Fillable CITY OF LAKE FOREST COMMUNITY DEVELOPMENT BLOCK GRANT (City of Lake Forest)

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CITY OF LAKE FOREST COMMUNITY DEVELOPMENT BLOCK GRANT (City of Lake Forest)

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BROWSE CITY OF LAKE FOREST (CA) FORMS

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City of Lake Forest 100 Civic Center Drive, Lake Forest, CA 92630 (949) 461-3449 www.lakeforestca.gov
CITY OF LAKE FOREST
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
2020-2021 APPLICATION
** DO NOT MODIFY THE APPLICATION FORM **
A. GENERAL GRANT APPLICANT INFORMATION
1. Name of Proposed Program: ____________________________________________
2. Location Where Proposed Program Will Be Provided:
______________________________________________________________________
3. Applicant Organization Full Legal Name: __________________________________
4. Mailing Address: _____________________________________________________
5. Federal Tax I.D. Number: ______________________________________________
6. DUNS: _____________________________________________________________
7. Name & Title of Applicant Primary Contact: ________________________________
8. Are you a faith-based organization? Yes No
Telephone No: ____________________ Email: __________________________
9. Organization’s Officials Authorized to Execute Contract (two are required):
Name: ___________________________ Title: ___________________________
Name: ___________________________ Title: ___________________________
Ensure you submit a complete application and Conflict of Interest questionnaire with original
signatures and email the completed application electronically.
Also submit all of the documents listed in section III, B of the Application Instructions in PDF
format on a CD-ROM or USB data storage device.
City of Lak
e Forest
FY 2020-2021 CDBG Application
Page
2
\\CLF400V\Departments\Development Services\CDBG & Housing\CDBG\FY 2019-2020\2019-20 PSG Application\LF - Application Master FY 2020-2021.docx
B. PROPOSED PROGRAM INFORMATION
1. Eligible service programs must meet one of three broad national objectives of the CDBG
Program. Indicate which of the following national objective the proposed program will
address:
Provide benefit to low and moderate-income persons
Aid in the prevention or elimination of slums or blight
Meet a community development urgent need (i.e., disaster recovery from earthquake,
floods, etc.)
2. Check the ONE category that best describes the proposed program:
Elderly/Frail Elderly Services
Youth Services
Physically/Developmentally Disabled Adults
Crime Awareness
HIV/AIDS Services
Homeless Services
Fair Housing Services
Substance Abuse Services
Mental Illness Services
Childcare Services
Other Public Services (Specify) ___________________
Health Services
3. Within the space provided below, identify the nature and extent of the community need in Lake
Forest to be addressed by the proposed program.
City of Lak
e Forest
FY 2020-2021 CDBG Application
Page
3
\\CLF400V\Departments\Development Services\CDBG & Housing\CDBG\FY 2019-2020\2019-20 PSG Application\LF - Application Master 2019.docx
4. In the space below, summarize how CDBG funds will be used. Specify if funds will be used for
staff salaries/benefits, program supplies, rent, utilities, etc. If direct client services will be
funded, specify the services, e.g., utility payments, rental assistance, etc.
5. In t
he space below, describe the characteristics of the targeted client population that will benefit
from the proposed program. Including information such as age, income level, target area, and
other unique characteristics as applicable.
City of Lak
e Forest
FY 2020-2021 CDBG Application
Page
4
\\CLF400V\Departments\Development Services\CDBG & Housing\CDBG\FY 2020-2021\2020-21 PSG Application\LF - Application Master 2020-2021.docx
6. Within the space below, describe your organizational and professional qualifications to carry
out the proposed program including all appropriate staff professional credentials (as applicable)
and related experience (with focus on positions proposed for CDBG funding).
City of Lak
e Forest
FY 2020-2021 CDBG Application
Page
5
\\CLF400V\Departments\Development Services\CDBG & Housing\CDBG\FY 2019-2020\2019-20 PSG Application\LF - Application Master 2019.docx
C. PROPOSED PROGRAM BUDGET & GOALS
1. Provide the following proposed program budget information:
Total agency budget (for ALL programs offered): $
Total program budget (ALL funds for similar program offered at all public entities): $
FY 2020-21 CDBG funds requested from Lake Forest: $
2. Provide the following information regarding the number of unduplicated clients to be
served by the proposed program between 7/1/2020 & 6/30/2021:
a. Total number of unduplicated clients to be served by the proposed program regardless
of city of residence:
b. Of the number of clients identified in “a,” the total number of unduplicated Lake Forest
clients to be served:
c. Of the number of Lake Forest clients identified in “b”, total number that will be assisted
with requested CDBG funds:
3. Is funding request for a New or Existing program? If for existing program, how will
this program be “expanded” from current program efforts (limit response to space provided
below)?
4. Has your organization previously received ANY CDBG funding from the City?
Yes No
If yes, identify the years, amounts and programs funded within the past five years.
YEAR
CDBG GRANT AMOUNT
PROGRAM NAME
City of Lak
e Forest
FY 2020-2021 CDBG Application
Page
6
\\CLF400V\Departments\Development Services\CDBG & Housing\CDBG\FY 2019-2020\2019-20 PSG Application\LF - Application Master 2019.docx
Within the past five years, if you also received CDBG funds from other entities, please
provide the names of programs, amounts of CDBG received, and funding agencies.
PROGRAM NAME & YR.
CDBG
G
RANT
AMOUNT
FUNDING AGENCY
6. Are you requesting CDBG funding for this program for FY 2020-21 from another city or the
County? Yes No
If yes, from whom and how much?
CDBG GRANT AMOUNT
7. All CDBG-funded activities must meet a HUD Objective and Outcome.
Objectives: Select one HUD objective that best applies to the proposed program:
Suitable Living Environment – The activity is designed to benefit community, families, or
individuals by addressing issues in their living environment.
Decent Housing – The activity is designed to cover a wide range of housing opportunities
that meet an individual family or community need.
Creating Economic Opportunities – The activity will generate economic development,
commercial revitalization, or job creation.
Outcomes: Select one HUD outcome that best applies to the proposed program:
Availability/Accessibility – The activity makes services, infrastructure, housing or shelter
available/accessible to low and moderate-income persons, including individuals with
disabilities.
Affordability – The activity provides affordability in a variety of ways for low and moderate-
income persons, including creation or maintenance of affordable housing, basic
infrastructure hook-ups, or services.
Sustainability (promoting livable & viable communities) – The activity aims to improve the
community or neighborhoods, helps to make them livable or viable by providing benefits to
low and moderate-income persons, or by removing/eliminating slums/blighted areas.
City of Lak
e Forest
FY 2020-2021 CDBG Application
Page
7
\\CLF400V\Departments\Development Services\CDBG & Housing\CDBG\FY 2019-2020\2019-20 PSG Application\LF - Application Master 2019.docx
D. PROPOSED 2020-2021 PROGRAM BUDGET
1. Complete the proposed program budget table below:
CATEGORY
LAKE FOREST
CDBG
OTHER SOURCES TOTAL BUDGET
Administration Staff Salaries &
Benefits
Program Staff Salaries &
Benefits
Program Supplies
Rent/Lease
Communications
Utilities
Insurance
Professional Services
(specify below)
Other (specify below)
Other (specify below)
Other (specify below)
TOTAL
NOTE: If your program is approved for funding, your request for reimbursement of budget expenditures must be
documented by receipts, time records, invoices, canceled checks, inventory records or other appropriate documentation which
fully and completely disclose the amount and nature of the expenditure.
“OTHER” PROGRAM FUNDS TO ASSIST LAKE FOREST RESIDENTS
SOURCE OF “OTHER”
PROGRAM FUNDS
AMOUNT OF OTHER
PROGRAM FUNDS
FUNDS SECURED FOR
FY 2020-21
VIA CONTRACT
(RESPOND YES OR NO)
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
TOTAL
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
City of Lak
e Forest
FY 2020-2021 CDBG Application
Page
8
\\CLF400V\Departments\Development Services\CDBG & Housing\CDBG\FY 2019-2020\2019-20 PSG Application\LF - Application Master 2019.docx
2. Provide a response to the following questions related to the proposed use of CDBG funds:
a. Describe your plans to seek funding to supplement CDBG funding. Describe the sources
wh
ich are secured and which are pending approval, the amounts sought, and the propos
ed
us
e of those funds (limit response to space below).
b. D
escribe the use of donated goods and services. Estimate the value of these services
and
des
cribe how you arrived at these amounts (limit response to space below).
City of Lak
e Forest
FY 2020-2021 CDBG Application
Page
9
\\CLF400V\Departments\Development Services\CDBG & Housing\CDBG\FY 2019-2020\2019-20 PSG Application\LF - Application Master 2019.docx
c. Compliance with Single Audit requirements: In any of the past 3 years has your agency
expended more than $750,000 in cumulative federal funds during one fiscal year?
Yes
No
If yes, did your agency prepare a Single Audit compliant with federal regulations?
Yes
No If yes, provide a copy of most recently completed Single Audit. If no,
explain why a Single Audit was not prepared (limit response to space below).
d. Discuss if the proposed program will assist Veterans and/or Veterans’ families. Include
information regarding the specific service to be provided, the number of individuals the
program will assist (include the percentage of Veterans to be served by the proposed
program), and how Veteran status will be verified (limit response to space below).
City of Lak
e Forest
FY 2020-2021 CDBG Application
Page
10
\\CLF400V\Departments\Development Services\CDBG & Housing\CDBG\FY 2019-2020\2019-20 PSG Application\LF - Application Master 2019.docx
E. CERTIFICATION
I hereby certify that, if funds are granted from the City of Lake Forest, they will be used to
benefit low- and moderate-income residents of Lake Forest. I understand that funding is
provided on a reimbursable basis only, that proof of liability insurance will be required and that
our formal agreement with the City will define other reporting and programmatic requirements.
I further certify that I am authorized on behalf of the applicant to submit this application for
CDBG funding from the City of Lake Forest.
Name: Title:
Signature: Date:
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CITY OF LAKE FOREST COMMUNITY DEVELOPMENT BLOCK GRANT (City of Lake Forest)

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Completed 3 August 2020

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