explanation of how the proposed activity
meets the national objective.
A. Objective One – Low/Moderate Income (check one):
Note: To meet this national objective, the proposed activity must benefit a specific clientele or residents
in a particular area of the County or participating city, of which at least 51 percent of who are low- and
moderate-income persons.
Select one:
Area Benefit – The project serves only a limited geographic area which is proven by 2010
Census data or survey to be a predominately (51% or more) low/moderate-income area.
Applicants choosing this category must be able to prove their project/activity primarily benefits
low/moderate-income households.
Clientele – The project benefits a specific group of people, at least 51% of whom are
low/moderate-income persons. Note: Income verification for clients must be provided for this
category. The following groups are presumed to be low/moderate-income: abused children; elderly
persons; battered spouses; homeless persons; illiterate adults; adults meeting census definition of
severely disabled; persons living with AIDS; and migrant farm workers.
Housing – The project adds or improves permanent residential structures that will be/are
occupied by low/moderate-income households upon completion.
Jobs – The project creates or retains permanents jobs, at least 51% of which are taken by
low/moderate-income persons or considered to be available to low/moderate-income persons.
Explain:
B. Objective Two – Slums or Blight
Assists in the prevention or elimination of slums or blight. Note: To meet this national objective, the
proposed activity must be within a designated slum or blighted area and must be designed to address
one or more conditions that contributed to the deterioration of the area.
Select one:
Addressing Slums or Blight on an Area Basis
Addressing Slums or Blight on a Spot Basis - This project will prevent or eliminate
specific conditions of blight or physical decay. Activities are limited to clearance, historic
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 5 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING & BUILDING WWW .SLOPLANNING.ORG
preservation, rehabilitation of buildings, but only to the extent necessary to eliminate
conditions detrimental to public health and safety.
Explain:
C. Objective Three – Urgent Need
Meets community development needs having a particular urgency where existing conditions
pose a serious and immediate threat to the health or welfare of the community, and no other
funding sources are available, i.e., a major catastrophe such as a flood or earthquake. Note: To
meet this national objective, the proposed activity must deal with major catastrophes or emergencies
such as floods or earthquakes.
Explain:
13. If the project or program is designed specifically to provide benefit to low- and moderate-
income persons, please estimate the number of unduplicated persons (or households) to
benefit from the project, and break that estimate down by income group. Note: Unduplicated
means the number who are served, i.e., the grant will allow 25 children to participate in preschool – not 25
children x 5 days x 52 weeks = 6,500.
a. Total number of persons or households who will benefit from the project or program
(regardless of income group):
Persons/households (circle the applicable unit)
b. Of the total number of persons or households entered above, how many will be
low-income (earning 51% - 80% or less of the County median-income)?
Persons/households (circle the applicable unit)
c. Of the total number of persons or households entered above, how many will be
very low-income (earning 50% or less of the County median-income)?
Persons/households (circle the applicable unit)
#
#
#
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 6 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING & BUILDING WWW .SLOPLANNING.ORG
14. If your project serves homeless households, please describe how your program coordinates
with other Continuum of Care projects and entities, and how it aligns with the San Luis
Obispo Countywide 10-Year Plan to Homelessness.
BENEFICIARY DATA
Note: Organizations will be asked to provide detailed data regarding race, ethnicity, gender, income,
etc. If they cannot provide data, they may not be eligible for funding.
15. How do you collect demographic data on the beneficiaries of the proposed project or
program? (Example: racial/ethnic characteristics) Please provide a sample of your intake process
as an attachment if possible.
16. How do you document and maintain income status of each client in compliance with HUD
regulations? (Example: very low ($0, , low ( $0,) and moderate-income $0, )
Area Median Income (AMI) Please provide a sample of your intake process as an attachment if
possible.
17. Provide the following information for the persons in your organization responsible for the
preparation and submittal of the quarterly reports and for collecting and reporting the
beneficiary data to the Urban County.
Contact Person/Title:__________________________________________________________
Phone/email:________________________________________________________________
FINANCIAL INFORMATION
For CDBG applications to the County of San Luis Obispo involving acquisition, construction, or
rehabilitation projects, the County will require additional information on financial source and
use of funds and other budget details prior to the draft Action Plan funding recommendations.
18. Attach a timeline of total expenditures.
N/A
Income and asset data is collected to determine eligibility. Demographic data is collected from
grant recipients on a quarterly and annual basis, consistent with HUD reporting requirements.
Income status is documented through the income-certification process, which is used to
determine eligibility of clients.
Jenny Wiseman, Acting Housing Programs Manager
805-781-7010, jwiseman@slocity.org
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 7 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING & BUILDING WWW .SLOPLANNING.ORG
19. Please identify the jurisdictions to which you are applying. If you are applying to one or
more jurisdictions, please provide a copy of the application to the County by the application
deadline. If you are requesting CDBG funds from more than one city, please break down the
amount shown above by the city listed below. The minimum requested CDBG amount is
$8,000 for public services per jurisdiction.
City of Arroyo Grande: $_______________ City of Paso Robles: $______________
City of Pismo Beach: $_______________ City of San Luis Obispo: $______________
City of Atascadero: $_______________ County of San Luis Obispo: $______________
City of Morro Bay: $_______________
Total amount of CDBG funds requested: $____________________________________
20. Please describe the budget for the proposed project or program. Itemize all sources of
funding expected to be available and used for this project (please include commitment
letters if available):
a. Revenues: Please identify funding sources for each category, if applicable.
1. CDBG Funds requested $ _________________
2. Other Federal fund(s): ___________________ $ _________________
3. State source(s): _______________________ $ _________________
4. Local source(s): _______________________ $ _________________
5. Applicant’s matching fund(s) $ __________________
6. Other funds: __________________________ $ _________________
_____________________________________ $ _________________
Total Revenues $ _________________
b. Expenditures under CDBG: List below by item or cost category.
$
$
$
$
$
$
$
$
$
TOTAL: $ ____________
30, 972
30,972
30,972
CDBG Program Administration
30,972
30,972
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 8 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING & BUILDING WWW .SLOPLANNING.ORG
21. How do you plan to fund the operation and maintenance costs (if any) associated with this
project? Are these funds available now? If not, when will they be available? And from what
sources?
22. Will CDBG funds be used to match/leverage other funds from other sources? List below
funding sources and amounts and identify award dates of these sources.
23. Federally funded projects/programs must comply with the following regulations. Please
explain how your organization will comply with the following requirements:
a. Civil Rights:
b. Section 504:
c. Fair Housing:
d. Limited English Proficiency:
I certify that the information in this application is true and accurate to the best of my knowledge and
ability.
___________________________________________________________
Signature Date
___________________________________________________________
Printed or typed name Title
CDBG funding will cover a portion of the operation and maintenance costs of the program, with
the balance provided by the City of San Luis Obispo Affordable Housing and General Funds.
Local funds would be used to cover program administration expenses in addition to the maximum
7% allowed by the 2015-17 City/County CDBG Cooperation Agreement
10/11/2016
Jenny Wiseman
Acting Housing Programs Manager
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 9 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
Notes to applicant:
The County and cities require all of the grant recipients to maintain general liability, automobile and
workman’s compensation insurance with limits of not less than $1 million. If you are successful in
obtaining an award, you will be asked to provide documentation regarding ability to provide the required
coverage.
Prior to HUD’s release of grant funds for the CDBG-funded project, a review of the project’s potential
impact on the environment must be conducted and approved by the County of San Luis Obispo prior
to obligating or incurring project costs. The County must certify to HUD that it has complied with all
applicable environmental regulations and requirements. If project costs are obligated or incurred prior
to the completion of the necessary environmental review, the project shall not benefit from the grant
funds. The level of environmental review required depends on the nature of the project. Tilte 24 CFR
Part 58 is available at http://www.hud.gov/offices/pih/ih/codetalk/onap/docs/24cfr58.pdf.
1.Please review the CDBG regulations and guidelines and the Request for Proposals before
completing your proposal. The CDBG regulations, under 24 CFR 570, are available at
www.sloplanning.org under “Federal HUD Grants.”
2.HMIS Reporting for 2015 homeless services, housing and shelter -All homeless service providers
applying for ESG funds to assist, house or shelter the homeless must identify and demonstrate its
capacity to participate in the County of San Luis Obispo Homeless Management Information
System (HMIS) to provide: personnel for data entry, user licensing, and hardware and software
necessary for compatibility with HMIS. HMIS is an electronic data collection system that stores
client level information about persons who access the homeless services system in a Continuum of
Care, and reports aggregate data for the County as per the U.S. Department of Housing and Urban
Development’s (HUD) Data Standards. HUD updated its data standards in 2014, and the new
standards are in effect starting October 1, 2014. More information can be found at
https://www.hudexchange.info/resources/documents/HMIS-Data-Standards-Manual.pdf and
https://www.hudexchange.info/resources/documents/HMIS-Data-Dictionary.pdf.
3.Affirmative Marketing: Quarterly and annual reports shall be submitted by the project/program
manager to the County for only CDBG-funded public services and housing projects. Each report
shall report the total number of project/program applicants and clients served with respect to race,
ethnicity, gender, and disability status. Affirmative marketing efforts shall be taken to increase the
participation of any underserved groups.
4.Section 504 of the Rehabilitation Act of 1979: The County does not discriminate on the basis of
disability in admission to, access to, or operation of its federally assisted programs and activities.
The Section 504 Coordinator maintains a Grievance Procedure that receives and responds to
Section 504 grievances / complaints. However, it applies only to County programs and activities
that are funded by HUD. You can reach the ActionPlan@co.slo.ca.us, at the beginning of this
application, if you would like more information or wish to contact the Section 504 Coordinator.
5.The Project Proposal submitted to the County of San Luis Obispo shall be examined in relation to
the County’s community development goals and funding priorities as presented in the Urban County
of San Luis Obispo 2015-2019 Consolidated Plan. The Housing and Economic Development team
will make draft funding recommendations using the rating criteria stated in the updated Request for
Proposals as well as other information including but not limited to: the County Board of Supervisors,
recommendations from the Homeless Services Oversight Council, online “needs” survey, other
participating jurisdictions of the Urban County of San Luis Obispo, identified needs that could be
addressed by the grant funds, consistency with goals and priorities in the 2015-2019 Consolidated
Plan and the Ten Year Plan to End Homelessness, results of the Needs Workshops, working
knowledge of the project and organization, and availability of limited funds.
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 10 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
6.Those awarded grants are required to provide beneficiary data at the end of each quarter and year
end data of the fiscal year.
7.* Relocation: Any project that involves the acquisition of property and/or rehabilitation and is funded
in whole or in part with federal funds, even if the federal funds are not used for the acquisition itself,
is subject to federal requirements related to acquisition and relocation. A project cannot be broken
into separate “projects” in order to avoid the federal requirements concerning property acquisition
and relocation. Any questions regarding the relocation regulations for a specific property
acquisition project should be directed to the County Housing and Economic Development staff
before any action is taken on the project.
If HUD funded project will cause a household or a business to move, evenly temporarily, the relocation
regulations will apply. Please submit the following:
x Estimate of relocation cost (moving costs, subsidy amount for suitable replacement dwelling).
x Letter to owner of voluntary acquisition and proof of delivery to owner.
x General Information letter to tenants (both business and residential tenants) and proof of
delivery to all.
x List of tenants (both business and residential tenants) at the time of application submittal.
x Refer to http://www.slocounty.ca.gov/planning/Housing_and_Economic_Development/ura.htm
for sample relocation letters under the downloadable manuals.
8.** Lead-Based Paint (LBP): LBP regulations apply if HUD funded project involves acquisition or
rehabilitation of a residential units that was built in 1978 or earlier. Please submit the following:
x Estimate of costs for LBP work prepared by certified LBP consultant. Or a statement letter by
LBP consultant explaining that the project is exempt.
x Include any temporary housing costs.
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM
APPLICATION FOR THE 2017 PROGRAM YEAR
SAN LUIS OBISPO COUNTY DEPARTMENT OF P LANNING AND BUILDING
976 O SOS STREET R OOM 200 S AN L UIS O BISPO CALIFORNIA 93408 (805) 781-5600
Promoting the Wise Use of Land Helping to Build Great Communities
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 1 OF 10
APPLICATION FOR FUNDING DURING 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
The County of San Luis Obispo is pleased to announce the availability of funds for the Community
Development Block Grant (CDBG) program. The CDBG program is a flexible program that provides
communities with resources to address a wide range of unique community development needs.
Applicants seeking CDBG funds MUST address one of the three national objectives, as provided by the
Department of Housing and Urban Development (HUD) (see question 10 for detailed information on the
objectives). Applications that do not address one of the objectives will NOT be considered for CDBG
funding. Furthermore, completed applications should provide the necessary exhibits, budgets, or
requested information on targeted populations.
Applications must be received by the County of San Luis Obispo. Please email grant applications to
ActionPlan@co.slo.ca.us by the application deadline of 5:00 P.M., Friday, October 21, 2016.
Please label your email subject by adding the grant program name and the agency name (Example:
CDBG – CAPSLO).
CONTACT INFORMATION
1. Qualifying Information
Organization Name: _________________________________DUNS number: _________________
Contact person/title/________________________________________________________________
Phone:____________________ Fax:____________________Email:________________________
Address (mailing and physical address requested if different):________________________________
__________________________________________________________________________________
Is your agency currently participating in Homeless Management Information System (HMIS)?
For more information see note #2 at the end of the application.
Yes No If not currently participating, does your agency have the capacity to participate
in HMIS? If yes, how so?
Total amount of CDBG funds requested: $____________________________________
Note:Please attach additional sheets for more detailed information of your proposed project or program for any of
the questions below.
PROJECT DESCRIPTION
2. Title/name/address of proposed project or program:
Transitions-Mental Health Association (TMHA)932777550
Jill Bolster-White, TMHA Executive Director
(805) 540-6505 (805) 540-6501 jbw@t-mha.org
P.O. Box 15408 San Luis Obispo, CA 93406 physical: 784 High Street SLO, CA 93401
650,000
Bishop Street Studios
1600 Bishop Street San Luis Obispo, CA 93401
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 2 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
3. Please describe the proposed project or program.Include a brief project/program description. For
projects, describe the location of the project (be as specific as possible, e.g. street address). For programs,
state the location from which the program will be operated, and describe the geographic area served by the
program.
4. Please attach a timeline of the project/program milestones.
5. Who are the clients of your organization and who will benefit from the CDBG funding?
(Example: low- to moderate-income persons, elderly persons, severely disabled persons, migrant
farm workers, battered spouses, etc.) Please explain how they will directly benefit from the
project or program.
6.Which of the 2015-2019 Consolidated Plan goal(s) does your project plan to address?Check
all that apply.
____ Create housing opportunities for residents
____ Preserve and maintain existing affordable housing
____ Reduce and end homelessness
____ Create suitable living environment through public services
____ Stabilize and revitalize diverse neighborhoods (Public facility improvements)
____ Improve educational and job readiness
7. Will the services offered by your organization increase or expand as a result of the CDBG
assistance? If yes, please answer the following questions:
a. What new programs or services will be provided?
b. Describe how existing programs or services will be expanded and what percentage of an
increase is expected?
Please see QUESTION 3: PROJECT within the attached document.
Clients of Transitions-Mental Health Services (TMHA) who will benefit from CDBG funding are
low- to very low-income adults and transition age youth living with a mental illness. The lack of
affordable housing for men and women with mental illness is one of the most powerful barriers
to their recovery. When this basic need cannot be met, people with mental illness cycle in and
out of homelessness, jails, shelters and hospitals. One of TMHA's goals is to reduce the
impact our clients have on county jails, shelters and hospitals and Bishop Street Studios will
help us achieve that goal.
✔
✔
✔
✔
✔
Supportive housing services for adults with mental illness will expand by 34
additional units.
The amount of supportive housing TMHA provides to adults with mental illness in
the City of San Luis Obispo will increase by nearly 30%, and nearly 20% for the
entire County of San Luis Obispo.
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 3 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
8. Check any of the following eligible activity categories that apply to the proposed project or
program:(Refer to CDBG regulations and the Guide to Eligible CDBG Activities).
____ Acquisition of real property*
____ Disposition of real property
____ Public facilities and improvements (may include acquisition, construction, reconstruction,
rehabilitation or installation)* and/or **
____ Privately owned utilities
____ Public services
____ Relocation of individuals, families, businesses, non-profit organizations, and/or farms
____ Removal of architectural barriers
____ Housing rehabilitation**
____ Homeownership assistance
____ Technical assistance to businesses/micro-enterprise development
____ Administrative technical assistance and planning studies (specified)
9. Describe the need and the degree of urgency for the proposed project or program.
What would the consequences be if the proposed project or program is not funded in the
next year?
8. Please describe your organization’s capacity to implement the proposed project/program.
Who will be involved in the project/program? (In-house employees, contractors, other agency
partners, etc.)
9. Does the project require the issuance of a permit (from local, state or federal agencies)?
Yes No
a. If yes, please identify the permits necessary to complete the project.
b. Have the necessary permits been issued? Please provide proof of permit issuance.
* Relocation
** Lead-Based Paint
(See note 7 and 8 on page 10)
✔
✔
✔
If Bishop Street Studios is not funded within the current grant cycle, the limited, time-sensitive
opportunity to acquire and rehabilitate the old Sunny Acres building will be jeopardized and the
potential to add 34 units of supportive housing for adults with mental illness within the City of
San Luis Obispo may be lost.
Please see QUESTION 8: CAPACITY & PARTNERS within the attached document.
Cultural Heritage Committee (CHC) review and Architectural Review Commission (ARC)
approval from the City of San Luis Obispo, and a ministerial building permit from the City
of San Luis Obispo.
CHC and ARC approved the project unanimously on September 19, 2016. An appeal
was filed and will considered by the San Luis Obispo City Council on November 15th.
We anticipated unanimous City Council support for this project.
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 4 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
c. If permits are required but not yet obtained, when will the permits be issued?
NATIONAL OBJECTIVES CRITERIA
10. Please identify the appropriate CDBG objective that applies to the proposed project/program
by choosing A, B, or C. Provide a corresponding explanation of how the proposed activity
meets the national objective.
A.Objective One – Low/Moderate Income (check one):
Note: To meet this national objective, the proposed activity must benefit a specific clientele or residents
in a particular area of the County or participating city, of which at least 51 percent of who are low- and
moderate-income persons.
Select one:
Area Benefit – The project serves only a limited geographic area which is proven by 2010
Census data or survey to be a predominately (51% or more)low/moderate-income area.
Applicants choosing this category must be able to prove their project/activity primarily benefits
low/moderate-income households.
Clientele – The project benefits a specific group of people,at least 51% of whom are
low/moderate-income persons. Note: Income verification for clients must be provided for this
category. The following groups are presumed to be low/moderate-income: abused children; elderly
persons; battered spouses; homeless persons; illiterate adults; adults meeting census definition of
severely disabled; persons living with AIDS; and migrant farm workers.
Housing – The project adds or improves permanent residential structures that will be/are
occupied by low/moderate-income households upon completion.
Jobs – The project creates or retains permanents jobs, at least 51% of which are taken by
low/moderate-income persons or considered to be available to low/moderate-income persons.
Explain:
B.Objective Two – Slums or Blight
Assists in the prevention or elimination of slums or blight. Note:To meet this national objective, the
proposed activity must be within a designated slum or blighted area and must be designed to address
one or more conditions that contributed to the deterioration of the area.
Select one:
Addressing Slums or Blight on an Area Basis
Addressing Slums or Blight on a Spot Basis - This project will prevent or eliminate
specific conditions of blight or physical decay. Activities are limited to clearance, historic
We expect City Council to deny the appeal of the Development Plan Approval on
November 15th. The building permit will be issued late 2017, within 180 days of 9%
Tax Credits being awarded in June 2017.
✔
HASLO will certify all residents as being at or below 60% of the Area Median Income
pursuant to the Low Income Housing Tax Credit Program. Additionally all residents will
be referred by SLO Department of Behavioral Health. Entry requirements include a
✔
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 5 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
preservation, rehabilitation of buildings, but only to the extent necessary to eliminate
conditions detrimental to public health and safety.
Explain:
C.Objective Three – Urgent Need
Meets community development needs having a particular urgency where existing conditions
pose a serious and immediate threat to the health or welfare of the community, and no other
funding sources are available, i.e., a major catastrophe such as a flood or earthquake.Note: To
meet this national objective, the proposed activity must deal with major catastrophes or emergencies
such as floods or earthquakes.
Explain:
11. If the project or program is designed specifically to provide benefit to low- and moderate-
income persons, please estimate the number of unduplicated persons (or households)to
benefit from the project, and break that estimate down by income group. Note:Unduplicated
means the number who are served, i.e., the grant will allow 25 children to participate in preschool – not 25
children x 5 days x 52 weeks = 6,500.
a.Total number of persons or households who will benefit from the project or program
(regardless of income group):
Persons/households (circle the applicable unit)
b.Of the total number of persons or households entered above, how many will be
low-income (earning 51% - 80% or less of the County median-income)?
Persons/households (circle the applicable unit)
c.Of the total number of persons or households entered above, how many will be
very low-income (earning 50% or less of the County median-income)?
Persons/households (circle the applicable unit)
#
#
#
The old Sunny Acres building has been abandoned for over 40 years. It is in a state of
extreme disrepair while remaining an attractive nuisance for vandals and graffiti artists.
34
1
33
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 6 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
12. If your project serves homeless households, please describe how your program coordinates
with other Continuum of Care projects and entities, and how it aligns with the San Luis
Obispo Countywide 10-Year Plan to Homelessness.
BENEFICIARY DATA
Note:Organizations will be asked to provide detailed data regarding race, ethnicity, gender, income,
etc. If they cannot provide data, they may not be eligible for funding.
13. How do you collect demographic data on the beneficiaries of the proposed project or
program? (Example: racial/ethnic characteristics)Please provide a sample of your intake process
as an attachment if possible.
14. How do you document and maintain income status of each client in compliance with HUD
regulations? (Example: very low ($0, , low ( $0,) and moderate-income $0, )
Area Median Income (AMI)Please provide a sample of your intake process as an attachment if
possible.
15. Provide the following information for the persons in your organization responsible for the
preparation and submittal of the quarterly reports and for collecting and reporting the
beneficiary data to the Urban County.
Contact Person/Title:__________________________________________________________
Phone/email:________________________________________________________________
FINANCIAL INFORMATION
For CDBG applications to the County of San Luis Obispo involving acquisition, construction, or
rehabilitation projects, the County will require additional information on financial source and
use of funds and other budget details prior to the draft Action Plan funding recommendations.
16. Attach a timeline of total expenditures.
7LPHOLQH$WWDFKHG
Bishop Street Studios will house numerous individuals who are at-risk of homelessness. TMHA
is a full participant in the County Continuum of Care and 10-Year Plan to End Homelessness
and the majority of our housing programs serve homeless households. We anticipate that a
number of our clients will transition from these programs into Bishop Street Studios.
Please see attached Housing Intake Form.
See Attached.The project will be subject to a 55 year TCAC Regulatory Agreement. The
affordability requirements utilized by TCAC mirror HUD requirements.
Jill Bolster-White, TMHA Executive Director
(805) 540-6505 jbw@t-mha.org
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 7 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
17. Please identify the jurisdictions to which you are applying. If you are applying to one or
more jurisdictions, please provide a copy of the application to the County by the application
deadline. If you are requesting CDBG funds from more than one city, please break down the
amount shown above by the city listed below.The minimum requested CDBG amount is
$8,000 for public services per jurisdiction.
City of Arroyo Grande: $_______________ City of Paso Robles: $______________
City of Pismo Beach: $_______________ City of San Luis Obispo: $______________
City of Atascadero: $_______________ County of San Luis Obispo: $______________
City of Morro Bay: $_______________
Total amount of CDBG funds requested: $____________________________________
18. Please describe the budget for the proposed project or program. Itemize all sources of
funding expected to be available and used for this project (please include commitment
letters if available):
a. Revenues: Please identify funding sources for each category, if applicable.
1. CDBG Funds requested $ _________________
2. Other Federal fund(s): ___________________ $ _________________
3. State source(s): _______________________ $ _________________
4. Local source(s): _______________________ $ _________________
5. Applicant’s matching fund(s) $ __________________
6. Other funds: __________________________ $ _________________
_____________________________________ $ _________________
Total Revenues $ _________________
b. Expenditures under CDBG: List below by item or cost category.
$
$
$
$
$
$
$
$
$
TOTAL: $ ____________
N&RXQW\N&LW\
200,000
450,000
650,000
650,000
County Home $300,000 300,000
Low-Income Housing Tax Credits 7,101,184
City Fee Deferrals, City Aff Hsg Funds 1,440,624
1,100,000
HASLO Section 8 Loan
Conventional Bank Mortgage
521,000
368,512
11,481,320
Site Acquistion & Offsite Improvements for New Affordble Housing 650,000
650,000
Attachment B
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 9 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
Notes to applicant:
The County and cities require all of the grant recipients to maintain general liability, automobile and
workman’s compensation insurance with limits of not less than $1 million. If you are successful in
obtaining an award, you will be asked to provide documentation regarding ability to provide the required
coverage.
Prior to HUD’s release of grant funds for the CDBG-funded project, a review of the project’s potential
impact on the environment must be conducted and approved by the County of San Luis Obispo prior
to obligating or incurring project costs. The County must certify to HUD that it has complied with all
applicable environmental regulations and requirements. If project costs are obligated or incurred prior
to the completion of the necessary environmental review, the project shall not benefit from the grant
funds. The level of environmental review required depends on the nature of the project. Tilte 24 CFR
Part 58 is available at http://www.hud.gov/offices/pih/ih/codetalk/onap/docs/24cfr58.pdf.
1.Please review the CDBG regulations and guidelines and the Request for Proposals before
completing your proposal. The CDBG regulations, under 24 CFR 570, are available at
www.sloplanning.org under “Federal HUD Grants.”
2.HMIS Reporting for 2015 homeless services, housing and shelter - All homeless service providers
applying for ESG funds to assist, house or shelter the homeless must identify and demonstrate its
capacity to participate in the County of San Luis Obispo Homeless Management Information
System (HMIS) to provide: personnel for data entry, user licensing, and hardware and software
necessary for compatibility with HMIS. HMIS is an electronic data collection system that stores
client level information about persons who access the homeless services system in a Continuum of
Care, and reports aggregate data for the County as per the U.S. Department of Housing and Urban
Development’s (HUD) Data Standards. HUD updated its data standards in 2014, and the new
standards are in effect starting October 1, 2014. More information can be found at
https://www.hudexchange.info/resources/documents/HMIS-Data-Standards-Manual.pdf and
https://www.hudexchange.info/resources/documents/HMIS-Data-Dictionary.pdf.
3.Affirmative Marketing: Quarterly and annual reports shall be submitted by the project/program
manager to the County for only CDBG-funded public services and housing projects. Each report
shall report the total number of project/program applicants and clients served with respect to race,
ethnicity, gender, and disability status. Affirmative marketing efforts shall be taken to increase the
participation of any underserved groups.
4.Section 504 of the Rehabilitation Act of 1979: The County does not discriminate on the basis of
disability in admission to, access to, or operation of its federally assisted programs and activities.
The Section 504 Coordinator maintains a Grievance Procedure that receives and responds to
Section 504 grievances / complaints. However, it applies only to County programs and activities
that are funded by HUD. You can reach the ActionPlan@co.slo.ca.us, at the beginning of this
application, if you would like more information or wish to contact the Section 504 Coordinator.
5.The Project Proposal submitted to the County of San Luis Obispo shall be examined in relation to
the County’s community development goals and funding priorities as presented in the Urban County
of San Luis Obispo 2015-2019 Consolidated Plan. The Housing and Economic Development team
will make draft funding recommendations using the rating criteria stated in the updated Request for
Proposals as well as other information including but not limited to: the County Board of Supervisors,
recommendations from the Homeless Services Oversight Council, online “needs” survey, other
participating jurisdictions of the Urban County of San Luis Obispo, identified needs that could be
addressed by the grant funds, consistency with goals and priorities in the 2015-2019 Consolidated
Plan and the Ten Year Plan to End Homelessness, results of the Needs Workshops, working
knowledge of the project and organization, and availability of limited funds.
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 10 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
6.Those awarded grants are required to provide beneficiary data at the end of each quarter and year
end data of the fiscal year.
7.* Relocation: Any project that involves the acquisition of property and/or rehabilitation and is funded
in whole or in part with federal funds, even if the federal funds are not used for the acquisition itself,
is subject to federal requirements related to acquisition and relocation. A project cannot be broken
into separate “projects” in order to avoid the federal requirements concerning property acquisition
and relocation. Any questions regarding the relocation regulations for a specific property
acquisition project should be directed to the County Housing and Economic Development staff
before any action is taken on the project.
If HUD funded project will cause a household or a business to move, evenly temporarily, the relocation
regulations will apply. Please submit the following:
x Estimate of relocation cost (moving costs, subsidy amount for suitable replacement dwelling).
x Letter to owner of voluntary acquisition and proof of delivery to owner.
x General Information letter to tenants (both business and residential tenants) and proof of
delivery to all.
x List of tenants (both business and residential tenants) at the time of application submittal.
x Refer to http://www.slocounty.ca.gov/planning/Housing_and_Economic_Development/ura.htm
for sample relocation letters under the downloadable manuals.
8.** Lead-Based Paint (LBP): LBP regulations apply if HUD funded project involves acquisition or
rehabilitation of a residential units that was built in 1978 or earlier. Please submit the following:
x Estimate of costs for LBP work prepared by certified LBP consultant. Or a statement letter by
LBP consultant explaining that the project is exempt.
x Include any temporary housing costs.
8.** Lead-Based Paint (LBP): LBP regulations apply if HUD funded project involves acquisition or ()gppy pj q
rehabilitation of a residential units that was built in 1978 or earlier.Please submit the following:
x
g
Estimate of costs for LBP work prepared by certified LBP consultant. Or a statement letter by pp y
LBP consultant explaining that the project is exempt.
x
pg p
Include any temporary housing costs.
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM
APPLICATION FOR THE 2017 PROGRAM YEAR
SAN LUIS OBISPO COUNTY DEPARTMENT OF P LANNING AND BUILDING
976 O SOS STREET R OOM 200 S AN L UIS O BISPO CALIFORNIA 93408 (805) 781-5600
Promoting the Wise Use of Land Helping to Build Great Communities
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 1 OF 10
APPLICATION FOR FUNDING DURING 2017 PROGRAM YEAR A UGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
The County of San Luis Obispo is pleased to announce the availability of funds for the Community
Development Block Grant (CDBG) program. The CDBG program is a flexible program that provides
communities with resources to address a wide range of unique community development needs.
Applicants seeking CDBG funds MUST address one of the three national objectives, as provided by the
Department of Housing and Urban Development (HUD) (see question 12 for detailed information on the
objectives). Applications that do not address one of the objectives will NOT be considered for CDBG
funding. Furthermore, completed applications should provide the necessary exhibits, budgets, or
requested information on targeted populations.
Applications must be received by the County of San Luis Obispo. Please email grant applications to
ActionPlan@co.slo.ca.us by the application deadline of 5:00 P.M., Friday, October 21, 2016.
Please label your email subject by adding the grant program name and the agency name (Example:
CDBG – CAPSLO).
CONTACT INFORMATION
1. Qualifying Information
Organization Name: _________________________________DUNS number: _________________
Contact person/title/________________________________________________________________
Phone:____________________Fax:____________________Email:________________________
Address (mailing and physical address requested if different):________________________________
__________________________________________________________________________________
Is your agency currently participating in Homeless Management Information System (HMIS)?
For more information see note #2 at the end of the application.
Yes No If not currently participating, does your agency have the capacity to participate
in HMIS? If yes, how so?
Total amount of CDBG funds requested: $_ _____________________________
Note:Please attach additional sheets for more detailed information of your proposed project or program for any of
the questions below.
PROJECT DESCRIPTION
2. Title/name/address of proposed project or program:
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__193,494____
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 2 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
3. Please describe the proposed project or program.Include a brief project/program description. For
projects, describe the location of the project (be as specific as possible, e.g. street address). For programs,
state the location from which the program will be operated, and describe the geographic area served by the
program.
4. Please attach a timeline of the project/program milestones.
5. Who are the clients of your organization and who will benefit from the CDBG funding?
(Example: low- to moderate-income persons, elderly persons, severely disabled persons, migrant
farm workers, battered spouses, etc.) Please explain how they will directly benefit from the
project or program.
6.Which of the 2015-2019 Consolidated Plan goal(s) does your project plan to address? Check
all that apply.
____ Create housing opportunities for residents
____ Preserve and maintain existing affordable housing
____ Reduce and end homelessness
____ Create suitable living environment through public services
____ Stabilize and revitalize diverse neighborhoods (Public facility improvements)
____ Improve educational and job readiness
7. Will the services offered by your organization increase or expand as a result of the CDBG
assistance? If yes, please answer the following questions:
a. What new programs or services will be provided?
b. Describe how existing programs or services will be expanded and what percentage of an
increase is expected?
1MFBTFTFF"UUBDINFOU"
Centrally located in the City of San Luis Obispo, MLM provide 49 beds nightly, 365 days/year.
An additional 25 to 45 beds for families and women are added through the Interfaith Coalition
for the Homeless "overflow" shelter program operated in rotating houses of worship. The
shelter opens at 5pm daily and offers meals, showers, information and referrals, and access to
case management More than 27 000 shelter nights and 62 000 meals are provided to roughly
Low-income men, women, and children who are homeless, including seniors and those with
disabilities. Shelter clients have “one stop” access to services that help stabilize their lives and
move them toward greater self-sufficiency. In addition to emergency shelter, the holistic
framework of services to help meet client needs include community meal programs, daytime
services at Prado Day Center, linkages and advocacy support, and access to case
management and permanent housing.
✔
No expansion is planned as a result of CDBG assistance; however, the new
consolidated service center, proposed to be operational by spring by 2018 will result
in an increase in beds and services.
CDBG funding enables the shelter to maintain current levels of services.
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 3 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
8. Check any of the following eligible activity categories that apply to the proposed project or
program:(Refer to CDBG regulations and the Guide to Eligible CDBG Activities).
____ Acquisition of real property*
____ Disposition of real property
____ Public facilities and improvements (may include acquisition, construction, reconstruction,
rehabilitation or installation)* and/or **
____ Privately owned utilities
____ Public services
____ Relocation of individuals, families, businesses, non-profit organizations, and/or farms
____ Removal of architectural barriers
____ Housing rehabilitation**
____ Homeownership assistance
____ Technical assistance to businesses/micro-enterprise development
____ Administrative technical assistance and planning studies (specified)
9. Describe the need and the degree of urgency for the proposed project or program.
What would the consequences be if the proposed project or program is not funded in the
next year?
10. Please describe your organization’s capacity to implement the proposed project/program.
Who will be involved in the project/program? (In-house employees, contractors, other agency
partners, etc.)
11. Does the project require the issuance of a permit (from local, state or federal agencies)?
Yes No
a. If yes, please identify the permits necessary to complete the project.
b. Have the necessary permits been issued? Please provide proof of permit issuance.
* Relocation
** Lead-Based Paint
(See note 7 and 8 on page 10)
✔
Please see Attachment B: Narrative Responses.
MLM is operated by the Community Action Partnership of San Luis Obispo County, Inc.
(CAPSLO), a private, not-for-profit, public benefit corporation. CAPSLO employs 7 full time staff
and 7 substitute staff at the shelter. Operations are supported by the all volunteer Interfaith
Coalition for the Homeless, who provide in-kind space and volunteers for the overnight shelter
provided to women and families with children.
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 4 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
c. If permits are required but not yet obtained, when will the permits be issued?
NATIONAL OBJECTIVES CRITERIA
12. Please identify the appropriate CDBG objective that applies to the proposed project/program
by choosing A, B, or C. Provide a corresponding explanation of how the proposed activity
meets the national objective.
A.Objective One – Low/Moderate Income (check one):
Note: To meet this national objective, the proposed activity must benefit a specific clientele or residents
in a particular area of the County or participating city, of which at least 51 percent of who are low- and
moderate-income persons.
Select one:
Area Benefit – The project serves only a limited geographic area which is proven by 2010
Census data or survey to be a predominately (51% or more)low/moderate-income area.
Applicants choosing this category must be able to prove their project/activity primarily benefits
low/moderate-income households.
Clientele – The project benefits a specific group of people,at least 51% of whom are
low/moderate-income persons. Note: Income verification for clients must be provided for this
category. The following groups are presumed to be low/moderate-income: abused children; elderly
persons; battered spouses; homeless persons; illiterate adults; adults meeting census definition of
severely disabled; persons living with AIDS; and migrant farm workers.
Housing – The project adds or improves permanent residential structures that will be/are
occupied by low/moderate-income households upon completion.
Jobs – The project creates or retains permanents jobs, at least 51% of which are taken by
low/moderate-income persons or considered to be available to low/moderate-income persons.
Explain:
B. Objective Two – Slums or Blight
Assists in the prevention or elimination of slums or blight. Note:To meet this national objective, the
proposed activity must be within a designated slum or blighted area and must be designed to address
one or more conditions that contributed to the deterioration of the area.
Select one:
Addressing Slums or Blight on an Area Basis
Addressing Slums or Blight on a Spot Basis - This project will prevent or eliminate
specific conditions of blight or physical decay. Activities are limited to clearance, historic
✔
100% of the clients served by this program are homeless.
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 5 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
preservation, rehabilitation of buildings, but only to the extent necessary to eliminate
conditions detrimental to public health and safety.
Explain:
C. Objective Three – Urgent Need
Meets community development needs having a particular urgency where existing conditions
pose a serious and immediate threat to the health or welfare of the community, and no other
funding sources are available, i.e., a major catastrophe such as a flood or earthquake. Note: To
meet this national objective, the proposed activity must deal with major catastrophes or emergencies
such as floods or earthquakes.
Explain:
13. If the project or program is designed specifically to provide benefit to low- and moderate-
income persons, please estimate the number of unduplicated persons (or households)to
benefit from the project, and break that estimate down by income group. Note: Unduplicated
means the number who are served, i.e., the grant will allow 25 children to participate in preschool – not 25
children x 5 days x 52 weeks = 6,500.
a.Total number of persons or households who will benefit from the project or program
(regardless of income group):
Persons/households (circle the applicable unit)
b.Of the total number of persons or households entered above, how many will be
low-income (earning 51% - 80% or less of the County median-income)?
Persons/households (circle the applicable unit)
c.Of the total number of persons or households entered above, how many will be
very low-income (earning 50% or less of the County median-income)?
Persons/households (circle the applicable unit)
#
#
#
800
20
780
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 6 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
14. If your project serves homeless households, please describe how your program coordinates
with other Continuum of Care projects and entities, and how it aligns with the San Luis
Obispo Countywide 10-Year Plan to Homelessness.
BENEFICIARY DATA
Note:Organizations will be asked to provide detailed data regarding race, ethnicity, gender, income,
etc. If they cannot provide data, they may not be eligible for funding.
15. How do you collect demographic data on the beneficiaries of the proposed project or
program? (Example: racial/ethnic characteristics)Please provide a sample of your intake process
as an attachment if possible.
16. How do you document and maintain income status of each client in compliance with HUD
regulations? (Example: very low ($0, , low ( $0,) and moderate-income $0, )
Area Median Income (AMI)Please provide a sample of your intake process as an attachment if
possible.
17. Provide the following information for the persons in your organization responsible for the
preparation and submittal of the quarterly reports and for collecting and reporting the
beneficiary data to the Urban County.
Contact Person/Title:__________________________________________________________
Phone/email:________________________________________________________________
FINANCIAL INFORMATION
For CDBG applications to the County of San Luis Obispo involving acquisition, construction, or
rehabilitation projects, the County will require additional information on financial source and
use of funds and other budget details prior to the draft Action Plan funding recommendations.
18. Attach a timeline of total expenditures.
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Please see Attachment B: Narrative Responses.
The agency uses HMIS to collect, store, and report data as prescribed by HUD requirements.
The agency currently has 12 certified HMIS data users across programs.
Income status is collected upon intake and is re-verified at the beginning of each calendar year
for all continuing clients. Please see Attachment C for a sample of the Client Intake Sheet.
Bryn Smith, Planning and Development Specialist
805.544.4355 ext 175/bsmith@capslo.org
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 7 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
19. Please identify the jurisdictions to which you are applying. If you are applying to one or
more jurisdictions, please provide a copy of the application to the County by the application
deadline. If you are requesting CDBG funds from more than one city, please break down the
amount shown above by the city listed below.The minimum requested CDBG amount is
$8,000 for public services per jurisdiction.
City of Arroyo Grande: $_______________ City of Paso Robles: $______________
City of Pismo Beach: $_______________ City of San Luis Obispo: $______________
City of Atascadero: $_______________ County of San Luis Obispo: $______________
City of Morro Bay: $_______________
Total amount of CDBG funds requested: $____________________________________
20. Please describe the budget for the proposed project or program. Itemize all sources of
funding expected to be available and used for this project (please include commitment
letters if available):
a. Revenues: Please identify funding sources for each category, if applicable.
1. CDBG Funds requested $ _________________
2. Other Federal fund(s): ___________________ $ _________________
3. State source(s): _______________________ $ _________________
4. Local source(s): _______________________ $ _________________
5. Applicant’s matching fund(s) $ __________________
6. Other funds: __________________________ $ _________________
_____________________________________ $ _________________
Total Revenues $ _________________
b. Expenditures under CDBG: List below by item or cost category.
$
$
$
$
$
$
$
$
$
TOTAL: $ ____________
125,000
68,494
193,494
193,494
EFSP 15,000
General Fund, ESG, County SLO 172,000
Donations, Community Support 217,284
597,778
Salaries 110,940
Fringe Benefits
68,221
Indirect 14,333
193,494
Attachment B
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROGRAM PAGE 8 OF 10
APPLICATION FOR THE 2017 PROGRAM YEAR AUGUST 26, 2016
SAN LUIS OBISPO COUNTY PLANNING &BUILDING WWW.SLOPLANNING.ORG
21. How do you plan to fund the operation and maintenance costs (if any)associated with this
project? Are these funds available now? If not, when will they be available? And from what
sources?
22. Will CDBG funds be used to match/leverage other funds from other sources? List below
funding sources and amounts and identify award dates of these sources.
23. Federally funded projects/programs must comply with the following regulations. Please
explain how your organization will comply with the following requirements:
a. Civil Rights:
b. Section 504:
c. Fair Housing:
d. Limited English Proficiency:
I certify that the information in this application is true and accurate to the best of my knowledge and
ability.
___________________________________________________________
Signature Date
___________________________________________________________
Printed or typed name Title
CAPSLO has an extremely low indirect cost rate of 8% that covers operation costs, including
HR, Facilities, Finance, and other administrative costs. The shelter operation and maintenance
is funded by a combination of federal pass-through and local grant funding, private donations
from individuals and groups, and through in-kind community donations. Donations and local
fundraising account for 36% of the shelter's overall projected budget.
While funding from CDBG is critical to MLM's operations, funding from CDBG is not currently
used to match or leverage other funds.
CAPSLO’s Human Resources (HR) Policy 2.1 addresses equal
opportunity employment and affirmative action, has a written Affirmative
Action Program,and is firmly committed to Equal Employment
HR policy 2.2 addresses the American Disabilities Act (ADA). CAPSLO
provides equal opportunities, with reasonable accommodation when
appropriate, for applicants and qualified employees with disabilities.
CAPSLO does not currently provide housing.
CAPSLO employs bilingual/bicultural staff who can assist
those with limited English proficiency, including translation
dit ltif
10/21/2016
Elizabeth "Biz" Steinberg CEO
Attachment B
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7LPHOLQHRI3URMHFW0LOHVWRQHV
Task/Activity
(Starts July 1, 2017)
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
"UUBDINFOU"
Nightly shelter for 49 individuals at MLM X x x x x x x x x x x x
Nightly Shelter for 25-45 women and families with children at ICH sites xxxx xxxx x x xx
Dinner for shelter clients and "Dine and Dash" clients who do not stay at the shelter xxxx xxxx x x xx
Showers x x x x x x x x x x x x
transportation between MLM and ICH sites xxxx xxxx x x xx
On-site AA meetings (weekly)x x x x x x x x x x x x
Quarterly Reporting X X X X
6 Bed Recuperative Care X X
Services Consolidated at the new Homeless Services Center at 40 Prado ??XX
Continuation of Recuperative Care Project ??XX
40hr/Week therapist for co-occurring drug/alcohol and mental health challenges ??XX
Traumatic Brain Injury Day Services ??XX
3 day/week Medical Health Home Clinic ??XX
Attachment B
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CAPSLO MLM CDBG
1. Describe the need and the degree of urgency for the proposed project or program.
What would be the consequences if the proposed project or program is not funded in
the next year?
Need/Urgency: All services offered are heavily used indicating a substantial need in the county. In the
12 months ending December 31, 2015, 810 unduplicated persons received one or more nights of shelter
for a total of 27,517 shelter nights. More than 40% of clients were women and 11.5% were children.
More than 57% of those served were disabled. An average of 75 persons per night are sheltered year-
round between MLM and the overflow shelter sites.
The MLM Shelter provides free dinner to shelter clients and other hungry community members. A total
of 64,566 meals were served in the 12 months ending December 31, 2015; 4,766 of those meals were
served to “diner/dashers” (persons who came for dinner and a shower but not a shelter bed).
Currently, the MLM has reached their capacity, needing to turn away an average of 3 people per night
during calendar year 2015. The 2015 Homeless Enumeration counted approximately 1,500 homeless
individuals living in San Luis Obispo County. While this is a decrease from 2013 count, CAPSLO served
more than 1,680 unduplicated homeless individuals across all programs. San Luis Obispo County’s high
cost of living and high cost of housing are heavily impacting the local homeless who are experiencing
longer spans of homelessness. Until there is an adequate supply of affordable housing in the county,
emergency sheltering will be a fact of life.
CAPSLO’s MLM Shelter has been serving the county’s homeless since 1989. Without CDBG funding from
the City and County of San Luis Obispo and other cities, the Shelter would be forced to close. The MLM
Shelter is also the “anchor” program for many providers and services. Without an overnight shelter to
meet the most basic needs of the homeless, outreach and assistance services are disrupted and ongoing
stabilization and self-sufficiency efforts are undermined. As MLM and Prado Day Center are
consolidated into the new Homeless Services Center at 40 Prado in Spring of 2018, these funds will more
critical than ever before to ensure that homeless individuals have access to basic needs and support
services while they get on a path toward permanent housing.
14. If your project serves homeless households, please describe how your program coordinates with
other continuum of care projects and entities and how it aligns with the San Luis Obispo Countywide
10-Year Plan to Homelessness.
CAPSLO’s Homeless Services Division works closely with other CoC providers, including: Transitions-
Mental Health Association, Departments of Social Services and Behavioral Health, Catholic Charities, SLO
Housing Authority, County of SLO VSO, ECHO, and 5 Cities Homeless Coalition, and others to ensure that
Attachment B
clients seamlessly receive the services needed to create a path out of homelessness as quickly as
possible.
CAPSLO Homeless Services supports the national priorities established in "Opening Doors: Federal
Strategic Plan to Prevent and End Homelessness" as described below:
A. Finish the job of ending chronic homelessness in 5 years
x CAPSLO has partnered with Transitions Mental Health and the 50 NOW program to help
ensure that fifty most vulnerable, chronically homeless individuals receive wraparound
case management and permanent housing solutions.
x Coordinated Entry Program is a collaborative project between three agencies in San Luis
Obispo County that provide existing homeless services programs: CAPSLO (Lead Agency),
5Cities Homeless Coalition (5Cities), and El Camino Homeless Organization (ECHO). The
program will use a common screening tool to help homeless individuals and families
access the services that they need to address their individual challenges to permanent
housing and self-sufficiency.
B.Prevent and end homelessness among Veterans in 5 years
x A three year Supportive Services for Veteran Families (SSVF) grant was awarded to
CAPSLO in 2014. Since October 1, 2014, 230 veterans/veteran family members have had
their housing stabilized through the program, including 166 who have been rapidly re-
housed. SSVF employs case managers in San Luis Obispo and North County to work with
veteran families who are homeless or at risk of losing their housing.
C.Prevent and end homelessness for families, youth, and children in 10 years
x CAPSLO Family Advocates meet with families at MLM to support their progress towards
self-sufficiency. In collaboration with CAPSLO Case Managers at Prado and MLM, schools,
and other CoC service providers, Advocates are a primary link to stability-promoting
resources for families.
D.Set a path to ending all types of homelessness
x Individuals with a variety of needs come to MLM and Prado- individuals struggling with
mental illness; veterans; single-parent families; individuals coping with AIDS; recently
evicted; chronically homeless. Whatever the type of homelessness is, and together with
the appropriate community partners, staff will help these individuals and families take
that first step toward re-establishing housing.
x In 2016, CAPSLO received funding support from CenCal to open the recuperative care
program at MLM, which addresses health and housing stability for people experiencing
homelessness who have frequent contact with hospitals (Objective 9 under Themes from
Opening Doors)
x T-MHA Homeless Outreach Team (HOT) works with Prado Staff to identify vulnerable new
participants who need to be linked to mental health services.
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CAPSLO MLM CDBG
Attachment B
CAPSLO Homeless Services 290 Check Completed By:___
Revised 4/1/2015 1
Taken By:Referral Source:Date
Office: Prado MLM SLO CM SC CM NC CM Link ECHO T-MHA
Household Type:Size:H of H:
First Name:Middle Name:
Last Name:Suffix:HMIS Release Signed?
Maiden Name or Nick Name:
Names of other adults in family:
Date of Birth:Age:Social Security Number:
Sex: Female Male Transgendered Male to Female Transgendered Female to Male
Height: Weight: Eye Color: Hair Color:
Identification Type:State:Number:
Ethnicity (Choose 1): Non-Hispanic or Non-Latino Hispanic or Latino
Race (Check all that apply):American Indian or Alaska Native Asian
Black or African American Native Hawaiian or Other Pacific Islander White
Relationship to H of H: Self Aunt/Uncle Daughter Foster Child Grandchild
Grandparent Niece/Nephew Parent Sig. Other Son Spouse Step Child
Does this person live in the same household as H of H? Yes No
Have you ever been on active duty in the U.S. military? Yes No Verified? Yes No
What brought you to this county: Family Friends Employment Born or Raised Here
Other:
Citizenship Status: American Legal Alien Other
Education Level Reached:HS Diploma GED x Post-Secondary Schooling
If post-secondary, please describe:
Are you a farmer? Yes No Type: Year-Round Seasonal Migrant
Are you pregnant? Yes No If yes, due date:Handout Provided Yes No
Contact Phone Number:Mailing Address:
Emergency Contact Person:Relationship:
Address:Phone Number:
Where did you stay last night? (What best describes your current living situation?) Continued On Next Page
Foster care home or foster care group home
Hospital or other residential non-psychiatric medical facility
Jail, prison or juvenile detention facility
Long-term care facility or nursing home
Psychiatric hospital or other psychiatric facility
Substance abuse treatment facility or detox center
Client doesn't know
Client refused
Other (Please Specify):
Owned by client, no ongoing housing subsidy
Homeless Services Adult Intake Form
1
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Attachment B
CAPSLO Homeless Services 290 Check Completed By:___
Revised 4/1/2015 2
Owned by client, with ongoing housing subsidy
Permanent housing for formerly homeless persons
Rental by client, with GPD TIP subsidy
Rental by client, no ongoing housing subsidy
Rental by client, with other ongoing housing subsidy
Rental by client, with VASH housing subsidy
Emergency shelter, including hotel or motel paid for with emergency shelter voucher
Hotel or motel paid for without emergency shelter voucher
Place not meant for human habitation (vehicle, abandoned building, bus/train station/airport, outside)
Residential project or halfway house with no homeless criteria
Safe Haven
Staying or living in a family member's room, apartment or house
Staying or living in a friend's room, apartment or house
Transitional housing for homeless persons
How long have you been staying in place marked above?
One day or less Two days to one week More than one week, but less than one month
One to three months More than three months, but less than one year One year or longer
Client doesn't know Client refused
Has the client been continuously homeless for at least one year? (The client has been homeless and living or
residing in a place not fit for human habitation, an emergency shelter, and/or a Safe Haven (as marked above)
continuously for at least one year as of the date of project entry. Stays in institutions (i.e. jail, hospital,
mental health facility) of 90 days or less do note constitute a break in homelessness, provided the client was
homeless prior to entering the institution.)
No Yes Client Doesn't Know Client Refused
Start date of time on street, in an emergency shelter, or safe haven? (literally homeless)
Number of times the client has been homeless in the past three years? (Enter "0 (not homeless - Prevention
only)" if the client did not experience homelessness in the past three years, including today. For example,
the client is entering a homeless prevention project and has not been homeless in the past three years. If the
client is entering a housing project for the homeless, "0 (not homeless - Prevention only)" may not be used.
Enter "1 (homeless only this time)", "2", "3", or "4 or more" based on the number of times the client was
homeless and living or residing in a place not fit for human habitation, an emergency shelter, and/or a Safe
Haven over the past three years. Count an episode of homelessness that begins as of project entry. For
example, a client is staying with a friend, is asked to leave, and then enters an emergency shelter. The
client had not previously stayed on the streets or in a shelter so the number of times homeless in the past
three years would be "1 (homeless this time only)".
0 1 2 3 4 or more Client Doesn't Know Client Refused
Total number of months homeless in the past three years? (If the number of times the client has been
homeless in the past three years is 4 or more, count months the client was homeless and living or residing
in a place not meant for human habitation, an emergency shelter, and/or Safe Haven in the past three years.
Any single day or part of a month spent homeless should be counted as one month.)
Total number of months continuously homeless immediately prior to project entry? (Indicate the number of
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Attachment B
CAPSLO Homeless Services 290 Check Completed By:___
Revised 4/1/2015 3
months the client has been continuously homeless including the day of project entry. For partial months, 1
day to 30 days = 1 month. For example, a client is living on the street from mid-July to the day the client
enters emergency shelter on August 5th. This would count as two months.
Status documented? (Is there documentation in the client's paper file or in the HMIS of the client's length of
homelessness (either continuously homeless, the number of times homeless, or the number of months
homeless in the past three years.)) No Yes
Housing Status: (Check the response which represents clients housing status prior to program entry.)
Homeless (Residing in a place not fit for human habitation, an emergency shelter, and/or Safe Haven.)
At imminent risk of losing housing (Needs to be out of current residence within 14 days)
Fleeing domestic violence
At-risk of homelessness
Stably housed
Client doesn't know
Client refused
Last Permanent Residence which Client has Stayed for 90 Days or Longer:
City: State: Zip Code:
Substance Abuse Problem: No Alcohol Abuse Drug Abuse
Both Alcohol and Drug Abuse Client Doesn't Know Client Refused
IF ALCOHOL ABUSE, DRUG ABUSE, OR BOTH ALCOHOL AND DRUG ABUSE:
Expected to be of long-continued and indefinite duration and substantially impairs ability to live independently?
No Yes Client Doesn't Know Client Refused
Currently receiving services/treatment for this condition?
No Yes Client Doesn't Know Client Refused
Documentation of the disability and severity on file? No Yes
Physical Disability: No Yes Client Doesn't Know Client Refused
IF YES:Description:
Expected to be of long-continued and indefinite duration and substantially impairs ability to live independently?
No Yes Client Doesn't Know Client Refused
Currently receiving services/treatment for this condition?
No Yes Client Doesn't Know Client Refused
Documentation of the disability and severity on file? No Yes
Developmental Disability: No Yes Client Doesn't Know Client Refused
IF YES:Description:
Expected to substantially impair ability to live independently?
No Yes Client Doesn't Know Client Refused
Currently receiving services/treatment for this condition?
No Yes Client Doesn't Know Client Refused
Documentation of the disability and severity on file? No Yes
Chronic Health Condition: No Yes Client Doesn't Know Client Refused
IF YES:Description:
Expected to be of long-continued and indefinite duration and substantially impairs ability to live independently?
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Attachment B
CAPSLO Homeless Services 290 Check Completed By:___
Revised 4/1/2015 4
No Yes Client Doesn't Know Client Refused
Currently receiving services/treatment for this condition?
No Yes Client Doesn't Know Client Refused
Documentation of the disability and severity on file? No Yes
HIV/AIDS: No Yes Client Doesn't Know Client Refused
IF YES:
Expected to substantially impair ability to live independently?
No Yes Client Doesn't Know Client Refused
Currently receiving services/treatment for this condition?
No Yes Client Doesn't Know Client Refused
Documentation of the disability and severity on file? No Yes
Mental Health Problem: No Yes Client Doesn't Know Client Refused
IF YES:Description:
Expected to be of long-continued and indefinite duration and substantially impairs ability to live independently?
No Yes Client Doesn't Know Client Refused
Currently receiving services/treatment for this condition?
No Yes Client Doesn't Know Client Refused
Documentation of the disability and severity on file? No Yes
Domestic Violence Victim/Survivor: No Yes Client Doesn't Know Client Refused
If yes, when experience occurred? Within Past 3 Months 3-6 Months Ago
6-12 Months Ago More Than 1 Year Ago Client Doesn't Know Client Refused
Currently taking any medications? Yes No Name of doctor:
If yes, what type:
Known allergies: Yes No Description:
Currently Receiving Income From Any Source?
No Yes Client Doesn't Know Client Refused If yes; enter type and amount below.
Currently Receiving Non-Cash Benefit From Any Source?
No Yes Client Doesn't Know Client Refused If yes; check type below.
WIC TANF Transportation Services
Private Disability Insurance Other:
Yes: Source Yes: Source
Food Stamps (SNAP, Cal Fresh) TANF Child Care Services
TOTAL
Unemployment Insurance TANF (Cal-Works/AFDC)
Soc Sec Disability (SSDI) Retirement from Social Sec.
Amount
Earned Income (Employment) Worker's Compensation
Yes: Source Amount Yes: Source
Alimony/Spousal Support
VA Non-Service-Connected
Disability Pension
VA Service-Connected
Disability Compensation
General Assistance (GA)
Pension/Retirement Income
From A Former Job
Supplemental Soc Sec (SSI)
Child Support
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Attachment B
CAPSLO Homeless Services 290 Check Completed By:___
Revised 4/1/2015 5
Currently Covered By Health Insurance?
No Yes Client Doesn't Know Client Refused If yes; check type below.
Are you a sex offender? Yes No Served any jail time in last 7 years? Yes No
On Parole On Probation PO Officer
Description of offense and year:
Do you have a vehicle? Yes No Year:Make:
Model:Color:License Plate:
Do you have any pets? Yes x No What kind?
Are you receiving services from any agencies? Yes No If yes, complete the following:
If you have a vehicle, are you current on the following?
Registration: Yes No Insurance: Yes No
Financial History: Have you ever filed for bankruptcy? Yes No
Comments:
I,, give the Community Action Partnership of San Luis Obispo County,
Inc. consent to release, obtain and share all pertinent identifying and non-confidential social, medical and
other information about myself that will allow me to benefit from services offered. In granting such permission,
I understand that such information will remain confidential and that such information will only be used for my
benefit or to benefit other members of my family. Only authorized personnel will share client information
needed to service delivery, to track demographic trends, service patterns and the client outcomes achieved.
I release the Community Action Partnership of San Luis Obispo County, Inc. and its staff from any liability
for disclosing or acquiring information that I have permitted by signing this form. Unless I make a formal
request to the Community Action Partnership of San Luis Obispo County, Inc. that I no longer want to
participate in the services offered, this release will remain in force for 3 years from today.
The statements made by me on this consent form are true, correct and complete to the best of my knowledge.
Client Signature Date Staff Signature Date
Credit Cards Child Support Utilities Medical Other Debts
Case Management Only
Agency Providing Service Address Phone Contact Person
Medi-Cal/Cen-Cal (Medicaid) Employer Provided Health Insurance
Medicare Health Insurance Obtained Through COBRA
VA Medical Services State Health Insurance For Adults
SCHIP (Healthy Families) Private Pay Health Insurance
Yes: Source Yes: Source
Sec. 8/PH/Rent Assistance Other TANF Funded Services
Temporary Rental Assistance Other:
ƚƚĂĐŚŵĞŶƚͶůŝĞŶƚ/ŶƚĂŬĞ
Attachment B
Domain 1 2 3 4 5 Score
Housing Homeless or threatened with
eviction.
In transitional, temporary or
substandard housing; and/or
current rent/mortgage payment is
unaffordable
(over 30% of income).
In stable housing that is safe but
only marginally adequate.
Household is in safe, adequate
subsidized housing.
Household is safe,
adequate, unsubsidized
housing.
Income No income.
Inadequate income and/or
spontaneous or inappropriate
spending.
Can meet basic needs with
subsidy; appropriate spending.
Can meet basic needs and
manage debt without
assistance.
Income is sufficient, well
managed; has discretionary
income
and is able to save.
Adult
Education
Literacy problems and/or no high
school diploma/GED are serious
barriers to employment.
Enrolled in literacy and/or GED
program and/or has sufficient
command of English to where
language is not a barrier to
employment.
Has high school diploma/GED.
Needs additional
education/training to improve
employment situation and/or to
resolve literacy problems to
where they are able to function
effectively in society.
Has completed
education/training needed to
become employable. No
literacy problems.
Life Skills
Unable to meet basic needs
such as hygiene, food, activities of
daily living.
Can meet a few but not all needs
of daily living without assistance.
Can meet most but not all daily
living needs without assistance.
Able to meet all basic needs of
daily living without assistance.
Able to provide beyond basic
needs of daily living for self
and family.
Family /Social
Relations
Lack of necessary support form
family or friends; abuse (DV, child) is
present or there is
child neglect.
Family/friends may be supportive,
but lack ability or resources to
help; family members do not relate
well with one another; potential
for abuse or neglect.
Some support from
family/friends; family members
acknowledge and seek to
change negative behaviors; are
learning to communicate and
support.
Strong support from family or
friends. Household members
support each other’s efforts.
Has healthy/expanding
support network; household
is stable and communication
is consistently open.
Legal Current outstanding tickets or
warrants.
Current charges/trial pending,
noncompliance with
probation/parole.
Fully compliant with
probation/parole terms.
Has successfully completed
probation/parole within past 12
months, no new charges filed.
No active criminal justice
involvement in more that 12
months and/or no felony
criminal history.
Mental
Health
Danger to self or others; recurring
suicidal ideation; experiencing
severe difficulty in day-to-day life
due to psychological problems.
Recurrent mental health
symptoms that may affect
behavior, but not a danger to
self/others; persistent problems
with functioning due to mental
health symptoms.
Mild symptoms may be present
but are transient; only moderate
difficulty in functioning due to
mental health problems.
Minimal symptoms that are
expectable responses to life
stressors; only slight
impairment in functioning.
Symptoms are absent or
rare; good or superior
functioning in wide range of
activities; no more than
every day problems or
concerns.
Substance
Abuse
Meets criteria for severe
abuse/dependence; resulting
problems so severe that institutional
living or hospitalization may be
necessary.
Meets criteria for dependence;
preoccupation with use and/or
obtaining drugs/alcohol;
withdrawal or withdrawal
avoidance behaviors evident; use
results in avoidance or neglect of
essential life activities.
Use within last 6 months;
evidence of persistent or
recurrent social, occupational,
emotional or physical problems
related to use (such as disruptive
behavior or housing problems);
problems have persisted for at
least one month.
Client has used during last 6
months, but no evidence of
persistent or recurrent social,
occupational, emotional, or
physical problems related to
use; no evidence of recurrent
dangerous use.
No drug use/alcohol abuse
in last 6 months.
Disabilities
In crisis – acute or chronic symptoms
affecting housing, employment,
social interactions, etc.
Vulnerable – sometimes or
periodically has acute or chronic
symptoms affecting housing,
employment, social interactions,
etc.
Safe – rarely has acute or
chronic symptoms affecting
housing, employment, social
interactions, etc.
Building Capacity –
asymptomatic – condition
controlled by services or
medication
Thriving – no identified
disability.
Total Score: 0
Self-Sufficiency Matrix
ƚƚĂĐŚŵĞŶƚͶůŝĞŶƚ/ŶƚĂŬĞ
Attachment B
Emergency Shelter
If the client and/or family have no place to stay, regardless of score on Self-Sufficiency Matrix, they can
be referred to the emergency shelters in the county, which are the Maxine Lewis Memorial Shelter in
SLO, or the ECHO shelter in Atascadero. No official written referral necessary. All ECHO clients who
utilize shelter services for 5 days or longer are required to be on case management (for other areas for
general case management, see below).
Referral Made:Yes No Case Manager:
Transitional Housing (T-MHA) Time Limit of 2 Years
Clients (this program is for single individuals only) who are homeless and disabled (mentally or
physically) are eligible. These clients generally score in the lower portion of the Self-Sufficiency
Matrix (9-25 pts.) and will need some type of income.
Referral Made:Yes No Case Manager:
Permanent Supportive Housing (CAPSLO and T-MHA) No Time Limit
CAPSLO
Clients (this program is for single individuals only, aside from 1 unit that is available for a couple) who
are chronically homeless (have a disability AND have either been consistently homeless for a year or
longer OR have had 4 bouts of homelessness in the last 3 years) and must have an income of at least
$750/mo. or more are eligible. These clients generally score in the lower portion of the Self-Sufficiency
Matrix (9-25 pts.).
Referral Made:Yes No Case Manager:
T-MHA
Clients (this program is for single individuals only, aside from 1 unit that is available for a family) who
are chronically homeless (have a disability AND have either been consistently homeless for a year or
longer OR have had 4 bouts of homelessness in the last 3 years) and must have an income. These
clients generally score in the lower portion of the Self-Sufficiency Matrix (9-25 pts.).
Referral Made:Yes No Case Manager:
Case Management (Supportive Service Only-No Housing Attached)
General case management is available to clients in SLO or South County for individuals and
households who are literally homeless, at imminent risk of being homeless, or are fleeing domestic
violence situations (certain documentation required to prove eligibility). These clients will have varying
scores on the Self-Sufficiency Matrix, but should not exceed 36 pts.
Referral Made:Yes No Case Manager:
Rapid Re-Housing/Eviction Prevention
Individuals and households who are in need of financial assistance to maintain their current housing or
to transition back into permanent housing may be eligible for assistance through The Link (certain
restrictions apply). Generally, these clients are mid-scoring on the Self-Sufficiency Matrix (25-36 pts.).
Referral Made:Yes No Case Manager:
50 Now
The most vulnerable homeless individuals in SLO County may be eligible to receive a housing choice
voucher along with case management to provide the supportive services needed to maintain their
housing.
Referral Made:Yes No Case Manager:
ƚƚĂĐŚŵĞŶƚͶůŝĞŶƚ/ŶƚĂŬĞ
Attachment B
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Attachment B
CDBG County of
SLO CDBG City of SLO TOTAL
Salaries 34,965 75,976 110,941
Payroll Taxes 3,520 7,138 10,658
Health & Disability Insurance 20,366 21,196 41,562
Worker's Compensation 3,965 5,971 9,936
Retirement 605 5,460 6,065
Indirect 5074 9,260 14,333
68,495 125,000 193,494
COMMUNITY ACTION PARTNERSHIP OF SAN LUIS OBISPO COUNTY, INC.
Maxine Lewis Memorial Shelter
July 1, 2017 to June 30,2018
ƚƚĂĐŚŵĞŶƚ
ƵĚŐĞƚ/ŶĨŽƌŵĂƚŝŽŶ
Attachment B
Attachment B
Attachment B
Attachment B
Attachment B
Attachment B
Attachment B
Attachment B
Attachment B
Attachment B
Attachment B
Attachment B
Attachment B
Attachment B
Attachment B
Attachment B
Attachment B
Attachment B
Attachment B
Attachment B
Attachment B