City General Fund (Cgf) & Federal Funds

2013-2015

CITY GENERAL FUND (CGF) & FEDERAL FUNDS

(CDBG, HOME, ESG, & HOPWA)

Request for Funding (RFF)

CHECKLIST

Check Box Below:

City General Fund (CGF)Federal Funds

City General Fund Applicants: Complete pages 1- 8, 13,14

Federal Fund Applicants: Complete pages 1 -14

Project name:

Applicant (Organization name):

Date Received By City

1. Application: (Submit 5 copies)

Attachment List

Request for Funding Form Completed

• Application (pages 1-8)
• Activity Budget Sheet (pages 9 – 12)(Federal Funds only):
• Overall Budget Sheet (pages 13 – 14):

1. Attachments (Provide, if applicable, & list on Attachment List):

(Submitattachments on CD)

Federal Tax Exempt Certification

Latest IRS 990 Report

By-Laws

Corporation Commission Certification

Central Contractor (CCR) Registration (Federal Funds applicants)

Articles of Incorporation

Organizational Chart

List of Full-time and Part-time Employees to Work on Project

Documentation of Partnership Agreements with Other Agencies

Council-Adopted Plan

List of Board of Directors Members & Executive Officers

Business or Strategic Plan (mandatory for CGF Applicants)

Personnel Manual

Policy/Procedures Manual

Previous Fiscal Year’s Audit and/or Financial Statements

Current Year Operating Budget (mandatory for CGF Applicants)

Employee Resumes

Site Control, Building or Zoning Documentation

Other (Specify)

2013-2015

CITY GENERAL FUND (CGF) & FEDERAL FUNDS

(CDBG, HOME, ESG, & HOPWA)

Request for Funding

Instructions: This form must be fully completed by all organizations and agencies applying for funds.

PLEASE NOTE: You must complete a separateapplication form for each project.

1.Funds Requested: City General Fund Federal Funds

2013-2014

CGF / CDBG / HOME / ESG / HOPWA
$ / $ / $ / $ / $

2014-2015

CGF / CDBG / HOME / ESG / HOPWA
$ / $ / $ / $ / $

2.Organization Information:

A. Organization Name:

DUNS Number:

B. Project Contact Person:

C. Mailing Address:

D. Phone: Facsimile: E-mail:

E. Board Chairperson: Signature:

F. Is your organization incorporated? Yes No

(If yes, attach verification)

G. Is your organization:

• a government entity? Yes No

• a nonprofit with approved Federal tax exempt certification? Yes No

(If yes, attach a copy of tax exempt documentationand record on the attachment list.

Also include a copy of your latest 990 report to IRS)

• a for-profit business Yes No

1. Total operating budget for the organization, including income/revenues for all sources. $

(Attach a copy of your current year’s operating budget)

3.Location of Project:

A. Is the project City-wide or does it serve a specific project area

B. Name and Geographic Boundaries of Project Area (Include street names):

C. Census Tract(s): Council District(s): NIB Area

4.Description: Provide a concise description of the proposed project and clients to be served, to include how additional services will be provided as a result of this funding or if an existing service will be discontinuedwithout funding.

5.Funds Received Previously for this Project by Year of Allocation:

Previous / Current / Request for / Request for
2011-2012 / 2012-2013 / 2013-2014 / 2014-2015
CITY GENERAL FUND: / $ / $ / $ / $
CITY CAPITAL BUDGET: / $ / $ / $ / $
CDBG: / $ / $ / $ / $
HOME: / $ / $ / $ / $
ESG: / $ / $ / $ / $
HOPWA: / $ / $ / $ / $

6.Accomplishments in the current fiscal year:

Whether or not the project received HUD or City funds before, describe project progress in the current fiscal year. Emphasize measurable outcomes and project benefit to the community.

FY2012-2013
Objectives / FY2012-2013
Accomplishments to Date / # of Units / # of Clients / # of Other

7.Proposed Objectives and Outcomes:

FY2013-2014
Objectives / FY 2013-2014
Outcomes / # of Units / # of Clients / # of Other
1.
2.
3.
4.
5.
6.
7.
FY2014-2015

Objectives

/ FY2014-2015
Outcomes / # of Units / # of Clients / # of Other
1.
2.
3.
4.
5.
6.
7.

8.Project Match:

List all sources of funds you will receive for FY2013-2014 and FY2014-2015 for this project.

(Denote all funds you anticipate receiving with an asterisk [*]).

Program Year / Dollar
Source of Funds / Status / Dates / Amount
1. / $
2. / $
3. / $
4. / $
5. / $
6. / $
7. / $
8. / $
9. / $
10. / $
2013-2014 Matching Total: / $
1. / $
2. / $
3. / $
4. / $
5. / $
6. / $
7. / $
8. / $
9. / $
10. / $
2014-2015 Matching Total: / $
Grand Total of Matching Funds: / $

9.Community Impact:

Briefly describe the neighborhood to be served, highlighting such items as: population to be served, housing conditions, median household income, neighborhood strengths/weaknesses and describe how the project will positively impact the community.

10.Description of Organization and Overall Capacity:

1. Briefly describe the organization’s background, mission, and area served.

B. Briefly highlight the organization’s significant achievements, including the capacity to complete current projects and development activities.

1. Attach the names, titles, experience, responsibilities and training for all full and part-time employees who will work on this project (attach resumes), including the percentage of time spent on this project.

1. Attach a list of current board members including address, occupation and role on the board.

1. Describe your organizational structure, including an organizational chart, your record keeping and financial/audit system, policies and procedures and program evaluation results. Attach the most recent audit report and/or financial statements.

1. Provide a brief description of any financial default or involvement in legal actions during the last 3 years. This would include lawsuits, tax delinquency, bankruptcy, client complaints, and violations of building, zoning, and environmental codes.

11.Consistency with City Strategic Priorities and the Consolidated Plan:

1. Describe how the project meets the priorities listed in the City of Richmond Focus Areas (See Attachment Bfor CGF projects or Attachment B-1 if this is a CGF Human Services Project).

1. How is your project consistent with the City’s Consolidated Plan strategies? (SeeConsolidated Plan summary or Attachment C; does not apply to CGF projects).

C. Briefly explain how your organization meets each of the Organizational ThresholdCriteria listed in Attachment D.

12.Evidence of Neighborhood/Partnership Support: Describe the neighborhood/partnership support for the proposal, including NIB Partnership, civic association or city department support, from groups that will assist in the implementationor be directly affected by the project. Attach written agreements with other groups/organizations to implement the program.

13.Sustainable/Green Practices: Describe any sustainable or “green” aspects or design elements that will be incorporated as part of the implementation of the proposed project.

14.Evidence of Site Control: If the project involves the development of a public facility, organizational offices or housing, attach plans and documentation of site control. If you have an existing facility, provide documentation that the facility is in compliance with building and zoning codes for the services provided.

15.Marketing Strategy: Briefly describe your strategies and methods for marketing your program and the target population of your efforts.

Attachment List

Instructions: All attachments for the Requests for Funding form must be listed below. If attachments are not available at the time of submission, an asterisk (*) should be placed next to these items to indicate that they are anticipated, and the date that they are anticipated should be included.

1. Partnership Agreements (formal agreements with other agencies, including City departments, to implement the proposal).

Contact Person / Telephone /

Organization

/

FAX

/

Address

/

Date

b.Other Documents (please refer to the Attachments List on the cover page of the application)

Name / Date

2013-2014

FEDERAL FUNDS ONLY

(CDBG, HOME, ESG, & HOPWA) Request For Funding

Activity Budget Sheet

Instructions: DO NOT complete this form until you have read the guidelines that define the eligible activities.

(See Attachment F). In the first column, check the funding activities requested and then show

all eligible costs for each activity.

CDBG Eligible Activities

Current Funds Allocation / Requested Funds / Other Funds
# of Units (where applicable) / FY2012-2013 / FY2013-2014 / FY2013-2014
1 / Acquisition of Real Property / $ / $ / $
2 / Disposition / $ / $ / $
3 / Public Facilities & Improvements / $ / $ / $
4 / Clearance & Demolition / $ / $ / $
5 / Public Services / $ / $ / $
6 / Interim Assistance / $ / $ / $
7 / Urban Renewal Completion / $ / $ / $
8 / Relocation / $ / $ / $
9 / Loss of Rental Income Replacement / $ / $ / $
10 / Removal of Architectural Barriers / $ / $ / $
11 / Privately Owned Utility Development / $ / $ / $
12 / Construction of Housing / $ / $ / $
13 / Direct Homeownership Assistance / $ / $ / $
14 / Micro Enterprise Assistance / $ / $ / $
15 / Rehabilitation / $ / $ / $
16 / Lead-Based Paint Hazard Evaluation/Reduction / $ / $ / $
17 / Code Enforcement / $ / $ / $
18 / Historic Preservation / $ / $ / $
19 / Commercial/Industrial Improvement by Nonprofit / $ / $ / $
20 / Economic Development Services / $ / $ / $
21 / Direct Economic Development Assistance to
Private For-Profit Entities / $ / $ / $
22 / CBDO Activities for Otherwise Ineligible Activities / $ / $ / $
23 / Planning / $ / $ / $
24 / Program Administration (For City Administration Projects Only) / $ / $ / $
TOTAL CDBG FUNDING / $ / $ / $

(Federal Funds)

HOME Eligible Activities

Current Funds Allocation / Requested Funds / Other Funds
# of Units (where applicable) / FY2012-2013 / FY2013-2014 / FY2013-2014
1 / Acquisition of Real Property / $ / $ / $
2 / Rehabilitation / $ / $ / $
3 / Homeownership Assistance / $ / $ / $
4 / New Construction / $ / $ / $
5 / Program Administration (For City Administration Projects Only) / $ / $ / $
6 / CHDOCapacityBuilding / $ / $ / $
7 / CHDO Loan Funds / $ / $ / $
TOTAL HOME FUNDING / $ / $ / $

ESG Eligible Activities

Current Funds Allocation / Requested Funds / Other Funds
# of Units (where applicable) / FY2012-2013 / FY2013-2014 / FY2013-2014
1 / Street Outreach Component / $ / $ / $
2 / Emergency Shelter Component / $ / $ / $
3 / Homelessness Prevention Component / $ / $ / $
4 / Rapid Re-Housing Component / $ / $ / $
5 / Homeless Management Information System (HMIS) Component / $ / $ / $
6 / Administrative Costs / $ / $ / $
TOTAL ESG FUNDING / $ / $ / $

HOPWA Eligible Activities

Current Funds Allocation / Requested Funds / Other Funds
# of Units (where applicable) / FY2012-2013 / FY2013-2014 / FY2013-2014
1 / Housing Information and Counseling / $ / $ / $
2 / Resource Identification and Development / $ / $ / $
3 / Acquisition, Rehab, Conversion & Repair of Facilities / $ / $ / $
4 / Lease of Facilities / $ / $ / $
5 / New Construction / $ / $ / $
6 / Project or Tenant-Based Rental Assistance (Long-Term) / $ / $ / $
7 / Short-Term Rent, Mortgage and Utility Payments / $ / $ / $
8 / Supportive Services / $ / $ / $
9 / Operating Costs for Housing Facilities / $ / $ / $
10 / Technical Assistance / $ / $ / $
11 / Administrative Expenses (Grantee and Project Sponsor) / $ / $ / $
TOTAL HOPWA FUNDING / $ / $ / $

FY 2014-2015

Federal Funds Only

(CDBG, HOME, ESG, & HOPWA) Request For Funding

Activity Budget Sheet

Instructions: DO NOT complete this form until you have read the guidelines that define the eligible activities.

(See Attachment F) In the first column, check the funding activities requested and then show

all eligible costs for each activity.

CDBG Eligible Activities

Requested Funds / Other Funds
# of Units (where applicable) / FY2014-2015 / FY2014-2015
1 / Acquisition of Real Property / $ / $
2 / Disposition / $ / $
3 / Public Facilities & Improvements / $ / $
4 / Clearance & Demolition / $ / $
5 / Public Services / $ / $
6 / Interim Assistance / $ / $
7 / Urban Renewal Completion / $ / $
8 / Relocation / $ / $
9 / Loss of Rental Income Replacement / $ / $
10 / Removal of Architectural Barriers / $ / $
11 / Privately Owned Utility Development / $ / $
12 / Construction of Housing / $ / $
13 / Direct Homeownership Assistance / $ / $
14 / Micro Enterprise Assistance / $ / $
15 / Rehabilitation / $ / $
16 / Lead-Based Paint Hazard Evaluation/Reduction / $ / $
17 / Code Enforcement / $ / $
18 / Historic Preservation / $ / $
19 / Commercial/Industrial Improvement by Nonprofit / $ / $
20 / Economic Development Services / $ / $
21 / Direct Economic Development Assistance to
Private For-Profit Entities / $ / $
22 / CBDO Activities for Otherwise Ineligible Activities / $ / $
23 / Planning / $ / $
24 / Program Administration (For City Administration Projects Only) / $ / $
TOTAL CDBG FUNDING / $ / $

(Federal Funds)

HOME Eligible Activities

Requested Funds / Other Funds
# of Units (where applicable) / FY2014-2015 / FY2014-2015
1 / Acquisition of Real Property / $ / $
2 / Rehabilitation / $ / $
3 / Homeownership Assistance / $ / $
4 / New Construction / $ / $
5 / Program Administration (For City Administration Projects Only) / $ / $
6 / CHDOCapacityBuilding / $ / $
7 / CHDO Loan Funds / $ / $
TOTAL HOME FUNDING / $ / $

ESG Eligible Activities

Requested Funds / Other Funds
# of Units (where applicable) / FY 2014-2015 / FY2014-2015
1 / Street Outreach Component / $ / $
2 / Emergency Shelter Component / $ / $
3 / Homelessness Prevention Component / $ / $
4 / Rapid Re-Housing Component / $ / $
5 / Homeless Management Information System (HMIS) Component / $ / $
6 / Administrative Costs / $ / $
TOTAL ESG FUNDING / $ / $

HOPWA Eligible Activities

Requested Funds / Other Funds
# of Units (where applicable) / FY2014-2015 / FY2014-2015
1 / Housing Information and Counseling / $ / $
2 / Resource Identification and Development / $ / $
3 / Acquisition, Rehab, Conversion & Repair of Facilities / $ / $
4 / Lease of Facilities / $ / $
5 / New Construction / $ / $
6 / Project or Tenant-Based Rental Assistance (Long-Term) / $ / $
7 / Short-Term Rent, Mortgage and Utility Payments / $ / $
8 / Supportive Services / $ / $
9 / Operating Costs for Housing Facilities / $ / $
10 / Technical Assistance / $ / $
11 / Administrative Expenses (Grantee and Project Sponsor) / $ / $
TOTAL HOPWA FUNDING / $ / $

1