Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
4.15 City of Dublin Fiscal Year 2021-22 Human Services Grant Program Funding
STAFF REPORT CITY COUNCIL Page 1 of 6 Agenda Item 4.15 DATE:June 1, 2021 TO:Honorable Mayor and City Councilmembers FROM:Linda Smith, City Manager SUBJECT:City of Dublin Fiscal Year 2021-22 Human Services Grant Program Funding Recommendations Prepared by: Tyler Phillips, Heritage & Cultural Arts Supervisor EXECUTIVE SUMMARY: The City Council will consider funding recommendations for the Fiscal Year 2021-22 Human Services Grant Program. STAFF RECOMMENDATION: Adopt the Resolution Approving Funding Recommendations for the Fiscal Year 2021-22 Human Services Grant Program. FINANCIAL IMPACT: The City of Dublin Human Services Grants Program is generally supported by three funding sources: the federally funded Community Development Block Grant (CDBG) Fund, and the City of Dublin’s General Fund and Affordable Housing Fund. The estimated Fiscal Year 2021-22 CDBG allocation is $99,183 for direct support of social service programs in the Dublin community. General Fund support is $160,000, and the Affordable Housing Fund support is $8,000. Additional funding for the program in Fiscal Year 2021-22, provided by the American Rescue Plan Act (ARPA), was authorized by the City Council at its April 20, 2021 meeting. The applicable amount of ARPA funding is $163,251. This additional funding source could reduce the impact on the General Fund and Affordable Housing Fund, while providing additional funding to designated eligible organizations that are responding to the COVID-19 pandemic. Each organization applying for grants is eligible for a minimum award of $3,500 and a maximum of $25,000. DESCRIPTION: The Human Services Grants Program provides financial support to local non-profit organizations 773 Page 2 of 6 serving the Dublin community. Each year the City Council awards funding to organizations that best meet the community’s needs in support of the City’s adopted Mission and Vision (Attachment 4) and needs identified in the Tri-Valley Needs Assessment (Attachment 5). Funding Support History Fiscal Year 2021-22 marks the 17 th year of Dublin’s Human Services Grant Program, with the recent allocation history shown in the table below. TABLE 1: FUNDING SUPPORT HISTORY (past 10 years) Fiscal Year General Fund Affordable Housing Fund CDBG 2012-13 $125,000 $36,000 $54,746 2013-14 $135,000 $33,000 $45,184 2014-15 $120,000 $7,000 $67,402 2015-16 $120,000 $8,000 $69,812 2016-17 $140,000 $8,000 $75,602 2017-18 $140,000 $8,000 $79,781 2018-19 $130,000 $8,000 $91,462 2019-20 $130,000 $8,000 $93,970 2020-21 $160,000 $8,000 $99,711 2021-22*$160,000 $8,000 $99,183 *Fiscal year 2021-22 also includes $163,251 in ARPA Funding. Analysis The City’s Fiscal Year 2021-22 initial funding budget was estimated at $267,183 which includes CDBG funds estimated at $99,183, a City General Fund contribution of $160,000, and a City Affordable Housing Fund contribution of $8,000. At its April 20, 2021 meeting, the City Council authorized the allocation of $163,251 in funding from the American Rescue Plan Act (ARPA) to support the Human Services Grants Program where applicable. The total available funding, including ARPA, is $430,434. Of the $99,183 estimated for CDBG, a portion is earmarked for support to Axis Community Health for the Health Clinic loan obligation. On May 6, 2014, the City Council adopted Resolution 51-14 authorizing the City to enter into a Public Participating Jurisdiction Agreement (PPJ) with the cities of Pleasanton, Livermore, and the County of Alameda for repayment of a HUD loan to support Axis Community Health’s Health Center expansion. The agreement was executed in July 2015 and the facility grand opening was held in May 2016. The PPJ allowed the agencies, with the City of Pleasanton acting as lead agency, to borrow $1.25 million to support Axis Community Health’s facility construction. Per the agreement, the City of Dublin is required to repay its portion of the loan, a total of $265,618, with CDBG funds. The estimated loan repayment amount for Fiscal Year 2021-22 is $15,575. While not technically included in the application process, this payment is shown in this Staff Report as a CDBG-funded request. 774 Page 3 of 6 During this year’s application period, the City of Dublin received 20 qualifying applications (Attachment 7), from 16 organizations. Of the 20 qualifying applications, eight are eligible for CDBG funding and 10 are eligible for ARPA funding. The total dollar amount requested was $397,767. Review and Rating Criteria In February 2021, Staff and Human Service Commissioners reviewed the Fiscal Year 2021-22 grant applications to verify that all requests qualify for funding based on the adopted program guidelines. As part of the review, the City Council-approved Rating Criteria worksheet (Attachment 6) was applied to each grant application. The Rating Criteria worksheet is one of several factors used in determining funding recommendations. Other factors include considerations of: The number of Dublin residents served and cost per participant; Past performance of existing Dublin programs; Whether the project addresses one or more of the 14 Key Areas of Concern identified in the 2011 Tri-Valley Needs Assessment report; and Whether City funds are used to leverage other funding sources. City and Regional Priorities At its meeting of October 20, 2015, the City Council discussed the funding priorities and directed that the Grants Program emphasize funding programs specifically directed towards human service needs. As such, the City Council decided that grants will not be awarded to arts or school-based programming or events but will focus on the most critical human services needs such as health care, food and nutrition, homelessness, and childcare. Funding Recommendations The Human Services Commission is responsible for providing grant funding recommendations to the City Council each year. At its meeting of March 25, 2021, the Commission considered funding allocations for Fiscal Year 2021-22 and voted unanimously in support of a recommendation to the City Council based on their collective group averages. At a Special Meeting on May 20, 2021, the Commission conducted another review of funding allocations due to the addition of available ARPA funding. The Commission considered updated funding allocations and voted 4-1 in support of a revised recommendation to the City Council. Detail of funding amounts requested, previous year funding amounts, and recommendations are included with this Staff Report as Attachment 3. A summary is listed in the following table: 775 Page 4 of 6 TABLE 2: GRANT PROGRAM RECOMMENDATION HUMAN SERVICES COMMISSION RECOMMENDATION AND STAFF ADJUSTED RECOMMENDATION FOR FISCAL YEAR 2021-22 HUMAN SERVICES GRANT PROGRAM Organization Name and Proposal Title FY 2021-22 Requested Final FY 2021-22 Recommendation Source(s) Axis Community Health - Loan Obligation $15,575 $15,575 CDBG Axis Community Health – Triage Call Nurse $9,135 $9,135 CDBG/ARPA CALICO Center - Dublin Child Prevention $15,000 $15,000 CDBG Community Resources for Independent Living - Housing and Independent Living Skills $15,000 $15,000 CDBG Legal Assistance for Seniors - Legal Services, Medicare Counseling and Education for Dublin Seniors $7,500 $7,500 CDBG Open Heart Kitchen - Dublin Meal Programs $25,000 $25,000 ARPA Spectrum Community Services - Meals on Wheels for Dublin's Homebound Elderly $20,000 $20,000 ARPA Centro Legal de la Raza $22,984 $22,984 CDBG Tri-Valley Haven – Homeless Services Program $24,000 $24,000 ARPA Chabot-Las Positas Community College District/Tri-Valley Career Center – Job Support Expansion $14,308 $9,400 General Fund Chabot-Las Positas Community College District/Tri-Valley Career Center – EITC Support Program $9,240 $9,240 ARPA City Serve of the Tri-Valley - Homelessness Prevention/Crisis Intervention Services $25,000 $25,000 ARPA Easter Seals Bay Area - Kaleidoscope Community Adult Program $24,420 $10,830 General Fund Hively – Community Resources $25,000 $25,000 ARPA Hively – Early Childhood Literacy $15,000 $9,810 General Fund Hively – Strengthening Families Through Trauma Informed Care $25,000 $25,000 ARPA Hope Hospice - Grief Support Center and Hospice Volunteer Program $20,000 $10,830 General Fund Narika – Culturally Responsive Domestic Violence Support Services $25,000 $10,930 General Fund Senior Support Program of the Tri Valley - Case Management $16,505 $15,020 General Fund Sunflower Hill - Program Support for Adults with Developmental Disabilities $20,100 $13,790 General Fund Tri-Valley Haven – Domestic Violence Services $24,000 $24,000 ARPA Total $397,767 $343,044 776 Page 5 of 6 Project Types and Funding Breakdown The table below reflects the number of projects by type, and total recommended funding. TABLE 3: PROJECTS RECOMMENDED BY PROJECT TYPE *Includes the Axis Community Heath Facility Loan Obligation Alameda County Urban County CDBG Program The City of Dublin participates in Alameda County’s Urban-County CDBG Program, along with the cities of Albany, Emeryville, Newark, and Piedmont (cities whose population is or was less than 50,000 residents). These are called the “Urban County Cities,” along with the unincorporated areas of Alameda County. During the current fiscal year, Dublin received $99,711 in CDBG funding for direct support to organizations. The amount being estimated for Fiscal Year 2021-22 is $99,183. This estimate may change slightly until the City is provided the final approved funding level from Alameda County. Project Type: Public Service Project vs. Capital Project Each year, the County limits the Urban County Cities to approximately 15% of the CDBG allocation for service-based organizations and projects. The County’s past practice has been to review all applications to determine if the overall request for service-based projects exceeds the 15% limit. For the past few years, the County has requested that the City adjust the service-based project allocation as the County was projected to exceed the 15% limit. If adjustments are needed for Fiscal Year 2021-22, Staff will work with eligible grant applicants and the County to adjust the allocation, including applying a prorated reduction of all CDBG awards, if necessary. Typically, the City receives far more service project requests than capital project requests. This year, the City did not receive any capital project requests. Funding Summary In total, grant applicants requested $397,767 with $343,044 in grant funds allocated. Additionally, the ARPA supplement has resulted in a savings of $79,390 in the General Fund $8,000 in the Affordable Housing Fund. The following table summarizes the total funding requests and the amount being recommended for the Fiscal Year 2021-22 Human Services Grants Program: Project Type Quantity Recommended Funding Services - Domestic Violence and Child Abuse 3 $49,930 Services - Disabled/Special Needs 3 $39,620 Services - Food 2 $45,000 Services - Financial/Legal 2 $45,504 Services - Homeless 2 $49,000 Services - Medical/Health 3 $44,965 Services - Other *5 $69,025 Total 21 $343,044 777 Page 6 of 6 TABLE 4: GRANT FUNDING SOURCE SUMMARY Funding Sources FY 2021-22 Funds Requested FY 2021-22 Funds Available FY 2021-22 Funds Allocated CDBG Fund $154,194 $99,183 $99,183 General Fund $243,573 $160,000 $80,610 Affordable Housing Fund*$0 $8,000 $0 ARPA Supplement**$0 $163,251 $163,251 Total $397,767 $430,434***$343,044 * Specific requests for the $8,000 from the Affordable Housing Fund are not solicited. Staff allocates this funding to eligible applications. In FY 2021-22, this funding is not being utilized. ** ARPA Funding was not a known funding source during the grant application process. $163,251 was authorized by the City Council at its April 20, 2021 meeting and subsequently utilized to augment funding allocations. ***The funding amount available exceeds the amount requested; however, grant criteria limits funding to not exceed the amount requested. STRATEGIC PLAN INITIATIVE: None. NOTICING REQUIREMENTS/PUBLIC OUTREACH: The City Council Agenda was posted and a weblink to the Staff Report was provided to all grant applicants. ATTACHMENTS: 1) Resolution Approving Funding Recommendations for Fiscal Year 2021-22 Human Services Grant Program 2) Exhibit A to the Resolution – Fiscal Year 2021-22 Human Services Grant Program Funding 3) Human Services Grant Program Past Funding & Human Services Commission Recommendation for Fiscal Year 2021-22 4) City of Dublin Mission and Vision Statements 5) Tri-Valley Needs Assessment 14 Areas of Concern 6) Grant Application Rating Criteria Sheet 7) Fiscal Year 2021-22 Grant Applications 778 Attachment 1 RESOLUTION NO. XX - 21 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF DUBLIN APPROVING FUNDING RECOMMENDATIONS FOR FISCAL YEAR 2021-22 HUMAN SERVICES GRANT PROGRAM WHEREAS,the City received 20 qualifying applications for the Fiscal Year 2021-22 Human Services Grant Program; and WHEREAS, funding sources for the Human Services Grants Program include the federally funded Community Development Block Grant (CDBG), and the City of Dublin General Fund and Affordable Housing Fund; and WHEREAS,on March 25, 2021, the Human Services Commission recommended that 21 projects/programs receive grant funding through the Human Services Grant Program; and WHEREAS,on April 20, 2021, the City Council authorized the use of funding that the City received from the American Rescue Plan Act (ARPA) to augment existing funding sources; and WHEREAS,on May 20, 2021, the Human Services Commission revised its initial recommendation by incorporating the additional available ARPA funding into the allocation for projects/programs being recommended to receive grant funding through the Human Services Grant Program; and WHEREAS,the Human Services Commission has provided the City Council with Fiscal Year 2021-22 Human Services Grant Program funding recommendations, attached hereto as Exhibit A; and WHEREAS, the action taken by this Resolution shall approve the funding recommendations of all funds. NOW, THEREFORE, BE IT RESOLVED that the City Council of the City of Dublin does hereby take the following actions: 1.Approve the Human Services Grant fund allocations, for Fiscal Year 2021-22, as attached hereto as in Exhibit A; and 2.Direct Staff to work with the County of Alameda as required on the CDBG funding allocations by reallocating funds as needed based on the confirmed CDBG funding guidelines and funding level; and 3.Authorize the City Manager to execute agreements with the County of Alameda for use of CDBG funds and the funding agreements with each grant recipient effective July 1, 2021 and 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 1st day of June 2021, by the following vote: AYES: NOES: 779 ABSENT: ABSTAIN: ______________________________ Mayor ATTEST: _________________________________ City Clerk 780 ORGANIZATION NAME GRANT PROGRAM GRANT AMOUNT REQUESTED FY21‐22 GRANT AMOUNT FUNDED FY21‐22 CDBG FUNDING GENERAL FUND AMERICAN RESCUE PLAN ACT FUNDING Axis Loan Obligation $15,575.00 $15,575.00 $15,575.00 Axis Triage Call Nurse $9,135.00 $9,135.00 $3,124.00 $6,011.00 CALICO Center Child Abuse Prevention $15,000.00 $15,000.00 $15,000.00 Community Resources for Independent Living Housing and Independent Living Skills $15,000.00 $15,000.00 $15,000.00 Legal Assistance for Seniors Legal Services, Medicare Counseling and Education for Dublin Seniors $7,500.00 $7,500.00 $7,500.00 Open Heart Kitchen Dublin Senior Meal Program $25,000.00 $25,000.00 $25,000.00 Spectrum Community Services Meals on Wheels for Dublin's Homebound Elderly $20,000.00 $20,000.00 $20,000.00 Centro Legal de la Raza Fair and Secure Housing Project $22,984.00 $22,984.00 $22,984.00 Tri‐Valley Haven Homeless Services Program $24,000.00 $24,000.00 $24,000.00 Chabot Las Positas Dublin Community Jobs Support Expansion $14,308.00 $9,400.00 $9,400.00 Chabot Las Positas Dublin EITC Support Program 2021‐22 $9,240.00 $9,240.00 $9,240.00 City Serve of the Tri‐Valley Homelessness Prevention / Family Stabilization $25,000.00 $25,000.00 $25,000.00 Easter Seals Bay Area Kaleidoscope Community Adult Program $24,420.00 $10,830.00 $10,830.00 Hively Community Resources $25,000.00 $25,000.00 $25,000.00 Hively Early Childhood Literacy $15,000.00 $9,810.00 $9,810.00 Hively Strengthening Families through Trauma Informed Care $25,000.00 $25,000.00 $25,000.00 Hope Hospice Grief Support Center and Hospice Volunteer $20,000.00 $10,830.00 $10,830.00 Narika Culturally Responsive Domestic Violence Surge Support Services $25,000.00 $10,930.00 $10,930.00 Senior Support Program of the Tri‐ Valley Case Management $16,505.00 $15,020.00 $15,020.00 Sunflower Hill Program Support for Adults with Developmental Disabilites $20,100.00 $13,790.00 $13,790.00 Tri‐Valley Haven Domestic Violence Services Program $24,000.00 $24,000.00 $24,000.00 TOTALS $397,767.00 $343,044.00 $99,183.00 $80,610.00 $163,251.00 City of Dublin ‐ Fiscal Year 2021‐22 ‐ Human Services Grant Program Funding Exhibit A to Resolution No. XX‐21 Attachment 2 781 CDBGARPA General FundAxis LoanAxis Section 108 Loan Obligation$16,932.00$15,575.00$15,575.00NANANA$15,575.00Chabot Las PositasDublin Community Jobs Support ExpansionNew$14,308.00$9,400.0014.3750$12.53$9,400.00Legal Assistance for SeniorsLegal Services, Medicare Counseling and Education for Dublin Seniors$6,268.00$7,500.00$7,500.0014.0142$52.82$7,500.00HivelyCommunity Resources$10,780.00$25,000.00$25,000.0014.0525$47.62$25,000.00AxisTriage Call Nurse$9,135.00$9,135.00$9,135.0013.71000$9.14$3,124.00 $6,011.00CALICO CenterChild Abuse Prevention$11,806.00$15,000.00$15,000.0013.718$833.33$15,000.00Community Resources for Independent Living Housing and Independent Living Skills$11,931.00$15,000.00$15,000.0013.730$500.00$15,000.00HivelyStrengthening Families through Trauma Informed CareNew$25,000.00$25,000.0013.7125$200.00$25,000.00Chabot Las PositasDublin EITC Support Program 2021‐22New$9,240.00$9,240.0013.775$123.20$9,240.00Open Heart KitchenDublin Senior Meal Program$21,211.00$25,000.00$25,000.0013.7500$50.00$25,000.00Hope HospiceGrief Support Center and Hospice Volunteer$17,690.00$20,000.00$10,830.0013.3336$32.23$10,830.00Senior Support Program of the Tri‐ValleyCase Management$15,593.00$16,505.00$15,020.0013.350$300.40$15,020.00Tri‐Valley Haven Homeless Services Program$16,878.46$24,000.00$24,000.0013.3425$56.47$24,000.00Tri‐Valley HavenDomestic Violence Services Program$24,087.00$24,000.00$24,000.0013.0 75 $320.00 $24,000.00City Serve of the Tri‐ValleyHomelessness Prevention / Family Stabilization$21,260.00$25,000.00$25,000.0013.0 30 $833.33 $25,000.00Spectrum Community Services Meals on Wheels for Dublin's Homebound Elderly$13,000.00$20,000.00$20,000.0012.760$333.33$20,000.00Sunflower Hill Program Support for Adults with Developmental Disabilites$16,177.00$20,100.00$13,790.0012.345$306.44$13,790.00HivelyEarly Childhood LiteracyNew$15,000.00$9,810.0012.3240$40.88$9,810.00Centro Legal de la RazaFair and Secure Housing ProjectNew$22,984.00$22,984.0012.360$383.07$22,984.00NarikaCulturally Responsive Domestic Violence Surge Support ServicesNew$25,000.00$10,930.0011.0125$87.44$10,930.00Easter Seals Bay AreaKaleidoscope Community Adult Program$16,273.00$24,420.00$10,830.0010.722$492.27$10,830.00Totals:$397,767.00$343,044.00$99,183.00 $163,251.00 $80,610.00City of Dublin Human Services Grant Program ‐ Grant Funding for Fiscal Year 2021‐22 OrganizationGrant ProposalFunding Amount Received FY20‐21Grant Amount Requested FY21‐22Average Cost Per Unduplicated ResidentFY21‐22 Recommended Funding AmountHuman Services Commissioners' Points AverageUnduplicated Residents ServedFY21‐22 Allocation Funding SourceAttachment 3782 MISSION The City of Dublin promotes and supports a high quality of life, ensures a safe and secure environment, fosters new opportunities, provides equity across all programs, and champions a culture of diversity and inclusion. VISION Dublin is a great community to live, work, and raise a family. Dublin values: •Safety – We are dedicated to excellent public safety resources, including police and fire. •Finances – We will strive to be fiscally transparent and balance our budgets annually. •Inclusivity – We will advocate for programs and policies that support inclusive access to housing and cultural opportunities. •Diversity – We will support a wide range of programs and events that reflect and cater to the diversity of our residents. •Equity – We will deliver our services in a way that ensures equitable access to all. •Innovation – We will continue to innovate in every aspect of government and promote innovation within the business community. •Customer Service – We will provide welcoming, excellent customer services to our residents and businesses at all times. •Living an Active Lifestyle – We will continuously promote an active lifestyle through our parks and facilities and encourage participation in local sports. •History – We will honor our history through places and programs that remind people of our beginnings. •Business – We will provide a full spectrum of opportunity by supporting current and prospective businesses through ongoing economic development efforts and helping them grow and thrive locally. •Environmental Sustainability – We will continue to lead in building a well-planned sustainable community and protecting our natural resources. Attachment 4 783 2011Tri ͲValleyNeeds Assessment FindingsbyAreaofConcern* 1 Behavioralhealth(mental healthandsubstanceabuse) 8 Disabilities 2Affordablehousing9Foodandnutrition 3 Healthcare 10 Seniorservices 4 Workforce development 11 Youth services 5 Homelessness 12 Childcare, earlychildhood developmentandeducation 6 Transportationservicesand access 13 Changing demographicsand growingdiversity 7 Domesticviolenceandchild abuse 14 Financialassistance *Page33EasternAlamedaCountyHumanServicesNeedsAssessment Attachment 5 784 1 Criteria Rating Sheet CITY OF DUBLIN UNIVERSAL GRANT RATING SHEET Organization:Program: PROPOSAL SCORE Maximum of 15 points RECOMMEND FUNDING Yes No FUNDING SOURCE CDBG Comm. Grant Incl. Fund Total Requested Total Recommended IF RECOMMENDING CDBG FUNDING, NOTE THAT CDBG FUNDS MAY ONLY BE USED FOR THE FOLLOWING ACTIVITIES AS DEFINED BY THE U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (CHECK ONE). CAPITAL PROJECTS PUBLIC SERVICE HOUSING ECONOMIC DEVELOPMENT THE WORD “PROGRAM” IS U SED BELOW ON THIS FORM TO INCLUDE SERVICES, ACTIVITIES OR IMPROVEMENTS. 1.Organization/Management The organization previously received funding from Dublin, and has fully complied with the City’s management procedures, including invoice and report deadlines. The organization, as presented in the application, is able to achieve the stated goals and outcomes. The organization and their staff are qualified and have the capacity to provide for the program. (i.e. non-profit status, resumes for staff, a Board of Directors, information on clients served). The organization has completed all required aspects of the application process. The proposed program has a successful proven track record (not a new program). (Maximum of 5) ______ 2. Needs/Benefit The beneficiaries are an appropriate target group (lower income residents, handicapped, elderly, youth, etc.) The organization provides an activity to Dublin residents that other organizations do not provide. Applicant’s activity: (choose a or b) a. benefits a majority of Dublin residents by meeting the City’s Mission, Vision and Values OR b. meets at least one of the U.S. Department of Housing and Urban Development’s Strategic Goals or Policy Priorities. The organization’s program meets one of the 14 Areas of Concern as identified in the 2011 Eastern Alameda County Needs Assessment Report The organization collaborates with other agencies to enhance services. (Maximum of 5) ______ Attachment 6 785 2 Criteria Rating Sheet 3. Funding/ Budget The amount of funding requested compared to the number of Dublin residents served is reasonable. Fiscal responsibility - evaluation of the most current audit does not reveal one or more *material weaknesses* (or equivalent) that could jeopardize other funding. Program and administrative budget covers the cost to provide for the program. The organization leverages other funding sources to provide activities/services/improvements. The organization charges a fee and/or produces other income that may be used to support this program (review submitted fee schedule if applicable). (Maximum of 5) ______ *Standardized accounting audit statements 1. A “Control Deficiency”, which is the lowest of the three deficiencies, exists when the design or operation of a control does not allow management or employees, in the normal course of performing their assigned functions, to prevent or detect misstatements on a timely basis. 2. A “Significant Deficiency” is a control deficiency or a combination of control deficiencies, that adversely effects the organization’s ability to initiate, authorize, record, process or report financial data in accordance with the Generally Accepted Accounting Principles, and that the likelihood of a misstatement of the organization’s financial statement that is more than inconsequential which will not be prevented or detected by the organization’s established internal controls. 3. A “Material Weakness”, is a significant deficiency or a combination of significant deficiencies, that results in more than a remote likelihood that a material misstatement of the financial statements which will not be prevented or detected by the organization’s established internal controls. Rating Criteria is subject to change from time to time to reflect the current industry or to address the type of applications received. Attachment 6 786 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin PCS - Human Services Division 2021-2022 Human Services Grant Program Deadline: 1/11/2021 Tri-Valley Haven Homeless Services Jump to: Organization Information Questions Budget Documents USD$ 24,000.00 Requested Submitted: 1/10/2021 7:04:33 PM (Pacific) Project Contact Cynthia Cunningham Morales cynthia@trivalleyhaven.org Tel: (925) 449-5845 Additional Contacts ralph@trivlleyhaven.org Tri-Valley Haven 3663 Pacific Avenue Livermore, CA 94550 United States Executive Director Ann King ann@trivalleyhaven.org Telephone(925) 449-5845 x Fax (925) 449-2684 x Web www.trivalleyhaven.org Organization Information top 1. Business License Number BL-007058 Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Tri-Valley Haven creates homes safe from abuse, contributes to a more peaceful society. One person, one family, one community at a time. Together we build a world without violence. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. ✔✔✔✔Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔Public Service Program or Project gfedc Yes Attachment 7 787 5. Is this request for one-time, seed or operational funding? 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Funding will support TVH’s Homeless and Family Support Services programs. TVH’s family shelter, Sojourner House, provides homeless clients with support services while the Food Pantry (FP) provides nutritious food to low income & homeless Tri-Valley residents. Sojourner House will continue to provide homeless clients (women, women with children, two parent families with children, men with children) with shelter and support services to help them to overcome the barriers that led to their homelessness and to assist them in securing stable housing. Program participants are offered up to six months shelter residency. Shelter clients are provided case management, life skills classes, parenting groups and counseling services. The FP will continue to provide food to low income, homeless, and “at risk of becoming homeless” Tri-Valley residents. On the third Wednesday of each month our Mobile Food Pantry distributes USDA items, meat and/or produce to three housing complexes in Dublin: Dublin Ranch Apartments, Wexford Way/Carlow Court and Wicklow Square. The FP receives food through the Alameda County Community Food Bank, participation in the local Grocery Rescue program and membership in the FEED TRI-VALLEY (Give Local/Stay Local) project. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 425 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) The funds requested from Dublin will be used to pay a portion of the time of the following positions: a) Sojourner House Case Manager and b) Food Pantry Coordinator. We utilize multiple funding sources to support the staff positions and operating costs at both Sojourner and the FP. The staffing at both programs is sufficient to meet and exceed the anticipated results. The FP relies on a large number of volunteers to address the collection, sorting, shelving and distribution of food to clients, as well as the implementation of the ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development ✔✔✔✔ Homelessness gfedc Transportation Services and Access ✔✔✔✔ Domestic Violence and Child Abuse gfedc Disabilities ✔✔✔✔ Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the Above ✔✔✔✔ Please explain: TVH provides a homeless shelter, a food pantry and mobile FP for seniors Attachment 7 788 Mobile Food Pantry. 10. 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)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low-come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. The success of the Sojourner House will be measured through statistical results and the individual goals set by the program participant and their case manager. Examples of those goals will include: a resident gaining employment, a family transitioning into a permanent living and feeling confident that it will be able to keep it, a family obtaining medical insurance etc. Long-term self-sufficiency achieved by a client would be a success. The population that we anticipate serving at Sojourner House continues to be drastically different from the population served in previous years. This is due to the County mandated Coordinated Entry System (CES). During the past year we have experienced a higher rate of individuals with mental health and/or substance abuse issues, conflicts arising between clients and a resistance to comply with shelter guidelines and expectations. The number of clients served has also been affected due to the Covid-19 pandemic. Since March of 2020 we have designated the four shelter rooms to either individuals or families in order to practice social distancing. We provide both staff and residents with gloves, masks, disinfectant and hand sanitizer. Other than employment or school, residents have limited hours to be in the community for medical care, food shopping and exercise. Sojourner House and Food Pantry clients are almost exclusively extremely low through low income single parents with their children, two parent families, single women, disabled individuals and seniors. Clients will also benefit from our Food Pantry by receiving free groceries that in many cases they can’t afford. Our clients in Dublin, most of them being seniors, will be getting their food from our Mobile Food Pantry, meaning that the transportation issues will be minimized. In FY 1920 Sojourner served 62 unduplicated clients, providing 4,292 bed nights, and the Food Pantry served 5,236 unduplicated clients. Statistics are maintained on the agency’s Os-Soft database which include individuals served at each program and services provided. We have multi-cultural staff members and volunteers who utilize their cultural backgrounds to enhance the services in the homeless program. We presently have multiple staff fluent in Spanish, Russian, Hindi, and Punjabi. Multi language fluency is always a consideration when hiring staff and recruiting volunteers. All of the Sojourner House and Food Pantry intake forms, paperwork and flyers are in English and Spanish, and some are in Chinese. We make sure that we have cooking utensils and dishes that are multi-culturally appropriate such as rice cookers, chopsticks, etc. Our Food Pantry has a capacity to offer ethnic food when needed. Every year our Holiday Program for low-income families from the Tri-Valley area brings new participants and spreads the word about our services. 160 Dublin residents participated in our 2020 Holiday Program. TVH staff maintains a good working relationship with CRIL, a local service provider for persons with disabilities and also is aware of key services such transportation for persons with disabilities and how to access them. Sojourner House was remodeled before it was opened in 2002 to include a ramp and a handicap accessible bathroom. No ramps are needed at the Food Pantry due to our moving distribution services to the parking lot due to Covid-19. There are many ways we outreach to Dublin residents. Together with the Cities of Dublin, Livermore, and Pleasanton, Open Heart Kitchen and Interfaith Sharing, Tri-Valley Haven participates annually in FEED TRI-VALLEY. The mission of FEED TRI- VALLEY is to end hunger by educating and soliciting donations to feed our local community. In addition, we regularly conduct presentations to the Dublin Police Services on Domestic Violence, Sexual Assault and Homelessness issues and the programs that Tri-Valley Haven offers. Our Community Education Program reaches 1,350 students through Health Education classes that we teach in Dublin High School covering topics such as healthy relationships and teen dating violence. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis-Bacon requirements. 12. ** QUESTIONS 13 THROUGH 23 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 13. 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? What access ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Yes. If so, check box here and answer questions 13 through 23. gfedc No. If no, check box here and enter NA gfedc Don't know. If you are unsure, please call City staff at (925) 833-6645. Attachment 7 789 accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. TVH is committed to providing services to limited English speaking clients. We presently have multiple staff fluent in Spanish. Additionally, staff is available to provide assistance in Russian, Punjabi, and Hindi. We seek out bilingual/bicultural staff, and provide a wage differential for those that speak Spanish. At Sojourner House and the Food Pantry we offer the use of Alameda County Social Services Agency’s Language Line Solutions service for clients to access an on-demand interpreter. In Dublin, our largest LEP client group is Chinese-speaking. We make sure that our intake forms for the mobile food pantry are available in Chinese. In addition most flyers, client materials and other communications are created in both English and Spanish. We produce and distribute documents in other languages when available. 14. CDBG ONLY - Identify at least one HUD Guiding Principle that relates to your project: 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: (Select Category and Applicable Goals) 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 17. CDBG ONLY - Select one HUD 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?") ✔✔✔✔ Be culturally accessible, appropriate and inclusive ✔✔✔✔ Encourage community engagement and involvement gfedc Promote energy and resource efficiency ✔✔✔✔ Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery gfedc Not Applicable. Not interested in CDBG funding. gfedc A) Housing gfedc Goal 1: Promote the production, rehabilitation, and preservation of affordable housing (rental and ownership) through acquisition, rehabilitation, new construction, and minor repair. gfedc Goal 2: Reduction of housing discrimination through provision of fair housing and tenant/landlord services. gfedc Goal 3: Use resources to assist low-income residents make rental assistance payments in response to Covid-19. ✔✔✔✔ B) Homeless ✔✔✔✔ Goal 1: Use resource to end homelessness by funding and supporting homeless service programs. gfedc C) Supportive Housing gfedc Goal 1: Increase the availability of services enriched housing for persons with special needs by supporting acquisition and new construction of housing units. gfedc D) Community Development gfedc Goal 1: Make improvements, including ADA accessibility and rehabilitation to public facilities, such as curbs and sidewalks, neighborhood parks and recreational improvements, homeless facilities and other public facilities/community centers. gfedc Goal 2: Fund economic development, micro-enterprise, and on-the-job training. gfedc Goal 3: Support public service programs for low income residents, preserving safety net services for families and individuals who are vulnerable or gfedc F) Not Applicable. Not interested in CDBG funding. ✔✔✔✔ Public Services gfedc Public Facilities gfedc Rental Assistance gfedc Affordable Housing gfedc Increase Opportunities for 1st Time Homebuyers gfedc Promote Decent Affordable Rental Housing ✔✔✔✔ Strengthen Communities gfedc Ensure Equal Opportunity in Housing gfedc Reduce Housing Discrimination ✔✔✔✔ Promote Participation of Grass-Roots, Faith-Based, and other Community-Based Organizations gfedc Not Applicable. Not interested in CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment Attachment 7 790 18. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?") 19. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. Not interested in CDBG funding. ✔✔✔✔ Availability/Accessibility gfedc Affordability gfedc Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Not Applicable. Not interested in CDBG funding Attachment 7 791 20. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 21. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 22. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMI") information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 23. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. Not interested in CDBG funding 35 Disabled 120 Women/Female Headed Households 225 Seniors 0 Youth 25 Homeless 0 Not Applicable. Not interested in CDBG funding (Type N/A) 405.00405.00 TOTAL 25 Low Income (50%-80% AMI) 400 Extremely Low Income (<30% AMI) 0 Not Applicable. Not interested in CDBG funding (Type N/A) 425.00425.00 TOTAL 100 White 0 White + HISPANIC 50 Black/African American 0 Black/African American + HISPANIC 200 Asian 0 Asian + HISPANIC 5 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 65 Multi Racial + HISPANIC OR other Multi Racial 0 Not Applicable. Not interested in CDBG funding. (Type N/A) Attachment 7 792 24. 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 420.00420.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed Alameda County SSA Shelter USD$ 213,275.00 USD$ 0.00 HCD Linkages USD$ 47,340.00 USD$ 0.00 Local Dublin/Livermore/Pleasanton USD$ 134,000.00 USD$ 0.00 Individual Donations/Foundations USD$ 12,000.00 USD$ 0.00 EFSP USD$ 27,500.00 USD$ 0.00 Alameda County ESG USD$ 26,575.00 USD$ 0.00 Alameda County SSA Food Pantry USD$ 103,388.00 USD$ 0.00 Total USD$ 564,078.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Salaries USD$ 297,479.00 USD$ 0.00 Benefits USD$ 79,070.00 USD$ 0.00 Supplies USD$ 36,906.00 USD$ 0.00 Printing/Copying USD$ 12,000.00 USD$ 0.00 Postage USD$ 30.00 USD$ 0.00 Telephone USD$ 6,023.00 USD$ 0.00 Rent and Utilities USD$ 51,462.00 USD$ 0.00 Accounting/Audit USD$ 5,650.00 USD$ 0.00 Other USD$ 75,458.00 USD$ 0.00 Total USD$ 564,078.00 USD$ 0.00 Budget Narrative Revenue: The composition of revenue is our best estimate based on the previous year of operation and also includes a contract from Alameda County ESG which ends 8/21/21. Expenses: personnel costs include salaries and benefits. Sick leave, vacation, and holidays are not included in the benefits calculation for staff that will be paid with the Dublin grant funds. Other operating expenses include: travel and mileage, maintenance and repair expenses, portion of liability, property, D&O, and auto insurance, auto expense, staff development, program expenses and client assistance. The Homeless and Family Supports Services budget is part of the overall agency budget that includes other programs and departments such as Domestic Violence Services, Sexual Assault Services, Finance, and Administration. Thus only a portion of liability insurance, auto insurance, audit etc. are being charged to this program. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget Attachment 7 793 Application ID: 326059 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2021 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ Agency Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ Form 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Resolution and Authority Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Resolution and Authority Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Insurance STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. 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. ✔✔✔✔ Non-profit Status Non-profit Status State Certified Audit and/or Certified Financial Statements ✔✔✔✔ Audit REQUIRED FOR CDBG ONLY - If requesting Capital Funding, please upload your Capital expenditure budget (your own format is acceptable) N/A REQUIRED FOR CDBG ONLY - Personnel Policies Including Affirmative Action Plan and Grievance Procedure Personnel Policies REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section Audit REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws Articles of Incorporation By-Laws REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) By-Laws 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. LEP Access Plan REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Strategic Plan Other Supporting Documents (Not Required) Attachment 7 794 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin PCS - Human Services Division 2021-2022 Human Services Grant Program Deadline: 1/11/2021 Axis Community Health Triage Call Nurse Jump to: Organization Information Questions Budget Documents USD$ 9,135.00 Requested Submitted: 1/11/2021 10:50:18 AM (Pacific) Project Contact Valerie Jonas vjonas@axishealth.org Tel: 925.201.6068 Additional Contacts scompton@axishealth.org,contracts@axishealth.org Axis Community Health 5925 W. Las Positas Blvd., Suite 100 Pleasanton, CA 94588 United States CEO Sue Compton scompton@axishealth.org Telephone(925) 201-6068 x Fax (925) 417-1503 x Web axishealth.org Organization Information top 1. Business License Number 112438 Questions top 1. Select the category that best describes your organization: (Select only one.) 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. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes Attachment 7 795 5. Is this request for one-time, seed or operational funding? 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. This project ensures patients have phone access to a triage nurse to talk with about health symptoms and to guide them in accessing treatment. During the current COVID-19 health emergency, the Triage Nurse provides immediate information to patients seeking guidance about potential COVID-19 symptoms and in providing ongoing health assistance to those diagnosed with the virus. Access to the Triage Nurse ensures patients receive safe, timely and appropriate care for COVID-19 and other health issues, and reduces risk for acute health problems. The role of the call center triage nurse is a vital part of the Axis care delivery system because it gives patients quick access to medical advice through our call center. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 1000 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) Funds from this grant will address the need to provide quick phone access to a medical professional when patients are experiencing a health problem. It is also the link for parents/guardians of children who tend to require more frequent medical guidance. This funding will ensure Axis’s ability to fund this critical position without a reduction in service hours. This swift access to medical information is imperative during the current COVID-19 health emergency. When a patient is experiencing symptoms of any nature, COVID-19 related or any health condition, they can call our main phone line and be connected to the Triage Nurse, a licensed RN with specialized training in responding to patient calls, gathering information on symptoms, and assisting patients with accessing appropriate care. The Triage Nurse is available during business hours to patients (Axis has an on-call phone service for after-hours care). When a call center operator receives a call requiring a response from a licensed professional, the call is transferred to the Triage Nurse. The caller describes symptoms to the nurse and responds to the nurse’s questions. The Triage Nurse uses a web-based decision- ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing ✔✔✔✔ Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the Above gfedc Please explain: Attachment 7 796 making tool, called Clear Triage, to assist in the process. Depending upon the severity of the symptoms and the patient’s condition, the nurse advises on the appropriate next step. Options include having the patient proceed to emergency care, scheduling a same-day appointment with their Axis provider, scheduling a future appointment for the patient, or giving the patient advice for home care and follow-up. During the COVID-19 pandemic, It should be noted that Axis continues to provide patient care via telehealth and in-person as needed. The nurse responds to patients of all ages, from newborns to geriatrics. As needed, the nurse brings a professional medical translator on the call to ensure clarity of information. The Triage Nurse is also the Specific Point of Contact (SPOC) for patients being discharged from the hospital. Through a dedicated phone line, area hospitals, including Stanford Health Care-Valley Care, Highland Hospital, and John George, call the Triage Nurse to arrange care for the patient after hospital discharge. This is a critical point of contact for ensuring continuity of care. During 2020, the Triage Nurse responded to 6,064 calls and assisted approximately1000 patients in discharge planning This call volume was an increase of 20% over the prior calendar year due to the COVID-19 health emergency. The Dublin grant funds, in combination with funds from the cities of Livermore and Pleasanton, will help support a .5 FTE Triage Nurse, who will be available to 1,810 Axis patients who are Dublin residents. Axis was receiving an operational support grant annually for 10 years from Blue Shield of California Foundation (BSCF) which helped support the Triage Nurse position. However, BSCF has depleted this special fund for community health centers and is not providing any future support. In order to continue to have this critical role in the care delivery system, Axis must find sufficient funding. The provision of Triage Nurse call services is central to providing an appropriate standard of health care. Moreover, the project is targeted to reduce health care costs by ensuring that appropriate care levels are accessed in relation to patient symptoms, and further reduces health care costs by prioritizing care access in appropriate timeframes. Without this resource, patients may delay accessing treatment which can escalate health problems and cost of care. This is of particular concern during this pandemic when it is essential that patient health be maintained and risk for acute care be lowered. The salary cost for Triage Nurse services are reasonable in relation to the cost-savings realized when people are able to access health information that directs them appropriately. 10. 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)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low-come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. Achieving appropriate levels of staffing that support a comprehensive system of care delivery is critical to the ongoing success of service delivery. The Triage Nurse is a position that, in many ways, is the backbone of medical serve delivery. Outcome measures that are crucial to the success of this project are: • Keeping patients who are experiencing symptoms safe by ensuring care that is timely and appropriate in relation to the symptoms. For example, directing a patient with chest pain or severe bleeding directly to emergency care which hastens access to essential care. • Preventing delay in care by promptly speaking with patients, or parents/guardians of patients, about the medical condition and facilitating appointments with care providers. • Assuring continuity of care for patients being discharged from an acute care setting by scheduling appropriate follow-up care with the patient’s provider. • Addressing the needs of patients who are being discharged from other care settings. Strategies and objectives that will be used to track the progress are: • Tracking phone system data to monitor call volume and disposition. • Ongoing review by the Nurse Manager and Chief of Clinic Operations of workflows for calls coming into the Triage Nurse and their disposition. • Ongoing review of patient health outcomes by Nurse Manager, Chief of Clinic Operations, and Quality Enhancement data team by utilization of our Electronic Health Records system (Epic) to track health data. Axis serves low-income and uninsured Tri-Valley residents of all ages with medical, mental health and dental services. This program serves Dublin families living below 200% of the federal poverty level (FPL)—Dublin’s most impoverished residents. Many are the working poor who are struggling to maintain life’s basic needs for their families. Dublin has experienced a 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 Tri-Valley Needs Assessment). The past decade has seen growing diversity, with an increase of nearly 400% in the Asian population . Twenty-one percent of Dublin residents are foreign-born and 29% speak a language other than English at home. These demographics present cultural and linguistic barriers to attaining and maintaining good health. Axis has seen a tremendous rise in the number of impoverished Dublin residents in need of our services. In fact, we have gone from providing services for 1,012 Dublin residents in 2010 to serving 1,810 in 2019, a 79% increase in (UDS Reports, 2010-2019). This project will benefit Attachment 7 797 these residents by providing them access to medical advice by phone. 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 throughout our organization, including with our Triage Nurse calls. All of our call center operators and front desk staff are bilingual (Spanish and English) and translation services for other languages are 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. Axis is the sole agency providing health care services for low-income and uninsured Dublin residents. Particular focus is put on reaching limited English speakers. These efforts have been successful and half our patients are limited English speakers. Axis promotes its services at community events, at organizations who serve low-income populations, and in media outlets. Activities include outreach at the library, presentations at low-income housing communities, and coordination with school nurses. While in-person outreach activities have been curtailed during the pandemic, we continue to outreach via on-line presentations, newsletters and social media. Our Enrollment Specialists and Community Relations Manager focus on reaching low-income limited English speakers and other challenged populations, such as those who have language or 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 CareMessage automated text appointment-reminders. In addition, Axis receives referrals form 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. Once enrolled as an Axis patient, these individuals benefit from the services offered through this Triage Nurse project. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis-Bacon requirements. 12. ** QUESTIONS 13 THROUGH 23 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 13. 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? What access accommodations are used? Etc. 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. 14. CDBG ONLY - Identify at least one HUD Guiding Principle that relates to your project: ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Yes. If so, check box here and answer questions 13 through 23. gfedc No. If no, check box here and enter NA gfedc Don't know. If you are unsure, please call City staff at (925) 833-6645. ✔✔✔✔ Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery gfedc Not Applicable. Not interested in CDBG funding. Attachment 7 798 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: (Select Category and Applicable Goals) 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 17. CDBG ONLY - Select one HUD 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?") 18. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?") 19. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc A) Housing gfedc Goal 1: Promote the production, rehabilitation, and preservation of affordable housing (rental and ownership) through acquisition, rehabilitation, new construction, and minor repair. gfedc Goal 2: Reduction of housing discrimination through provision of fair housing and tenant/landlord services. gfedc Goal 3: Use resources to assist low-income residents make rental assistance payments in response to Covid-19. gfedc B) Homeless gfedc Goal 1: Use resource to end homelessness by funding and supporting homeless service programs. gfedc C) Supportive Housing gfedc Goal 1: Increase the availability of services enriched housing for persons with special needs by supporting acquisition and new construction of housing units. gfedc D) Community Development gfedc Goal 1: Make improvements, including ADA accessibility and rehabilitation to public facilities, such as curbs and sidewalks, neighborhood parks and recreational improvements, homeless facilities and other public facilities/community centers. gfedc Goal 2: Fund economic development, micro-enterprise, and on-the-job training. ✔✔✔✔ Goal 3: Support public service programs for low income residents, preserving safety net services for families and individuals who are vulnerable or gfedc F) Not Applicable. Not interested in CDBG funding. gfedc Public Services gfedc Public Facilities gfedc Rental Assistance gfedc Affordable Housing gfedc Increase Opportunities for 1st Time Homebuyers gfedc Promote Decent Affordable Rental Housing ✔✔✔✔ Strengthen Communities gfedc Ensure Equal Opportunity in Housing gfedc Reduce Housing Discrimination gfedc Promote Participation of Grass-Roots, Faith-Based, and other Community-Based Organizations gfedc Not Applicable. Not interested in CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. Not interested in CDBG funding. ✔✔✔✔ Availability/Accessibility gfedc Affordability gfedc Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. Attachment 7 799 20. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 21. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Not Applicable. Not interested in CDBG funding ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. Not interested in CDBG funding 50 Disabled 150 Women/Female Headed Households 140 Seniors 230 Youth 20 Homeless Not Applicable. Not interested in CDBG funding (Type N/A) 590.00590.00 TOTAL Attachment 7 800 22. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMI") information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 23. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" 24. 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 220 Low Income (50%-80% AMI) 720 Extremely Low Income (<30% AMI) Not Applicable. Not interested in CDBG funding (Type N/A) 940.00940.00 TOTAL 275 White 395 White + HISPANIC 39 Black/African American 1 Black/African American + HISPANIC 228 Asian 2 Asian + HISPANIC 8 American Indian/Alaskan Native 1 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 40 Multi Racial + HISPANIC OR other Multi Racial Not Applicable. Not interested in CDBG funding. (Type N/A) 989.00989.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed City of Dublin USD$ 9,135.00 USD$ 0.00 Attachment 7 801 City of LIvermore USD$ 28,421.00 USD$ 28,421.00 City of Pleasanton USD$ 13,195.00 USD$ 13,195.00 Foundation Grants USD$ 40,753.00 USD$ 0.00 Community Donations USD$ 10,000.00 USD$ 0.00 Total USD$ 101,504.00 USD$ 41,616.00 Funding Uses/Expenses Budget Amount Amount Committed Triage Call Nurse Salary & Benefits USD$ 101,504.00 USD$ 41,616.00 Total USD$ 101,504.00 USD$ 41,616.00 Budget Narrative This project is for the salary for a 1.0 FTE phone Triage Nurse at a rate of $40/hour plus 22% for benefits. Funding is sought from Dublin, which will be combined with grant funds from Livermore and Pleasanton that have been committed from federal COVID relief funds, to fund .5 FTE. The request amounts for this funding is in ratio to the number of patients served from each city by this project. Axis is seeking funding from other sources for the remaining .5 FTE for this project. This critical service is in proportion to the overall staffing budget for health services at the organization. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information Form List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ Board of Directors 2021 Current Annual Budget for the Entire Agency ✔✔✔✔ Axis FY20-21 Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ IRS 990 Form Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Axis Authorized Official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ BOD Funding Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Proof of Insurance STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. 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. ✔✔✔✔ Federal Non-Profit Determination Letter State Non-Profit Determination Letter Certified Audit and/or Certified Financial Statements ✔✔✔✔ Axis Certified Audit 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 Grievance Procedure Axis Personnel Policies REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section Axis Audited Financials REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws Axis Articles of Incorporation Axis Bylaws Attachment 7 802 Application ID: 326530 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2021 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) 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. Axis LEP REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) Attachment 7 803 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin PCS - Human Services Division 2021-2022 Human Services Grant Program Deadline: 1/11/2021 Tri-Valley Haven Domestic Violence Services Jump to: Organization Information Questions Budget Documents USD$ 24,000.00 Requested Submitted: 1/10/2021 7:08:27 PM (Pacific) Project Contact Cynthia Cunningham Morales cynthia@trivalleyhaven.org Tel: (925) 449-5845 Additional Contacts vicki@trivalleyhaven.org Tri-Valley Haven 3663 Pacific Avenue Livermore, CA 94550 United States Executive Director Ann King ann@trivalleyhaven.org Telephone(925) 449-5845 x Fax (925) 449-2684 x Web www.trivalleyhaven.org Organization Information top 1. Business License Number BL-007058 Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Tri-Valley Haven creates homes safe from abuse, contributes to a more peaceful society. One person, one family, one community at a time. Together we build a world without violence. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes Attachment 7 804 5. Is this request for one-time, seed or operational funding? 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. TVH's Domestic Violence Services Program is an existing project. Our 24-hour Crisis Line is the main point of entry for survivors seeking shelter. Clients are referred to us via our website, law enforcement, hospitals, 211, shelter networks and other agencies. Clients are screened via telephone to assess their needs and safety, and then, if appropriate, an in-person intake is conducted. Each client is assigned to a Case Manager and individual counseling is available to adults and children. The following groups are available for adult clients: DV Support, Job Readiness, Parenting, Life Skills and Family Night. Goals are set with each client depending on their specific needs while meeting with their Case Manager, who will assist them in working toward their goals. The maximum length of stay at Shiloh is 105 days. Shiloh has its own vehicle which is used for client intakes and emergency transportation. While in the Shiloh program, Clipper cards, BART tickets and gas cards are available to clients. During their stay, clients can receive food from our pantry and Open Heart Kitchen. During the COVID 19 pandemic, we have reduced our on-site census to ensure that clients do not have to share rooms with non-family members and to allow for social distancing in common areas. We continue to shelter up to 30 adults and children by utilizing a local motel. While at the motel, clients have access to all of the supportive services available on site until space becomes available at Shiloh. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 75 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) The funds requested from Dublin will be used to pay part of the Bilingual Case Manager's time, and part of the Overnight staff's time. These positions are essential for the shelter operations. Tri-Valley Haven’s domestic violence services support Dublin’s mission to have a high quality of life and a safe and secure environment for all residents through prevention and intervention services. Furthermore, we will make these services available to all residents through provision of services that are culturally ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access ✔✔✔✔ Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the Above gfedc Please explain: We are the only confidential domestic violence shelter in the Tri-Valley, with over 43 years of experience in providing supportive services. Attachment 7 805 sensitive and appropriate. Clients will benefit from our program or by creating a safety plan for themselves and their children, developing goals and plan of action towards achieving self-sufficiency, and connecting with the resources available in our community. In FY 19-20, we served 98 survivors of domestic violence from Dublin through our crisis line and shelter. The Domestic Violence Services Program utilizes in-house and donated services as much as possible to meet clients' needs and hold down costs. Residents are able to obtain food from the TVH Food Pantry, they are given clothing vouchers and referrals to our Thrift Store, they receive assistance applying for government services such as CAL Fresh, CalWORKS, and Linkages. We refer our clients to AXIS for their health related needs. Trained volunteers provide overnight crisis line coverage as well as (along with TVH staff) around the clock response to sexual assault calls and referrals from local police departments and hospitals, and volunteers provide childcare for shelter children while their parents participate in educational and support groups. All of this contributes to a very reasonable budget. 10. 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)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low-come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. As required by Alameda County, TVH uses Results Based Accountability (RBA) to measure the success of our program. Our performance measures include: a) at least 75% of participants will report that they are Satisfied or Very Satisfied on the satisfaction surveys; b) 75% of Shelter program participants will be safely housed upon exit. Last Fiscal Year we met or nearly met both performance measures. The success of the Program will be measured through evaluation of client surveys, statistical results, and the individual goals set by the program participant and her/his case manager. Those goals will be set up on a case-by-case basis and may include: reuniting with their children through completing their CPS Plan, finding housing or employment. Some clients will only stay one or two nights, and their goals will be very different such as safely relocating to a different county or a state. Client progress will be tracked by the case manager during weekly meetings. Progress is also monitored at weekly staff meetings during case review. Additionally, case managers consult with staff counselors or the Clinical Supervisor as needed in order to provide the best client services. We have multi-cultural staff members and volunteers who utilize their cultural backgrounds to enhance the services we provide to our clients. We presently have staff fluent in Spanish, Hindi, Punjabi, Russian, French and several African languages. Multi language fluency is always a consideration when hiring staff and recruiting volunteers, and wage differentials are given to those fluent in Spanish, Cantonese, Mandarin, Russian, Hindi or Tagolog. All of the written materials at Shiloh are in both English and Spanish, and some are in Chinese. We make sure that at Shiloh we have cooking utensils and dishes that are multi-culturally appropriate such as rice cookers, chopsticks, and new sets of pots and pans for Muslim clients whose religious practice requires that these not be shared with other families. Ethnic food is available for our shelter clients at the Food Pantry and grocery store gift cards are available to assist with purchasing items that aren’t at the Food Pantry. We continue educating our staff through participation in Cultural Responsiveness development projects. TVH staff maintains a good working relationship with CRIL, a local service provider for persons with disabilities and also is aware of key services such transportation for persons with disabilities and how to access them. Telephone screenings and intake processes include questions about needed accommodations (such as a bottom bunk, private room or special dietary needs). Our shelter is handicap-accessible. We conduct restraining order clinics at the Dublin library on the first and third Saturday of each month (during the pandemic, this assistance is available remotely; we will resume in-person clinics when it is safe to do so), which increased our overall visibility in addition to making this service more accessible to those Dublin residents who need it. We conduct annual briefings at Dublin Police Services to update them about issues of domestic violence, sexual assault and homelessness, and our agency’s activities. All new staff and volunteers who attend our 70-hour domestic violence and sexual assault counselor training participate in a ride along with one of the three Tri-Valley police departments in order to maintain a strong connection to local law enforcement. Officers regularly tell us during the annual briefings that this is a positive experience for them. We are participants in the Family Violence Prevention Programs at Kaiser Permanente in Livermore and Pleasanton. While the Dublin Kaiser offices do not have a formal program in place, we have made presentations to staff about domestic violence, and they have supported several of our events, such as Back to School and the Pace for Peace. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis-Bacon requirements. 12. ** QUESTIONS 13 THROUGH 23 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 13. CDBG ONLY- Explain your Limited English Proficiency/Language Access Plan (LEP/LAP). How does your ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Yes. If so, check box here and answer questions 13 through 23. ✔✔✔✔ No. If no, check box here and enter NA gfedc Don't know. If you are unsure, please call City staff at (925) 833-6645. Attachment 7 806 agency outreach to limited English speaking residents to encourage access to services? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 14. CDBG ONLY - Identify at least one HUD Guiding Principle that relates to your project: 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: (Select Category and Applicable Goals) 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 17. CDBG ONLY - Select one HUD 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?") 18. CDBG ONLY - Select one HUD Outcome that relates to your project: gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc A) Housing gfedc Goal 1: Promote the production, rehabilitation, and preservation of affordable housing (rental and ownership) through acquisition, rehabilitation, new construction, and minor repair. gfedc Goal 2: Reduction of housing discrimination through provision of fair housing and tenant/landlord services. gfedc Goal 3: Use resources to assist low-income residents make rental assistance payments in response to Covid-19. gfedc B) Homeless gfedc Goal 1: Use resource to end homelessness by funding and supporting homeless service programs. gfedc C) Supportive Housing gfedc Goal 1: Increase the availability of services enriched housing for persons with special needs by supporting acquisition and new construction of housing units. gfedc D) Community Development gfedc Goal 1: Make improvements, including ADA accessibility and rehabilitation to public facilities, such as curbs and sidewalks, neighborhood parks and recreational improvements, homeless facilities and other public facilities/community centers. gfedc Goal 2: Fund economic development, micro-enterprise, and on-the-job training. gfedc Goal 3: Support public service programs for low income residents, preserving safety net services for families and individuals who are vulnerable or ✔✔✔✔ F) Not Applicable. Not interested in CDBG funding. gfedc Public Services gfedc Public Facilities gfedc Rental Assistance gfedc Affordable Housing gfedc Increase Opportunities for 1st Time Homebuyers gfedc Promote Decent Affordable Rental Housing gfedc Strengthen Communities gfedc Ensure Equal Opportunity in Housing gfedc Reduce Housing Discrimination gfedc Promote Participation of Grass-Roots, Faith-Based, and other Community-Based Organizations ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. Not interested in CDBG funding. Attachment 7 807 (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?") 19. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: 20. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. ✔✔✔✔ Not Applicable. Not interested in CDBG funding gfedc Persons gfedc Households Attachment 7 808 21. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 22. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMI") information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 23. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" 24. 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 ✔✔✔✔ Not Applicable. Not interested in CDBG funding Disabled Women/Female Headed Households Seniors Youth Homeless N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL Low Income (50%-80% AMI) Extremely Low Income (<30% AMI) N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL White White + HISPANIC Black/African American Black/African American + HISPANIC Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. Not interested in CDBG funding. (Type N/A) 0.000.00 TOTAL Attachment 7 809 only be one #1 PER AGENCY gfedc #1 - This program/project has the agency's highest priority for funding. ✔✔✔✔ #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed Alameda County Domestic Violence Center Act USD$ 36,974.00 USD$ 0.00 Local Livermore/Pleasanton USD$ 83,000.00 USD$ 0.00 Alameda County HCD Linkages USD$ 47,340.00 USD$ 0.00 CalOES DV USD$ 537,587.00 USD$ 0.00 Alameda County CalWORKS USD$ 70,000.00 USD$ 0.00 Donations/Foundations USD$ 12,000.00 USD$ 0.00 Alameda County SSA USD$ 79,978.00 USD$ 0.00 Total USD$ 866,879.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Salaries USD$ 535,481.00 USD$ 0.00 Benefits USD$ 88,935.00 USD$ 0.00 Supplies USD$ 14,746.00 USD$ 0.00 Printing/Copying USD$ 2,000.00 USD$ 0.00 Postage USD$ 500.00 USD$ 0.00 Telephone USD$ 11,553.00 USD$ 0.00 Rent and Utilities USD$ 18,292.00 USD$ 0.00 Accounting/Audit USD$ 8,669.00 USD$ 0.00 Other USD$ 186,703.00 USD$ 0.00 Total USD$ 866,879.00 USD$ 0.00 Budget Narrative Revenue: The composition of revenue is our best estimate based on the previous year of operation. Expenses: personnel costs include salaries and benefits. Sick leave, vacation, and holidays are not included in the benefits calculation for staff that will be paid with the Dublin grant funds. Other operating expenses include: travel and mileage, portion of liability, property, D&O, and auto insurance, auto expense, and staff development. Domestic Violence Services budget is part of the overall agency budget that includes other programs and departments such as Homeless and Family Support Services, Sexual Assault Services, Finance, and Administration. thus only a portion of liability insurance, auto insurance, audit etc. are being charged to this program. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ Agency Budget Attachment 7 810 Application ID: 326906 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2021 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ Form 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Resolution and Authority Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Resolution and Authority Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Insurance STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. 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. ✔✔✔✔ Non-profit Status Non-profit Status State Certified Audit and/or Certified Financial Statements ✔✔✔✔ Audit 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 Grievance 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 - 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 ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Strategic Plan Other Supporting Documents (Not Required) Attachment 7 811 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin PCS - Human Services Division 2021-2022 Human Services Grant Program Deadline: 1/11/2021 Spectrum Community Services Meals on Wheels more than a meal Jump to: Organization Information Questions Budget Documents USD$ 20,000.00 Requested Submitted: 1/10/2021 8:08:37 PM (Pacific) Project Contact Lara Calvert LCalvert@spectrumcs.org Tel: (510) 881-0300 ext. 243 Additional Contacts admin@spectrumcs.org, coldes@spectrumcs.org, pherndon@spectrumcs.org Spectrum Community Services 2621 Barrington Court Hayward, CA 94545 United States Executive Director Lara Calvert lcalvert@spectrumcs.org Telephone(510) 881-0300 x243 Fax (510) 537-3340 Web www.spectrumcs.org Organization Information top 1. Business License Number 006992 Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Spectrum Community Services’ mission is to improve the health and safety of seniors and low-income residents in Alameda County by enhancing their quality of life and helping them age at home with dignity. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project Attachment 7 812 operation. 5. Is this request for one-time, seed or operational funding? 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Spectrum Community Services’ Meals on Wheels Program will deliver at least 10,500 nutritious, life-sustaining meals and a vital daily safety check to low/extremely low-income disabled and homebound seniors residing in Dublin. This will be achieved with a strong, devoted, and trained volunteer team. Safety protocols that were implemented because of COVID 19 are now an integral part of how we serve our clients. Meals are delivered in a contactless manner. Our processes are continually evaluated and updated to meet the ever changing requirements. We continue to strive to ensure the safety, well being and nutritional needs of our clients. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) Spectrum’s Meals On Wheels Program will provide daily meals to approximately 60 unduplicated Dublin senior/disabled adult residents. 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) Spectrum is asking for $20,000 to support its Meals on Wheels Program. A portion of this request will fund a percentage of salaries for two positions: our Meals on Wheels Program Manager ($6,890); our Dublin Meals on Wheels Coordinator ($4,914). It will also fund a proportional share of the benefits ($2,595) for these positions. Our Dublin Meals on Wheels Coordinator is the backbone of the program. They are the main contact for each of our seniors and disabled adults, whether it is to register them for new service or to complete their intake assessment or to talk to them about their meal schedule, preferences and other needs. The Coordinator completes in-depth semiannual assessments with each senior/disabled adult. Before and again after the pandemic, these initial and semiannual assessments are completed gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse ✔✔✔✔ Disabilities ✔✔✔✔ Food and Nutrition ✔✔✔✔ Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the Above ✔✔✔✔ Please explain: Spectrums Meals on Wheels Program provides a hot nutritious meal and a daily wellness to homebound seniors and disable residents of Dublin. Attachment 7 813 inside the client's home. During the pandemic, we have adjusted to a combination of extended phones calls or physically distanced 'front Porch" in-person assessments. This allows the Coordinator to provide personal attention and better understand each senior’s needs and additional resources they might benefit from. The Meals on Wheels Coordinator also works daily with volunteer scheduling and /planning routes to ensure all meals are delivered timely. Spectrum’s Meals on Wheels Program Manager recruits, trains, schedules and manages the community volunteers. They oversee all of the operating functions of the program. Meals are delivered daily, primarily by volunteers, who are dedicated to the program and the seniors/ disabled adults they serve. The Program Manager is an active participant in the community and leads Spectrum’s outreach efforts in the Tri-Valley. The Program Manager works to cultivate connections in Dublin with faith- based, cultural, business, community organizations where seniors and their families gather and are connected. Involvement in the community is not only important to raise awareness of services Meals on Wheels offers, it provides opportunities to support the program through recruiting new volunteers. Trained volunteers are an essential component of providing daily meals and safety-checks for homebound seniors and disabled adults. Due to the limited number of meals funded through the Alameda County Area Agency on Aging (Federal/State.County funds), we must have additional funds to meet the needs of all eligible homebound Dublin seniors and disabled adults.. We are asking for direct funding of $5,600 to pay for the direct food costs of additional meals, primarily for the disabled adults who do not qualify for funding through the Alameda County Area of Aging contract. 10. 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)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low-come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. The first and primary outcome measure crucial to Spectrum’s Meals On Wheels Program success is to ensure all low/extremely low-income frail, homebound seniors and disabled adults, who reside in Dublin, have access to our program services. This guarantees we can meet their nutritional needs through our home delivered meals, as well as safeguard their wellbeing through daily safety checks. We want to ensure if a senior qualifies and wants our support, we will be there to assist. Our goal is to meet or exceed our contracted outcome by providing home-delivered meals to 60 or more unduplicated Dublin in FY2020-2021. Another outcome that measures the success of our Program is the number of meals we deliver each fiscal year. In FY2020- 2021 we will home-deliver 10,500 or more meals to Dublin seniors and disables adults, sometimes the only full meal they get each day. Finally, the Meals on Wheels Program can only be successful if, not only seniors served are happy with our meals and services, but we ensure Dublin seniors and disabled adults thrive by positively impacting their health through a well- balanced/nutrient-rich diet. To certify this outcome, our meals comply with the Dietary Guidelines for Older Americans, meeting 1/3 of the Dietary Reference Intakes for seniors, and meet strict food safety guidelines. We also guarantee seniors and disable adults are happy with our meals through periodic Satisfaction Surveys filled out by our program clients. Spectrum's demographic data is collected daily through self-reporting of the client or family member of the client upon initial intake. The other outcome data are collected daly through program meal orders and then input into the agency’s database. Reports are generated monthly and Spectrum’s management staff review these reports to confirm the program is on track to meet our stated goals, thus ensuring the success of Spectrum’s Meals On Wheels Program. Through our partnerships with other non profit agencies will we continue to inform the community of this program designed for the homebound senior and disabled adults. We will continue with outreach to local medical offices, hospitals, faith based groups and places where seniors gather, to ensure that all eligible Dublin residents in need are served. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis-Bacon requirements. 12. ** QUESTIONS 13 THROUGH 23 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Yes. If so, check box here and answer questions 13 through 23. gfedc No. If no, check box here and enter NA Attachment 7 814 13. 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? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. Spectrum performs an annual language survey of staff, volunteers, clients, and the community, making note of any gaps and lining up resources and protocols to address needs. The plan informs our staffing, outreach activities, consumer materials, web site, communications and operations. In between the annual language survey, we periodically update our Internal Language Directory that allows staff to quickly access non-English proficient speakers on staff (we update this document whenever there is a staff change). Should a staffer with language expertise be on vacation or out sick, Spectrum’s management staff uses the Language Directory so that, should the need arise, a fluent speaker from another department can assist. Our goal is that all clients and prospective clients and their families have access to Spectrum services in the language in which they are proficient, that they are treated with respect and that their questions are answered in a timely manner. In conjunction with our annual survey we reach out to other service Agencies to help ensure that all seniors have access to our service. By sharing information with as many entities as possible our hope is that all are included. 14. CDBG ONLY - Identify at least one HUD Guiding Principle that relates to your project: 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: (Select Category and Applicable Goals) 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: gfedc Don't know. If you are unsure, please call City staff at (925) 833-6645. ✔✔✔✔ Be culturally accessible, appropriate and inclusive ✔✔✔✔ Encourage community engagement and involvement gfedc Promote energy and resource efficiency ✔✔✔✔ Encourage networking and information sharing across service providers ✔✔✔✔ Encourage process streamlining ✔✔✔✔ Consolidate service delivery gfedc Not Applicable. Not interested in CDBG funding. gfedc A) Housing gfedc Goal 1: Promote the production, rehabilitation, and preservation of affordable housing (rental and ownership) through acquisition, rehabilitation, new construction, and minor repair. gfedc Goal 2: Reduction of housing discrimination through provision of fair housing and tenant/landlord services. gfedc Goal 3: Use resources to assist low-income residents make rental assistance payments in response to Covid-19. gfedc B) Homeless gfedc Goal 1: Use resource to end homelessness by funding and supporting homeless service programs. gfedc C) Supportive Housing gfedc Goal 1: Increase the availability of services enriched housing for persons with special needs by supporting acquisition and new construction of housing units. ✔✔✔✔ D) Community Development gfedc Goal 1: Make improvements, including ADA accessibility and rehabilitation to public facilities, such as curbs and sidewalks, neighborhood parks and recreational improvements, homeless facilities and other public facilities/community centers. gfedc Goal 2: Fund economic development, micro-enterprise, and on-the-job training. ✔✔✔✔ Goal 3: Support public service programs for low income residents, preserving safety net services for families and individuals who are vulnerable or gfedc F) Not Applicable. Not interested in CDBG funding. gfedc Public Services gfedc Public Facilities gfedc Rental Assistance gfedc Affordable Housing gfedc Increase Opportunities for 1st Time Homebuyers gfedc Promote Decent Affordable Rental Housing ✔✔✔✔ Strengthen Communities gfedc Ensure Equal Opportunity in Housing gfedc Reduce Housing Discrimination Attachment 7 815 17. CDBG ONLY - Select one HUD 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?") 18. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?") 19. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: ✔✔✔✔ Promote Participation of Grass-Roots, Faith-Based, and other Community-Based Organizations gfedc Not Applicable. Not interested in CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. Not interested in CDBG funding. gfedc Availability/Accessibility gfedc Affordability ✔✔✔✔ Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc Jobs retained: Of the total number of jobs retained, this indicator shows the number of jobs retained, the number of jobs Attachment 7 816 20. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 21. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 22. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMI") information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 23. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" with employer-sponsored health care benefits, and the types of jobs retained (using EDA classifications) gfedc 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. gfedc 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. gfedc Not Applicable. Not interested in CDBG funding ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. Not interested in CDBG funding 60 Disabled 20 Women/Female Headed Households 60 Seniors Youth Homeless Not Applicable. Not interested in CDBG funding (Type N/A) 140.00140.00 TOTAL 30 Low Income (50%-80% AMI) 30 Extremely Low Income (<30% AMI) Not Applicable. Not interested in CDBG funding (Type N/A) 60.0060.00 TOTAL 23 White 9 White + HISPANIC 8 Black/African American Black/African American + HISPANIC 7 Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Attachment 7 817 24. 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 Black/African American and White Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC 13 Multi Racial + HISPANIC OR other Multi Racial Not Applicable. Not interested in CDBG funding. (Type N/A) 60.0060.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed Area Agency on Aging USD$ 41,000.00 USD$ 41,000.00 MOWAC USD$ 75,000.00 USD$ 75,000.00 City of Livermore USD$ 60,000.00 City of Pleasanton USD$ 40,000.00 Private Donations USD$ 135,558.00 Program Revenue USD$ 65,000.00 Volunteers - In Kind USD$ 85,000.00 Total USD$ 501,558.00 USD$ 116,000.00 Funding Uses/Expenses Budget Amount Amount Committed Salaries and Wages USD$ 191,919.00 Benefits USD$ 30,892.00 Supplies USD$ 2,500.00 Postage USD$ 750.00 Telephone USD$ 2,000.00 Rent and Utilities USD$ 2,300.00 Accounting/Audit USD$ 1,200.00 Taxes & Licenses USD$ 5,500.00 Contracted Services USD$ 163,982.00 Travel & Company Vehicles USD$ 8,825.00 In Kind USD$ 85,000.00 Misc Expense USD$ 26,690.00 Total USD$ 521,558.00 USD$ 0.00 Budget Narrative We are asking for $20,000 from the City of Dublin to fund 3.8% of this project. We will use this funding for the salaries of two key individuals in this life saving service to Dublin residents as well as to continue to try to meet the needs of all of the Dublin Seniors. These funds will help prevent us from going back to a wait list. Individual 1. - Meals on Wheels coordinator who ensures that daily operations run smoothly - 19% of her salary and benefits which Attachment 7 818 is $499.50/mos, $5,994 annually. 2. Meals on Wheels Program Manager establishes partnerships as well as trains, recruits, and appreciates volunteers which is vital to our program - 11% of her salary and benefits which is $700/mos, $8,406 annually. We are asking for direct funding of $5,600 to pay for the direct food costs of additional meals. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information Form List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ Agency Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ 990 Tax Return Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Authorized Official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Board Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Insurance Certificate STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. 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. ✔✔✔✔ IRS Exempt Letter Certified Audit and/or Certified Financial Statements ✔✔✔✔ Financial Audit 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 Grievance Procedure Affirmative Plan and Grievance Procedure Affirmative Plan and Grievance Procedure REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section Financial Audit REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws Articles of Incorporation Bylaws REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) Conflict of Interest 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. Language Access Plan REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Attachment 7 819 Application ID: 327288 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2021 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. Other Supporting Documents (Not Required) Attachment 7 820 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin PCS - Human Services Division 2021-2022 Human Services Grant Program Deadline: 1/11/2021 CALICO Center Dublin Child Abuse Intervention Jump to: Organization Information Questions Budget Documents USD$ 15,000.00 Requested Submitted: 1/11/2021 4:22:51 PM (Pacific) Project Contact Erin Harper calicocenter@yahoo.com Tel: 5108950702 Additional Contacts none entered CALICO Center 524 Estudillo Ave San Leandro, CA 94577 United States Executive Director Erin Harper executive.director@calicocenter.org Telephone(510) 895-0702 Fax (510) 895-0706 Web www.calicocenter.org Organization Information top 1. Business License Number BL-109881 Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). CALICO achieves justice and healing for abused children and adults with developmental disabilities, and promotes the safety and well-being of children everywhere. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes Attachment 7 821 5. Is this request for one-time, seed or operational funding? 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. CALICO proposes to conduct 10 forensic interviews with 7 Dublin children who have been sexually or physically abused, provide support services to 8 caregivers of the Dublin victims and facilitate a multi-disciplinary response to the allegations. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 18 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) City of Dublin Human Services Grant funding would help offset the cost of our Child Interview Specialist (CIS) team. CALICO’s services are crisis-oriented, meaning that an interview may be scheduled with little notice to accommodate the urgent needs of a particular case. In most situations, fewer than 24 hours elapse from the time we get the initial referral from the Dublin detective or child welfare worker to seeing the child at our center. In some cases, that time may shrink to under one hour. For that reason, we have a minimum of two CIS scheduled to work during normal business hours (we maintain a minimum staff of two because CALICO works simultaneously out of two locations, San Leandro and Oakland). In addition, all CIS are available by pager evenings and weekends for situations that require immediate attention. Please note that our Family Advocates (FA) are also available, but funding for those positions will be covered by other sources. The estimated cost to ensure that CALICO staff are available, when needed, to respond to the referrals of Dublin children and families is approximately $22,000 in FY21-22. Of that, the most significant expenses are staff salaries and benefits. City of Dublin funds would specifically offset a portion of staff salaries and benefits of the CIS team, which includes six part-time interviewers (including three bilingual Latinas who serve bilingual and mono-lingual Spanish-speaking families). When interviewers are not conducting interviews, they are performing other related tasks, including client intakes, data entry and quality control, observing and providing feedback to other interviewers, participating in trainings, planning and participating in monthly case review meetings and testifying in court, all necessary for the successful completion of our forensic interviewing ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None ✔✔✔✔ Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development ✔✔✔✔ Homelessness gfedc Transportation Services and Access ✔✔✔✔ Domestic Violence and Child Abuse ✔✔✔✔ Disabilities gfedc Food and Nutrition gfedc Senior Services ✔✔✔✔ Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the Above gfedc Please explain: Attachment 7 822 services. 10. 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)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low-come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. GOAL 1: Minimize trauma to abused children.1a. At least 75% of children interviewed will feel positive/neutral about their experience. 1b. At least 75% of caregivers will indicate that their child felt safe at CALICO. GOAL 2: Improve coordination of child-abuse case investigations among multiple agencies. 2a. A multi-disciplinary team (comprised of a prosecutor, Dublin detective, and/or child welfare worker) will observe at least 75% of interviews. 2b. At least 70% of children eligible for a forensic medical exam will receive one. 2c. Monthly case review meetings will be held at least 10 times per year to review select cases in depth from start to finish. GOAL 3: Improve the mental health of caregivers. 3a. An FA will conduct a crisis assessment with at least 75% of families. 3b. An FA will initiate a California Victim Compensation Program (CalVCP) application (or ensure one was already completed) on behalf of at least 50% of caregivers (to access funds for mental health services for the caregiver). 3d. At least 75% of caregivers will report that CALICO gave them information about how to get services like counseling or family support for themselves. Goal 4: Improve the mental health of victims. 4a. At least 75% of caregivers will report that CALICO, "provided me with resources to support my child and respond to his or her needs in the days and weeks ahead." 4b. An FA will assist at least 75% of families with a CalVCP application on behalf of the child to provide funds for counseling. 4c. At least 75% of caregivers contacted will report that CALICO gave them information about how to get services like counseling or family support for their child/children. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis-Bacon requirements. 12. ** QUESTIONS 13 THROUGH 23 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 13. 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? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. CALICO is sensitive to the unique cultural and linguistic needs of each family served. At intake, we collect information about the race/ethnicity of the child, the child’s primary language, and the caregiver’s primary language. Three CALICO staff members are bilingual/bi-cultural Latinas who accommodate Spanish-speaking families as needed. Over the last five years, approximately 26% of the forensic interviews we conducted with Dublin victims were with children who identified as Latinx. If families speak a language other than English or Spanish (including ASL), we work with the referring agency to arrange for a court-certified interpreter and may use the services of the county’s language line, called Lionbridge. In addition, CALICO has translated all of our key documents into Spanish, and we can download select materials in other languages. 14. CDBG ONLY - Identify at least one HUD Guiding Principle that relates to your project: ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Yes. If so, check box here and answer questions 13 through 23. gfedc No. If no, check box here and enter NA gfedc Don't know. If you are unsure, please call City staff at (925) 833-6645. ✔✔✔✔ Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement ✔✔✔✔ Promote energy and resource efficiency Attachment 7 823 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: (Select Category and Applicable Goals) 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 17. CDBG ONLY - Select one HUD 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?") 18. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?") 19. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: ✔✔✔✔ Encourage networking and information sharing across service providers ✔✔✔✔ Encourage process streamlining ✔✔✔✔ Consolidate service delivery gfedc Not Applicable. Not interested in CDBG funding. gfedc A) Housing gfedc Goal 1: Promote the production, rehabilitation, and preservation of affordable housing (rental and ownership) through acquisition, rehabilitation, new construction, and minor repair. gfedc Goal 2: Reduction of housing discrimination through provision of fair housing and tenant/landlord services. gfedc Goal 3: Use resources to assist low-income residents make rental assistance payments in response to Covid-19. gfedc B) Homeless gfedc Goal 1: Use resource to end homelessness by funding and supporting homeless service programs. gfedc C) Supportive Housing gfedc Goal 1: Increase the availability of services enriched housing for persons with special needs by supporting acquisition and new construction of housing units. gfedc D) Community Development gfedc Goal 1: Make improvements, including ADA accessibility and rehabilitation to public facilities, such as curbs and sidewalks, neighborhood parks and recreational improvements, homeless facilities and other public facilities/community centers. gfedc Goal 2: Fund economic development, micro-enterprise, and on-the-job training. ✔✔✔✔ Goal 3: Support public service programs for low income residents, preserving safety net services for families and individuals who are vulnerable or gfedc F) Not Applicable. Not interested in CDBG funding. gfedc Public Services gfedc Public Facilities gfedc Rental Assistance gfedc Affordable Housing gfedc Increase Opportunities for 1st Time Homebuyers gfedc Promote Decent Affordable Rental Housing ✔✔✔✔ Strengthen Communities gfedc Ensure Equal Opportunity in Housing gfedc Reduce Housing Discrimination gfedc Promote Participation of Grass-Roots, Faith-Based, and other Community-Based Organizations gfedc Not Applicable. Not interested in CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. Not interested in CDBG funding. ✔✔✔✔ Availability/Accessibility gfedc Affordability gfedc Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc Public facility or infrastructure: This indicator shows the number of persons that have been assisted by public facility or Attachment 7 824 20. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 21. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Not Applicable. Not interested in CDBG funding ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. Not interested in CDBG funding 1 Disabled 2 Women/Female Headed Households 0 Seniors Attachment 7 825 22. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMI") information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 23. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" 24. 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 10 Youth 0 Homeless Not Applicable. Not interested in CDBG funding (Type N/A) 13.0013.00 TOTAL 13 Low Income (50%-80% AMI) 5 Extremely Low Income (<30% AMI) Not Applicable. Not interested in CDBG funding (Type N/A) 18.0018.00 TOTAL 11 White 5 White + HISPANIC 2 Black/African American Black/African American + HISPANIC Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial Not Applicable. Not interested in CDBG funding. (Type N/A) 18.0018.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Attachment 7 826 Budget top Funding Sources/Revenues Budget Amount Amount Committed Request from the City of Dublin USD$ 15,000.00 USD$ 0.00 Dublin Police Services USD$ 4,500.00 USD$ 0.00 Alameda County DA's Office (in-kind) USD$ 3,000.00 USD$ 3,000.00 Alameda County Social Services Agency USD$ 2,400.00 USD$ 2,400.00 Community Fundraising USD$ 5,000.00 USD$ 0.00 Total USD$ 29,900.00 USD$ 5,400.00 Funding Uses/Expenses Budget Amount Amount Committed Personnel Salary: Staff USD$ 12,195.00 USD$ 0.00 Personnel Benefits: Staff USD$ 2,805.00 USD$ 0.00 Personnel Salary & Benefits: ED (in kind) USD$ 3,000.00 USD$ 3,000.00 Supplies USD$ 1,551.00 USD$ 459.00 Printing USD$ 792.00 USD$ 250.00 Postage USD$ 240.00 USD$ 200.00 Communications USD$ 1,547.00 USD$ 200.00 Rent and Utilities USD$ 1,142.00 USD$ 300.00 Audit and Accounting USD$ 583.00 USD$ 241.00 Outside Service USD$ 3,370.00 USD$ 3,075.00 USD$ 2,675.00 USD$ 2,675.00 Total USD$ 29,900.00 USD$ 10,400.00 Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ Board of Directors Roster Current Annual Budget for the Entire Agency ✔✔✔✔ Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Board Authorization Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Board Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Proof of Insurance STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. 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. ✔✔✔✔ Federal Non-Profit Determination State Non-Profit Determination Certified Audit and/or Certified Financial Statements ✔✔✔✔ Audit REQUIRED FOR CDBG ONLY - If requesting Capital Funding, please upload your Capital expenditure budget (your own format is acceptable) Attachment 7 827 Application ID: 327584 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2021 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. REQUIRED FOR CDBG ONLY - Personnel Policies Including Affirmative Action Plan and Grievance Procedure Employee Manual REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws Bylaws Articles of Incorporation Articles of Incorporation - Amended REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) Conflict of Interest Policy 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. LEP - LAP REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) Attachment 7 828 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin PCS - Human Services Division 2021-2022 Human Services Grant Program Deadline: 1/11/2021 Narika Culturally Responsive Domestic Violence Surge Support Services Jump to: Organization Information Questions Budget Documents USD$ 25,000.00 Requested Submitted: 1/6/2021 5:13:08 PM (Pacific) Project Contact Bindu Fernandes narika@narika.org Tel: (650)686-7944 Additional Contacts none entered Narika P O Box 1708 Fremont, CA 94538 Executive Director Bindu Fernandes bindu@narika.org Telephone6506867944 Fax Web www.narika.org Organization Information top 1. Business License Number 94-3162871 Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Serve survivors of domestic violence with free counseling, workforce development and other programs to support safety, empowerment and wellness. Our mission is to eradicate domestic violence by offering culturally responsive programs. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes Attachment 7 829 5. Is this request for one-time, seed or operational funding? 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Our program will offer safety planning, counseling, job training, shelter and essentials, legal support and wraparound services for survivors of intimate partner violence. The funds will also meet the drastic increase in domestic violence caseload our organization has seen as a result of the pandemic which have most impacted immigrants, our low-income, unhoused, and people of color. Cases are projected to increase due to economic instability and the rise of unemployment and divorce rates as a result of COVID-19, especially as our survivors spend more time at home with their abusers. Our services are specialized for Asian, immigrant and low-income survivors who face additional cultural, legal and lingual barriers to recovery and empowerment and who also experience higher rates of domestic violence. Asians are the largest ethnic group in Dublin, many of whom also live in poverty. Over a third of the population are immigrants, who face immense isolation and social disconnection and additional legal challenges when separating from an abusive visa sponsor. We address all of these complex needs, thereby cohering with Dublin’s Program Priority for domestic violence and child abuse services and the 2011 Tri-Valley Needs Assessment which identifies domestic violence, workforce development, housing, unemployment and homelessness as primary concerns. We address all of these as they pertain to domestic violence survivors, clients who often experience at least three of these barriers. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) We expect to serve 125 Dublin residents with roughly 5 hours of free counseling each. 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) The majority of the requested funds will be used as payroll for our team which includes our domestic violence case managers, job training program facilitator team and community outreach team. This will fund our bilingual team that offers these key services including safety planning, advocacy, counseling, employment search and training support and support groups, rooted ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access ✔✔✔✔ Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the Above gfedc Please explain: Attachment 7 830 in a culturally responsive model. A section of the funds will also supplement our client management systems which includes our CRM software for our client case notes, our Zoom, phone and internet that allows our Dublin constituents to reach our free Domestic Violence hotline and have case continuity through our case management software. A section of the funds will be used to design, launch and amplify community awareness campaigns for Dublin’s constituents about our free services and programs. To ensure the project is cost effective, we will be ensuring our payroll is on par with the Alameda Fair Pay Report and partner organizations within similar operating budgets. To measure how the budget meets the needs of our clients, we will ensure that ongoing client feedback mechanisms are in place to ensure that the urgent and unmet needs of our clients are met through the course of their time with us and these are collected through satisfaction surveys. We will also be collecting feedback from our partner organizations who refer clients to us, to ensure the needs of our clients are met in a timely and respectful manner. 10. 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)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low-come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. Narika's Outcome measures include, Unique and repeat number of Dublin constituents served through this project Total number of free counseling sessions offered Number of job training workshops and other programs conducted in Dublin Client Urgent and Unmet Needs reduced after support from Narika Community Outreach Programs launched in Dublin. We will be tracking the progress through our client management tool and our internal spreadsheets that our program teams use. This is done on a weekly basis. We anticipate serving around 125 Dublin constituents. Our target audience is primarily immigrant and low-income survivors of domestic violence and intimate partner abuse. Our typical survivor is a low-income and/or unemployed woman with children seeking shelter and recovery from an abusive household or partner. On average, we serve over 450 number of clients a year, providing safety planning, counseling, job training and microenterprise programs, legal and other emergency support, financial assistance and more. Narika focuses its outreach and services on immigrant, low-income, and culturally diverse communities. Our organization therefore reflects this commitment. We are 100% staffed and led by women of color, representing several different backgrounds and over 13 underrepresented languages. If we do not speak the language of a monolingual client, we hire experienced interpreters to establish clarity and communication and best address their needs. Our programs allow for survivors to utilize our services not only via the phone but also email and video, supporting hearing impaired and differently abled survivors. Our outreach strategies target spaces and communities in which immigrant and low-income women can frequent without their abuser, like grocery stores, public restrooms, medical centers and places of worship, cultural centers and local companies. We partner with disability-focused organizations, like DeafHope, and homeless-focused organizations, like Hearts For Homeless to expand our reach to these communities. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis-Bacon requirements. ✔✔✔✔ Not Applicable gfedc Yes gfedc No Attachment 7 831 12. ** QUESTIONS 13 THROUGH 23 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 13. 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? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. NA 14. CDBG ONLY - Identify at least one HUD Guiding Principle that relates to your project: 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: (Select Category and Applicable Goals) 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: gfedc Yes. If so, check box here and answer questions 13 through 23. ✔✔✔✔ No. If no, check box here and enter NA gfedc Don't know. If you are unsure, please call City staff at (925) 833-6645. gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc A) Housing gfedc Goal 1: Promote the production, rehabilitation, and preservation of affordable housing (rental and ownership) through acquisition, rehabilitation, new construction, and minor repair. gfedc Goal 2: Reduction of housing discrimination through provision of fair housing and tenant/landlord services. gfedc Goal 3: Use resources to assist low-income residents make rental assistance payments in response to Covid-19. gfedc B) Homeless gfedc Goal 1: Use resource to end homelessness by funding and supporting homeless service programs. gfedc C) Supportive Housing gfedc Goal 1: Increase the availability of services enriched housing for persons with special needs by supporting acquisition and new construction of housing units. gfedc D) Community Development gfedc Goal 1: Make improvements, including ADA accessibility and rehabilitation to public facilities, such as curbs and sidewalks, neighborhood parks and recreational improvements, homeless facilities and other public facilities/community centers. gfedc Goal 2: Fund economic development, micro-enterprise, and on-the-job training. gfedc Goal 3: Support public service programs for low income residents, preserving safety net services for families and individuals who are vulnerable or ✔✔✔✔ F) Not Applicable. Not interested in CDBG funding. gfedc Public Services gfedc Public Facilities gfedc Rental Assistance gfedc Affordable Housing gfedc Increase Opportunities for 1st Time Homebuyers gfedc Promote Decent Affordable Rental Housing gfedc Strengthen Communities gfedc Ensure Equal Opportunity in Housing gfedc Reduce Housing Discrimination gfedc Promote Participation of Grass-Roots, Faith-Based, and other Community-Based Organizations ✔✔✔✔ Not Applicable. Not interested in CDBG funding. Attachment 7 832 17. CDBG ONLY - Select one HUD 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?") 18. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?") 19. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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 Attachment 7 833 20. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 21. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 22. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMI") information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 23. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" new businesses that remain operational for three years after assistance. gfedc 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. ✔✔✔✔ Not Applicable. Not interested in CDBG funding gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. Not interested in CDBG funding Disabled Women/Female Headed Households Seniors Youth Homeless NA Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL Low Income (50%-80% AMI) Extremely Low Income (<30% AMI) NA Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL White White + HISPANIC Black/African American Black/African American + HISPANIC Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC Attachment 7 834 24. 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 American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial NA Not Applicable. Not interested in CDBG funding. (Type N/A) 0.000.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed Contra Costa County USD$ 4,427.00 USD$ 4,427.00 Annual Fundraiser USD$ 50,000.00 USD$ 0.00 OVW TH USD$ 11,814.00 USD$ 11,814.00 CAL OES XH USD$ 10,000.00 USD$ 10,000.00 CAL OES DVAP USD$ 13,500.00 USD$ 13,500.00 Kaiser USD$ 5,000.00 USD$ 0.00 Board Contributions USD$ 12,500.00 USD$ 12,500.00 Total USD$ 107,241.00 USD$ 52,241.00 Funding Uses/Expenses Budget Amount Amount Committed Counselor Payroll USD$ 155,000.00 USD$ 85,000.00 Rent USD$ 25,200.00 USD$ 25,200.00 Utilities USD$ 3,200.00 USD$ 1,200.00 Program Supplies USD$ 6,340.00 USD$ 4,340.00 Other Program Costs (Software, etc) USD$ 4,880.00 USD$ 2,880.00 Total USD$ 194,620.00 USD$ 118,620.00 Budget Narrative Our organization sustains its funding through a combination of our annual fundraiser, board contributions, individual donations and grants (from federal, state, county, foundations and more) In 2020, we shifted our expected funding from being primarily from our fundraiser (individual donations and corporate sponsorships to seeking more funding from government grants and foundations. We intend to commit a larger amount of our funding to both counseling employees at Narika as well as more field community outreach, awareness campaigns and serving Dublin constituents that might be lesser supported by mainstream domestic violence agencies. The proposed program is core to our organization, our mission is to offer culturally responsive services to survivors of domestic violence , primarily safety planning, case management and job training programs and this project allows us to continue doing this critical service especially in response to the surge of domestic violence cases during the pandemic. Our focus is to continue serving our low income, immigrant and unhoused survivors of domestic violence who are more prone to family violence and is a reflection of the constituent base in the City of Dublin, and the expenses reflect this prioritization. Documents top Attachment 7 835 Application ID: 327690 * ZoomGrants™ is not responsible for the content of uploaded documents. Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ BoD Current Annual Budget for the Entire Agency ✔✔✔✔ budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ Tax Return Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ OfficialLetter Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ letter Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ cert cg insurance renewal STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. 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. ✔✔✔✔ 501c3 Certified Audit and/or Certified Financial Statements ✔✔✔✔ Audit 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 Grievance 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 - 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 ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) insurance Attachment 7 836 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2021 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser Attachment 7 837 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin PCS - Human Services Division 2021-2022 Human Services Grant Program Deadline: 1/11/2021 Sunflower Hill Program Support for Adults with Developmental Disabilities Jump to: Organization Information Questions Budget Documents USD$ 20,100.00 Requested Submitted: 1/11/2021 9:21:03 AM (Pacific) Project Contact Pamela Zielske Kathyl@sunflowerhill.org Tel: 925-519-1347 Additional Contacts pamela@sunflowerhill.org Sunflower Hill P.O. Box 11436 Pleasanton, CA 94588 Executive Director Edie Nehls Edie@sunflowerhill.org Telephone925-519-1347 Fax Web www.sunflowerhill.org Organization Information top 1. Business License Number BL-110708 Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Sunflower Hill is a Tri-Valley nonprofit that is dedicated to creating vibrant residential communities and programs where adults with developmental disabilities live, work, learn, and thrive as part of the greater community. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes Attachment 7 838 5. Is this request for one-time, seed or operational funding? 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. The Sunflower Hill Garden is an outdoor, instructional space providing educational, therapeutic, and life skills training for adults with developmental disabilities since April 2015. The program focuses on person-centered instruction with program participants working alongside staff planting and harvesting produce. In addition, the Sunflower Hill Garden produces thousands of pounds of fresh, organic produce each year. While produce is typically planted and harvested by Sunflower Hill program participants under the guidance of staff, COVID-19 restrictions forced the garden to close for much of 2020 to program participants and volunteers. Deemed an essential business, Sunflower Hill’s staff continued to plant, grow, harvest, and donate over 4,500 pounds of produce to Tri-Valley nonprofits, supporting low-income households and those with health concerns. As a result of the pandemic, we developed and introduced our distance learning plan, Sunflower Hill Online Activities. This program was created with the goal of assisting caregivers with developing a routine of participating in regular Sunflower Hill Online Activities. Each week our team posts a variety of free, online activities, specifically designed for individuals with developmental disabilities. In October 2020, we were able to safely bring in-person programs back to the garden. Following strict COVID-19 protocols, our Hands-On Garden Program is designed for adults with developmental disabilities and meets weekly. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 45 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) The funds requested are to be used to support the Sunflower Hill Garden Program and our Garden Coordinator specifically, through funding 50% of the salary for this position. The Garden Coordinator is an integral member of the Sunflower Hill ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) ✔✔✔✔ Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse ✔✔✔✔ Disabilities ✔✔✔✔ Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education ✔✔✔✔ Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the Above gfedc Please explain: Attachment 7 839 Programs team. The Coordinator is responsible for spearheading oversight and maintenance of the garden infrastructure and crop plan, as well as performing gardening and field work tasks to ensure a healthy crop production and a supportive environment for program participants. The Coordinator is also be responsible for developing and maintaining relationships with local nonprofits that receive our produce donations. Additionally, the Coordinator collaborates with Sunflower Hill’s Garden Teacher to implement dynamic programs to enhance the experience and meet the diverse range of needs of Sunflower Hill’s program participants. Prior to the onset of the pandemic, our team was serving approximately 50 program participants each week from 16 different high school transition, adult-in-transition and adult day programs in the Tri-Valley and beyond. These participants included students from Valley High School, Dublin High School, and the Kaleidoscope Adult Day Program in Dublin. As a result of COVID-19, our staff restructured our programs to meet the needs of our program participants while maintaining strict, safety protocols. These efforts have a resulted in a robust and creative offering of virtual and in-person programs to meet the diverse needs of individuals with developmental disabilities living the in Tri-Valley and beyond. As noted above, we returned to in-person programming at the garden in October through our Hands-On Garden Program. This program is specifically designed for adults with developmental disabilities and meets weekly in small cohort groups to ensure that we are able to follow strict safety protocols. These cohorts of six are uniquely designed to honor all ability levels and are smaller in size to guarantee intentional interaction, ensuring an environment that equips each person for success. Weekly tasks are designed with individual participants in mind, allowing for a variety of garden tasking to appeal to all functioning levels. Tasks include a range of gross and fine motor movements and a variety of standing, kneeling, lifting, and/or table top tasks. While we intend to return to our previous model of welcoming a larger number of groups to the garden in 2021, until it is safe to do so, we will continue to offer programming to small groups of participants. In addition to working with Hands-On Garden groups, the Coordinator is responsible for developing content for our virtual programming. Within 10 days of implementation of the first shelter in place order, our staff developed and introduced our distance learning plan, Sunflower Hill Online Activities. As many of our program participants are considered vulnerable with underlying health concerns, and disruptions in daily schedules severely impact individuals with developmental disabilities, this program was created with the goal of assisting caregivers with developing a routine of participating in regular online activities. Since March 2020, our team has continued to post a variety of free, online activities each week, including garden updates, scavenger hunts, simple cooking lessons, yoga and meditation exercises, arts and crafts activities, and skill challenges. The Garden Coordinator is responsible for developing content for our Online Activities while using the garden as a backdrop for programming. This unique curriculum is designed to keep program participants connected with up-to-date happenings at the Sunflower Hill Garden, as well as inspire them to explore new ways of interacting with the nature surrounding their own homes. Sunflower Hill’s Garden program is also tremendously cost effective. Our team is comprised of a full-time Garden Coordinator, Teacher, and Program Manager, who all work collaboratively to ensure we are offering a variety of engaging, person-centered programs. We also have a team of dedicated and talented volunteers who work in the garden each week. These individuals are vital to our program, assist with labor in the field, and are trained and supervised by our Garden Coordinator. While we have scaled back our volunteer program significantly to comply with COVID-related protocols, we are grateful for the generosity and expertise of the small group of regular volunteers who continue to work in the garden. Our staff have also taken significant efforts to ensure the garden’s sustainability. The Garden Coordinator sheet mulches, using cardboard and organic materials (wood chips and straw) between perennial beds. This practice conserves water, builds soil, and reduces weed pressure. The staff have also streamlined our composting practices by using more of the green waste produced in the garden throughout the year. 10. 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)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low-come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. This project is specifically designed to meet the unique needs of the local developmentally disabled population. The CDC estimates that 1 in 6 children, or approximately 17%, aged 3-17 have one or more developmental disabilities. These conditions begin early in childhood, impact day-to-day functioning, and continue throughout a person's lifetime. Locally, these numbers are consistent with national trends, with approximately 5,500 individuals with developmental disabilities living in Alameda County. Furthermore, it is estimated that roughly 395 Dublin residents, 471 Pleasanton residents, and 580 Livermore residents have a developmental disability. Individuals with developmental disabilities represent overlooked population groups in Eastern Alameda County with respect to living options and job opportunities, as was reported in the 2011 Human Services Needs Assessment. It is critical for Tri- Valley cities to solicit and implement programs that address the diverse needs of the adult developmentally disabled population, as programs and activities are significantly reduced once a person ages out of the public-school system. In addition, individuals with developmental disabilities are considered extremely low income, living as adults on Supplemental Security Income, or with assistance from family, if available. Attachment 7 840 Through an engaging curriculum and guidance from staff, participants are able to achieve a number of objectives that lead to greater independence and empowerment. Sessions are designed so that program participants are able to achieve the following: • Working to stay focused on a task until completion; • Following step by step instructions; • Practicing simple math, writing, and life science concepts; • Improving social skills and developing friendships; • Learning how food is grown from seed to harvest; • Harvesting, washing, packing, and weighing food for donation. Support of our Garden Coordinator will further enable the execution of the above objectives. Our staff assess progress through a variety of mechanisms. We rely on gathering feedback through surveys of program participants and caregivers, teachers, and volunteers. Our team then innovates our programs based on this feedback. For example, our virtual programming was initially all pre-recorded. However, based on participant feedback, we transitioned to offering a combination of pre-recorded and live content, which enables greater opportunities for engagement for the individuals we serve. These live offerings currently include a virtual cooking class, featuring seasonable produce grown in the garden. This interactive class builds independent living skills through cooking discussions, and teacher demonstrations. We now offer a series of life skills virtual sessions, called Popcorn Chats, as well. These weekly sessions provide participants with a sense of community and opportunities to build friendships and valuable social skills. We also monitor the feedback our Online Activities receive, which has been overwhelmingly positive. We track comments through social media, feedback communicated directly to staff, and the number of views our online videos receive. Since March 2020, we have created a robust repository of 134 free, activity videos, which have been viewed 6,027 times, and are designed specifically for individuals with developmental disabilities. In addition, we regularly share our virtual programs broadly. Our virtual programming is currently being utilized by our colleagues in the industry including Tri-Valley REACH, Pleasanton RADD, Strides in Castro Valley, and the Developmental Disabilities Councils in Contra Costa and Alameda Counties. We also continue to share our online activities with Dublin programs that were previously enjoying in-person programs at the garden, including Valley High School, Dublin High School, and Kaleidoscope Adult Day Program. This widespread use of our programming enables us to further track our program’s progress. Furthermore, we measure success through the amount of produce we donate to local nonprofits. In 2020, we donated 4,551.56 pounds, or 82% of our produce, to Culinary Angels, Tri-Valley Haven, and Shepherd’s Gate. These produce donations serve local residents, including those in Dublin. For example, our produce donations are supporting Tri-Valley Haven’s Food Pantry, which served approximately 158 Dublin households, with produce grown in Sunflower Hill’s Garden in 2020. Culinary Angels, a nonprofit providing meals to individuals undergoing a significant medical challenge, uses our produce to prepare approximately 185 nutrient-rich meals each month that serve households throughout the Tri-Valley. In 2020, they served an average of 7 households each month in Dublin. Our staff also actively engage in a variety of community outreach efforts, including producing a monthly newsletter and maintaining an active social media presence to encourage community engagement. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis-Bacon requirements. 12. ** QUESTIONS 13 THROUGH 23 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? gfedc Not Applicable gfedc Yes ✔✔✔✔ No gfedc Yes. If so, check box here and answer questions 13 through 23. ✔✔✔✔ No. If no, check box here and enter NA gfedc Don't know. If you are unsure, please call City staff at (925) 833-6645. Attachment 7 841 13. 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? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 14. CDBG ONLY - Identify at least one HUD Guiding Principle that relates to your project: 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: (Select Category and Applicable Goals) 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 17. CDBG ONLY - Select one HUD 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?") gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc A) Housing gfedc Goal 1: Promote the production, rehabilitation, and preservation of affordable housing (rental and ownership) through acquisition, rehabilitation, new construction, and minor repair. gfedc Goal 2: Reduction of housing discrimination through provision of fair housing and tenant/landlord services. gfedc Goal 3: Use resources to assist low-income residents make rental assistance payments in response to Covid-19. gfedc B) Homeless gfedc Goal 1: Use resource to end homelessness by funding and supporting homeless service programs. gfedc C) Supportive Housing gfedc Goal 1: Increase the availability of services enriched housing for persons with special needs by supporting acquisition and new construction of housing units. gfedc D) Community Development gfedc Goal 1: Make improvements, including ADA accessibility and rehabilitation to public facilities, such as curbs and sidewalks, neighborhood parks and recreational improvements, homeless facilities and other public facilities/community centers. gfedc Goal 2: Fund economic development, micro-enterprise, and on-the-job training. gfedc Goal 3: Support public service programs for low income residents, preserving safety net services for families and individuals who are vulnerable or ✔✔✔✔ F) Not Applicable. Not interested in CDBG funding. gfedc Public Services gfedc Public Facilities gfedc Rental Assistance gfedc Affordable Housing gfedc Increase Opportunities for 1st Time Homebuyers gfedc Promote Decent Affordable Rental Housing gfedc Strengthen Communities gfedc Ensure Equal Opportunity in Housing gfedc Reduce Housing Discrimination gfedc Promote Participation of Grass-Roots, Faith-Based, and other Community-Based Organizations ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. Not interested in CDBG funding. Attachment 7 842 18. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?") 19. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: 20. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. ✔✔✔✔ Not Applicable. Not interested in CDBG funding gfedc Persons Attachment 7 843 21. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 22. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMI") information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 23. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" 24. If your agency is submitting more than one application or the same agency has different programs within it, gfedc Households ✔✔✔✔ Not Applicable. Not interested in CDBG funding Disabled Women/Female Headed Households Seniors Youth Homeless N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL Low Income (50%-80% AMI) Extremely Low Income (<30% AMI) N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL White White + HISPANIC Black/African American Black/African American + HISPANIC Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. Not interested in CDBG funding. (Type N/A) 0.000.00 TOTAL Attachment 7 844 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 agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed City of Dublin (Garden Coordinator) USD$ 20,100.00 City of Pleasanton (Garden Teacher) USD$ 23,232.00 Clif Family Foundation USD$ 2,000.00 USD$ 2,000.00 Robert Half USD$ 3,500.00 USD$ 3,500.00 Rotarian Foundation of Livermore USD$ 5,000.00 Monthly Giving Program/Individual donations USD$ 54,250.00 Sunflower Showcase USD$ 70,000.00 Giving Tuesday campaign USD$ 30,000.00 Registration fees USD$ 14,400.00 NXP Community Impact Grant USD$ 5,500.00 Total USD$ 227,982.00 USD$ 5,500.00 Funding Uses/Expenses Budget Amount Amount Committed Sunflower Hill Garden Coordinator salary USD$ 20,100.00 USD$ 0.00 Total USD$ 20,100.00 USD$ 0.00 Budget Narrative Sunflower Hill's funding request of $20,100 will cover 50% of the salary of our Garden Coordinator in FY 2021. The remaining budget required for both the Garden Coordinator’s salary as well as the Garden program as a whole will be covered by contributed income from other city, corporate, and private grants, as well as Sunflower Hill's robust fundraising efforts, including events and gifts from individual donors. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ SFH Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ SFH Financial Information List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ SFH 2021 Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ SFH FY 21 Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ Sunflower Hill 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ SFH Board Authorization Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ SFH Board Authorization Proof of insurance carried, including bonding, liability ✔✔✔✔ SFH Worker's Compensation insurance Attachment 7 845 Application ID: 328073 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2021 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. and/or workers' compensation SFH Liability Insurance STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. 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. ✔✔✔✔ SFH 501c3 status Certified Audit and/or Certified Financial Statements ✔✔✔✔ Sunflower Hill 990 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 Grievance 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 - 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 ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Dublin business license Other Supporting Documents (Not Required) Sunflower Hill 2020 Programs video Attachment 7 846 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin PCS - Human Services Division 2021-2022 Human Services Grant Program Deadline: 1/11/2021 Chabot-Las Positas Community College District Dublin EITC Support Program 2021-22 Jump to: Organization Information Questions Budget Documents USD$ 9,240.00 Requested Submitted: 1/6/2021 12:04:00 PM (Pacific) Project Contact Sarah Holtzclaw sholtzclaw@clpccd.org Tel: 925-416-5108 Additional Contacts none entered Chabot-Las Positas Community College District DBA Tri-Valley Career Center 7600 Dublin Blvd. Dublin, CA 94568 United States Vice Chancellor for Business Services, designated signer Jonah Nicholas jnicholas@clpccd.org Telephone(925) 416-5100 Fax Web www..trivalleycareercenter.org Organization Information top 1. Business License Number BL-010043 Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). The Career Center (TVCC) is part of the College District’s Econ. Dev. Dept. Along with Apprenticeships, OSHA Training and Foster Care Support, “we empower individuals and communities to thrive by creating career, education and economic opportunities”. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. gfedc Non-Profit ✔✔✔✔ Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project Attachment 7 847 5. Is this request for one-time, seed or operational funding? 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. The Earned Income Tax Credit (EITC) is, by most accounts, the most effective anti-poverty program run by the federal government and augmented by the State. The EITC has been shown to not only encourage work (especially by single mothers), but also to help families meet basic needs and to improve children’s success in school and, thus, likely increasing their earnings as adults. It has the ability to lift families out of poverty. It has also been shown to be used by most families as a short-term safety net when there is a job loss or other event that reduces income. Working households qualify for an EITC and CA-EITC based on earnings and family size. The credit increases as earnings increase to a point when the tax incentive plateaus and starts to decrease. Unlike many tax credits, the EITC is refundable, giving families a refund over what they owe in income taxes. Studies show that this refund is used to pay day care, needed car repairs, past medical or rent bills, and other necessary items. It is used to get the family back on track. The only way to receive the EITC is to file taxes. However, this is both difficult and expensive for these families. The Volunteer Income Tax Assistance (VITA) program run by TVCC offers free tax preparation done by volunteers to low- to moderate- income individuals and families. Its sole purpose is to help people in poverty, and especially EITC-eligible families, access their benefits and to file taxes as required by law. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) Our goal is to continually increase the number of working families served by the VITA program, and to increase the number of families who receive the federal and state EITC. Our goal for 2021-22 is to file a minimum of 75 Dublin tax returns. 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) ✔✔✔✔ Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the Above gfedc Please explain: Attachment 7 848 Created during the War on Poverty, the VITA program provides free tax preparation for low-to moderate families working paycheck to paycheck, trying to make ends meet. Funded every year for over 50 years, the program has allowed recipients to maximize their tax credits, avoid unnecessary fees and increase their financial stability. The VITA program is so successful in lifting families out of poverty that all but 6 states have added a refunded able EITC to their annual budgets on top of the federal credit. California created its EITC in 2015, increasing the refundable credits each year since. The VITA program does not run itself however. It takes dedicated organizations and people to establish the services and provide the free tax preparation. It takes a small army of volunteers to be certified and prepare the taxes. And it takes funding. The IRS funds organizations nationwide to provide the VITA services. In the Bay Area, that funding regularly goes to United Way, which then parcels out its allocation to organizations in 7 Bay Area counties, including TVCC. However, this funding does not cover all of our expenses to plan, market and execute a successful VITA program in the Tri-Valley. The COVID-19 pandemic also added expenses to the program not needed in prior years such as PPE and secure sharing software. TVCC has 1 staff member who oversees the VITA program each year. She, a very part-time assistant and a few devoted volunteers plan the TVCC services starting in September for the following tax season. Since TVCC began providing VITA services in 2014, these dedicated individuals have prepared nearly 2500 tax returns, bringing over $3.4 million dollars back to the Tri-Valley in federal refunds. During the 2020 tax season, the average household income for the 471 families served was less that $29,000 a year. It should be noted that the TVCC VITA program is one of only 2 programs in the 7 Bay Area counties that is growing and one of only 3 that found a way to provide virtual tax services during the 2020 pandemic. It should also be noted that the VITA program is one of only a handful of safety net programs whose return on investment can be calculated almost immediately after its annual conclusion. The TVCC budget for the 2021-22 VITA program is $68,796. Should we meet our overall goals of 560 returns filed, at total federal refunds of $710,500, the return of the investment on the program could be $647,046 or more that 1,000%. Moreover, research shows there is a multiplier effect of at least 1.5 to the refunds spent in the region. Thus, the economic effect of the VITA program is far greater for the community than even just for the families served. The TVCC VITA is a workforce development program as the EITC has been shown to encourage work for low-income families. However, our efforts in this are outside our main workforce development contracts. As such, the program is entirely grant funded and must be exceedingly efficient with its small dedicated funds. The program’s efficiency is borne out of a number of things: - First, by law, the taxes can only be prepared by volunteers. These volunteers must be certified by the IRS in the appropriate tax law and the software used nationally for the returned to be e-filed. TVCC normally has over 30 volunteers who speak 5 different languages. - Second, the College district donates the supervisory management of VITA program. Though the Program Coordinator is the strength of the TVCC VITA program. It does take a manager to oversee it, plan the marketing and write reports. This time is donated to the program. - Thirdly, TVCC uses its network of other community service providers and as much free marketing placement as is feasible. As a nonprofit, TVCC has become effective in using free media and word of mouth for this program as well as others. The TVCC VITA program uses its funds on the dedicated coordinating staff; costs directly associated with the services provided; and marketing to grow the program and help more EITC-eligible tax payers. This, along with the return on investment, makes the TVCC VITA program one of the most efficient and effective anti-poverty programs in the region. 10. 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)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low-come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. Each year, we track the following measurements for our VITA program: - Total number of clients served; - Percentage increase of clients served; - Total federal dollars returned to clients; - Average and Total Earned Income Tax Credits (EITCs) returned to clients served; - Average Adjusted Gross Income of clients served; and - The total number if ITIN applications filed From this, we can extrapolate Dublin data to know the above information specific to the City. The goal of the TVCC VITA program is to grow and serve more people in the region who are EITC-eligible. Given the nature of the service, our results are tracked meticulously by the IRS. Each tax return is e-filed through the IRS proprietary system. This system gives us information in aggregate of all our tax clients. Each tax returned e-filed is tracked by the IRS through our location codes. Not long after the end of each tax season, we are able to discern the number of tax returns filed as well as the amount of federal/state refunds, the total EITC returns, and the average household income among other things. As anti-poverty safety-net program, the population that the VITA program targets are low- to moderate-income working Attachment 7 849 families. Like the Federal Poverty Guidelines, the VITA program sets its income limits on a national level. Thus, the annual income limit to the VITA service is $67,000. For a family in the Tri-Valley, this is far below the living wage. However, the average income that the families we served earned last tax season was $28,968. This is consistent to the last 5 years that we have offered VITA services. Many of the families we serve year after year speak a language other than English at home. We offer the services in at least 5 languages, depending on our volunteer’s bi-lingual abilities. Spanish the main language other than English that we serve. The VITA Program Coordinator’s first language is Spanish and thus, we are able to help a number of families in the Tri-Valley who desperately need this service. Though the TVCC VITA program has grown from 63 returns to nearly 600 pre-pandemic, there remains hundreds of families who could benefit from our services but do not know about them. Some simply do not file taxes as they should. Others pay extraordinary fees to have them done by a for-profit company. Each year, we plan to promote the services so that others may know of them. Each year, however, our budget comes up short and we cannot afford to pay for the development and placement of advertising. In those plans, for the 2021-22 season, is the development of online ads in English and Spanish. These online ads will compliment messages we have given other service partners. The partners are trusted sources of information for our potential clients and can pass information about the EITC and the importance of the VITA program. As people in poverty often have trust issues with the government and its extended services, these word-of-mouth referrals are critical to the growth of the VITA program. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis-Bacon requirements. 12. ** QUESTIONS 13 THROUGH 23 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 13. 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? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 14. CDBG ONLY - Identify at least one HUD Guiding Principle that relates to your project: 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: (Select Category and Applicable Goals) ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Yes. If so, check box here and answer questions 13 through 23. ✔✔✔✔ No. If no, check box here and enter NA gfedc Don't know. If you are unsure, please call City staff at (925) 833-6645. gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc A) Housing gfedc Goal 1: Promote the production, rehabilitation, and preservation of affordable housing (rental and ownership) through acquisition, rehabilitation, new construction, and minor repair. gfedc Goal 2: Reduction of housing discrimination through provision of fair housing and tenant/landlord services. gfedc Goal 3: Use resources to assist low-income residents make rental assistance payments in response to Covid-19. gfedc B) Homeless gfedc Goal 1: Use resource to end homelessness by funding and supporting homeless service programs. gfedc C) Supportive Housing gfedc Goal 1: Increase the availability of services enriched housing for persons with special needs by supporting acquisition Attachment 7 850 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 17. CDBG ONLY - Select one HUD 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?") 18. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?") 19. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: and new construction of housing units. gfedc D) Community Development gfedc Goal 1: Make improvements, including ADA accessibility and rehabilitation to public facilities, such as curbs and sidewalks, neighborhood parks and recreational improvements, homeless facilities and other public facilities/community centers. gfedc Goal 2: Fund economic development, micro-enterprise, and on-the-job training. gfedc Goal 3: Support public service programs for low income residents, preserving safety net services for families and individuals who are vulnerable or ✔✔✔✔ F) Not Applicable. Not interested in CDBG funding. gfedc Public Services gfedc Public Facilities gfedc Rental Assistance gfedc Affordable Housing gfedc Increase Opportunities for 1st Time Homebuyers gfedc Promote Decent Affordable Rental Housing gfedc Strengthen Communities gfedc Ensure Equal Opportunity in Housing gfedc Reduce Housing Discrimination gfedc Promote Participation of Grass-Roots, Faith-Based, and other Community-Based Organizations ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc Homeownership units constructed or acquired with rehabilitation: This indicator shows the total number of Attachment 7 851 20. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 21. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 22. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMI") information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 23. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. ✔✔✔✔ Not Applicable. Not interested in CDBG funding gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. Not interested in CDBG funding Disabled Women/Female Headed Households Seniors Youth Homeless N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL Low Income (50%-80% AMI) Extremely Low Income (<30% AMI) N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL Attachment 7 852 "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" 24. 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 White White + HISPANIC Black/African American Black/African American + HISPANIC Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. Not interested in CDBG funding. (Type N/A) 0.000.00 TOTAL gfedc #1 - This program/project has the agency's highest priority for funding. ✔✔✔✔ #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed City of Dublin USD$ 9,240.00 USD$ 0.00 City of Livermore USD$ 9,736.00 USD$ 0.00 City of Pleasanton USD$ 10,015.00 USD$ 0.00 United Way of the Bay Area USD$ 20,000.00 USD$ 0.00 Wells Fargo USD$ 5,000.00 USD$ 0.00 CLPCCD USD$ 14,805.00 USD$ 14,805.00 USD$ 0.00 USD$ 0.00 USD$ 0.00 USD$ 0.00 Total USD$ 68,796.00 USD$ 14,805.00 Funding Uses/Expenses Budget Amount Amount Committed Salaries USD$ 35,774.00 USD$ 1,796.00 Attachment 7 853 Benefits USD$ 12,712.00 USD$ 3,914.00 Supplies USD$ 325.00 USD$ 0.00 Printing/Copying USD$ 1,750.00 USD$ 0.00 Rent & Utilities USD$ 9,095.00 USD$ 9,095.00 Marketing Development USD$ 0.00 Marketing Placement USD$ 5,800.00 USD$ 0.00 Travel USD$ 540.00 USD$ 0.00 Total USD$ 65,996.00 USD$ 14,805.00 Budget Narrative By law, the VITA program is a completely free service. However, it is not free to operate. The largest share of the budget is for staff salaries and benefits, of which the Program Coordinator is the largest portion. She is helped by a short-term, contracted site coordinator, and two other staff members and the manager during the season. The value of the volunteers is nearly double the over-all budget. Operational costs include supplies needed to run the program, printing/paper required so tax payers have a copy of their return, rent and utilities for the space used, marketing and travel. Rent and utilities are program expenses that the College District will absorb as part of its leveraged costs. Though critical to the successful growth of the program, marketing is the one variable cost that will not be spent if there is no funding to cover it. 40% of the operating budget is earmarked for the development and placement of marketing. However, these are also costs that will only be spent if the money is available. Depending on the amount of grants received each year, the College District invests anywhere from 20-40% of the total program budget to its success. The ask for the City is to cover 13.1% of the total budget, which is less than the percentage of the Dublin residents served by the program (14.1%). We believe this is a fair ask, with an incredible return on investment for the City. Over all, the VITA program is a small percentage of the Career Center’s annual budget and even smaller amount of the College District’s budget. It constitutes about one percentage of the Career Center’s overall budget, which is turn less than one tenth of one percentage of the College District’s budget. This does not, however, negate the impact that this small program makes on the lives of people in poverty in the Tri-Valley. The dollars spent on the VITA program bring nearly 600 families out of poverty and allow them to survive another year in the region. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expenses_CLPCCD-EITC Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Info-CLPCCC_EITC List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ CLPCCD Board of Trustees-Jan 2021 Current Annual Budget for the Entire Agency ✔✔✔✔ CLPCCD Most Recent Adopted Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ CLPCCD no 990 or Tax Return Filed Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ CLPCCD Designated Authority Policies Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ CLPCCD Designated Authority Policies Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ CLPCCD General Cert of Insurance STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. 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. ✔✔✔✔ CLPCCD IRS Letter Attachment 7 854 Application ID: 328535 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2021 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. Certified Audit and/or Certified Financial Statements ✔✔✔✔ CLPCCD Most Recent Audit 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 Grievance 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 - 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 ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) Attachment 7 855 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin PCS - Human Services Division 2021-2022 Human Services Grant Program Deadline: 1/11/2021 Hively Hively Strengthening Families through Trauma Informed Care Jump to: Organization Information Questions Budget Documents USD$ 25,000.00 Requested Submitted: 1/11/2021 10:08:02 PM (Pacific) Project Contact Kelly O'Lague Dulka kelly@behively.org Tel: (925) 417-8733 Additional Contacts vdilks@behively.org, mkochly@behively.org Hively 6601 Owens Dr. Ste 100 Pleasanton, CA 94588 United States CEO Kelly O'Lague Dulka kelly@behively.org Telephone(925) 417-8733 Fax (925) 730-4942 Web www.behively.org Organization Information top 1. Business License Number BL-109890 Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Hively’s mission is to provide resources so everyone in our community can thrive. Resources include community outreach programs (food, clothing, diapers); affordable mental health services; child care subsidies; parent education and support; and more. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project Attachment 7 856 5. Is this request for one-time, seed or operational funding? 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Nearly 2 in 3 low-income children have had multiple adverse childhood experiences (ACEs) before they enter kindergarten. ACEs such as abuse, neglect or household substance abuse can result in developmental/behavioral impacts and adverse health consequences. Hively’s program will focus on the prevention and treatment of trauma from ACEs. Hively will offer workshops on trauma-informed care and strategies for strengthening families. The intended audience includes parents, educators, child care professionals and mental health professionals. Hively CEO Kelly O’Lague Dulka, LCSW is an expert in trauma-informed care with 35 years’ experience treating children affected by trauma. Having developed her own trauma-informed care curriculum, Ms. Dulka has been a trailblazer in addressing the effects of trauma on children and families. The vast majority of families Hively serves are low-income. Of the children who receive child care subsidies, 40% are Black and 35% are Hispanic. In our everyday work, Hively is experienced in providing trauma-informed resources and services to children who are most vulnerable to ACEs, and in providing supportive services and resources, we have built a relationship of trust with the families we serve. Families come to Hively seeking healing. Educators and other professionals come to Hively seeking tools and strategies to help children heal. Hively is uniquely positioned to provide services to children and families and training to those who support them 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 125 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) The 2011 Tri-Valley Human Services Needs Assessment identified mental health as one of the urgent needs to be addressed in eastern Alameda County, noting the lack of services, hard to reach populations, and lack of knowledge about services. The gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None ✔✔✔✔ Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services ✔✔✔✔ Youth Services ✔✔✔✔ Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the Above gfedc Please explain: Attachment 7 857 COVID-19 pandemic is only increasing the need for mental health services. Maria is a single parent with two small children. She works in a restaurant, and her hours have been cut due to COVID-19 restrictions. Her children are subject to a variety of adverse childhood events, including separated parents. They live in an unheated illegally rented garage. We met Maria through our Diaper Pantry and Community Closet. Maria is stressed, and she knows her children are stressed, but cannot afford mental health services and even lacks knowledge of what services might be available. As time passes, if these stresses are not addressed these adverse events can turn into what the California Surgeon General in her 2020 report ‘Roadmap to Resilience’ calls ‘toxic stress’, and it can affect the children’s development and threaten their future physical and mental health. The Rapid Assessment of Pandemic Impact on Development Early Childhood Household Survey Project (RAPID-EC Project) reported in August 2020 that caregiver stress affects children as young as birth to age 5, and 68% of caregivers see a significant increase in stress and 78% reported behavior problems. Hively is uniquely qualified to offer this program to try to recognize and mitigate these stresses. Unlike most other non-profits in the Tri-Valley, Hively offers ‘one stop shopping’: we offer both help for physical needs, such as access to subsidized child care, diaper pantry, food pantry, and a community closet for clothing and household items, as well as behavioral health therapy through licensed therapists and workshops such as proposed for this program. In addition, Hively has already held a series of Trauma-Informed Care workshops in 2018-19 and 2019-20 that trained nearly 100 participants. The original curriculum was developed by Hively CEO Kelly O’Lague Dulka, an expert in the field of trauma-informed care. With over 35 years’ experience treating children affected by trauma, Ms. Dulka has been in the field as it has emerged and taken shape. She has consulted widely across the country on issues related to the sexual abuse of children and has been an expert witness in both civil and criminal court cases throughout California. She has been at the forefront of curriculum development for professionals who work with children affected by adverse childhood experiences. Grant funds will be used to pay the salary and benefits of licensed clinical staff members and Children’s Trust Fund Alliance certified trainers. Existing workshops will be updated to include the adverse effects of the COVID-19 pandemic on child and family mental health. They will also add modules on developing the key factors for strengthening families. Prevention and early intervention are the most cost-effective services available in dealing with ACEs, trauma, and toxic stress. Because a baseline exists for this training, Hively is well positioned to provide this program in a very cost-effective way. And our existing trusted relationships with low-income families and child care providers places us in a perfect place to be in contact with those most at risk. According to the Surgeon General’s report, results of ACEs and toxic stress on children can be extreme. If they occur in the birth to kindergarten age, they can result in disruption of the development of brain architecture and other organ systems and an increase in lifelong risk for physical and mental disorders. Toxic stress can damage regions of the brain responsible for learning, memory, impulse control, and attention, making learning more difficult. It also impairs parts of the brain controlling attachment and emotional regulation making forming healthy relationships difficult. Since the report estimates the cost of the associated health care and loss of productivity from stress-related diseases to be $112.5 billion annually in California, any intervention before the developmental and physical or mental health damage begins is extremely cost-effective. 10. 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)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low-come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. Hively plans to reach 240 attendees and will monitor attendance at each session. We plan to offer two workshops each month to diverse groups that include families, child care professionals, educators, law enforcement, and medical personnel. Because all of these groups will be in sessions together, they can develop a common vocabulary to assist attendees in coordinating to deal with the effects of trauma on behavior and child development. In addition to bi-monthly workshops, we will offer ongoing coaching sessions for participants. We anticipate serving families that are in the variety of programs offered trough Hively. Since Hively serves primarily extremely-low- to low-income families, poverty makes them most vulnerable to adverse experiences and most in need of ways to mitigate the effects. Hively has a diverse staff with fluency in 14 languages and can offer translation services to clients who need it. We are inclusive and strive to employ staff who reflect the communities we serve and who are experienced in providing support and resources to the target population. Hively uses a variety of ways to communicate with our families: directly through our Family Support Specialists as well as electronically through email, social media, ConstantContact, and the Community Calendar on the Hively web page. Many of our families use the services of our Diaper Pantry, Food Pantry, and Community Closet and information will be available there. Hively also will offer these workshops to child care providers as they are often the most likely to recognize the possibility of an ACE and toxic stress in parents or children. They also play a crucial role in providing positive, buffering interventions preventing the transmission of adversity. Communication with child care providers will be through the agency's weekly Hively Listening Session with child care providers where they are given the opportunity to meet with Hively staff and discuss their current challenges, and issues of concern with their child care programs. Further communication will be offered through the agency's social media, email, and ConstantContact, and the Community Calendar on the Hively web page. Finally, these workshops will be available to others who work with children, such as K-12 educators, law enforcement, and medical personnel. Hively has strong partnerships with the Tri-Valley Anti-Poverty Collaborative; Axis Community Health; WIC; Community Care Licensing; CityServe; CAPE Head Start; Kaiser; the Dublin, Pleasanton, and Livermore school districts; First 5 Alameda County; California Child Care Initiative Project; and Livermore Community Needs. Hively expects to continue to seek new community partnerships and to target health care providers, school district social workers, and other community organizations who serve low-income families, limited English speakers, and youth. Attachment 7 858 During COVID-19 restrictions all workshops and coaching sessions will be held virtually through teleconferencing. Even parents without computers can join by telephone. Once COVID restrictions are lifted, some workshops will be held in Hively’s facilities in Pleasanton. Child care will be available. Virtual workshops will also continue as they allow attendees with travel, child care, or employment restrictions to attend more easily. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis-Bacon requirements. 12. ** QUESTIONS 13 THROUGH 23 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 13. 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? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 14. CDBG ONLY - Identify at least one HUD Guiding Principle that relates to your project: 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: (Select Category and Applicable Goals) 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Yes. If so, check box here and answer questions 13 through 23. ✔✔✔✔ No. If no, check box here and enter NA gfedc Don't know. If you are unsure, please call City staff at (925) 833-6645. gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc A) Housing gfedc Goal 1: Promote the production, rehabilitation, and preservation of affordable housing (rental and ownership) through acquisition, rehabilitation, new construction, and minor repair. gfedc Goal 2: Reduction of housing discrimination through provision of fair housing and tenant/landlord services. gfedc Goal 3: Use resources to assist low-income residents make rental assistance payments in response to Covid-19. gfedc B) Homeless gfedc Goal 1: Use resource to end homelessness by funding and supporting homeless service programs. gfedc C) Supportive Housing gfedc Goal 1: Increase the availability of services enriched housing for persons with special needs by supporting acquisition and new construction of housing units. gfedc D) Community Development gfedc Goal 1: Make improvements, including ADA accessibility and rehabilitation to public facilities, such as curbs and sidewalks, neighborhood parks and recreational improvements, homeless facilities and other public facilities/community centers. gfedc Goal 2: Fund economic development, micro-enterprise, and on-the-job training. gfedc Goal 3: Support public service programs for low income residents, preserving safety net services for families and individuals who are vulnerable or ✔✔✔✔ F) Not Applicable. Not interested in CDBG funding. gfedc Public Services Attachment 7 859 17. CDBG ONLY - Select one HUD 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?") 18. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?") 19. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc Public Facilities gfedc Rental Assistance gfedc Affordable Housing gfedc Increase Opportunities for 1st Time Homebuyers gfedc Promote Decent Affordable Rental Housing gfedc Strengthen Communities gfedc Ensure Equal Opportunity in Housing gfedc Reduce Housing Discrimination gfedc Promote Participation of Grass-Roots, Faith-Based, and other Community-Based Organizations ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. Attachment 7 860 20. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 21. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 22. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMI") information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 23. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. ✔✔✔✔ Not Applicable. Not interested in CDBG funding gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. Not interested in CDBG funding Disabled Women/Female Headed Households Seniors Youth Homeless N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL Low Income (50%-80% AMI) Extremely Low Income (<30% AMI) N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL White White + HISPANIC Black/African American Black/African American + HISPANIC Asian Asian + HISPANIC American Indian/Alaskan Native Attachment 7 861 24. 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 American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. Not interested in CDBG funding. (Type N/A) 0.000.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed City of Dublin USD$ 25,000.00 USD$ 0.00 City of Pleasanton USD$ 25,000.00 USD$ 0.00 City of Livermore USD$ 25,000.00 USD$ 0.00 Morris Stulsaft Foundation USD$ 22,175.00 USD$ 0.00 Sunlight Giving Foundation USD$ 10,000.00 USD$ 10,000.00 Individual Donors USD$ 20,000.00 USD$ 20,000.00 California Department of Education USD$ 24,000.00 USD$ 24,000.00 Total USD$ 151,175.00 USD$ 54,000.00 Funding Uses/Expenses Budget Amount Amount Committed Licensed clinician .25 FTE USD$ 30,000.00 USD$ 0.00 Certified trainers/coaches 2 @ .4 FTE USD$ 76,000.00 USD$ 19,000.00 Clinical Director .1 FTE USD$ 12,000.00 USD$ 8,000.00 Community Services Director .1 FTE USD$ 12,000.00 USD$ 8,000.00 Benefits USD$ 6,000.00 USD$ 6,000.00 Computer USD$ 1,200.00 USD$ 1,200.00 Phone USD$ 600.00 USD$ 600.00 Charting and office supplies USD$ 600.00 USD$ 600.00 Rent USD$ 6,000.00 USD$ 6,000.00 EHR softtware USD$ 2,400.00 USD$ 2,400.00 Materials/books/shipping USD$ 3,175.00 USD$ 1,000.00 Accounting/Audit USD$ 1,200.00 USD$ 1,200.00 Total USD$ 151,175.00 USD$ 54,000.00 Attachment 7 862 Budget Narrative Grant funds will be used to provide a portion of salary and benefits for a licensed clinician and certified trainers as well as operating expenses for the program. While the overall agency budget is nearly $23 million, approximately 95% of the funds are considered “pass through” dollars, which we use to pay subsidies for child care. The remainder of the operating budget is approximately $1 million. When combined with the services now being provided in the San Leandro clinic, mental health services will make up approximately 5% of the budget. Providing operating funds (through this grant and other funding sources) to support mental health services in the Tri-Valley will represent approximately 8% of the overall mental health operation. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Hively Strengthening Families Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Hively Strengthening Families FIF List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ BOD List Current Annual Budget for the Entire Agency ✔✔✔✔ Hively Agency Budget 2020-21 Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ Hively Form 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Designated Official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Authorization to Seek Funding Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ COI Dublin STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. 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. ✔✔✔✔ 501(c) Certified Audit and/or Certified Financial Statements ✔✔✔✔ Hively Financial Statements 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 Grievance 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 - 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 ONLY - LEVERAGING Attachment 7 863 Application ID: 328826 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2021 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) Attachment 7 864 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin PCS - Human Services Division 2021-2022 Human Services Grant Program Deadline: 1/11/2021 Hively Hively Community Resources Jump to: Organization Information Questions Budget Documents USD$ 25,000.00 Requested Submitted: 1/11/2021 9:02:00 PM (Pacific) Project Contact Kelly O'Lague Dulka kelly@behively.org Tel: (925) 417-8733 Additional Contacts etrueblood@behively.org,vdilks@behively.org Hively 6601 Owens Dr. Ste 100 Pleasanton, CA 94588 United States CEO Kelly O'Lague Dulka kelly@behively.org Telephone(925) 417-8733 Fax (925) 730-4942 Web www.behively.org Organization Information top 1. Business License Number BL-109890 Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Hively’s mission is to provide resources so everyone in our community can thrive. Resources include community outreach programs (food, clothing, diapers); affordable mental health services; child care subsidies; parent education and support; and more. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project Attachment 7 865 5. Is this request for one-time, seed or operational funding? 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Many families in the Tri-Valley struggle to obtain the basic resources they need to thrive. Hively offers three community outreach programs - the Diaper Pantry, the Food Pantry, and the Community Closet - that provide basic resources to the lowest income, most vulnerable families in the Tri-Valley. The Diaper Pantry provides a month’s supply of diapers and wipes, an age-appropriate children’s book, and parent education materials promoting children’s literacy. The Food Pantry provides families with fresh and non-perishable food items, toilet paper, hand soap, and other basic necessities. The Community Closet collects new and gently-used items - including clothing, shoes, baby items, books, toys, and housewares - and provides them free of charge to Tri-Valley families in need. When families come to Hively for basic essentials, they receive more than just diapers, food, and clothing. They gain access to a wealth of resources and services offered by Hively, including affordable mental health services; child care subsidies and referrals; parent education workshops; and family-strengthening events like Parent Cafe and Parent-Child Book Club. Offering a “one-stop shop” is critically important to the families we serve so they do not need to seek help from several different agencies to obtain all the resources and services they need. Just as important as access to resources and services, when families come to Hively, they receive compassion, caring, and hope. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 525 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) With diapers costing $100+ per month per child, purchasing a sufficient supply of diapers puts a financial strain on 1 in 3 gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development ✔✔✔✔ Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse ✔✔✔✔ Disabilities ✔✔✔✔ Food and Nutrition ✔✔✔✔ Senior Services ✔✔✔✔ Youth Services ✔✔✔✔ Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity ✔✔✔✔ Financial Assistance gfedc None of the Above ✔✔✔✔ Please explain: community resources to fulfill basic needs Attachment 7 866 families. Without our help, these parents delay changing soiled diapers, use paper towels instead of diapers, or worse, clean out and reuse soiled diapers. Having an adequate supply of diapers ensures that children do not suffer health problems like urinary tract infections and that children can attend child care so their parents can work or go to school. Each month, Hively provides an average of 35,000 diapers to families in need. According to the Urban Institute, who issued a 2019 report on food need in Alameda County, 25% of African American families and 30% of Latino families were food insecure prior to the pandemic. Since the pandemic, food insecurity has skyrocketed and has had a greater impact on people of color. The majority of the families Hively serves belong to multiple vulnerable populations: African American, Hispanic, low-income, families with young children, immigrants, and limited English- speaking. The Hively Food Pantry aims to reduce food insecurity by providing free food and basic essentials to these vulnerable populations. The Food Pantry has provided 40,000+ meals to families in need since the beginning of the pandemic. The Hively Community Closet collects new and gently-used items and provides them free of charge to families in need, including clothing, shoes, baby items, books, toys, and housewares. Donated items often come and go within days because the need for them is so great. During the COVID-19 pandemic, the need for shoes and clothing has increased dramatically. At our December 2020 community distribution event, 450 warm coats were distributed within a matter of hours. Grant funding would be used to purchase program supplies and to fund partial employee salaries to help run the Diaper Pantry, Food Pantry, and Community Closet. Director of Community Services Vanessa Dilks and Director of Business Services Nina Hourel are co-managers. Community Services Supervisor Tommy McCoy, Community Services Coordinator Andres Jankowski, and Facilities Manager Hani Halim ensure the smooth, everyday running of the programs - picking up donations; sorting, organizing, and storing donated items; supervising volunteers; purchasing program supplies; stocking and replenishing merchandise; cultivating and maintaining relationships with donors; and providing customer service when families come in to shop and at community distribution events. Hively is fiscally responsible and strives to be as cost effective as possible in running the three programs. Hively has built a strong network of Diaper Pantry supporters. Last year, several individuals and community organizations conducted diaper drives on our behalf, including the Michael D'Ambrosio and the Tri-Valley Community Helps During SIP Facebook page, Valley Family Child Care Association, Rebecca Bauer-Kahan for Assembly, Pine Valley Middle School, Arrive Real Estate Group, and the Church of Jesus Christ of Latter-Day Saints. Through these community diaper drives, about 40% of the diapers and wipes Hively distributed last year were donated at NO cost to our program. We will continue to cultivate new and existing supporters to hold diaper drives and fundraise on our behalf as a vital part of our Diaper Pantry program. The Food Pantry enjoys broad community support from individual donors, local businesses and restaurants, and philanthropic organizations, including Albertsons Companies Foundation and Sunlight Giving. The vast majority of the items that are offered through the Community Closet have been donated by corporations, community organizations, and individuals at NO cost to our program. Hively’s corporate partners who donate new merchandise to the Community Closet include Cost Plus and Bed Bath & Beyond. Hively has partnered with several charitable and community organizations, who collect gently used material goods from their members and provide the donations to Hively. These organizations include Tri-Valley Haven, Shepherd's Gate, and CityServe of the Tri-Valley. In turn, Hively provides donated items to eligible clients of these organizations, thereby reaching more people in need through these partnerships. Hively utilizes individual volunteers and volunteer organizations like Boys Team Charity, National Charity League, boy scouts, and church groups, who not only help with the day-to-day of sorting/organizing/storing donations, but also help during our monthly community distribution events. By cultivating partnerships with community supporters, who provide a significant portion of food, diapers, clothing, and volunteer manpower, we are able to stretch every dollar of program funding to support as many families as possible. With continued support from the City of Dublin and other funders, we will continue to provide families in need with the basic necessities they need to thrive. 10. 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)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low-come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. Hively’s mission is to provide resources and support to ensure that everyone in our community can thrive. As a mission- focused organization, we constantly ask ourselves, “What do our clients need and how can we meet those needs?” Hively conducted a needs assessment and determined that the families we serve were in desperate need of basic necessities, which they could not afford to purchase themselves. In response to the needs assessment, Hively opened the Diaper Pantry, Food Pantry, and Community Closet. Criteria for success of the three programs include: cost effectiveness of the program; accessibility; coordination with other service providers; and an increase in the number of Dublin residents who utilize the programs. Attachment 7 867 The programs are cost effective because we have tremendous community support for the programs and enjoy successful partnerships with philanthropic organizations, community-based organizations, local businesses, volunteer organizations, and individual community members. At Hively, we embrace the old saying “a dollar saved is a dollar earned” and we seek in-kind donations and monetary donations from community members; our community-based partners solicit in-kind donations on our behalf; we seek grant funding from other sources, including corporate philanthropies and local philanthropic organizations; and we rely on volunteer manpower whenever possible. These cost-saving measures allow us to stretch the City of Dublin’s grant funding further and to serve even more families. Hively ensures accessibility in many ways. The programs offer varied hours of operation to accommodate a variety of schedules, including monthly Saturday distribution events. Hively is easily accessible via bus and BART. With over half of our clients being Spanish speakers, we employ Spanish-speaking staff in order to communicate effectively with our clients. Finally, in emergency situations, Hively can meet the person where they are and bring resources to them (including, for example, crisis intervention services from a mental health professional, shoes, blankets, diapers, or a car seat). Hively services and programming are culturally appropriate. We are inclusive and strive to employ staff who reflect the communities we serve and who are experienced in providing support and resources to the target populations. Our staff is very diverse with fluency in 14 languages, which ensures that we can communicate effectively with our families. The Diaper Pantry is culturally appropriate because we provide bilingual children’s books and parent educational materials in Spanish. This not only meets the needs of our Spanish-speaking population, it also provides an opportunity for parents and children to increase their dual-language literacy skills together. Hively enjoys successful partnerships, including CityServe of the Tri-Valley, Axis Community Health, and WIC of Pleasanton, all of whom refer qualified clients to Hively’s Diaper Pantry. Shepherd’s Gate provides donated clothing and shoes to Hively’s Community Closet. In turn, Shepherd’s Gate brings clients like Laura to Hively for resources. Laura was pregnant and found herself in an unsafe home environment. She fled across the country to a shelter in California, arriving with nothing but the clothes on her back and a backpack. A case worker from Shepherd's Gate brought Laura to Hively, where she shopped at the Community Closet for whatever she needed. Laura selected a stroller, baby items, and clothes for herself, all of which were free of charge. While there, Laura learned about Hively's other resources which could help her when her baby arrived, including the Diaper Pantry; the Food Pantry; child care subsidies and referrals; and parent education classes. In joining forces with these partners, Hively aims to deliver the most comprehensive services to our families. Our outreach efforts also include digital and printed community resource materials, Constant Contact, SurveyMonkey, social media, community events, and the agency website. Hively’s goal is to provide comprehensive support to the most vulnerable members of our community. The desperate need for basic resources skyrocketed dramatically due to the COVID-19 pandemic, and the economic effects of job and wage loss will be felt by low-income families long after COVID-19 ceases to be a public health threat. Funding safety net programs to fulfill basic needs is crucial now more than ever before. Hively was recently recognized for our safety net support efforts and received the “2020 California Nonprofit of the Year” award for Assembly District 16 by Assemblyperson Rebecca Bauer-Kahan. We are deeply grateful for the partnership and support of the City of Dublin. We hope that, together, we can significantly diminish diaper need and hunger, and can provide for the basic needs of the Tri-Valley’s most vulnerable families so they can thrive. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis-Bacon requirements. 12. ** QUESTIONS 13 THROUGH 23 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 13. 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? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A gfedc Not Applicable gfedc Yes ✔✔✔✔ No gfedc Yes. If so, check box here and answer questions 13 through 23. ✔✔✔✔ No. If no, check box here and enter NA gfedc Don't know. If you are unsure, please call City staff at (925) 833-6645. Attachment 7 868 14. CDBG ONLY - Identify at least one HUD Guiding Principle that relates to your project: 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: (Select Category and Applicable Goals) 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 17. CDBG ONLY - Select one HUD 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?") 18. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?") gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc A) Housing gfedc Goal 1: Promote the production, rehabilitation, and preservation of affordable housing (rental and ownership) through acquisition, rehabilitation, new construction, and minor repair. gfedc Goal 2: Reduction of housing discrimination through provision of fair housing and tenant/landlord services. gfedc Goal 3: Use resources to assist low-income residents make rental assistance payments in response to Covid-19. gfedc B) Homeless gfedc Goal 1: Use resource to end homelessness by funding and supporting homeless service programs. gfedc C) Supportive Housing gfedc Goal 1: Increase the availability of services enriched housing for persons with special needs by supporting acquisition and new construction of housing units. gfedc D) Community Development gfedc Goal 1: Make improvements, including ADA accessibility and rehabilitation to public facilities, such as curbs and sidewalks, neighborhood parks and recreational improvements, homeless facilities and other public facilities/community centers. gfedc Goal 2: Fund economic development, micro-enterprise, and on-the-job training. gfedc Goal 3: Support public service programs for low income residents, preserving safety net services for families and individuals who are vulnerable or ✔✔✔✔ F) Not Applicable. Not interested in CDBG funding. gfedc Public Services gfedc Public Facilities gfedc Rental Assistance gfedc Affordable Housing gfedc Increase Opportunities for 1st Time Homebuyers gfedc Promote Decent Affordable Rental Housing gfedc Strengthen Communities gfedc Ensure Equal Opportunity in Housing gfedc Reduce Housing Discrimination gfedc Promote Participation of Grass-Roots, Faith-Based, and other Community-Based Organizations ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability Attachment 7 869 19. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: 20. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 21. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. ✔✔✔✔ Not Applicable. Not interested in CDBG funding gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. Not interested in CDBG funding Attachment 7 870 22. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMI") information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 23. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" 24. 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 Disabled Women/Female Headed Households Seniors Youth Homeless N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL Low Income (50%-80% AMI) Extremely Low Income (<30% AMI) N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL White White + HISPANIC Black/African American Black/African American + HISPANIC Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. Not interested in CDBG funding. (Type N/A) 0.000.00 TOTAL gfedc #1 - This program/project has the agency's highest priority for funding. ✔✔✔✔ #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. Attachment 7 871 gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed Albertson's Families Foundation USD$ 100,000.00 USD$ 50,000.00 Sunlight Giving Foundation USD$ 15,000.00 USD$ 15,000.00 StopWaste USD$ 5,000.00 USD$ 5,000.00 City of Dublin USD$ 25,000.00 USD$ 0.00 City of Pleasanton USD$ 25,000.00 USD$ 0.00 City of Livermore USD$ 25,000.00 USD$ 0.00 Rotary Clubs USD$ 10,000.00 USD$ 0.00 Share the Spirit USD$ 5,000.00 USD$ 0.00 Walmart USD$ 2,500.00 USD$ 0.00 Individual donors USD$ 43,300.00 USD$ 25,000.00 Total USD$ 255,800.00 USD$ 95,000.00 Funding Uses/Expenses Budget Amount Amount Committed .5 FTE Community Outreach Manager USD$ 38,000.00 USD$ 28,000.00 1 FTE Community Outreach Coordinator USD$ 60,000.00 USD$ 0.00 .2 FTE Facilities Manager USD$ 15,000.00 USD$ 0.00 .2 FTE Administrative Staff USD$ 15,000.00 USD$ 5,000.00 Program Supplies USD$ 30,000.00 USD$ 12,000.00 Rent USD$ 84,000.00 USD$ 50,000.00 Utilities USD$ 12,000.00 USD$ 0.00 Phone and Internet USD$ 1,800.00 USD$ 0.00 Total USD$ 255,800.00 USD$ 95,000.00 Budget Narrative The partial salaries of Hively employees comprise the bulk of this grant request. Grant funding would be used to purchase program supplies and to fund partial employee salaries to help run the Diaper Pantry, Food Pantry, and Community Closet. Community outreach and facilities staff ensure the smooth, everyday running of the programs - picking up donations; sorting, organizing, and storing donated items; supervising volunteers; purchasing program supplies; stocking and replenishing merchandise; cultivating and maintaining relationships with donors; and providing customer service when families come in to shop and at community distribution events. Therefore, customer service on diaper distribution days is an integral part of the success of this program. In addition, developing and maintaining community partnerships and executing successful fundraising strategies is vital to maximizing resources, securing diverse funding streams, and reducing program costs. Hively utilizes in-kind resources, community partnerships, fundraising strategies, and volunteers to help minimize costs. The COVID-19 pandemic has had a devastating and disproportionate impact on the low-income families we serve, and these families will suffer from the economic effects of the pandemic long after COVID-19 ceases to be an imminent health threat to society. Hively's community resource programs are desperately needed now more than ever. Hively aims to provide holistic support to the most vulnerable members of our community. We are deeply grateful for the City of Dublin's partnership and support. We hope that together, we can significantly diminish diaper need and hunger and can provide for the basic needs of the Tri-Valley’s most vulnerable families so they can thrive. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Hively Community Closet Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Hively Community Closet FIF Attachment 7 872 Application ID: 328830 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2021 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ BOD List Current Annual Budget for the Entire Agency ✔✔✔✔ Hively Budget 20-21 Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ Form 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Designated Official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Authorization to Seek Funding Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ COI Dublin STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. 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. ✔✔✔✔ Non Profit Letter Certified Audit and/or Certified Financial Statements ✔✔✔✔ Hively Financials 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 Grievance 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 - 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 ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) Attachment 7 873 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin PCS - Human Services Division 2021-2022 Human Services Grant Program Deadline: 1/11/2021 Open Heart Kitchen Dublin Meal Programs Jump to: Organization Information Questions Budget Documents USD$ 25,000.00 Requested Submitted: 1/7/2021 2:43:06 PM (Pacific) Project Contact Heather Greaux executivedirector@openheartkitchen.org Tel: 925-580-1616 ext 402 Additional Contacts denise@openheartkitchen.org,taylor@openheartkitchen.org Open Heart Kitchen 1141 Catalina Drive #137 Livermore, CA 94550 United States Executive Director Heather Greaux executivedirector@openheartkitchen.org Telephone(925) 580-1616 Fax Web www.openheartkitchen.org Organization Information top 1. Business License Number BL-009270 Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Open Heart Kitchen’s Mission is to serve prepared, nutritious meals free of charge to the hungry people of the Tri-Valley area. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. 5. Is this request for one-time, seed or operational funding? ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding Attachment 7 874 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Open Heart Kitchen (OHK) is seeking funding for meal programs conducted in the City of Dublin. We serve meals to seniors 5 days a week at the Dublin Senior Center, and we deliver meals to various homeless encampments 6 days a week. Since COVID-19, OHK has seen a significant increase in the demand for emergency food and has shifted operations to provide food in to-go containers. Our Senior Meal Program, addresses the nutritional gap of low-income seniors. Meals are picked up curbside and taken to-go. The program provides necessary nutrition as well as emotional support. Getting out of the house and interacting with staff at the meal sites helps break the isolation that impacts many seniors. The rate of food insecurity has risen by nearly 5 percent in Alameda County from 9.1% to 13.9% in just two years, according to a Feeding America report, "The Impact of the Coronavirus on Food Insecurity." Since the beginning of the pandemic, we surpassed the 250,000 meal mark and we saw over 772 seniors sign up for our Senior Meal Program for the first time. The pandemic also prompted OHK to ramp up our Street Outreach, in which breakfast and hot meals are delivered to about 100 people living in homeless encampments, spread over 13 locations throughout the Tri-Valley, Monday through Saturday. Ready-made food is particularly important for unhoused and precariously housed individuals who do not have access to a kitchen. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 500 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) This grant will address food insecurity and the distribution of food to underserved, low-income seniors, and people experiencing homelessness in Dublin. The grant funds will be used to purchase the food used in the Dublin meal programs as well as program staff salaries. In an effort to provide a program based budget for Board Approval, OHK staff performs an extensive review of all program expenses and goals. The program budget includes an appropriate meal count growth and new program expansion goals established by the OHK Strategic Planning Committee. All organization budgets are approved by the Board of Directors annually. Budget performance is reviewed by the Board of Directors quarterly and by staff monthly. OHK utilizes donated food and holds food drives throughout the year in an effort to reduce the amount of purchased food. A contract with US Foods has also been established that takes advantage of their Manufacturer Cost Reduction Program. OHK is also a member of the local affiliate of Feeding America, the Alameda County Community Food Bank. As a member agency, OHK is able to purchase food from the Alameda County Community Food Bank in bulk below wholesale prices. The Alameda County Community Food Bank also provides fresh produce at no cost that OHK distributes directly to clients, as well as utilizes in the prepared meal programs. 10. 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)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low-come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. Metrics gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development ✔✔✔✔ Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities ✔✔✔✔ Food and Nutrition ✔✔✔✔ Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the Above gfedc Please explain: Attachment 7 875 Objective: End hunger by providing nutritious food. Activities: Work with the Alameda County Community Food Bank to distribute fresh produce. Follow nutrition guidelines for meal programs. Provide nutrition education to clients so they make healthy food choices. Timeline 07/01/2021-06/30/2022 Outcomes Clients have access to fresh produce. Clients only receive food that is healthy and appealing. Nutrition education outreach will be performed at the Dublin Senior Center quarterly. Measurement Pounds of produce delivered. Nutritional analysis by Registered Dietitian. Annual satisfaction surveys. Number of outreach days. Number of people served. Given the vulnerability to diet-related diseases such as diabetes, people facing food insecurity deserve food that will not aggravate their existing medical predispositions. OHK focuses on distributing food that is high quality and healthful. Open Heart Kitchen’s Senior Meal Program serves seniors 60 years and older. Food insecurity especially impacts our growing senior population. Our Senior Meal Program sees continued growth as the cost of housing, food, and health care continues to rise and the COVID- 19 pandemic continues on. The meals for our Senior Meal Program are reviewed by a Registered Dietitian, then approved by the County of Alameda Area Agency on Aging. The senior meal menu is specifically designed to meet the special dietary needs of seniors. OHK recognizes that the low-income and unhoused population is considered an "at-risk" population. They are much more likely to suffer from many health problems such as obesity and diabetes. Many of our clients have severe dental problems from lack of access to dental care. Several of our unhoused clients are seniors with special dietary needs. We have a responsibility to provide our guests with the most nutritious meal as we possibly can. People experiencing homelessness are not able to fully utilize other food services since they are unable to store and/or refrigerate food. Some of Open Heart Kitchen’s clients simply lack access to kitchen facilities and our meal services are a better fit for them. For some, having a hot meal in their time of need was all that was needed to get their life back on track. We find that many of our unhoused and low-income clients utilize mobile devices to find services. Our website offers a daily calendar of our meal sites and hours of operation. We are also registered with City Serve and 211. We are a part of Alameda County Community Food Bank's referral system and we collaborate with several local churches and community service organizations. We distribute our meal program flyers in multiple languages. The Dublin Senior Center helps promote our Senior Meal Program to its visitors. We are always trying to recruit volunteers who speak languages other than English and encourage them to interact with our guests who speak the same language not only to tell them about our services, but to get to know them a little better. We also participate in several outreach events. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis-Bacon requirements. 12. ** QUESTIONS 13 THROUGH 23 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 13. 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? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. OHK is committed to making sure individuals with limited English proficiency have access to our programs. We recruit multilingual volunteers and offer our quarterly surveys and program flyers in multiple languages. We collaborate with agencies like the Alameda County Community Food Bank that provide translation services. All OHK program staff have been provided with "I Speak" cards to assist in identifying the language interpretation a guest may need should the occasion arise. The OHK staff are informally surveyed periodically on their experience concerning any contact with LEP persons during the year. This allows OHK to identify what translation services may need to be provided in the future. OHK takes reasonable steps to provide the opportunity for meaningful access to guests who have difficulty ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Yes. If so, check box here and answer questions 13 through 23. gfedc No. If no, check box here and enter NA gfedc Don't know. If you are unsure, please call City staff at (925) 833-6645. Attachment 7 876 communicating in English, although a very low percentage of OHK clients are limited English speaking. 14. CDBG ONLY - Identify at least one HUD Guiding Principle that relates to your project: 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: (Select Category and Applicable Goals) 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 17. CDBG ONLY - Select one HUD 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?") 18. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?") 19. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: ✔✔✔✔ Be culturally accessible, appropriate and inclusive ✔✔✔✔ Encourage community engagement and involvement gfedc Promote energy and resource efficiency ✔✔✔✔ Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery gfedc Not Applicable. Not interested in CDBG funding. gfedc A) Housing gfedc Goal 1: Promote the production, rehabilitation, and preservation of affordable housing (rental and ownership) through acquisition, rehabilitation, new construction, and minor repair. gfedc Goal 2: Reduction of housing discrimination through provision of fair housing and tenant/landlord services. gfedc Goal 3: Use resources to assist low-income residents make rental assistance payments in response to Covid-19. ✔✔✔✔ B) Homeless ✔✔✔✔ Goal 1: Use resource to end homelessness by funding and supporting homeless service programs. gfedc C) Supportive Housing gfedc Goal 1: Increase the availability of services enriched housing for persons with special needs by supporting acquisition and new construction of housing units. gfedc D) Community Development gfedc Goal 1: Make improvements, including ADA accessibility and rehabilitation to public facilities, such as curbs and sidewalks, neighborhood parks and recreational improvements, homeless facilities and other public facilities/community centers. gfedc Goal 2: Fund economic development, micro-enterprise, and on-the-job training. ✔✔✔✔ Goal 3: Support public service programs for low income residents, preserving safety net services for families and individuals who are vulnerable or gfedc F) Not Applicable. Not interested in CDBG funding. ✔✔✔✔ Public Services gfedc Public Facilities gfedc Rental Assistance gfedc Affordable Housing gfedc Increase Opportunities for 1st Time Homebuyers gfedc Promote Decent Affordable Rental Housing gfedc Strengthen Communities gfedc Ensure Equal Opportunity in Housing gfedc Reduce Housing Discrimination gfedc Promote Participation of Grass-Roots, Faith-Based, and other Community-Based Organizations gfedc Not Applicable. Not interested in CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. Not interested in CDBG funding. gfedc Availability/Accessibility gfedc Affordability ✔✔✔✔ Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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 Attachment 7 877 20. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 21. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 22. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMI") information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Not Applicable. Not interested in CDBG funding ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. Not interested in CDBG funding 40 Disabled 50 Women/Female Headed Households 500 Seniors 0 Youth 5 Homeless 0 Not Applicable. Not interested in CDBG funding (Type N/A) 595.00595.00 TOTAL Attachment 7 878 23. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" 24. 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 20 Low Income (50%-80% AMI) 480 Extremely Low Income (<30% AMI) 0 Not Applicable. Not interested in CDBG funding (Type N/A) 500.00500.00 TOTAL 163 White 5 White + HISPANIC 10 Black/African American 5 Black/African American + HISPANIC 240 Asian 0 Asian + HISPANIC 0 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 77 Multi Racial + HISPANIC OR other Multi Racial 0 Not Applicable. Not interested in CDBG funding. (Type N/A) 500.00500.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed City of Dublin USD$ 25,000.00 USD$ 0.00 County of Alameda USD$ 87,500.00 USD$ 0.00 Individual Contributions USD$ 265,801.00 USD$ 0.00 In-Kind Food Donations USD$ 14,840.00 USD$ 0.00 Total USD$ 393,141.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Personnel Expenses USD$ 137,557.00 USD$ 0.00 Food USD$ 112,553.00 USD$ 0.00 Printing/Copying USD$ 817.00 USD$ 0.00 Postage USD$ 307.00 USD$ 0.00 Attachment 7 879 Telephone USD$ 2,856.00 USD$ 0.00 Rent and Utilities USD$ 3,939.00 USD$ 0.00 Contracted Services USD$ 255.00 USD$ 0.00 Auto USD$ 7,020.00 USD$ 0.00 Facility/Equipment Maintenance USD$ 15,830.00 USD$ 0.00 Information Technology USD$ 3,600.00 USD$ 0.00 Insurance USD$ 2,040.00 USD$ 0.00 Office Expenses USD$ 2,090.00 USD$ 0.00 Other USD$ 104,277.00 USD$ 0.00 Total USD$ 393,141.00 USD$ 0.00 Budget Narrative The $25,000 request from the City of Dublin will help defray 11% of the cost of the food used in the Dublin meal programs, primarily the meals served at the Dublin Senior Center. In addition to food costs, the grant from the City of Dublin will also help pay for 11% of staff salaries attributed to Dublin meal program operations. More specifically it will pay one staff member's salary who works at the Dublin Senior Center operating the Senior Meal Program. The total budget for the Dublin Meal program ($393,141) is approximately 35% of Open Heart Kitchen's Tri-Valley senior meal program budget. The total budget for the Dublin Meal program is 16% of Open Heart Kitchen's overall organization budget. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Form Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ OHK Board Current Annual Budget for the Entire Agency ✔✔✔✔ Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Authorization Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Authorization for funding request Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Insurance STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. 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. ✔✔✔✔ State Federal Certified Audit and/or Certified Financial Statements ✔✔✔✔ Audit 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 Grievance Procedure Employee Handbook REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section Audit REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws Articles of Incorporation Bylaws REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) Conflict of Interest 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. LEP Plan REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- Attachment 7 880 Application ID: 329159 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2021 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Strategic Plan Other Supporting Documents (Not Required) Attachment 7 881 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin PCS - Human Services Division 2021-2022 Human Services Grant Program Deadline: 1/11/2021 CityServe of the Tri-Valley Homeless Prevention and Family Stabilization Program Jump to: Organization Information Questions Budget Documents USD$ 25,000.00 Requested Submitted: 1/7/2021 8:59:36 PM (Pacific) Project Contact Christine Beitsch data@cityservetrivalley.org Tel: 510-789-5443 Additional Contacts none entered CityServe of the Tri-Valley P.O. Box 1613 Pleasanton, CA 94566 United States CEO Christine Beitsch-Bahmani christine@cityservecares.org Telephone925-222-2273 Fax Web www.cityservecares.org Organization Information top 1. Business License Number BL-109916 Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). We exist to CARE for people in crisis, COORDINATE resources and CONNECT volunteers to mobilize mercy throughout the Tri-Valley. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes Attachment 7 882 5. Is this request for one-time, seed or operational funding? 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. CityServe serves underserved individuals, primarily low income, homeless or destitute. Our focus is to mobilize mercy and compassion through community volunteers, street outreach efforts and client-centered case management services; this mobilization is designed to humanize human services as our staff and volunteers walk alongside the most vulnerable families and individuals in the Tri-Valley. Our goal is to both resource and motivate participants toward a future full of stability, self-efficacy, community and sustainability. We have two main programs Intervention and Prevention. This request falls under the prevention program. The work of prevention requires a high level of coordination between service providers & volunteers that care for the residents of Dublin. We believe the most cost-effective way to end homelessness is to prevent it in the first place. As a result of the pandemic, we added services assisting families in crisis with emergency rental assistance, topical webinars to help tenants understand their rights, and job navigation. Our Homeless Prevention and Family Stabilization Program involves a multifaceted approach of providing safety-net emergency fiscal resources, individualized resourcing to connect those in need to existing infrastructures of support, & mobilizing the wider community, including churches, the business community, & individuals to provide volunteer assistance & care support to those in crisis. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 30 Dublin Residents – will receive safety net fiscal assistance, individualized resourcing (aka case management, special programs), and workshops focused on education and skills training for stabilization. 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None ✔✔✔✔ Behavioral Health (mental health and substance abuse) ✔✔✔✔ Affordable Housing gfedc Health Care (including dental) ✔✔✔✔ Workforce Development ✔✔✔✔ Homelessness ✔✔✔✔ Transportation Services and Access ✔✔✔✔ Domestic Violence and Child Abuse ✔✔✔✔ Disabilities ✔✔✔✔ Food and Nutrition ✔✔✔✔ Senior Services ✔✔✔✔ Youth Services ✔✔✔✔ Child Care, Early Childhood Development and Education ✔✔✔✔ Changing Demographics and Growing Diversity ✔✔✔✔ Financial Assistance gfedc None of the Above gfedc Please explain: Attachment 7 883 results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) The requested funding of $25,000 will go specifically to sustain current capacity for our Homeless Prevention and Family Stabilization Program. This program in its entirety serves Dublin, Pleasanton and Livermore residents. This is a regional program and costs approximately $615,000 to run annually. With Regional HEAP dollars expiring in Feb 2021, this program will take an enormous financial hit. Therefore, we will need gap funding in order to maintain the level of services provided to Dublin residents while we build capacity during the pandemic. Without proper funding we will have to cut or reduce the current services provided which will thereby directly impact Dublin residents. Specifically, the funds requested will pay the partial salary for one caseworker who will be available for Dublin residents that need individualized action planning, resourcing, and help navigating existing support systems such as federal and state benefits. The average caseload for a Full-Time Resource specialist is 20 households at a time (with an average case turn-over of 2-3 times a year), which means that at .4 FTE, this Case Worker will be able to, conservatively, provide 15 households with highly individualized care, which amounts to an averaged annual total of 30 Dublin Residents served with the $25,000 investment averaging service cost of approximately ($416) per household.. In addition to this individualized care, $3,000 requested in this grant application will go towards direct service safety-net fiscal assistance (formerly known as Community Care funds) that will serve to stabilize and keep Dublin residents housed. With a City Council focus on, “critical or essential needs and services such as food shelter and healthcare” we can assure you that our safety-net fiscal and supportive services asses critical needs such as utility payments, gas cards and car registration payments (and back-payments) to allow individuals to access employment and services, transportation costs for those without vehicles, clothing, food and other necessary supplies for families and individuals for work or education, and other critical expenditures that help stabilize our participants and their families so they can continue working towards self- sufficiency. Please note: Rental assistance payments are provided by other funding resources that we administer and pay directly to the residents. 10. 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)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low-come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. CityServe has a diverse clientele with the population served being; Extremely Low Income (<30% AMI), Very Low Income (30%-50% AMI), Low Income (50%-80% AMI), Moderate Income (80%-120% AMI), Above Moderate Income (>120% AMI) The success of the project can be measured by our process, quality and impact. Process: How effective we are at reaching the residents about our services through outreach efforts, access resources through our referrals and/or if they enroll in either case management or a specialized program such as Emergency Rental Assistance Program (ERAP) Quality: How well we track progress towards the established action plan goal (a plan that is crafted between case worker and the participant), track all applicable expenses and time spent with participants, and finally track the measurable outcomes that CityServe and the participant have worked together to facilitate.outcomes include eviction prevention, safety net fiscal assistance (utility bills), increased fiscal literacy, establishing sustainable transportation to and from work/school (in the form of auto repair, or license/registration fees), supporting the participant’s increase of legal income through better employment, enrollment in school or job training program, and accessing higher levels of services (such as critical mental health care or medical care). Impact: Did their life change for the better? Our ultimate marker of success for all CityServe participants is demonstrated sustainable self-sufficiency. We also have implemented a client satisfaction survey to track overall impact. CityServe has a robust client database framework that allows us to enroll participants in our programs, capture all critical demographic information (such as disability status, race/ethnicity, age, veteran status, self-reported income & income verification, and language translation needs), track progress towards the established action plan goal (a plan that is crafted between case worker and the participant), track all applicable expenses and time spent with participants, and finally track the measurable outcomes such as increased income, benefits accessed and employment secured that CityServe and the participant have worked together to facilitate. In regard to accessibility, during the pandemic CityServe staff are available via virtual meetings, local outside pop-up Attachment 7 884 outreaches and or by appointment to go to the individual when needed to capture their information and create action plans with them, or clients can call in to our offices for assistance. We are a bilingual staff (currently have 2 Spanish speaking team- members), as well as widening our network with local churches and community groups that can translate other languages on our behalf. CityServe markets primarily via our website and email/social media presence, through our partners, working closely with the city and police department, schools and churches. We are also a direct referral agency from 211 and we are a part of the Alameda County Continuum of Care which allows higher levels of interagency collaboration for increased social impact. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis-Bacon requirements. 12. ** QUESTIONS 13 THROUGH 23 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 13. 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? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 14. CDBG ONLY - Identify at least one HUD Guiding Principle that relates to your project: 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: (Select Category and Applicable Goals) gfedc Not Applicable gfedc Yes ✔✔✔✔ No gfedc Yes. If so, check box here and answer questions 13 through 23. ✔✔✔✔ No. If no, check box here and enter NA gfedc Don't know. If you are unsure, please call City staff at (925) 833-6645. gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc A) Housing gfedc Goal 1: Promote the production, rehabilitation, and preservation of affordable housing (rental and ownership) through acquisition, rehabilitation, new construction, and minor repair. gfedc Goal 2: Reduction of housing discrimination through provision of fair housing and tenant/landlord services. gfedc Goal 3: Use resources to assist low-income residents make rental assistance payments in response to Covid-19. gfedc B) Homeless gfedc Goal 1: Use resource to end homelessness by funding and supporting homeless service programs. gfedc C) Supportive Housing gfedc Goal 1: Increase the availability of services enriched housing for persons with special needs by supporting acquisition and new construction of housing units. gfedc D) Community Development gfedc Goal 1: Make improvements, including ADA accessibility and rehabilitation to public facilities, such as curbs and sidewalks, neighborhood parks and recreational improvements, homeless facilities and other public facilities/community centers. gfedc Goal 2: Fund economic development, micro-enterprise, and on-the-job training. gfedc Goal 3: Support public service programs for low income residents, preserving safety net services for families and individuals who are vulnerable or ✔✔✔✔ F) Not Applicable. Not interested in CDBG funding. Attachment 7 885 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 17. CDBG ONLY - Select one HUD 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?") 18. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?") 19. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc Public Services gfedc Public Facilities gfedc Rental Assistance gfedc Affordable Housing gfedc Increase Opportunities for 1st Time Homebuyers gfedc Promote Decent Affordable Rental Housing gfedc Strengthen Communities gfedc Ensure Equal Opportunity in Housing gfedc Reduce Housing Discrimination gfedc Promote Participation of Grass-Roots, Faith-Based, and other Community-Based Organizations ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. Attachment 7 886 20. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 21. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 22. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMI") information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 23. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. ✔✔✔✔ Not Applicable. Not interested in CDBG funding gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. Not interested in CDBG funding Disabled Women/Female Headed Households Seniors Youth Homeless N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL Low Income (50%-80% AMI) Extremely Low Income (<30% AMI) N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL White White + HISPANIC Black/African American Black/African American + HISPANIC Asian Attachment 7 887 24. 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 Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. Not interested in CDBG funding. (Type N/A) 0.000.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed Church Contributions USD$ 58,550.00 USD$ 0.00 Business Contributions USD$ 60,250.00 USD$ 0.00 Foundation Contributions USD$ 50,000.00 USD$ 0.00 Individual Contributions USD$ 72,270.00 USD$ 0.00 Government Grants USD$ 371,600.00 USD$ 253,500.00 Other Income USD$ 2,500.00 USD$ 0.00 Total USD$ 615,170.00 USD$ 253,500.00 Funding Uses/Expenses Budget Amount Amount Committed Crisis Prevention Payroll Costs USD$ 411,540.00 USD$ 0.00 Payroll Taxes, Benefits, Workers Comp USD$ 55,630.00 USD$ 0.00 Safety-Net Fiscal Assistance to Clients USD$ 63,500.00 USD$ 0.00 Program Technology USD$ 23,500.00 USD$ 0.00 Building Rent & Maintenance USD$ 18,500.00 USD$ 0.00 Program Supplies USD$ 5,000.00 USD$ 0.00 Caseworker Mileage & Vehicle Costs USD$ 5,000.00 USD$ 0.00 Audit, Legal & Professional Services USD$ 10,000.00 USD$ 0.00 Other Administrative Program Costs USD$ 22,500.00 USD$ 0.00 Total USD$ 615,170.00 USD$ 0.00 Attachment 7 888 Budget Narrative The $25,000 funding we are requesting will all be focused on homelessness prevention and crisis intervention (in order to maintain household stability) for extremely low, very low, and low income families in Dublin. It will go towards three critical aspects of prevention/stabilization -- individualized care and resourcing in the form of a Part-Time Resource Specialist (case manager) who will be dedicated to serving Dublin residents, as well as $3000 Safety-Net Fiscal Assistance (formerly referred to as Community Care funding). As mentioned: Although we have another important program we offer, we specifically did not request funding at this time for our Homeless Intervention and Crisis Stabilization Program due to funding committed through Measure A that will provide us with one unsheltered mental health street outreach worker and one case manager for the Tri-Valley area. In light of this funding, we plan to utilize these employees to cover Dublin homeless residents as needs arise. In our continually expanding role of providing critical safety net services for the three Alameda County Tri-Valley cities, we are in need of this funding in order to provide responsive, effective services to Dublin residents in crisis need. Our overall organization budget is designed to reduce homelessness, prevent homelessness, and increase housing security and household stability in Dublin and the Tri-Valley through our services. This project highlights our services for Dublin residents. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ CityServe Program Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information Form List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ Annual Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ CityServe 990 2019 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Board Designation Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Board Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Work Comp Insurance General Liability Insurance Property Insurance D&O Insurance STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. 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. ✔✔✔✔ Federal Determination letter Articles of Incorporation Certified Audit and/or Certified Financial Statements ✔✔✔✔ Audit in Process 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 Grievance Procedure REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section Attachment 7 889 Application ID: 329312 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2021 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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 - 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 ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) Organizations We Coordinate With CityServe Employee Manual CEO Resume Finance Manager Resume Org Chart Articles of Incorporation Attachment 7 890 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin PCS - Human Services Division 2021-2022 Human Services Grant Program Deadline: 1/11/2021 Chabot-Las Positas Community College District Dublin Community Jobs Support Expansion 2021-22 Jump to: Organization Information Questions Budget Documents USD$ 14,308.00 Requested Submitted: 1/6/2021 12:01:51 PM (Pacific) Project Contact Sarah Holtzclaw sholtzclaw@clpccd.org Tel: 925-416-5108 Additional Contacts none entered Chabot-Las Positas Community College District DBA Tri-Valley Career Center 7600 Dublin Blvd. Dublin, CA 94568 United States Vice Chancellor for Business Services, designated signer Jonah Nicholas jnicholas@clpccd.org Telephone(925) 416-5100 Fax Web www..trivalleycareercenter.org Organization Information top 1. Business License Number BL-010043 Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). The Career Center (TVCC) is part of the College District’s (CLPCCD) Econ. Dev. Dept. Along with Apprenticeships, OSHA Training and Foster Care Support, “we empower individuals and communities to thrive by creating career, educ 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. gfedc Non-Profit ✔✔✔✔ Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes Attachment 7 891 5. Is this request for one-time, seed or operational funding? 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. TVCC has helped thousands find new careers for 20 years with its successful pairing of free workshops and counseling. We teach essential skills to help job seekers succeed in the complicated job market of today adding connections to employers. Pre-Covid, 87% of our job seekers found work within six months. Our success is due to the serving hearts of our highly experienced staff and our commitment to human-centered services – putting the needs of our clients before everything. TVCC’s dedicated staff always looks for ways to improve our services. We want to expand our post-pandemic services to residents who cannot get to our offices or do not know about the services. Though we have helped thousands of unemployed Tri-Valley residents, the pandemic has created an enormous increase of job seekers who could use our help. Future plans for TVCC services include taking our services into the community through our community partners. Unfortunately, our available funds are primarily spent the Career Center’s staff and standard operational costs. This leaves little for marketing our programs or for the development of new services. This grant will help: - Translate our services and website into Spanish and Simplified Chinese in order to offer guidance to those whose first language is not English - Develop and place marketing messages in English, Spanish, and Simplified Chinese - Offer in-person services in Spanish throughout the community and virtually. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) TVCC serves clients both in person and online, with videos, tip sheets and workshops, in a combination of three languages. Counted together, we will be able to serve 750 Dublin job seekers throughout 2021-22. 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) ✔✔✔✔ Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the Above gfedc Please explain: Attachment 7 892 TVCC has been a part of the Tri-Valley for over 20 years. In that time, the staff have helped thousands of job seekers find their next path in life - stopping a reliance on unemployment and other benefits and to return to the working world. Our successful combination of self-paced and staff-assisted services allow job seekers to find their own path. Our experienced staff walk beside them, teaching skills, offering encouragement and building confidence through our workshops, Job Club, 1-on-1 counseling & hiring events. Yet, for all the success that we have seen over the years, TVCC is still relatively unknown. We believe this is due to: 1) as a grant-funded program, the vast majority of its budget is spent on staff, which is the heart of the service and required operational costs; 2) the program relying on the Employment Department and unemployment insurance to refer job seekers; and 3) community outreach and marketing were not a priority for the first 15 years. Though the first above is still true, the others are not. Over the last five years, TVCC staff have paid a special attention to community outreach and partnerships with organizations and agencies in the region. It has focused on offering excellent services which is rewarded in word-of-mount referrals. It has focused on its website and social media. The TVCC website is often lifted as the most professional, helpful career center website in the region and found at the top of an internet search for job search assistance or training in the region. The ground work is laid. Now, TVCC wants to reach out to micro-communities within the Tri-Valley that it cannot reach through its traditional, place-bound services. However, with diminishing funds from its long-term grantors, TVCC does not have additional resources to connect with these populations and serve them in their neighborhoods. We ask that the City help with this so that more vulnerable job seekers can take advantage of the expertise TVCC offers. The City’s grant funds will pay for staff, marketing and translation services. The objective is to translate the TVCC website and accompanying collateral into Spanish and Simplified Chinese in order to help residents of the region whose English is not strong. We have chosen to start with these two languages as our tax services and community involvement have shown that these have the most prevalent need. Additionally, the U.S. Census ACS indicates that the Asian languages and Spanish are the most common languages spoken at home other than English, which is more than one-third of the region’s population. It also shows that of these, 33% speak English “less than very well”. It is this population that we are targeting with our translation of our website and collateral. We will also offer our job search services in English and Spanish at the region’s adult schools and libraries in order to reach job seekers who cannot come to our offices. We have 3 Spanish-speaking staff who can now offer services to this population. As we do not yet have Mandarin- or Cantonese-speaking staff, these clients will be referred to our written guidance and translation services. Our budget for this project is both efficient and effective. The costs within the budget are directly associated with the project, including the translation of our website and targeted collateral; marketing in three languages; and staff and operational costs to develop the marketing and offer in-person or virtual services within the community. The website translation services we have chosen are a direct translation of the website, using professional services that understand the nuances of language. We chose this rather than a cheaper, artificial intelligence or Google Translate option as it both allows us to own the translations and to have mirror websites in Spanish and Simplified Chinese rather than an on- going subscription service that would disappear if we stopped it. Additionally, it allows us to massage the nuances of the second language to fit with a sensitive subject such as job search. Marketing costs indicated in the budget are the City’s share of an estimate for the design, production and placement of materials to promote the language-specific services that TVCC will be able to offer. The plan, depending on available funds includes both online ads and printed flyers/posters materials. The staff costs included in the budget are a portion of the development of workshops in Spanish, the coordination with community partners and the execution of workshops in English and Spanish within the community. All of these costs are directly applicable to this project and the efforts to reach this community. They are costs that TVCC cannot cover with its current contracts or grants but that the staff know is a gap in the community that can and should be filled in order to help this population become employed and become a productive member of the Tri-Valley. 10. 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)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low-come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. Our goal is to help clients find new careers. The objective is to teach them the skills they need to land a new job and to be able to feed their families, pay their rent and thrive as a Tri-Valley resident. To that end, we offer guidance and support to help Attachment 7 893 them in their new career search. Traditionally, we track the number of clients who visit our offices, take our workshops, enroll in our staff-assisted programs and find work – as well their city of residence. Tracking office visits has been somewhat upended by the pandemic with all our services going virtual. We do track the rest still, however. As the start of the 2021-22 fiscal year begins, we expect to be back in-person to tracking these same metrics for our job seekers. In addition, we will want to measure the effectiveness of our translated website, collateral and marketing. Thus, for the fiscal year and this particular program will track: General Services 1. # of Dublin residents who visit the Career Center’s new Pleasanton location, compared to the total visits 2. # of Dublin residents who take workshops through TVCC (virtually or in-person), compared to total workshops taken 3. # of Dublin residents who seek TVCC services off-site at community partner locations 4. # of Dublin enrolled clients who find work, including the occupation and hourly wage 5. # of Dublin residents who visit the TVCC website, compared to the total visits Translated Services 6. Development of translated sub-websites for TVCC to Spanish and Simplified Chinese 7. Development of translated collateral to Spanish and Simplified Chinese 8. # of Dublin residents who visit the translated sites 9. # of workshops offered in Spanish, virtually and in-person 10. # of people who attend Spanish workshops We have multiple means of tracking these measurements. -We track each visit to Career Center through a survey at the receptionist’s desk when anyone enters the career center. This allows us to track city of residence as well as additional demographic data. -We track all participation in workshops. This allows us to not only track which workshops are more popular but also to track the activity of individual job seekers. This is done through sign-in sheets both in person or virtually. -We track all of our enrolled clients who seek more intense, 1-on-1 help with our counselors. This is done through our CalJobs system through the Employment Development Department -Our website software tracks the visits to our site and should be able to track the translated sites separately from the English version. -The marketing, which will likely be online ads can be tracked through the platforms where the ads are placed, such as Facebook, Google and such. -We will ask our workshop attendees how they heard about the workshop in order to track the effectiveness of marketing, collateral and partner referrals. TVCC is moving its physical location in the first quarter of 2021. Our new offices will be directly across the street from the East Dublin/Pleasanton BART station in Pleasanton. This allows for much greater public transportation access than our previous offices. There will be a greater amount of parking and better ADA access in the building. For those job seekers who will be joining us in person at the Career Center, there will be greater access in a larger, up-to-date office. For those who cannot come to the Career Center, we want to come to them both in person and virtually. A good portion of this project is targeting the ESL population of the Tri-Valley. We understand the gap that exists in this area for those who do not speak English fluently and would like to fill that gap. The vast majority of the hard costs included in this budget are to translate our website and collateral into Spanish and Simplified Chinese, and then to market to these populations. Marketing includes online advertising and posters/flyers in English, Spanish, and Simplified Chinese, as well as word of mouth through our community partners. It also includes the staff time to travel to and offer services at remote locations such as our region’s adult schools and libraries. The Community Job Support Program is geared toward filling language gaps and serving populations that are not presently served with job search services in the Tri-Valley. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis-Bacon requirements. 12. ** QUESTIONS 13 THROUGH 23 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? gfedc Not Applicable gfedc Yes ✔✔✔✔ No gfedc Yes. If so, check box here and answer questions 13 through 23. Attachment 7 894 13. 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? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 14. CDBG ONLY - Identify at least one HUD Guiding Principle that relates to your project: 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: (Select Category and Applicable Goals) 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 17. CDBG ONLY - Select one HUD 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?") ✔✔✔✔ No. If no, check box here and enter NA gfedc Don't know. If you are unsure, please call City staff at (925) 833-6645. gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc A) Housing gfedc Goal 1: Promote the production, rehabilitation, and preservation of affordable housing (rental and ownership) through acquisition, rehabilitation, new construction, and minor repair. gfedc Goal 2: Reduction of housing discrimination through provision of fair housing and tenant/landlord services. gfedc Goal 3: Use resources to assist low-income residents make rental assistance payments in response to Covid-19. gfedc B) Homeless gfedc Goal 1: Use resource to end homelessness by funding and supporting homeless service programs. gfedc C) Supportive Housing gfedc Goal 1: Increase the availability of services enriched housing for persons with special needs by supporting acquisition and new construction of housing units. gfedc D) Community Development gfedc Goal 1: Make improvements, including ADA accessibility and rehabilitation to public facilities, such as curbs and sidewalks, neighborhood parks and recreational improvements, homeless facilities and other public facilities/community centers. gfedc Goal 2: Fund economic development, micro-enterprise, and on-the-job training. gfedc Goal 3: Support public service programs for low income residents, preserving safety net services for families and individuals who are vulnerable or ✔✔✔✔ F) Not Applicable. Not interested in CDBG funding. gfedc Public Services gfedc Public Facilities gfedc Rental Assistance gfedc Affordable Housing gfedc Increase Opportunities for 1st Time Homebuyers gfedc Promote Decent Affordable Rental Housing gfedc Strengthen Communities gfedc Ensure Equal Opportunity in Housing gfedc Reduce Housing Discrimination gfedc Promote Participation of Grass-Roots, Faith-Based, and other Community-Based Organizations ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing Attachment 7 895 18. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?") 19. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. ✔✔✔✔ Not Applicable. Not interested in CDBG funding Attachment 7 896 20. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 21. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 22. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMI") information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 23. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. Not interested in CDBG funding Disabled Women/Female Headed Households Seniors Youth Homeless N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL Low Income (50%-80% AMI) Extremely Low Income (<30% AMI) N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL White White + HISPANIC Black/African American Black/African American + HISPANIC Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. Not interested in CDBG funding. (Type N/A) Attachment 7 897 24. 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 0.000.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed City of Dublin USD$ 0.00 City of Livermore USD$ 13,797.00 USD$ 0.00 City of Pleasanton USD$ 14,055.00 USD$ 0.00 USD$ 25,000.00 CLPCCD USD$ 21,911.00 USD$ 21,911.00 Total USD$ 49,763.00 USD$ 46,911.00 Funding Uses/Expenses Budget Amount Amount Committed Wages USD$ 28,140.00 USD$ 19,698.00 Benefits USD$ 14,090.00 USD$ 9,863.00 Supplies USD$ 325.00 USD$ 120.00 Printing/Copying USD$ 950.00 USD$ 45,391.00 USD$ 16,878.00 Other- travel USD$ 65.00 Total USD$ 88,896.00 USD$ 46,624.00 Budget Narrative TVCC is a grant-funded program of CLPCCD, through its Economic Development Department. Its main grant, which helps pay for select staff salaries has been rapidly dwindling over the last 5 years. Projects that we know will help the Tri-Valley community but are out of the scope of our Alameda County Workforce Development Board (ACWDB) contract need to be funded in other ways. The 3 cities of the Tri-Valley have been fantastic partners in this way for the past several years. The budget for this project is shared between the three Tri-Valley Cities (47.33%), CLPCCD (24.6%), and the Alameda County-Oakland Community Action Partnership (AC-OCAP) (28.1%). It is an ambitious project but one that will offer a wide variety of job search guidance to clients who are missed in our current environment. The budget is broken into three areas: Salaries, Benefits and Operating Costs. Though career services are normally heavily weighted on salaries and benefits, this project is flipped. Within this, the largest costs are operational, and specifically, the translation of the TVCC website and two dozen Tip Sheets into both Spanish and Simplified Chinese. These translations are one-time costs as we will own the translations once they are complete. Should we not receive the full amount of the budget in our grant requests, we will need to decide how to cut in the translations, either all of the Tip Sheets or all of one language for everything while keeping another for both website and Tip Sheets. Within the budget for this grant request and that for the other two cities, the wages and benefits equal 10% of the full budget. Hard costs in this request equal the percentage of our clients from the City of Dublin. In this case, it equals 21.5% of the full operational cost budget. The hard costs in the budget as the basis of this grant request and will not be carried out without the help of additional grantors. We appreciate all the help of the City of Dublin. Documents top Attachment 7 898 Application ID: 329492 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2021 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. * ZoomGrants™ is not responsible for the content of uploaded documents. Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expenses_CLPCCD-Jobs Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Info-CLPCCD_Jobs List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ CLPCCD Board of Trustees-Jan 2021 Current Annual Budget for the Entire Agency ✔✔✔✔ CLPCCD Most Recent Adopted Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ CLPCCD no 990 or Tax Return Filed Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ CLPCCD Designated Authority Policies Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ CLPCCD Designated Authority Policies Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ CLPCCD General Cert of Insurance STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. 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. ✔✔✔✔ CLPCCD IRS Letter Certified Audit and/or Certified Financial Statements ✔✔✔✔ CLPCCD Most Recent Audit 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 Grievance 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 - 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 ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) Attachment 7 899 Logout | Browser Attachment 7 900 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin PCS - Human Services Division 2021-2022 Human Services Grant Program Deadline: 1/11/2021 Senior Support Program of the Tri Valley Case Management Jump to: Organization Information Questions Budget Documents USD$ 16,505.00 Requested Submitted: 1/10/2021 9:28:05 PM (Pacific) Project Contact Robert Taylor rtaylor@ssptv.org Tel: 925-931-5394 Additional Contacts none entered Senior Support Program of the Tri Valley 5353 Sunol Blvd Pleasanton, CA 94566 United States Executive Director Robert Taylor rtaylor@ssptv.org Telephone(925) 931-5379 Fax (925) 931-3499 Web www.ssptv.org Organization Information top 1. Business License Number BL-007038 Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Senior Support Program of the Tri-Valley's mission is to provide seniors in-home services, free of charge, to foster independence, promote safety and well-being, preserve dignity, and improve quality of life. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes Attachment 7 901 5. Is this request for one-time, seed or operational funding? 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Senior Support Program of the Tri-Valley (SSPTV) has 17 essential programs, serving as a “one-stop resource center” for older Americans in Dublin plus surrounding areas. SSPTV obtained our 501c3 in 2006 and has operated as a nonprofit agency since. Currently, we have 22 employees (5 FT/17 PT), giving us collectively over 135 years of experience with Senior markets. Since 1981, we have successfully managed the responsibilities and regulations of private, foundation, city, state, and county grants. These years of training, education, and experience from trained and professional staff, compliance with contract requirements, accurate recordkeeping, timely reporting and billing, strong Board and Executive Director, collaboration with other local CBO’s and open lines of communication between service providers and funders are vital details qualifying SSPTV for this project. The head of our Fiscal Committee is a CPA and has experience managing large contracts in the nonprofit industry. SSPTV contracts with BayVap accounting professionals for accounting and payroll services. BayVap manages large accounts in addition to ours and has experience utilizing nonprofit bookkeeping practices. We have an annual audit prepared by Noe & Company(see attached documents) who complies with all audit standards and protocols 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 50 seniors (60 years plus) 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) Case Management services are typically provided directly in the senior’s home (when applicable given COVID19 protocols) after a phone intake determines the individual needs based on activities of daily living (ADLs) and indirect activities of daily living (IADLs) levels. An initial, in-home or virtual comprehensive assessment is made of the senior's living situation(when applicable given COVID19 protocols); the senior’s physical, mental, environmental, spiritual, and emotional status as well as the need for assistance with ADLs are identified. After the initial session, call or virtual meeting, a care plan is formulated with the senior and family, if involved. Some of the services the Case Manager arranges, coordinates and supervises are: meals, transportation, home care, safety devices, social activities, medical/dental care, applying to government benefits when ✔✔✔✔ No ✔✔✔✔ One-time funding gfedc Seed funding gfedc One-time and Seed funding gfedc Operational funding gfedc None ✔✔✔✔ Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition ✔✔✔✔ Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the Above gfedc Please explain: Attachment 7 902 appropriate, bill paying, and living arrangements. One of the most critical parts of the program is the ongoing monitoring, reassessment and periodic follow up of each client. Follow-ups are done by phone calls (volunteers and interns assist in reducing the cost) and repeat video or home visits. The monitor checks to ensure implemented services are stable and sufficient. When basic physical, social and emotional needs are met, even in small increments, lives are changed and enhanced resulting in the senior’s ability to engage and interact with their communities. Volunteers also help Case Managers with entering reports, copying information, printing documents, and various admin special projects keeping the costs as minimal as possible. Case Managers also utilize volunteers to assist with IT and data entry related tasks keeping the expenses down. While we receive funding for Case Management from the cities of Pleasanton, Livermore, and Dublin, we keep city dollars separate from County (AAA-funded) dollars. County files are indicated with a different color sticker, and our Lead Case Manager designates County-funded clients after an initial phone screening; this helps us easily separate County and city funds. SSPTV is constantly expanding our network of local and regional partners, which includes senior housing facilities, senior centers, John Muir Health, Kaiser, Stanford Valley Care, and Tri-Valley emergency responders. When Livermore-Pleasanton Police and Fire Departments respond to a 911 call and find a senior in crisis, they can directly refer the senior to SSPTV for comprehensive services. The past year, we worked closer than ever with Alameda County’s Adult Protective Services (APS) to ensure referred seniors referred have a Case Manager to visit their home, assess, and assist. We have one-on-one relationships with Spectrum Community Services, Legal Aid for Seniors, HICAP (health insurance counseling), City Serve (faith-based community), Public Health, CRIL (Community Resources for Independent Living), Open Heart Kitchen, Tri-Valley Haven, Wiesner Foundation, Social Security, Alameda County’s Senior Service Coalition, Behavioral Health, Tri-Valley Rotary groups, AXIS Community Health, In-Home Supportive Services, local transportation agencies, and food pantries. SSPTV has established referral procedures between agencies, eliminating delays and confusion. A simple phone call from these agencies is all that is needed for support to begin helping a senior remain independent. The timeline for clients varies greatly depending on the primary service needs but generally speaking, we provide case management services on a monthly basis (i.e. virtual/home visit plus phone follows) then re-evaluate each client within 12 months of service. During the re-evaluation period, we determine the next steps which could include continued service for an additional year, abbreviated service (quarterly), referrals to high-level service (i.e. Adult Protective Service) and/or discharge because clients have successfully completed case management program and are considered self-sufficient. 10. 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)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low-come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. To ensure we continue to provide high quality programs, SSPTV employs a variety of evaluation measures. Outcomes in Case Management are defined by improvements in the quality of life of the seniors who have received our services. This improvement may be evident in a cleaner living environment, receiving a daily home delivered meal, taking advantage of referrals services provided, feedback from family or friends or the fact that the senior is able to successfully remain in their own home. Success may be evident when the fire department no longer is making repeat calls to lift a senior off the floor or no longer calling EMS for emergency services. Success may be found in that a trusting relationship has been forged with the Case Manager, and the senior is starting to accept the help that will improve their life. Improvement in ADLs and IADLs are recorded in the client file. Case Management is all about small successes. Our primary function is to give seniors the tools and support that will enable them to make the choices necessary to maintain their independence, improve their quality of life, and ensure their safety and well-being with dignity intact. Files are maintained for each client that include referrals, services implemented, outcomes, and reassessments. Care plans are updated and outcomes are recorded after each home visit. Staff and/or trained and supervised volunteers make phone calls to monitor the implementation of services and clients' well-being. Biweekly team meetings are held to discuss issues and problem solve. Data and statistics are kept, including the number of seniors served, units of services received, and seniors placed, relocated or discharged. The Case Manager maintains statistics and reports as required by the contract via quarterly Zoomgrant updates. SSPTV clients evaluate our programs annually by means of a questionnaire mailing. Family members or caregivers are included when appropriate. Since conception, SSPTV has been designed by the needs of the clients who have participated in programs, along with their caregivers and community members. SSPTV staff is continuously engaging in training sessions and asked to be a part of focus groups and needs assessments. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis-Bacon requirements. ✔✔✔✔ Not Applicable Attachment 7 903 12. ** QUESTIONS 13 THROUGH 23 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 13. 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? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 14. CDBG ONLY - Identify at least one HUD Guiding Principle that relates to your project: 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: (Select Category and Applicable Goals) 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: gfedc Yes gfedc No gfedc Yes. If so, check box here and answer questions 13 through 23. ✔✔✔✔ No. If no, check box here and enter NA gfedc Don't know. If you are unsure, please call City staff at (925) 833-6645. gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc A) Housing gfedc Goal 1: Promote the production, rehabilitation, and preservation of affordable housing (rental and ownership) through acquisition, rehabilitation, new construction, and minor repair. gfedc Goal 2: Reduction of housing discrimination through provision of fair housing and tenant/landlord services. gfedc Goal 3: Use resources to assist low-income residents make rental assistance payments in response to Covid-19. gfedc B) Homeless gfedc Goal 1: Use resource to end homelessness by funding and supporting homeless service programs. gfedc C) Supportive Housing gfedc Goal 1: Increase the availability of services enriched housing for persons with special needs by supporting acquisition and new construction of housing units. gfedc D) Community Development gfedc Goal 1: Make improvements, including ADA accessibility and rehabilitation to public facilities, such as curbs and sidewalks, neighborhood parks and recreational improvements, homeless facilities and other public facilities/community centers. gfedc Goal 2: Fund economic development, micro-enterprise, and on-the-job training. gfedc Goal 3: Support public service programs for low income residents, preserving safety net services for families and individuals who are vulnerable or ✔✔✔✔ F) Not Applicable. Not interested in CDBG funding. gfedc Public Services gfedc Public Facilities gfedc Rental Assistance gfedc Affordable Housing gfedc Increase Opportunities for 1st Time Homebuyers gfedc Promote Decent Affordable Rental Housing gfedc Strengthen Communities gfedc Ensure Equal Opportunity in Housing gfedc Reduce Housing Discrimination gfedc Promote Participation of Grass-Roots, Faith-Based, and other Community-Based Organizations Attachment 7 904 17. CDBG ONLY - Select one HUD 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?") 18. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?") 19. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) Attachment 7 905 20. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 21. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 22. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMI") information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 23. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" gfedc 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. gfedc 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. ✔✔✔✔ Not Applicable. Not interested in CDBG funding gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. Not interested in CDBG funding Disabled Women/Female Headed Households Seniors Youth Homeless N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL Low Income (50%-80% AMI) Extremely Low Income (<30% AMI) N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL White White + HISPANIC Black/African American Black/African American + HISPANIC Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White Attachment 7 906 24. 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 Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. Not interested in CDBG funding. (Type N/A) 0.000.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed City of Pleasanton USD$ 22,000.00 USD$ 22,000.00 City of Livermore USD$ 18,500.00 Total USD$ 40,500.00 USD$ 22,000.00 Funding Uses/Expenses Budget Amount Amount Committed Salaries & Wages USD$ 14,195.00 Benefits USD$ 1,910.00 Travel-Mileage USD$ 400.00 Total USD$ 16,505.00 USD$ 0.00 Budget Narrative Program funds will be used for Case Management Direct Services. Robert Taylor is the Executive Director, who has been with the agency 4 years; attends all City of Dublin meetings and prepares all materials, represents Senior Support in all Dublin activities/services plus works as a manager. Jennifer Nelson and Kathryn Gilbreth are Case Managers with a vast experience in the fields of geriatrics plus one PT Case Manager (Laura Lepe) with case management experience in the Tri-Valley. Our bookkeeper manages invoices and financial requirements with our outsdie accountant. Please note: The $14,195 amount requested covers direct salary costs. An additional $1,910 is proposed to cover benefits and fringe costs. Travel costs are only $400 due to C-19. This brings the total amount requested to: $16,505. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Dublin Case Mgmt Program Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Agency wide budget List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ Board Roster Current Annual Budget for the Entire Agency ✔✔✔✔ FY'20-21 agency budget Copy of most recently submitted IRS 990 form or Tax ✔✔✔✔ 990 Attachment 7 907 Application ID: 329662 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2021 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. Return (include complete form) Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Board Authorization Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Board Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ COI current COI WC STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. 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. ✔✔✔✔ Non profit memo-certification Certified Audit and/or Certified Financial Statements ✔✔✔✔ Certified Audit 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 Grievance 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 - 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 ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) Attachment 7 908 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin PCS - Human Services Division 2021-2022 Human Services Grant Program Deadline: 1/11/2021 Centro Legal de la Raza Fair and Secure Housing Project Jump to: Organization Information Questions Budget Documents USD$ 22,984.00 Requested Submitted: 1/11/2021 7:18:33 PM (Pacific) Project Contact Brenda Orellana borellana@centrolegal.org Tel: 510-227-4451 Additional Contacts none entered Centro Legal de la Raza 3400 E 12th St Oakland, CA 94601 United States Executive Director Theresa Gonzales tgonzales@centrolegal.org Telephone510-437-1554 Fax Web https://www.centrolegal.org/ Organization Information top 1. Business License Number BL-113233 Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Protecting and advancing the rights of low-income, immigrant, Black, and Latinx communities through bilingual legal representation, education, and advocacy. By combining quality legal services with know-your-rights education and youth development. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project Attachment 7 909 5. Is this request for one-time, seed or operational funding? 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Alameda County’s housing crisis, and its impact on low-income tenants is currently being exacerbated and amplified by the COVID-19 pandemic. Between 2000 - 2015, the share of renters that were burdened by the cost of housing in Dublin went from 37% to 44% (https://bayareaequityatlas.org/indicators/housing-burden#/?geo=07000000000620018). Low-income tenants already vulnerable to eviction and homelessness are now facing job loss, loss of childcare, and extreme risks to their health. Even after the health impacts of COVID-19 diminish, the economic impacts will continue and low-income tenants will be vulnerable to eviction when they can’t pay rent because they’ve lost jobs and income because of the pandemic. Legal service providers are preparing to defend an unprecedented wave of evictions when temporary emergency eviction protections are lifted. In 2018 Centro Legal was awarded funding from the County to be the administrator for Alameda County Housing Secure (ACHS), a county-wide anti-displacement partnership to serve as an intervention in the displacement crisis. ACHS served to scale up legal housing services by increasing referrals amongst participating legal service providers, by providing effective emergency financial assistance, and by creating a more coordinated infrastructure designed to address the specific needs emerging from the housing crisis in our area. This project expands existing tenant legal services to low-income Dublin tenants by building on ACHS. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 60 (10 rep.’s/households (20 unduplicated residents assuming 2 per household) 20 consultations (40 unduplicated residents assuming 2 per household)) 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) gfedc Yes ✔✔✔✔ No ✔✔✔✔ One-time funding gfedc Seed funding gfedc One-time and Seed funding gfedc Operational funding gfedc None gfedc Behavioral Health (mental health and substance abuse) ✔✔✔✔ Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development ✔✔✔✔ Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the Above gfedc Please explain: Attachment 7 910 This project is designed to strategically target low-income tenants most at risk of displacement. About 5,000 unlawful detainer (eviction) actions are filed in Alameda County yearly. More than 88% of these landlords are represented by counsel, while only 11% of renters are represented by counsel (Information obtained by EBCLC through observing 46 weeks of court calendars and roll call in court in conjunction with Volunteer Legal Services Corporation data.) Research shows that low- income residents who have the right to stay in their homes need legal representation in order to make that right a reality. As Professor Desmond noted in his book, Evicted: Poverty and Profit in the American City (2016), “A program that ran from 2005- 2008 in the South Bronx provided more than 1,300 families with legal assistance and prevented eviction in 86% of cases.” In addition, preservation of an affordable tenancy for a low-income resident saves public spending on the production of more affordable housing and homelessness services (Flaming, Daniel John and Toros, Halil and Burns, Patrick. 2015). This project expands access to low-income tenants at risk of displacement in Dublin by providing legal services spanning the entire continuum of homelessness prevention and anti-displacement interventions. (A)Upstream Prevention: Pre-eviction Consultations Broad, inclusive service provision via remote and/or in-person drop-in clinics and workshops. We provide one-to-one legal consultation services that can include drafting letters, providing legal advice, reviewing notices and contracts, helping tenants respond to notices, and providing other short-term, limited assistance to address risks such as eviction notices, rent increases, uninhabitable conditions, and landlord harassment. Legal consultations and clinics provide broad access to legal advice. Tenants can get legal advice on a wide range of housing issues, and legal services providers can spot emerging issues and trends that are contributing to displacement. Early intervention in landlord-tenant conflicts can prevent eviction lawsuits from being filed and provide tenants with important information about how to exercise their rights and the resources available. Consultations are an efficient way of preventing displacement since they can be made available to large numbers of people and can prevent resource-intensive litigation. Legal consultation services are short-term, limited legal services that may include: (1) advice and counsel; (2) assistance completing forms or preparing correspondence; (3) supporting individuals in representing themselves; (4) assistance with reviewing contracts, letters, or written documents; (5) addressing issues related to various COVID-19 related eviction protections, and/or (6) other short-term, limited assistance aimed at preventing displacement. Many of the legal consultations provided will take place through regularly scheduled remote or in-person drop-in clinics or workshops for tenants. These clinics will be held in key locations to ensure that underserved populations are able to utilize services. Centro Legal has developed strategies to serve large numbers of people during shelter-in-place orders due to the coronavirus pandemic and will continue to provide services remotely. (B) Downstream Intervention: Legal Representation Legal representation services are more expansive than legal consultation and will be provided where it is determined that more extensive services are necessary or appropriate to prevent displacement. Such services may include: (1) Representing a tenant in mediation or negotiations aimed at avoiding the filing of an unlawful detainer action and/or a rent increase that would result in displacement or (2) Defending an unlawful detainer (eviction) action. We ensure this project is cost effective and that the budget meets the needs of the anticipated results by leveraging existing infrastructure funded through ACHS, State Bar funding, and foundation grants. ACHS is a program that Centro has administered since 2018, administrative infrastructure and staffing of the program has been well established. Staff such as our outreach coordinator, data and policy analyst, paralegals, housing advocates and staff attorneys are already doing this work. Additionally, ACHS provides emergency financial assistance funds that Dublin residents are eligible for. There will be increased access for Dublin tenants to an entire team of attorneys and staff dedicated to this work. This project allows for the ACHS program to be scaled up and leverages the program structure already created. Deliverables are based on average attorney caseloads and are in proportion to the amount of funding received which creates realistic deliverable goals. 10. 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)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low-come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. Outcome Measures Our primary goal and objective is to enhance the quality of life for low-income tenants of Dublin via housing related services to prevent homelessness and to promote self sufficiency, creating housing stabilization. Measurable outcome for Goal 1: At least 80% of Tenants will report that they are more aware of available resources and legal options and that legal consultation better prepared them to successfully resolve their housing issues. Measurable outcome for Goal 2: After legal representation, at least 60% of Tenants will successfully resolve their legal Attachment 7 911 matters and report improved housing stability, avoided an eviction, avoided homelessness, having a rent increase rescinded, receiving a rent reduction securing time and/or money to move. To assist with those outcomes we have set the following performance goals: Performance Goal 1: 20 Tenants receive legal consultation for housing related problems such as resources and information about their legal options and rights. Performance Goal 2: 10 Tenants receive legal representation for housing related issues Centro Legal uses a Salesforce database, which allows us to track a significant amount of client data and assess quantitative goals on a monthly basis. Centro Legal also uses anonymous client surveys to measure our impact. Centro Legal uses case outcome data and program evaluations to determine if a program is effectively meeting clients’ needs. We also use information on the number of clients we serve and the types of issues our clients are facing to determine the level and types of services needed. Based on this information, we make changes to program design and our budget to expand services and staffing as needed. Centro Legal has current CDBG contracts with the City of Hayward, San Leandro and Oakland,. We are familiar with the CDBG guidelines and ensure that clients are low-income according to the guidelines. Prior to receiving a consultation, tenants are required to either provide proof of income or certify their income in writing. If awarded this contract, we will continue to require income and residency verification and also continue to monitor our client information through monthly reports from our client database to ensure that the funding is benefiting low-income Dublin residents. In addition to income information Centro Legal is also collecting a lot of other demographic data such as race and ethnicity to ensure we are serving a diverse group. Marketing and Outreach Centro Legal provides Know-Your-Rights (KYR) community-based training to low-income, underserved populations. By training community members and community leaders, we seek to embed tenants’ rights expertise within the community itself, thereby better informing underserved communities of their rights and empowering them to seek legal services when faced with unlawful housing practices. Our existing Centro Legal outreach coordinator will conduct outreach to community organizations, schools, and places of worship and coordinate KYR training for their staff and leadership. We coordinate and conduct Know-Your-Rights workshops at community-based sites such as schools, community centers, libraries, and places of worship or remotely, with simultaneous Spanish translation if appropriate. The team works to train community leaders to generate widespread grassroots knowledge of tenants’ rights. We also hold regular mass eviction workshops on Zoom that combine Know-Your-Rights presentations and 1-on-1. We invite members of the community, tenants and other organizations to present services and resources, and we provide simultaneous translation for Spanish-speaking attendees. We have recently started doing Facebook Live Q & A sessions (in Spanish and English) where attorneys give an overview of a few key topics and answer questions from viewers to reach tenants who might have difficulties utilizing Zoom. Centro Legal also does outreach to tenants through our website, social media, radio, community partners and word of mouth. For example, Centro Legal has run radio and digital ads in Spanish and Tagalog in order to reach Latino and Filipino Bay Area communities. Materials are translated into various languages and staff speak Spanish, Arabic, Mandarin, Hindi. In addition, we have a dedicated Mam interpreter on staff. We use a phone interpretation service for additional languages. Phone interpretation is a three-way phone conversation with a human interpreter. The interpreter facilitates meaning-for-meaning communication between a limited-English proficient person and our English-speaking staff. Video interpretation adds a visual component to the communication process, enabling face-to-face interaction with interpreters. Lastly, Centro Legal’s website has been fully translated into Spanish. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis-Bacon requirements. 12. ** QUESTIONS 13 THROUGH 23 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Yes. If so, check box here and answer questions 13 through 23. gfedc No. If no, check box here and enter NA gfedc Don't know. If you are unsure, please call City staff at (925) 833-6645. Attachment 7 912 13. 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? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. We incubate community empowerment by advocating for positive change in local and state governments, creating meaningful dialogue on issues through our communications and media strategies, and by engaging in true, collaborative based, community lawyering. Finally, we ensure equity through high quality bilingual legal services and courtroom advocacy. Centro Legal de la Raza (Centro Legal) is committed to providing high quality legal assistance regardless of a client’s language or disability. Centro Legal utilizes the following strategies to provide services to individuals who are non-English speaking or have limited English proficiency by making our services accessible through 3-way phone interpretation with a human interpreter. The interpreter facilitates meaning-for-meaning communication between a limited-English proficient person and our English-speaking staff. Video interpretation adds a visual component to the communication process, enabling face-to- face interaction with interpreters. Centro Legal has substantial experience working with non- and limited English speakers. 95% of our Tenants’ Rights Practice staff are multilingual. Attorneys and paralegals speak the following languages: Spanish, Hindi, Mandarin, and Arabic. Centro Legal also has a dedicated Mam interpreter. Centro Legal’s website has been fully translated into Spanish. Outreach and educational materials are translated into multiple languages. Workshops and clinics both in-person and virtual are conducted in Spanish and English using simultaneous interpretation. The COVID-19 pandemic has forced us to explore additional ways to reach clients such as through Facebook Live and Zoom and by phone to allow Centro Legal to easily reach clients regardless of location. 14. CDBG ONLY - Identify at least one HUD Guiding Principle that relates to your project: 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: (Select Category and Applicable Goals) 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: ✔✔✔✔ Be culturally accessible, appropriate and inclusive ✔✔✔✔ Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery gfedc Not Applicable. Not interested in CDBG funding. ✔✔✔✔ A) Housing gfedc Goal 1: Promote the production, rehabilitation, and preservation of affordable housing (rental and ownership) through acquisition, rehabilitation, new construction, and minor repair. ✔✔✔✔ Goal 2: Reduction of housing discrimination through provision of fair housing and tenant/landlord services. gfedc Goal 3: Use resources to assist low-income residents make rental assistance payments in response to Covid-19. ✔✔✔✔ B) Homeless ✔✔✔✔ Goal 1: Use resource to end homelessness by funding and supporting homeless service programs. gfedc C) Supportive Housing gfedc Goal 1: Increase the availability of services enriched housing for persons with special needs by supporting acquisition and new construction of housing units. ✔✔✔✔ D) Community Development gfedc Goal 1: Make improvements, including ADA accessibility and rehabilitation to public facilities, such as curbs and sidewalks, neighborhood parks and recreational improvements, homeless facilities and other public facilities/community centers. gfedc Goal 2: Fund economic development, micro-enterprise, and on-the-job training. ✔✔✔✔ Goal 3: Support public service programs for low income residents, preserving safety net services for families and individuals who are vulnerable or gfedc F) Not Applicable. Not interested in CDBG funding. gfedc Public Services gfedc Public Facilities gfedc Rental Assistance Attachment 7 913 17. CDBG ONLY - Select one HUD 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?") 18. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?") 19. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc Affordable Housing gfedc Increase Opportunities for 1st Time Homebuyers gfedc Promote Decent Affordable Rental Housing ✔✔✔✔ Strengthen Communities ✔✔✔✔ Ensure Equal Opportunity in Housing ✔✔✔✔ Reduce Housing Discrimination gfedc Promote Participation of Grass-Roots, Faith-Based, and other Community-Based Organizations gfedc Not Applicable. Not interested in CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. Not interested in CDBG funding. gfedc Availability/Accessibility gfedc Affordability ✔✔✔✔ Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency Attachment 7 914 20. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 21. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 22. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMI") information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 23. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" 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. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Not Applicable. Not interested in CDBG funding gfedc Persons ✔✔✔✔ Households gfedc Not Applicable. Not interested in CDBG funding 5 Disabled 6 Women/Female Headed Households 2 Seniors 0 Youth 2 Homeless Not Applicable. Not interested in CDBG funding (Type N/A) 15.0015.00 TOTAL 5 Low Income (50%-80% AMI) 18 Extremely Low Income (<30% AMI) Not Applicable. Not interested in CDBG funding (Type N/A) 23.0023.00 TOTAL 4 White White + HISPANIC 4 Black/African American Black/African American + HISPANIC 3 Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Attachment 7 915 24. 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 Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC 19 Multi Racial + HISPANIC OR other Multi Racial Not Applicable. Not interested in CDBG funding. (Type N/A) 30.0030.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed Contributions & Donations USD$ 2,000.00 USD$ 2,000.00 Litigation USD$ 100,000.00 USD$ 100,000.00 Alameda County Housing Secure USD$ 125,593.00 USD$ 125,593.00 Chan Zuckerburg Initative USD$ 132,000.00 USD$ 132,000.00 Sunlight Giving USD$ 15,000.00 USD$ 15,000.00 State Bar IOLTA USD$ 76,480.00 USD$ 76,480.00 State Bar EAF- HP USD$ 174,590.00 USD$ 174,590.00 Livermore USD$ 60,164.00 Pleasanton USD$ 59,245.00 Total USD$ 745,072.00 USD$ 625,663.00 Funding Uses/Expenses Budget Amount Amount Committed Salaries USD$ 17,127.00 USD$ 0.00 Benefits USD$ 3,768.00 USD$ 0.00 Rent and Utilities USD$ 2,089.00 USD$ 0.00 Total USD$ 22,984.00 USD$ 0.00 Budget Narrative Centro Legal's Tri-Valley project will expand on the existing Alameda County Housing Secure (ACHS) program that Centro Legal has administered since 2018. Funds provided under this grant can be leveraged with ACHS funds to exponentially increase reach. ACHS has a significant marketing budget that can be used to create broad awareness of legal services provided to low-income tenants throughout the Tri-Valley. Dedicating resources to the Tri-Valley project ensures that low-income tenants in Dublin, Pleasanton, and Livermore can access Centro Legal’s full team of eleven tenants’ rights attorneys, four paralegals, and outreach coordinator for legal assistance. Attachment 7 916 The Tri-Valley project will help Centro Legal reach low-income Tri-Valley residents, building on existing infrastructure from the ACHS program. This proposal requests funding for staff attorney time to provide legal consultations and representations. Know Your Rights (KYR) presentations etc. Additional funding sources listed, apart from funds requested from the City of Livermore and the City of Pleasanton, are funds that are committed from other grants that allow Centro Legal to provide legal services to tenants throughout Alameda County or are not restricted funds and can be used to leverage City of Dublin funds. For the budget above we have included 0.25 FTE of attorney time. We hope to obtain funding from the City of Pleasanton and the City of Livermore that will allow us to hire one full-time attorney dedicated to providing tenant legal services to the Tri-Valley. In the event that additional funding is not obtained from the City of Pleasanton and the City of Livermore, services will be provided to low-income Dublin tenants in proportion to funding. We utilize 22% as our standard calculation for fringe which includes benefits. 10% indirect costs are intended to cover insurance, rent, utilities, postage, bar dues, office supplies, and other non-salary program expenses. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Centro Legal Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Centro Legal Financial Information Form List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ Centro Legal List of Board of Directors 2020 Current Annual Budget for the Entire Agency ✔✔✔✔ Cento Legal_FY20-21_Organizational Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ Centro_Form 990 2018-19 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Centro Legal Board Authorization Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Centro Legal Board Authorization Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Centro Legal COI-Info Only STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. 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. ✔✔✔✔ Centro Legal Non-Profit Determination Letter Certified Audit and/or Certified Financial Statements ✔✔✔✔ Centro Legal 2020 Audited Financial Statements 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 Grievance Procedure Centro Legal Personnel Policy & Affirmative Action, Grievance Policy REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section Centro Legal Agency Audit Req and Audit 2020 REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws Centro Legal Articles of Incorporation & Bylaws Original & Amended Restated.pdf REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) Centro Legal Conflict of Interest Policy REQUIRED FOR CDBG ONLY - AGENCY'S LIMITED ENGLISH PROFICIENCY LANGUAGE ACCESS PLAN (LEP/LAP). Must include outreach Centro Legal Limited English Proficiency Access Plan Attachment 7 917 Application ID: 329714 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2021 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. to limited English speaking residents to encourage access to services & housing. Include what access accommodations are used. REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) Attachment 7 918 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin PCS - Human Services Division 2021-2022 Human Services Grant Program Deadline: 1/11/2021 Hope Hospice, Inc Grief Support Services and Volunteer Program Jump to: Organization Information Questions Budget Documents USD$ 20,000.00 Requested Submitted: 1/11/2021 1:33:59 PM (Pacific) Project Contact Jennifer Pettley jenniferp@hopehospice.com Tel: (925) 829-8770 Additional Contacts none entered Hope Hospice, Inc 6377 Clark Avenue Suite 100 Dublin, CA 94568 Chief Executive Officer Jennifer Hansen jenniferh@hopehospice.com Telephone(925) 829-8770 Fax (925) 829-0868 Web www.hopehospice.com Organization Information top 1. Business License Number BL-005299 Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Hope Hospice provides compassionate in-home health care services for people at the end of life and support for their families., and guidance and assistance to families who are caring for them. Hope is the leading non-profit hospice provider in Tri-Valley. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes Attachment 7 919 5. Is this request for one-time, seed or operational funding? 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Grief Support and Volunteer Services are key components of Hope Hospice's patient care program which in FY 19/20 cared for 558 patients at the end of life and their families. Following the loss of their loved one, hospice family members receive through the Grief Support Center one-on-one or group bereavement support as well as follow up contacts for up to 13 months to ascertain how they are coping. Members of the community are also welcomed into the program. Presented in an online format during the pandemic, participants learn coping skills, how to connect with other community resources, and how to move successfully forward in their lives. The City of Dublin funding will allow Hope to offer these programs throughout the year for adults, youth and children in the community at no charge. Through the Volunteer Dept., trained volunteers provide cost-effective, high-quality support and companionship to Hope's patients, and vital respite for their caregivers. Unique to the hospice model of care, each patient care volunteer undergoes extensive training, including how to support patients with dementia-related conditions which create special challenges for families. These cases now comprise nearly 50 percent of Hope's admissions. Other volunteers serve on the board of directors and committees, and help with administrative tasks and outreach projects. This funding will allow Hope to recruit and train patient care volunteers and manage more than 150 volunteers. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 336 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing ✔✔✔✔ Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition ✔✔✔✔ Senior Services ✔✔✔✔ Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the Above ✔✔✔✔ Please explain: mental health as it relates to coping and well-being with the grief experience. Attachment 7 920 The Dublin grant funds will be utilized to help cover the salary and benefits of the professional staff members who oversee and manage Hope's Volunteer Services and the Grief Support Services departments. While direct patient care at Hope is reimbursed by Medicare or other insurances, Hope’s Grief Support and Volunteer Services Programs are funded in part with grants and community donations. These resources make it possible for Hope to provide services at no charge to community members who need them. Both programs complement Hope’s direct medical care for patients, offering connection and support at a time when families need it most. Volunteers are utilized whenever possible, greatly enhancing the cost effectiveness of the programs. During the pandemic, in-home visits are temporarily suspended but volunteers continue to make important connections with families in new and innovative ways, reaching out and engaging by telephone and written correspondence. According to the Independent Sector, in 2020 the value of a volunteer hour in California was $31.51. During FY 19/20, Hope’s volunteers logged 4,472 hours, saving a total staffing cost of $140,912 to the agency. But volunteers bring so much more to Hope's patient care program as well as other areas of the agency. They enhance Hope's ability to sustain the connection and emotional support that our patients and families need, and especially during a pandemic when in-home visits have been put on hold. Their continued support helps reduce patients' and families' feelings of anxiety and isolation. Other volunteers assist with administrative, outreach, and event activities (pre-pandemic). Grief Support Program and families Funding from the City of Dublin will allow Hope to offer a variety of Grief Support Groups and recruit and train at least 50 patient care volunteers throughout the grant period. City of Dublin funds will be used to administer and operate Hope’s Grief Support and Volunteer Services Programs, including staffing costs. Grief Support includes groups and individual sessions, which are currently offered by videoconferencing platforms; telephone follow-up, and mailed correspondence. In addition to general grief support, specific groups are offered for children and teens, and those who have lost a partner or child. Children are currently engaged individually through videoconference as group sessions in this format are not appropriate for this age group. Overall, in FY19/20, Hope served 1,162 individuals in its Grief Support program, 15% of which were Dublin residents. Grief Support helps family members who have lost a loved one process their grief, learn healthy coping skills, and connect with a caring community. Hope staff and volunteers monitor and follow the progress of grieving individuals for up to 13 months. Hope’s grief support team helps adults and youth learn healthy ways to process feelings and rebuild their lives in the aftermath of their heartbreaking loss. Our grief support groups and workshops offer an environment of hope, acceptance, and cooperative learning. We believe: • Grief is a natural reaction to death. • Everyone processes death and loss differently. • Sharing one’s story of pain and loss helps lessen suffering. • Being in community with others helps process grief. Volunteer Services Program Through Hope’s Volunteer Services Program, trained volunteers during the pandemic era are providing support and companionship to patients and families through telephone calls and correspondence. Their assistance is invaluable to the hospice patient care experience and in assisting the organization with administrative and community outreach tasks. The Manager of Volunteers and staff conduct recruitment, training, scheduling and monitoring of Hope's 125 volunteers. Volunteers are initially interviewed to determine their area of interest and level of time commitment and then complete a registration and orientation process. Patient care volunteers undergo nearly 20 hours of online training and preparation on how to support someone who is critically ill or a family member who is caring for a patient with a dementia-related condition. 10. 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)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low-come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. Strategies and Objectives Objectives include the following: Grief Support Objective: Hope Hospice will provide 300 hours of Grief Support sessions during the grant period, as well as other support activities. Grief Support staff collect client satisfaction surveys following its programs, as well as evaluations from hospice families 13 months after their loss. The surveys and evaluations measure perceptions and assess how participants are coping in their grief experience. Service contacts and number of sessions are tracked in Hope’s extensive database management system. The results help drive the development of new services and help to refine current services to ensure they continue to meet community needs. In addition, Grief Support staff make frequent follow up contacts with grief clients to ensure they are moving Attachment 7 921 forward successfully in their grief journey or if they may need referrals to additional community services. Volunteer Services Objective: Hope Hospice will recruit and train at least 50 new volunteers during the grant period who will provide more than 4,000 hours of volunteer services throughout the year. Volunteer hours and progress are carefully monitored and logged. Families complete satisfaction surveys which help us understand and respond to the ongoing and emerging needs of those in our care, including services provided by volunteers. In addition, our case managers, registered nurses, and medical social workers are in constant contact with our patients and families. The team regularly conducts needs assessments and measures levels of satisfaction. Population to be Served Hope Hospice served 558 patients last year, and 1,162 family members and members of the general public through Grief Support Services. Eighty-nine percent of our hospice patients are aged 70 or more, a demographic group that is growing as our population ages. Dementia-related conditions have surpassed cancer as the most common condition on admission. Hope Hospice serves primarily frail seniors with advanced illnesses who have received diagnoses limiting life to six months or less. Often their main caregiver is a spouse of equivalent age, also of frail condition. The hospice approach is to also support the needs of family caregivers as they cope with the care of their loved one at home. Case managers arrange in-home visits by social workers, chaplains, or volunteers (pre-pandemic). Accessibility to Low-Income, ESL and Disabled Persons Hope's community-centered services are provided free of charge, enabling low-income residents to access them. Hope Hospice is committed to serving families of diverse backgrounds. Patients are admitted for Hope Hospice patient care services following a doctor's referral and after receiving a diagnosis that will limit their life to six months or less. Our patient care and clinical support services are fully accessible since they are provided in the patient's home. Hope employs a diverse clinical team with multiple language and cultural capacity, including bilingual staff. We utilize a language translation service, including ASL, which is available 24/7/365. For now, all services are offered on line or by telephone. However, when it is safe to resume in-person services at the Grief Support Center, participants can easily access the second-floor facility by elevator and the Center can fully accommodate the needs of disabled persons. We are walking distance to BART, one block from the Dublin City Center and accessible by all major bus lines. Cultural Appropriateness All staff and patient care volunteers are trained in cultural sensitivity with special focus on the emotional, social and spiritual issues of the dying and bereaved, family dynamics and communication. In particular, they learn about beliefs held by many cultural and religious groups surrounding death and dying in the home setting and elsewhere. The experiences of caring for a dying loved one and grieving are unique to each individual. Our professionally trained hospice and grief support providers skillfully apply their experience and training in dealing with highly individualized cultural experiences. Marketing and Outreach Our Outreach staff continues its daily connections with senior centers, assisted living facilities, physicians' offices and medical groups, hospitals and health centers, elder care facilities, elder care nonprofits, and chambers of commerce, making some 110 presentations this fall alone. In addition, Hope periodically presents webinars on various end-of-life care planning and caregiving education, and regularly posts educational material and information on our website and blog and on Facebook and Twitter. Our Family Caregiver Education workshops had 207 attendees and our 10 webinars this fall had 310 attendees. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis-Bacon requirements. 12. ** QUESTIONS 13 THROUGH 23 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 13. 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? What access ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Yes. If so, check box here and answer questions 13 through 23. ✔✔✔✔ No. If no, check box here and enter NA gfedc Don't know. If you are unsure, please call City staff at (925) 833-6645. Attachment 7 922 accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 14. CDBG ONLY - Identify at least one HUD Guiding Principle that relates to your project: 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: (Select Category and Applicable Goals) 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 17. CDBG ONLY - Select one HUD 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?") 18. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?") gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc A) Housing gfedc Goal 1: Promote the production, rehabilitation, and preservation of affordable housing (rental and ownership) through acquisition, rehabilitation, new construction, and minor repair. gfedc Goal 2: Reduction of housing discrimination through provision of fair housing and tenant/landlord services. gfedc Goal 3: Use resources to assist low-income residents make rental assistance payments in response to Covid-19. gfedc B) Homeless gfedc Goal 1: Use resource to end homelessness by funding and supporting homeless service programs. gfedc C) Supportive Housing gfedc Goal 1: Increase the availability of services enriched housing for persons with special needs by supporting acquisition and new construction of housing units. gfedc D) Community Development gfedc Goal 1: Make improvements, including ADA accessibility and rehabilitation to public facilities, such as curbs and sidewalks, neighborhood parks and recreational improvements, homeless facilities and other public facilities/community centers. gfedc Goal 2: Fund economic development, micro-enterprise, and on-the-job training. gfedc Goal 3: Support public service programs for low income residents, preserving safety net services for families and individuals who are vulnerable or ✔✔✔✔ F) Not Applicable. Not interested in CDBG funding. gfedc Public Services gfedc Public Facilities gfedc Rental Assistance gfedc Affordable Housing gfedc Increase Opportunities for 1st Time Homebuyers gfedc Promote Decent Affordable Rental Housing gfedc Strengthen Communities gfedc Ensure Equal Opportunity in Housing gfedc Reduce Housing Discrimination gfedc Promote Participation of Grass-Roots, Faith-Based, and other Community-Based Organizations ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. Not interested in CDBG funding. Attachment 7 923 19. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: 20. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. ✔✔✔✔ Not Applicable. Not interested in CDBG funding gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. Not interested in CDBG funding Attachment 7 924 21. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 22. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMI") information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 23. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" 24. 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 Disabled Women/Female Headed Households Seniors Youth Homeless N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL Low Income (50%-80% AMI) Extremely Low Income (<30% AMI) N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL White White + HISPANIC Black/African American Black/African American + HISPANIC Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. Not interested in CDBG funding. (Type N/A) 0.000.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. Attachment 7 925 gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed Individual and Community Contributions USD$ 80,000.00 USD$ 80,000.00 Grants USD$ 60,000.00 USD$ 0.00 Total USD$ 140,000.00 USD$ 80,000.00 Funding Uses/Expenses Budget Amount Amount Committed Staffing Costs - Grief Support USD$ 89,689.00 USD$ 89,689.00 Staffing Costs - Volunteer Dept. USD$ 100,464.00 USD$ 100,464.00 Total USD$ 190,153.00 USD$ 190,153.00 Budget Narrative Hope Hospice remained steady in its patient care admissions and provision of services during FY19/20 during the onset of the pandemic and to date. Both the Grief Support and Volunteer Support programs have developed creative new ways to stay connected and support our patients and families and other community members. While we are a Medicare- certified agency in which reimbursement for most clinical patient care is received, many support services, which are unique to the hospice experience, have no reimbursement source and some continue long after the patient has died. Hospice families are followed in their grief journey for up to 13 months after the passing of their loved one. In addition, we welcome members of the community who have experienced a loss and we do not charge for these services. Our caregiving workshops and presentations on end-of-life care and planning at local facilities, senior centers and other locations (currently provided temporarily online) in the community also remain free of charge. Four fundraising events during the pandemic period had to be cancelled and the nation's deep economic uncertainties have impacted the level of individual contributions to the agency. These programs are made possible through community support from contributions and grants. Therefore, we are having to rely to a greater extent on grant funding into FY21-22 to ensure these programs can continue to serve the community. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget Form Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information Form - Project List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ Annual Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ Form 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Designation of official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Authorization to Request Funding Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Certificate of Liability Insurance Workers Compensation Attachment 7 926 Application ID: 329805 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2021 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. 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. ✔✔✔✔ Nonprofit Determination - State and Federal Certified Audit and/or Certified Financial Statements ✔✔✔✔ Financial Information 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 Grievance 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 - 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 ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) Attachment 7 927 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin PCS - Human Services Division 2021-2022 Human Services Grant Program Deadline: 1/11/2021 Hively Hively Early Childhood Literacy Jump to: Organization Information Questions Budget Documents USD$ 15,000.00 Requested Submitted: 1/11/2021 7:50:50 PM (Pacific) Project Contact Kelly O'Lague Dulka kelly@behively.org Tel: (925) 417-8733 Additional Contacts mkochly@behively.org,vdilks@behively.org Hively 6601 Owens Dr. Ste 100 Pleasanton, CA 94588 United States CEO Kelly O'Lague Dulka kelly@behively.org Telephone(925) 417-8733 Fax (925) 730-4942 Web www.behively.org Organization Information top 1. Business License Number BL-109890 Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Hively’s mission is to provide resources so everyone in our community can thrive. Resources include community outreach programs (food, clothing, diapers); affordable mental health services; child care subsidies; parent education and support; and more. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project Attachment 7 928 5. Is this request for one-time, seed or operational funding? 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. At Hively, a top area of focus is on early care and education. Recognizing that 90% of brain development occurs by the age of five, we provide children and families with the foundational support they need to ensure success in the future. Studies show that children who have five books a day read to them enter kindergarten having heard 1.4 million more words than kids who are not read to. Even if only one book is read each day, a child will hear 290,000 more words by age 5 and is likely to pick up reading skills more quickly and easily. Since studies show that 61% of low-income households do not have a single children’s book in the house, Hively is aggressively working to get books into the hands of both caregivers and families. Hively is uniquely positioned to address early literacy disparities by providing virtual book clubs for parents and child care professionals to help bridge this million-word gap. For caregivers, a book club is proposed to be weekly, for parents, monthly. For both groups, a book will be read by a reader who will share how the book can be used to enrich a child's learning. A copy of the book will be provided to attendees free of charge. First 5 Alameda has found that 44% of children in our county are not ready for kindergarten. Having books available and reading to children will help make sure ALL Dublin children will be kindergarten ready. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 240 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) When we met Marta through our Diaper Pantry, she was mom to then 3-year-old Jose and 1-year-old Gabby. Marta knows from reading Hively's early literacy materials the importance of ‘talking, reading, and singing’ with her children. Now she longs for more books so she can read to them and is worried about Jose’s kindergarten readiness. Deepti is a family home child care professional. Her day is busy with attending to children, preparing food, providing activities, changing diapers, and ✔✔✔✔ Yes gfedc No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse gfedc Disabilities gfedc Food and Nutrition gfedc Senior Services ✔✔✔✔ Youth Services ✔✔✔✔ Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the Above gfedc Please explain: Attachment 7 929 making sure they are healthy and happy. She knows that for some children, the time spent in her care may be the only reading time they get and wants to enrich that time. But she doesn’t have a lot of spare time at the end of her exhausting often 12-hour day to do research to find new books that will enrich the children both educationally and in their social and emotional development. Nor does she have a lot of spare money to purchase books for her children's book library. Hively’s early childhood literacy program will help both in acquiring new books and helping parents and caregivers maximize the benefits of reading to children. Grant funds will be used to partially fund the salary of a Training and Inclusion Coordinator who will coordinate book readers, book manage club registrations, research and purchase books (including books covering various social-emotional topics), prepare books for video presentation, and handle book distribution. This program is cost effective because of our our ability to purchase books at a volume discount. Once COVID-19 restrictions are lifted, the parent/child reading may begin in person, and supplies will be needed such as for snacks. For child care professionals, reading will continue to be online so that they can take time out of their day without leaving their sites to participate. First 5 Alameda County has found that 44% of children are not ready for kindergarten. The non-profit group Reading Partners says that a low-income student not reading at grade level by the end of the third grade is six times less likely to graduate from high school than those reading at grade level, and high school dropouts are 63 times more likely to be incarcerated than college graduates. Hively’s Early Childhood Literacy program is like a pebble tossed into a pond. It creates a ripple effect of benefits that last far beyond early childhood by promoting kindergarten readiness, academic success in kindergarten and beyond, increased high school graduation rates, decreased incarceration rates, and greater success in job employment and in life. 10. 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)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low-come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. Hively will measure the outcomes by counting unduplicated attendees for each book club series. We will also track the number of books distributed. Hively uses a variety of ways to communicate with our families and network of child care professionals: directly through our Family Support Specialists as well as electronically through email, social media, ConstantContact, and the Community Calendar on the Hively web page. Many of our families use the services of our Diaper Pantry, Food Pantry, and Community Closet. Information regarding all of Hively's services are made available and easily accessible to families.. Books to be used are often bilingual, and include stories of children from diverse backgrounds, ethnicities, abilities, and personalities. They will cover a wide variety of social emotional topics such as celebrating our differences, bullying, friendships, positivity, and how to manage emotions. We plan to use volunteer readers, many of whom are bilingual, and will pull from diverse backgrounds and ethnicities, ranging in age from teenagers to senior citizens, and use both male and female readers. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis-Bacon requirements. 12. ** QUESTIONS 13 THROUGH 23 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 13. 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? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 14. CDBG ONLY - Identify at least one HUD Guiding Principle that relates to your project: gfedc Not Applicable gfedc Yes ✔✔✔✔ No gfedc Yes. If so, check box here and answer questions 13 through 23. ✔✔✔✔ No. If no, check box here and enter NA gfedc Don't know. If you are unsure, please call City staff at (925) 833-6645. gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement Attachment 7 930 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: (Select Category and Applicable Goals) 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 17. CDBG ONLY - Select one HUD 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?") 18. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?") 19. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc A) Housing gfedc Goal 1: Promote the production, rehabilitation, and preservation of affordable housing (rental and ownership) through acquisition, rehabilitation, new construction, and minor repair. gfedc Goal 2: Reduction of housing discrimination through provision of fair housing and tenant/landlord services. gfedc Goal 3: Use resources to assist low-income residents make rental assistance payments in response to Covid-19. gfedc B) Homeless gfedc Goal 1: Use resource to end homelessness by funding and supporting homeless service programs. gfedc C) Supportive Housing gfedc Goal 1: Increase the availability of services enriched housing for persons with special needs by supporting acquisition and new construction of housing units. gfedc D) Community Development gfedc Goal 1: Make improvements, including ADA accessibility and rehabilitation to public facilities, such as curbs and sidewalks, neighborhood parks and recreational improvements, homeless facilities and other public facilities/community centers. gfedc Goal 2: Fund economic development, micro-enterprise, and on-the-job training. gfedc Goal 3: Support public service programs for low income residents, preserving safety net services for families and individuals who are vulnerable or ✔✔✔✔ F) Not Applicable. Not interested in CDBG funding. gfedc Public Services gfedc Public Facilities gfedc Rental Assistance gfedc Affordable Housing gfedc Increase Opportunities for 1st Time Homebuyers gfedc Promote Decent Affordable Rental Housing gfedc Strengthen Communities gfedc Ensure Equal Opportunity in Housing gfedc Reduce Housing Discrimination gfedc Promote Participation of Grass-Roots, Faith-Based, and other Community-Based Organizations ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. Attachment 7 931 20. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 21. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. ✔✔✔✔ Not Applicable. Not interested in CDBG funding gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. Not interested in CDBG funding Disabled Women/Female Headed Households Attachment 7 932 22. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMI") information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 23. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" 24. 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 Seniors Youth Homeless N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL Low Income (50%-80% AMI) Extremely Low Income (<30% AMI) N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL White White + HISPANIC Black/African American Black/African American + HISPANIC Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. Not interested in CDBG funding. (Type N/A) 0.000.00 TOTAL gfedc #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. ✔✔✔✔ #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. Attachment 7 933 gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed Sunlight Giving Foundation USD$ 2,500.00 USD$ 2,500.00 East Bay Community Foundation USD$ 2,500.00 USD$ 2,500.00 Individual and Corporate Donations USD$ 1,500.00 USD$ 1,500.00 Morris Stulsaft Foundation USD$ 3,500.00 USD$ 0.00 City of Dublin USD$ 15,000.00 USD$ 0.00 City of Pleasanton USD$ 15,000.00 USD$ 0.00 City of Livermore USD$ 15,000.00 USD$ 0.00 Total USD$ 55,000.00 USD$ 6,500.00 Funding Uses/Expenses Budget Amount Amount Committed Early Literacy Facilitator/Coach .2 FTE USD$ 15,000.00 USD$ 2,500.00 Training Coordinator .15 FTE USD$ 11,250.00 USD$ 1,500.00 290 books per month, 3480 total USD$ 23,440.00 USD$ 2,500.00 Distribution of books USD$ 910.00 Administrative Support USD$ 4,400.00 Total USD$ 55,000.00 USD$ 6,500.00 Budget Narrative Grant funds will be used to provide a portion of salary and benefits for a Training and Inclusion Coordinator as well as operating expenses for the program. While the overall agency budget is nearly $23 million, approximately 95% of the funds are considered “pass through” dollars, which we use to pay subsidies for child care. The remainder of the operating budget is approximately $1 million. This program will represent approximately ___% of the overall Community Services budget. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget ECL Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information ECL List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ BOD List Current Annual Budget for the Entire Agency ✔✔✔✔ Hively Budget 20-21 Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ Form 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Designated Official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Authorization to Seek Funding Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ COI Dublin STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. 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. ✔✔✔✔ Non Profit Letter Attachment 7 934 Application ID: 330026 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2021 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. Certified Audit and/or Certified Financial Statements ✔✔✔✔ Hively Financials 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 Grievance 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 - 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 ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) Attachment 7 935 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin PCS - Human Services Division 2021-2022 Human Services Grant Program Deadline: 1/11/2021 Legal Assistance for Seniors Legal Services, Medicare Counseling and Education for Dublin Seniors Jump to: Organization Information Questions Budget Documents USD$ 7,500.00 Requested Submitted: 1/11/2021 2:57:15 PM (Pacific) Project Contact James Treggiari jtreggiari@lashicap.org Tel: (510) 832-3040 x302 Additional Contacts emercado@lashicap.org Legal Assistance for Seniors 333 Hegenberger Road Suite 850 Oakland, CA 94621 United States Executive Director James Treggiari jtreggiari@lashicap.org Telephone(510) 832-3040 x302 Fax (510) 842-1080 Web www.lashicap.org Organization Information top 1. Business License Number BL-110718 Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). The mission of Legal Assistance for Seniors is to ensure the independence and dignity of seniors by protecting their legal rights through education, counseling and advocacy. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes Attachment 7 936 5. Is this request for one-time, seed or operational funding? 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Legal Assistance for Seniors (LAS) will provide free legal services, community education, and health insurance counseling to Dublin older adults. LAS’ legal program will serve elder abuse survivors and those needing legal help with guardianship, citizenship, public benefits, health law and housing. Legal services include representation in court and administrative hearings, legal advice and counsel and referrals to other resources. LAS will also provide free community education and outreach to older adults, their families, and service providers. Presentations include How to Get Help with Health Care Costs, Navigating Medicare for LGBT Beneficiaries, and Basic Housing Rights for Seniors, and more. Finally, the Health Insurance Counseling and Advocacy Program (HICAP) will provide free individual counseling on Medicare and related health insurance issues. State-registered volunteer HICAP counselors help older adults and people with disabilities enroll in Medicare, supplemental and prescription drug plans and apply for cost-saving programs. Counselors also assist to resolve coverage issues, referring to LAS’ legal program for further help if necessary. Typically, many of these services would be provided in the community at locations such as the Dublin Senior Center and in clients’ homes. However, due to COVID-19, most services are being provided via phone, video conference, webinar, and email. In-person and community-based services will resume as soon as it is safe to do. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 142 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) ✔✔✔✔ No gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None gfedc Behavioral Health (mental health and substance abuse) gfedc Affordable Housing ✔✔✔✔ Health Care (including dental) gfedc Workforce Development ✔✔✔✔ Homelessness gfedc Transportation Services and Access ✔✔✔✔ Domestic Violence and Child Abuse ✔✔✔✔ Disabilities gfedc Food and Nutrition ✔✔✔✔ Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the Above ✔✔✔✔ Please explain: Senior services for elder abuse, eviction defense, health coverage. Culturally competent services, accessible for people with disabilities. Attachment 7 937 The proposed funds from the City of Dublin will be used to provide free legal services, community education, outreach, and HICAP counseling to Dublin older adults. Services will be focused on low or extremely low-income older adults. As mentioned, these services cannot safely be provided in-person at LAS’ office or directly in the Dublin community at this time. As such, LAS has now shifted its efforts to providing outstanding remote services so every older adult can meaningfully access help despite the pandemic. HICAP and legal client meetings are through phone or video conference, but for clients with heightened needs, staff will meet in person, following all safety protocols. Staff will also pick up paperwork from clients' homes in order to avoid unnecessary court delays. In addition, because court hearings are conducted remotely, staff work with clients to prepare them for the remote hearing. Community education is being offered online, and the community education department continually reaches out to organizations in Dublin and surrounding areas, including the Dublin Senior Center and Creating New Hope, to offer webinars and outreach materials. Once it is safe to do so, all in-person and community-based services, including home visits, HICAP appointments at the Dublin Senior Center, and community education at various Dublin locations, will resume. Funds from the City of Dublin will contribute to salaries for LAS’ program staff, including staff attorneys and advocates. Funds will also be used for postage, phones, rent, and outreach activities, plus materials expenses such as printing costs for legal cases. COVID-19 has not impacted the range of services offered but has significantly impacted the time required per case. Arranging meetings and gathering documents, signatures and witnesses are all taking longer, meaning a greater amount of staff time and resources are spent on every case. Funding from the City of Dublin is critical to continue this high level of remote service. To ensure services are provided in a cost-effective manner, LAS works extensively with volunteers who provide both overall program support and direct services to clients, with supervision and support from program staff. For example, LAS currently has 30 extensively trained and state-registered volunteer HICAP counselors who provide hundreds of hours of service per year. Additionally, ten paid staff counselors provide supervision and support to the volunteers. In addition to providing individual health insurance counseling, a select number of LAS’ HICAP counselors also provide community education and translation services. LAS also works with legal interns and summer law clerks to provide support to the legal program, including legal research, writing, and intake. Because LAS has provided legal, educational, and HICAP services in Dublin for many years, we are able to base the current year’s budget on past results. This helps to ensure that the current budget will meet the needs of the anticipated results. Further, the project budget is also leveraged with additional county grants. 10. 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)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low-come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. LAS will provide services to a total of 142 unduplicated Dublin older adults across the legal services, HICAP and community education departments. While services are available to residents of any income, LAS focuses its efforts on serving low income clients, including conducting outreach in low income areas and partnering with other agencies that serve low income communities. Legal services will be provided to seven Dublin older adults. LAS’ legal services program will provide free services in the areas of elder abuse, health law, public benefits, guardianship, naturalization, housing, and general legal services for those needing assistance in other areas. Services will be provided to Dublin residents age 60 and older, or 50 and older for guardianship. For elder abuse, LAS will assist those over age 65, or dependent adults of any age. Services range from legal counsel and advice to full representation in court, depending on the client’s situation. LAS’ HICAP will provide free individual HICAP counseling to 65 Dublin Medicare recipients. Again, all HICAP counseling is currently being performed remotely; in-person counseling at the Dublin Senior Center will resume when safe. While most Medicare recipients are older adults, LAS will also provide HICAP counseling to younger individuals who are eligible for Medicare due to disability. LAS will also provide three community education presentations and/or outreach events, reaching a minimum of 100 Dublin residents. These presentations will be targeted to Dublin older adults, pre-retirees, caregivers, and senior and disability service providers. Currently, presentations are being provided via webinar only; in-person event will resume when it is safe to do so. Presentations will cover a wide variety of topics that are relevant to older adults’ lives, including health care, avoiding scams and fraud, hiring and working with caregivers, public benefits, and more. To monitor the progress of these outcomes, LAS will utilize client databases that track client demographics and case outcomes. Periodic database reports will be generated and reviewed by LAS’ management team to ensure LAS is on track to meet all project goals. If LAS notices a deficiency in one program area, adjustments will be made to ensure that all goals are met, including increasing outreach efforts in Dublin to make more seniors aware of LAS’ services. LAS also distributes Attachment 7 938 evaluation forms to all clients and community education participants to assess the quality of services provided. LAS’ management team reviews all returned evaluations to ensure compliance with LAS’ standards of service. LAS’ services are designed to be easily accessible for older adults who have language barriers. To make sure non-English speaking seniors can meaningfully access LAS’ services, written materials are provided in multiple languages. LAS staff and volunteers can also provide services in several languages, and for all other language needs, a phone interpretation service is used. Community education presentations are provided in multiple languages, including Cantonese, Mandarin, Spanish, Hindi and Punjabi. For court appearances, LAS attorneys arrange with the court to have an interpreter provided when needed. While we are currently unable to conduct home visits due to the pandemic, to ensure older adults with heightened needs or disabilities are able to access services, LAS staff continue to meet with these clients when necessary, following all safety protocols for the safety of staff and the client. To ensure older adults from isolated or underserved areas are aware of the services offered, LAS also conducts extensive outreach activities across the county, which we have increased since the pandemic. These increased efforts include finding new pathways to connect with older adults, such as partnering with Meals on Wheels and Open Heart Kitchen to include LAS outreach materials, in multiple languages, with deliveries. Since the pandemic, LAS has distributed over 1000 fliers on our services and other important information for older adults, such as avoiding COVID-19 fraud and scams. To ensure LAS’ services are culturally appropriate, LAS collaborates with several cultural centers, including Multicultural Institute, Asian Health Services, and The Fruitvale Senior Center. LAS is also continuing its comprehensive Equity, Diversity and Inclusion (EDI) initiative, including agency-wide staff training and a staff EDI committee, to make our services as welcoming as possible to all older adults, regardless of ethnicity, sexual orientation, language, or disability. LAS’ marketing and outreach strategies include distributing marketing communications to the Dublin Senior Center and throughout its robust network of partners. These marketing communications include event and service fliers, a quarterly newsletter, blog posts on LAS’ website, Facebook posts, other publicity, and informative literature. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis-Bacon requirements. 12. ** QUESTIONS 13 THROUGH 23 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 13. 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? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. LAS does not allow language to prevent clients from meaningfully accessing services. Our Language Access Plan states that all program notices include a statement that translators will be available upon request for presentations, meetings, and all other client activities. To encourage limited English speaking residents to access LAS’ services, we coordinate with partnering agencies that specialize in serving monolingual older adults whenever possible. For example, prior to COVID-19, we maintained Medicare counseling and community education sites at Fruitvale Senior Center, which serves predominately Hispanic seniors in Oakland, and Asian Health Services, serving many mono-lingual seniors, also in Oakland. Although we had to pause in- person services for the time being, we have maintained communication with these community sites to disseminate outreach materials to their clientele. LAS also outreaches to limited English speaking residents by making program materials available in various languages. We use translators to review any materials created and translated by LAS for accuracy. LAS also uses government documents for HICAP counseling that explain Medicare in multiple languages. In the past, we have provided written materials in Chinese, Farsi, Korean, Spanish, Tagalog, and Vietnamese. In addition, LAS recruits and trains HICAP counselors whose ethnicities reflect the diverse communities that we serve. It is common for LAS to have HICAP counselors that speak Cantonese, Mandarin, Spanish, Korean, Hindi, and Punjabi. LAS uses ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Yes. If so, check box here and answer questions 13 through 23. gfedc No. If no, check box here and enter NA gfedc Don't know. If you are unsure, please call City staff at (925) 833-6645. Attachment 7 939 a telephone interpreter service (Language Line Solutions) for its legal and HICAP counseling services, which provides translators in 240 different languages including American Sign Language. LAS also arranges interpreter services with the courts in legal cases to ensure a translator is available. In addition, LAS uses bilingual staff and volunteers to provide translation for all its services. 14. CDBG ONLY - Identify at least one HUD Guiding Principle that relates to your project: 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: (Select Category and Applicable Goals) 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 17. CDBG ONLY - Select one HUD 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?") 18. CDBG ONLY - Select one HUD Outcome that relates to your project: ✔✔✔✔ Be culturally accessible, appropriate and inclusive ✔✔✔✔ Encourage community engagement and involvement gfedc Promote energy and resource efficiency ✔✔✔✔ Encourage networking and information sharing across service providers ✔✔✔✔ Encourage process streamlining ✔✔✔✔ Consolidate service delivery gfedc Not Applicable. Not interested in CDBG funding. ✔✔✔✔ A) Housing gfedc Goal 1: Promote the production, rehabilitation, and preservation of affordable housing (rental and ownership) through acquisition, rehabilitation, new construction, and minor repair. ✔✔✔✔ Goal 2: Reduction of housing discrimination through provision of fair housing and tenant/landlord services. gfedc Goal 3: Use resources to assist low-income residents make rental assistance payments in response to Covid-19. ✔✔✔✔ B) Homeless ✔✔✔✔ Goal 1: Use resource to end homelessness by funding and supporting homeless service programs. gfedc C) Supportive Housing gfedc Goal 1: Increase the availability of services enriched housing for persons with special needs by supporting acquisition and new construction of housing units. ✔✔✔✔ D) Community Development gfedc Goal 1: Make improvements, including ADA accessibility and rehabilitation to public facilities, such as curbs and sidewalks, neighborhood parks and recreational improvements, homeless facilities and other public facilities/community centers. gfedc Goal 2: Fund economic development, micro-enterprise, and on-the-job training. ✔✔✔✔ Goal 3: Support public service programs for low income residents, preserving safety net services for families and individuals who are vulnerable or gfedc F) Not Applicable. Not interested in CDBG funding. gfedc Public Services gfedc Public Facilities gfedc Rental Assistance gfedc Affordable Housing gfedc Increase Opportunities for 1st Time Homebuyers gfedc Promote Decent Affordable Rental Housing ✔✔✔✔ Strengthen Communities gfedc Ensure Equal Opportunity in Housing gfedc Reduce Housing Discrimination gfedc Promote Participation of Grass-Roots, Faith-Based, and other Community-Based Organizations gfedc Not Applicable. Not interested in CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. Not interested in CDBG funding. Attachment 7 940 (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?") 19. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: 20. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) gfedc Availability/Accessibility gfedc Affordability ✔✔✔✔ Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc 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. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Not Applicable. Not interested in CDBG funding ✔✔✔✔ Persons gfedc Households Attachment 7 941 21. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 22. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMI") information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 23. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" 24. 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 gfedc Not Applicable. Not interested in CDBG funding 4 Disabled 3 Women/Female Headed Households 7 Seniors 0 Youth 0 Homeless 0 Not Applicable. Not interested in CDBG funding (Type N/A) 14.0014.00 TOTAL 1 Low Income (50%-80% AMI) 6 Extremely Low Income (<30% AMI) 0 Not Applicable. Not interested in CDBG funding (Type N/A) 7.007.00 TOTAL 2 White White + HISPANIC 2 Black/African American Black/African American + HISPANIC 2 Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial 1 Not Applicable. Not interested in CDBG funding. (Type N/A) 7.007.00 TOTAL Attachment 7 942 only be one #1 PER AGENCY ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed State of California, Office of Emergency Services USD$ 120,000.00 County of Alameda Social Services Agency: Title III lgl svcs, Title TVII, HICAP, MIPPA, DCFS, Home Safe USD$ 1,082,552.00 USD$ 18,750.00 County of Contra Costa/HICAP USD$ 8,000.00 Cities of Alameda, Dublin, Fremont, Hayward, Livermore, Pleasanton & Union City USD$ 84,500.00 State Bar of California: IOLTA, EAF, EAP & Bank USD$ 373,592.00 USD$ 197,127.00 Daybreak & Family Support Svcs MOUS USD$ 15,000.00 Foundations/Corporations: Bigglesworth, CHA, Hindu Comm&Cultural Cntr,Menorah Park's Comm., Stern Memorial,VLS/Rembe Rock, West Davis & Bergard, San Francisco, Sr Assistance Fdn EastBay, East Bay Fdn on Aging, Witkin Foundation and others USD$ 352,755.00 USD$ 125,000.00 Court Awarded Fees USD$ 150,000.00 Individual Donations, Annual Appeal, Fundraising Event, Donor soliciations USD$ 138,000.00 Elder Abuse Conference Sponsorships/Registration Fees USD$ 60,000.00 Total USD$ 2,384,399.00 USD$ 340,877.00 Funding Uses/Expenses Budget Amount Amount Committed Personnel Salaries (See budget narrative) USD$ 1,448,270.00 USD$ 224,031.00 Fringe Benefits USD$ 379,881.00 USD$ 57,178.00 Supplies & Minor Equipment USD$ 13,000.00 Printing USD$ 18,000.00 Postage USD$ 8,000.00 Telephone USD$ 15,000.00 Rent & Facility Costs USD$ 248,785.00 USD$ 37,318.00 Accounting/Audit/Payroll Fees USD$ 18,000.00 USD$ 2,700.00 Contracted Services: Computer, Database, Translation,General USD$ 36,000.00 USD$ 5,400.00 Insurance USD$ 45,000.00 USD$ 6,750.00 Membership, Books USD$ 20,000.00 USD$ 3,000.00 Equipment Lease, Maintenance, software/upgrades USD$ 12,963.00 Computer Equipment USD$ 13,500.00 Equipment Technology USD$ 30,000.00 USD$ 4,500.00 Food & Entertainment (Conference, Annual Event) USD$ 13,000.00 Client Costs USD$ 27,500.00 Outreach/Bank Fees/Processing Fees USD$ 9,500.00 Staff/Volunteer Travel & Training, Support & Recruitment USD$ 28,000.00 Total USD$ 2,384,399.00 USD$ 340,877.00 Attachment 7 943 Budget Narrative The requested $7,500 budget from the City of Dublin represents salaries for our Legal Director ($721), three Supervising Attorneys ($2,529) , 2 Staff Attorneys ($1,157), 2 Advocates ($745) and 1 Community Education Advocate ($374). Fringe Benefits ($1,449 or approx. 26%) include FICA, Unemployment Insurance, Workers Compensation, Health (including dental, vision & life) insurance and our Retirement benefit plan and Plan Fees. Operating expenses include Rent & Facility costs (CAM), Office supplies, printing and postage, telephone and professional liability insurance. LAS will underwrite the described costs to fully provide assistance to Dublin clients, including travel & training expenses, telephone, outreach expenses, membership and books/subscriptions. Prior to the Covid pandemic, LAS made home visits to our clients throughout the County or arranged for transportation if funding from other sources were available. The requested amount of $7,500 represents less than 1% of of the entire agency budget. Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ FY2020-21 Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ FY2020-21 Board Approved Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ Tax Return Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ Board Resolution Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ Board Resolution Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ FY2020-21 General Liability and Auto COI 2020-21 Workers Compensation STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. 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. ✔✔✔✔ IRS Determination Letter State of CA Franchise Tax Board Determination Letter Certified Audit and/or Certified Financial Statements ✔✔✔✔ FY2019-20 Financial Audit 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 Grievance Procedure Personnel Policies REQUIRED FOR CDBG ONLY - Agency Audit Requirements and Copy of Last Audit Highlighting "Findings" Section Audit Requirements FY201920 Audit Management Letter REQUIRED FOR CDBG ONLY - Articles of Incorporation and Bylaws Articles of Incorporation LAS By Laws REQUIRED FOR CDBG ONLY - Conflict of Interest Statement (if not included in Bylaws) Conflict of Statement 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. Limited English Proficiency Attachment 7 944 Application ID: 330443 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2021 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. REQUIRED FOR CDBG ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) Attachment 7 945 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin PCS - Human Services Division 2021-2022 Human Services Grant Program Deadline: 1/11/2021 Easterseals Northern California Kaleidoscope Community Adult Program Jump to: Organization Information Questions Budget Documents USD$ 24,420.00 Requested Submitted: 1/11/2021 4:50:43 PM (Pacific) Project Contact Easterseals Northern California development@esnorcal.org Tel: (510) 910-3089 Additional Contacts none entered Easterseals Northern California 5601 Arnold Road Suite 104 Dublin, CA 94568 United States CEO Jim Kelleher development@esnorcal.org Telephone(925) 326-0072 Fax Web www.esnorcal.org Organization Information top 1. Business License Number BL-005301 Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). Our mission is to lead the way to ensure that individuals and families affected by disabilities and special needs can live, learn, work, and play to their full potential. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes Attachment 7 946 5. Is this request for one-time, seed or operational funding? 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. Kaleidoscope is a Community Adult Program based in Dublin, California that offers specific programming for adults with a developmental disability. Starting in March 2020, we transitioned our in-person services to remote services, via Zoom, and implemented a new virtual program called myBrightlink Virtual Club. The club provides participants and families the opportunity to complete art, fun and skill building projects that include activities with instruction by a Life Skills Coach. The needed art/fun/skill building supplies are pre-packaged and delivered to the participants’ homes. The hands-on and remote activities keep participants engaged and socially interacting during these trying times. The myBrightlink Virtual Club sessions have been very well received by clients and families, and we regularly get feedback about how excited clients get when it's club day. Easterseals Northern California is requesting $24,420 to cover the cost for 22 Kaleidoscope clients to participate in the 13- week, 2021 Summer Session of myBrightlink Virtual Club. The funding would also cover the cost for 22 Kaleidoscope clients to participate in 4 weeks of the 2021 Fall Session of myBrightlink Virtual Club. Securing these funds would ensure that 22 Kaleidoscope clients and families will receive 17-weeks of needed services and support in 2021. The club has become a vital part of the services and support for Kaleidoscope clients and families. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 22 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) The myBrightlink Virtual Club Summer Session is a 13-week long program. The cost for one client to participate in the entire summer session is $850.00. That amount covers the following costs associated with the program: camp management and coordination, staff costs and external/misc. costs (i.e., art supplies, boxes, shipping). The $850 breaks down to $65 per week, per client for participation. Funding the myBrightlink Virtual Club Summer Session for 22 Kaleidoscope clients and ✔✔✔✔ No ✔✔✔✔ One-time funding gfedc Seed funding gfedc One-time and Seed funding gfedc Operational funding gfedc None ✔✔✔✔ Behavioral Health (mental health and substance abuse) gfedc Affordable Housing gfedc Health Care (including dental) ✔✔✔✔ Workforce Development gfedc Homelessness gfedc Transportation Services and Access gfedc Domestic Violence and Child Abuse ✔✔✔✔ Disabilities gfedc Food and Nutrition gfedc Senior Services gfedc Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity gfedc Financial Assistance gfedc None of the Above gfedc Please explain: Attachment 7 947 families will cost $18,700. The additional 4-weeks of the myBrightlink Virtual Club Fall Session will cost $5,720 for 22 Kaleidoscope clients and families to participate. $18,700 + $5,720 equals the requested amount of $24,420. This budget ensures that every participant and their family are able to receive our specialized services. During these clubs, the participants are receiving support, guidance, and peer interaction. Our Life Skills Coaches facilitate these lessons at a 1:3 staff to participant ratio. This budget provides all clients and families 51 hours of support over 17-weeks. The goal of keeping participants engaged and socially interacting is achieved during every session. Additionally, many participants gain skills from their participation in the clubs that align with their treatment plan such as an increase in vocabulary or an expanded tolerance of sounds. 10. 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)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low-come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. One metric we use to measure the club’s success is the attendance rate. Since the inception of the myBrightlink Virtual Club, we’ve had an average of 17 participants in the club and an attendance rate of 96%. Another way we measure success is by participant engagement. The participants are adults and are able to make their own decisions, which includes whether or not they want to participate in the club. Most parents report that their son/daughter get extremely excited for the club and love seeing their peers and staff. Consistent participation is a good indication that the participants are enjoying the program and finding value in the clubs. The Kaleidoscope Community Adult Program also sent out a survey to families and participants to gauge what level of engagement and interest they had for receiving services through myBrightlink Virtual Club. All 22 families responded to the survey: • 77% (17 of 22 participants) responded that they are “Extremely Interested” in the myBrightlink Virtual Clubs • 14% (3 of 22 participants) responded that they are “Somewhat Interested” in the myBrightlink Virtual Clubs • 9% (2 of 22 participants) responded that they are “Not Interested” in the myBrightlink Virtual Clubs because the participant cannot tolerate screen time, for any duration of time Some of the feedback provided by families: • “Kai is new to the program and has the opportunity to meet new friends, do projects that he is interested in and really feels like part of a group. He looks forward to camp every day and is often up early setting up the projects on his own.” – Kai’s Mother • “David gets excited before the Zoom classes because he gets to see his friends and favorite staff. He enjoys the art projects and loves showing the completed projects to our family.” – Ahn Phan, David’s Sister Since we are operating these clubs remotely, we have been flexible with our time and made adjustments for participants that cannot attend at the normally scheduled time. Participants encounter barriers such as access issues because multiple people need technology equipment at the same time. We have accommodated our participants and offer support to them when it is convenient and available. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis-Bacon requirements. 12. ** QUESTIONS 13 THROUGH 23 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 13. 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? What access ✔✔✔✔ Not Applicable gfedc Yes gfedc No gfedc Yes. If so, check box here and answer questions 13 through 23. ✔✔✔✔ No. If no, check box here and enter NA gfedc Don't know. If you are unsure, please call City staff at (925) 833-6645. Attachment 7 948 accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. N/A 14. CDBG ONLY - Identify at least one HUD Guiding Principle that relates to your project: 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: (Select Category and Applicable Goals) 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 17. CDBG ONLY - Select one HUD 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?") 18. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?") gfedc Be culturally accessible, appropriate and inclusive gfedc Encourage community engagement and involvement gfedc Promote energy and resource efficiency gfedc Encourage networking and information sharing across service providers gfedc Encourage process streamlining gfedc Consolidate service delivery ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc A) Housing gfedc Goal 1: Promote the production, rehabilitation, and preservation of affordable housing (rental and ownership) through acquisition, rehabilitation, new construction, and minor repair. gfedc Goal 2: Reduction of housing discrimination through provision of fair housing and tenant/landlord services. gfedc Goal 3: Use resources to assist low-income residents make rental assistance payments in response to Covid-19. gfedc B) Homeless gfedc Goal 1: Use resource to end homelessness by funding and supporting homeless service programs. gfedc C) Supportive Housing gfedc Goal 1: Increase the availability of services enriched housing for persons with special needs by supporting acquisition and new construction of housing units. gfedc D) Community Development gfedc Goal 1: Make improvements, including ADA accessibility and rehabilitation to public facilities, such as curbs and sidewalks, neighborhood parks and recreational improvements, homeless facilities and other public facilities/community centers. gfedc Goal 2: Fund economic development, micro-enterprise, and on-the-job training. gfedc Goal 3: Support public service programs for low income residents, preserving safety net services for families and individuals who are vulnerable or ✔✔✔✔ F) Not Applicable. Not interested in CDBG funding. gfedc Public Services gfedc Public Facilities gfedc Rental Assistance gfedc Affordable Housing gfedc Increase Opportunities for 1st Time Homebuyers gfedc Promote Decent Affordable Rental Housing gfedc Strengthen Communities gfedc Ensure Equal Opportunity in Housing gfedc Reduce Housing Discrimination gfedc Promote Participation of Grass-Roots, Faith-Based, and other Community-Based Organizations ✔✔✔✔ Not Applicable. Not interested in CDBG funding. gfedc Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities ✔✔✔✔ Not Applicable. Not interested in CDBG funding. Attachment 7 949 19. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: 20. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) gfedc Availability/Accessibility gfedc Affordability gfedc Sustainability ✔✔✔✔ Not Applicable. I am not interested in qualifying for CDBG funding. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. ✔✔✔✔ Not Applicable. Not interested in CDBG funding gfedc Persons gfedc Households ✔✔✔✔ Not Applicable. Not interested in CDBG funding Attachment 7 950 21. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". 22. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMI") information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 23. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" 24. 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 Disabled Women/Female Headed Households Seniors Youth Homeless N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL Low Income (50%-80% AMI) Extremely Low Income (<30% AMI) N/A Not Applicable. Not interested in CDBG funding (Type N/A) 0.000.00 TOTAL White White + HISPANIC Black/African American Black/African American + HISPANIC Asian Asian + HISPANIC American Indian/Alaskan Native American Indian/Alaskan Native + HISPANIC Native Hawaiian/Other Pacific Islander Native Hawaiian/Other Pacific Islander + HISPANIC American Indian/ Alaskan Native and White American Indian/ Alaskan Native and White + HISPANIC Asian and White Asian and White + HISPANIC Black/African American and White Black/African American and White + HISPANIC American Indian/Alaskan Native and Black/African American American Indian/Alaskan Native and Black/African American + HISPANIC Multi Racial + HISPANIC OR other Multi Racial N/A Not Applicable. Not interested in CDBG funding. (Type N/A) 0.000.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. Attachment 7 951 gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Budget top Funding Sources/Revenues Budget Amount Amount Committed Regional Center of the East Bay USD$ 148,614.00 Total USD$ 148,614.00 USD$ 0.00 Funding Uses/Expenses Budget Amount Amount Committed Staffing USD$ 114,162.00 Program Supplies USD$ 30,000.00 Other: Curriculum Development, etc. USD$ 11,454.00 Total USD$ 155,616.00 USD$ 0.00 Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ ES NorCal Program Expense Budget Financial Information Form for ALL Grant Requests download template ✔✔✔✔ ES NorCal Financial Info. Form List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ ES NorCal Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ ES NorCal 2021 Annual Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ ES NorCal 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ ES NorCal Designation of Authorized Official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ ES NorCal Authorization to Request Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ ES NorCal Proof of Insurance STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. 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. ✔✔✔✔ ES NorCal Determination Letter Certified Audit and/or Certified Financial Statements ✔✔✔✔ 2019 Audited Financials 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 Grievance Procedure REQUIRED FOR CDBG ONLY - Agency Audit Attachment 7 952 Application ID: 330732 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2021 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. 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 - 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 ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) Attachment 7 953 Powered by ZoomGrants™ Email This Preview Save as PDF Print Close Window A▲▼ City of Dublin PCS - Human Services Division 2021-2022 Human Services Grant Program Deadline: 1/11/2021 Community Resources for Independent Living Housing and Independent Living Skills Jump to: Organization Information Questions Budget Documents USD$ 15,000.00 Requested Submitted: 1/11/2021 3:46:55 PM (Pacific) Project Contact Michael Galvan Programs@crilhayward.org Tel: 510 881 5743 x30 Additional Contacts none entered Community Resources for Independent Living 439 A Street Hayward, CA 94541 United States Executive Director Michael Galvan Michael.Galvan@crilhayward.org Telephone(510) 881-5743 Fax (510) 881-1593 Web www.crilhayward.org Organization Information top 1. Business License Number Questions top 1. Select the category that best describes your organization: (Select only one.) 2. Please describe your agency's mission (no more than 3 sentences or 250 characters). CRIL is a peer-based disability resource agency that provides advocacy, services and resources for people with disabilities to improve lives and make communities fully accessible. 3. Select the category that best describes the project: (Select only one.) 4. Is this a "new" service, program, project or activity? "New" is identified as not yet started, implemented or in operation. ✔✔✔✔ Non-Profit gfedc Public Agency gfedc Other: gfedc Capital Project ✔✔✔✔ Public Service Program or Project gfedc Yes ✔✔✔✔ No Attachment 7 954 5. Is this request for one-time, seed or operational funding? 6. Provide a concise, executive summary of the project (no more than 1500 characters). This summary will be used widely during the review and implementation process to describe your project. CRIL's Independent Living Services for Persons with Disabilities will provide low-income Dublin residents who have a disability with peer counseling, independent living skills & self-advocacy training, personal assistant/homecare worker referrals, benefits advocacy, travel training, housing search assistance and emergency preparation planning. The primary goals of the program are to: 1) Enhance the self-efficiency of low income Dublin residents with disabilities, including youth and seniors with functional limitations; 2) Increase the availability of resources to Dublin's most vulnerable residents; and 3) Improve the integration of existing social services in Dublin. 4) Assist people with disabilities who use life-saving to obtain alternative sources energy during Public Safety Power Shut-offs (PSPS). CRIL will directly serve 30 low-income Dublin residents, In addition, CRIL will indirectly serve 75 more individuals and businesses through disability education, technical assistance and information & referral. 7. Estimate the total number of UNDUPLICATED Dublin residents to be served by this project. (UNDUPLICATED means client is counted only once regardless of number of services received in a year.) 30 8. Which of the 14 Areas of Concern identified in the Eastern County 2011 Needs Assessment Report does your project identify with? Please explain how your project meets the selected Areas of Concerns as well as helps the City of Dublin archive its Vision Statement that was included in its 2018 Strategic Plan. The mission and vision statements are available online at www.dublin.ca.gov/1956/Application-Requirements-Process 9. Describe in detail how Dublin grant funds will be used for this project. In this narrative, please include what measures are taken to ensure this project is cost effective, and how the budget meets the needs of the anticipated results. If capital funding is being requested, this narrative should include a detailed project scope and project timeline. (What specifically will the grant funds be used for?) CRIL is requesting $15,000 in Dublin funding for FY 2021-22, which will allow us to increase Independent Living (IL), Housing Search Services, Youth Services, Travel Training, as well as, Job Readiness support in the Tri-Valley area. CRIL projects to serve 30 low income Dublin seniors and residents with disabilities (a 380% increase in consumers since 2011), as well as provide I & R to 75 other residents. CRIL will actively recruit youth to form a Disability Action Network for Youth (group advocacy) and to offer a Community Leadership Academy: Leaders Without Leaders which develops leadership skills and gfedc One-time funding gfedc Seed funding gfedc One-time and Seed funding ✔✔✔✔ Operational funding gfedc None gfedc Behavioral Health (mental health and substance abuse) ✔✔✔✔ Affordable Housing gfedc Health Care (including dental) gfedc Workforce Development ✔✔✔✔ Homelessness ✔✔✔✔ Transportation Services and Access gfedc Domestic Violence and Child Abuse ✔✔✔✔ Disabilities gfedc Food and Nutrition ✔✔✔✔ Senior Services ✔✔✔✔ Youth Services gfedc Child Care, Early Childhood Development and Education gfedc Changing Demographics and Growing Diversity ✔✔✔✔ Financial Assistance gfedc None of the Above gfedc Please explain: Attachment 7 955 encourages participants to join community and government committees and commissions. FY 2021-22 will continue to see an increase in the number of Dublin consumers served. Once the Shelter-in-Place is lifted, the requests and needs for services will be greater. there will be more persons with disabilities from COVID and many will have delayed services due to the SIP. Funds will primarily cover 25% of the salary and benefits of the IL Coordinator with a small amount for shared indirect costs associated with necessary program admin and office operations (e.g., admin, telephone, supplies, insurance, etc.). 10. 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)? This should include the population your agency anticipates serving, how this project is culturally appropriate, and how low-come, ESL persons, and/or disabled persons will access this project. Be sure to include your agencies marketing and outreach strategies and efforts. CRIL's Housing, Employment & IL Services for people with disabilities will provide 30 Dublin residents with improved access to affordable housing, peer counseling, employment & benefits counseling, travel training, I & R, assistive technology info & AT device loans & advocacy. Housing Search Counseling will include local resource info, application assistance, budgeting & credit counseling, landlord mediation and/or applications to Season of Sharing and Dept. of Rehabilitation's housing transition fund. CRIL will also provide indirect information & referral, technical & assistive technology support, ADA & disability law education and community advocacy to 75 additional Dublin residents & businesses to increase their knowledge & independence. CRIL utilizes a national online database management system called CILSuite, which is specifically designed to track data and services for independent living centers. Data can be entered securely from any computer with internet access and CRIL management is able to monitor the timeliness and completeness of every consumer's service record. The structure of the online Intake form and data logs allows for uniformity and consistency in all consumer service records. CILSuite allows CRIL staff and management to regularly track and monitor each consumer's status with completing steps to achieve their personalized goals, as well as progress toward achieving the defined program outcomes: retention or placement in affordable, accessible housing & an increase in personal independence & self-sufficiency. Consumers complete an annual Satisfaction Survey which allows us to evaluate the type & quality of services provided. Consumers provide management & the board of directors with feedback on the impact that our services & supports have had on their level of independence. 11. If your agency is requesting Capital funding, will this project require implementation of Davis-Bacon/Fair Labor Standards Act requirements? NOTE: Please contact City staff immediately if you have any questions regarding Davis-Bacon requirements. 12. ** QUESTIONS 13 THROUGH 23 ARE FOR THOSE ORGANIZATIONS INTERESTED IN APPLYING FOR FEDERAL COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDING ONLY. ** Are you are interested in applying for CDBG funds? 13. 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? What access accommodations are used? Etc. Provide detail Please enter "N/A" if you are not interested in qualifying for CDBG funding. CRIL offers it services in English, Spanish, Farsi and Dari. CRIL materials are available in English, Spanish, Chinese, Braille, in enlarged format, on CD, and electronically which is accessible. CRIL utilizes the County's Language Line for other language translations. CRIL's website (www.crilhayward.org) has a button which provides basic translation into many different languages. CRIL's website also can adjust size of text and brightness of page. 14. CDBG ONLY - Identify at least one HUD Guiding Principle that relates to your project: ✔✔✔✔ Not Applicable gfedc Yes gfedc No ✔✔✔✔ Yes. If so, check box here and answer questions 13 through 23. gfedc No. If no, check box here and enter NA gfedc Don't know. If you are unsure, please call City staff at (925) 833-6645. ✔✔✔✔ Be culturally accessible, appropriate and inclusive ✔✔✔✔ Encourage community engagement and involvement gfedc Promote energy and resource efficiency ✔✔✔✔ Encourage networking and information sharing across service providers Attachment 7 956 15. CDBG ONLY - Identify at least HUD Consolidated Plan Goal that relates to your project: (Select Category and Applicable Goals) 16. CDBG ONLY - Identify at least one HUD Strategic Goal that relates to your project: 17. CDBG ONLY - Select one HUD 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?") 18. CDBG ONLY - Select one HUD Outcome that relates to your project: (TIP: When selecting an outcome ask yourself, "What type of change or result am I seeking?") 19. CDBG ONLY - Select one HUD Specific Indicator that relates to your project: ✔✔✔✔ Encourage process streamlining gfedc Consolidate service delivery gfedc Not Applicable. Not interested in CDBG funding. ✔✔✔✔ A) Housing gfedc Goal 1: Promote the production, rehabilitation, and preservation of affordable housing (rental and ownership) through acquisition, rehabilitation, new construction, and minor repair. gfedc Goal 2: Reduction of housing discrimination through provision of fair housing and tenant/landlord services. ✔✔✔✔ Goal 3: Use resources to assist low-income residents make rental assistance payments in response to Covid-19. ✔✔✔✔ B) Homeless ✔✔✔✔ Goal 1: Use resource to end homelessness by funding and supporting homeless service programs. ✔✔✔✔ C) Supportive Housing ✔✔✔✔ Goal 1: Increase the availability of services enriched housing for persons with special needs by supporting acquisition and new construction of housing units. ✔✔✔✔ D) Community Development ✔✔✔✔ Goal 1: Make improvements, including ADA accessibility and rehabilitation to public facilities, such as curbs and sidewalks, neighborhood parks and recreational improvements, homeless facilities and other public facilities/community centers. gfedc Goal 2: Fund economic development, micro-enterprise, and on-the-job training. ✔✔✔✔ Goal 3: Support public service programs for low income residents, preserving safety net services for families and individuals who are vulnerable or gfedc F) Not Applicable. Not interested in CDBG funding. ✔✔✔✔ Public Services ✔✔✔✔ Public Facilities ✔✔✔✔ Rental Assistance ✔✔✔✔ Affordable Housing gfedc Increase Opportunities for 1st Time Homebuyers ✔✔✔✔ Promote Decent Affordable Rental Housing ✔✔✔✔ Strengthen Communities ✔✔✔✔ Ensure Equal Opportunity in Housing ✔✔✔✔ Reduce Housing Discrimination gfedc Promote Participation of Grass-Roots, Faith-Based, and other Community-Based Organizations gfedc Not Applicable. Not interested in CDBG funding. ✔✔✔✔ Creating a Suitable Living Environment gfedc Providing Decent Affordable Housing gfedc Creating Economic Opportunities gfedc Not Applicable. Not interested in CDBG funding. ✔✔✔✔ Availability/Accessibility gfedc Affordability gfedc Sustainability gfedc Not Applicable. I am not interested in qualifying for CDBG funding. ✔✔✔✔ 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 Attachment 7 957 20. CDBG ONLY - Please choose a common indicator that your agency will use to track clients: (Select only ONE.) 21. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". household units that no longer have access to a substandard service. gfedc 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. gfedc 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. gfedc 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. gfedc Brownfields remediated: This indicator shows the number of acres of brownfields that were remediated. gfedc 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. gfedc 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. gfedc 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. gfedc 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. gfedc Direct financial assistance to homebuyers: This indicator shows the number of homebuyers receiving direct financial assistance, housing counseling, and down payment assistance/closing costs. gfedc 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. gfedc Homeless shelters: This indicator shows the number of homeless persons given overnight shelter. gfedc Emergency housing: This indicator shows the number of beds created in an overnight shelter or other emergency housing. gfedc Homeless prevention: This indicator shows the number of households that received emergency financial assistance to prevent homelessness and emergency legal assistance to prevent homelessness. gfedc 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. gfedc 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) gfedc 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. gfedc 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. gfedc Not Applicable. Not interested in CDBG funding ✔✔✔✔ Persons gfedc Households gfedc Not Applicable. Not interested in CDBG funding 30 Disabled 5 Women/Female Headed Households 10 Seniors 3 Youth Attachment 7 958 22. CDBG ONLY - Based on the common indicator you selected above, please list the number of unduplicated Dublin clients (EITHER Persons OR Households) your agency anticipates serving in each category. If none, please enter "0". Area Median Income ("AMI") information is available online at www.dublin.ca.gov/1956/Application-Requirements-Process 23. CDBG ONLY - List the number of clients your agency anticipates serving in race/ethnicity categories. Per HUD, "Hispanic" is an ethnicity, not a race. The sum entered below must match the total clients entered in Question #9 above. If none, please enter "0" 24. 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 2 Homeless 0 Not Applicable. Not interested in CDBG funding (Type N/A) 50.0050.00 TOTAL 10 Low Income (50%-80% AMI) 20 Extremely Low Income (<30% AMI) Not Applicable. Not interested in CDBG funding (Type N/A) 30.0030.00 TOTAL 10 White 8 White + HISPANIC 5 Black/African American 0 Black/African American + HISPANIC 3 Asian 2 Asian + HISPANIC 0 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 2 Multi Racial + HISPANIC OR other Multi Racial 0 Not Applicable. Not interested in CDBG funding. (Type N/A) 30.0030.00 TOTAL ✔✔✔✔ #1 - This program/project has the agency's highest priority for funding. gfedc #2 - This program/project has the agency's 2nd highest priority for funding. gfedc #3 - This program/project has the agency's 3rd highest priority for funding. gfedc #4 - This program/project has the agency's 4th highest priority for funding. gfedc #5 - This program/project has the agency's 5th highest priority for funding. gfedc #6 - This program/project has the agency's 6th highest priority for funding. gfedc If you have more than 6 applications per organization, agency, district or entity, check here. Attachment 7 959 Budget top Funding Sources/Revenues Budget Amount Amount Committed City of Dublin USD$ 15,000.00 City of Livermore USD$ 15,000.00 City of Pleasanton USD$ 15,000.00 Department of Rehabilitation: General Fund USD$ 14,500.00 Metropolitan Transportation Commission USD$ 61,068.00 Total USD$ 106,068.00 USD$ 14,500.00 Funding Uses/Expenses Budget Amount Amount Committed Personnel Salaries USD$ 68,950.00 USD$ 8,900.00 Personnel Benefits USD$ 17,513.30 USD$ 2,260.60 Operating: Supplies USD$ 750.00 USD$ 350.00 Operating: Printing/Copying USD$ 825.00 USD$ 150.00 Operating: Postage USD$ 550.00 USD$ 250.00 Operating: Telephone USD$ 2,960.00 USD$ 750.00 Operating: Rent & Utilities USD$ 225.00 USD$ 25.00 Operating: Accounting/Audit USD$ 1,250.00 USD$ 350.00 Contracted Services USD$ 3,950.00 USD$ 325.00 Dues, Books/Publications: Insurance USD$ 7,800.00 USD$ 850.00 Travel USD$ 544.70 USD$ 175.00 Staff Development USD$ 750.00 USD$ 114.40 Total USD$ 106,068.00 USD$ 14,500.00 Documents top Documents Requested *Required?Attached Documents * Program Expense Budget for ALL Grant Requests download template ✔✔✔✔ Program Expense Budget Financial Information Financial Information Form for ALL Grant Requests download template ✔✔✔✔ Financial Information List of Board of Directors (or governing body) with agency contact information ✔✔✔✔ Board of Directors Current Annual Budget for the Entire Agency ✔✔✔✔ 2020-21 Budget Copy of most recently submitted IRS 990 form or Tax Return (include complete form) ✔✔✔✔ 990 Board of Director's (or governing body's) designation of authorized official ✔✔✔✔ authorized official Board of Director's (or governing body's) authorization to request funding (may be same document as one above) ✔✔✔✔ request funding Workers Comp Proof of insurance carried, including bonding, liability and/or workers' compensation ✔✔✔✔ Liability STATE AND FEDERAL NON-PROFIT DETERMINATION LETTER. 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. ✔✔✔✔ IRS Non-Profit Certified Audit and/or Certified Financial Statements ✔✔✔✔ 2018-2019 Audit REQUIRED FOR CDBG ONLY - If requesting Capital Funding, please upload your Capital expenditure budget (your own format is acceptable) Attachment 7 960 Application ID: 330743 Become a fan of ZoomGrants™ on Facebook Problems? Contact us at Questions@ZoomGrants.com ©2002-2021 GrantAnalyst.com. All rights reserved. "ZoomGrants" and the ZoomGrants logo are trademarks of GrantAnalyst.com, LLC. Logout | Browser * ZoomGrants™ is not responsible for the content of uploaded documents. REQUIRED FOR CDBG ONLY - Personnel Policies Including Affirmative Action Plan and Grievance 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 - 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 ONLY - LEVERAGING REPORT- this is due with the 2nd quarter report no later than January 15th Supporting Documents such as Agency Strategic Plan, Needs Assessment, etc. (Not Required) Other Supporting Documents (Not Required) Attachment 7 961