HomeMy WebLinkAboutItem 2 - 2019 CDBG Staff ReportMeeting Date: December 5, 2018
Item Number: 2
2
HUMAN RELATIONS COMMISSION AGENDA REPORT
SUBJECT: 2019 CDBG Funding Recommendations
PROJECT ADDRESS: Citywide BY: Cara Vereschagin, Assistant Planner
Phone Number: (805) 781-7596
e-mail: cvereschagin@slocity.org
FILE NUMBER: GENP-1907-2018
BACKGROUND
The City received a total of four applications for the 2019 Community Development Block Grant
(CDBG) program, requesting a total of $512,361. Estimated funding for the 2019 Program Year is
$453,691. Of the total estimated allocation, 20% of the funds are reserved for administrative costs. This
allocation is further distributed by 65% to the County of San Luis Obispo, with the remaining 35%
returning to the City. Therefore, of the City’s $453,691 total estimated CDBG allocation, the County is
eligible to receive $58,980 for administration purposes and the remaining $31,758 can be utilized for
City costs. In this funding year, the City intends to use half of the program administration allocation, a
total of $15,879, for administrative costs, and use the remaining $15,879 for housing capacity building.
FUNDING PRIORITIES
On November 13, 2018, the City Council endorsed the HRC’s recommended funding priorities for the
2019 CDBG funding year. The ranked priorities established by the HRC and City Council are as follows:
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 developing funding recommendations of the 2019 CDBG
applications. Staff recommends funding all of the four applications, as shown in Attachment A. All
applicable projects align with the established Funding Priorities and are more thoroughly described
below. A copy of each 2019 CDBG application is also provided for HRC review in Attachment B1.
Project Overview and Funding Recommendations
1. Community Action Partnership of San Luis Obispo (CAPSLO) - 40 Prado Homeless Services
Center: CAPSLO has requested $71,623 in CDBG funds to increase the capacity, range, and
efficiency of services offered at the new 40 Prado Homeless Services Center; as well as to
increase on-site partnerships with community organizations. The City typically chooses to fund
100% of the public services allocation of CDBG funds (15% of total) to homeless shelters and
1 The application from the County of San Luis Obispo for CDBG Administration is not included in Attachment B .
Packet Page 5
GENP-1907-2018 (Citywide)
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services. This project aligns with the first Funding Priority. The estimated public services
allocation is $68,054 and therefore the City is recommending funding $68,054 to CAPSLO.
2. Housing Authority of San Luis Obispo (HASLO) and San Luis Obispo Nonprofit Housing
Corporation (SLONP) – Special Needs Housing Acquisition: The Housing Authority of San
Luis Obispo and their affiliate, the San Luis Obispo Nonprofit Housing Corporation, are seeking
CDBG funds to assist with the acquisition of an existing home. This home will be utilized as
permanent housing for special needs households that are either homeless or at risk of becoming
homeless. The request of $350,000 would leverage funds from the County Housing Trust Fund,
HASLO, and as well as private bank financing. The project aligns with the first and second
Funding Priorities, thus staff recommends allocating the entirety of the remaining funds for
housing and public facilities, a sum of $294,899, to this very crucial affordable housing project.
3. City of San Luis Obispo – CDBG Administration and Capacity Building: City Community
Development staff are requesting $15,879 for administrative costs of the CDBG program, and
$15,879 for housing capacity building. The capacity building allocation can be used for
affordable housing-related City programs. Staff anticipates using a portion of this funding for
the upcoming affordable housing nexus study. Per the CDBG guidelines, a maximum of 20% of
the total grant allocation can be utilized for program administration. The City is thus eligible to
utilize 35% of the program administration allocation for associated City costs, per the 2018 -20
Cooperation Agreement with the County. The two requests of $15,879 each, are consistent with
the 35% allocation of $31,758.
4. County of San Luis Obispo – CDBG Administration: County Planning and Building staff are
requesting $58,980 for administrative costs of the CDBG program. Per the CDBG guidelines, a
maximum of 20% of the total grant allocation can be utilized for program administration. The
County is thus eligible to utilize 65% of the program administration allocation for associated
County costs, per the 2018-20 Cooperation Agreement with the City. The request is consistent
with the 65% allocation.
ROLE OF THE HUMAN RELATIONS COMMISSION
These recommendations are provided for the benefit of the public and HRC. The HRC’s role is to
consider these recommendations in light of public testimony and either, (1) accept the allocations
proposed if the HRC concurs, or (2) make changes so that the recommendation reflects the views o f a
majority of the Commission. The adopted priorities should guide the Commission throughout the
discussion.
The HRC’s recommended allocations will be forwarded to the County for incorporation into the 2019
Draft Action Plan, and also to the City Council for a final recommendation. The Action Plan will be
considered for approval by the Board of Supervisors in March 2019.
ATTACHMENTS
A. 2019 CDBG Draft Funding Recommendations
B. 2019 CDBG Applications
Packet Page 6
2019 CDBG General
Fund
Other
Sources
No. Activity (Note 1)(Note 2)(Note 3)Total
1 40 Prado Homeless Services Center 71,623$ 68,054$ 57,000$ -$ 125,054$
SUBTOTAL, Public Services - 15% Max 71,623$ 68,054$ 57,000$ -$ 68,054$
2 Special Needs Housing Acquisition 350,000$ 294,899$ -$ -$ 294,899$
350,000$ 294,899$ -$ -$ 294,899$
3a CDBG Administration 15,879$ 15,879 -$ -$ 31,758$
3b Capacity Building 15,879$ 15,879 -$ -$
4 County of San Luis Obispo (Note 4)CDBG Administration 58,980$ 58,980$ -$ -$ 58,980$
90,738$ 90,738$ -$ -$ 90,738$
512,361$ 453,691$ 57,000$ -$ 453,691$
1 Estimated Funding for CDBG Program Year 2018: $453,691
2 Tenative General Fund allocations for FY 19-20 (Estimate based on previous awards)
3 Additional Funding (i.e. Affordable Housing Fund Awards)
4 CDBG administration funding share per the 2018-20 Cooperation Agreement
Housing/Public Facilities/Economic Development
City of San Luis Obispo
SUBTOTAL, Program Admin/Planning - 20% Max
TOTAL
NOTES:
Housing Authority of San Luis Obispo
(HASLO) & San Luis Obispo Nonprofit
Housing Corporation (SLONP)
Program Administration (20% of $453,691)
City of San Luis Obispo
SUBTOTAL, Housing/Public Facilities
Exhibit A
2019 CDBG DRAFT Funding Recommendations
Amount Recommended
Amount
RequestedApplicant
Community Action Partnership of San
Luis Obispo (CAPSLO)
Public Services (15% of $453,691)
Page 1
Attachment AAttachment BAttachment BAttachment BAttachment B
Packet Page 7
COUNTY OF SAN LUIS OBISPO
DEPARTMENT OF PLANNING & BUILDING
Community Development Block Grant (CDBG)
Program Year 2019 Application
The County of San Luis Obispo is pleased to announce the availability of funds for the Community
Development Block Grant (CDBG) program. Applications MUST address one of the three national objectives
set by the U.S. Department of Housing and Urban Development (HUD), or they will NOT be considered for
CDBG funding (see the section on Qualifying Criteria for detailed information on the objectives).
Furthermore, completed applications should provide the necessary exhibits, budgets, or requested
information on targeted populations. Please email grant applications to ActionPlan@co.slo.ca.us by the
application deadline of 5:00 P.M., Friday, October 19, 2018. Please label your email subject with the grant
program name and the agency name (Example: CDBG – CAPSLO). *Note: Supplemental documents and
information or answers which exceed the allotted space or character limit may be added as attachments.
APPLICANT INFORMATION
(1-1) Organization Name
DUNS Number
Project Manager/Title
Phone/Fax Numbers
Email
Address
City, State, Zip
PROJECT SUMMARY
(2-1) Project/Program Title
Project/Program Address
Jurisdiction/Area Served
Targeted clientele
Project type (select one):
Public Service Public Facilities Economic Development Housing
(2-2) Brief Project Description:
(2-3) Total CDBG Funding Requested
Total Cost to Complete Project
Anticipated Start Date: Anticipated End Date:
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1 PAGE 1 OF 22
www.sloplanning.org | actionplan@co.slo.ca.us
HSG-1003
08/28/2018
Attachment BAttachment BAttachment BAttachment B
Packet Page 8
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1
planning@co.slo.ca.us | www.sloplanning.org
PAGE 2 OF 22
AGENCY DETAILS, CAPACITY, AND EXPERIENCE (25 points)
(3-1) Type of Agency ✔ 501 (c)(3) For Profit Gov’t/Public Faith-based Other:
Date of Incorporation Annual Operating Budget
Number of Paid Staff Number of Volunteers
(3-2) Agency Mission Statement:
(3-3) 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.) List
projects of similar size and type that your organization has completed.
Attachment BAttachment BAttachment B
Packet Page 9
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1
planning@co.slo.ca.us | www.sloplanning.org
PAGE 3 OF 22
(3-4) Briefly describe your agency’s record keeping system with relevance to the proposed project/program:
(3-5) Briefly describe your agency’s auditing requirements, including those for the proposed
project/program, and attach a copy of your most recent audit:
Attachment BAttachment BAttachment B
Packet Page 10
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1
planning@co.slo.ca.us | www.sloplanning.org
PAGE 4 OF 22
(3-6) Will the services offered by your organization increase or expand
as a result of CDBG assistance? If YES, please answer the following two
questions.
Yes No
What new programs or services will be provided?
Describe how existing programs or services will be expanded and what percentage of an increase is
expected?
(3-7) If your program serves homeless households, please describe how your program coordinates with
other homeless service providers to connect homeless individuals and families to resources.
Attachment BAttachment BAttachment B
Packet Page 11
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1
planning@co.slo.ca.us | www.sloplanning.org
PAGE 5 OF 22
QUALIFYING CRITERIA (10 points)
The Community Development Block Grant program was established by Congress in 1974 with
passage of the Housing and Community Development Act and is administered by the United
States Department of Housing and Urban Development (HUD). This program provides funds to
municipalities and other units of government around the country to develop viable urban
communities. This is accomplished by providing affordable, decent housing, a suitable living
environment and by expanding economic opportunities principally for low and moderate income
persons. Although local units of government develop their own programs and funding priorities,
all activities must be consistent with one or more of the following HUD national objectives:
•Principally benefits low- and moderate-income persons
•Prevents or eliminates slum or blight
•Addresses an urgent need or problem in the community (e.g., natural disaster)
As an entitlement Urban County under the CDBG program, the County of San Luis Obispo receives
annual funding allocations from the federal government to fund activities to address these
national objectives.
As a funding recipient, San Luis Obispo County is required to submit an Annual Action Plan that
describes how the Urban County will utilize federal funds to address the national objectives in a
manner that will produce the greatest measurable impact on the Urban County communities. The
lead agency responsible for submission of this Plan to HUD is the Planning and Building
Department of the County of San Luis Obispo.
(4-1) Please identify the appropriate CDBG objective that applies to the proposed
project/program by checking the box next to A, B, or C. In addition, please 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 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; however, the following groups are presumed to be low/moderate-income: abused children;
■
Attachment B
Packet Page 12
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1
planning@co.slo.ca.us | www.sloplanning.org
PAGE 6 OF 22
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.
Assistance to Microenterprises – The project provides technical assistance to microenterprises
owned by low/moderate-income persons.
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 preservation,
rehabilitation of buildings, but only to the extent necessary to eliminate conditions detrimental to
public health and safety.
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.
Please explain how the proposed activity meets the selected National Objective:
Attachment B
Packet Page 13
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1
planning@co.slo.ca.us | www.sloplanning.org
PAGE 7 OF 22
(4-2) Which of the 2015-2019 Consolidated Plan goal(s) does your project/program plan to
address? Check all that apply.
Create housing opportunities for residents
Preserve and maintain existing affordable housing
✔ Reduce and end homelessness
Create a suitable living environment through public services
Stabilize and revitalize diverse neighborhoods (public facility improvements)
✔ Improve educational and job readiness
(4-3) Check any of the following eligible activity categories that apply to the proposed
project or program: (Refer to CDBG regulations and
https://www.hudexchange.info/resources/documents/Basically-CDBG-Chapter-2-Activity.pdf )
Acquisition of real property*
Disposition of real property
Public facilities and improvements (may include acquisition, construction, reconstruction, rehabilitation or
installation)*†
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)
* See relocation provisions in Exhibit A
† See lead-based paint provisions in Exhibit A
PROJECT DETAILS/DESCRIPTION (25 points)
(5-1) Targeted Clientele: Individuals or households? Identify the projected target population your
proposed activity will serve. (Include age, race, residency, handicap status, income level or other unit
characteristics or subgroup information)
✔
Attachment BAttachment BAttachment B
Packet Page 14
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1
planning@co.slo.ca.us | www.sloplanning.org
PAGE 8 OF 22
(5-2) 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.
(Check box if project serves households or individual
persons)
Number Households Persons
TOTAL Number of Persons or Households
(regardless of income): ✔
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)
✔
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)
✔
(5-3) Please describe the proposed project or program in detail. Make a case for why your
project should be funded. 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? Please attach a
timeline of the project/program milestones.
Attachment BAttachment BAttachment B
Packet Page 15
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1
planning@co.slo.ca.us | www.sloplanning.org
PAGE 9 OF 22
(5-4) Does the project require the issuance of a permit? (State, local, or federal)
Yes No
If YES, please respond to the following:
Identify the permits necessary:
Have the necessary permits been issued? Please provide proof of issuance:
If permits are required but not yet obtained, when will the permits be issued?
Attachment BAttachment BAttachment B
Packet Page 16
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1
planning@co.slo.ca.us | www.sloplanning.org
PAGE 10 OF 22
BENEFICIARY DATA (15 points)
Organizations will be asked to provide detailed beneficiary data regarding race, ethnicity, gender,
income, etc. If they cannot provide data, they may not be eligible for funding.
(6-1) How do you document and maintain income status of each client in compliance with
HUD regulations? (Example: very low (≤50% AMI) and low (≤80% AMI) Area Median Income (AMI). Please
provide a sample of your intake process as an attachment if possible.
(6-2) 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.
Attachment BAttachment B
Packet Page 17
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1
planning@co.slo.ca.us | www.sloplanning.org
PAGE 11 OF 22
FINANCIAL INFORMATION (20 points)
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.
(7-1) 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? Will the
project be required to pay a prevailing wage?
(7-2) Do you have any CDBG funds remaining from prior Fiscal Year allocations?
Yes No If YES, answer the following:
What fiscal year did you receive funding?
What project did you receive funding for?
How much is remaining?
Attachment BAttachment B
Packet Page 18
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1
planning@co.slo.ca.us | www.sloplanning.org
PAGE 12 OF 22
(7-3) Itemize all sources of funding expected to be available for each category, if applicable
(please include commitment letters if available):
CDBG Funds Requested
Other Federal Fund(s)
State Source(s)
Local Source(s)
Title 29 Requested
Applicants Matching Funds
Other:
(7-4) 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.
Source(s): Amount:
TOTAL
(7-5) Identify all jurisdictions you are applying to for CDBG funds. Indicate the amount
applied for at each jurisdiction, and the total amount requested. Note: Any project/program
being recommended less than $8,000 total will not be funded per the Cooperation Agreement.
City of Arroyo Grande
City of Atascadero
City of Morro Bay
City of Paso Robles
City of Pismo Beach
■ City of San Luis Obispo
■ County of San Luis Obispo
TOTAL
Attachment BAttachment B
Packet Page 19
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1
planning@co.slo.ca.us | www.sloplanning.org
PAGE 13 OF 22
(7-6) Please list expenditures under CDBG by item or cost category, and attach a timeline of
the expenditures.
TOTAL
FEDERAL REQUIREMENTS ACKNOWLEDGEMENTS
Every person or Agency awarded a 2019 CDBG Contract or grant by San Luis Obispo County for the
provision of services shall be required to certify to the County that they will comply with federal and local
requirements including, but not limited to, those listed below. Please initial each certification listed to
indicate you or your agency can and will comply with these requirements if funded.
Federal Requirements Initials
Affirmative Marketing Quarterly and annual reports shall be submitted by the
project/program manager to the County for CDBG-funded public
services and housing projects. Each report shall include 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.
ES
Americans with
Disabilities
Certify that this agency has reviewed its projects, programs and
services for compliance with all applicable regulations contained in
Title II, Americans with Disabilities Act of 1990. ES
Audits Agrees to have an annual audit conducted in accordance with current
San Luis Obispo County policy regarding audits and 2 CFR 200.501 audit
requirements. Shall comply with current San Luis
Obispo County policy concerning the purchase of equipment and shall
maintain inventory records of all non-expendable personal property as
defined by such policy as may be procured with funds provided
through the grant.
ES
Civil Rights Act Certify that it complies with and prohibits discrimination in accordance with Title VI of the Civil Rights Act of 1964. ES
Attachment B
Packet Page 20
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1
planning@co.slo.ca.us | www.sloplanning.org
PAGE 14 OF 22
HSG-1003
08/28/2018
2019 CDBG APPLICATION
Conflict of Interest (2 CFR 200.112, 200.318, and 570.611) Certify and agree that no
covered persons who exercise or have exercised any functions or
responsibilities with respect to CDBG-assisted activity, or who are in
a position to participate in a decision-making process or gain inside
information with regard to such activities, may obtain a financial
interest in any contract, or have a financial interest in any contract,
subcontract, or agreement with respect to the CDBG-assisted
activity, either for themselves or those with whom they have
business or immediate family ties, during their tenure or for a period
of one (1) year thereafter. A “covered person” includes any person
who is an employee, agent, consultant, officer, or elected or
appointed official of the agency
ES
Debarment Status of
Contractors
Certify that, to the best of its knowledge and belief, that it and its
principals will not knowingly enter into any subcontract with a
person who is, or organization that is, debarred, suspended,
proposed for debarment, or declared ineligible from award of
contracts by any Federal agency
(https://www.sam.gov/portal/public/SAM/)
ES
Drug-Free Workplace Certify that it will provide a drug-free workplace. ES
Environmental
Review
Prior to HUD’s release of grant conditions and/or 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 procedures and requirements. Should project costs
be obligated or incurred prior to the completion of the necessary
environmental review, the project shall not benefit from the federal
funds. The level of environmental review required depends on the
nature of the project. 24 CFR Part 58 is available at
http://www.hud.gov/offices/pih/ih/codetalk/onap/docs/24cfr58.pdf.
ES
Financial
Management
Accounting Standards: Agrees to comply with 2 CFR 200(E)(F) and
agrees to adhere to the accounting principles and procedures
required therein, utilize adequate internal controls, and maintain
necessary source documentation for all costs incurred.
ES
Cost Principles: Shall administer its program in conformance with 2
CFR 200(E), “Cost Principles for Non-Profit Organizations,” or 2 CFR
225, “Cost Principles for State and Local Governments,” as applicable.
These principles shall be applied for all costs incurred whether
charged on a direct or indirect basis.
ES
Procurement Policies: Certify and agree to procure all materials,
property, or services in accordance with the requirements of 2 CFR
200.320-326.
ES
Attachment B
Packet Page 21
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1
planning@co.slo.ca.us | www.sloplanning.org
PAGE 15 OF 22
HMIS Reporting All homeless service providers applying for CDBG funds to assist,
house, or shelter the homeless must identify and demonstrate the
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 HUD’s Data Standards. HUD
updated its data standards in 2014, and the new standards are in
effect as of 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.
ES
Liability The County and cities require all grant recipients to maintain general
liability, automobile and workman’s compensation insurance with
limits of not less than $1 million (may vary by jurisdiction). If you are
successful in obtaining a reward, you will be asked to provide
documentation regarding your ability to provide the required
coverage.
ES
Lobbying Activities Certify that no Federal appropriated funds have been paid or will be
paid, by or on behalf of the agency, to any person for influencing or
attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with the awarding
of any Federal contract, the making of any Federal grant, the making
of any Federal loan, the entering into of any cooperative agreement,
and the extension, continuation, renewal, amendment, or
modification of any Federal contract, grant, loan or cooperative
agreement.
ES
Lobbying Disclosure The undersigned certifies to the best of his or her knowledge and
belief, that:
A. No federal appropriated funds have been paid or will be paid, by
or on behalf of the Subrecipient, to any person for influencing or
attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with the awarding
of any Federal contract, the making of any Federal grant, the making
of any Federal loan, the entering into a cooperative agreement, and
the extension, continuation, renewal, amendment, or modification of
ES
Attachment B
Packet Page 22
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1
planning@co.slo.ca.us | www.sloplanning.org
PAGE 16 OF 22
any Federal contract, grant loan, or cooperative agreement in
accordance with the Department of Interior and Related Agencies
Appropriations Act, known as the Byrd Amendments, and HUD'S 24
Code of Federal Regulations (CFR) 87.
B. If any funds other than federal appropriated funds have been paid
or will be paid to any person for influencing or attempting to
influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a
member of Congress in connection with this federal contract, grant,
loan, or cooperative agreement, the Subrecipient shall complete and
submit Standard Form LL, “Disclosure Form to Report Lobbying,” in
accordance with its instructions, and other federal disclosure forms
as requested.
C. The Subrecipient shall require that the language of this
certification be included in the award documents for all subawards
at all tiers (including subcontracts, subgrants, and contracts under
grants, loans, and cooperative agreements) and that all subrecipients
shall certify and disclose accordingly.
This certification is a material representation of fact upon which
reliance was placed when this transaction was made or entered into.
Submission of this certification is a prerequisite for making or
entering into this transaction imposed by Section 1352, Title 31, U.S.
Code. Any person who fails to file the required certification shall be
subject to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure.
ES
Mandatory Disclosure The non-Federal entity or applicant for a Federal award must
disclose, in a timely manner*, in writing to the Federal awarding
agency or pass-through entity all violations of Federal criminal law
involving fraud, bribery, or gratuity violations, potentially affecting
the Federal award. Failure to make required disclosures can result in
any of the remedies described in 2 CFR 200.338 (Remedies for
Noncompliance), including suspension or debarment. (See also 2 CFR
Part 180 and 31 USC 3321). Limit one violation per form. The
subrecipient acknowledges that the completion and submission of
this form will satisfy the requirement in 2 CFR 200.113 (Mandatory
Disclosure) and will be done at the time of subrecipient agreement
execution with the County.
ES
Minority Business
Enterprise (MBE),
Women’s Business
Certify that it will comply with 2 CFR 200.321 to take all necessary
affirmative steps to assure that minority firms, women business
enterprises, and labor surplus area firms are used when possible.
ES
Attachment B
Packet Page 23
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1
planning@co.slo.ca.us | www.sloplanning.org
PAGE 17 OF 22
Enterprise (WBE),
Small Business
Contracting
Further certify that it will submit to San Luis Obispo County at the
time of project completion a report of the MBE and WBE status of all
subcontractors to be paid with CDBG funds with contracts of $10,000
or greater, in a format that will be provided by the County.
ES
Real Property Certify that it will comply with real property standards (24 CFR Part
570.505) applicable to any property within the owner’s control that is
acquired or improved in whole or in part using CDBG funds in excess
of $25,000.
ES
Religious Activities Certify and agree that funds provided to the agency will not be
utilized for inherently religious activities prohibited by 24 CFR
570.200(j), such as worship, religious instruction, or proselytization.
ES
Relocation Any project that involves the acquisition of property, construction,
and/or rehabilitation and that is funded in whole or in part with
federal CDBG funds is subject to federal relocation requirements. In
general, any property owner, commercial business, or residential
occupant who is displaced by a HUD-funded project may be eligible
for relocation benefits. A project cannot be broken into separate
“projects” in order to avoid the federal requirements connected with
property acquisition and relocation. Any questions concerning 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.
ES
Section 3 Certify and agree to ensure that opportunities for training and
employment arising in connection with contracts or subcontracts for
a housing rehabilitation (including reduction and abatement of lead-
based paint hazards), housing construction, or other public
construction project are given to low- and very low-income persons
residing within the metropolitan area in which the CDBG-funded
project is located; where feasible, priority should be given to low-
and very low-income persons within the service area of the project
or the neighborhood in which the project is located, and to low- and
very low-income participants in other HUD programs; and award
contracts for work undertaken in connection with a housing
rehabilitation (including reduction and abatement of lead-based
paint hazards), housing construction, or other public construction
project to business concerns that provide economic opportunities
for low- and very low-income persons residing within the
metropolitan area in which the CDBG-funded project is located;
where feasible, priority should be given to business concerns that
provide economic opportunities to low- and very low-income
residents within the service area or the neighborhood in which the
project is located, and to low- and very low-income participants in
other HUD programs.
ES
Attachment B
Packet Page 24
5٥٥ﻩ(>ﻩﺍﺍ٥ﺩ
Attachment BAttachment BAttachment BAttachment BAttachment BAttachment BAttachment BAttachment BAttachment BAttachment B
Packet Page 25
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1
planning@co.slo.ca.us | www.sloplanning.org
PAGE 19 OF 22
HSG-1003
08/28/2018
2019 CDBG APPLICATION
Exhibit A – Housing Rehab and Construction Projects
Will the affordable housing project be applying for tax credits? Yes No
If yes, what round? March June
If March was selected and if your project is identified to receive funds, will your
project require a Reservation Letter for the state tax creditors Yes No
Has NEPA been completed on this project? Yes No
What is the age of the property/building in years?
Has a property inspection report been completed if undertaking rehab? Yes No
For buildings/structures constructed prior to 1978:
Have asbestos and lead hazard risk assessment reports been issued for the facility? Yes No
Has the facility been abated for asbestos and lead paint? Yes No
Will children occupy the facility? Yes No
If yes, indicate the age range of children:
Has a Phase I or Phase II environmental assessment been conducted for the
property? If so, please provide a copy.
Yes No
List and describe any known hazards (e.g. asbestos, storage tanks – underground, aboveground):
Attachment B
Packet Page 26
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1
planning@co.slo.ca.us | www.sloplanning.org
PAGE 20 OF 22
Has the property been designated or been determined to be potentially eligible
for designation as a local, state, or national historic site? If Yes, describe below: Yes No
Is the building/structure located on a Historic Site? Yes No
Is the building/structure located in a Historic District? Yes No
Is the building/structure in a Flood Zone? Yes No
Is the building/structure in a Flood Plain? Yes No
Does your agency have flood insurance? Yes No
Will there be demolition required? Yes No
The questions below ask about zoning. If zoning information is not known, contact the local municipality
to request assistance.
What is the project structure type?
Residential Commercial Public facility Public right-of-way
What is the current zoning of the project site?
Is the project site zoned correctly for the proposed
activity? Yes No
If no, provide below an explanation of efforts and a timetable to change the zoning or obtain a variance:
Attachment B
Packet Page 27
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1
planning@co.slo.ca.us | www.sloplanning.org
PAGE 21 OF 22
B.15. Does the project require temporary/permanent relocation of occupants?Yes No
If yes, this project is subject to the Uniform Relocation Assistance and Real Property Acquisition
Policies Act (URA). Describe the relocation plans, including timetable and notifications to occupants.
List how many of the occupied units are: (a) owner-occupied; (b) renter-occupied; or (c) businesses.
Indicate whether temporary and/or permanent displacement is required. [NOTE: This will be for site
information only. Relocation activities will not be eligible for funding with Fiscal Year 2018 CDBG
funds.]
Attachment BAttachment B
Packet Page 28
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1
planning@co.slo.ca.us | www.sloplanning.org
PAGE 22 OF 22
Federal regulations require that all facilities and/or services assisted with CDBG funds be accessible to the
disabled. Accessibility includes such things as: entrance ramps, parking with universal logo signage,
grab bars around commodes and showers, top of toilet seats that meet required height from the
floor, drain lines under lavatory sink either wrapped or insulated, space for wheelchair
maneuverability, accessible water fountains, access between floors (elevators, ramps, lifts), and
other improvements needed to assure full access to funded facilities/programs, including serving
the blind and deaf.
Describe below whether the project currently meets ADA standards for accessibility by the disabled. If
not, describe the accessibility problems and methods to be utilized to address the problems,
including funding and timetable.
Attachment B
Packet Page 29
Attachment A:
FY 2017-2018 Audit
Please see attachment on email submission. This is a secure document and it cannot be
attached to the application.
Attachment B
Packet Page 30
Attachment B: Program Timeline
Exhibit A – Work Plan and Performance Schedule
List all project milestones and their anticipated work period. There will be an opportunity to update the
project timeline after grant notification and before executing a grant agreement. Any proposed changes,
including extension and early completion, must be requested in writing and approved in advance by the
jurisdiction receiving the funding application. Project schedule should be comprehensive and include clear
documentation that the project is ready to start upon approval of funding. Project schedule should be
feasible and able to be completed within the 12- or 18-month period as applicable. Applicant will assume all
financial risk if work on the proposed project begins before environmental clearance is obtained.
Task/Activity
(Starts July 1, 2019)
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
CHC medical care x x x x x x x x x x x x
Client Laundry x x x x x x x x x x x x
Coordinated Entry System x x x x x x x x x x x x
HMIS Reporting Compliance x x x x x x x x x x x x
Mental Health Support x x x x x x x x x x x x
Nightly shelter for up to 100 x x x x x x x x x x x x
Three daily meals served x x x x x x x x x x x x
Quarterly Reporting x x x x
Recuperative Care Program x x x x x x x x x x x x
Reproductive Health
x x x x x x x x x x x x
SLO Hub Program x x x x x x x x x x x x
Designated Safe Parking for
x x x x x x x x x x x x
Showers x x x x x x x x x x x x
Warming Center x x x x x x x
Attachment B
Packet Page 31
Attachment C:
CAPSLO, HMIS & Coordinated Entry
Client Intake Forms
Attachment B
Packet Page 32
Community Action Partnership
Client Intake Form
* = Section must be completed
Revised 8/31/2018
Last Name*: First Name*:
Middle Name/Initial*: Soc. Sec. # (at least last 4): _____ - _____ - ______
Date of Birth*: ____ - ____ - ______ (Mo.-Day-Yr.)
Sex Assigned at Birth: Female Male Intersex
Gender Identity* (How Do You Describe Yourself): Another Identity, Please Specify:____________________
Man Non-Binary Not Sure
Trans Man Trans Woman Woman
Sexual Orientation/Identity (Do You Consider Yourself to Be):
Another Orientation, Please Specify:____________________________ Asexual
Bisexual Gay Heterosexual or Straight Lesbian Not Sure
Pansexual Queer
If Between the Ages of 14-24, Are You Currently Working or in School*: Yes No
If 18+, Describe Work Status*: (check all that apply) Retired
Employed Full-Time Employed Part-Time
Migrant Seasonal Farm Worker Unemployed (Short-Term, 6 months or less)
Unemployed (Long-Term, 6+ months) Unemployed (Not in Labor Force)
Military Status*: Veteran Active Military None
Address: Apt#: __________
City*: Zip Code*: ____________
Home Phone #: Cell Phone #:
Email Address: ______________________________
Emergency Contact Name: Relationship:
Emergency Contact Phone #:
Ethnicity*: (check one) Hispanic, Latino or Spanish Origins NOT Hispanic, Latino or Spanish Origins
Race*: (check all that apply) American Indian or Alaskan Native Asian
Black or African American Native Hawaiian and Other Pacific Islander White
Primary Language: English Spanish Other
Citizen Status*: US Citizen Eligible Non-Citizen Ineligible Non-Citizen N/A
Family Type*: (check one) Single Person Two Adults NO Children
Single Parent Female Single Parent Male Two Parent Household
Non-Related Adults with Children Multigenerational Household Other
Education*: (check highest grade completed)
No School Completed 12th Grade, No Diploma Doctorate
Nursery School to 4th Grade High School Diploma Other Graduate/Professional
5th or 6th Grade GED Degree
7th or 8th Grade Some College Certificate of Advanced
9th Grade Associates Degree Training or Skilled Artisan
10th Grade Bachelors
11th Grade Masters
Attachment B
Packet Page 33
Revised 8/31/2018
Housing Status for Family*: (check one) Rent (Stably Housed) Own (Stably Housed)
Literally Homeless Imminently Losing Housing (within 14 days) Other
Unstably Housed and at risk of losing your house Other Permanent Housing
If “Other”, “Other Permanent Housing”, “Imminently losing your housing”, or “Unstably Housed”, Describe:
Health Insurance Source(s)*: None Medi-Cal/Cen-Cal (Medicaid) Medicare
Healthy Families (State Children’s Health Insurance Program) Military Health Care
State Health Insurance for Adults Direct-Purchase Employment Based
Disabling Condition*: (check one) Yes No
Family Size*: (check one) One Two Three Four Five Six or More
Source(s) of Family Income*: (check one) No Income Income from Employment Only
Income from Employment and Other Income Source Other Income Source Only
Income from Employment and Non-Cash Benefits Other Income Source and Non-Cash
Income from Employment, Other Income Source, Benefits
and Non-Cash Benefits Non-Cash Benefits Only
Amount(s) of Family Income (Monthly)*:
Earned Income/Employment $ __________ TANF $ __________
Supplemental Security Income (SSI) $ __________ Pension $ __________
Social Security Disability Income (SSDI) $ __________ Child Support $ __________
Private Disability Insurance $ __________ General Assistance $ __________
Unemployment Insurance $ __________ Workers Comp $ __________
Alimony or Other Spousal Support $ __________ EITC $ __________
Retirement Income from Social Security $ __________ Other $ __________
VA Service-Connected Disability Compensation $ ____________
VA Non-Service Connected Disability Pension $ ____________
Non-Cash Benefits of Family*: SNAP/Food Stamps LIHEAP
Public Housing Housing Choice Voucher/Section 8 Childcare Voucher
HUD-VASH Permanent Supportive Housing WIC
Other Affordable Care Act Subsidy
For single parent families, was the custodial parent given a copy of the appropriate child support referral
form?* Yes No N/A
If you have additional family members in your household attach the “Additional Family Information” sheet.
I, __________________________, understand that pertinent identifying information about myself/my family will
remain confidential and that such information will only be used for my benefit or to benefit other members of my
family. Client information needed for service delivery and other data gathering purposes, including service patterns
and client outcomes achieved, will only be shared with other authorized agency staff. I release the Community Action
Partnership of San Luis Obispo County, Inc. and its staff from any legal liability for disclosing or acquiring information
that I have permitted by signing this form. The statements made by me on this consent form are true, correct and
complete to the best of my knowledge.
Client signature: Date:
For Office use only: Entered into ClientTrack Date: ______________ Person entering: __________________________
Attachment B
Packet Page 34
Additional Family Information
Provide information below for all your family members
For all items marked with a s
Use the codes listed below the table to complete the form
Notes:*Check if Client: If the family member listed in the row is also benefitting from these program services, place a check in the box.
**Name: Include middle name or initial if available.
***Relationship: How is this person related to the client on the main “Client Intake Form” (example: spouse, daughter, son, etc.)
sINFORMATIONAL CODES
SEX ASSIGNED AT BIRTH: F-Female; M-Male; I-Intersex
GENDER IDENTITY: M-Man; NB-Non-Binary; NS-Not Sure; TM-Trans Man; TW-Trans Woman; W-Woman; Another Identity-Write-In Response
SEXUAL ORIENTATION/IDENTITY: A-Asexual; B-Bisexual; G-Gay; H-Heterosexual or Straight; L-Lesbian; N-Not Sure; P-Pansexual; Q-Queer; Another Orientation-Write-In Response
ETHNICITY: H-Hispanic, Latino or Spanish Origins; NH-NOT Hispanic, Latino or Spanish Origins
RACE: AI-American Indian or Alaska Native; A-Asian; B-Black or African American; NH-Native Hawaiian and Other Pacific Islander; W-White
WORK STATUS: FT-Employed Full-Time; PT-Employed Part-Time; MS-Migrant Seasonal Farm Worker; US-Unemployed (Short-Term, 6 months or less); UL-Unemployed (Long-Term, 6+ months);
UN-Unemployed (Not in Labor Force); R-Retired
MILITARY STATUS: A-Active Military; V-Veteran; N-None
EDUCATION LEVEL: A-No School Completed; B-Nursery School to 4th Grade; C-5th or 6th Grade; D-7th or 8th Grade; E-9th Grade; F-10th Grade; G-11th Grade; H-12th Grade, No Diploma;
I-High School Diploma; J-GED; K-Some College; L-Associates Degree; M-Bachelors; N-Masters; O-Doctorate; P-Other Graduate/Professional Degree;
Q-Certificate of Advanced Training or Skilled Artisan
INSURANCE: N-None; MC-Medi-Cal/Cen-Cal (Medicaid); M-Medicare; H-Healthy Families (State Children's Health Insurance Program); V-Military Health Care; S-State Health Insurance for Adults;
P-Direct-Purchase; E-Employment Based
Gender
Idenditys ***Relationship Disabled
(Y or N)
*Check
if Client
()
Date of Birth
(Mo-Day-Yr)
Social
Security #
(at least last
four #s)
Race (List
all that
apply)
s
Highest
Education
Level
Completed
s
Health
Insurance
(List all that
apply)
s
**Name (Last, First)
Eth-
nicity
s
If 14-24,
Currently
Working
or in
School
(Y or N)
If 18+
Military
Status
s
If 18+
Work
Status
s
Sexual
Orientation/
Identitys
Sex
Assigned
at Births
Revised 8/31/2018
Attachment B
Packet Page 35
CAPSLO Homeless Services 290 Check Completed By:___
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 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
Revised 4/1/2015 1
Attachment B
Packet Page 36
CAPSLO Homeless Services 290 Check Completed By:___
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
Revised 4/1/2015 2
Attachment B
Packet Page 37
CAPSLO Homeless Services 290 Check Completed By:___
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?
Revised 4/1/2015 3
Attachment B
Packet Page 38
CAPSLO Homeless Services 290 Check Completed By:___
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.
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
Amount
Earned Income (Employment)Worker's Compensation
Yes:Source Amount Yes:Source
Unemployment Insurance TANF (Cal-Works/AFDC)
Soc Sec Disability (SSDI)Retirement from Social Sec.
Private Disability Insurance Other:
Yes:Source Yes:Source
Food Stamps (SNAP, Cal Fresh)TANF Child Care Services
TOTAL
WIC TANF Transportation Services
Revised 4/1/2015 4
Attachment B
Packet Page 39
CAPSLO Homeless Services 290 Check Completed By:___
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 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
Temporary Rental Assistance Other:
Yes:Source Yes:Source
Sec. 8/PH/Rent Assistance Other TANF Funded Services
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
Case Management Only
Agency Providing Service Address Phone Contact Person
Credit Cards Child Support Utilities Medical Other Debts
Revised 4/1/2015 5
Attachment B
Packet Page 40
CAPSLO Homeless Services
Taken By:H of H Date:
First Name:Middle Name:
Last Name:Suffix:
Date of Birth:Age:Social Security Number:
Sex:Female Male Transgendered Male to Female Transgendered Female to Male
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
Hair Color:Eye Color:
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
Name of Co-Parent:Involvement:Part of Family
Not Part of Family, Actively Involved Absent, Financially Supportive Absent, No Financial Support
Citizenship Status:American Legal Alien Other
Education Level Reached:HS Diploma GED Post-Secondary Schooling
If post-secondary, please describe:
School:Teacher:
Are you pregnant?Yes No If yes, due date:Handout Provided Yes No
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
Homeless Services Child Intake Form
Revised 4/1/2015
Attachment B
Packet Page 41
CAPSLO Homeless Services
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?
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
Currently taking any medications?Yes No Name of doctor:
If yes, what type:
Known allergies:Yes No Description:
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:
Parent provided a copy of McKinney Vento rights?Yes No
Parent or Guardian Signature Date Staff Signature Date
(If child/children under 5, complete public health referral.)
SCHIP (Healthy Families)Private Pay Health Insurance
VA Medical Services State Health Insurance For Adults
Medicare Health Insurance Obtained Through COBRA
Yes:Source Yes:Source
Medi-Cal/Cen-Cal (Medicaid)Employer Provided Health Insurance
Revised 4/1/2015
Attachment B
Packet Page 42
CAPSLO Homeless Services 290 Check Completed By:___
First Name:Middle Name:
Last Name:Suffix:
Year Entered Military Service:Year Separated from Military Service:
Theatre of Operations:
World War II:
No Yes Client Doesn't Know Client Refused
Korean War:
No Yes Client Doesn't Know Client Refused
Vietnam War:
No Yes Client Doesn't Know Client Refused
Persian Gulf War (Operation Desert Storm)
No Yes Client Doesn't Know Client Refused
Afghanistan (Operation Enduring Freedom)
No Yes Client Doesn't Know Client Refused
Iraq (Operation Iraqi Freedom)
No Yes Client Doesn't Know Client Refused
Iraq (Operation New Dawn)
No Yes Client Doesn't Know Client Refused
Other Peace-Keeping Operations or Military Interventions (such as Lebanon, Panama, Somalia, Bosnia,
Kosovo)
No Yes Client Doesn't Know Client Refused
Branch of the Military:
Army Air Force Navy Marines Coast Guard
Client Doesn't Know Client Refused
Discharge Status:
Honorable General under honorable conditions Under other than honorable conditions (OTH)
Bad conduct Dishonorable Uncharacterized Client Doesn't Know Client Refused
Household Income as a Percentage of AMI?
Less than 30%30% to 50%Greater than 50%
Last Permanent Address:
Street Address:
City:State:Zip Code:
Client Signature Date Staff Signature Date
Additional Info for SSVF (Complete for Veteran's Only)
Revised 4/1/2015
Attachment B
Packet Page 43
Coordinated Entry - Basic Eligibility Screening Tool
San Luis Obispo County Homeless Services Providers
Person Completing Screening:Date:
[If the person asks for homeless assistance help, let them know you have a release of information form you'd like
them to sign. Ask them if they'd like you to read the release of information form or if they'd like to read it. Read it
verbatim or have them read it. Then ask them to sign it. Then use the script below.]
Now I have a few questions to ask you to see if you might qualify for assistance. This will take about 10 minutes.
You have the right to refuse to answer any of these questions and I'll still try to help you, but the more questions
you answer, the more I can determine if you might qualify for any available programs. All information provided will
be shared between CAPSLO, 5 Cities Homeless Coalition, ECHO, The Link, and Department of Social Services
Initials of staff verifying that the above actions were completed (include verification of verbal consent if needed)
Initials:Verification:
1.First Name:MI:Last Name:
Phone:
2.Are you or a family member a registered sex offender?No Yes
3.Are you currently homeless?No Yes
First time being homeless?No Yes
Number of times homeless in past 3 years:
Number of months homeless in past 3 years:
3a.If CURRENTLY HOMELESS, where did you sleep last night?
(If response is not listed below, client does not currently meet the definition of homeless)
Sleeping in an emergency shelter
Sleeping in a place not meant for human habitation
Staying in a hospital or other institution for up to 90 days AND was homeless immediately
prior to entering the hospital or institution
Staying in transitional housing program for homeless persons
Victim of domestic violence
3b.If NOT currently homeless, do you currently reside in permanent housing:No Yes
If yes, please indicate which of the following applies to help determine if the person/household is
in imminent risk for losing their housing.
3 day pay or quit notice Date received:
Eviction within two weeks from a private dwelling (eviction notice)Expires:
Discharge within two weeks from an institution in which the person has been a resident for
more than 90 days (including prison, MH institution, and hospital)
Place where person/family is living has been condemned by housing officials and is no longer
meant for human habitation.
Sudden and significant loss of income
Physical or behavioral health conditions which are barriers to employment and result in
extremely low income (less than 30% AMI)
Recent traumatic life event has prevented household from meeting its financial responsibilities
Revised 7/16/2018 1
Attachment B
Packet Page 44
Coordinated Entry - Basic Eligibility Screening Tool
San Luis Obispo County Homeless Services Providers
Pending foreclosure of housing
Other:
4.Do you have any type of housing subsidy?No Yes
If yes, type:
5.Address (if homeless, use last permanent address)
Street Address:
Apt #:City:Zip:
If homeless, last city/state stayed in for 90+ days:
6.Date of Birth:
If ages 18-24, have you ever been in foster care?No Yes
Gender Identity (How Do You Describe Yourself):Another identity, please specify:
Genderqueer/gender non-conforming Man Not sure
Trans man Trans woman Woman
7.What is your household size?
Anyone in household pregnant:No Yes
Name of spouse/significant other:
Spouse/significant other date of birth:
7a.Number of children under the age of 18:
Number of children over the age of 18:
School(s) attended:
7b.Number of other adults in the family:
Pets:No Yes
If yes, type:
8.Have you or a current family member ever been on active duty in the US Military?No Yes
If yes, STOP here and refer to SSVF.
9.Applicant(s) would be homeless "but for" this assistance. To meet the "but for " criteria,
applications must demonstrate all of the following:
No other housing options are available (family, friends)
Household lacks the financial resources to obtain immediate housing or remain in its existing housing
Household lacks support networks needed to obtain immediate housing or remain in its
existing housing
10.Special Needs - Does anyone in your household have any of the following:
Substance abuse problem:No Alcohol abuse Drug abuse
Both alcohol and drug abuse Don't know Refused
If Yes :Is condition expected to be of long and indefinite duration and impairs ability to live
independently: No Yes Don't know Refused
Currently receiving treatment or services:No Yes Don't know Refused
Revised 7/16/2018 2
Attachment B
Packet Page 45
Coordinated Entry - Basic Eligibility Screening Tool
San Luis Obispo County Homeless Services Providers
Physical disability:No Yes Don't know Refused
If Yes :Is condition expected to be of long and indefinite duration and impairs ability to live
independently: No Yes Don't know Refused
Currently receiving treatment or services:No Yes Don't know Refused
Developmental disability: No Yes Don't know Refused
If Yes :Is condition expected to be of long and indefinite duration and impairs ability to live
independently: No Yes Don't know Refused
Currently receiving treatment or services:No Yes Don't know Refused
Chronic health condition:No Yes Don't know Refused
If Yes :Is condition expected to be of long and indefinite duration and impairs ability to live
independently: No Yes Don't know Refused
Currently receiving treatment or services:No Yes Don't know Refused
HIV/AIDS:No Yes Don't know Refused
If Yes :Is condition expected to be of long and indefinite duration and impairs ability to live
independently: No Yes Don't know Refused
Currently receiving treatment or services:No Yes Don't know Refused
Mental health problem:No Yes Don't know Refused
If Yes :Is condition expected to be of long and indefinite duration and impairs ability to live
independently: No Yes Don't know Refused
Currently receiving treatment or services:No Yes Don't know Refused
Domestic violence survivor:No Yes Don't know Refused
If Yes :When did the most recent domestic violence experience occur:
11.Are you employed? No Part-time Full-time Retired
Total household income types and amounts, including all children's benefits:
Employment SSI SSDI
Retirement TANF Other
AMI levels may change; see AMI at http://www.huduser.org/portal/datasets/il.html
12.What other agencies have you worked with or are working with you now?
How did you hear about us?
If referred, what is the referring agency?
Caseworker or referring person name:
Phone:Email:Fax:
Staff Signature Client Signature (If available)Date
For The Link Only
Household Size
50% AMI
30% AMI
1 Person
$28,600
$17,150
2 Person
$32,700
$19,600
3 Person
$36,800
$22,050
4 Person 5 Person 6 Person
$40,850
$24,600
$44,150
$28,780
$47,400
$32,960
Revised 7/16/2018 3
Attachment B
Packet Page 46
Coordinated Entry - Referral Form
San Luis Obispo County Homeless Services Providers
This referral is not a guarantee of services. Based upon the information provided on the Coordinated Entry
Screening Tool, you may be eligible for services through the agency/program listed below.
Final eligibility for services will be determined by the agency you are being referred to.
Client First Name:MI:Last Name:
Contact Phone:Email:
Referring Agency:Worker:
Agency Phone:Email:
Did client sign a Release of Information?No Yes If yes, date signed:
Reason for Referral:
Referred to:
5Cities Homeless Coalition ECHO - El Camino Homeless Organization
1566 West Grand Avenue 6370 Atascadero Avenue
Grover Beach, CA 93433 Atascadero, CA 93422
(805) 574-1638 (805) 462-3663
Hours: 11am - 7pm
Maxine Lewis Memorial Shelter (CAPSLO)
750 Orcutt Road Prado Day Center (CAPSLO)
San Luis Obispo, CA 93401 43 Prado Road
(805) 781-3993 San Luis Obispo, CA 93401
Hours: Opens at 5pm, must check in by 7pm.(805) 786-0617
Clients must leave by 7:30am.Hours: 8:30am - 4:30pm
T-MHA - Transitions Mental Health Association The Link Family Resource Center
50Now Permanent Supportive Housing 6500 Morro Road #A
Other:Atascadero, CA 93422
784 High Street (805) 466-5404
San Luis Obispo, CA 93401
(805) 592-2888
Hours: 8am - 5pm
Other:Other:
Type of Referral to Client:Telephone Copy of Form Provided
Referred Agency/Agencies Contacted:Telephone Faxed Form Email ClientTrack
Client Signature Date
Staff Signature Date
Revised 06/29/2017 4
Attachment B
Packet Page 47
Attachment D:
40 Prado Homeless Services Center
Expenditure Timeline 2019-2020
Attachment B
Packet Page 48
COMMUNITY ACTION PARTNERSHIP OF SAN LUIS OBISPO COUNTY, INC.
HOMELESS SERVICE CENTER
CDBG EXPENDITURE TIMELINE
18-Jul 18-Aug 18-Sep 18-Oct 18-Nov 18-Dec 19-Jan 19-Feb 19-Mar 19-Apr 19-May 19-Jun Totals
Salaries 10,580 10,580 10,580 10,580 10,580 10,580 10,580 10,580 10,580 10,580 10,580 10,580 126,960
Benefits 5,396 5,396 5,396 5,396 5,396 5,396 5,396 5,396 5,396 5,395 5,395 5,395 64,749
Supplies 974 974 974 974 974 974 974 974 975 975 975 975 11,692
Repairs 853 853 853 853 853 853 853 853 853 853 853 854 10,237
Food Supplies 873 873 873 873 873 873 873 873 873 873 873 872 10,475
Indirect 1,494 1,494 1,494 1,494 1,494 1,494 1,494 1,494 1,495 1,494 1,494 1,494 17,929
20,170 20,170 20,170 20,170 20,170 20,170 20,170 20,170 20,172 20,170 20,170 20,170 242,042
Attachment B
Packet Page 49
COMMUNITY ACTION PARTNERSHIP OF SAN LUIS OBISPO COUNTY, INC.
40 PRADO HOMELESS SERVICE CENTER
CDBG EXPENDITURE TIMELINE
Aug-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Totals
Salaries 10,352 10,352 10,352 10,353 10,353 10,353 10,353 10,353 10,353 10,353 10,353 10,353 124,233
Benefits 5,825 5,825 5,825 5,825 5,825 5,825 5,826 5,826 5,826 5,826 5,826 5,826 69,906
Indirect 1,294 1,294 1,294 1,294 1,294 1,294 1,294 1,294 1,295 1,294 1,294 1,294 15,531
17,471 17,471 17,471 17,472 17,472 17,472 17,473 17,473 17,474 17,473 17,473 17,473 209,670
Attachment BAttachment BAttachment BAttachment BAttachment BAttachment BAttachment BAttachment BAttachment BAttachment BAttachment BAttachment BAttachment BAttachment BAttachment B
Packet Page 50
Attachment E:
40 Prado Homeless Services Center Budget
FY 2019-2020
Attachment B
Packet Page 51
Revenue
County of SLO - Gen'l Fund 78,310
County of SLO - CDBG 106,210
County of SLO - ESG 74,354
City of SLO - Gen'l Fund 113,450
City of SLO - CDBG 69,188
County of SLO - CBO -
FEMA/EFSP 16,500
County of SLO - Safe Parking 10,000
SLO City - Safe Parking 10,000
DSS TANF 23,400
Foundations (BofA)5,000
Donations/Fundraising/Friends of Prado 382,342
CSBG Funds 82,529
Total Revenues 971,283
Expense
Salaries 520,423
Fringe Benefits 225,629
Food Supplies 19,438
Laundry 7,999
Building/Equipment Repair 22,258
Office/Program/IT Supplies 33,893
Utilities 32,239
Telephone 3,653
Liability/Auto Insurance 4,670
Vehicle Maintenance 4,275
Local Mileage 300
Training 996
Recruitment 1,186
Fundraising 5,154
Interest Expense 1,784
PR Fees 600
Laundry 14,971
Indirect 71,815
Total Expenses 971,283
Net Surplus (Deficit)-
2017-18 Homeless Operating Budget
2019 ESG APPLICATION
40 PRADO HOMELESS SERVICES
Attachment B
Packet Page 52
Revenue
County of SLO - Gen'l Fund 140,770
County of SLO - CDBG 131,473
County of SLO - ESG 83,270
City of SLO - Gen'l Fund 132,700
City of SLO - CDBG 68,212
County of SLO - CBO 25,000
FEMA/EFSP 26,082
County of SLO - Safe Parking 10,000
SLO City - Safe Parking 10,000
DSS TANF 23,400
Foundations (BofA)5,000
Donations/Fundraising/Friends of Prado 526,008
CSBG Funds 83,415
Total Revenues 1,265,330
Expense
Salaries 583,675
Fringe Benefits 269,958
Food Supplies 28,100
Laundry 31,200
Building/Equipment Repair 28,280
Office/Program/IT Supplies 46,100
Utilities 41,550
Telephone 4,820
Liability/Auto Insurance 6,750
Vehicle Maintenance 4,200
Local Mileage 1,150
Training 8,000
Recruitment 2,300
Fundraising 5,000
Interest Expense 95,600
PR Fees 4,500
Laundry 17,500
Indirect 86,647
Total Expenses 1,265,330
Net Surplus (Deficit)-
2018-19 Homeless Operating Budget
2019 ESG APPLICATION
40 PRADO HOMELESS SERVICES
Attachment B
Packet Page 53
SLONP/HASLO CDBG APPLICATION
Permanent Supportive Housing for
Special Needs Homeless/At Risk of
Homeless
Location: San Luis Obispo
Eligible Activity: Acquisition of Vacant
Housing
Housing Our Community
Attachment B
Packet Page 54
71 Zaca Lane, Suite 130, San Luis Obispo, CA 93401 (805) 543-5970 www.slochtf.org
October 18, 2018
Delivered via email to SSmith@haslo.org
Scott Smith
Housing Authority of San Luis Obispo
487 Leff Street
San Luis Obispo, CA 93401
Re: Support for CDBG application
Dear Mr. Smith:
The San Luis Obispo County Housing Trust Fund strongly supports HASLO’s request for CDBG funds to
purchase homes in the City of San Luis Obispo for special needs households and individuals.
Increasing the supply of affordable rental housing for lower income households is rightfully the City’s top
housing priority. Your proposal addresses this priority and it does far more.
Safe, supportive and affordable housing for our neighbors with special needs is even more critical than
affordable apartments. It is a matter of life and death for many. It is also more difficult and expensive
than simply building new apartment units. It can be just as difficult and time consuming to get the needed
approvals and financing for just one or two units of special needs housing as it is for 30 or 40 apartments.
In addition to the housing structure, you need to secure, coordinate and fund various services for the
clients who live in these homes.
HASLO has a long track record of partnering with local governments, funders and service providers to
make special needs housing successful. The Housing Trust Fund is proud to have worked with you on a
number of these projects. Incidentally, our most recent loan was for Hope House in Los Osos. We
partnered with you and Restorative Partners to provide a housing environment in which women released
from incarceration can re-enter society and reunite with their children. Kudos for your great work.
The Housing Trust Fund has always prioritized financing housing for those with special needs. We look
forward to partnering with you again to create more safe, supportive and affordable housing for those
with special needs using your new CDBG grant.
Best of luck.
Sincerely,
Gerald L. Rioux
Executive Director
Attachment B
Packet Page 55
COUNTY OF SAN LUIS OBISPO
DEPARTMENT OF PLANNING & BUILDING
HSG-1003
08/28/2018
Community Development Block Grant (CDBG)
Program Year 2019 Application
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1 PAGE 1 OF 22
www.sloplanning.org | actionplan@co.slo.ca.us
The County of San Luis Obispo is pleased to announce the availability of funds for the Community
Development Block Grant (CDBG) program. Applications MUST address one of the three national objectives
set by the U.S. Department of Housing and Urban Development (HUD), or they will NOT be considered for
CDBG funding (see the section on Qualifying Criteria for detailed information on the objectives).
Furthermore, completed applications should provide the necessary exhibits, budgets, or requested
information on targeted populations. Please email grant applications to ActionPlan@co.slo.ca.us by the
application deadline of 5:00 P.M., Friday, October 19, 2018. Please label your email subject with the grant
program name and the agency name (Example: CDBG – CAPSLO). *Note: Supplemental documents and
information or answers which exceed the allotted space or character limit may be added as attachments.
APPLICANT INFORMATION
(1-1) Organization Name
DUNS Number
Project Manager/Title
Phone/Fax Numbers
Email
Address
City, State, Zip
PROJECT SUMMARY
(2-1) Project/Program Title
Project/Program Address
Jurisdiction/Area Served
Targeted clientele
Project type (select one):
Public Service Public Facilities Economic Development Housing
(2-2) Brief Project Description:
(2-3) Total CDBG Funding Requested
Total Cost to Complete Project
Anticipated Start Date: Anticipated End Date:
Attachment B
Packet Page 56
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1 PAGE 2 OF 22
planning@co.slo.ca.us | www.sloplanning.org
AGENCY DETAILS, CAPACITY, AND EXPERIENCE (25 points)
(3-1) Type of Agency 501 (c)(3) For Profit Gov’t/Public Faith-based Other:
Date of Incorporation Annual Operating Budget
Number of Paid Staff Number of Volunteers
(3-2) Agency Mission Statement:
(3-3) 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.) List
projects of similar size and type that your organization has completed.
Attachment B
Packet Page 57
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1 PAGE 3 OF 22
planning@co.slo.ca.us | www.sloplanning.org
(3-4) Briefly describe your agency’s record keeping system with relevance to the proposed project/program:
(3-5) Briefly describe your agency’s auditing requirements, including those for the proposed
project/program, and attach a copy of your most recent audit:
Attachment B
Packet Page 58
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1 PAGE 4 OF 22
planning@co.slo.ca.us | www.sloplanning.org
(3-6) Will the services offered by your organization increase or expand
as a result of CDBG assistance? If YES, please answer the following two
questions.
Yes No
What new programs or services will be provided?
Describe how existing programs or services will be expanded and what percentage of an increase is
expected?
(3-7) If your program serves homeless households, please describe how your program coordinates with
other homeless service providers to connect homeless individuals and families to resources.
Attachment B
Packet Page 59
HSG-1003
08/28/2018
2019 CDBG APPLICATION
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1 PAGE 5 OF 22
planning@co.slo.ca.us | www.sloplanning.org
QUALIFYING CRITERIA (10 points)
The Community Development Block Grant program was established by Congress in 1974 with
passage of the Housing and Community Development Act and is administered by the United
States Department of Housing and Urban Development (HUD). This program provides funds to
municipalities and other units of government around the country to develop viable urban
communities. This is accomplished by providing affordable, decent housing, a suitable living
environment and by expanding economic opportunities principally for low and moderate income
persons. Although local units of government develop their own programs and funding priorities,
all activities must be consistent with one or more of the following HUD national objectives:
•Principally benefits low- and moderate-income persons
•Prevents or eliminates slum or blight
•Addresses an urgent need or problem in the community (e.g., natural disaster)
As an entitlement Urban County under the CDBG program, the County of San Luis Obispo receives
annual funding allocations from the federal government to fund activities to address these
national objectives.
As a funding recipient, San Luis Obispo County is required to submit an Annual Action Plan that
describes how the Urban County will utilize federal funds to address the national objectives in a
manner that will produce the greatest measurable impact on the Urban County communities. The
lead agency responsible for submission of this Plan to HUD is the Planning and Building
Department of the County of San Luis Obispo.
(4-1) Please identify the appropriate CDBG objective that applies to the proposed
project/program by checking the box next to A, B, or C. In addition, please 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 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; however, the following groups are presumed to be low/moderate-income: abused children;
Attachment B
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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.
Assistance to Microenterprises – The project provides technical assistance to microenterprises
owned by low/moderate-income persons.
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 preservation,
rehabilitation of buildings, but only to the extent necessary to eliminate conditions detrimental to
public health and safety.
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.
Please explain how the proposed activity meets the selected National Objective:
Attachment B
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planning@co.slo.ca.us | www.sloplanning.org
(4-2) Which of the 2015-2019 Consolidated Plan goal(s) does your project/program plan to
address? Check all that apply.
Create housing opportunities for residents
Preserve and maintain existing affordable housing
Reduce and end homelessness
Create a suitable living environment through public services
Stabilize and revitalize diverse neighborhoods (public facility improvements)
Improve educational and job readiness
(4-3) Check any of the following eligible activity categories that apply to the proposed
project or program: (Refer to CDBG regulations and
https://www.hudexchange.info/resources/documents/Basically-CDBG-Chapter-2-Activity.pdf )
Acquisition of real property*
Disposition of real property
Public facilities and improvements (may include acquisition, construction, reconstruction, rehabilitation or
installation)*†
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)
PROJECT DETAILS/DESCRIPTION (25 points)
(5-1) Targeted Clientele: Individuals or households? Identify the projected target population your
proposed activity will serve. (Include age, race, residency, handicap status, income level or other unit
characteristics or subgroup information)
* See relocation provisions in Exhibit A
† See lead-based paint provisions in Exhibit A
Attachment B
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planning@co.slo.ca.us | www.sloplanning.org
(5-2) 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.
(Check box if project serves households or individual
persons)
Number Households Persons
TOTAL Number of Persons or Households
(regardless of income):
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)
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)
(5-3) Please describe the proposed project or program in detail. Make a case for why your project
should be funded. 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? Please attach
a timeline of the project/program milestones.
Attachment B
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planning@co.slo.ca.us | www.sloplanning.org
(5-4) Does the project require the issuance of a permit? (State, local, or federal)
Yes No
If YES, please respond to the following:
Identify the permits necessary:
Have the necessary permits been issued? Please provide proof of issuance:
If permits are required but not yet obtained, when will the permits be issued?
Attachment B
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planning@co.slo.ca.us | www.sloplanning.org
BENEFICIARY DATA (15 points)
Organizations will be asked to provide detailed beneficiary data regarding race, ethnicity, gender,
income, etc. If they cannot provide data, they may not be eligible for funding.
(6-1) How do you document and maintain income status of each client in compliance with
HUD regulations? (Example: very low (≤50% AMI) and low (≤80% AMI) Area Median Income (AMI). Please
provide a sample of your intake process as an attachment if possible.
(6-2) 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.
Attachment B
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planning@co.slo.ca.us | www.sloplanning.org
FINANCIAL INFORMATION (20 points)
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.
(7-1) 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? Will the
project be required to pay a prevailing wage?
(7-2) Do you have any CDBG funds remaining from prior Fiscal Year allocations?
Yes No If YES, answer the following:
What fiscal year did you receive funding?
What project did you receive funding for?
How much is remaining?
Attachment B
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planning@co.slo.ca.us | www.sloplanning.org
(7-3) Itemize all sources of funding expected to be available for each category, if applicable
(please include commitment letters if available):
CDBG Funds Requested
Other Federal Fund(s)
State Source(s)
Local Source(s)
Title 29 Requested
Applicants Matching Funds
Other:
(7-4) 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.
Source(s): Amount:
TOTAL
(7-5) Identify all jurisdictions you are applying to for CDBG funds. Indicate the amount
applied for at each jurisdiction, and the total amount requested. Note: Any project/program
being recommended less than $8,000 total will not be funded per the Cooperation Agreement.
City of Arroyo Grande
City of Atascadero
City of Morro Bay
City of Paso Robles
City of Pismo Beach
City of San Luis Obispo
County of San Luis Obispo
TOTAL
Attachment B
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planning@co.slo.ca.us | www.sloplanning.org
Exhibit A – Housing Rehab and Construction Projects
Will the affordable housing project be applying for tax credits? Yes No
If yes, what round? March June
If March was selected and if your project is identified to receive funds, will your
project require a Reservation Letter for the state tax creditors Yes No
Has NEPA been completed on this project? Yes No
What is the age of the property/building in years?
Has a property inspection report been completed if undertaking rehab? Yes No
For buildings/structures constructed prior to 1978:
Have asbestos and lead hazard risk assessment reports been issued for the facility? Yes No
Has the facility been abated for asbestos and lead paint? Yes No
Will children occupy the facility? Yes No
If yes, indicate the age range of children:
Has a Phase I or Phase II environmental assessment been conducted for the
property? If so, please provide a copy.
Yes No
List and describe any known hazards (e.g. asbestos, storage tanks – underground, aboveground):
No Rehab. This is Acquistion Only
Attachment B
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planning@co.slo.ca.us | www.sloplanning.org
Has the property been designated or been determined to be potentially eligible
for designation as a local, state, or national historic site? If Yes, describe below: Yes No
Is the building/structure located on a Historic Site? Yes No
Is the building/structure located in a Historic District? Yes No
Is the building/structure in a Flood Zone? Yes No
Is the building/structure in a Flood Plain? Yes No
Does your agency have flood insurance? Yes No
Will there be demolition required? Yes No
The questions below ask about zoning. If zoning information is not known, contact the local municipality
to request assistance.
What is the project structure type?
Residential Commercial Public facility Public right-of-way
What is the current zoning of the project site?
Is the project site zoned correctly for the proposed
activity? Yes No
If no, provide below an explanation of efforts and a timetable to change the zoning or obtain a variance:
Attachment B
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planning@co.slo.ca.us | www.sloplanning.org
B.15. Does the project require temporary/permanent relocation of occupants?Yes No
If yes, this project is subject to the Uniform Relocation Assistance and Real Property Acquisition
Policies Act (URA). Describe the relocation plans, including timetable and notifications to occupants.
List how many of the occupied units are: (a) owner-occupied; (b) renter-occupied; or (c) businesses.
Indicate whether temporary and/or permanent displacement is required. [NOTE: This will be for site
information only. Relocation activities will not be eligible for funding with Fiscal Year 2018 CDBG
funds.]
Attachment B
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planning@co.slo.ca.us | www.sloplanning.org
Federal regulations require that all facilities and/or services assisted with CDBG funds be accessible to the
disabled. Accessibility includes such things as: entrance ramps, parking with universal logo signage,
grab bars around commodes and showers, top of toilet seats that meet required height from the
floor, drain lines under lavatory sink either wrapped or insulated, space for wheelchair
maneuverability, accessible water fountains, access between floors (elevators, ramps, lifts), and
other improvements needed to assure full access to funded facilities/programs, incl uding serving
the blind and deaf.
Describe below whether the project currently meets ADA standards for accessibility by the disabled. If
not, describe the accessibility problems and methods to be utilized to address the problems,
including funding and timetable.
Attachment B
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2019 CDBG APPLICATION(7-6) Please list expenditures under CDBG by item or cost category, and attach a timeline ofthe expenditures.Housing AcquisitionFEDERAL REQU I REMENTS ACKNOWLEDGEMENTSEvery person or Agency awarded a 2019 CDBG Contract or grant by San Luis Obispo County for theprovision of services shall be required to certify to the County that they will comply with federal and localrequirements including, but not limited to, those listed below. Please initialeach ceftification listed toindicate you or your agency can and will comply with these requirements if funded,Affirmative MarketingAmericans withDisabilities ActQuarterly and annual repofts shall be submitted by theproject/program manager to the County for CDBG-funded publicservices and housing projects. Each report shall include the totalnumber of project/program applicants and clients served withrespect to race, ethnicity, gender, and disability status' Affirmativemarketing efforts shall be taken to increase the participation of any$350,000Federal RequirementsTOTALunderserved groups,Certify that this agency has reviewed its projects, programs andservices for compliance with all applicable regulations contained inTitle ll, Americans with Disabilities Act of 1990,Civil Rights ActAgrees to have an annual audit conducted in accordance withcurrent San Luis Obispo County policy regarding audits and 2 CFR200,501 audit requirements. Shall comply with current San LuisObispo County policy concerning the purchase of equipment andshall maintain inventory records of all non-expendable personalproperty as defined by such policy as may be procured with funds976 OSOS SIREET, ROOM 300 | SAN LUIS OBISPO, C493408 | (805) 781-s600 I TTY/TRS 7-1-1planning@co.slo,ca.us I www.sloplanning.orgrovided through the grant,Certifu that it complies with and prohibits discriminationaccordance with Title Vl of the Civil Rights Act of 1964.lnitialsPAGE 13 OF 22Attachment BPacket Page 72
20'19 CDBG APPLICATIONConflict of lnterest(2 CFR 200.112,200.318, and 570,611) CeftiÛ and agree that nocovered persons who exercise or have exercised any functions orresponsibilities with respect to CDBG-assisted activity, or who are ina position to participate in a decision-making process or gain insideinformation with regard to such activities, may obtain a financialinterest in any contract, or have a financial interest in any contract,subcontract, or agreement with respect to the CDBG-assistedactivity, either for themselves or those with whom they havebusiness or immediate family ties, during their tenure or for a periodof one (1 ) year thereafter. A "covered person" includes any personwho is an employee, agent, consultant, officer, or elected orDebarment Status ofContractorsDrug-Free Workplaceappointed official of the agencEnvironmentalReviewCertify that, to the best of its knowledge and beliel that it and itsprincipals will not knowingly enter into any subcontract with aperson who is, or organization that is, debarred, suspended,proposed for debarment, or declared ineligible from award ofcontracts by any Federal agency(https://www,sa m, gov/po rta l/pu bl i c/SAM/)Certify that it will provide a drug-free workplace.Prior to HUD's release of grant conditions and/or funds for theCDBG-funded project, a review of the project's potential impact onthe environment must be conducted and approved by the County ofSan Luis Obispo prior to obligating or incurring project costs, TheCounty must certify to HUD that it has complied with all applicableenvironmental procedures and requirements. Should project costsbe obligated or incurred prior to the completion of the necessaryenvironmental review, the project shall not benefit from the federalfunds, The level of environmental review required depends on thenature of the project. 24 CFR Part 58 is available atFinancialManagementhttp://www.hud,gov/offi ces/pih/i h/codetal k/ona p I docs/24cf r58Accounting Standards: Agrees to comply with 2 CFR 200(EXF) andagrees to adhere to the accounting principles and proceduresrequired therein, utilize adequate internal controls, and maintainnecessary source documentation for all costs incurred.Cost Principles: Shall administer its program in conformance with 2CFR 200(E), "Cost Principles for Non-Profit Organizations," or 2 CFR225,"Cosl Principles for State and Local Governments," as applicable.These principles shall be applied for all costs incurred whether976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-s600 | TTY/TRS 7-1-1p!-anning@co.slo.ca.us I www.sloplanning'orgcharged on a direct or indirect basis.Procurement Policies: Certify and agree toproperty, or services in accordance with the200.320-326.procure all materials,requirements of 2 CFRPAGE 14 OT 22Attachment BPacket Page 73
2019 CDBG APPLICATIONHMIS RepoftingAll homeless seruice providers applying for CDBG funds to assist,house, or shelter the homeless must identify and demonstrate thecapacity to participate in the County of San Luis Obispo HomelessManagement lnformation System (HMIS) to provide: personnelfordata entry, user licensing, and hardware and software necessary forcompatibility with HMIS. HMIS is an electronic data collection systemthat stores client level information about persons who access thehomeless services system in a Continuum of Care, and reportsaggregate data for the County as per HUD's Data Standards, HUDupdated its data standards in2014, and the new standards are ineffect as of October 1,2014. More information can be found athttps://www.hudexchange,info/resources/docu ments/H M lS-Data-Standarcls-Manual.pdf andhttps://www, hudexchange.info/resou rces/d ocu ments/H M lS-Data-LiabilityLobbying ActivitiesThe County and cities require all grant recipients to maintain generalliability, automobile and workman's compensation insurance withlimits of not less than $1 million (may vary by jurisdiction). lf you aresuccessful in obtaining a reward, you will be asked to providedocumentation regarding your ability to provide the requiredCertify that no Federal appropriated funds have been paid or will bepaid, by or on behalf of the agency, to any person for influencing orattempting to influence an officer or employee of any agency, aMember of Congress, an officer or employee of Congress, or anemployee of a Member of Congress in connection with the awardingof any Federal contract, the making of any Federal grant, the makingof any Federal loan, the entering into of any cooperative agreement,and the extension, continuation, renewal, amendment, ormodification of any Federal contract, grant, loan or cooperativeLobbying DisclosureThe undersigned certifies to the best of his or her knowledge andbeliel that:A, No federal appropriated funds have been paid or will be paid, byor on behalf of the Subrecipient, to any person for influencing orattempting to influence an officer or employee of any agency, aMember of Congress, an officer or employee of Congress, or anemployee of a Member of Congress in connection with the awardingof any Federal contract, the making of any Federal grant, the makingof any Federal loan, the entering into a cooperative agreement, andement,976 OSOS SIREET, ROOM 300 | SAN LU lS OBISPO, CA 93408 | (805) 781-s600 | TTY/TRS 7-1-1planning@co.slo.ea,us I www.sloplanninS'orgthe extension, continuation, renewal, amendment, or modification ofPAGE15OF22Attachment BPacket Page 74
2019 CDBG APPLICATIONany Federal contract, grant loan, or cooperative agreement inaccordance with the Department of lnterior and Related AgenciesAppropriations Act, known as the Byrd Amendments, and HUD'S 24Code of Federal Regulations (CFR) 87.B. lf any funds other than federal appropriated funds have been paidor will be paid to any person for influencing or attempting toinfluence an officer or employee of any agency, a Member ofCongress, an officer or employee of Congress, or an employee of amember of Congress in connection with this federal contract, grant,loan, or cooperative agreement, the Subrecipient shall complete andsubmit Standard Form LL, "Disclosure Form to Report Lobbying," inaccordance with its instructions, and other federal disclosure formsas requested,C. The Subrecipient shall require that the language of thiscertification be included in the award documents for all subawardsat alltiers (including subcontracts, subgrants, and contracts undergrants, loans, and cooperative agreements) and that all subrecipientsshall certify and disclose accordingly.This certification is a material representation of fact upon whichreliance was placed when this transaction was made or entered into.Submission of this certification is a prerequisite for making orentering into this transaction imposed by Section 1352, Title 3'1, U,S,Code, Any person who fails to file the required certification shall besubject to a civil penalty of not less than $10,000 and not more thanMandatory Disclosure$100,000 for each such failure,The non-Federal entity or applicant for a Federal award mustdisclose, in a timely manner*, in writing to the Federal awardingagency or pass-through entity all violations of Federal criminal lawinvolving fraud, bribery, or gratuity violations, potentially affectingthe Federal award, Failure to make required disclosures can result inany of the remedies described in 2 CFR 200.338 (Remedies forNoncompliance), including suspension or debarment, (See also 2 CFRPart 'l 80 and 31 USC 3321). Limit one violation per form' Thesubrecipient acknowledges that the completion and submission ofthis form will satisfy the requirement in 2 CFR 200.1 13 (MandatoryDisclosure) and will be done at the time of subrecipient agreementMinority BusinessEnterprise (MBE),Women's Business976 OSOS STREET, ROOM 300 | SAN LUIS OBlSPO, CA 93408 | (80s) 781-s600 I TTY/TRS 7-1-1planning@co.slo.ca.us I www.sloplanninS'orgexecution with the CountY,Certify that it will comply with 2 CFR 200.321 to take all necessaryaffirmative steps to assure that minority firms, women businessenterprises, and labor surplus area firms are used when possible.PAGE16OF22Attachment BPacket Page 75
2019 CDBG APPLICATIONEnterprise (WBE),Small BusinessContractingReal PropertyFurther certify that it will submit to San Luis Obispo County at thetime of project completion a report of the MBE and WBE status of allsubcontractors to be paid with CDBG funds with contracts of $10,000Religious ActivitiesRelocationor greater, in a format that will be provided by the County.Certify that it will comply with real property standards (24 CFR Part570,505) applicable to any property within the owner's control that isacquired or improved in whole or in part using CDBG funds in excessof $25,000.Certiñ7 and agree that funds provided to the agency will not beutilized for inherently religious activities prohibited by 24 CFR570.200(i), such as worship, religious instruction, or proselytization.Any project that involves the acquisition of property, construction,and/or rehabilitation and that is funded in whole or in part withfederal CDBG funds is subject to federal relocation requirements, lngeneral, any property owner, commercial business, or residentialoccupant who is displaced by a HUD-funded project may be eligiblefor relocation benefits, A project cannot be broken into separate"projects" in order to avoid the federal requirements connected withproperty acquisition and relocation. Any questions concerning therelocation regulations for a specific property acquisition projectshould be directed to the County Housing and EconomicSection 3Development staff before anv action is taken on the project.Certify and agree to ensure that opportunities for training andemployment arising in connection with contracts or subcontracts fora housing rehabilitation (including reduction and abatement of lead-based paint hazards), housing construction, or other publicconstruction project are given to low- and very low-income personsresiding within the metropolitan area in which the CDBG-fundedproject is located; where feasible, priority should be given to low-and very low-income persons within the service area of the projector the neighborhood in which the project is located, and to low- andvery low-income participants in other HUD programs; and awardcontracts for work undeftaken in connection with a housingrehabilitation (including reduction and abatement of lead-basedpaint hazards), housing construction, or other public constructionproject to business concerns that provide economic opportunitiesfor low- and very low-income persons residing within themetropolitan area in which the CDBG-funded project is located;where feasible, priority should be given to business concerns thatprovide economic opportunities to low- and very low-incomeresidents within the service area or the neighborhood in which theproject is located, and to low- and very low-income participants in976 OSOS STREEI, ROOM 300 | SAN LUlS OBISPO, CA 93408 | (80s) 781-5600 I TTY/TRS 7-1-1planning@co.slo.ca.us I www.sloplanning.orgother HUD programs.PAGE 17 OF 22Attachment BPacket Page 76
2019 CDBG APPLICATIONSection 504Do not hesitate to contact Tony Navarro at: tnavarro@co.slo.ca.us, or by phone at 805-781 -5787 ifyou have any questions.Section 504 of the Rehabilitation Act of 1973: Certify that it has readand understands all of its obligations under Section 504 to prohibitdiscrimination against persons with disabilities in the operation ofroqra ms receivi ng federal fi nancia I assista nce.I certifySignScottrmation in th ion is true and accurate to the best of my knowledge and ability,Printed orSLONP/HASLO/a -/g' / øDATE10t18118976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1planning@co.slo,ca.us I www.sloplanning'orgTitlePAGE 18 QI22Attachment BPacket Page 77
COUNTY OF SAN LUIS OBISPO
DEPARTMENT OF PLANNING & BUILDING
HSG-1003
08/28/2018
Community Development Block Grant (CDBG)
Program Year 2019 Application
976 OSOS STREET, ROOM 300 | SAN LUIS OBISPO, CA 93408 | (805) 781-5600 | TTY/TRS 7-1-1 PAGE 1 OF 22
www.sloplanning.org | actionplan@co.slo.ca.us
The County of San Luis Obispo is pleased to announce the availability of funds for the Community
Development Block Grant (CDBG) program. Applications MUST address one of the three national objectives
set by the U.S. Department of Housing and Urban Development (HUD), or they will NOT be considered for
CDBG funding (see the section on Qualifying Criteria for detailed information on the objectives).
Furthermore, completed applications should provide the necessary exhibits, budgets, or requested
information on targeted populations. Please email grant applications to ActionPlan@co.slo.ca.us by the
application deadline of 5:00 P.M., Friday, October 19, 2018. Please label your email subject with the grant
program name and the agency name (Example: CDBG – CAPSLO). *Note: Supplemental documents and
information or answers which exceed the allotted space or character limit may be added as attachments.
APPLICANT INFORMATION
(1-1) Organization Name
DUNS Number
Project Manager/Title
Phone/Fax Numbers
Email
Address
City, State, Zip
PROJECT SUMMARY
(2-1) Project/Program Title
Project/Program Address
Jurisdiction/Area Served
Targeted clientele
Project type (select one):
Public Service Public Facilities Economic Development Housing
(2-2) Brief Project Description:
(2-3) Total CDBG Funding Requested
Total Cost to Complete Project
Anticipated Start Date: Anticipated End Date:
Attachment B
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planning@co.slo.ca.us | www.sloplanning.org
AGENCY DETAILS, CAPACITY, AND EXPERIENCE (25 points)
(3-1) Type of Agency 501 (c)(3) For Profit Gov’t/Public Faith-based Other:
Date of Incorporation Annual Operating Budget
Number of Paid Staff Number of Volunteers
(3-2) Agency Mission Statement:
(3-3) 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.) List
projects of similar size and type that your organization has completed.
Attachment B
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planning@co.slo.ca.us | www.sloplanning.org
(3-4) Briefly describe your agency’s record keeping system with relevance to the proposed project/program:
(3-5) Briefly describe your agency’s auditing requirements, including those for the proposed
project/program, and attach a copy of your most recent audit:
Attachment B
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planning@co.slo.ca.us | www.sloplanning.org
(3-6) Will the services offered by your organization increase or expand
as a result of CDBG assistance? If YES, please answer the following two
questions.
Yes No
What new programs or services will be provided?
Describe how existing programs or services will be expanded and what percentage of an increase is
expected?
(3-7) If your program serves homeless households, please describe how your program coordinates with
other homeless service providers to connect homeless individuals and families to resources.
Attachment B
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planning@co.slo.ca.us | www.sloplanning.org
QUALIFYING CRITERIA (10 points)
The Community Development Block Grant program was established by Congress in 1974 with
passage of the Housing and Community Development Act and is administered by the United
States Department of Housing and Urban Development (HUD). This program provides funds to
municipalities and other units of government around the country to develop viable urban
communities. This is accomplished by providing affordable, decent housing, a suitable living
environment and by expanding economic opportunities principally for low and moderate income
persons. Although local units of government develop their own programs and funding priorities,
all activities must be consistent with one or more of the following HUD national objectives:
•Principally benefits low- and moderate-income persons
•Prevents or eliminates slum or blight
•Addresses an urgent need or problem in the community (e.g., natural disaster)
As an entitlement Urban County under the CDBG program, the County of San Luis Obispo receives
annual funding allocations from the federal government to fund activities to address these
national objectives.
As a funding recipient, San Luis Obispo County is required to submit an Annual Action Plan that
describes how the Urban County will utilize federal funds to address the national objectives in a
manner that will produce the greatest measurable impact on the Urban County communities. The
lead agency responsible for submission of this Plan to HUD is the Planning and Building
Department of the County of San Luis Obispo.
(4-1) Please identify the appropriate CDBG objective that applies to the proposed
project/program by checking the box next to A, B, or C. In addition, please 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 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; however, the following groups are presumed to be low/moderate-income: abused children;
Attachment B
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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.
Assistance to Microenterprises – The project provides technical assistance to microenterprises
owned by low/moderate-income persons.
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 preservation,
rehabilitation of buildings, but only to the extent necessary to eliminate conditions detrimental to
public health and safety.
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.
Please explain how the proposed activity meets the selected National Objective:
Attachment B
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(4-2) Which of the 2015-2019 Consolidated Plan goal(s) does your project/program plan to
address? Check all that apply.
Create housing opportunities for residents
Preserve and maintain existing affordable housing
Reduce and end homelessness
Create a suitable living environment through public services
Stabilize and revitalize diverse neighborhoods (public facility improvements)
Improve educational and job readiness
(4-3) Check any of the following eligible activity categories that apply to the proposed
project or program: (Refer to CDBG regulations and
https://www.hudexchange.info/resources/documents/Basically-CDBG-Chapter-2-Activity.pdf )
Acquisition of real property*
Disposition of real property
Public facilities and improvements (may include acquisition, construction, reconstruction, rehabilitation or
installation)*†
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)
PROJECT DETAILS/DESCRIPTION (25 points)
(5-1) Targeted Clientele: Individuals or households? Identify the projected target population your
proposed activity will serve. (Include age, race, residency, handicap status, income level or other unit
characteristics or subgroup information)
* See relocation provisions in Exhibit A
† See lead-based paint provisions in Exhibit A
Attachment B
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(5-2) 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.
(Check box if project serves households or individual
persons)
Number Households Persons
TOTAL Number of Persons or Households
(regardless of income):
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)
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)
(5-3) Please describe the proposed project or program in detail. Make a case for why your project
should be funded. 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? Please attach
a timeline of the project/program milestones.
Attachment B
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(5-4) Does the project require the issuance of a permit? (State, local, or federal)
Yes No
If YES, please respond to the following:
Identify the permits necessary:
Have the necessary permits been issued? Please provide proof of issuance:
If permits are required but not yet obtained, when will the permits be issued?
Attachment B
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BENEFICIARY DATA (15 points)
Organizations will be asked to provide detailed beneficiary data regarding race, ethnicity, gender,
income, etc. If they cannot provide data, they may not be eligible for funding.
(6-1) How do you document and maintain income status of each client in compliance with
HUD regulations? (Example: very low (≤50% AMI) and low (≤80% AMI) Area Median Income (AMI). Please
provide a sample of your intake process as an attachment if possible.
(6-2) 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.
Attachment B
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FINANCIAL INFORMATION (20 points)
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.
(7-1) 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? Will the
project be required to pay a prevailing wage?
(7-2) Do you have any CDBG funds remaining from prior Fiscal Year allocations?
Yes No If YES, answer the following:
What fiscal year did you receive funding?
What project did you receive funding for?
How much is remaining?
Attachment B
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(7-3) Itemize all sources of funding expected to be available for each category, if applicable
(please include commitment letters if available):
CDBG Funds Requested
Other Federal Fund(s)
State Source(s)
Local Source(s)
Title 29 Requested
Applicants Matching Funds
Other:
(7-4) 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.
Source(s): Amount:
TOTAL
(7-5) Identify all jurisdictions you are applying to for CDBG funds. Indicate the amount
applied for at each jurisdiction, and the total amount requested. Note: Any project/program
being recommended less than $8,000 total will not be funded per the Cooperation Agreement.
City of Arroyo Grande
City of Atascadero
City of Morro Bay
City of Paso Robles
City of Pismo Beach
City of San Luis Obispo
County of San Luis Obispo
TOTAL
Attachment B
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(7-6) Please list expenditures under CDBG by item or cost category, and attach a timeline of
the expenditures.
TOTAL
FEDERAL REQUIREMENTS ACKNOWLEDGEMENTS
Every person or Agency awarded a 2019 CDBG Contract or grant by San Luis Obispo County for the
provision of services shall be required to certify to the County that they will comply with federal and local
requirements including, but not limited to, those listed below. Please initial each certification listed to
indicate you or your agency can and will comply with these requirements if funded.
Federal Requirements Initials
Affirmative Marketing Quarterly and annual reports shall be submitted by the
project/program manager to the County for CDBG-funded public
services and housing projects. Each report shall include 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.
Americans with
Disabilities Act
Certify that this agency has reviewed its projects, programs and
services for compliance with all applicable regulations contained in
Title II, Americans with Disabilities Act of 1990.
Audits Agrees to have an annual audit conducted in accordance with
current San Luis Obispo County policy regarding audits and 2 CFR
200.501 audit requirements. Shall comply with current San Luis
Obispo County policy concerning the purchase of equipment and
shall maintain inventory records of all non-expendable personal
property as defined by such policy as may be procured with funds
provided through the grant.
Civil Rights Act Certify that it complies with and prohibits discrimination in
accordance with Title VI of the Civil Rights Act of 1964.
Attachment B
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Conflict of Interest (2 CFR 200.112, 200.318, and 570.611) Certify and agree that no
covered persons who exercise or have exercised any functions or
responsibilities with respect to CDBG-assisted activity, or who are in
a position to participate in a decision-making process or gain inside
information with regard to such activities, may obtain a financial
interest in any contract, or have a financial interest in any contract,
subcontract, or agreement with respect to the CDBG-assisted
activity, either for themselves or those with whom they have
business or immediate family ties, during their tenure or for a period
of one (1) year thereafter. A “covered person” includes any person
who is an employee, agent, consultant, officer, or elected or
appointed official of the agency
Debarment Status of
Contractors
Certify that, to the best of its knowledge and belief, that it and its
principals will not knowingly enter into any subcontract with a
person who is, or organization that is, debarred, suspended,
proposed for debarment, or declared ineligible from award of
contracts by any Federal agency
(https://www.sam.gov/portal/public/SAM/)
Drug-Free Workplace Certify that it will provide a drug-free workplace.
Environmental
Review
Prior to HUD’s release of grant conditions and/or 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 procedures and requirements. Should project costs
be obligated or incurred prior to the completion of the necessary
environmental review, the project shall not benefit from the federal
funds. The level of environmental review required depends on the
nature of the project. 24 CFR Part 58 is available at
http://www.hud.gov/offices/pih/ih/codetalk/onap/docs/24cfr58.pdf.
Financial
Management
Accounting Standards: Agrees to comply with 2 CFR 200(E)(F) and
agrees to adhere to the accounting principles and procedures
required therein, utilize adequate internal controls, and maintain
necessary source documentation for all costs incurred.
Cost Principles: Shall administer its program in conformance with 2
CFR 200(E), “Cost Principles for Non-Profit Organizations,” or 2 CFR
225, “Cost Principles for State and Local Governments,” as applicable.
These principles shall be applied for all costs incurred whether
charged on a direct or indirect basis.
Procurement Policies: Certify and agree to procure all materials,
property, or services in accordance with the requirements of 2 CFR
200.320-326.
Attachment B
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HMIS Reporting All homeless service providers applying for CDBG funds to assist,
house, or shelter the homeless must identify and demonstrate the
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 HUD’s Data Standards. HUD
updated its data standards in 2014, and the new standards are in
effect as of 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.
Liability The County and cities require all grant recipients to maintain general
liability, automobile and workman’s compensation insurance with
limits of not less than $1 million (may vary by jurisdiction). If you are
successful in obtaining a reward, you will be asked to provide
documentation regarding your ability to provide the required
coverage.
Lobbying Activities Certify that no Federal appropriated funds have been paid or will be
paid, by or on behalf of the agency, to any person for influencing or
attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with the awarding
of any Federal contract, the making of any Federal grant, the making
of any Federal loan, the entering into of any cooperative agreement,
and the extension, continuation, renewal, amendment, or
modification of any Federal contract, grant, loan or cooperative
agreement.
Lobbying Disclosure The undersigned certifies to the best of his or her knowledge and
belief, that:
A. No federal appropriated funds have been paid or will be paid, by
or on behalf of the Subrecipient, to any person for influencing or
attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with the awarding
of any Federal contract, the making of any Federal grant, the making
of any Federal loan, the entering into a cooperative agreement, and
the extension, continuation, renewal, amendment, or modification of
Attachment B
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any Federal contract, grant loan, or cooperative agreement in
accordance with the Department of Interior and Related Agencies
Appropriations Act, known as the Byrd Amendments, and HUD'S 24
Code of Federal Regulations (CFR) 87.
B. If any funds other than federal appropriated funds have been paid
or will be paid to any person for influencing or attempting to
influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a
member of Congress in connection with this federal contract, grant,
loan, or cooperative agreement, the Subrecipient shall complete and
submit Standard Form LL, “Disclosure Form to Report Lobbying,” in
accordance with its instructions, and other federal disc losure forms
as requested.
C. The Subrecipient shall require that the language of this
certification be included in the award documents for all subawards
at all tiers (including subcontracts, subgrants, and contracts under
grants, loans, and cooperative agreements) and that all subrecipients
shall certify and disclose accordingly.
This certification is a material representation of fact upon which
reliance was placed when this transaction was made or entered into.
Submission of this certification is a prerequisite for making or
entering into this transaction imposed by Section 1352, Title 31, U.S.
Code. Any person who fails to file the required certification shall be
subject to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure.
Mandatory Disclosure The non-Federal entity or applicant for a Federal award must
disclose, in a timely manner*, in writing to the Federal awarding
agency or pass-through entity all violations of Federal criminal law
involving fraud, bribery, or gratuity violations, potentially affecting
the Federal award. Failure to make required disclosures can result in
any of the remedies described in 2 CFR 200.338 (Remedies for
Noncompliance), including suspension or debarment. (See also 2 CFR
Part 180 and 31 USC 3321). Limit one violation per form. The
subrecipient acknowledges that the completion and submission of
this form will satisfy the requirement in 2 CFR 200.113 (Mandatory
Disclosure) and will be done at the time of subrecipient agreement
execution with the County.
Minority Business
Enterprise (MBE),
Women’s Business
Certify that it will comply with 2 CFR 200.321 to take all necessary
affirmative steps to assure that minority firms, women business
enterprises, and labor surplus area firms are used when possible.
Attachment B
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Enterprise (WBE),
Small Business
Contracting
Further certify that it will submit to San Luis Obispo County at the
time of project completion a report of the MBE and WBE status of all
subcontractors to be paid with CDBG funds with contracts of $10,000
or greater, in a format that will be provided by the County.
Real Property Certify that it will comply with real property standards (24 CFR Part
570.505) applicable to any property within the owner’s control that is
acquired or improved in whole or in part using CDBG funds in excess
of $25,000.
Religious Activities Certify and agree that funds provided to the agency will not be
utilized for inherently religious activities prohibited by 24 CFR
570.200(j), such as worship, religious instruction, or proselytization.
Relocation Any project that involves the acquisition of property, construction,
and/or rehabilitation and that is funded in whole or in part with
federal CDBG funds is subject to federal relocation requirements. In
general, any property owner, commercial business, or residential
occupant who is displaced by a HUD-funded project may be eligible
for relocation benefits. A project cannot be broken into separate
“projects” in order to avoid the federal requirements connected with
property acquisition and relocation. Any questions concerning 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.
Section 3 Certify and agree to ensure that opportunities for training and
employment arising in connection with contracts or subcontracts for
a housing rehabilitation (including reduction and abatement of lead-
based paint hazards), housing construction, or other public
construction project are given to low- and very low-income persons
residing within the metropolitan area in which the CDBG-funded
project is located; where feasible, priority should be given to low-
and very low-income persons within the service area of the project
or the neighborhood in which the project is located, and to low- and
very low-income participants in other HUD programs; and award
contracts for work undertaken in connection with a housing
rehabilitation (including reduction and abatement of lead-based
paint hazards), housing construction, or other public construction
project to business concerns that provide economic opportunities
for low- and very low-income persons residing within the
metropolitan area in which the CDBG-funded project is located;
where feasible, priority should be given to business concerns that
provide economic opportunities to low- and very low-income
residents within the service area or the neighborhood in which the
project is located, and to low- and very low-income participants in
other HUD programs.
Attachment B
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Section 504 Section 504 of the Rehabilitation Act of 1973: Certify that it has read
and understands all of its obligations under Section 504 to prohibit
discrimination against persons with disabilities in the operation of
programs receiving federal financial assistance.
Do not hesitate to contact Tony Navarro at: tnavarro@co.slo.ca.us, or by phone at 805-781-5787 if
you have any questions.
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
Attachment B
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Exhibit A – Housing Rehab and Construction Projects
Will the affordable housing project be applying for tax credits? Yes No
If yes, what round? March June
If March was selected and if your project is identified to receive funds, will your
project require a Reservation Letter for the state tax creditors Yes No
Has NEPA been completed on this project? Yes No
What is the age of the property/building in years?
Has a property inspection report been completed if undertaking rehab? Yes No
For buildings/structures constructed prior to 1978:
Have asbestos and lead hazard risk assessment reports been issued for the facility? Yes No
Has the facility been abated for asbestos and lead paint? Yes No
Will children occupy the facility? Yes No
If yes, indicate the age range of children:
Has a Phase I or Phase II environmental assessment been conducted for the
property? If so, please provide a copy.
Yes No
List and describe any known hazards (e.g. asbestos, storage tanks – underground, aboveground):
Attachment B
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Has the property been designated or been determined to be potentially eligible
for designation as a local, state, or national historic site? If Yes, describe below: Yes No
Is the building/structure located on a Historic Site? Yes No
Is the building/structure located in a Historic District? Yes No
Is the building/structure in a Flood Zone? Yes No
Is the building/structure in a Flood Plain? Yes No
Does your agency have flood insurance? Yes No
Will there be demolition required? Yes No
The questions below ask about zoning. If zoning information is not known, contact the local municipality
to request assistance.
What is the project structure type?
Residential Commercial Public facility Public right-of-way
What is the current zoning of the project site?
Is the project site zoned correctly for the proposed
activity? Yes No
If no, provide below an explanation of efforts and a timetable to change the zoning or obtain a variance:
Attachment B
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B.15. Does the project require temporary/permanent relocation of occupants?Yes No
If yes, this project is subject to the Uniform Relocation Assistance and Real Property Acquisition
Policies Act (URA). Describe the relocation plans, including timetable and notifications to occupants.
List how many of the occupied units are: (a) owner-occupied; (b) renter-occupied; or (c) businesses.
Indicate whether temporary and/or permanent displacement is required. [NOTE: This will be for site
information only. Relocation activities will not be eligible for funding with Fiscal Year 2018 CDBG
funds.]
Attachment B
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Federal regulations require that all facilities and/or services assisted with CDBG funds be accessible to the
disabled. Accessibility includes such things as: entrance ramps, parking with universal logo signage,
grab bars around commodes and showers, top of toilet seats that meet required height from the
floor, drain lines under lavatory sink either wrapped or insulated, space for wheelchair
maneuverability, accessible water fountains, access between floors (elevators, ramps, lifts), and
other improvements needed to assure full access to funded facilities/programs, incl uding serving
the blind and deaf.
Describe below whether the project currently meets ADA standards for accessibility by the disabled. If
not, describe the accessibility problems and methods to be utilized to address the problems,
including funding and timetable.
Attachment B
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