Emergency Food & Shelter Program

Emergency Food & Shelter Program

Miami-Dade County

Jurisdiction #1594-00

Phase 31 Application

Complete and return ONE application by 5:00 p.m. on Tuesday, October 15, 2013. Application should be emailed to .

(Please Note: Applications submitted after the deadline will NOT be accepted or reviewed.)

COVER PAGE

APPLICANT INFORMATION

Name of Organization:

Program Name:

Program Address:

Mailing Address:

(if different from Program)

Executive Director’s Name:

Contact Name:

Contact Title:

Phone #:

E-mail Address:

Website Address:

# of Previous EFSP Awards:

0-4

5 or more /

Year of Last

EFSP Award:

TOTAL AMOUNT REQUESTED:

To the best of my knowledge and belief, the data in this proposal is true and correct and the governing body of the applicant has duly authorized the enclosed documents. I understand that incomplete applications or applications submitted after the deadline will not be accepted or reviewed. In addition, I (or an agency representative) have attended the mandatory application meeting and have been fully advised of this process.

By signing below, the undersigned acknowledges having read and understood the program guidelines and will be able to fully comply with the provisions of these guidelines as well as any additional applicable federal, state and local requirements, including procurement and financial management. Applicant also acknowledges that if a funding recommendation is made for less than the full amount applied for, additional documentation to include but not limited to a revised budget, scope or work, and proposed accomplishments may be requested prior to final funding determinations.

Authorized Signature: ______Date:______

Printed Name: ______Title:______

Table of Contents

Cover Page 1

Table of Contents 2

SECTION 1: EFSP LRO Criteria 3

SECTION 2: Program 5

SECTION 3: Budget 6

SECTION 4: Local Board Priorities……………………..8

SECTION 5:Geographic Information 9

Required Attachments:

501(c)3 Form

Board of Directors List

Non-discrimination Policy

FEIN and Tax-Exempt Status

Table of Organization

Budget Form: Agency Revenues and Expenses

SECTION 1: EFSP LOCAL RECIPIENT ORGANIZATION (LRO) CRITIERIA

For a local agency to be eligible for funding, it must meet all the following criteria. Please provide the appropriate documentation as requested.

Be nonprofit or an agency of government. Please provide a copy of your 501(c)3 certification.

Attached N/A

If private, not-for-profit, have a voluntary board. Please provide a copy of your current Volunteer Board Member Roster.

Attached N/A

Practice nondiscrimination (those agencies with a religious affiliation wishing to participate in the program must not refuse services to an applicant based on religion or require attendance at religious services as a condition of assistance, nor will such groups engage in any religious proselytizing in any program receiving EFSP funds). Please provide a copy of your agency’s non-discrimination policy for the provision of services (this is NOT your nondiscrimination policy for employment or volunteer services).

Attached N/A

Have a Federal Employer Identification Number (FEIN), (note: contact local IRS office for more information on securing FEIN and the necessary form (SS-4) (Website: Please provide a copy of your FEIN and a copy of tax-exempt status, which you must utilize the FEIN of a fiscal agent. A fiscal agent is another non-profit organization that may receiver Emergency Food and Shelter Program funds and maintains fiscal responsibility on behalf of another organization.

Attached N/A

Does your agency attempt to involve homeless individuals and families in the provision of emergency food and shelter services (through employment, volunteer programs, etc.)?

Yes (if yes, describe below how they are involved)

No (if no, describe below how you plan to involve them through this program to the extent practicable).

Does your agency have an accounting process in place by which you would manage EFSP funding if you are awarded funds?

YesNo

If yes, briefly describe the process utilized and provide the name, title and contact information of the person responsible for authorizing and managing EFSP expenditures.

Conduct an independent annual audit if receiving $25,000 or more in EFSP. Does your agency conduct an independent annual audit? (Please note: DO NOT submit your audit with your application. If you are awarded more than $25,000 in EFSP funds you will be asked to submit your audit.)

YesNo

(Please Note: Applications that do not meet all of the program requirements listed below or do not submit all necessary documentation will not be accepted or reviewed.)

SECTION 2: PROGRAM (THIS SECTION IS NOT TO EXCEED TWO PAGES)

Please describe the mission of the organization and provide a table of organization (place an asterisk next to the program for which you are requesting funding).

Provide a succinct summary of the program for which you are requesting funding to include: (a) target population, (b) number of clients currently served (without EFSP funding), (c) a general description of program activities and processes used by the agency to deliver proposed services, and (d) how the EFSP funds will be used to enhance the current services.

(a) Target Population:

(b) Clients Currently Served Without EFSP Funding:

(d) How will EFSP funds be used to enhance current services:

Please describe the need for these services in Miami-Dade County or your specific service area, and provide local data to support your case for funding.
Please list all of the proposed service locations for the program for which you are requesting funding, hours of operation, the number of staff members at each site, and their role in providing these services.
What are the eligibility criteria for individuals requesting services and how is this documented?
How will these services be coordinated with other programs within your agency and within the community?
Describe what mechanism your agency has implemented to prevent fraud and misuse of funds.

SECTION 3: BUDGET

Total amount of funding requested:

The intent of the EFSP is to supplement and expand current available resources and not to substitute or reimburse ongoing programs and services or to start new programs. Services for which funding is being requested must already be provided by your agency through other funding sources.

For each EFSP line item for which you are requesting funding, please indicate number of units you propose to serve with those funds, the cost per unit, the total amount of your request, other available funding for the service area, and the source of this funding.

For each requested line item, please answer the following:
(a) Describe the services currently being provided
(b) Describe the process by which the services are provided

Please note: transportation costs should be included in the cost per unit for each line item for which it’s applicable.

A / B / C / D / E
Food Services / # of Units / Cost per Unit / Total EFSP Request
(AxB=C) / Current Program Funds (Non-EFSP Funds) / Sources of Current Prog Funds (Non-ESFP)
Bulk Food
Congregate Meals
Food Vouchers
Home Delivered Meals
Total
A / B / C / D / E
Shelter Services / # of Units / Cost per Unit / Total EFSP Request
(AxB=C) / Current Program Funds (Non-EFSP Funds) / Sources of Current Prog Funds (Non-ESFP)
Rent/Mortgage
Mass Shelter
Utilities
Total

Please note: agencies receiving funding in the area of Mortgage Assistance will be required to process cases through the EFSP Clearinghouse and receive approval prior to releasing the funds on behalf of the client.

Supplies & Equipment / Total EFSP Request ($300 max. per item)
Small equipment essential to the operation of food banks or pantries
Consumable supplies essential to distribution of food
Consumable supplies essential to mass feeding and/or mass shelters of 5+ beds
Small equipment essential to mass feeding and/or mass shelters
Total

Please note: If requesting Supplies & Equipment funds, please list the items you intend to purchase and for what purpose.

Please complete the attached revenue and expenses for your program and agency. This form should NOT include the EFSP funding that you are requesting. If there is a budget deficit, please explain how you will ensure that EFSP funds are not used to meet that deficit.

SECTION 4: LOCAL BOARD PRIORITIES

Please check off all of the Local Board priorities that services provided by your agency address:

Agencies that provide rental assistance in excess of $100,000 (non-EFSP funding) to families facing court-ordered eviction or who are already homeless. (If your agency selects this priority, please answer the questions below).

(a)Provide a clearly detailed list of federal, state and/or local grants (non-EFSP) and funding amount that your agency currently receives to provide rental assistance to families that are homeless or facing eviction.

(b)Please provide a detailed plan on how your agency would utilize EFSP funding, in conjunction with current funding streams noted above, towards rental-assistance for families that are homeless or facing eviction.

Rent/mortgage assistance for families

Families facing recent economic hardship

Food assistance in the form of food vouchers and/or bulk food

South Dade

SECTION 5: GEOGRAPHIC INFORMATION

Please check off all of the geographic areas listed below that are served by your agency:

Emergency Food & Shelter Program

Miami-Dade County

Jurisdiction #1594-00

Phase 31 Application

[ ] Allapattah

[ ] Aventura

[ ] BalHarbour

[ ] Bay Harbor Islands

[ ] Biscayne Bay

[ ] Biscayne Park

[ ] Brickell

[ ] Brownsville

[ ] Carol City

[ ] Coconut Grove

[ ] Coral Gables

[ ] Cutler Ridge

[ ] Doral

[ ] Edison

[ ] El Portal

[ ] Florida City

[ ] Golden Beach

[ ] Golden Glades

[ ] Goulds

[ ] Hialeah

[ ] Hialeah Gardens

[ ] Homestead

[ ] Homestead AFB

[ ] Indian Creek

[ ] Islandia

[ ] Kendale Lakes

[ ] Kendall

[ ] Key Biscayne

[ ] Leisure City

[ ] Liberty City

[ ] Little Haiti

[ ] Little Havana

[ ] Medley

[ ] Melrose

[ ] Miami

[ ] Miami Beach

[ ] Miami Gardens

[ ] Miami Lakes

[ ] Miami Shores

[ ] Miami Springs

[ ] Model City

[ ] Norland

[ ] North Bay Village

[ ] North Miami

[ ] North Miami Beach

[ ] Opa-Locka

[ ] Overtown

[ ] Palmetto Bay

[ ] Perrine

[ ] Pinecrest

[ ] Princeton

[ ] Redlands

[ ] Richmond Heights

[ ] South Miami

[ ] South Miami Beach

[ ] Sunny Isles Beach

[ ] Surfside

[ ] Sweetwater

[ ] Tamiami

[ ] Virginia Gardens

[ ] West Kendall

[ ] West Miami

Emergency Food & Shelter Program

Miami-Dade County

Jurisdiction #1594-00

Phase 31 Application

[ ] All of Miami-Dade County (includes all the areas listed in this section)

Other (Please specify) ______

END OF APPLICATION

**********************************

EFSP LOCAL BOARD/PROGRAM ADMINISTRATIVE OFFICE:

CONTACT:Jessica MartinezCONTACT:Vanessa Benavides

Tel:(305) 646-7076Tel:(305) 646-7085

Fax:(305) 646-7079Fax:(305) 646-7079

E-mail:-mail: