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HomeMy WebLinkAbout4.06 Human Services Program Special Projector 19 82 /ii � 111 DATE: May 3, 2016 STAFF REPORT CITY COUNCIL TO: Honorable Mayor and City Councilmembers FROM: Christopher L. Foss, City Manager " SUBJECT: Human Services Program Special Project Prepared by Rhonda Franklin, Management Analyst EXECUTIVE SUMMARY: CITY CLERK File #920 -75 The City Council will consider approving a recommendation from the Human Services Commission to allocate special project funds of $30,000 to the Axis Community Health Capital Project for Dental Services. FINANCIAL IMPACT: As part of the Fiscal Year 2015 -16 budget, the City Council approved a one -time allocation of $30,000 from the General Fund for a special project to be recommended by the Human Services Commission for City Council review and approval. RECOMMENDATION: Staff recommends that the City Council adopt the Resolution Approving the One -Time Human Services Program Special Project Fund of $30,000 for the Axis Community Health Capital Project for Dental Services Feasibility Study Costs. `Reviewed By Assistant City Manager DESCRIPTION: At the City Council March 7, 2015 Strategic Planning Workshop, the City Council discussed and subsequently approved (at the Fiscal Year 2015 -16 Budget Hearing on June 2, 2015) the one- time $30,000 seed funding for a human services program special project, subject to City Council review and approval. These funds are in addition to the Human Services Grants Program and Community Development Block Grant funds, and are intended to provide one -time seed funding to support a project that benefits a human services need in the community. The allocation of these funds is in Page 1 of 3 ITEM NO. 4.6 line with the Tri- Valley Needs Assessment (Assessment), regional priorities, and the Human Services Commission's mission and vision. The Assessment identified 14 areas of concern or service gaps in the Tri - Valley (Attachment 1). In June 2014, the Human Services Commissions from the cities of Dublin, Livermore, and Pleasanton held a joint meeting and identified three priorities for future regional work: • Behavioral Health • Health Care (including Dental) • Senior Services Of the three priorities, behavioral health services, senior services, and most components of health care are currently being provided for low- income residents by community -based non- profit organizations with financial support from the three Tri - Valley cities. Some of the organizations providing these services include Axis Community Health, CALICO, CityServe of the Tri - Valley, CRIL, Senior Support of the Tri - Valley, Spectrum Community Services, Tri - Valley Haven, and YMCA. Dental services are an area of health care in which a majority of the underserved community's needs are not being met. The Assessment identified dental care as a most critical need that has significant barriers for access, including insurance coverage and transportation. The Assessment found that "subsidized dental care for low- income residents, particularly the elderly, is very scarce." An estimated 20,000 to 30,000 Tri - Valley residents are in need of dental care. Over the past several years, Dublin, Livermore, Pleasanton, Alameda County, and Axis Community Health have engaged in discussions about the feasibility of a future dental clinic in the Tri - Valley. Staff has met with all parties twice over the past six months to discuss the growing need and lack of services for dental care for low- income residents, and to explore opportunities and barriers. The last meeting took place on February 26, at which Alameda County informed attendees that a Request for Proposals (RFP) for Dental Health Services for Children and Families in East County had been issued. This is one of the first steps towards selecting and contracting with a qualified dental service provider. As part of the City of Dublin 2016 -2017 Human Services Grants Program, Axis Community Health submitted an application to request grant funding for a feasibility study for development of a dental care facility (Attachment 2). Preconstruction activities include a feasibility study that will provide recommendations for a site location, the quantity of dental chairs to provide, and other items based on current and projected dental care needs for the low- income and uninsured Tri - Valley residents. The Human Services Commission did not recommend an allocation through the Grants program at that time, but believed that this request would be an appropriate candidate for the one -time set aside by the City Council for the special human services project. At the March 24, 2016 Human Services Commission meeting, the Commission received a report from Axis Community Health and the Commission voted to recommend to the City Council the use of the one -time human services program special project fund of $30,000 in Fiscal Year 2015 -16 for the Axis Community Health Capital Project for Dental Services feasibility study by a unanimous vote of 5 -0 -0. NOTICING REQUIREMENTS /PUBLIC OUTREACH: Page 2 of 3 A copy of this Staff Report has been sent to Axis Community Health and the Human Services Commission. ATTACHMENTS: 1. Resolution Approving One -Time Human Services Program Special Project Fund of $30,000 for the Axis Community Health Capital Project for Dental Services Feasibility Study Costs 2. Tri- Valley Needs Assessment 14 Areas of Concern 3. Axis Community Health Capital Project for Dental Services Application Page 3 of 3 ATTACHMENT 1 RESOLUTION NO. XX - 16 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF DUBLIN * * * * * * * * * ** APPROVING ONE -TIME HUMAN SERVICES PROGRAM SPECIAL PROJECT FUND OF $30,000 FOR THE AXIS COMMUNITY HEALTH CAPITAL PROJECT FOR DENTAL SERVICES FEASIBILITY STUDY COSTS WHEREAS, on January 28, 2016, Axis Community Health presented a request to the Human Services Commission for the Fiscal Year 2016 -17 Human Services Grants Program for a Capital Project for Dental Services; and WHEREAS, the Human Services Commission did not recommend an allocation through the Human Services Grants Program; and WHEREAS, the Human Services Commission recommended the project be considered for the one -time set aside fund of $30,000 by the City Council for a special human services project which was established as part of the Fiscal Year 2015 -2016 Budget Hearing on June 2, 2015; and WHEREAS, the 2011 Tri- Valley Needs Assessment identities dental care as a most critical need that has significant barriers for access; and WHEREAS, dental care services are an area of health care in which a majority of the underserved community's needs are not being met; and WHEREAS, on March 24, 2016, the Human Services Commission recommended to the City Council use of the one -time human services program special project fund of $30,000 in fiscal Year 2015 -2016 for the Axis Community Health Capital Project for Dental Services. NOW, THEREFORE, BE IT RESOLVED that the City Council of the City of Dublin does hereby authorize the City Manager to take such further actions as may be necessary or appropriate to carry out the City Council's obligations pursuant to this Resolution. PASSED, APPROVED AND ADOPTED this 3rd day of May 2016, by the following vote- AYES- NOES- ABSENT- ABSTAIN- ATTEST- City Clerk Mayor N H z w x U H H - C: •O _0 C: ca O +' U U Q O a-+ U i, -0 o a--+ > N _0 N w E C.0 _0 }' C6 cn L N U p N O •� _ > O 4-J � N U U � ateJ � a-J � C6 N N W O N N U N O N N cNn N p - U N O .> U O 0 N O -0 O ca O ' ' y City of Dublin Parks and Community Services Department 2016 -2017 Community Grants Program 12/11/2015 deadline $ 25,000 Requested ATTACHMENT 3 'n aull l Ili 11 Ih revl11aw Savo as II3II "'t11 I'311'I1 Ili V Close Whindow A.mllm. "'11111'" Axis Community Health Capital Project for Dental Services Submitted: 12/11/2015 9:50:50 AM (Pacific) Project Contact Valerie Jonas Tel: 925.201.6068 Additional Contacts apimentel@ axishealth .org,scompton@axishealth.org Application Questions Axis Community Health 4361 Railroad Avenue Pleasanton, CA 94566 United States CEO Sue Compton Telephone(925) 201 -6068 x Fax (925) 417 -1503 x Web axishealth.org Some answers will not be presented because they are not part of the selected group of questions based on the answer to #30. Please describe your organization category (select one of the following): ✓ Private Non - Profit u Public Agency u Other: 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Axis provides quality, affordable, accessible and compassionate health care services that promote the well -being of all members of the community. 3. For what type of Dublin Grant is your agency applying? ✓ Capital Project F' Public Service Program or Project 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. ✓ Yes F No 5. Please indicate below if this application is a request for one -time funding and /or "seed" funding. ✓ One -time funding F Seed funding F' One -time and Seed funding u Operational funding �........ None 6. If your agency has NEVER received grant funding from the City of Dublin, please describe any other City /County funding received within the last three years (jurisdiction, year, amount, purpose, etc.). Enter "N /A" if you HAVE received Dublin Funds. N/A 7. Please provide information to justify your agency's capacity to conduct this project (type of management or governing body, fiscal staff resources, skills and experience, etc.). Axis, a non - profit Federally Qualified Health Center (FQHC), provides medical, behavioral health, and WIC nutrition services to more than 14,000 Tri- Valley residents. We are the sole provider of care for low- income and uninsured residents enrolled in Medi -Cal or the county health program (HealthPac). Options for dental services for low- income residents are extremely limited, leaving most with no local access to care. Patients needing urgent dental care must travel to Alameda County's Highland Hospital in Oakland, where waiting lists stretch out for months. The lack of dental services means low - income patients do not receive essential preventive care, resulting in unnecessary dental and health complications. In response, Axis is working with the cities of Dublin, Livermore and Pleasanton and Alameda County Health Services to develop dental services in the Tri- Valley. As an FQHC, our organization would qualify as a Denti -Cal provider and be able to receive reimbursement for dental services at a rate that supports a financially feasible model. Our objective is to develop a locally -based dental service to serve low- income children and adults. Axis's infrastructure meets federal regulatory requirements for provision of services. We've maintained contracts with the State, the County and the cities of Pleasanton, Livermore and Dublin for more than two decades. We have fulfilled contractual requirements and passed all audits without findings. Financial records are maintained to standard accounting procedures and annual audits are conducted by an independent CPA firm. In the past 8 years, we have completed 6 facility projects; 5 involved federal funds including HRSA/CIP and CDBG federal funds through local jurisdictions, under the purview HUD. We have expertise in project development, federal procurement requirements, the public bid process, and reporting requirements. Each project has been on time, on budget, and in full compliance with federal requirements. 8. Provide a brief summary of the project for which your agency is seeking funding (no more than three sentences or 250 characters). This text will be used widely during the review and implementation process to describe your project. To meet the need for affordable dental care for low- income or uninsured residents, Axis is developing a facility that will house this service. Funds are sought for pre- construction costs for project activities during FY 2016/17. 9. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED: client is counted only once regardless of number of services received in a year.) 7,000 upon project completion 10. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? u Behavioral Health (mental health and substance abuse) u Affordable Housing ✓ Health Care (including dental) F Workforce Development F' Homelessness u Transportation Services and Access u Domestic Violence and Child Abuse F' Disabilities u Food and Nutrition u Senior Services u Youth Services u Child Care, Early Childhood Development and Education F' Changing Demographics and Growing Diversity u Financial Assistance u None of the above 11. Explain how this project will be implemented, administered, and operated. This project is being implemented at the direction of the CEO and the Axis Community Health Board of Directors. A capital project oversight committee, comprised of members of the board of directors, CEO, CFO, and Chief Development Officer, will oversee project administration and operations. The committee will report to Axis's board of directors. The committee's role will be to develop the project scope, timelines and budget; secure qualified services, including architectural, legal and financial consultants, and general contractor; and to oversee project activities. Additionally, the CEO and Chief Development Officer will work collaboratively with the Tri - Valley Dental Project Stakeholder Group to ensure that input from key stakeholders is integrated into project plans. 12. Describe in detail the role of Dublin grant funds in this project (e.g., what specifically will the grant funds be used for ?). Funding from Dublin for this capital project will address the gap in dental services for low- income and uninsured residents. Specifically, Dublin grant funds, in combination with CDBG funds from the cities of Pleasanton and Livermore, will be used for phase one of pre - development during which Axis will conduct a demographic assessment of the population to be served; develop a business plan that takes into account projected revenues and operational expenses; develop a capital project budget for the facility; determine the project site; and engage an architect to initiate pre- design and programming of space. Development of dental services has been a priority for Axis for many years. The majority of dentists in the Tri - Valley do not accept Denti -Cal -- only four dentists do. Our patients must go to Highland Hospital in Oakland (or other out -of -area providers) for dental services, where the wait time is 6 -8 months. Based on our patient population and other community data, we estimate 20- 30,000 people in the Tri Valley need access to dental services. In the 2011 Eastern Alameda County Human Services Needs Assessment conducted by the Cities of Dublin, Livermore and Pleasanton, a key finding in the health care area indicated that "dental care for low- income residents, particularly the elderly, is very scarce." The report quoted one Medi -Cal recipient as follows: "People do not understand the gravity of not having dental needs met. The only thing Med -Cal provides right now is extraction." In 2014 staff from the Cities of Dublin, Livermore and Pleasanton and Axis Community Health, began to meet to discuss addressing this serious need. In 2015 a Key Stakeholders group began to meet to clarify the need, identify barriers, and identify resources. The Key Stakeholders agreed on working toward Axis providing dental services for the Tri - Valley and to assist us in effectively designing a clinic and services that best meet the needs of area residents. 13. Please list and briefly describe the outcome measures that are crucial to the success of this project. What strategies or objectives will your agency use to track the progress of meeting the outcome(s)? Healthy People 2020, the standards of health care for the U.S., states: "A growing body of evidence has linked oral health, particularly periodontal (gum) disease, to several chronic diseases, including diabetes, heart disease, and stroke. In pregnant women, poor oral health has also been associated with premature births and low birth weight. These conditions may be prevented in part with regular visits to the dentist." Healthy People 2020 sets the Leading Health Indicator target at 49% of persons (aged 2 or older who visited the dentist in the past year. This indicator was at 44.5% in 2007, and went down to 41.8% in 2011. Data indicate that socio- economic factors, such as education and income, drive this percentage down. In eastern Alameda County, the resources currently do not exist for achieving this goal. This project seeks to address this issue. Success will be measured by achieving the following objectives: • Completion of demographic assessment of the population to be served. This information is essential to determining the scope of the project, e.g., number of chairs and providers needed. • Development of a business plan that projects revenues and operational expenses. This pro forma budget will analyze anticipated reimbursements from payer sources and staffing costs. It will guide development of services that are achievable and sustainable. • Development of a capital project budget for facility development. Based on costs for the physical site and construction, this budget will determine the amount of capital needed for project construction and completion. • Engagement of an architectural firm to initiate pre- design and programming of space. Architectural and engineering analyses are essential to site selection. Initial pre- design and programming of the space into functional areas (e.g., x -ray, reception, dental chair) are important factors in site maximization. 14. Describe the population your agency anticipates serving with these funds and how they will benefit from the implementation of this project, i.e. seniors, youth, disabled, low- income, etc. There is a growing number of low- income and uninsured Tri- Valley residents who do not have access to dental services. Axis's new dental program will serve Dublin families living below 200% FPL. This project serves Dublin's most impoverished residents; many are the working poor who are struggling to maintain life's basic needs for their families. Dublin is experiencing substantial population growth and a growing poverty rate. The population jumped more than 53% over the past decade (Census 2010) and the number of Dublin residents in need of general assistance has doubled since 2003 (2011 Needs Assessment). The past decade has seen growing diversity, with an increase of nearly 400% in the Asian population (3,101 to 12,321). Twenty -one percent of Dublin residents are foreign -born, and 29% speak a language other than English at home. These demographics present potential cultural and linguistic barriers to attaining and maintaining good health, including dental health. Axis continues to see a tremendous rise in the number of Dublin residents in need of our services. In fact, we have gone from providing medical services for 1,012 Dublin residents in 2010 to serving 1,371 in 2014, a 35% increase in just four years (UDS Reports, 2011 - 2014). This project will benefit low- income and uninsured Dublin residents by providing access to dental services. 15. How is this project culturally appropriate (i.e., describe how it is specifically tailored to the client /customer population served)? Axis's mission is to provide quality, affordable, accessible and compassionate health care services that promote the well -being of all members of our community. To meet this goal, Axis provides linguistically and culturally appropriate services and dental services will embrace these policies as well. Front -line dental staff will be bilingual in Spanish and English. Translation services for other languages will be available as needed. Our employees are trained to recognize and respect differences among patients' values, expectations and experiences. Staff members represent the cultures and backgrounds of our patients, with care providers fluent in many languages. 16. Explain how your agency will outreach to low- income, limited English speakers, and /or disabled persons. How will each of these groups access the project for which your agency is requesting funding? Axis is the sole agency providing health care services for low- income and uninsured Dublin residents. Half of our patients are limited English speakers. Axis promotes its services, in English and Spanish, through community events, organizations and media outlets. Our Enrollment Specialists and Community Relations Coordinator focus on reaching low- income, limited English speakers and other challenged populations, including those with disabilities, to assist them in overcoming common barriers to accessing care, such as language, cultural differences, or a lack of knowledge of how to enroll in public insurance. Other multi - lingual referral mechanisms include the patient services specialists who field calls from the public and the TeleMinder automated appointment- reminder service. In addition, Axis receives referrals from Alameda County's 211 agency, whose staff has the capacity to speak to callers in more than 150 languages. All Axis services are designed to accommodate individuals with disabilities and to comply with the Americans with Disabilities Act. 17. Identify the organizations that your agency partners with and describe their relevant capabilities that result in greater service integration. Axis coordinates services on a number of levels. For patient care, we have cooperative agreements with partners regarding specific needs, such as ValleyCare Medical Center for obstetrics services and Highland Hospital for specialty medical services. Additionally, Axis is part of the Alameda Health Consortium and works with the other community health centers to assess community needs, identify new opportunities for collaboration, coordinate patient advocacy, delineate effective continuums of care and prevent duplication of services. Among our safety -net services partners are Tri - Valley Haven, which provides a food bank and shelter services for homeless families and victims of domestic violence; Hope Hospice, the area's hospice and grief counseling service; Open Heart Kitchen, which offers a hot -meal program; and CAPE /Head Start, which provides early intervention and educational services for low- income children. For this project, Axis has been working actively with all three Tri - Valley cities through the Dental Services Key Stakeholder Group. Additional partners include Alameda County Health Services, CAPE, Senior Support Program of the Tri - Valley, and Southern Alameda County Dental Society. 18. Describe the marketing and outreach your organization has done, particularly to Dublin residents. In addition, outline specific collaboration with other service organizations in the City of Dublin or Tri - Valley. Axis's Community Outreach Coordinator and Enrollment Specialists perform regular outreach at health fairs, community forums and faith -based events and work closely with Head Start, school -based services, parent- education programs and other human services providers to identify prospective clients. Axis also alerts underserved populations to its services through its own client - friendly website; through 211.org, a free information and referral service; and through AC Healthcare.org, a website that enables Alameda County residents to locate the nearest health care provider, with special emphasis on programs that can assist non - English speakers. Because one -third of clients rely on public transportation, Axis sites are located near bus lines. Our enrollment specialists have been providing services at the Dublin library on a regular basis and attending Dublin's Wells Middle School annual services fair for parents in the fall. With the start of the Affordable Care Act in 2013, Axis has increased its outreach and marketing throughout the Tri - Valley. In Dublin, Axis has presented at Dublin library, at Covered California information nights, at low- income housing meetings, and many other places. We are actively setting up more informational opportunities in Dublin to reach people newly eligible for Medi -Cal and coverage through the health exchange, particularly since our demographic studies indicate that Dublin has a large number of newly eligible families. 19. Referring to questions 28, 29 and 30, describe the project for which your agency is requesting funding and how this serves Dublin residents by meeting at least one of the City of Dublin's Mission, Vision, and Values. This project meets a number of the City of Dublin's Mission, Vision, Values and Strategies. The project aligns with the Mission or Vision statement to "promote and support a high quality of life which ensures a safe and secure environment that fosters new opportunities." This project provides capacity to meet the needs of the increasing number of low- income and uninsured Dublin residents in need of dental services. Access to dental care directly impacts the quality of life of these families. Among Dublin's Values is an emphasis on "encouraging collaboration and communication with other communities on issues of mutual concern." This project is collaborative amongst the cities of the Tri- Valley which seek to provide dental care capacity for the Tri - Valley's neediest residents. 20. BUDGET NARRATIVE Describe how this project is cost effective and how the budget is reasonable for the anticipated result. The provision of dental services is directly related to maintaining good health and to preventing the onset of other diseases. The critical lack of dental services for low- income and uninsured residents in the Tri - Valley is an ongoing cause of concern amongst local government, county health agencies, and area safety -net providers. This project is targeted to reduce healthcare costs by providing ongoing preventive dental services. It will also offer treatment for people with critical dental care needs that may prevent them from obtaining and sustaining jobs. Furthermore, provision of care will hugely reduce the amount of suffering borne by those who must travel out of area and wait long months for treatment. Axis anticipates being able to develop and deliver this service at a reasonable and sustainable cost. The pre - development capital project costs for this Phase I project are in -line with the overall ratios of the project scope. 21. If this application does not receive funding, or receives reduced funding, what will be the effect on the project? Axis is seeking funding for pre- construction of this capital project from all three Tri - Valley cities. Securing $25,000 in funding from the City of Dublin will greatly improve our ability to seek further public funding as it demonstrates the continued collaborative effort within the Tri - Valley to meet the health care needs of low- income residents. Without this grant funding, we will be less well - positioned in our efforts, and will also need to find other sources for the $25,000 we are seeking from the City of Dublin. 22. Does your agency anticipate having any unspent grants funds at the end of the fiscal year? F. Yes ✓ No 23. If you answered yes to the preceding question please explain. Enter "N /A" if not applicable. N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting funds for a Capital project (e.g. one time expenses for construction, equipment, furniture, fixtures)? F Yes ✓ No. If no, enter N/A for questions 25 & 26, and check Not applicable for question 27 25. If your agency is requesting Capital funding, describe the detailed scope of work for the project. [You will also be asked to attach a budget, photos, designs, site plans, specs, etc. later in the "Documents" tab.] Enter "N /A" if not applicable. N/A 26. If your agency is requesting Capital funding please describe any land tenure issues (e.g. does your agency own or lease the property, lease terms, plans for future relocation or expansion, etc.). Enter "N /A" if not applicable. N/A 27. If your agency is requesting Capital funding, will this project require implementation of Davis - Bacon /Fair Labor Standards Act requirements? ✓ Not Applicable F. Yes �........ No Not known (please contact staff at 925 - 833 -6645 immediately if you have any questions regarding Davis -Bacon requirements) 28. PERFORMANCE MEASURES Identify AT LEAST ONE of the City of Dublin's Mission & Vision Statements: (you may choose more than one) ✓ Promotes and supports a high quality of life which ensures a safe and secure environment that fosters new opportunities. Balance history with progress, to sustain an enlightened, economically balanced and diverse community. Encourages innovation of City life, including programs to strengthen our economic vitality, supports environments stewardship and sustainability through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of first -class recreational opportunities, facilities and programs 29. Identify AT LEAST ONE of the City of Dublin's Values: (you may choose more than one) Building Community: by promoting locations and events that brings people of all ages together; providing more venues for family -based activities and fostering heritage and cultural development F' Ensuring a Safe Community: by providing high quality police and fire services to insure the safety of the citizens living in the community and providing education and training to residents and businesses that would promote public safety Guiding Development: to assure that development contributes positively to the City's fiscal health; supports pedestrian - friendly development, transit - oriented development, green building and environmental responsiveness; promotes high quality design and architectural standards in private development and in all public facilities and develops transportation systems that facilitate ease of movement throughout the City Governing: that commits to openness and responsiveness to the public and community; operates at all times with honesty and integrity; exercises fairness in consideration of issues and provides a high level of customer service; responsiveness from City staff to citizens; embraces technology to improve effectiveness and efficiency and strives to build an informed community through communication ✓ Relating to Other Communities and Entities: by encouraging collaboration and communication with other communities on issues of mutual concern, and encouraging public and private partnerships of mutal benefit 30. " QUESTIONS 31 THROUGH 43 ARE FOR THOSE AGENCIES INTERESTED IN APPLYING FOR COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. " Are you are interested in applying for CDBG funds? ✓ Yes. If so, answer questions 31 through 43. F No. If no, check box here, and questions 31 through 43 will not be required.. F' Don't know. If you are unsure, please call the City at (925) 833 -6645 and speak to a staff person that can answer your questions. 31. CDBG ONLY- Explain your Limited English Proficiency /Language Access Plan(LEP /LAP). How does your agency outreach to limited English speaking residents to encourage access to services & housing? What access accommodations are used? Provide detail Please enter "N /A" if you are not interested in qualifying for CDBG funding. Axis's mission is to provide preventive and primary medical care to all members of the community, regardless of income, language, ethnicity or any other factor. Axis's services are designed to reach out to underserved and uninsured populations, including low- income racial and ethnic minority populations who otherwise lack access to health care. Our ability to effectively engage this population is evidenced by the increasing number of Dublin residents we serve. As the sole provider of medical services for the region's low- income and uninsured population, Axis serves a patient population that is ethnically and linguistically diverse. Because half of our medical patients are Spanish- speaking, all front -line staff (call center, case managers, enrollment staff, receptionists and medical assistants) are required to be bilingual in English and Spanish. Axis's medical staff speaks a variety of languages, including Spanish, Hindi, Farsi, Mandarin, and Urdu and also has expert multicultural health care skills and specific knowledge relevant to serving low- income, culturally diverse communities. This expertise successfully transcends cultural and other barriers, creating a bridge to health care and a medical home for Dublin's underserved residents. 32. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Guiding Principle that relates to your project: ✓ Be culturally accessible, appropriate and inclusive F Encourage community engagement and involvement F' Promote energy and resource efficiency Encourage networking and information sharing across service providers u Encourage process streamlining u Consolidate service delivery u Not Applicable. I am not interested in qualifying for CDBG funding. 33. CDBG ONLY - Identify AT LEAST ONE U.S. Department of Housing and Urban Development (HUD) Consolidated Plan Goals that relates to your project: A) Support and develop a continuum of housing resources that will increase access to low- income, seniors, disabled and homeless persons with emphasis on activities that: 'Increase and maintain transitional housing opportunities with supportive services to increase positive outcomes and stability into permanent housing. F' 'Preserve and increase affordable rental housing opportunities for low and moderate income households. 'Assist with homeownership opportunities for first -time homebuyers and ensure existing homeowners have safe housing that maintains affordability. u `Promote fair housing and reduce housing discrimination. ✓ B) Improve community health and access to basic and specialty care including dental and optometry care, behavioral and mental health care services especially for low- income, uninsured and under - insured residents with emphasis on activities that: ✓ ` Support the maintenance and expansion of services and programs aimed at wellness and preventative care services. ✓ ` Increase outreach and access for underserved populations including limited English speaking persons, youth, disabled, seniors and homeless persons. C) Increase and maintain affordable and accessible wellness and development opportunities for youth that are age appropriate. D) Support and expand programs and opportunities that keep seniors engaged and involved in their community. F' E) Foster and encourage innovative programs that meet emerging community needs with emphasis on low- income and underserved populations. u F) Not Applicable. I am not interested in qualifying for CDBG funding. 34. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal that relates to your project: F Increase homeownership F' Promote decent affordable housing ✓ Strengthen communities F Ensure equal opportunity in housing F, Promote participation of grass- roots, faith - based, and other community -based organizations F Not Applicable. I am not interested in qualifying for CDBG funding. i. CDBG ONLY - Identify AT LEAST ONE U.S. Department of HUD Policy Priority that relates to your project: Provide increased homeownership and rental opportunities for low and moderate - income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. ✓ Improving the quality of life for our Nation's communities F Encouraging accessible design features. F' Participation of minority - serving institutions in HUD programs. u End chronic homelessness within ten years. u Removal of barriers to affordable housing. u Not Applicable. I am not interested in qualifying for CDBG funding. 36. CDBG ONLY - Identify AT LEAST ONE Consolidated Plan objective that relates to your project: F' Increase the availability of affordable rental housing for extremely low income (30 %), very low income (50 %) and low income (80 %) households. Preserve existing affordable rental housing and ownership for households at or below 80% of Area Median Income (AMI). u Assist low and moderate income first -time homebuyers. u Reduce housing discrimination. ✓ Maintain, improve and expand (as needed) the capacity of housing, shelter and services for homeless individuals and families including integrated healthcare, employment services and other supportive services. Maintain and expand activities designed to prevent those currently housed from becoming homeless. F' Build on inter - jurisdictional cooperation to achieve housing and homeless needs. Increase the availability of service- enriched housing for persons with special needs. u Not Applicable. I am not interested in qualifying for CDBG funding. 37. CDBG ONLY - Select ONE Objective that relates to your project (TIP: When selecting an objective ask yourself, "What is the purpose of the activity? What is the larger community need that I am seeking to address ? "): ✓ Creating a Suitable Living Environment u Providing Decent Affordable Housing u Creating Economic Opportunities F' Not Applicable. I am not interested in qualifying for CDBG funding. 38. CDBG ONLY - Select ONE Outcome that relates to your project (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking ? "): ✓ Availability /Accessibility F Affordability F' Sustainability F Not Applicable. I am not interested in qualifying for CDBG funding. 39. CDBG ONLY - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or infrastructure activities that provide individuals with new or improved access to the facility or infrastructure. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of household units that no longer have access to a substandard service. ✓ Public Service: This indicator shows the number of persons that have been assisted with new or improved access to a service. If the activity was used to meet a quality standard or to measurably improve quality, then this indicator will report the number of persons that no longer have access to a substandard service. Targeted revitalization: This indicator shows a range of outcomes such as jobs created and retained, businesses assisted, low- and moderate - income persons and households served, slum /blight demolition, number of acres of brownfields remediated, etc. in a targeted area. F' Commercial facade treatments or business building rehabilitation: This indicator shows the number of commercial facade treatments undertaken and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. F' Rental units constructed: This indicator shows the number of affordable rental units created, as well as the number of years of affordability, number of units occupied by the elderly, and those units designated for chronically homeless persons and persons with HIV /AIDS. Rental units rehabilitated: This indicator shows the number of affordable rental units rehabilitated as well as the number of years of affordability, units for chronically homeless persons, elderly persons, and persons with HIV /AIDS. Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of homeownership units constructed, acquired, and /or acquired with rehabilitation per activity. This includes total number of affordable units, number of years of affordability, Energy Star qualified units, section 504 accessible units, and number of households previously living in subsidized housing. In addition, data will be collected on the number of units occupied by the elderly, number of units designated for persons with HIV /AIDS, and number of units for the chronically homeless. Owner occupied units rehabilitated: This indicator shows the total number of owner occupied units rehabilitated, including the number of these units occupied by the elderly, number of units designated for persons with HIV /AIDS, and number of units for the chronically homeless. Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance /closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the total number of households receiving TBRA as well as the number with short -term rental assistance (less than 12 months) and the number of homeless and chronically homeless households assisted. Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicator shows the number of jobs that have employee- sponsored health care, the types of jobs created (using Economic Development Administration (EDA) classifications) and the number of persons unemployed before taking the job. Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs with employer - sponsored health care benefits, and the types of jobs retained (using EDA classifications) F' Business assistance: This indicator shows the total number of businesses assisted. Specifically, it shows the number of new businesses, existing businesses, and the DUNS number of each business so that HUD can track the number of new businesses that remain operational for three years after assistance. F' Businesses providing goods or services: This indicator shows whether an assisted business provides goods or services to meet the needs of the service area, neighborhood, or community, as determined by the grantee. u Not Applicable. I am not interested in qualifying for CDBG funding. 40. CDBG ONLY - Please choose a common indicator that your agency will use to track clients (select only ONE): ✓ Persons F' Households F Not Applicable. I am not interested in qualifying for CDBG funding. 41. CDBG ONLY - For the category you selected above, provide the total number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving through this project: 7000 42. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients your agency anticipates serving in each category. "If none, please enter "0 ". 1960 Low Income (50 % -80% AMI; please refer to the Income Limits chart at www.dublin.ca.gov /housing /) 5040' Extremely Low Income ( <30% AMI; please refer to the Income Limits chart at www.dublin.ca.gov /housing /) 350' Disabled 1120' Female Headed Households 490' Senior 1820' Youth 140' Homeless Not Applicable. I am not interested in qualifying for CDBG funding. (Type N /A) -2 i7i) TOTAL 43. CDBG ONLY - List the number of clients your agency anticipates serving in race /ethnicity categories. The sum entered below must match the total clients entered in #42 above. Per HUD "Hispanic" is an ethnicity, not a race. "if none, please enter "0" 2380' White 3150' White + HISPANIC 350' Black/African American 0' Black/African American + HISPANIC 840' Asian 0' Asian + HISPANIC 70' American Indian /Alaskan Native 0' American Indian /Alaskan Native + HISPANIC 0' Native Hawaiian /Other Pacific Islander 0' Native Hawaiian /Other Pacific Islander + HISPANIC 0' American Indian/ Alaskan Native and White 0' American Indian/ Alaskan Native and White + HISPANIC 0' Asian and White 0' Asian and White + HISPANIC 0' Black /African American and White 0'' Black/African American and White + HISPANIC 0' American Indian /Alaskan Native and Black/African American 0 ' American Indian /Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial Not Applicable. I am not interested in qualifying for CDBG funding. (Type N /A) TOTAL 44. If your agency is submitting more than one application or the same agency has different programs within it, please RANK the priority of this application, with number 1 being the highest priority for funding. There should only be one #1 PER AGENCY ✓ #1 - This program /project has the highest priority for funding within the organization, agency, district or entity. F' #2 - This program /project has the 2nd highest priority for funding within the organization, agency, district or entity. #3 - This program /project has the 3rd highest priority for funding within the organization, agency, district or entity. #4 - This program /project has the 4th highest priority for funding within the organization, agency, district or entity. F' #5 - This program /project has the 5th highest priority for funding within the organization, agency, district or entity. #6 - This program /project has the 6th highest priority for funding within the organization, agency, district or entity. If you have more than 6 applications per organization, agency, district or entity, check here. 45. Please describe actions your organization is taking to become financially self- sufficient (i.e. what steps are you taking to reduce dependency on the City's grant program). Axis continually seeks funding from private foundations and donations from individuals to cover operational costs that are not covered by reimbursements from public health insurance, such as Medi -Cal, Medicare and HealthPac. 46. All organizations must provide valid City of Dublin Business Registration number at time of application. Please provide the organization's registration number here. BL- 010832 Budget Funding Sources /Revenues Budget Amount Amount Committed City of Livermroe $ 125,000.00 $ 0.00 City of Pleasanton $ 100,000.00 $ 0.00 City of Dublin $ 25,000.00 $ 0.00 Total $ 250,000.00 $ 0.00 Funding Uses /Expenses Budget Amount Amount Committed Design $ 25,000.00 $ 0.00 Aquisition $ 140,000.00 $ 0.00 Other Soft Costs $ 85,000.00 $ 0.00 Total $ 250,000.00 $ 0.00 Budget Narrative During Phase I of pre- construction for this capital project the costs are as follows: $25,000 Architectural for site assessment during site selection and pre- design for programmatic use of space $140,000 Acquisition provides initial funds (down payment) for acquiring $1- 2 million site $20,000 Demographic Assessment to determine utilization and required space $20,000 Business Plan Analysis to determine revenues and costs for operations $20,000 Contractor Pre - Construction Services $20,000 Due Diligence and other items required for site acquisition (ALTA, Phase 1 Environmental, etc.) $5,000 Legal fees Documents Documents Requested " Program Expense Budget for ALL Grant Requests nJawicicrwJ orniolulc Financial Information Form for ALL Grant Requests nJawiclawJ orninlalo List of Board of Directors (or governing body) with contact information Current Annual Budget for the Entire Agency Copy of most recently submitted IRS 990 form or Tax Return (include complete form) Board of Director's (or governing body's) designation of authorized official Required? Attached Documents " ✓ uruQ1219 IILN2.2Lr.29...II:(.u.1fAlet ✓ l::liu�nuu�dalll Ilurloin natlion II of i n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ✓ :snnrn9 a[ If:Irocior, li,i; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ✓ gc,icc I:tun9 ° .I! ✓ ax rolunc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ✓ ILc igicglJ alc... o..(... L. L. Gl" !.o.!:!..'.!.I.Ltl...o.(:(!..al Board of Director's (or governing body's) authorization to t/ 1: :: a rl «9 1 io cu, LLCn f,c.I „r117ul li „I, G,I,rani, request funding (may be same document as one above) Proof of insurance carried, including bonding, liability and /or t/ insurancc , workers' compensation REQUIRED FOR CDBG ONLY -If requesting Capital Funding, please upload your Capital expenditure budget (your own format is acceptable) REQUIRED FOR CDBG ONLY- PERSONNEL POLICIES INCLUDING AFFIRMATIVE ACTION PLAN AND GRIEIVANCE PROCEDURE REQUIRED FOR CDBG ONLY- AGENCY AUDIT REQUIREMENTS AND COPY OF LAST AUDIT HIGHLIGHTING "FINDINGS” SECTION REQUIRED FOR CDBG ONLY- ARTICLES OF INCORPORATION AND BYLAWS. REQUIRED FOR CDBG ONLY- CONFLICT OF INTEREST STATEMENT (IF NOT INCLUDED IN BYLAWS) REQUIRED FOR CDBG ONLY- ORGANIZATION CHART STATE AND FEDERAL NON- PROFIT DETERMINATION LETTER. ✓ ion �;9c onrnllnailaln Idic°ir All organizations MUST have approved non - profit status from the State of California and Federal Tax Identification Number at time of application. Non - compliant applicants will be disqualified. REQUIRED FOR CDBG ONLY- AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP /LAP). Must include outreach to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used. REQUIRED FOR CDBG- LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Certified Audit and /or Certified Financial Statements ✓ xi , a «9i l x «9 II xl xl , CI i u . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . * ZoomGrantsTM is not responsible for the content of uploaded documents. Application ID: 47547 Become a f,vi cif '�joW ,��its- onFacebook . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Problems? Contact us atf;A4u,.ln,� n..., I'r,,rr, „� iir.. ( t, . wll ©2002 -2016 GrantAnalyst.com. All rights reserved. 'ZoomGrants” and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. I U LUi I