Fillable CITY OF MASSILLON, OHIO (City of Massillon)

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CITY OF MASSILLON, OHIO (City of Massillon)

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The CITY OF MASSILLON, OHIO (City of Massillon) form is 6 pages long and contains:

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  • 18 check-boxes
  • 95 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Massillon

BROWSE CITY OF MASSILLON (OH) FORMS

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FY 2020 CDBG Application
Page 1 of 6
CITY OF MASSILLON, OHIO
FY 2020/2021 Community Development Block Grant Program
Application for Project Funding
Project Name
Community Development Block Grant Fund (CDBG) Request
Total FY 2020 CDBG funds request: $
Total Estimated Project Cost: $
Applicant/Organization/Agency
Name:
Mailing Address:
City & Zip:
Contact Person/Title:
Phone: Fax:
E-Mail Address:
Organization’s Federal Tax ID #
Organization’s DUNS Number
Name of Representative who attended CDBG Workshop
Application Scoring:
National Objective (0-5 points)
Project Summary (0-15 points)
Project Location (0-10 points)
Mission Objectives (0-15 points)
Past Experience/Performance (0-15 points)
Type of Activity (0-10 points)
New or Existing Service (0-10 points)
Number of people served (0-10 points)
Project Budget (0-10 points)
Total Points Scored (0-100 points)
Workshop Attendance Bonus (10 points)
Grant Total (0-110 points)
FY 2020 CDBG Application
Page 2 of 6
1. National Objective: Check all that apply (0-5 points)
Benefit to Low/Moderate Income Persons
Prevention/Elimination of Slum & Blight
2. Type of organization (Check all that apply)
Non-Profit Organization For-Profit Business or Corporation
Faith-Based Organization Unit of Government
3. Project Timetable
Proposed Start Date: ______________________________________________________
Proposed Completion Date:
(CDBG funds would not be available until July, 2020. Please base your timetable accordingly)
4. Project Description
A. Project Summary (0-15 points) - Describe in detail the activities to be carried out with CDBG
funds. Attach additional pages if necessary.
FY 2020 CDBG Application
Page 3 of 6
B. Project Location (0-10 points) - Describe the location of the project or the geographic area to be
served by the activity. Please be aware that the City of Massillon will not provide CDBG funds
for any activities outside the corporate limits of Massillon.
C. Mission/Objectives (0-15 points) – What is the rationale for the project – the major results being
sought? Why is the project needed? What community need is being met or mitigated? What
problem(s) are you attempting to address by requesting funds for this project?
D. Past Experience and Performance (0-15 points) – Include the agency’s length of time in business
and experience in undertaking projects of similar complexity as the one for which funds are
being requested.
FY 2020 CDBG Application
Page 4 of 6
5. Project Goals and Beneficiaries
A. Type of Activity (Select one of the following) (0-10 points)
___ Housing (10 points)
___ Economic Development (10 points)
___ Public Facilities/Public Improvements (10 points)
___ Public Services (5 points)
___ Homeless housing and support (10 points)
B.
Public Service Activity (0-10 points):
___ Existing Service (duplication of current services) (5 points)
___ New Service (non-duplication of current service) (10 points)
___ Quantifiable increase to an existing service (10 points)
C.
Project Beneficiaries (0-10 points) - Provide an estimate of the total numbers expected to be
served for those categories applicable to the proposed project.
___ Over 100 Persons/Households/Businesses (10 points)
___ 51 to 100 Persons/Households/Businesses (7 points)
___ Less than 50 Persons/Households/Businesses (5 points)
6. Proposed Project Budget (0-10 points)
*Keep in mind that your entire budget request may not be funded.*
A. Project Budget Sheet
List other funding obtained or solicited for this project (including other public funds, private funds, and
foundations). All projects must include funding from other sources. Due to the limited amount of HUD
dollars available, no agency’s project can be 100% CDBG funded.
FUNDING SOURCES COMMITTED AMOUNT PENDING AMOUNT
TOTAL FUNDING SOURCES
$ 0.00
$ 0.00
FY 2020 CDBG Application
Page 5 of 6
B. Project Budget Sheet - Allowable expenses are those listed in OMB Circular Cost
Principles (A-87 or A-122).
COLUMN A
COLUMN B
COLUMN C
COLUMN D
Budget Line Items (Be specific)
CDBG
Funds Requested
Other Funds
Committed
Totals (Column B
plus Column C)
PROJECT TOTALS
• Construction Projects - Please try to get and use a current, itemized industry professional cost
estimate when completing this budget.
• Direct vs. Indirect Costs – CDBG funds can only be used to fund direct project costs, no indirect
costs (i.e. rental, telephone, clerical costs, etc.) can be considered for funding without submission
and approval of an indirect cost allocation plan. Please refer to OMB Circular A-122 for a
detailed description of direct and indirect costs. (If requesting CDBG funding for staff salaries,
please attach an agency staff chart, listing job descriptions and staff experience.)
$ 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
FY 2020 CDBG Application
Page 6 of 6
Non-profits complete:
If non-profit, attach:
* Tax status certifications (501 [c][3]) * Board By Laws
* Board of Directors List * Board minutes for last 3 Meetings
* Executive Directors report for last 3 months * Agency brochure or narrative outlining
(If not included as part of Minutes) services available
7. Signature Section
TO THE BEST OF MY KNOWLEDGE AND BELIEF, THE STATEMENTS AND DATA IN THIS APPLICATION ARE TRUE
AND CORRECT AND ITS SUBMISSION HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE
APPLICANT
. WITH THIS SUBMISSION, WE ALSO AGREE TO FOLLOW ALL RULES AND REGULATIONS
GOVERNING FEDERAL CDBG
AND HUD FUNDING.
____________________________________ ____________________________________
SIGNATURE, CHIEF OFFICIAL NAME (TYPED OR PRINTED)
____________________________________ ____________________________________
DATE TITLE
8. Application Submission
Applications shall be submitted to the following address:
Massillon Community Development Department
Municipal Government Annex
151 Lincoln Way East
Massillon, Ohio 44646
Submission Deadline – January 17, 2020, 4:00 P.M., EST
Any application received after this date will be returned to the applicant and will not be
considered for funding. In addition, any incomplete application will not be considered for
funding.
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CITY OF MASSILLON, OHIO (City of Massillon)

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Completed 20 July 2020

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