Budget Year: / Applicant: / County:

Community Development Block Grant – Superstorm Sandy

Essential Services Grant Application for Municipalities (4th Round)

Division of Local Government Services - Department of Community Affairs

General Instructions: This application shall be read in conjunction with the Program’s Round 4 Program Guidelines. Information contained in the application is subject to independent verification by the Division, which may request additional documentation as needed.

Only municipalities and school districts that received an Essential Services Grant in 2015 may apply for a Fourth Round CDBG Essential Services Grant. Eligible school districts must apply through a separate process and cannot use this form. Applications and all accompanying documentation shall be submitted via email to the attention of Jason Martucci, Program Manager, at no later than April 8, 2016; however, DLGS reserves the right to modify said date as circumstances require.

Please refer to the Round 4 Program Guidelines for additional information about this program and the application process. Funding will only be made available for current year budgets. In the event applicant data or narrative statements fail to fit into the allotted space on the application, please attach a separate document.

Name of Local Government / County
Mayor (or head of governing body)
Phone / Fax / E-mail
Chief Administrative Officer
Phone / Fax / Email
Chief Financial Officer
Phone / Fax / Email

I. Materials to be Submitted with Application:

o  Introduced CY2016/FY2017 budget and all documentation provided to the governing body relating to same

o  Most recent Audit and Annual Financial Statement

o  In Excel format, the name of each local government officer and employee as of the first payroll of the budget year together with their annual salary, title, department and date of hire

o  Current organization chart showing budgeted positions and titles (do not include salaries on the chart)

o  List of all new hires from July 1, 2015 through present

o  Fully-executed Application for the Community Disaster Loan Program, along with updated revenue and expenditure figures to reflect actual experience or more current estimates as compared to projections shown in the Community Disaster Loan Application.

o  Proposed Grant Budget (utilizing template supplied by the Division of Local Government Services)

o  Either a governing body resolution or a signed statement from the head of governing body, chief financial officer and chief administrative officer authorizing application submission.

II. Aid Request

State the Essential Services Grant amount being sought, which shall not exceed what the municipality can in good faith demonstrate is its 2016 Superstorm Sandy Budgetary Impact: $______

III. Explanation of Need for Essential Services Grant

Essential Service Grants are only available to provide funding to pay for essential services. See the Round 4 Program Guidelines for a further explanation on what qualifies as an “essential service” under this Program.

1.  In summary form, explain why a gap remains between essential service needs and revenues (not including the requested Essential Service Grant) available to the municipality in support of its budget. Detail what essential services would not be funded in 2016 without the requested Essential Services Grant. Describe the impact that the lack of such services will have on residents. If layoffs, furloughs, or reductions in hours of essential public safety personnel or other essential service personnel would be necessitated due to budget constraints, please specify them.

IV. Historical Fiscal Statistics

Item / 2012 / 2013 / 2014 / 2015 / Proposed 2016
Property Tax/Budget Info
Municipal tax rate / $ / $ / $ / $ / $
Municipal Purposes tax levy / $ / $ / $ / $ / $
Total general appropriations / $ / $ / $ / $ / $
Assessment Data
Assessed value (as of
application submission date) / $ / $ / $ / $ / $
Average Residential
Assessment / $ / $ / $ / $ / $
Cash Status Information
% of current taxes collected / % / % / %
% used in computing
reserve / % / % / % / % / %
Reserve for Uncollected
Taxes / $ / $ / $ / $ / $
Total year end cash surplus / $ / $
Total non-cash surplus / $ / $
Year-end deferred charges / $ / $
Water and/or Sewer Fees
% of current fees collected / % / % / % / % / %
Actual fees collected / $ / $ / $ / $ / $
Full time Staffing Levels
Uniformed Police - Staff #
Total S&W Expend. / $ / $ / $ / $ / $
Uniformed Fire - Staff #
Total S&W Expend. / $ / $ / $ / $ / $
All Other Emp. - Staff #
Total S&W Expend. / $ / $ / $ / $ / $

V. Revenue Measures and Cost Restraint

A. Revenue Measures

Please describe any additional revenue strategies being employed in support of your 2016 budget

B. Cost Restraint Measures in 2016 Budget

List and describe all actions in the municipality’s introduced 2016 budget that have limited or reduced expenditures versus 2015 (e.g. reductions in staff, curtailing or elimination of services).

Line Item / Prior Year Actual / Application Year Proposed / Explanation of Changes

VI. Employee Salary and Contract Information

1. Non-Union Employees

a.  Please list each non-union position receiving a pay increase of greater than 2% in 2015, if any.

b.  Please list each non-union position for which there any planned salary increases above 2% in 2016 and/or 2017.

2. Union Employees

a.  Salary Increases (when more than one bargaining unit for each category, use average):

Question / Police / Fire / Other Contract
Average percentage increase (2013) / % / % / %
Average percentage increase (2014) / % / % / %
Average percentage increase (2015) / % / % / %
Average percentage increase (2016) / % / % / %
Average percentage increase (2017) / % / % / %

b. Status of Collective Negotiation (Labor) Agreements: List each labor agreement by employee group, contract expiration date, and the status of negotiations of expired contracts in the following format:

Employee Group / Expiration Date / Status of Negotiations of Expired Agreement

VII. Shared/Privately Contracted Services & Capital Assets

1. List all services with which the local government shares with another government agency or contracts out to either a private (commercial) entity or a non-profit organization. Cooperative purchasing agreements do not constitute a shared service for purposes of this question.

Service / Name of Entity (state whether applicant receives or provides the service) / Estimated Amount of Contract / Year Last Negotiated (as applicable)

2. Discuss any shared services or privatized services you are considering going forward.

3. Discuss any plans for sharing capital assets (e.g. buildings, equipment) with another government entity. One example of capital asset sharing could be jointly utilizing a public works facility with one or more municipalities.

VIII. Surplus

If the municipality’s introduced budget displays a surplus, please provide an explanation as to why this amount of surplus 1) is necessary to maintaining the applicant’s fiscal integrity and 2) does not obviate the need for an Essential Services Grant in 2016.

IX. Other Sandy Related Grants

List all Sandy-related grants being sought or that have been awarded in 2016.

X. Rebuilding for Resiliency

1.  Describe the actions being taken to facilitate appropriate and timely reconstruction of public and private property, including efforts to enhance resiliency and preparedness for the impact of future storms. Include in this section answer to the following, as applicable:

a.  Discuss any plans to locate capital assets in non-flood-prone areas.

b.  Describe efforts to modernize zoning and capital plans to ensure appropriate construction that anticipates future flooding;

c.  Describe initiatives to modernize redevelopment plans or master plans to ensure appropriate development;

d.  Describe efforts to secure easements, permits, and funding necessary to advance shore protection or flood control measures;

XI. Agreement to Housing and Urban Development Conditions.

If aid is granted, the municipality will be required to limit grant usage and submit to certain reporting and auditing conditions. Please mark each box below indicating that the applicant understands, and agrees to comply with certain basic reporting and oversight provisions.

Yes / No
1.  Funds must be segregated and used only to support essential services that could not otherwise have been provided.
2.  Reporting and auditing requirements to verify appropriate fund usage will be complied with.
3.  Execute a Grant Agreement and comply with all its provisions, without exception.

XII. CERTIFICATION OF APPLICATION

The undersigned herewith certify that they have reviewed this application and find its contents to be true and that it accurately portrays the circumstances regarding the local government's fiscal practices and need for financial assistance.

Name/Title ______Date: ______

Signature: ______

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