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CDBG -CV (2) APPLICATION r fo (Macon-Bibb County, Georgia)

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CDBG -CV (2)
APPLICATION
fo
r
Community Development Block Grant (CDBG) -Coronavirus (CV) 2
Macon-Bibb County
Economic & Community Development Department
CD
BG funding is made possible by the US Department of HUD and is administered by the Local
government, Economic and Community Development Department.
ECONOMIC AND COMMUNITY DEVELOPMENT DEPARTMENT
200 Cherry Street, Suite 100
Macon, Georgia 31201
MAIN (478) 751-7190, TDD (478) 803-2306, FAX (478) 751-7390
http://www.maconbibb.us/economic-community-development/
CDB
G – CV (2) Applications will be distributed via email to eligible Agencies.
Deadline for Submission to ECDD, Monday, July 12, 2021, 5:00 p.m.
Conflict of Interest Forms due on July 26, 2021.
No facsimile or E-mail submissions will be accepted.
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
2
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) - CV
MACON-BIBB COUNTY ECONOMIC & COMMUNITY DEVELOPMENT
DEPARTMENT
CDBG – CV (2)
TABLE OF CONTENTS
Required Documents Check list – All Applicants
A. Agency Information _____
B. Agency Background and Experience _____
Organization Chart
C. Agency/Organization Capacity _____
D. Statement of Need
E. Project Description _____
Program Implementation Schedule
F. Program Delivery _____
G. Coordination _____
Performance Measures
o Program Goals and Objectives Chart
H. Leveraging Other Funds _____
I. Additional Support Documents ______
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
3
REQUIRED DOCUMENTS CHECKLIST:
GENERAL REQUIRED DOCUMENTS
1. Application complete, approved, and signed by Executive Director or Board
President
2. Complete and accurate CDBG – CV (2) Budget Forms
_____ 3. C
urrent 501(c)(3) status (attach documentation)
4. Annual financial statement and/or most recent audit, management letter and Agency
response
_____ 5. P
roposed service/program/project meets one of the CDBG National Objectives
_____ 6. C
onflict of Interest disclaimers from each member of the Board of Directors
_____ 7. Organization By-Laws
_____ 8. L
ist of Board of Directors and Officers (including address), meeting schedule, and sample
governance training materials
_____ 9.
Articles of Incorporation
_____ 10. Rés
umés of:
a. Executive Director
b. Fiscal Officer
c. Program Administrator / significant program staff
_____ 11. O
rganizational Chart with all employee names and titles
_____ 12.
Job descriptions with pay scales and hourly rate for CDBG – CV (2) funded positions
_____ 13. Procedures for selecting contractors/consultants
_____ 14. Q
uotes for any equipment or real property to be leased or purchased
_____ 15. M
aps showing project area to be served and census tract
_____ 16.
Letters of Commitment from other funding sources
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
4
ADDITIONAL REQUIRED DOCUMENTS FOR CONSTRUCTION AND ACQUISITION
PROJECTS
1. If construction or renovation projects, include construction estimates (using Davis-
Bacon Wages, Labor Standards and Section 3 Program information.)
2. For any facility acquired, leased, or improved, include a photograph of the facility.
3. If providing services or improvements to a facility not owned by the applicant, the
applicant must submit a long-term lease agreement (at minimum 10 years) and
letter from the owner confirming agreement to participate in this project.
4. Include proof of proper zoning and conformance to building and fire codes for an
acquired, leased, or improved facility. Projects requiring land use and/or zoning
change will not be considered.
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
5
A. AGENCY INFORMATION (please refer to page 15 of application instructions)
I. Project Title:
Organization or Agency:
DUNS # Fed. I.D. #
Address: Zip Code:
Contact Person(s):
Telephone No: Fax No: E-mail:
Date of Most Recent Audit_______________________________
Amount Requested: $
Matching Funds: $
In-Kind Contributions: $
II. In two sentences, concisely describe your project and how it addresses one of the following
CDBG priorities: (1) Community Building/Neighborhood Revitalization, (2) Homeless Services,
(3) Economic Development/Job Creation, (4) Rehabilitation and Development
III. Total number of individuals expected to be served by program being proposed
IV. Is the program located in a CDBG target low-moderate area (L/MA)? Yes No
Census Tract:
Census Tract information located at:
Location of proposed service/program/project:
Street Address:
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
6
Neighborhood/Area to be served by program/project:
V. Does the proposed service/program/project meet one of the following CDBG National
Objectives?
Benefit to low/moderate income persons Low/moderate income area (LMA)
(Check one) Low/moderate income clientele (LMC)
Low/moderate income housing (LMH)
Prevention or elimination of slums or blight Slum/blighted area (SBA)
(Check one) Slum/blighted spot (SBS)
VI. Has your organization previously been awarded CDBG or CDBG-CV 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
License to operate (if applicable) please attach copy:
_________________________________________
Does the organization have liability coverage? If so, in what amount and with what insurance
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?
______________________________________________________________________________
*When answering narrative questions, you are not limited to the amount of space shown on the
application. Use as much space as is needed to completely answer the question.
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
7
B. AGENCY BACKGROUND AND EXPERIENCE: (please refer to pages 15-16 of
application instructions)
I. Background and Experience
II. Conflict of Interest Forms (Due by July 26, 2021)
III. Agency's Annual Financial Information (Enclose document if applicable)
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
8
C. AGENCY CAPACITY: (please refer to page 16 of application instructions)
I. Administrative Organization and Capacity
II. Staff and Agency Experience
D. STATEMENT OF NEED: (please refer to page 17 of application instructions)
I. Community Problem or Need
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
9
II. Supporting Plans, Studies, or Reports
III. Urgency of Need
IV. Target Population and Service Delivery Area
V. Supporting Demographic Data
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
10
E. PROJECT DESCRIPTION: (please refer to page 17 of application instructions)
I. Program/Project Description
II. How Program/Project satisfy Community Problem or Need
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
11
III. Potential Challenges
IV. Goals and Outcomes of Previous Program Years
V. Community Benefits
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
VI. PROGRAM/PROJECT IMPLEMENTATION SCHEDULE (please refer to pages 17-18 of application instructions)
CDBG – CV (2)
List the key steps or activities required for the conduct of the proposed program. Check the month(s) in which each step or activity
will occur.
Implementation Steps
Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12
Step 1:
Step 2:
Step 3:
Step 4:
Step 5:
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
F. PROGRAM DELIVERY: (please refer to page 19-20 of application instructions)
I. Describe Program Goals and Objectives
II. Program Goals and Objectives Chart
(Each program goal requires a separate chart- see the prior page for the template.)
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
III. Agency Experience with the Specific Services Proposed for CDBG – CV (2) Support
IV. Responsibilities of Staff, Volunteers and Consultants in this Program/Project
V. Résumés and Job Descriptions*
VI. Organization Chart of Staff*
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
VII. Long-Term Plans for Sustaining the Proposed Program/Project
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
PROGRAM/PROJECT GOALS AND OBJECTIVES (See instructions pages 20-23 of application instructions.)
A. Program Name:
B. Program Goal(s):
PROGRAM/PROJECT OBJECTIVES:
Program Objective:
Expected Outcomes:
Indicators:
When Measured:
Activities
Person Responsible
Due Date
1)
2)
3)
4)
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
G. COORDINATION: (please refer to page 24 of application instructions)
I. Avoiding Duplication of Services
II. Community Outreach
III. Collaborative Efforts
IV. Letters of Support
CDBG – CV (2)
Submission Deadline: July
12, 2021, 5:00 P.M.
H. LEVERAGING OTHER FUNDS: (please refer to page 24 of application instructions)
FUNDING SOURCE AMOUNT ($) USES
*FUNDING SOURCES – COMMITTED
LOCAL
$
$
FEDERAL
$
$
STATE
$
$
FUNDING SOURCES – PENDING
LOCAL
$
$
FEDERAL
$
$
STATE
$
$
*Note: Please attach documentation from funding source(s) of committed funds to these
project/programs.
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
I. ADDITIONAL SUPPORT DOCUMENTS (please refer to page 25 of application instructions)
Checklist: Please mark the forms enclosed in this application. Only submit forms which are relevant to
the agency or the program for which this application is written. (Delete irrelevant forms to maintain
pagination.)
______ Resolution of Application (Required for all applications)
______ Conflict of Interest Forms from each member of the Board of Directors, including ex officio
members (Required for all applications)
______ Conflict of Interest Disclosure Forms (Required, if relevant)
______ Conflict of Interest Disclosure Form Attachments (Required, if relevant)
______ Acknowledgement of CDBG Funded Construction/Rehabilitation Projects (Required, if relevant)
______ Acknowledgement of Lead-Based Paint Requirements (Required, if relevant)
______ Acknowledgement of Religious Organization Requirements (Required, if relevant)
______ Construction/Facility Improvement Projects Form (Required, if relevant)
______ Acquisition Project Form (Required, if relevant)
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)
Macon-Bibb County - Economic & Community Development Department
CDBG – CV (2)
APPLICATION
RESOLUTION
I, the Certifying Representative of
authorize the application for and use of Community Development Block Grant (CDBG-CV-2) funds as
administered by the Macon-Bibb County Economic and Community Development Department (ECDD)
for the activities described within this proposal and; if awarded funds, ,
Executive Director/Chief Officer, of the applicant agency, has approval to execute the program agreement
related to the award of CDBG-CV-2 funds and shall implement all contracted activities in a manner to
ensure compliance with all applicable Federal and local laws and regulations.
CERTIFYING REPRESENTATIVE
Signature Date
Printed Name Telephone Number
Title/Position of Certifying Representative
WITNESS, BOARD SECRETARY
Signature Date
Printed Name Telephone Number
(Insert Name of Agency)
(Insert Name)
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)
Macon-Bibb County - Economic & Community Development Department
CDBG – CV (2)
APPLICATION
CONFLICT OF INTEREST
Federal Law (24 CFR 570.611) prohibits persons who exercise or who have exercised any functions or
responsibilities with respect to the Community Development Block Grant…or who are in the position to
participate in a decision making process or to gain inside information with regard to such activities, may
obtain a financial interest or benefit from an assisted activity…either for themselves or those whom they
have family or business ties, during their tenure or for one year thereafter.
I hereby certify that the information provided on the Conflict of Interest Disclosure Form(s) is true
and accurate to the best of my knowledge. I also certify that to the best of my knowledge and belief,
no staff member of the Board of Director's, nor officer of
(agency) is currently, nor has been within one year of the date of this application, employed by the
local government, a member of the Economic and Community Development Department, nor an
elected official of the local government (Member of Board of Commissioners, Clerk, Judge, etc.)
I further attest that no staff member of the Board of Director's, nor officer of the applicant agency, is a
business partner or immediate family member of a County employee, a member of the Economic and
Community Development Department, or a member of the local government.
Funds requested will not be used to pay the salaries of any of the applicant agency's staff nor will the
applicant agency award a subcontract to any individual who is or has been within one year of the date of
this application a county employee, a member of the Economic and Community Development Department,
or a member of the local government.
Name: _____________________________________ Signature: ________________________________
Title: _____________________________________ Date: ___________________________________
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
C
ONFLICT OF INTEREST DISCLOSURE FORM
Conflict of Interest Regulation. No persons who exercise or have exercised any functions or responsibilities with respect
to activities assisted with federal funds or who are in a position to participate in a decision making process or gain inside
information with regard to these activities, may obtain a financial interest or benefit from an assisted activity, or have an
interest in any contract, subcontract or agreement with respect thereto, or the proceeds there under, either for themselves or
those with whom they have family or business ties, during their tenure or for one year thereafter.
N
ame: ____________________________________ Program Name: _____________________________________
A
ddress: ____________________________________ Program Client #: __________________________________
City, State, Zip: _____________________________ Contractor/Vendor#: ____________________________
The purpose of this document is to assist in the determination of whether additional restrictions, oversight, or other conditions
might be advisable prior to execution of any contract, funding or providing assistance. The term “Conflict Of Interest” refers to
situations in which financial or other personal considerations may compromise, or have the appearance of compromising
professional judgment in following the rules and regulations of the program. Please check the appropriate box for each question
and complete the attachment if indicated. This form (with Attachments, if required) must be completed and returned to your
Program Representative.
A
.
F
amily Relationships:
Do you have a family member directly or indirectly involved or employed with MACON-BIBB COUNTY that creates a conflict
of interest or the appearance of a conflict under the Conflict of Interest Regulation provided above?
YES NO (if YES, please complete Part A of the Attachment)
B
.
P
rogram Relationships:
Are you involved in any other activity directly or indirectly with MACON-BIBB COUNTY that may create a conflict of interest
or the appearance of a conflict under the Conflict of Interest Regulation provided above?
YES NO (if YES, please complete Part B of the Attachment)
C
.
Bu
siness Relationships:
Are you or a family member (spouse, child, stepchild, parent, sibling, or domestic partner) involved as an investor, owner,
employee, consultant, contractor, or board member with an entity that has a contractual relationship with MACON-BIB
B
C
OUNTY to provide goods or services, sponsor development activities and/or receive referrals from MACON-BIBB COUNTY?
YES NO (if YES, please complete Part C of the Attachment)
D. G
ifts for Personal Use:
To the best of your knowledge, have you or your family members accepted gratuity gifts, or special favors from someone that i
s
doing business with or proposing to do business with YOUR ORGANIZATION?
YES NO (if YES, please complete Part D on Attachment)
T
o the best of your knowledge, have you or your family members made any donations or gifts, or provided special favors to
MACON-BIBB COUNTY or any employee of MACON-BIBB COUNTY who exercises or may exercise any functions or
responsibility with respect to the activities involving your award, contract or program assistance.
YES NO (if YES, please complete Part D on Attachment)
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
E. Legal Proceedings and Debarment
Have you been involved in any fraud, antitrust or criminal proceedings as a defendant (other than a minor traffic offense) or
been debarred, suspended or otherwise excluded by a duly authorized regulatory agency or had a transaction with any such
agency terminated for any reason?
YES NO (if YES, please complete Part E on Attachment)
I ha
ve read and understand the Conflict of Interest Disclosure Form and have disclosed all information required by this
disclosure, if any, in an attached statement. I agree to comply with any conditions or restrictions imposed by the agency to reduce
or eliminate actual and/or potential conflicts of interest. I will update this disclosure form promptly if relevant circumstances
change. I understand that this Disclosure Form is not a confidential document.
Pr
int Name: ________________________________ Date: ____________________________
Si
gnature: ________________________________ Date: ____________________________
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
CONFLICT OF INTEREST DISCLOSURE FORM
ATTACHMENT
Conflict of Interest Regulation. No persons who exercise or have exercised any functions or responsibilities with respect
to activities assisted with federal funds or who are in a position to participate in a decision-making process or gain inside
information with regard to these activities, may obtain a financial interest or benefit from an assisted activity, or have an
interest in any contract, subcontract or agreement with respect thereto, or the proceeds there under, either for themselves or
those with whom they have family or business ties, during their tenure or for one year thereafter.
Nam
e: _________________________________ Program Name: ________________________________
Ad
dress: _____________________________ Program Client #: ______________________________
City, State, Zip: _____________________ Contractor/Vendor#____________________________
If
you answered YES to any question on the previous page, please complete the relevant section(s) below. If you answered
No to All questions, you may discard this attachment. Give your completed form to your Program Representative.
PART A: FAMILY RELATIONSHIPS
1. Na
me of your family member (s) directly or indirectly involved or employed at MACON-BIBB COUNTY:
2. Do a
ny of your family members work in the program area? _________________________
3. Ar
e any of your family members elected officials or members of the Local Housing Authority Board of Commissioners?
_________________________________________________________________________________________
4. Relationship to you: ____________________________ Position: _______________________________
D
epartment: __________________________________ Supervisor: _____________________________
PART B: PROGRAM RELATIONSHIPS
1. Act
ivities: Name and describe the activity and/or program that you are directly or indirectly involved with:
2. Ha
ve you used the name of YOUR ORGANIZATION, or their resources (facilities, personnel, or equipment), or confidential
information in connection with the activity and/or program?
Y
ES NO if YES, describe the resource used:
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
PART C: BUSINESS RELATIONSHIPS
Pleas
e complete this section for each business relationship, or attach a separate explanation of business and research activities.
1. Nam
e of business: ______________________________________________________________________
2. Categ
orize the business’ relationship with MACON-BIBB COUNTY.
Cons
ultant or advisor
Research activities
Business or referrals
Other contractual or business relationship
Brief
ly, describe the business, or licensing activity:
3. Have
you used YOUR ORGANIZATION’s name, resources (facilities, personnel, or equipment), or confidential information
in connection with the activity?
YE
S NO if YES, describe the resource used:
4. Who is
involved with the business? Check all that apply:
Yourself
Your family member (name and relationship) ______________________________________________________
Des
cribe the position or involvement (check all that apply):
Owner/Investor
Board Member
Employee/Manager
Other ______________________________________________________________________________________
5. Are you receiving any type of compensation? No Yes: If yes, describe _______________________________
__________
_______________________________________________________________________________________
6. Who at
YOUR ORGANIZATION oversees the relationship with this business?
Name: _____________________________________ Title: _________________________________________
Depa
rtment: ________________________________ Phone: ________________________________________
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
PART D: GIFTS FOR PERSONAL USE:
1. Wha
t was the dollar value of the gift (s) you or your family member received or donated? _____________________
2. Who w
as the donor or donee of the gift? _____________________________________________________________
3. Wha
t is the donor’s or donee’s relationship with MACON-BIBB COUNTY?
______________________________________________________________________________________________
PART E: LEGAL PROCEEDINGS AND DEBARMENT
Describe any legal proceedings or debarment situations: ____________________________________________________
Print Name: _________________________________________ Date: ___________________________
Si
gnature: __________________________________________ Date: ___________________________
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
ACKNOWLEDGEMENT OF
CDBG FUNDED CONSTRUCTION/REHABILITATION PROJECTS
If the applicant anticipates using CDBG-CV (2) funds for construction or rehabilitation, the following
Federal and Local government requirements must be acknowledged:
1. All construction or rehabilitation plans and specifications for the project must be approved by the
department of Planning and Zoning, Inspection and Fees, and Fire (if applicable). If the project affects a
building listed or eligible for listing on the National Register of Historic Places, all plans and specifications
must be approved by the Historic Preservation Review Person in accordance with the Memorandum of
Understanding with the State Historic Preservation Office, the Local government, and the Macon Heritage
Foundation.
2. The local government shall not be obligated to pay any funds to the project prior to the completion by
the local government of an environmental review of the projects, and said review is approved by any
government agencies as may be required by law.
3. This applicant will assure all wages paid to construction workers by it or its subcontractors are in
compliance with federal, state, and local labor requirements. The applicant agrees to include in the
construction bid specifications in connection with this agreement and the applicable Federal Wage
Determination assigned to this project by HUD. The applicant must also inform his
contractor/subcontractor that they will be required to submit documents after an ECDD-conducted pre-
construction conference and prior to construction. Weekly and/or monthly reports must be submitted
thereafter, as required by the federal government.
4. The applicant agrees to comply with, and to assume that its subcontractors comply with the 2 CFR
Grant and Agreements Part 200 Uniform Guidance Subparts A-E for programs funded in whole or in part
by CDBG funds, with 2 CFR Grant and Agreements Part 200 Uniform Guidance Subpart D for the
procurement of supplies, equipment, construction and services, and with 2 CFR Grant and Agreements
Part 200 Uniform Guidance Subpart E.
5. Pursuant to Section 109 of the Act, the applicant specifically agrees that no person shall be denied the
benefits of the program on the grounds of race, color, sex, religion or national origin.
6. The applicant agrees, on its own behalf and on the behalf of its contractors and subcontractors, to take
affirmative action attempting to employ low income and minority persons, as mandated by law.
7. As required by 2 CFR Grant and Agreements Part 200 Uniform Guidance Subpart D, professional
services must be competitively selected. The competitive selection process must include: a public
advertisement, issuance of a request for proposal and a competitive review based on uniform criteria.
Selection criteria must consider the basic qualifications, professional competence, experience and
suitability of each firm. Fees for professional services must be requested as a fixed sum and not stated as
a percentage of construction costs.
8. All documents, bid specifications, notices and construction drawings must be submitted for review and
approval of the Economic and Community Development Department prior to public advertisement.
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
9. The bidding process for construction contracts must include a formal advertisement, published in The
Macon Telegraph and at least one of the following minority owned newspapers: the Middle Georgia
Informer or ¿Que Pasa? In order to assure compliance with this section, the Economic and Community
Development Department will be responsible for the advertisements. The expense of such advertisements
shall be a part of the overall project expense.
10. All bid openings shall be held at the local government's Purchasing Department.
11. The applicant agrees to submit to the Economic and Community Development Department all
documentation of the steps followed in the selection of professional services and construction contracts.
12. The applicant agrees to specify a time of completion and include a liquidated damage clause in all
construction contracts. Cost plus a percentage of costs, and percentage of construction costs contracts will
not be permitted.
13. If the applicant is awarded CDBG-CV-2 funds, other conditions and requirements will be specified in
the funding agreement.
14. The applicant agrees that it will not start construction until an official "Notice to Proceed" has been
issued.
15. Pursuant to 570.608 of the CDBG regulations and the provisions in the Housing and Community
Development Act of 1987, the applicant agrees to comply with the inspection, notification, testing and
abatement procedures concerning lead-based paint.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THE SPECIFIC REQUIREMENTS CONTAINED
IN THIS ATTACHMENT "A", AND THAT ELIGIBILITY OF MY ORGANIZATION'S PROJECT
DEPENDS UPON COMPLIANCE WITH THE REQUIREMENTS CONTAINED IN THIS
ATTACHMENT.
______________________________________ _________________________________________
SIGNATURE DATE
___________________________________________________________________________________
NAME / TITLE OF SIGNATURE
___________________________________________________________________________________
NAME OF ORGANIZATION
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
ACKNOWLEDGEMENT OF LEAD BASED PAINT REQUIREMENTS
(24 CFR 35)
1. APPLICABILITY
a. CDBG funded housing activities involving construction, purchase and rehabilitation must comply
with U.S. Department of Housing and Urban Development guidelines for the evaluation and control of
lead-based paint hazards in housing, dated September 15, 1999.
b. The following housing rehabilitation activities are excepted:
(1) Emergency repairs (but no lead based related emergency repairs).
(2) Weatherization
(3) Water and/or sewer hookups
(4) Installation of security devices
(5) Facilitation of tax exempt bond issuances for funds
(6) Other single-purpose activities that do not include physical repairs or remodeling of applicable
surfaces.
(7) Other activities that do not involve applicable surfaces and do not exceed $5000.00 per unit.
2. INSPECTION AND TESTING REQUIREMENTS
a. The recipient shall be required to test the lead content of chewable surfaces of an apartment building
to be rehabilitated, if there is a family residing in one of the units with a child under seven years of
age with an identifiable elevated blood level condition (concentration of lead in the blood of 25
micrograms per deciliter or greater) and the building was constructed prior to 1978.
b. Chewable surfaces are defined as all exterior surfaces of a residential structure, up to five feet from
the floor or ground, such as a wall, stairs, deck, porch, railing, windows, or doors that are readily
accessible to children under seven years of age, and all interior surfaces of a residential structure.
c. Lead content shall be tested by using an x-ray fluorescence analyzer or other method approved by
HUD. Test readings of 1 mg per cm² or higher shall be considered positive for presence of lead
based paint.
3. REQUIRED TREATMENT
a. Treatment of lead based paint conditions must be included as part of the proposed rehabilitation
work. All chewable surfaces in any room found to contain lead based paint must be treated before
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
final inspection and approval of work. Similarly, all exterior chewable surfaces must be treated
when they are found to contain lead based paint.
b. Minimum treatment involves covering or removing the painted surface. Washing and repainting
without thorough removal or covering does not constitute adequate treatment.
c. Covering can be achieved by adding a layer of gypsum wallboard or fiberglass cloth barrier.
Depending on the wall condition, permanently attached, non-strippable wallpaper may be applied.
Covering or replacing trim surfaces is also permitted.
d. Removal can be accomplished by scraping, heat treatment (infra-red or coil type heat guns) or
chemicals. Machine sanding and propane torch use are not allowed.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THE SPECIFIC REQUIREMENTS FOR LEAD
BASED PAINT CONTAINED IN THIS ATTACHMENT, AND UNDERSTAND THAT MY
ORGANIZATION'S PROJECT ELIGIBILITY DEPENDS UPON COMPLIANCE WITH THE
REQUIREMENTS CONTAINED IN THIS ATTACHMENT.
_________________________________________ _______________________________________
SIGNATURE DATE
___________________________________________________________________________________
NAME / TITLE OF SIGNATOR
___________________________________________________________________________________
NAME OF ORGANIZATION
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
ACKNOWLEDGEMENT OF RELIGIOUS ORGANIZATION REQUIREMENTS
1. In accordance with the First Amendment of the United States Constitution - "church/state principles
set forth at 24 CFR 570.200," - CDBG assistance may not, as a general rule, be provided to primarily
religious entities for any activities, including secular activities.
2. The following restrictions and limitations therefore apply to the use of CDBG funds by any provider
which represents that it is, or may be deemed to be, a religious or denominational institution or an
organization operated for religious purposes which are supervised or controlled by, or operates in
conjunction with, a religious or denominational institution or organization.
3. Any religious entity that applies for and is granted CDBG funds for public service must agree to the
following:
a. It will not discriminate against any employee or applicant for employment on the basis of religion
and will not limit employment or give preference in employment to persons on the basis of religion;
b. It will not discriminate against any person applying for such public services on the basis of religion
and will not limit such services or give preference to persons on the basis of religion;
c. It will provide no religious instruction or counseling, conduct no religious worship or service,
engage in no religious proselytizing, and exert no other religious influence in the provision of such
public services;
d. CDBG funds may not be used for the acquisition of property or the construction or rehabilitation
(including historic preservation or removal of architectural barriers) or structures to be used for
religious purposes or which will otherwise promote religious interests.
4. CDBG funds may be used to rehabilitate buildings owned by primarily religious entities which are to
be used for a wholly secular purpose under the following conditions:
a. The building (or portion thereof) that is to be improved with CDBG assistance has been leased to
an existing or newly established wholly secular entity (which may be an entity established by the
religious entity);
b. The CDBG assistance is provided to the lessee (and not to the lessor) to make improvements;
c. The leased premises will be used exclusively for secular purposes available to all persons regardless
of religious affiliation;
d. The lease payments do not exceed fair market value of the premises as they were before the
improvements were made;
e. The portion of the cost of any improvements that also serve a non-leased portion of the building
will be allocated to and paid by the lessor;
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
f. The lessor enters into a binding agreement that unless the lessee, or a qualified successor lessee,
retains the use of the leased premises for a wholly secular purpose for at least the useful life of the
improvements, the lessor will pay to the lessee an amount equal to the residual value of the
improvements;
g. The lessee must remit the amount received from the lessor to the recipient or sub-recipient from
which the CDBG funds were derived.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THE SPECIFIC REQUIREMENTS CONTAINED
IN THIS ATTACHMENT "C", AND THAT ELIGIBILITY OF MY ORGANIZATION'S PROJECT
DEPENDS UPON COMPLIANCE WITH THE REQUIREMENTS CONTAINED IN THIS
ATTACHMENT.
____________________________________________ ____________________________________
SIGNATURE DATE
___________________________________________________________________________________
NAME / TITLE OF SIGNATURE
___________________________________________________________________________________
NAME OF ORGANIZATION
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CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
CONSTRUCTION/FACILITY IMPROVEMENT PROJECT
Complete this page if funds will be used for construction projects.
1. Describe in detail the physical improvements that will be made. Attach construction estimates
(using Davis-Bacon Wages, Labor Standards and Section 3 Program), preliminary designs,
photograph blueprints, and specifications:
a. Does applicant own the property or site? Yes No
If not, provide a copy of lease agreement and letter from the owner confirming.
Requests for property leased/purchased with CDBG funds for $100,000 and under will
require an eligible CDBG use for 5 years; $100,000 to $300,000 requires 10 years and
$300,000 and above requires 20 years.
2. Does the project require land use and/or zoning change? Yes No
If yes, explain:
3. Describe long-term operation and maintenance plans for the project:
4. Provide evidence of funds by letters of commitment with contact person.
5. Must submit a signed construction estimate from a licensed contractor.
6. Contractor Name:
Address: Zip Code:
Telephone:
License Number:
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CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
ACQUISITION PROJECT
Acquisition of Real Property
(CDBG funds will only be used to purchase property at Fair Market Value (FMV) appraised value.
Applicants will be responsible for purchase cost above FMV.)
1. Describe in detail the acquisition of the property. (Attach photograph)
2. Letter of intent to sell from property owner attached? Yes No
3. Does the project require land use and/or zoning change? Yes No
If yes, explain:
4. Provide evidence of funds by letters of commitment with contact person.
Requests for property leased/purchased with CDBG funds for $100,000 and under will require an
eligible CDBG use for 5 years; $100,000 to $300,000 requires 10 years and $300,000 and above
requires 20 years.
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
Community Development Block Grant (CDBG)
Macon-Bibb County - Economic & Community Development Department
CDBG – CV (2)
TABLE OF CONTENTS
A. Budget Itemization Form(s) (please see pages 26-27 of application instructions)
*Examples on pages 29-34 of application instructions.
B. Budget Narrative of Proposed Expenditures (Insert attachment containing narrative)
C. Budget Summary Form (please see page 28 of application instructions)
*Example on page 35 of application instructions.
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CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
BUDGET ITEMIZATION SHEET*
Project Operator________________________________ CDBG – CV (2) 2021 Date Submitted ________
Line
Item
Number
Line Item Breakdown
Category Amount
Total Project
Cost
CD
Funds
Other
Funds
Sources of
Match
In-kind
Match
Funds
Total Amount:
$
$
$
$
CDBG – CV (2)
Submission Deadline: July 12, 2021, 5:00 P.M.
*Copy this sheet as many times as is necessary for your budget itemization.
BUDGET SUMMARY SHEET
Project Operator________________________________ CDBG – CV (2) 2021 Date Submitted ___________
Line
Item
Number
Line Item Breakdown
CD Funds
Other Funds
Sources of Match
Funding
In-Kind
Match Funds
Total Funds
$
$
$
Total CD Funds
$
Other Funds:
$
Total Funds:
$
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CDBG -CV (2) APPLICATION r fo (Macon-Bibb County, Georgia)

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Completed 24 July 2021

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