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HomeMy WebLinkAboutItem 4.06 Human Services Program Special Project STAFF REPORT CITY CLERK File #920-75 CITY COUNCIL DATE:May 3, 2016 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: 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: Resolution Staff recommends that the City Council adopt the 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 ITEM NO. 4.6 Page 1 of 3 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 : ______________________________ Mayor ATTEST : _________________________________ City Clerk ATTACHMENT 3                         Email This PreviewSave as PDFPrintClose Window Powered by ZoomGrants™ 2016-2017 Community Grants Program 12/11/2015 deadline Axis Community Health Capital Project for Dental Services Axis Community Health $ 25,000 Requested Submitted: 12/11/2015 9:50:50 AM (Pacific) 4361 Railroad Avenue (925) 201-6068 x Pleasanton, CA 94566 Fax(925) 417-1503 x Webaxishealth.org Project Contact Valerie Jonas vjonas@axishealth.org Tel: 925.201.6068 scompton@axishealth.org Additional Contacts apimentel@axishealth.org,scompton@axishealth.org Application Questions Some answers will not be presented because they are not part of 1. Please describe your organization category (select one of the -Profit Public Agency Other:   2. Please describe your agency's mission (no more than 3 sentenc Axis provides quality, affordable, accessible and compassionate -being of all members of the community. 3. For what type of Dublin Grant is your agency applying? 4. Is this a "new" service, program, project or activity? "New" Yes 5. Please indicate below if this application is a request for on-time funding and/or "seed" funding. - Seed funding -time and Seed funding Operational funding 6. If your agency has NEVER received grant funding from the City within the last three years (jurisdiction, year, amount, purpose N/A 7. Please provide information to justify your agency's capacity staff resources, skills and experience, etc.). Axis, a non-profit Federally Qualified Health Center (FQHC), provides medica- Valley residents. We are the sole provider of care for low-income and uninsured residents enrolled in Medi-Cal or the county health program Options for dental services for low-income residents are extremely limited, leaving most with no loc care must travel to Alameda Countys Highland Hospital in Oakland, where waiting lists stretch out - income patients do not receive essential preventive care, result In response, Axis is working with the cities of Dublin, Livermor -Valley. As an FQHC, our organization would qualify as a Denti-Cal provider and be able to receive reimbursement for dental ser supports a financially feasible model. Our objective is to devel-based dental service to serve low-income children and adults. Axiss infrastructure meets federal regulatory requirements for provive maintained contracts with the State, the County and the cities of Pleasanton, Livermore and Dublin for more than two dec findings. Financial records are maintained to standard accountin In the past 8 years, we have completed 6 facility projects; 5 in jurisdictions, under the purview HUD. We have expertise in proje reporting requirements. Each project has been on time, on budget 8. Provide a brief summary of the project for which your agency characters). This text will be used widely during the review and To meet the need for affordable dental care for low-income or uninsured residents, Axis is developing a facility tha sought for pre-construction costs for project activities during FY 2016/17. 9. Estimate the total number of UNDUPLICATED Dublin residents to 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 C with? Behavioral Health (mental health and substance abuse) Affordable Housing Workforce Development Homelessness Transportation Services and Access Domestic Violence and Child Abuse Senior Services Youth Services Changing Demographics and Growing Diversity Financial Assistance None of the above 11. Explain how this project will be implemented, administered, This project is being implemented at the direction of the CEO an comprised of members of the board of directors, CEO, CFO, and Ch committee will report to Axiss board of directors. The committees role will be to develop the project scope, timelines and budge services, including architectural, legal and financial consultan Chief Development Officer will work collaboratively with the Tri-Valley Dental Project Stakeholder Group to ensure that input fro integrated into project plans. 12. Describe in detail the role of Dublin grant funds in this pr Funding from Dublin for this capital project will address the ga-income and uninsured residents. Specifically, Dublin grant funds, in combination with CDBG funds from the cities of Pleasan-development during which Axis will conduct a demographic assessment of the population to be se operational expenses; develop a capital project budget for the f-design and programming of space. Development of dental services has been a priority for Axis for -Valley do not accept Denti--- only four dentists do. Our patients must go to Highland Hospital in O-of-area providers) for dental services, where the wait time is 6-8 months. Based on our patient population and other community data-30,000 people in the Tri Valley need access to dental services. In the 2011 Eastern Alameda County Human Services Needs Assessme the health care area indicated that “dental care for low-income residents, particularly the elderly, is very scarce.” The report quoted one Medi- recipient as follows: “People do not understand the gravity of not having dental needs -Cal provides right now is extraction.” In 2014 staff from the Cities of Dublin, Livermore and Pleasanto In 2015 a Key Stakeholders group began to meet to clarify the ne working toward Axis providing dental services for the Tri-Valley and to assist us in effectively designing a clinic and se needs of area residents. 13. Please list and briefly describe the outcome measures that a objectives will your agency use to track the progress of meeting Healthy People 2020, the standards of health care for the U.S., “A growing body of evidence has linked oral health, particularly (gum) disease, to several chronic diseases, including diabetes, associated with premature births and low birth weight. These con” 2020 sets the Leading Health Indicator target at 49% of persons in 2007, and went down to 41.8% in 2011. Data indicate that soci-economic factors, such as education and income, drive this perce In eastern Alameda County, the resources currently do not exist measured by achieving the following objectives: • Completion of demographic assessment of the population to be ser number of chairs and providers needed. • Development of a business plan that projects revenues and operat from payer sources and staffing costs. It will guide development • Development of a capital project budget for facility development 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 a -design and programming of the space into functional areas (e.g.,-ray, reception, dental chair) are important factors in site 14. Describe the population your agency anticipates serving with 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 will serve Dublin families living below 200% FPL. This project ss most impoverished residents; many are the working poor who are struggling to maintain lifes basic needs for their families. Dublin is experiencing substan population jumped more than 53% over the past decade (Census 201 since 2003 (2011 Needs Assessment). The past decade has seen gro to 12,321). Twenty-one percent of Dublin residents are foreign-born, and 29% speak a language other than English at home. These present potential cultural and linguistic barriers to attaining Axis continues to see a tremendous rise in the number of Dublin services for 1,012 Dublin residents in 2010 to serving 1,371 in -2014). This project will benefit low-income and uninsured Dublin residents by providing access to den 15. How is this project culturally appropriate (i.e., describe h Axiss mission is to provide quality, affordable, accessible and comp-being of all members of our community. To meet this goal, Axis provides linguistically and c Front-line dental staff will be bilingual in Spanish and English. Tran trained to recognize and respect differences among patients' val backgrounds of our patients, with care providers fluent in many 16. Explain how your agency will outreach to low-income, limited English speakers, and/or disabled persons. How w groups access the project for which your agency is requesting fu Axis is the sole agency providing health care services for low-income and uninsured Dublin residents. Half of our patients are speakers. Axis promotes its services, in English and Spanish, th and Community Relations Coordinator focus on reaching low-income, limited English speakers and other challenged population disabilities, to assist them in overcoming common barriers to ac enroll in public insurance. Other multi-lingual referral mechanisms include the patient services special -reminder service. In addition, Axis receives referrals from Alams 211 agency, whose staff has the capacity to speak to callers in more than 150 languages. All Axi with the Americans with Disabilities Act. 17. Identify the organizations that your agency partners with an integration. Axis coordinates services on a number of levels. For patient car ValleyCare Medical Center for obstetrics services and Highland H Consortium and works with the other community health centers to patient advocacy, delineate effective continuums of care and pre Among our safety-net services partners are Tri-Valley Haven, which provides a food bank and shelter services fo domestic violence; Hope Hospice, the area's hospice and grief co- CAPE/Head Start, which provides early intervention and education-income children. For this project, Axis has been working actively with all three -Valley cities through the Dental Services Key Stakeholder Group. include Alameda County Health Services, CAPE, Senior Support Pro-Valley, and Southern Alameda County Dental Society. 18. Describe the marketing and outreach your organization has do collaboration with other service organizations in the City of Du-Valley. Axiss Community Outreach Coordinator and Enrollment Specialists perf-based events and work closely with Head Start, school-based services, parent-education programs and other human services providers to identif clients. Axis also alerts underserved populations to its service-friendly website; through 211.org, a free information and referral service; and through ACHealthcare.org, a website that e special emphasis on programs that can assist non-English speakers. Because one-third of clients rely on public transportation, Axis sites are l near bus lines. Our enrollment specialists have been providing s School annual services fair for parents in the fall. With the st throughout the Tri-Valley. In Dublin, Axis has presented at Dublin library, at Cove-income housing meetings, and many other places. We are actively setting up more informational-Cal and coverage through the health exchange, particularly since our demographic 19. Referring to questions 28, 29 and 30, describe the project f serves Dublin residents by meeting at least one of the City of D’s Mission, Vision, and Values. This project meets a number of the City of Dublins 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 that fosters new opportunities.” This project provides capacity to meet the needs of the increasi- residents in need of dental services. Access to dental care dires Values is an emphasis on “encouraging collaboration and communication with other communiti” 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 The provision of dental services is directly related to maintain services for low-income and uninsured residents in the Tri-Valley is an ongoing cause of concern amongst local government, and area safety-net providers. This project is targeted to reduce healthcare costs by providing dental care needs that may prevent them from obtaining and susta borne by those who must travel out of area and wait long months Axis anticipates being able to develop and deliver this service -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 re 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 Dubl will greatly improve our ability to seek further public funding -Valley to meet the health care needs of low-income residents. Without this grant funding, we will be less we-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 Yes 23. If you answered yes to the preceding question please explain N/A 24. CAPITAL EXPENDITURE NARRATIVE Is your agency requesting fund construction, equipment, furniture, fixtures)? Yes No. If no, enter N/A for questions 25 & 26, and check Not applic 25. If your agency is requesting Capital funding, describe the d attach a budget, photos, designs, site plans, specs, etc. later N/A 26. If your agency is requesting Capital funding please describe property, lease terms, plans for future relocation or expansion, N/A 27. If your agency is requesting Capital funding, will this proj-Bacon/Fair Labor Standards Act requirements? Not Applicable Yes 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 Du’s Mission & Vision Statements: (you may choose more than one) Promotes and supports a high quality of life which ensures a saf Balance history with progress, to sustain an enlightened, econom Encourages innovation of City life, including programs to streng through the preservation of our natural surroundings. Promotes active and healthy lifestyle through the creation of fi-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 bring-based activities and fostering heritage and cultural development Ensuring a Safe Community: by providing high quality police and providing education and training to residents and businesses tha Guiding Development: to assure that development contributes posis fiscal health; supports pedestrian-friendly development, transit-oriented development, green building and environmental responsiv private development and in all public facilities and develops tr Governing: that commits to openness and responsiveness to the pu exercises fairness in consideration of issues and provides a hig embraces technology to improve effectiveness and efficiency and Relating to Other Communities and Entities: by encouraging colla concern, and encouraging public and private partnerships of muta (CDBG) FUNDING ONLY. ** Are you are interested in applying for C Yes. If so, answer questions 31 through 43. No. If no, check box here, and questions 31 through 43 will not 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. - Explain your Limited English Proficiency/Language Access Plan(L English speaking residents to encourage access to services & hou Please enter "N/A" if you are not interested in qualifying for C Axis's mission is to provide preventive and primary medical care other factor. Axis's services are designed to reach out to under-income racial and ethnic minority populations who otherwise lack access to health care. Our abilit Dublin residents we serve. As the sole provider of medical servi-income and uninsured population, Axis serves a patient population that is ethnically and linguistically diverse. Becaus-speaking, all front-line staff (call center, case managers, enrollment staff, receptionists and medical assistants variety of languages, including Spanish, Hindi, Farsi, Mandarin, relevant to serving low-income, culturally diverse communities. This expertise successfu health care and a medical home for Dublin's underserved resident - Identify AT LEAST ONE U.S. Department of Housing and Urban Deve Principle that relates to your project: Be culturally accessible, appropriate and inclusive Encourage community engagement and involvement Promote energy and resource efficiency Encourage networking and information sharing across service prov Encourage process streamlining Consolidate service delivery Not Applicable. I am not interested in qualifying for CDBG fundi - Identify AT LEAST ONE U.S. Department of Housing and Urban Deve relates to your project: A) Support and develop a continuum of housing resources that wil-income, seniors, disabled and homeless persons with emphasis on activities that: *Increase and maintain transitional housing opportunities with s housing. *Preserve and increase affordable rental housing opportunities f *Assist with homeownership opportunities for first-time homebuyers and ensure existing homeowners have safe housing affordability. *Promote fair housing and reduce housing discrimination. B) Improve community health and access to basic and specialty ca services especially for low-income, uninsured and under-insured residents with emphasis on activities that: Support the maintenance and expansion of services and programs a Increase outreach and access for underserved populations includi persons. C) Increase and maintain affordable and accessible wellness and D) Support and expand programs and opportunities that keep senio E) Foster and encourage innovative programs that meet emerging c-income and underserved populations. F) Not Applicable. I am not interested in qualifying for CDBG fu - Identify AT LEAST ONE U.S. Department of HUD Strategic Goal tha Increase homeownership Promote decent affordable housing Strengthen communities Ensure equal opportunity in housing Promote participation of grass-roots, faith-based, and other community-based organizations Not Applicable. I am not interested in qualifying for CDBG fundi - Identify AT LEAST ONE U.S. Department of HUD Policy Priority th Provide increased homeownership and rental opportunities for low-income persons, persons with disabilities, the elderly, minorities, and families with limited English proficiency. Improving the quality of life for our Nation's communities Encouraging accessible design features. Participation of minority-serving institutions in HUD programs. End chronic homelessness within ten years. Removal of barriers to affordable housing. Not Applicable. I am not interested in qualifying for CDBG fundi - Identify AT LEAST ONE Consolidated Plan objective that relates Increase the availability of affordable rental housing for extre households. Preserve existing affordable rental housing and ownership for ho Assist low and moderate income first-time homebuyers. Reduce housing discrimination. Maintain, improve and expand (as needed) the capacity of housing integrated healthcare, employment services and other supportive Maintain and expand activities designed to prevent those current -jurisdictional cooperation to achieve housing and homeless needs Increase the availability of service-enriched housing for persons with special needs. Not Applicable. I am not interested in qualifying for CDBG fundi - Select ONE Objective that relates to your project (TIP: When se purpose of the activity? What is the larger community need that Providing Decent Affordable Housing Not Applicable. I am not interested in qualifying for CDBG fundi - Select ONE Outcome that relates to your project (TIP: When sele change or result am I seeking?"): Availability/Accessibility Affordability Sustainability Not Applicable. I am not interested in qualifying for CDBG fundi - Select ONE Specific Indicator that relates to your project: Public facility or infrastructure: This indicator shows the numb that provide individuals with new or improved access to the faci measurably improve quality, then this indicator will report the Public Service: This indicator shows the number of persons that was used to meet a quality standard or to measurably improve qua access to a substandard service. Targeted revitalization: This indicator shows a range of outcome- and moderate- income persons and households served, slum/blight demolition, nu Commercial facade treatments or business building rehabilitation and the number of business buildings that were rehabilitated. Brownfields remediated: This indicator shows the number of acres Rental units constructed: This indicator shows the number of aff number of units occupied by the elderly, and those units designa Rental units rehabilitated: This indicator shows the number of a affordability, units for chronically homeless persons, elderly p Homeownership units constructed or acquired with rehabilitation: acquired, and/or acquired with rehabilitation per activity. This Star qualified units, section 504 accessible units, and number o collected on the number of units occupied by the elderly, number chronically homeless. Owner occupied units rehabilitated: This indicator shows the tot units occupied by the elderly, number of units designated for pe Direct financial assistance to homebuyers: This indicator shows counseling, and down payment assistance/closing costs. Tenant Based Rental Assistance (TBRA): This indicator shows the short-term rental assistance (less than 12 months) and the number of h Homeless shelters: This indicator shows the number of homeless p Emergency housing: This indicator shows the number of beds creat Homeless prevention: This indicator shows the number of househol and emergency legal assistance to prevent homelessness. Jobs created: Of the total number of jobs created, this indicato-sponsored health care, the types of jobs created (using Economic Development Administration the job. Jobs retained: Of the total number of jobs retained, this indica- sponsored health care benefits, and the types of jobs retained ( Business assistance: This indicator shows the total number of bu existing businesses, and the DUNS number of each business so tha three years after assistance. Businesses providing goods or services: This indicator shows whe the service area, neighborhood, or community, as determined by t Not Applicable. I am not interested in qualifying for CDBG fundi - Please choose a common indicator that your agency will use to t Persons Households Not Applicable. I am not interested in qualifying for CDBG fundi - For the category you selected above, provide the total number o Households) your agency anticipates serving through this project 7000 - Based on the common indicator you selected above, please list t agency anticipates serving in each category. "If none, please en Low Income (50%-80% AMI; please refer to the Income Limits chart at www.dublin.c Extremely Low Income (<30% AMI; please refer to the Income Limit Senior Youth Not Applicable. I am not interested in qualifying for CDBG fundi TOTAL - List the number of clients your agency anticipates serving in r must match the total clients entered in #42 above. Per HUD "Hisp Black/African American Asian American Indian/Alaskan Native Native Hawaiian/Other Pacific Islander American Indian/ Alaskan Native and White Asian and White Black/African American and White American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISP Not Applicable. I am not interested in qualifying for CDBG fundi TOTAL 44. If your agency is submitting more than one application or th priority of this application, with number 1 being the highest pr #1 - This program/project has the highest priority for funding within #2 - This program/project has the 2nd highest priority for funding w #3 - This program/project has the 3rd highest priority for funding w #4 - This program/project has the 4th highest priority for funding w #5 - This program/project has the 5th highest priority for funding w #6 - This program/project has the 6th highest priority for funding w If you have more than 6 applications per organization, agency, d 45. Please describe actions your organization is taking to becom-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 dona reimbursements from public health insurance, such as Medi- 46. All organizations must provide valid City of Dublin Business organization's registration number here. -010832 Funding Sources/Revenues Budget Amount City of Livermroe $ 125,000.00 $ 0.00 City of Pleasanton $ 100,000.00 $ 0.00 $ 25,000.00 $ 0.00 Total $ 250,000.00$ 0.00 Funding Uses/Expenses Budget Amount $ 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 -design for programmatic use of space $140,000 Acquisition provides initial funds (down payment) for a- $20,000 Demographic Assessment to determine utilization and requ $20,000 Business Plan Analysis to determine revenues and costs f $20,000 Contractor Pre-Construction Services $20,000 Due Diligence and other items required for site acquisit $5,000 Legal fees Documents * * Documents RequestedAttached Documents Program Expense Budget for ALL Grant Requests   download template Financial Information Form for ALL Grant Requests   download template List of Board of Directors (or governing body) with contact Board of Directors list  information Current Annual Budget for the Entire Agency Agency Budget  Copy of most recently submitted IRS 990 form or Tax Return Tax return  (include complete form) Board of Director's (or governing body's) designation of Designation of authorizing official  authorized official Board of Director's (or governing body's) authorization to Board Resolution for Dublin Grant  request funding (may be same document as one above) Proof of insurance carried, including bonding, liability and/or Insurance certificate  workers' compensation - please upload your Capital expenditure budget (your own format is acceptable) - - - AND BYLAWS. - - - -profit determination letter  All organizations MUST have approved non-profit status from the State of California and Federal Tax Identification Number at -compliant applicants will be disqualified. - include outreach to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used. -- this is due with the 2nd quarter report no later than January 15th Certified Audit and/or Certified Financial Statements Axis Audited Financials 06-15  * ZoomGrants™ is not responsible for the content of uploaded doc ©-  |