FY2018 CDBG Competitive Application

Prince William Area

Community Development Block Grant (CDBG) Application

EXHIBIT A

Prince William County Office of Housing and Community Development

15941 Donald Curtis Drive, Suite 112, Woodbridge, Virginia 22191

Applicant Information

Applicant Organization
Mailing Address
Phone #
Fax #
E-mail Address
Tax ID #
DUNS #

Application Preparer/Staff Contact Information

Name/Title
Organization/Agency
Address
Phone
Fax
E-mail Address

Type of Organization

Non-Profit 501 (c)

Faith Based Organization

Government/Public Agency

For-Profit

Project Title(please use a simple phrase or sentence)

Project Address

Funding Request

PrinceWilliamCountyManassasCityBoth

County / City / Total
Minimum Funding Request to Implement & Complete Project / $ / $ / $
Amount of Other Funds Secured for the Project / $ / $ / $
Total Cost to Complete the Project / $ / $ / $

1st Year Funding2nd Year Funding 3rd Year Funding

Request for Repayable LoanRepayable Loans indicate # of years (15-30):

Request for Forgivable Loan (Public Service)

Request for 30 Year Deferred Forgivable Loan (Acquisition/Rehab)

Request for Deferred Loan (Rehab only)

I.NATIONAL OBJECTIVE CRITERIA AND ELIGIBLE ACTIVITIES

A.National Objectives

To be eligible for CDBG funding from the County, the project must meet the National Objective: Benefits low – and moderate-income (LMI) persons. In order to be considered as benefiting low – and moderate-income persons, an activity must fall into one of the categories below. Please check the applicable box for your project.

Area Benefit – The project serves only a limited area which is proven by 2010 Census data or survey to be LMI. By choosing this category you must be able to prove your project/activity primarily benefits LMI households. At least 51% of the residents within the targeted activity area are LMI income persons.

Census Tract / Block Group

Limited Clientele – The project/activity benefits a specific group of people (rather than all areas in a particular area), at least 51% of whom are LMI. Note: Income verification for clients must be provided for this category. To qualify under this subcategory, a limited clientele activity must meet one of the following tests. Please check the appropriate box.

Clientele must be one of the following groups (please check which group best describes your clients):

abused children illiterate adults

elderly persons persons living with HIV/AIDS

battered spouses migrant farm workers

severely disabled persons homeless persons

Require information on family size and income so that it is evident that at least 51% of the clientele are persons whose family income does not exceed the LMI limits; or

Have income eligibility requirements, which limit the activity exclusively to LMI persons.

Housing – The project/activity adds or improves permanent, residential structures that will be occupied by LMI persons upon completion. The housing can be either owner or renter occupied. Rental units occupied by LMI persons must be at affordable rents based on established standards.

Jobs– The project/activity creates or retains permanent jobs, at least 51% of which are taken by LMI persons or considered to be available to LMI persons.

Number & Percentage of LMI Served

Please select the beneficiary accomplishment type

Unit / Total Served / Total LMI / % LMI
People to be Served
Households
Housing Units
Public Facilities
Jobs

Method of data collection to track persons, households, or housing units served for ethnicity and income levels.

Use of Computer Software Package
Manual Collection for Verification of Income Eligibility
Target Area Benefit
Other

B.Eligibility Activity

Indicate with an “X” the activity category that most closely describes your proposed use of CDBG funds. Only one category maybe selected.

570.201 (a) / Acquisition of Real Property
570.201 (b) / Disposition
570.201 (c) / Public Facilities & Improvements
570.201 (d) / Clearance Activities
570.201 (e) / Public Service – Check one of the following
New Public Service
Quantifiable increase in level of an existing public service
570.201 (f) / Interim Assistance
570.201 (g) / Payment of Non-Federal Share
570.201 (h) / Urban Renewal Completion
570.201 (i) / Relocation
570.201 (j) / Loss of Rental Income
570.201 (k) / Housing Services
570.201 (l) / Privately Owned Utilities
570.201 (m) / Not Applicable - Repealed
570.201 (n) / Homeownership Assistance
570.201 (o) / Micro-enterprise Assistance
570.201 (p) / Technical Assistance
570.201 (q) / Assistance to Institutions of Higher Education
570.202 (a) / Eligible Rehabilitation & Preservation Activities
570.202 (c) / Code Enforcement
570.202 (d) / Historic Preservation
570.202 (e) / Renovation of Closed Buildings
570.202 (f) / Lead-based Paint Hazard Evaluation & Reduction
570.203 / Special Economic Development
570.204 / Special Activities by Community-Based Development Org. (CDBO)

II.CONSISTENCY WITH FY2016-2020 (FFY2015-2019) CONSOLIDATE PLAN

Indicate with an “X” the specific Objective and Outcome that the proposed funded activity will satisfies. Only one goal per application may be selected.

SERVICES
Youth Services - Services to address needs of youth.
Child Care - Services to care for children.
Disability Services - Services to meet the needs of persons with disabilities.
Health Services/Substance Abuse - Services to address the healthcare needs of residents, including substance abuse treatment.
Senior Services - Services to meet the needs of seniors.
Legal Services - Services to meet the legal needs of low-income residents.
Domestic Violence/Child Abuse - Services to meet the needs of those who have experience domestic violence or child abuse.
Emergency Assistance - Assistance to households to help them remain in their homes and prevent homelessness.
Meals/Food - Provision of services that help feed residents.
Transportation - Services that help meet the transportation needs of residents.
Job Training and Workforce Development - Programs that prepare residents for employment opportunities.
Employment Training - Training programs to meet specific employment opportunities.
Rental Housing Subsidies - Assistance to renters to reduce their housing expenses.
HOUSING & PUBLIC FACILITIES
Housing Assistance – Homeownership - Downpayment and closing cost assistance to low-income homebuyers.
Housing Repair - Grants or loans to assist homeowners with needed home repairs.
Emergency Home Repairs - Assistance to homeowners to address emergency repair needs.
Housing Development and Reconstruction - Housing development and reconstruction for the creation of new affordable housing units.
Public and Community Facilities - Funding to assist with development of or repairs to public and community facilities in CDBG eligible areas.
Public Improvements - Improvements to public systems within CDBG eligible areas.
Other Public Facility Needs - Funding to address other public facility needs.
Infrastructure - Improvements to streets and sidewalks in CDBG eligible areas.
Parks and Recreation Facilities - Improvements to parks and recreation facilities within CDBG eligible areas.
HOMELESS
Homeless Case Management - Case management services for homeless persons to assist them in finding services they need.
Homeless Supportive Services – Transportation - Transportation services that assist homeless persons utilize services to address their needs.
Homeless Prevention and Emergency Assistance - Services designed to keep households in their homes and prevent homelessness.
Domestic Violence Shelters - Funding for shelters for victims of domestic violence.
Transitional Housing - Housing designed to help homeless persons transition from emergency shelter to permanent housing.

III.PROJECT DESCRIPTION

Project Summary (maximum 2 pages)

Provide a brief summary of your project to include a description with reference to 1) “Eligible Activities”, 2) who will administer the project, 3) where the project is located and why, 4) how lead-based paint requirements will be addressed if applicable 5) Single Service Delivery agencies and public service activity describe new or increased level of service. How many new (existing) positions will be created and number of persons served, 6)how Davis-Bacon wage rates for improvements will be followed 7) type of loan and provisions, if applicable for repayment, 8) match, 9) what methods will be used to publicize funding of this activity with CDBG funds?

B.Special Needs Served

Please identify the number of persons with special needs that this project will serve, if applicable. If not applicable indicate with N/A

Persons who are homeless
Persons with physical disabilities
Persons with mental illness
Persons with HIV/AIDS
Elderly persons
At-risk children and youth
Other:

C.Project Site

We have site control. We own or are leasing the real property on which the proposed project will be located; or we have executed a legally binding agreement or option to buy or lease the real property,

We have identified the real property on which the proposed property will be located; AND we have secured a verbal or binding agreement (e.g. memorandum of understanding) to buy or lease the real property.

We do not know where the proposed project will be located.

For acquisition, construction activities or service delivery, what is the address or location of the site

Does zoning allow the use you are proposing?YesNo

For projects that will include any type of construction, rehabilitation, or demolition please provide map and indicate area(s) that will be directly affected by the project

D.Accessibility

Federal regulations require that all facilities and/or services assisted with CDBG funds be accessible to disable, whenever feasible. Accessibility includes such things as: entrance ramps, parking with universal logo signage, grab bars around commodes and showers, top of toilet seats that meet required height from the floor, drain lines under lavatory sink either wrapped or insulated, space for wheelchair maneuverability, accessible water fountains, access between floors (elevators, ramps, lifts), and other improvements needed to assure full access to funded facilities/programs, including serving the blind and deaf. Will the completed project meet standards for accessibility? Yes No

E.Project Cost

What is the total project cost?$

Cost Estimate(s)

List sources and dates of project cost estimates and identify as “Attachment I, Cost Estimates”, limit one page per estimate. This attachment must follow Exhibit A application.

Source:Date: Cost:

G.Project Budget

Line Item / CDBG Funds / Non-CDBG Funds / Total
Salary / $ / $ / $
Fringe / $ / $ / $
Supplies / $ / $ / $
Arch./ Engineer Fees / $ / $ / $
Acquisition / $ / $ / $
Construction / $ / $ / $
Rehabilitation / $ / $ / $
Contingency Funds / $ / $ / $
$ / $ / $
$ / $ / $
In-Kind Services / $ / $ / $
TOTAL / $ / $ / $

1. Will this activity incur ongoing operating cost? Yes No

2. Describe plans for providing source of funds for subsequent years activity cost and if application is for repayable loan, from what source will funds be provided.

3. Was this project awarded CDBG funds in prior years? Yes No

FY2015$FY2016$ FY2017 $

Was your organization awarded CDBG Funds in FY16 and did your organization utilize all of the funds within the agreement period? Yes No

H.Subsequent Year Activity Budget

Project Schedule (July 1, 2017 - June 30, 2018)

Steps you will take to complete the project within the 12 month timeframe allowed

Implementation/Milestones / Responsible Staff / Start Date / Completion Date

J.Displacement

If you intend to acquire, rehabilitate or demolish property, are there any persons who are currently living on the property, conducting a business on it, or storing personal property on it? Yes No N/A

IV.SPONSOR CAPACITY

A.Experience (maximum 1 page)

Explain your past experience in undertaking activities of similar complexity as the one for which funds are being requested. Describe the project manager’s experience administering grants, regulatory compliance, and fiduciary responsibilities for programs at the Federal, State or local level.

B.Staffing

Describe specifically the classification, name and hours per week of all staff within your organization that will be involved in the administration and implementation of your proposed project.

Name / Classification/Job Title / Hours Per Week

C.Administrative Systems

Indicate your organization’s administrative systems by checking each item that exists within your agency’s organizational structure.

Formal Personnel System

Are written procedures in place? Yes No

Staff Salary Tracking System by Funding Source

Audit System

Are formal written accounting procedures in place? Yes No

Recordkeeping System/Separate Tracking for Each Funding Source

Hard Copy Files and Computer Records Systems with Security and Back-up

Internal Monitoring/Evaluation System

Are written procedures in place? Yes No

Client Eligibility Verification

Client Demographic Data Collection and Reporting System

Procurement Policy

Are formal written procedures in place? Yes No

Conflict of Interest Policies

Client Grievance Policies

Annual Fundraising/Revenue Generation – Non-profit only

Financial Oversight by Board of Directors

Program Oversight by Board of Directors

D.Organization Current Budget

Attach copy of the organization’s current budget and identify as“Attachment II, Current Budget”. This attachment must follow Exhibit A application. If you have a deficit, please explain how CDBG funds will not be used to meet deficit.

E.Audit

Does your organization have an audit completed by an independent certified public accountant (CPA)? Yes No Date of Audit

If yes, attach copy of the most recently complete Audit which includes the “Management Letter” or written certification from a CPA that a Management Letter was NOT issued. Include your response(s) to the Management Letter if applicable and identify each as “Attachment III, Audit”. This attachment must follow Exhibit A application.

F.Income Tax

Did your organization file and income tax return last year? Yes No

Attach income tax return [Form 990 or 990EZ non-profit] and label as ”Attachment IV Income Tax Return”. This attachment must follow Exhibit A application.

III.MATCH

Applicants requesting funding may want to include a dollar-for-dollar ratio of match to demonstrate financial support of the project. List the amount of match resources, from all sources available for use along with CDBG dollars for your proposed project? A Match must match or exceed CDBG funds requested in project budget to receive Bonus Points. Federal dollars cannot be used for match points, but should be included in overall budget if applicable and identified as Federal dollars.

The evidence MUST state the dollar value and verify the availability of match resources obligated to this project. For non-profits, for-profits or governmental entities that have a Board of Directors, a Board Resolution must be provided. For non-profits, for-profits and governmental entities that do not have a Board of Directors, a letter from the Executive Director/President will be acceptable. In-Kind Agreements for Professional Services such as legal, accounting, engineering, management, planning, etc. can also be used as a match for the project. In-Kind contributors must state the value of their services for the project. Volunteer hours except for professional services are not applicable. Identify verification of match as “Attachment V, Leverage”. This attachment must follow Exhibit A application.

Line Item / CDBG Funds / Non-CDBG Funds / Total
Salary / $ / $ / $
Fringe / $ / $ / $
Supplies / $ / $ / $
Arch./ Engineer Fees / $ / $ / $
Acquisition / $ / $ / $
Construction / $ / $ / $
Rehabilitation / $ / $ / $
Other: / $ / $ / $
$ / $ / $
$ / $ / $
In-Kind Services / $ / $ / $
TOTAL / $ / $ / $

VI.BOARD AUTHORIZATION RESOLUTION

All applicants must provide a Board Authorization Resolution that allows the organization to make application for CDBG funds for project(s). Failure to provide a Board Authorization Resolution will preclude the application from being considered for funding. The resolution must indicate the project, amount of request, match if applicable, and repayment provisions in the format provided. For non-profit, for-profit and governmental entities that do not have a Board of Directors, verification can be a letter from the Executive Director/President. Identify verification of authorization to make application and terms of loan as “Attachment V, Board Authorization Resolution”. This attachment must follow Exhibit A application. If vote is by e-mail By-Laws must verify this means of voting is allowed.

#1 CERTIFICATION OF APPLICATION

SUBMITTAL OF AN APPLICATION IS NOT A GUARANTEE OF FUNDING

The undersigned acknowledge the following:

That, to the best knowledge and belief, all factual information provided is true and correct and all estimates are reasonable. This application and all attachments are complete and accurate.
That submittal of an application for this project is not a guarantee of funding from the Prince William County Office of Housing and Community Development (OHCD).
That the proposed project described in this application meets the following National Objective: Benefits low- or moderate (L/M) income persons, governing the use of CDBG funds.
That no revised applications may be made in connection with this application once the deadline for applications has passed, unless revisions and/are additional documentation are mandated by CDBG Program during their application review process.
That, if the project is funded, the OHCD reserves the right to reduce and/or cancel the allocation if federal entitlements are canceled, reduced, or rescinded.
That, if the project is funded, a written agreement that includes a statement of work, records retention and reporting, program income procedures, local and federal requirements, circumstances that would trigger grant suspensions and terminations, and reversions of assets would be required between the applicant and OHCD.
That, if the project is funded, the applicant shall comply with all federal and OHCD policies and requirements, OHCD procedures must be followed, as applicable to the CDBG Program.
That, if the project is funded, the applicant understands that HUD release of FY FY2018 CDBG funds must be obtained by the County prior to the obligation of funds (execution of a written agreement).
That, if the project is funded, OHCD will perform a National Environmental Policy Act (NEPA) review prior to the obligation of funds (execution of a written agreement).
That if the project is a facility, the applicant shall ensure the facility is maintained and operated for its approved use throughout its economic life, with a minimum period of five years from completion of the project, if the project is funded.
That a project’s funding does not guarantee its continuation in the County’s subsequent Action Plans.
That written signatory authority from the applicant’s governing body indicating who can execute written agreements/contracts and amendments on its behalf has been included with this application packet.
That, if the project is funded, the proposed activities (project tasks) listed in this application may be implemented without delay upon the execution of a written agreement between OHCD and the applicant.
That the proposed funding requested represents the amount needed to complete the project within 12 months.
That the applicant understands that all CDBG funds allocated to projects must be expended within 12 months of the date of the Agreement, or such funds are subject to being reprogrammed by OHCD.

That the applicant is fully capable of fulfilling its obligation under this application. That, if the project is funded, the applicant understands that CDBG funds are provided on a reimbursement basis and that required supporting documentation must be reviewed and accepted by assigned Contract Administrators or Project Manager prior to approval of payment to the applicant.
That, if the project is funded, all required federal and county certifications and assurances will be adhered to.
That the applicant will not use CDBG funds for grant writing, fundraising or lobbying per OMB Circular 2 CFR part 200.
That the applicant possesses the legal authority to apply for CDBG funds and to implement the proposed project.
That the applicant does not have any unresolved audit findings for prior CDBG and/or other federal-funded projects.
That there are no pending lawsuits that have been filed against the applicant.
That the applicant understands that OHCD may verify any or all statements contained in this application packet, and that any intentionally false information or omission may disqualify the applicant from consideration for CDBG funding in the current and future years.
That the applicant understands that, upon submission, this application packet becomes the property of OHCD and will not be returned to the applicant in whole or in part.
That the undersigned has reviewed this application packet for completeness and accuracy and have approved the description, performance goals, budget, and other aspects of the described project listed in this application
That the governing body of the applicant organization authorizes the submission of this application.
If the applicant fails to comply with the Reporting Requirements, Implementation Schedule or the expenditure of 50% of obligated funds by the 3rd Quarterly Report, the County can terminate the contract without giving a 30-day notice.

Name of Applicant Organization
Signature of Authorized Certifying Official/Representative Date
Print Name and Title of Authorized Certifying Official/Representative
CDBG Project Name

#2 CERTIFICATION REGARDING LOBBYING