5. Will the portion of the cost of any improvements that also serve a non-leased part
of the building be allocated to and paid for by your organization?
YES NO
6. Has your organization entered into a binding agreement that it will pay to the
lessee the value of the improvements if the lessee (or qualified successor lessee)
fails to retain the use of the leased premises for a wholly secular purpose for at
least the useful life of the improvements and that the lessee (or qualified
successor lessee) also agrees that it must remit such amount received from your
organization back to the City?
YES NO
If you responded NO to all of the questions above, proceed to Part IV.
If you responded YES to any of the questions above, proceed to Part IV, but
please note that if funded, grant agreements will include the following provisions.
If you will be unable to comply with any of the provisions below, please notify City
staff in writing at the time the CDBG funding application is submitted.
The applicant agrees not to 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;
The applicant agrees not to discriminate against any person seeking CDBG-
funded assistance on the basis of religion and will not limit assistance or give
preference to persons on the basis of religion; and,
The applicant agrees not to provide religious instruction or counseling, conduct
religious worship or services, engage in religious proselytizing, or exert any
other religious influence in the provision of CDBG-funded assistance.
IV. Certification:
__________________________________ ________________________________
Name of Applicant Organization Date
__________________________________ ________________________________
Signature of Applicant Representative Title
