Fillable 3265 FY2020 CDBG Application- Fillable (City of Warner Robins)

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3265 FY2020 CDBG Application- Fillable (City of Warner Robins)

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CDBG

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

CITY OF WARNER ROBINS

REQUEST FOR PROPOSAL (RFP) APPLICATION

PROGRAM YEAR 2020

PREPARED BY:

COMMUNITY DEVELOPMENT DEPARTMENT

P.O. BOX 8629

Warner Robins, Georgia 31095

(478) 302-5514, FAX (478) 929-6944

APPLICATION REQUIREMENTS:

 Applicant organizations must be either a (1) public agency or (2) private, non-profit entity with a

current 501 (c)(3) status, or (3) neighborhood group/agency partnering with a private, non-profit

entity with current 501 (c)(3) status all with at least 12 months experience.

 To be considered for CDBG funding, a project must meet one of the following National Objectives:

 BENEFIT LOW- AND MODERATE-INCOME PERSONS

 AID IN THE PREVENTION OR ELIMINATION OF SLUMS OR BLIGHT

 MEET A PARTICULAR URGENT NEED

 Applicants must demonstrate that they have attempted to obtain funding from other sources.

Evidence (a letter, statement, or other documentation) of this should be included as part of the

project narrative and submitted with the proposal, with response from potential funding sources.

 Applications must be complete and include all applicable supporting documents.

ELIGIBLE CDBG ACTIVITIES:

• Acquisition of Real Property – Purchase, long-term lease, donation of real property.

• Public Facilities and Improvements – Construction, reconstruction and rehabilitation of public

facilities.

• Clearance – Removal of unsafe buildings for improvements.

• Public Service – A public service must be either a new service or a quantifiable increase in the level

of an existing service to low- and moderate-income persons; i.e. employment, crime prevention, child

care, health, drug abuse, education, fair housing counseling, energy conservation, home ownership

assistance, or recreational needs. (See list of eligible CDBG activities.)

• Removal of Architectural Barriers – Special projects directed to the removal of material and

architectural barriers that restrict the mobility and accessibility of elderly or handicapped persons

to buildings and facilities.

• Housing Rehabilitation – Assistance for the rehabilitation of unsafe structures; i.e. Minor Home and

Emergency Home Repair.

• Special Economic Development – Special activities that address job creation or elimination of slum or

blighted areas for economic development.

• Special Activities by Neighborhood Groups – Carry out neighborhood revitalization, stresses

communities economic development projects or energy conservation projects.

COMMUNITY DEVELOPMENT BLOCK GRANT

2020 REQUEST FOR PROPOSAL (RFP) REQUIREMENTS

1) NEIGHBORHOOD REVITALIZATION

a. Crime Prevention

Activities that reduce or eliminate the crime within a neighborhood or several neighborhoods.

The activity (ies) may include: youth intervention programs, educational opportunities for

neighborhood residents, service learning opportunities for the youth, entrepreneurial

opportunities to be executed within the specified neighborhood(s). Other activities may

include theft-deterrent jobs such as: additional street lighting and installation of security

lights and motion sensors, removal of blight that obstructs public view, planting of thorny

shrubbery, and installation of dead bolts. Data will need to be collected for the duration of

the grant i.e., the number of persons served or assisted, services provided, documented

volunteer hours. Performance measures and outcomes statement will need to be provided as

to how the funding/service impacted the community.

b. Homeless Services

Services that assist in the reduction of impoverished families and individuals at-risk of

becoming homeless, or in reducing the number of homeless residing in places not meant for

human habitation, such as: parks, streets, abandoned structures, personal vehicles, and

others defined in the McKinney-Vento Act and the U.S. Department of Housing and Urban

Development’s (HUD) definition of homelessness. Services may include sustainability of a

participant’s basic needs: shelter, clothing, water, food, transportation, and

healthcare/medical assistance. Performance measures and outcomes statement will need to

be provided as to how the funding/service impacted the community.

c. Neighborhood Organizing

Funds will be made available for community activities such as: small area plans, attainment of

master plans, collaborative efforts in working with consultants for planning projects and

neighborhood initiatives as well as activities that involve plans that address community needs

and gaps in services. Materials such as flyers, newsletters, surveys, and community pride

paraphernalia for community activities (T-Shirts, name badges, lawn signs, etc.) can be

purchased for execution of activities. The funds may also be available for the

establishment/strengthening of a neighborhood organization. Performance measures and

outcomes statement will need to be provided as to how the funding/service impacted the

community.

d. Neighborhood Clean-ups/Board-up Activities

Concurrent community clean-ups, which consist of: Garbage pick-ups, light blight removal,

residential painting, board-ups for vacant homes and commercial buildings, and volunteer

recruitment. Expenses for trash bins, trash bags, lawn services, paint, boarding materials,

and other related items would be considered eligible for this activity.

2) HOUSING REHABILITATION AND DEVELOPMENT

a. Minor Home Repairs

Minor home repair activities are when there is evidence of necessary repairs within a

homeowner-occupied home, where the homeowner is unable to afford the cost required to

repair the home. Fixing the repairs that will assist the homeowner in efficient utility bills,

future emergency repairs, esthetics, and standard property maintenance.

b. Emergency Home Repairs

Emergency repairs are services that must be addressed in an expeditious manner. These

services assist needs within a homeowner-occupied home which exhibit one or more areas of

deterioration and pose immediate threats to the health and safety of the occupants.

c. Housing Counseling

Activities that educate low- and moderate-income city residents on: personal budget and

financial strategies, home maintenance, mortgage loans and rate information, fair housing

topics, and the homeownership process. The agency (ies) must be able to aid in the resale of

government-owned houses.

d. Homeowner Façade Improvements

Exterior improvements such as painting, minor repairs to roofs, external window

replacements/repairs, and weatherization efforts.

3) FUNDING GUIDELINES

a. Proposed projects will only be eligible for funding July 1, 2020 to June 30, 2021.

b. Project goals should be attainable within a defined period of time (typically one year) and

should achieve measurable results.

c. Funds will not be granted to reduce existing deficits, entertainment, lobbying expenses,

audits, or other ineligible expenses under the CDBG program.

d. Applicants will be required to execute a contract with the City before receiving any

approved funds. Funding is disbursed on a reimbursement basis.

e. All applicants approved for funding must provide the City with certificates of insurance in a

form acceptable to the City for all required insurance.

f. Projects must meet all applicable grant requirements of the U.S. Department of Housing and

Urban Development (HUD).

g. Applicants must demonstrate adequate management and fiscal controls within its current

organization to undertake the proposed project.

4) APPLICATION CRITERIA

 Applicants must report the status of all funds that are requested or proposed from other sources.

 Applicants who previously received CDBG funding must report the status of that funding, including

actual accomplishments.

 Strong consideration will be given to projects that serve low- to moderate-income residents within

designated targeted neighborhoods, or CDBG low-moderate income areas. (See targeted

neighborhood map, Exhibit A.)

 Applications must address one or more of the following priorities set forth in the Consolidated

Plan/Action Plan:

1. Housing Rehabilitation/Development/Homeownership/Affordability

2. Neighborhood Revitalization/Beautification

3. Economic Development/Job Creation

4. Non-Housing Community Development/Special Needs (Public Service: elderly, homeless, youth)

CDBG FUNDS MAY NOT BE OBLIGATED UNTIL THE CONTRACT IS ACCEPTED

AND SIGNED BY ALL PARTIES.

 Submit one (1) original completed application to:

Kim Mazo

Community Development Department

 Applications must be delivered no later than 5:00 p.m. on FRIDAY, DECEMBER 13, 2019

5) REVIEW PROCESS

• Threshold Requirements must be met or the application will not be reviewed for funding,

they are as follows:

o Application complete, approved, and signed by Executive Director or Board President

o Proposed operation budget

o Proposed service/program/project meets one of the CDBG National Objectives

o Organizations must have a current City of Warner Robins Business License and include a

copy with application.

o Organization must be registered with the Data Universal Numbering System (DUNS)

o Organization must have a Federal Identification Number.

o Must be a current 501(c)(3) and been in operation for at least 12 months.

o Applicant must provide a financial statement and/or independent audit covering the past

12 months.

o Applicant must submit a copy of written financial management procedures including

policies/procedures for (a) managing and tracking cash receipts/disbursements, (b)

budgeting, (c) purchasing or procurement, and (d) program income.

o Must provide a copy of most recent 990 Form

• All applicants will be notified of the funding recommendations in writing, on or about June 2020.

Receipt of an award letter is not a guarantee of funding. All awards are subject to further

pre-contract negotiation and an award of the annual entitlement appropriation by the U.S.

Department of Housing and Urban Development to the City of Warner Robins.

• It is the responsibility of the City of Warner Robins to ensure that federal funds are disbursed

wisely and managed efficiently in the delivery of services that are most beneficial to the

community. To fulfill this responsibility, the City of Warner Robins will conduct a review of all

applicants applying for funding to evaluate their operation, services, projects, and budgets.

• Currently funded agencies or agencies who have received prior funding from Community

Development Department will also be evaluated on past performance in carrying out programmatic

activities and contractual compliance. Factors such as agency ability to meet service delivery

goals, timely expenditure of funds, timely reporting, accuracy of reporting, ability to meet audit

requirements, and other programmatic and fiscal contractual requirements will be considered.

These other factors will be considered in conjunction with the proposal score in developing an

overall recommendation for agency funding.

APPLICATION PROCESS TIMELINE: ***This schedule is subject to change

October 17, 2019 Application Workshop (10:00 am)

October 23, 2019 Application available On-line: www.wrga.gov

October & November 2019 One-on-one technical assistance available BY APPOINTMENT ONLY

December 13, 2019 Applications due to CD office no later than 5:00PM

December 16, 2019 – January 03, 2020 Application Pre-Qualification Review by Community Development Office

January 7, 2020 1

CDBG Public Hearing (10:00 am)

January 14, 2020 Notification to Applicant regarding disqualification

January 7 – February 7, 2020 Committee Review Period & Individual Interviews

February 20, 2020 2

Public Hearing (5:30 pm) to discuss Proposed Statement

March 2, 2020 Proposed Statement submitted to Mayor & Council

April 20, 2020 Mayor & Council Meeting to Adopt Final Statement

May 15, 2020 Submit Annual Plan to HUD

June, 2020 Notification to Applicant regarding Allocations

6) CRITERIA FOR REQUEST OF FUNDING

The following criteria will be considered in developing a recommendation for agency funding.

 Agency Background and Experience

• Administrative structure of Agency

• Details of past program years results vs. goals

• Evidence of board training and development

• Financial statement and/or most recent Audit, Management Letter and Agency Response

 Agency/Organization Capacity

• Evidence of adequate fiscal planning and managerial capabilities

• Staff experience

 Statement of Need

• Describe the community problem or need this program/project is designed to addressed.

• What plans, studies or reports support this need?

• Describe the urgency of meeting this need.

• Describe the target population and target service delivery area - CDBG low-mod target

area.

 Project Description

• Description of proposed program/project

• Proposed work plan/timeline

 Program Delivery

• Program goals and objectives

• Organization chart

• Responsibilities of persons associated with delivery of project/program

 Coordination

• Collaborations implemented to enhance services and programs

• Community outreach

• Leveraging other funds

• Financial support through earned income, private giving and governmental support

 Budget

• Sources of other revenue and expenses

• Matching Funds

Community Development Block Grant (CDBG)

City of Warner Robins - Community Development Department

Fiscal Year 2020 (Program Year July 1, 2020 - June 30, 2021)

Section II

APPLICATION

CDBG funding is made possible by the US Department of HUD and is administered by the

City of Warner Robins, Community Development Department.

APPLICATION INSTRUCTIONS

2020 Community Development Block Grant Program

City of Warner Robins, Georgia

Please find attached a Community Development Block Grant (CDBG) application from the City of

Warner Robins, Georgia for the 2020 Program Year (July 1, 2020 – June 30, 2021). To be

considered for funding, all applicants should be mindful of the following:

1) The CDBG Program is a Federal program designed to improve the living environment for all

community residents, but principally, those residents of low and moderate income (see

appendix A for definition). As such, all applications should detail, to the greatest extent

possible, how their program will benefit at least 51% low and moderate income Warner

Robins residents.

2) Only certain activities are eligible for assistance under the CDBG program. Please consult

appendix A for a summary of eligible activities. If you are unsure about your project’s

eligibility, please contact the Warner Robins Department of Community Development.

3) In addition to basic eligibility criteria, applications will be evaluated as to how well they

meet identified community development needs (see appendix A) AND the extent to which

they leverage other funding sources or collaborate with the services of other agencies.

4) All applicants must complete the standard CDBG application for funding consideration.

5) The deadline for receipt of applications is: Friday, December 13, 2019 at 5:00 P.M.

NO EXCEPTIONS

6) Applications should be hand-delivered or sent in care of:

City of Warner Robins

Department of Community Development

2020 Grant Year Application

P.O. BOX 8629

700 Watson Blvd

Warner Robins, Georgia 31095

Attention: Kim Mazo

7) Applicants may be required to make a brief presentation of their funding request at a Public

Hearing on Tuesday, January 7, 2020 at 10:00 AM in Council Chambers, City Hall, 700

Watson Blvd, Warner Robins, GA, 31099.

8) Applicants who require assistance in completing the application may contact Kim Mazo at

Warner Robins Community Development at 478-302-5514 or kmazo@wrga.gov

APPENDIX A

SUMMARY OF ELIGIBLE AND INELIGIBLE

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM ACTIVITIES

This is a summary of the activities that are eligible and ineligible for assistance under the

Community Development Block Grant (CDBG) Program pursuant to the governing regulations of the

Code of Federal Regulations, Title 24, Part 570, Sections 570.200-570.207. This summary is

based upon the Final Rules published in March 1996.

General Policies – 570.200

The primary objective of the CDBG Program is the development of viable urban communities by

providing decent housing and a suitable living environment, and expanding economic opportunities,

principally for persons of low and moderate-income. Funds must be used so as to give maximum

feasible priority to activities which will carry out one of the three broad national objectives of:

benefit to low and moderate-income families; or aid in the prevention or elimination of slums or

blight; or activities designed to meet other community development needs having a particular

urgency because existing conditions pose a serious and immediate threat to the health or welfare

of the community where other financial resources are not available to meet such needs. At least

70% of the total CDBG funds must be used for activities that benefit low and moderate-income

persons; and at least 51% of the beneficiaries of individual activities must be low and moderate-

income persons.

Houston County, Georgia

2019

Income

Limit

Area

Median

Income

FY 2019

Income

Limit

Category

Person

Houston

County

$75,300

Very Low

(50%)

Income

Limits

$25,800

$29,500

$33,200

$36,850

$39,800

$42,750

$45,700

$48,650

Extremely

Low

(30%)

Income

Limits

$15,500

$17,700

$21,330

$25,750

$30,170

$34,590

$39,010

$43,430

Low

(80%)

Income

Limits

$41,300

$47,200

$53,100

$58,950

$63,700

$68,400

$73,100

$77,850

Basic Eligible Activities – 570.201

(a) Acquisition in whole or in part by purchase, long-term lease, donation, or otherwise, of real

property for any public purpose.

(b) Disposition of real property acquired with CDBG funds through sale, lease, donation, or

otherwise; or its retention for public purposes, including reasonable costs of temporarily

managing such property.

improvements, except buildings for the general conduct of government. Activities may

include:

∗

Removal of material and architectural barriers that restrict the mobility and

accessibility of elderly or severely disabled persons to public facilities or improvements;

∗

Design features and improvements which promote energy efficiency;

∗

Architectural design features and similar treatments intended to enhance the aesthetic

quality of facilities and improvements receiving CDBG assistance.

(d) Eligible facilities include homeless shelters, convalescent homes, hospitals, nursing homes,

battered spouse shelters, halfway houses, group homes for mentally retarded persons; and

temporary housing for disaster victims.

(e) Provisions of public services (including labor, supplies and materials) such as those

concerned with childcare, health, education, job training, public safety, fair housing

counseling, senior citizens, homeless persons, drug abuse, energy conservation, employment,

crime prevention, welfare, homebuyer down-payment assistance, or recreational needs. The

services must meet each of the following criteria:

∗

A service must either be new or be a quantifiable increase in the level of an existing

service above that which has been provided with State or Local funds in the previous

twelve calendar months; and

∗

The amount obligated for public services shall not exceed 15 percent of the annual grant

and of program income received during the immediately preceding program year.

(f) Interim assistance to correct objectively determinable signs of physical deterioration in

areas where immediate action is necessary and where permanent improvements will be

carried out as soon as practicable, or to alleviate emergency conditions threatening the

public health and safety and requiring immediate resolution.

(g) Payment of the non-Federal share required in connection with a Federal grant-in-aid

program undertaken as part of CDBG activities.

(h) Completion of urban renewal projects.

(i) Relocation payments and assistance for relocated individual, families, businesses, nonprofit

organizations, and farm operations.

(j) Payment to housing owners for losses of rental income incurred in holding units for

individuals and families displaced by relocation activities.

(k) Housing services, such as tenant counseling in connection with tenant-based rental

assistance and affordable housing projects, energy auditing, preparation of work

specifications, loan processing, inspections, tenant selection, management of tenant-based

rental assistance, and other services related to assisting owners, tenants, contractors, and

other entities participating or seeking to participate in housing activities assisted under

title II of the Cranston-Gonzalez National Affordable Housing Act.

(l) Acquisition, construction, reconstruction, rehabilitation, or installation of the distribution

lines and facilities of privately owned utilities.

(m) Construction of housing assisted under Section 17 of the United States Housing Act of

1937.

(n) Direct homeownership assistance to low and moderate-income homebuyers:

1. To subsidize interest rates and mortgage principal amounts;

2. To finance the acquisition of owner-occupied property;

3. To acquire guarantees for mortgage financing obtained from private lenders, but not to

guarantee such mortgage financing directly’

4. To provide up to 50 percent of any required down payment’

5. To pay reasonable closing costs.

(o) Micro-enterprise assistance through the provision of assistance to facilitate economic

development by providing credit for the establishment, stabilization and expansion of micro-

enterprises; providing technical assistance, advise and business support service to owners or

developers for micro-enterprises; and providing general support to owners and developers

or micro=enterprises. Training and technical assistance may also be provided.

(p) Provision of technical assistance to public or nonprofit entities to increase their capacity to

carry out eligible neighborhood revitalization or economic development activities.

(q) Assistance to institutions of higher education to carry out eligible activities.

Eligible Rehabilitation and Preservation Activities – 570.202

(a) Rehabilitation assistance for:

∗

Privately owned residential buildings and improvements;

∗

Low-income public housing and other publicly owned residential buildings and

improvements;

∗

Publicly and privately owned commercial or industrial buildings; and

(b) Financing assistance through grants, loans, loan guarantees, interest supplements, or other

means for:

1. Private individuals and entities, including profit making and nonprofit organizations, to

acquire and rehabilitate, and to rehabilitate properties for use or resale for residential

purposes;

2. Labor, materials and other rehabilitation costs, including repair, replacement of principal

fixtures and components, installation of security devices, and renovations of existing

structures;

3. Loans for refinancing existing indebtedness secured by a property being rehabilitated;

4. Improvements to increase the efficient use of energy;

5. Improvements to increase the efficient use of water;

6. Connection of residential structures to water distribution or local sewer collection lines;

7. Initial homeowner warranty premiums, hazard insurance premiums, flood insurance premiums

and lead-based paint testing and abatement;

8. Acquisition of tools to be lent to carry out rehabilitation;

9. Rehabilitation services related to assisting participants in rehabilitation activities; and

10. Rehabilitation of housing under Section 17 of the U. S. Housing Act of 1937.

11. Improvements designed to remove material and architectural barriers that restrict the

mobility and accessibility of elderly or severely disabled persons.

deteriorated areas.

(d) Rehabilitation, preservation or restoration of publicly or privately owned historic

properties.

(e) Renovation of closed school or other buildings for use as an eligible public facility or for

housing.

(f) Lead-based paint hazard evaluation and reduction.

Special Economic Development Activities – 570.203

Activities that are listed as eligible may be carried out as part of an economic development

project. In addition, special economic development activities that are necessary or appropriate to

carry out an economic development project – but not including assistance for the construction of

new housing may be carried out including:

(a) Acquisition, construction, reconstruction, rehabilitation or installation of commercial or

industrial buildings, structures, and other real property equipment and improvements,

including railroad spurs or similar extensions. Such activities may be carried out by the

recipient, or public or private nonprofit subrecipients.

(b) The provision of assistance to private for profit businesses, including, but not limited to

grants, loans, loan guarantees, interest supplements, technical assistance, and other forms

of support, for any activity where the assistance is appropriate to carry out an economic

development project – except for buildings for the general conduct of government, general

government expenses, and political activities.

available forms of assistance, screening of applicants, reviewing and underwriting

applications for assistance, preparations of all necessary agreements, management of

assisted activities, and the screening, referral and placement of applicants for employment

opportunities generated by CDBG-eligible economic development activities, including the

costs of necessary training.

Special Activities by Community-Based Development Organizations (CBDO’s) – 570.204

(a) Assistance may be provided to carry out a neighborhood revitalization, community economic

development, or energy conservation project, including:

∗

Activities listed as eligible; and

∗

Activities not otherwise listed as eligible – excluding buildings for the general conduct

of government business, general government expenses, and political activities.

(b) Activities must: (1) meet the public service requirements although services specifically

designed to increase economic opportunities through job training and placement and other

employment support services; (2) meet the requirements of the guidelines for evaluating

and selecting economic development projects under Section 570.209; and (3) must not

result in the recipient exceeding the 20% limit on planning and administrative costs.

1. Non-profit or for-profit associations or corporations organized to engage in community

development activities primarily within an identified geographic area and whose primary

purpose is the improvement of the physical, economic or social environment.

2. Section 301(d) Small Business Investment Companies, including those which are profit

making, State or local development companies, or Community Housing Development

Organizations.

3. Organization similar in purpose, function and scope.

Eligible Planning, Urban Environmental Design and Policy-Planning-Management-Capacity

Building Activities – 570.205

(a) Planning activities such as data gathering, studies, analyses, preparation of plans, and

identification of actions to implement plans.

(b) Activities

Program Administration Costs – 570.206

(a) Reasonable costs of overall program management, coordination, monitoring and evaluation,

including:

∗

Staff salaries, wages, and related costs;

∗

Administrative services such as general legal, accounting and audit services performed

under third-party contracts; and

∗

Other goods and services required for administration of the program.

(b) Provision of information and other resources to residents and citizens organizations.

(d) (Removed and Reserved)

(e) Indirect costs.

(f) Preparation of applications for Federal program.

(g) Necessary administrative expenses in planning or obtaining financing for housing units which

are identified in the HUD approved Housing Assistance Plan.

(h) Overall program management of the Rental Rehabilitation and Housing Development

programs.

(i) Overall program management of:

1. A Federally designated Empowerment Zone or Enterprise Community; and

2. The HOME program under Title II of the Cranston-Gonzalez Affordable Housing Act.

Ineligible Activities – 570.207

(a) Assistance for:

∗

Buildings used for the general conduct of government;

∗

General government expenses; and

∗

Political activities.

(b) Assistance for:

∗

Purchase of construction equipment, fire protection equipment, furnishings and personal

property;

∗

Repairing, operating and maintaining public facilities, improvements and services;

∗

New housing construction; and Income payments. Except when carried out as a special

economic development activities, or as a public service, or by an eligible community-

based development organization, or by the recipient as specifically authorized.

II. APPLICATION

IF YOU HAVE NOT RECEIVED CDBG FUNDING IN THE PAST 24 MONTHS OR HAVE

MADE CHANGES TO ANY OF THESE FORMS PLEASE SUBMIT THE FOLLOWING:

a. REQUIRED DOCUMENTS CHECKLIST

□ Application complete

□ Current 501 (c)(3) status letter from IRS (attach documentation)

□ Proposed service/program/project meets one of the CDBG National Objectives

(Located on page 2)

□ Conflict of Interest disclaimers from each member of the Board of Directors or

Executive Director

□ Organization By-Laws

□ List of Board of Directors and officers (including address) and Meeting Schedule

□ Articles of Incorporation

□ Resume of:

a. Executive Director

b. Fiscal Officer

c. Program Administrator

□ Organizational Chart with employee names and titles

□ Job descriptions with pay scales for CDBG funded positions

□ Letters of commitment from other funding sources

□ Statistical report for last 12-month period

□ Current Year City of Warner Robins Business License if applicable

□ Current year’s fiscal documents

□ For all non-profit agencies (NO EXCEPTIONS)

□ Audited current year’s Financial Statement, AND

□ Fully signed copy of the current year’s Federal form 990

□ For all government agencies

□ Audited current year’s Financial Statement

Revised 9/26/2019

□ For ANY agencies that expended more than $500,000 in federal funding for

the year, the following must ALSO be included with the documents above.

□ Current year’s Single Audit

□ Written Financial Management Procedures

IF YOU HAVE RECEIVED CDBG FUNDING IN THE PAST 24 MONTHS PLEASE

SUBMIT THE FOLLOWING:

b. REQUIRED DOCUMENTS CHECKLIST

□ Application complete

□ Letters of commitment from other funding sources

□ Current Year City of Warner Robins Business License if applicable

□ Current year’s fiscal documents

□ For all non-profit agencies (NO EXCEPTIONS)

□ Audited current year’s Financial Statement, AND

□ Fully signed copy of the current year’s Federal form 990

□ For all government agencies

□ Audited current year’s Financial Statement

□ For ANY agencies that expended more than $500,000 in federal funding for

the year, the following must ALSO be included with the documents above.

□ Current year’s Single Audit

Revised 9/26/2019

A. AGENCY INFORMATION DUNS# ___________________________________

FED. I.D.# ________________________________

Project Title:

Organization or

Agency:___________________________________________________________________

Address: Zip Code:____________

Contact Person(s):

Telephone No: Fax No: E-mail:

 Date of Most Recent Audit _______________________________

 Amount Requested: $

 Matching Funds: $

 In-Kind Contributions: $

In two sentences, concisely describe your project and how it addresses a CDBG priority and how

CDBG Funds will be used for this project.

Is the program located in the Neighborhood Strategy Area? Yes No

 Location of proposed service/program/project:

Street Address: OR □ Citywide

Census Tract:

Census Tract information located at: See Exhibit "A"

Revised 9/26/2019

Which CDBG National Objective does your program serve?

ONLY SELECT ONE option (1) OR option (2)

(1) Benefit to low/moderate income persons Low/moderate income area (LMA)

(Check one) Low/moderate income clientele (LMC)

Low/moderate income housing (LMH)

(2) Prevention or elimination of slums or blight Slum/blighted area (SBA)

(Check one) Slum/blighted spot (SBS)

 Has your organization previously been awarded CDBG funds? Yes No

 If yes, did the organization meet all obligations under the previous contract?

Yes No

 If no, please explain why not:

 Has your organization previously carried out services/programs/projects similar in nature to

the proposed service/program/project? Yes No

 Approximate number of participants to be served:

 % Low/Mod Income: ____________ (must be at least 51%)

 Does your organization have a current year City of Warner Robins Business License:

Yes No

 Does the organization have liability coverage? If so, in what amount and with what

insurance agency?

AMOUNT: $_____________________________

AGENCY: ____________________________________________________

 Does the organization have fidelity bond coverage for principals on staff who handle the

organization's account? If so, in what amount and with what insurance agency?

AMOUNT: $_____________________________

AGENCY: ____________________________________________________

Revised 9/26/2019

B. AGENCY BACKGROUND AND EXPERIENCE:

 Include a brief history of the organization, including the organization's mission.

 Describe the experience of the organization in carrying out the type of activities proposed

in the application and the length of time the organization has been involved in providing the

proposed services (even if services has not been provided through CDBG grant funds.)

 Describe in detail past program/project year's results versus goals.

 Describe any success the organization has had in providing the proposed services to the

community and how the community has benefited from the organization carrying out the

activities.

 Describe the administrative structure of the organization. The role of the board and

committees and include strategies for board training and development.

C. AGENCY /ORGANIZATION CAPACITY:

• Detail the staff's experience in working with projects of this type in general and in the

proposed service area in particular. If the agency staff does not have prior experience in

providing the proposed service, please indicate experience and successes in carrying out

similar programs and in working in partnerships with other agencies and/or consultants.

D. STATEMENT OF NEED:

• Describe the community problem or need this program/project is designed to address.

• What plans, studies or reports support this need?

• Describe the urgency of meeting this need.

E. PROJECT DESCRIPTION:

 Describe the program/project being proposed.

 How does this program/project meet the needs?

 What is the proposed work plan and time line?

 Is the program/project on going, an expansion of an existing program, or a “start-up”

program? For start-up programs, describe the challenges you face and the time needed

before services will be delivered.

Revised 9/26/2019

BUDGET

The budget section of the application contains two components: the BUDGET

ITEMIZATION SHEET and the BUDGET SUMMARY SHEET. If CDBG funds are being

requested as a match, please include additional Budget Summary and Budget Itemization

sheets showing the breakdown of the other funding sources, which activities the other

funding sources will fund and when the other funding sources will be used.

Explanations and samples of correctly completed Budget Itemization and Budget Summary

Sheets are contained in the following pages.

HOW TO COMPLETE A BUDGET ITEMIZATION SHEET

A Budget Itemization Sheet is composed of four columns and twelve rows, eleven are for

category breakdowns.

COLUMNS: The following columns are as followed:

a. Category Number To find the category number, it is necessary to refer to the

Budget Summary Sheet. See “HOW TO COMPLETE THE BUDGET SUMMARY

SHEET” on the following page for an explanation of each category number. Place

the appropriate category number in the category number column and proceed to the

category breakdown column.

NOTE: A SEPARATE BUDGET ITEMIZATION SHEET MUST BE USED FOR EACH

CATEGORY NUMBER. (You may need to make additional copies of the blank

itemization sheets provided in this application packet).

b. Category Breakdown Provide a detailed description of each expenditure identified

for a category. The basic format for completing this column is as follows:

Number of Items (x) Description of Items (x) Price of Items Example: 1 IBM

Typewriter @ $800. Use additional sheets as necessary. See illustration in the

Sample Budget Sheets.

c. Category Amount: This is the total cost completed for each item in the Category

Breakdown column. Enter the category amount under column 3 (CDBG Funds) 4

(Other Funds). If any item or service is being donated, enter the estimated cost

under the Other Funds column and indicate accordingly under the Category

Breakdown by writing DONATED next to Item Description.

Revised 9/26/2019

ROWS: There are twelve rows and these are divided as follows:

Rows 1-11 Use for completing the basic information described above,

Row 12 This row should record the total dollar amount by category number

identified on the Budget Itemization Sheets. This row is reserved

strictly for the last page of the Budget Itemization Sheet for each

category number. Thus, if four pages are devoted to itemizing your

expenses for a particular category number only the fourth page should

have this row completed. To complete this row, add the amounts in the

CDBG Funds column, and the Other Funds column, and insert each

amount under its respective column.

Revised 9/26/2019

HOW TO COMPLETE A BUDGET SUMMARY SHEET

This sheet is a summary of the information contained in the Budget Itemization Sheet.

COLUMNS: There are six columns two of which are already filled.

a. COLUMN ONE (Category Number) This column contains the category number which

is used on the Budget Itemization Sheet.

b. COLUMN TWO (Category Breakdown) This column contains nine categories which

are to be used when completing the Budget Itemization Sheet.

1. Salaries and Benefits: This represents full and part-time staff used in the proposed

activity. This includes related costs such as pension, Social Security, health/life

insurance, etc.

2. Consultant and Contract Services: Includes all consultants, temporary help and services

which you may contact.

3. Space Rental: Includes rental building or office space for the project.

4. Travel: Includes both local and non-local travel. (Be sure to distinguish between the two

when completing the Budget Itemization Sheet).

5. Other Operating Expenses: Included in this category are monthly cost for telephone,

electricity, water and installation cost if necessary.

6. Materials: This category is to be used for construction project cost such as pipes,

streetlights, etc.

7. Rehabilitation: Includes renovation and remodeling of office space and/or any building.

Specific cost breakdown should be indicated on the Budget Itemization Sheet.

8. Real Property Acquisition: Includes the purchase of land or buildings.

9. Gasoline/Fuel Expenses: Includes fuel cost to operate vehicles used for project.

c. COLUMN THREE (CDBG Funds) List the total dollar amount of funds you are requesting

from the CDBG program for each category. This amount can be obtained from the Budget

Itemization Sheet.

d. COLUMN FOUR (Other Funds) The dollar amount received from other funding sources.

This amount can be found on the Budget Itemization Sheet.

Revised 9/26/2019

e. COLUMN FIVE (Other Funding Sources) Identify the organization(s) providing the funding

amount listed in column four (Other Funds). Also, include the time period during which

funding will be available.

f. COLUMN SIX (Total Funds) To obtain this amount, add CDBG Funds to Other Funds and

place that sum in the appropriate box.

ROWS: There are twelve rows divided as follows:

ROWS 1-9 These rows list the nine category numbers and their respective categories.

ROW 10 (TOTAL CDBG FUNDS) This is the sum of column three. Place the total

amount in the appropriate box.

ROW 11 (TOTAL OTHER FUNDS) The sum of column four. Place the total amount in

the appropriate box.

ROW 12 (GRAND TOTAL) To record the total dollar amount required for operating

your project, add the above two rows, (TOTAL CDBG FUNDS and TOTAL

OTHER FUNDS) and insert the grand total in the appropriate box.

**EXAMPLE 1** BUDGET ITEMIZATION SHEET

Organization Name: ABC COUNSELING CENTER Funding Year: FY 2020 Date: 7/01/2020

Page 1 of 4

CATEGORY

NUMBER

CATEGORY BREAKDOWN

CATEGORY AMOUNT

CDBG

FUNDS

OTHER

FUNDS

Two Outreach workers @ $832/month (100% time) x 12 months

$19,968

One Executive Secretary @ $694/month (100% time) x 12 months

$8,328

One Executive Director @ $1,100/month (100% time) x 12 months

$13,200

Fringe Benefits @ 15% x 41,496

$6,225

TOTAL AMOUNT:

$47,721

**EXAMPLE 2** BUDGET ITEMIZATION SHEET

Organization Name: ABC COUNSELING CENTER Funding Year: FY 2020 Date: 7/01/2020

Page 2 of 4

CATEGORY

NUMBER

CATEGORY BREAKDOWN

CATEGORY AMOUNT

CDBG

FUNDS

OTHER

FUNDS

1 office @500 sq. ft. @ 354/month x 12 months

$4,248

TOTAL AMOUNT:

$4,248

**EXAMPLE 3** BUDGET ITEMIZATION SHEET

Organization Name: ABC COUNSELING CENTER Funding Year: FY 2020 Date: 7/01/2020

Page 3 of 4

CATEGORY

NUMBER

CATEGORY BREAKDOWN

CATEGORY AMOUNT

CDBG

FUNDS

OTHER

FUNDS

Transportation (Dodge van) – gasoline 1,000 miles/mo.

$840

(20 miles per gallon) x $1.40/gal x 12 months

Example: 1,000 divided by 20 miles per gallon x $1.40/gal =

$70 per month x 12 months = $840 per year for gas

Transportation (Ford van) – gasoline 500 miles/mo.

(20 miles per gallon) x $1.40/gal x 12 months (United Way)

$420

TOTAL AMOUNT:

$840

$420

**EXAMPLE 4** BUDGET ITEMIZATION SHEET

Organization Name: ABC COUNSELING CENTER Funding Year: FY 2020 Date: 7/01/2020

Page 4 of 4

CATEGORY

NUMBER

CATEGORY BREAKDOWN

CATEGORY AMOUNT

CDBG

FUNDS

OTHER

FUNDS

Telephone monthly service @ $50/mo. X 12 months (United Way)

$600

Electricity monthly service @ $125/mo. X 12 months (United Way)

$1,500

Insurance (Agency Funds)

$1,200

Postage 264 pieces/mo. @ .15 cent each = $39.60 month x 12

(Private donations)

$475

Office supplies @ $50/mo. X 4 employees = $200 month x 12

(Private donations)

$2,400

TOTAL AMOUNT:

$6,175

BUDGET ITEMIZATION SHEET

Organization Name: ___________________ Funding Year: _______ Date: ______

PAGE _____ of ______

CATEGORY

NUMBER

CATEGORY BREAKDOWN

CATEGORY AMOUNT

CDBG

FUNDS

OTHER

FUNDS

TOTAL AMOUNT:

** EXAMPLE **BUDGET SUMMARY SHEET

Organization Name: ABC COUNSELING CENTER Funding Year: FY 2020 Date: 7/01/2020

Fillable 3265 FY2020 CDBG Application- Fillable (City of Warner Robins)

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