AGENCY: Click here to enter text. Facility Address: Click here to enter text.
Program(s) on site: Click here to enter text.
Staff Contact for the GNA (Name/Title): Click here to enter text.
Phone: Click here to enter text. Email:Click here to enter text.
GNA EXEMPTION: Please discuss your exemption request with your City Program Coordinator prior to submittal.
This facility is exempt from a GNA for the following reason (check one):
☐ Facility address is confidential ☐ Facility is located within a larger campus ☐Facility is administrative only
Please describe the reason for your exemption: Click here to enter text.

As a Human Services Grant Program grantee, you must have a City-approved Good Neighbor Agreement Policies and Practices description (GNA) on file.

Compliance with the GNA is noted in your contract as a Special Funding Condition (Exhibit A). The City will measure compliance as follows:

  • Timely submittal of a City-approved Good Neighbor Agreement Policies and Practices.
  • Documentation of agency’s good faith efforts to address complaints in a timely manner with consistency, including written notification to City staff of any on-going issues as appropriate.
  • Good faith efforts generally include modifications to facilities and program operations that do not present fiscal hardships to the agency and can include, but are not limited to: program modifications that do not negatively impact the ability of clients in need to access services, such as adjusting operating hours; additional training of staff; documented meetings/negotiations with neighbors; documented communication with HSD staff and SMPD as appropriate; capital improvements; banning/suspending participants who generate multiple complaints.
  • Lack of evidence of good faith efforts may be considered as non-compliance with this contract provision and could be cause for contract termination.
  • Updated complaints log must be available for City review at any time upon request, and submitted at mid-year and year-end.

The City may, at any time, require the agency to revisit and/or update a GNA, in the event that the facility generates excessive complaints, complaints are not resolved appropriately or in a timely manner or if the facility is cited for zoning or code violations.

I agree to comply with the attached Good Neighbor Agreement Policies and Practices for the facility and programs named above:

Name:Click here to enter text. Title: Click here to enter text.

Date:Click here to enter text. Signature: ______

INSTRUCTIONS:

  • EXEMPT FACILITIES – please complete the exemption box on Page 1 of the Good Neighbor Agreement Policies and Practices Form, and sign and date the form. Do not complete any of the following sections.
  • NON-EXEMPT FACILITIES - please complete the appropriate sections based on the following criteria:

Tier 1 Facilities: If this facility has not previously been required to submit a Good Neighbor Agreement to the City as a funding condition, and has no prior history of community complaints, please complete Section 1 and 2 only.

Tier 2 Facilities:If this facility has previously been required to submit a Good Neighbor Agreement to the City as a funding condition, or has some prior history of community complaints, please complete Sections 1 -5.

SECTION 1: Complaints

  1. Does your agency currently have a process for tracking and responding to community complaints?Yes☐ No☐

  1. If NO, each program must identify a staff person assigned to coordinate and track complaints, and maintain, at minimum, a compliant log. Please consult with your City Program Coordinator.

  1. Who is responsible for managing community complaints?
(Staff name and title)Click here to enter text.
  1. Briefly describe the steps for responding to complaints, including the turn-around time from comment to response, if responses are provided in writing or orally, and how you deal with un-resolved issues.
    2. Click here to enter text.

SECTION 2: Clients

  1. Do your facility rules have clearly stated expectations for client behavior in and around the facility? Yes☐ No☐

  1. Does your facility have sufficient space for clients to wait inside for services? Yes☐ No☐

  1. If “No”, please describe how you manage clients outside the facility.
    2. Click here to enter text.

SECTION 3: Facility Description

  1. How many years has the facility been used to provide social services? Click here to enter text.

  1. Does the facility have on-site security? Yes☐ No☐

If Yes, is security provided 24 hrs? Yes☐ No☐
  1. Does the facility have external security cameras? Yes☐ No☐

  1. Briefly describe the day-to-day steps taken to keep the facility’s exterior clean and well maintained.
    2. Click here to enter text.

SECTION 4: Neighborhood Description

  1. Is the neighborhood around the facility: Mostly residential ☐ Mostly commercial ☐ Mixed☐

  1. Please check the “Active” box if the neighborhood has one of the following. Also indicate if your agency participates.

Type of Association (If association has a formal name, please include) / Active / Participation
Neighborhood Watch Program: Click here to enter text. / ☐ / Yes☐ No☐
Neighborhood Association: Click here to enter text. / ☐ / Yes☐ No☐
Other: Click here to enter text. / ☐ / Yes☐ No☐
Other: Click here to enter text. / ☐ / Yes☐ No☐
Other: Click here to enter text. / ☐ / Yes☐ No☐
  1. Who is your police department Neighborhood Resource Officer (SMPD) or Senior Lead Officer (LAPD)?
    2. Click here to enter text.

  1. Please attach any existing Good Neighbor Agreements this facility currently has in effect.

SECTION 5: Community Outreach

  1. Check the box to indicate which of the following communication strategies your agency uses to reach people in your community and indicate how often you use the strategy and how many stakeholders are reached each time:

Strategy / In Use / Frequency / # of Stakeholders Reached
Open House/Public Events / ☐ / Click here to enter text. / Click here to enter text. /
Newsletter / ☐ / Click here to enter text. / Click here to enter text. /
Flyers / ☐ / Click here to enter text. / Click here to enter text. /
Community Meetings / ☐ / Click here to enter text. / Click here to enter text. /
Social Networking (web) / ☐ / Click here to enter text. / Click here to enter text. /
Other (please specify)
Click here to enter text. / ☐ / Click here to enter text. / Click here to enter text. /

Good Neighbor Agreement Policies and Practices Form / Page 1 of 3

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