SECTION 1.0 PRE-PROPOSAL INFORMATION 1.1 Summary Statement The City of Flint anticipates receiving Emergency Solutions Grant (ESG) Program awards for the 2018 Program Year (PY), distributed by the U.S. Department of Housing and Urban Development (HUD). ESG Program funds are authorized by subtitle B of Title IV of the Stewart B. McKinney Homeless Assistance Act, as amended by the Homeless Emergency Assistance and Rapid Transition to Housing Act of 2009 (Hearth Act). The Emergency Solutions Grant program replaces the Emergency Shelter Grant program, and expands the eligible activities to include homelessness prevention and rapid re-housing components. The purpose of the ESG program is to assist individuals and families quickly regain stability in permanent housing after experiencing a housing crisis or homelessness. Program components are very similar to the Homeless Prevention and Rapid Re-housing Program. Eligible activities include: emergency shelter, homelessness prevention, rapid re-housing assistance, and data collection through the Homeless Management Information System (HMIS). A summary of these components and related eligible costs is listed on the attached document.

1.2 Issuing Office City of Flint

Department of Community and Economic Development 1101 S. Saginaw Street, Room N102 Flint, MI 48502 Contact Person: Kevin Miller (810) 766-7436, x 3023 1.3 Closing Date

Proposals must be HAND DELIVERED to the City of Flint Department of Community and Economic Development, 1101 S. Saginaw Street, South Building Basement, Flint, MI by 5:00 p.m. local time on Wednesday, January 31st, 2018.

Applicants must submit one double-sided, hole-punched set of the attachments identified on

pages 11-18, plus ten (10) double-sided, hole-punched copies of the requested information in Sections 5.0; 5.1; and 5.2 (pages 7-10) no later than 5:00 p.m. on January 31, 2018. Proposals or unsolicited amendments arriving after the closing date will not be considered.

ADDITIONALLY, A FULL ELECTRONIC PDF OF YOUR ENTIRE PROPOSAL MUST BE UPLOADED TO THE CED DROPBOX – found at https://www.cityofflint.com/planning-and-development/community-and-economic-development/

1.4 Proposal Acceptance The City of Flint reserves the right to accept or reject any and all proposals, in whole or in part,

or to negotiate with all responsible agencies, in any manner necessary, to service the program's best interests. The issuing offices reserve the right to waive minor irregularities in proposals, or to allow the non-profit organization to correct minor irregularities if the best interest of the issuing office will be served by doing so. This RFP does not constitute a commitment to award a contract, or a commitment for the Department to pay for any costs incurred in the preparation of the proposal.

1.5 Discharge Coordination Policy As certified by the City of Flint, a policy for the discharge of persons from publicly funded

institutions or systems of care must be established by each ESG Program grantee in order to prevent such discharge from immediately resulting in homelessness for such persons. The

Discharge Policy is required to reduce homelessness resulting from the inappropriate discharge of individuals from state, federal and locally funded institutions or systems of care. Applicants for 2015 ESG Program funds must submit their organization's Discharge Policy, including established practices and protocols, as one of the Required Attachments in Section 6.0 of this proposal.

1.6 Additional Information Non-profit organizations that submit proposals may be required to provide additional

information orally or in writing, or to submit to a site inspection by City, County, State or Federal representatives in order to clarify or document their proposal prior to the 1/31/18 deadline. NOTE: Mandatory ESG Pre-Proposal meeting will take place on January 4, 2018.

SECTION 2.0 SPECIFICATIONS 2.1 Eligible Activities

• Emergency Shelter (Operations or Essential Services) • Homelessness Prevention • Rapid Re-Housing • Data Collection (HMIS)

See Section 2.6 B below for more information regarding Emergency Solutions Grant categories.

2.2 Agreement Term It is anticipated that written agreements will be executed by July 1, 2018. Agreements are in

effect for twelve months from their respective Program Year (PY) start date, and may be extended up to six (6) additional months upon written request by grantees to the City of Flint. Circumstances necessitating the extension must be reasonable, and in accordance with the contract amendment process, spelled out in the written agreement. Approval of grant extensions is solely at the discretion of the City of Flint.

2.3 Review Committee A review committee comprised of members of the Continuum of Care (CoC) and/or

Community Collaborative, along with City staff, will be established for the purpose of reviewing and prioritizing proposals. Each proposal that meets the 2018 ESG Program requirements and received by the closing deadline will be prioritized as to how well it meets the CoC needs of the Community.

2.4 Qualifying Proposals The review committee shall first review each proposal for compliance with Section 2.6 of this

Application - “Program Requirements.” 2.5 Eligible Organizations

• Any organization with a 501(c) designation obtained from the U.S. Internal Revenue Service, that provides for crisis relief of the homeless or near homeless on a daily basis with no fee or religious participation requirement may submit a proposal.

• Organizations must have been a voting member of the Genesee County/City of Flint CoC

for at least one year.

• For shelter providers, the organization must provide humane care, reasonable security, client safety, a drug-free work place, and referrals to other agencies.

• The proposal must fill a gap as identified in the Genesee County/City of Flint CoC, in accordance with eligible ESG categories as identified in Section 2.6 below.

2.6 Program Requirements A. Eligible Clients 1. An individual or family who lacks a fixed, regular, and adequate night-time residence; or 2. An individual or family who has a primary nighttime residence that is:

a. A supervised publicly or privately operated shelter designed to provide temporary living accommodations (including welfare hotels, and congregate shelters); or

b. An institution that provides a temporary residence for individuals intended to be institutionalized; or

c. A public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings.

3. An individual or family who is in imminent danger of becoming homeless. REFER to Handout Materials distributed at the pre-proposal conference for additional information on definitions of homeless and homeless at-risk. Also visit HUD Homeless Resource Exchange for additional guidance on eligibility and homeless definitions (http://www.hudhre.info/esg/index.cfm) B. Eligible Activities. ESG Program funds may be used for one or more of the following activities relating to emergency shelter for the homeless: 1. Emergency Shelter: Essential Services such as case management, childcare, education services, employment assistance and job training, outpatient health services, legal services, life skills training, mental health services, substance abuse treatment services, transportation, and services for special populations. Shelter Operations, including maintenance, rent, repair, security, fuel, equipment, insurance, utilities, relocation, and furnishings. 2. Homelessness Prevention Housing relocation and stabilization services and short-and/or medium-term rental assistance as necessary to prevent the individual or family from becoming homeless if:

• Annual income of the individual or family is below 30 percent of median area income for a household of the same size, as determined by HUD.

• Assistance is necessary to help program participants regain stability in their current permanent housing or move into other permanent housing and achieve stability in that housing.

Eligible costs include utilities, rental application fees, security deposits, last month's rent, utility deposits and payments, moving costs, housing search and placement, housing stability, case management, landlord-tenant mediation, tenant legal services, and credit repair.

REFER to Handout Materials distributed at the pre-proposal conference for additional information on definitions of homeless and homeless at-risk. Also visit HUD Homeless Resource Exchange for additional guidance on eligibility and homeless definitions (http://www.hudhre.info/esg/index.cfm)

3. Rapid Re-Housing Housing relocation and stabilization services and short-and/or medium-term rental assistance as necessary to help individuals or families living in shelters or in places not meant for human habitation move as quickly as possible into permanent housing and achieve stability in that housing. Eligible costs include utilities, rental application fees, security deposits, last month's rent, utility deposits and payments, moving costs, housing search and placement, housing stability case management, landlord-tenant mediation, tenant legal services, and credit repair. 4. Data Collection (HMIS): Funds may be used to pay the costs for contributing data to the HMIS designated by the Continuum of Care for the area. Eligible activities include (computer hardware, software, or equipment, technical support, office space, salaries of operators, staff training costs, and participation fees). C. Ineligible Activities: ESG Program funds may not be used for activities other than those authorized under Section 2.6 B "Eligible Activities" of this RFP. For example, grant amounts may not be used for:

• acquisition or construction of an emergency shelter for the homeless; • the costs of staff involved in operating the shelter; or • rehabilitation services performed by the staff of a grantee or recipient, such as

preparation of work specifications, loan processing, or inspections; or • transitional housing activities • motel vouchers

2.7 Agreement Requirements Organizations submitting proposals must: A. Have provided shelter or services for the homeless for at least one year prior to submitting

their application. B. Have 501(c)3 designation or be a local unit of government.

C. Document that assisted shelter buildings or other assisted units are safe, sanitary, and comply

with all applicable local building codes and HUD Section 8 Housing Quality Standards. D. Agree to follow the HUD Lead Based Paint Requirements for Housing for assisted shelter

buildings or other assisted units. Refer to 576.403 for shelter and housing standards applicable to ESG-funded facilities http://www.gpo.gov/fdsys/pkg/CFR-2012-title24-vol3/pdf/CFR-2012-title24-vol3-sec576-403.pdf

E. Agree to provide supportive services to the homeless, or formally refer them for services, such as assistance in obtaining permanent housing, medical and mental health treatment, counseling, and other services essential for achieving independent living.

F. Agree to provide reports and submit to audit, monitoring, and administrative requirements

(including those related to non-discrimination and equal opportunity) of the Federal Government and City of Flint.

G. Provide matching funds, as required by HUD, on a one dollar-for-one dollar basis. These

matching funds may include the value of any donated material or building, the value of any

lease on a building, any salary paid to operational staff, and the value of time and services of volunteers who carry out the program.

1. General. Each grantee must supplement its 2014 ESG Program funds with an equal

amount of funds from other sources. The source of these funds must be identified in this application under Section 6.0 - "Required Attachments".

2. Calculating the matching amount. The amount of supplemental funds may include the

value of any donated materials or buildings; the value of any lease on a building; any salary paid to staff of the grantee in carrying out general operations for activities assisted with ESG Program funds; and the time and services contributed by volunteers to carry out ESG assisted activities, based on a rate of $5 per hour. For purposes of this paragraph the grantee will determine the value of any donated material or building, or any lease, using any method reasonably calculated to establish a fair market value. Copies of this documentation must be submitted as required in Section 6.0. If funded, agencies will be further required to submit evidence of payment of matching funds with their monthly requests for reimbursement.

H. Have been a voting member of the Genesee County/City of Flint CoC for at least one year.

I. Demonstrate applicant/agency's current attendance, and commitment to maintaining voting

membership in the Flint/Genesee County Continuum of Care, as well as be a licensed member of the HMIS.

J. Attend the mandatory ESG pre-proposal meeting on January 4, 2018. SECTION 3.0 AGREEMENT A written agreement must be executed between the issuing office and the grant recipient prior to disbursement of any 2015 ESG funds awarded under this proposal. This agreement will incorporate the projected budget, agreements relating to non-discrimination and equal employment opportunity, historical designation, length of time for use as a shelter, and require the recapture of funds in the event that budget timeliness and/or project proposals are not adequately followed. Other requirements include: A. Appropriate fidelity bonding coverage, accounting, reporting and internal controls. B. An external annual audit. C. One million-dollar ($1,000,000) liability and property damage insurance with the City of Flint

named as also insured. D. The Agency agrees to hold the City harmless.

SECTION 4.0 Application Instructions

INSTRUCTIONS

Please read carefully before you begin. 1. Place the name of your organization, along with the date, on each page of the application. 2. Number each attachment as they correspond with the information in the application. 3. Beginning with Section 5.0, answer each question as requested in the application. 4. Applicants must submit one double-sided, hole-punched set of the attachments identified on

pages 11-18, plus ten (10) double-sided, hole-punched copies of the requested information in Sections 5.0; 5.1; and 5.2 (pages 7-10) no later than 5:00 p.m. on January 31, 2018. Proposals or unsolicited amendments arriving after the closing date will not be considered.

ADDITIONALLY, A FULL ELECTRONIC PDF OF YOUR ENTIRE PROPOSAL MUST BE UPLOADED TO THE CED DROPBOX – found at https://www.cityofflint.com/planning-and-development/community-and-economic-development/

Attention: Kevin Miller City of Flint Department of Community and Economic Development

1101 S. Saginaw Street South Building Basement Flint, MI 48502

Please Note: 2018 City of Flint ESG Applications will NOT be accepted at the Genesee County Metropolitan Planning Commission offices.

CONTENT: 1. Provide all information and/or materials that are requested in the application. 2. Please limit written narrative to ensure clarity and brevity of all answers. 3. Sections 5.0, 5.1 and 5.2 of the application will be distributed to the review committee.

Beside each question is the maximum number of points which can be awarded during the evaluation.

City of Flint Emergency Solutions Grant (ESG) Program

2018 Application Section 5.0 Cover Sheet Submit 1 original and 4 copies of Sections 5.0 (Cover Sheet), 5.1 (Program Specific Information), and 5.2 (General Program Information). Clearly label which submission is the original. Label and date each page of the submission. Label all sections and budget narrative attachment. Number each page. Agency Name:

Phone:

Agency Address:

Fax:

City/State/ Zip: Email:

Facility Address:

Phone:

Program Contact Person:

Fiscal Officer or Accounting Firm:

Phone:

Address, if different than above:

Program/Project:

Amount Requested:

Name of Authorized Agency Official:

Signature of Authorized Agency Official:

Date:

Section 5.1 Program Specific Information (100 points) Please summarize the program and activities for which you are requesting funds in a written narrative of no more than 2 printed pages. 1. Provide a short, succinct description of your proposed service. This information should be able to

be excerpted out and provide reviewers with a clear understanding of exactly how ESG funds will be used in a summary form of the detailed information requested in the remainder of this application. Paragraph should include the following: what service your organization provides with ESG funds; exactly what ESG funds are paying for (i.e., 2 FTE case managers, $5,000 for first month’s rent/security deposits to assist 10 homeless clients, etc.); where you will provide the service (identify specific addresses); what population will be served; what unit of service will be assisted (households, persons, etc.); how many units of service will be provided. (10 points possible)

2. Describe how your program addresses the need(s) and gap(s) of the Continuum of Care? (20 points possible)

3. Describe the client population being served, specific to the homeless. Provide the number of

persons that will be served if your proposal is funded. Be specific. Provide the number of unduplicated persons served directly as a result of the ESG funding received. State the number of men, women and children to be served based on the number of beds, expected length of stay, and services to be offered. (10 points possible)

4. Is this proposal an increase in the number of persons that would be served? If yes, circle the level

of additional persons served:

Increase of 10%, Increase of 10-25%, Increase of 26-70%, Increase of 70%+ (10 points possible)

5. Identify the specific services that will be provided with funding received from the ESG program. Is

this an expansion in existing services because of grant? Will new services be provided because of this grant? (10 points possible)

6. Detail the outcome expected for those served. (10 points possible)

7. Provide a timeline for all steps needed to achieve program start-up.

(5 points possible)

8. Performance Measurement Requirements Referring to the following chart, please identify performance outcomes, objectives, and statements that best describe your proposed accomplishments with the assistance of ESG Program funds. Provide the total number of households projected to be assisted with ESG funds. (5 points possible) The implementation of the outcome performance measurement system and its use by grantees will enable the City of Flint and the U.S. Department of Housing and Urban Development (HUD) to

collect information on the outcomes of activities funded with ESG Program assistance. This data will be entered into the Integrated Disbursement and Information System (IDIS) and will be aggregated at the national level to provide HUD with the information necessary to show local, state and national results and benefits of the expenditure of federal funds using ESG Program. Organizations that are granted ESG Program funds must report data on their activities to the issuing office with which they have entered into their written Agreement. A Monthly Shelter and Service Assistance for Homeless & Near -Homeless Form is included as attachment 16 (last page of this Application. This form does not need to be submitted with this application but is required for submittal with each monthly request for reimbursement from 2015 ESG Program grantees.

EMERGENCY SOLUTIONS GRANT (ESG)

PROJECTS/ACTIVITIES OUTCOME

Accessibility or Affordability)

OBJECTIVE (Suitable Living

Environment or Decent Housing)

STATEMENT

EMERGENCY SHELTER Essential Services

EMERGENCY SHELTER Shelter Operations

HOMELESSNESS PREVENTION

RAPID RE-HOUSING

DATA COLLECTION (HMIS)

8. Budget (15 points possible)

Complete both the program budget (below), and the attached budget detail (attachment #1). NOTE: Sample Budget Detail enclosed for your reference.

Emergency Shelter Request A. Essential Services $ 1. Case Management $ 2. Childcare $ 3. Education Services $ 4. Employment Assistance and Job Training 5. Outpatient health services $ 6. Legal services $ 7. Life Skills Training $ 8. Mental Health Services 9. Substance Abuse Treatment Services $ 10. Transportation $ 11. Services for Special Populations B. Shelter Operations including maintenance, rent, repair, security, fuel, equipment, insurance, utilities, relocation, and furnishings.

$

1. Maintenance $ 2. Rent $ 3. Repair $ 4. Security $ 5. Fuel $ 6. Equipment $ 7. Insurance $ 8. Utilities $ 9. Relocation $ 10. Furnishings $

Total Emergency Shelter $

Homelessness Prevention - Housing relocation and stabilization services and short-and/or medium-term rental assistance as necessary to prevent the individual or family from becoming homeless

1. Utilities $ 2. Rental Application Fees $ 3. Security Deposits $ 4. Last Month’s rent $ 5. Utility Deposits and Payments $ 6. Moving Costs $ 7. Housing Search and Placement $ 8. Housing Stability $ 9. Case Management $ 10. Landlord-tenant Mediation $ 11. Tenant Legal Services $ 12. Credit Repair $

13. Short- and/or medium-term rental assistance

Total Homelessness Prevention $

Rapid Re-Housing - Housing relocation and stabilization services and short-and/or medium-term rental assistance as necessary to help individuals or families living in shelters or in places not meant for human habitation move as quickly as possible into permanent housing and achieve stability in that housing.

1. Utilities $ 2. Rental Application Fees $ 3. Security Deposits $ 4. Last Month’s Rent $ 5. Utility Deposits and Payments $ 6. Moving Costs $ 7. Housing Search and Placement $ 8. Housing Stability Case Management $ 9. Landlord-tenant Mediation $ 10. Tenant Legal Services $ 11. Credit Repair $ 12. Short- and/or medium-term rental assistance

Total Rapid Re-housing $ 5. Data Collection (HMIS) - Funds to pay the costs for contributing data to the HMIS designated by the Continuum of Care for the area.

1. Computer hardware $ 2. Computer software or equipment $ 3. Technical Support $ 4. Office Space $ 5. Salaries of operators $ 6. Staff Training Costs $ 7. Participation Fees $ Total Data Collection $

Grand Total All Categories $

9. Please list your sources of non-ESG match. A minimum of one-for-one cash match of total

funding requested is required. Identify all sources of non-federal match funds and include supporting documentation. Include letters of intent, award notices, verification letters, and other credible evidence of funding. Provide copies of all written grant agreements with this application if available. All applicants who are awarded 2015 ESG funds prior to other funding awards, must submit documentation to the issuing office at the time any such award may occur. (Attach supporting documentation as attachment #2) (5 points possible)

Section 5.2 General Program Information Provide a written narrative of no more than two (2) printed pages, answering the following specific questions.

1. Describe the responsibilities and qualifications, if part of the grant proposal, of each staff person funded with ESG funds (indicate whether volunteer or salary). Identify the staff titles, hourly wage, fringe breakdown, and distribution across funding sources (if applicable)

2. Is the facility barrier-free? If so, how many accessible units are there?

3. Specify any needed minor renovations/rehabilitation, extent of modifications and approximate costs (please identify the funding source).

4. Provide your organization’s intake policy, including process, eligibility, and service determination.

5. Describe how your organization's program activities are incorporating the Continuum of Care approach into its provision of services.

6. Describe your agency’s coordination with programs and other community agencies in the provision of client services, and the benefits of such linkages: i.e., share van with "HELP Inc.," to provide transportation to client appointments which reduces the cost of service.

7. Identify staff or other person(s) responsible for maintaining fiscal records. If someone provides bookkeeping other than agency staff, i.e., board treasurer, indicate that person's experience or preparation for such responsibility.

8. Describe the systems used for client record keeping and statistical reporting.

9. Describe how client confidentiality is maintained.

10. Describe your organization’s ongoing monitoring system for program and staff evaluation. 11. Outline the capacity and experience of your agency with similar populations and/or programs

(15 points possible)

12. Outline your procedures for follow-up services.

13. Describe your agency's HMIS process for collecting and reporting demographic data on clients who will be provided services under an ESG award

Section 6.0 Organizational Required Attachments 1. Provide a copy of your agency’s IRS 501(c) designation (attachment 3) 2. Provide a copy of the insurance certificate indicating coverage for the structure where services

and/or shelter is provided (attachment 4) 3. Provide copy of the insurance certificate detailing the agency’s liability, fidelity bonding coverage,

workmen’s compensation, and auto insurance for the agency as applicable (attachment 5) 4. Attach any written agreements that document the coordination/collaboration efforts of your

agency with others (attachment 6) 5. Attach a copy of your agency’s organizational chart (attachment 7) 6. Attach a copy of job descriptions for each staff person, volunteer or salary, included in this grant

proposal (attachment 8) 7. Attach a copy of your agency’s latest audit summary including management letter (attachment 9) 8. Complete and sign and attach the enclosed Minimum Requirements for ESG Applicants

(attachment 10) 9. Complete, sign, and attach a copy of the enclosed Emergency Solutions Grant Program

Certifications by the Authorized Agency Official (attachment 11) 10. Provide Agency Discharge Coordination Policy - sample is enclosed (attachment 12) 11. Attach copy of resolution approved by Board of Directors or other legal entity identifying

authorized signatory for the agency (attachment 13) 12. Attach copy of current Financial 990 Report (attachment 14) 13. Attach a copy of your agency’s most recent program evaluation report (attachment 15)

Minimum Requirements for Emergency Solutions Grant Applicants (attachment 10) An emergency shelter provides crisis relief for the homeless on a daily basis with no fee or religious participation required. It provides the basic needs of a place to sleep, humane care, reasonable security, safety, and referrals to other agencies. The following requirements are categorized as Essential (E) or Desirable (D). A shelter will comply 100% with the essential requirements and 70% with the desirable requirements. In order to receive funds, shelters will be asked to answer “YES” or “NO” to the following statements, and to sign their responses. Administration

E 1.

Our Agency has 501(c) IRS designation or is a governmental agency.

Yes �

No �

E 2.

Our Agency shall provide a policy statement which includes our shelter’s purpose(s), population served, program(s) description, shelter criteria and non-discrimination policy. Our shelter does not require religious participation, and does not discriminate on the basis of race, religion, or natural origin.

Yes �

No �

D 3. Our agency has an organizational chart delineating the administrative responsibilities of all persons working in the shelter.

Yes �

No �

D 4. Our agency has space designated for securing all documents in order to ensure client confidentiality.

Yes �

No �

E 5. Our agency, on an annual basis, conducts an evaluation of our services to determine program effectiveness.

Yes �

No �

Personnel

E 1. Our agency has enough adequately trained on-staff persons (paid or volunteer) to meet the needs of residents, and insure the safety of the facility during all hours the facility is open to residents. (A recommended ratio during awake hours should be 1 staff to 50 residents for an adults-only facility, and 1 staff to 25 residents for a facility housing children.

Yes �

No �

E 2. Our agency’s staff has received ongoing in-service training in counseling skills, handling tensions in a non-violent manner, emergency assistance, skills, etc.

Yes �

No �

D 3. Our agency has a written position description for each type of position, which includes (at a minimum) job responsibilities, qualifications and salary range.

Yes �

No �

D 4. Our agency has written personnel policies in effect which include, at least, a Code of Ethics for all of our personnel.

Yes �

No �

D 5. Our agency’s staff has been trained in emergency evacuation, first aid procedures, and CPR procedures.

Yes �

No �

D 6. Our agency has an organized method of selecting and training all volunteers. In addition, volunteers have job descriptions and identifiable lines of authority.

Yes �

No �

Fiscal Management

E 1. Our agency carries out fiscal activities, which are consistent with sound financial practices based upon our last audit.

Yes �

No �

E 2. Our agency has records of accountability for any client’s funds or valuables we are holding or managing.

Yes �

No �

D 3. Our agency has received an independent audit and will make available all financial records as may be required.

Yes �

No �

Procedures

E 1. Our agency has written policies for intake procedures and criteria for admitting people to our shelter.

Yes �

No �

E 2. Our agency keeps a daily office log which documents the activities of each shift, and any unusual or special situations and instructions regarding special clients (such as children, medicine, illness, etc.).

Yes �

No �

E 3. Our agency maintains an attendance list which includes at least the name, age, and sex of all persons residing at our agency

Yes �

No �

D 4. Our agency reads to all residents our house rules, regulations, and disciplinary procedures; asks residents to sign a copy, and/or post a copy in a conspicuous place.

Yes �

No �

D 5. Our agency refers people to the appropriate shelter or agency if we cannot provide shelter.

Yes �

No �

D 6. Our agency provides all residents with a one-page handout which summarizes our program and, when needed, the handout is read to and explained to the clients.

Yes �

No �

Medical

E 1. Our agency has available at all times first aid equipment and supplies in case of medical emergency.

Yes �

No �

E 2. Our agency has at least one staff person on duty that is trained in emergency first aid procedures.

Yes �

No �

E 3. Our agency has a written policy regarding the possession and use of controlled substances, prescription medicine and over-the-counter medication.

Yes �

No �

D 4. Our on-duty agency staff has available the 911 phone. Our agency’s staff relies on EMT personnel or a physician to determine medical status.

Yes �

No �

Food Service

E 1. (For agencies that provide food service): Our agency has made adequate provision for sanitary storage and preparation of food.

Yes �

No �

E 2. (For agencies which serve infants, young children, or pregnant women): Our agency has made provision to meet their nutritional requirements.

Yes �

No �

D 3. (For agencies which do not provide food services): Our agency has a nearby food system available for our residents.

Yes �

No �

Safety

E 1. Our agency has a fire safety plan, including a fire detection system.

Yes �

No �

E 2. Our agency has an emergency evacuation plan posted. Yes �

No �

E 3. Our agency has an office phone to contact fire, emergency squad or police.

Yes �

No �

Equipment and Environment

E 1. Our agency has a housekeeping and maintenance plan.

Yes �

No �

E 2. Our agency provides each person with at least a crib or bed with linen or a mat.

Yes �

No �

E 3. Our agency has adequate ventilation and heating system.

Yes �

No �

E 4. Our agency is clean and in good repair.

Yes �

No �

E 5. Our agency has adequate toilets, wash basins and shower facilities for men and women.

Yes �

No �

D 6. Our agency has reasonable access to public transportation.

Yes �

No �

D 7. Our agency has private space in which to meet with individual residents.

Yes �

No �

D 8. Our agency has laundry facilities available to residents or access to laundry facilities nearby.

Yes �

No �

D 9. Our agency has secure storage for checking in/out residents’ personal belonging.

Yes �

No �

Signature of Authorized Agency Official Date: __________________________________________________ _______________

Emergency Solutions Grant Program Certifications by the Authorized Agency Official (attachment 11) I _______________________, Chief Executive Officer / Director of ______________________ certify that ____________________ will ensure the provisions of the matching supplemental funds required by the regulation 24 CFR 576.71. I further certify that _______________________ will comply with: 1. The requirements of 24 CFR 576.21(a) (4)(ii) providing that the funding of homeless prevention

activities for families that have received eviction notices or notices of termination of utility services will meet the requirements that (A) the inability of the family to make the required payments must be the result of a sudden reduction of income; (B) the assistance must be necessary to avoid eviction of the family or termination of the services to the family; (C) there must be a reasonable prospect that the family will be able to resume payments within a reasonable period of time; and (D) the assistance must not supplant funding for preexisting homeless prevention activities from any other source.

2. The requirements of 24 CFR 576.23 concerning the requirements that organizations that

participate in the ESG Program shall not, in providing program assistance, discriminate against a program beneficiary or prospective program beneficiary on the basis of religion or religious belief. Further, organizations that are directly funded under the ESG Program may not engage in inherently religious activities, such as worship, religious instruction, or proselytization as part of the programs or services funded under the ESG Program.

3. The requirements of 24 CFR 576.51(b) (2) (v) concerning the funding of emergency shelter in the

hotels or motels of commercial facilities providing transient housing. 4. The requirements of 24 CFR 576.73 concerning the continued use of buildings for which

Emergency Solutions Grant are used for rehabilitation or conversion of buildings for use as emergency shelters for the homeless; or when funds are used solely for operating costs or essential services, concerning the population to be served.

5. The building standards requirement 24 CFR 576.75; 6. The requirement of 24 CFR 576.77, concerning assistance to the homeless; and 7. The requirements of 24 CFR 576.79, other appropriate provisions of 24 CFR Part 576, and other

applicable Federal laws concerning nondiscrimination and equal opportunity. 8. The requirement of 24 CFR 576.80 concerning the Uniform Relocation Assistance and Real

Property Acquisition Policies Act of 1970. 9. The requirement of 24 CFR 576.80 concerning minimizing the displacement of persons as a result

of a project assisted with these funds. 10. The requirement of 24 CFR Part 24 concerning the Drug Free Workplace Act of 1988. 11. The requirement of the National Affordable Housing Act (Pub. L. 101-625, November 28, 1990)

contained in Section 832 (e) (2) (c) that grantees develop and implement procedures to ensure

the confidentiality of records pertaining to any individual provided family violence prevention or treatment services under any project assisted” under the Emergency Solutions Grant Program and “that the address or location of any family violence shelter project assisted” under the Emergency Solutions Grant Program “will, except with written authorization of the person or persons responsible for the operation of such shelter, not be made public.”

12. The requirement that recipients involve, to the maximum extent practicable, homeless individuals

and families in constructing, renovating, maintaining, and operating facilities assisted under the ESG program, and in providing services for occupants of these facilities (42 U.S.C. 1375 (c) (7), as added by Section 1402(b) of the Housing and Community Development Act of 1992).

I further certify that ______________________ will comply with the provisions of, and regulations and procedures applicable under, Section 104(g) of the Housing and Community Development Act of 1974 with respect to the environmental review responsibilities under the National Environmental Policy Act of 1969 and related authorities as specified in 24 CFR Part 58. I further certify that the submission of an application for any Emergency Solutions Grant is authorized under State and/or local law and that _____________________, possesses legal authority to carry out Emergency Solutions Grant activities in accordance with applicable law and regulations of the Department of Housing and Urban Development. ______________________________ Name and Title ________________________________ Signature of Authorized Agency Official ______________________________ Date

SAMPLE DISCHARGE COORDINATION POLICY (Please provide your Agency’s policy as Attachment 12)

I hereby certify that if _________________________________________________________ (organization name) project(s) are selected for funding as a result of this application process, we will coordinate and integrate our homeless program with other mainstream health, housing, social services, and employment programs for which homeless populations may be eligible, including, but not limited to Medicaid, Medicare, Children’s' health insurance programs, Temporary Assistance for Needy Families, Food Programs, Supplemental Security Income, Workforce Investment Act and Veterans' Programs and Services. Further, as a condition for any funding received as a result of this application process, our organization agrees to develop and implement, to the maximum extent practicable and where appropriate, policies and protocols for the discharge of persons from publicly funded institutions or systems of care (such as health care facilities, foster care or other youth facilities, physical and mental healthcare facilities, emergency shelters, or correction programs and institutions) in order to prevent such discharge from immediately resulting in homelessness for such persons. ________________________________ Signature of Authorized Agency Official ________________________________ Title ________________________________ Date

OMB APPROVAL NO. 1121-0188EXPIRES 5-98 (Rev. 1/97)

Budget Detail WorksheetPurpose: The Budget Detail Worksheet may be used as a guide to assist you in the preparation ofthe budget and budget narrative. You may submit the budget and budget narrative using this form or inthe format of your choice (plain sheets, your own form, or a variation of this form). However, allrequired information (including the budget narrative) must be provided. Any category of expense notapplicable to your budget may be deleted.

A. Personnel - List each position by title and name of employee, if available. Show the annualsalary rate and the percentage of time to be devoted to the project. Compensation paid for employeesengaged in grant activities must be consistent with that paid for similar work within the applicantorganization.

Name/Position Computation Cost

SUB-TOTAL__________

B. Fringe Benefits - Fringe benefits should be based on actual known costs or an establishedformula. Fringe benefits are for the personnel listed in budget category (A) and only for thepercentage of time devoted to the project. Fringe benefits on overtime hours are limited to FICA,Workman’s Compensation, and Unemployment Compensation.

Name/Position Computation Cost

SUB-TOTAL__________

Total Personnel & Fringe Benefits__________

OJP FORM 7150/1 (5-95)

C. Travel - Itemize travel expenses of project personnel by purpose (e.g., staff to training, fieldinterviews, advisory group meeting, etc.). Show the basis of computation (e.g., six people to 3-daytraining at $X airfare, $X lodging, $X subsistence). In training projects, travel and meals for traineesshould be listed separately. Show the number of trainees and the unit costs involved. Identify thelocation of travel, if known. Indicate source of Travel Policies applied, Applicant or Federal TravelRegulations.

Purpose of Travel Location Item Computation Cost

TOTAL__________

D. Equipment - List non-expendable items that are to be purchased. Non-expendable equipmentis tangible property having a useful life of more than two years and an acquisition cost of $5,000 ormore per unit. (Note: Organization’s own capitalization policy may be used for items costing less than$5,000). Expendable items should be included either in the “supplies” category or in the “Other”category. Applicants should analyze the cost benefits of purchasing versus leasing equipment, espe-cially high cost items and those subject to rapid technical advances. Rented or leased equipment costsshould be listed in the “Contractual” category. Explain how the equipment is necessary for the successof the project. Attach a narrative describing the procurement method to be used.

Item Computation Cost

TOTAL__________

E. Supplies - List items by type (office supplies, postage, training materials, copying paper, andexpendable equipment items costing less that $5,000, such as books, hand held tape recorders) andshow the basis for computation. (Note: Organization’s own capitalization policy may be used foritems costing less than $5,000). Generally, supplies include any materials that are expendable orconsumed during the course of the project.

Supply Items Computation Cost

TOTAL__________

F. Construction - As a rule, construction costs are not allowable. In some cases, minor repairs orrenovations may be allowable. Check with the program office before budgeting funds in thiscategory.

Purpose Description of Work Cost

TOTAL__________

G. Consultants/Contracts - Indicate whether applicant’s formal, written Procurement Policy orthe Federal Acquisition Regulations are followed.

Consultant Fees: For each consultant enter the name, if known, service to be provided, hourly or dailyfee (8-hour day), and estimated time on the project. Consultant fees in excess of $450 per day requireadditional justification and prior approval from OJP.

Name of Consultant Service Provided Computation Cost

Subtotal__________

Consultant Expenses: List all expenses to be paid from the grant to the individual consultants inaddition to their fees (i.e., travel, meals, lodging, etc.)

Item Location Computation Cost

Subtotal__________

Contracts: Provide a description of the product or service to be procured by contract and an estimateof the cost. Applicants are encouraged to promote free and open competition in awarding contracts.A separate justification must be provided for sole source contracts in excess of $100,000.

Item Cost

Subtotal__________

TOTAL__________

H. Other Costs - List items (e.g., rent, reproduction, telephone, janitorial or security services,and investigative or confidential funds) by major type and the basis of the computation. For example,provide the square footage and the cost per square foot for rent, or provide a monthly rental cost andhow many months to rent.

Description Computation Cost

TOTAL__________

I. Indirect Costs - Indirect costs are allowed only if the applicant has a Federally approved indirectcost rate. A copy of the rate approval, (a fully executed, negotiated agreement), must be attached. Ifthe applicant does not have an approved rate, one can be requested by contacting the applicant’scognizant Federal agency, which will review all documentation and approve a rate for the applicantorganization, or if the applicant’s accounting system permits, costs may be allocated in the direct costscategories.

Description Computation Cost

TOTAL__________

Budget Summary- When you have completed the budget worksheet, transfer the totals for eachcategory to the spaces below. Compute the total direct costs and the total project costs. Indicate theamount of Federal requested and the amount of non-Federal funds that will support the project.

Budget Category Amount

A. Personnel ___________

B. Fringe Benefits ___________

C. Travel ___________

D. Equipment ___________

E. Supplies ___________

F. Construction ___________

G. Consultants/Contracts ___________

H. Other ___________

Total Direct Costs ___________

I. Indirect Costs

TOTAL PROJECT COSTS ___________

Federal Request ___________

Non-Federal Amount ___________

Sample Budget DetailWorksheet

S A M P L E

OMB APPROVAL NO. 1121-0188EXPIRES 5-98 (Rev. 1/97)

Budget Detail WorksheetPurpose: The Budget Detail Worksheet may be used as a guide to assist you in the preparation ofthe budget and budget narrative. You may submit the budget and budget narrative using this form or inthe format of your choice (plain sheets, your own form, or a variation of this form). However, allrequired information (including the budget narrative) must be provided. Any category of expense notapplicable to your budget may be deleted.

A. Personnel - List each position by title and name of employee, if available. Show the annualsalary rate and the percentage of time to be devoted to the project. Compensation paid for employeesengaged in grant activities must be consistent with that paid for similar work within the applicantorganization.

Name/Position Computation Cost

John Smith, Investigator ($50,000 x 100%) $50,0002 Investigators ($50,000 x 100% x 2) $100,000Secretary ($30,000 x 50%) $15,000Cost of living increase ($165,000 x 2% x .5 yr.) $1,650Overtime per investigator ($37.50/hr. x 100 hrs. x 3) $11,250

The three investigators will be assigned exclusively to homicide investigations. A 2% cost of living adjustment isscheduled for all full-time personnel 6 months prior to the end of the grant. Overtime will be needed during someinvestigations. A half-time secretary will prepare reports and provide other support to the unit.

TOTAL $177,900

B. Fringe Benefits - Fringe benefits should be based on actual known costs or an establishedformula. Fringe benefits are for the personnel listed in budget category (A) and only for thepercentage of time devoted to the project. Fringe benefits on overtime hours are limited to FICA,Workman’s Compensation, and Unemployment Compensation.

Name/Position Computation Cost

Employer’s FICA ($177,900 x 7.65%) $13,609Retirement *($166,650 x 6%) $9,999Uniform Allowance ($50/mo. x 12 mo. x 3) $1,800Health Insurance *($166,650 x 12%) $19,998Workman’s Compensation ($177,900 x 1%) $1,779Unemployment Compensation ($177,900 x 1%) $1,779*($177,900 less $11,250)

TOTAL $48,964Total Personnel & Fringe Benefits $226,864

OJP FORM 7150/1 (5-95)

S A M P L E

C. Travel - Itemize travel expenses of project personnel by purpose (e.g., staff to training, fieldinterviews, advisory group meeting, etc.). Show the basis of computation (e.g., six people to 3-daytraining at $X airfare, $X lodging, $X subsistence). In training projects, travel and meals for traineesshould be listed separately. Show the number of trainees and the unit costs involved. Identify thelocation of travel, if known. Indicate source of Travel Policies applied, Applicant or Federal TravelRegulations.

Purpose of Travel Location Item Computation Cost

Training Boston Airfare ($150 x 2 people x 2 trips) $600Hotel ($75/night x 2 x 2 people

x 2 trips) $600Meals ($35/day x 3 days x 2 people

x 2 trips) $420Investigations New York City Airfare ($600 average x 7) $4,200

Hotel and Meals ($100/day average x 7 x 3 days) $2,100

Two of the investigators will attend training on forensic evidence gathering in Boston in October and January. Theinvestigators may take up to seven trips to New York City to follow up investigative leads. Travel estimates are basedon applicant’s formal written travel policy.

TOTAL $7,920

D. Equipment - List non-expendable items that are to be purchased. Non-expendable equipmentis tangible property having a useful life of more than two years and an acquisition cost of $5,000 ormore per unit. (Note: Organization’s own capitalization policy may be used for items costing lessthan $5,000). Expendable items should be included either in the “supplies” category or in the “Other”category. Applicants should analyze the cost benefits of purchasing versus leasing equipment, espe-cially high cost items and those subject to rapid technical advances. Rented or leased equipment costsshould be listed in the “Contractual” category. Explain how the equipment is necessary for the suc-cess of the project. Attach a narrative describing the procurement method to be used.

Item Computation Cost

3 - 486 Computer w/CD ROM ($2,000 x 3) $6,000Video Camera $1,000 $1,000

The computers will be used by the investigators to analyze case and intelligence information. The camera will be usedfor investigative and crime scene work.

TOTAL $7,000

S A M P L E

E. Supplies - List items by type (office supplies, postage, training materials, copying paper, andexpendable equipment items costing less that $5,000, such as books, hand held tape recorders) andshow the basis for computation. (Note: Organization’s own capitalization policy may be used foritems costing less than $5,000). Generally, supplies include any materials that are expendable orconsumed during the course of the project.

Supply Items Computation Cost

Office Supplies ($50/mo. x 12 mo.) $600Postage ($20/mo. x 12 mo.) $240Training Materials ($2/set x 500 sets) $1,000

Office supplies and postage are needed for general operation of the program. Training materials will be developed andused by the investigators to train patrol officers how to preserve crime scene evidence.

TOTAL $1,840

F. Construction - As a rule, construction costs are not allowable. In some cases, minor repairs orrenovations may be allowable. Check with the program office before budgeting funds in thiscategory.

Purpose Description of Work Cost

Renovation Add walls $5,000Build work tables $3,000Build evidence storage units $2,000

The renovations are needed to upgrade the forensic lab used to analyze evidence for homicide cases.

TOTAL $10,000

S A M P L E

G. Consultants/Contracts - Indicate whether applicant’s formal, written Procurement Policy orthe Federal Acquisition Regulations are followed.

Consultant Fees: For each consultant enter the name, if known, service to be provided, hourly or dailyfee (8-hour day), and estimated time on the project. Consultant fees in excess of $250 per day requireadditional justification and prior approval from OJP.

Name of Consultant Service Provided Computation Cost

John Doe Forensic Specialist ($150/day x 30 days) $4,500

John Doe, Forensic Specialist, will be hired, as needed, to assist with the analysis of evidence in homicide cases.

Subtotal $4,500

Consultant Expenses: List all expenses to be paid from the grant to the individual consultants inaddition to their fees (i.e., travel, meals, lodging, etc.)

Item Location Computation Cost

Airfare Miami ($400 x 6 trips) $2,400Hotel and Meals ($100/day x 30 days) $3,000

John Doe is expected to make up to 6 trips to Miami to consult on homicide cases.

Subtotal $5,400

Contracts: Provide a description of the product or service to be procured by contract and an estimateof the cost. Applicants are encouraged to promote free and open competition in awarding contracts.A separate justification must be provided for sole source contracts in excess of $100,000.

Item Cost

Intelligence System Development $102,000

The State University will design an intelligence system to be used in homicide investigations. A sole source justificationis attached. Procurement Policy is based on the Federal Acquisition Regulation.

Subtotal $102,000

TOTAL $ 111,900

S A M P L E

H. Other Costs - List items (e.g., rent, reproduction, telephone, janitorial or security services,and investigative or confidential funds) by major type and the basis of the computation. For example,provide the square footage and the cost per square foot for rent, or provide a monthly rental cost andhow many months to rent.

Description Computation Cost

Rent (700 sq. ft. x $15/sq. ft.)($875/mo. x 12 mo.) $10,500

This rent will pay for space for the new homicide unit. No space is currently available in city-owned buildings.

Telephone ($100/mo. x 12 mo.) $1,200Printing/Reproduction ($150/mo. x 12 mo.) $1,800

TOTAL $13,500

I. Indirect Costs - Indirect costs are allowed only if the applicant has a Federally approved indirectcost rate. A copy of the rate approval, (a fully executed, negotiated agreement), must be attached. Ifthe applicant does not have an approved rate, one can be requested by contacting the applicant’scognizant Federal agency, which will review all documentation and approve a rate for the applicantorganization, or if the applicant’s accounting system permits, costs may be allocated in the direct costscategories.

Description Computation Cost

10% of personnel and ($226,864 x 10%) $22,686fringe benefits

The indirect cost rate was approved by the Department of Transportation, the applicant’s cognizant Federal agency,on January 1, 1994. (A copy of the fully executed, negotiated agreement is attached.)

TOTAL $22,686

S A M P L E

Budget Summary- When you have completed the budget worksheet, transfer the totals for eachcategory to the spaces below. Compute the total direct costs and the total project costs. Indicate theamount of Federal requested and the amount of non-Federal funds that will support the project.

Budget Category Amount

A. Personnel $177,900

B. Fringe Benefits $48,964

C. Travel $7,920

D. Equipment $7,000

E. Supplies $1,840

F. Construction $10,000

G. Consultants/Contracts $111,900

H. Other $13,500

Total Direct Costs $379,024

I. Indirect Costs $22,686

TOTAL PROJECT COSTS $401,710

Federal Request $301,283

Non-Federal Amount $100,427

To receive federal grant funds, it is necessary for organizations to submit a certification of the adequacy of their accounting system. This certification must be completed by an Independent Certified Public Accountant.

On behalf of , I hereby certify that the

accounting system for the above organization is adequate to manage federal grant funds in accordance with generally accepted accounting principles and standards set forth in the U.S. Office of Management and Budget (OMB) Circular A-102.

Signed:Independent CPA Date

Firm Name

Address

City, State, Zip Code

ACCOUNTING CERTIFICATION

Organization Name