Joint Federal Emergency Solutions Grant andCalifornia Emergency Solutions Grant Program

2017 ApplicationFor the Continuum of Care Allocation

State of CaliforniaGovernor Edmund G. Brown Jr.

Alexis Podesta, SecretaryBusiness, Consumer Services and Housing Agency

Ben Metcalf, DirectorDepartment of Housing and Community Development

NOFA Section, ESG Program2020 West El Camino Avenue, Suite 500, Sacramento, CA 95833

ESG Program Email: ESG@hcd.ca.gov

FINAL FILING DATE: SEPTEMBER 1, 2017, 5:00 P.M.

TABLE OF CONTENTS

GENERAL INSTRUCTIONS 3APPLICATION FORMS CHECKLIST 4FORM I: AWARD PACKAGE 5FORM II: APPLICANT CONTACT INFORMATION 6FORM III: CONTINUUM OF CARE CONTACT INFORMATION 7FORM IV: LEGISLATIVE AND CONGRESSIONAL INFORMATION 8FORM V: BUDGET WORKBOOK 9FORM VI: CERTIFICATE OF INDIRECT COSTS 10FORM VII: PAYEE DATA RECORD 11FORM VIII: PROJECTED OUTCOMES 12FORM IX: GOVERNING BOARD AUTHORIZING RESOLUTION 13FORM X: ADMINISTRATIVE ENTITY (AE) COMPLIANCE CERTIFICATION 17

GENERAL INSTRUCTIONS

This application is subject to the Emergency Solutions Grants (ESG) Program federal regulations established by the U.S. Department of Housing and Urban Development (HUD), 24 Code of Federal Regulations (CFR), Parts 91 and 576, as well as 25 California Code of Regulations (CCR), Section 8400 et seq and the California Emergency Solutions Grant (CA ESG) Program guidelines.

A. Please read the ESG 2017 Notice of Funding Availability (NOFA) for the Continuum of Care (CoC) Allocation, as well as the federal and State ESG regulations and CA ESG program guidelines cited above.

B. Application Submittal : Submit one original (hard copy) application with wet, original signatures in a 3-Ring Binder with pockets, and one USB flash drive that includes a copy of the application with signatures. Applicants are required to submit Application Forms I to X; each section should have an individual tab in the submitted 3-Ring Binder.

Application forms and the budget workbook for the CoC Allocation are available on-line to download at:http://www.hcd.ca.gov/grants-funding/active-funding/esg.shtml.

Application forms including the budget workbook must be submitted no later than 5:00 p.m. Pacific Standard Time on September 1, 2017. Application forms not submitted by deadline will result in a denial of funds to your CoC Service Area. AEs are responsible for ensuring that all required materials are submitted by the deadline. The Department of Housing and Community Development (HCD) will not grant any extensions.

C. All HCD funding decisions are final.

Department of Housing and Community Development ESG Application - CoC Allocation

APPLICATION FORMS CHECKLIST

The checklist below summarizes the application forms required to be submitted in order to receive a funding allocation. Application forms not submitted to HCD by September 1, 2017 will result in a denial of funds to your CoC Service Area. HCD will not grant any extensions.

Form I Award Package

Form II Applicant Contact Information

Form III Continuum of Care Contact Information

Form IV Legislative and Congressional Information

Form V Budget Workbook

Form VI Certificate of Indirect Costs

Form VII Payee Data Record

Form VIII Projected Outcomes

Form IX Governing Board Authorizing Resolution

Form X Administrative Entity Compliance Certification

Department of Housing and Community Development 4 ESG Application - CoC Allocation

FORM I: AWARD PACKAGE

In order to document that your provider selection process meets ESG requirements, please submit the following:

DOCU

MEN

TS

ATTA

CHED AWARD PACKAGE DOCUMENTS

DUE BY SEPTEMBER 1, 2017

A letter which describes your provider selection process, and certifies that this process meets the requirements at 25 CCR Section 8403 (g).

The applicant ranking list which shows for each application recommended for funding:

A. The applicant name and address;B. Project name and address;C. Proposed activities and any proposed subpopulation targeting with ESG

funds;D. City(ies) and county(ies) where proposed activities will be provided; and, E. Dollar amounts recommended for funding by activity. Please breakout

HMIS and CES amounts by activity if applicable.

For each application not recommended for funding:

A. The applicant name and address; B. Project name and address;C. Proposed subpopulation targeting with ESG funds; D. City(ies) and county(ies) where the activities were proposed; and, E. Dollar amounts requested by activity.

All documents, forms and certifications listed in the Application.

Department of Housing and Community Development 5 ESG Application - CoC Allocation

FORM II: APPLICANT CONTACT INFORMATION

Note: Name of applicant must be the same as stated in the Board Resolution and Payee Data Record.

Name of the Unit of General Purpose Local Government      County:     

Federal Tax ID Number (EIN):     

Address:      

Data Universal Numbering System (DUNS):     

City, State and Zip:     

Authorized Representative Information (Per Board Resolution attached to this application)

Last, Middle and First Names:          Mr. Mrs. Ms. Other      

Title:        Address:         

City, State and Zip:     

Phone No.:      

Fax No.:      

E-Mail Address:     

Administrative Fiscal Representative Information (i.e., CFO, Accountant/Bookkeeper)

Last, Middle and First Names:          Mr. Mrs. Ms. Other      

Title:        Address:         

City, State and Zip:     

Phone No.:     

Fax No.:      

E-Mail Address:     

Department of Housing and Community Development 6 ESG Application - CoC Allocation

FORM III: CONTINUUM OF CARE CONTACT INFORMATION

Provide information for the CoC where the applicant will provide assistance with the ESG funding requested in this application.

Continuum of Care (CoC) Name:         

CoC Contact: Last, First and Middle Names:         Mr. Mrs. Ms. Other      

Title:        

CoC No.:        

Address:         

City, State and Zip:     

Area Code / Phone No.: Fax No.:                 

E-Mail Address:     

CoC Homeless Management Information System (HMIS):         HMIS Software:         

HMIS Lead: Last, First & Middle Names:         Mr. Mrs. Ms. Other      

Title:        Address:         

City, State and Zip:     

Area Code / Phone No.: Fax No.:                 

E-Mail Address:     

Victim Service Provider Comparable Database Name (if applicable):         Contact: Last, First and Middle Names:         Mr. Mrs. Ms. Other      

Title:        Address:         

City, State and Zip:     

Area Code / Phone No.: Fax No.:                 

E-Mail Address:     

Legal Service Provider Comparable Database Name (if applicable):         Contact: Last, First and Middle Names:         Mr. Mrs. Ms. Other      

Title:        Address:         

City, State and Zip:     

Area Code / Phone No.: Fax No.:                 

E-Mail Address:     

Department of Housing and Community Development 7 ESG Application - CoC Allocation

FORM IV: LEGISLATIVE AND CONGRESSIONAL INFORMATION

Provide the Legislative and Congressional information for the applicant and each activity location, (if different than applicant location), included in this application. To locate or verify the Legislative and Congressional information, click on the respective links below and enter the applicant office location zip code, the activity location site zip code(s) (i.e., zip code(s) where activities are performed), and any additional activity location site(s), as applicable.

State Legislators: http://www.leginfo.ca.gov

U.S. House of Representatives: http://www.house.gov/

Applicant Office Location District # First Name Last NameState Assembly Member                  

State Senate Member                  

U.S. House of Representatives                  

Activity Location(s) – (if different from applicant location)

District # First Name Last Name

State Assembly Member                  

State Senate Member                  

U.S. House of Representatives                  

Activity Location(s) – (if different from applicant location)

District # First Name Last Name

State Assembly Member                  

State Senate Member                  

U.S. House of Representatives                  

Activity Location(s) – (if different from applicant location)

District # First Name Last Name

State Assembly Member                  

State Senate Member                  

U.S. House of Representatives                  

.

Department of Housing and Community Development 8 ESG Application - CoC Allocation

FORM V: BUDGET WORKBOOK

To Locate Budget Workbook:

Complete the Budget Workbook located on the HCD website at:http://www.hcd.ca.gov/grants-funding/active-funding/esg.shtml ;

Under the heading ESG NOFA for the Continuum of Care Allocation and Application Forms, locate the 2017 Budget Workbook.

Open the worksheet labeled Proposed ESG Budget and Match. Complete this worksheet for your total 2017 CoC allocation of ESG funds as instructed.

This worksheet must be submitted with the Application package.

Department of Housing and Community Development 9 ESG Application - CoC Allocation

FORM VI: CERTIFICATE OF INDIRECT COSTS

Will the applicant’s selected provider seek reimbursement for indirect costs for the 2017 ESG funds?

Yes No

I certify under penalty of perjury that:

(1) to the best of my knowledge and belief that the form is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of the ESG program. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and Title 31, Sections 3729-3730 and 3801-3812),

(2) If the applicant will allow their providers to seek reimbursement for indirect costs, the applicant must:

a. comply with all OMB requirements and standards including 2 CFR 200.403, 200.415, and Part 200 Appendix 4,

b. certify that any providers seeking reimbursement for indirect costs at the de minimis rate do not meet the definition of a major nonprofit organization as defined by OMB 2 CFR 200.414, and

c. maintain records including evidence of the Modified Total Direct Cost (MTDC) (2 CFR 200.68) calculations, indirect cost limits, and supporting documentation for actual direct cost billing. 

I further certify that I am aware that there are penalties for willfully and knowingly giving false information on an application for federal or State funds that may include immediate repayment of all federal or State funds received.  I understand that the information submitted is subject to verification by federal or State personnel as part of compliance monitoring. 

C E R T I F I C A T I O N O F I N D I R E C T C O S T S

The signee to this certification must be the Authorized Representative named in the Resolution

           PRINTED NAME OF AUTHORIZED REPRESENTATIVE TITLE

_________________________________________________AUTHORIZED REPRESENTATIVE SIGNATURE

      DATE

Department of Housing and Community Development 10 ESG Application - CoC Allocation

FORM VII: PAYEE DATA RECORD

To Locate Payee Data Record, STD 204 Form:

Complete the form located on the HCD website at:

http://www.hcd.ca.gov/grants-funding/nofas.shtml

This form must be submitted with the application package.

Department of Housing and Community Development 11 ESG Application - CoC Allocation

FORM VIII: PROJECTED OUTCOMES

Provide the projected performance data for each application recommended for funding. Emergency Shelter projects should provide the performance data in both Chart A and B.

Chart A:

Activity Projected Number of Persons Served

Projected Number of Households Served

Emergency Shelter            Street Outreach            Homelessness Prevention            Rapid Re-Housing            

Chart B - Emergency Shelter Projects Only:

Household:

A household is defined as an individual or a family that will be served during the duration of the grant. For projects that serve single individuals, the household is the same as the individual. For projects that serve couples, families with children, and other multi-person households, the household outcome should be based on the head of household.

Department of Housing and Community Development 12 ESG Application - CoC Allocation

Total Number of Cribs      

+ Total Number of Beds      

=Total Bed Capacity:      

FORM IX: GOVERNING BOARD AUTHORIZING RESOLUTION

Guidelines for Preparing the Resolution:Resolutions need to substantially conform to the attached Sample Resolution. Any changes to the attached language must be legally sufficient language approved by HCD.

Resolution Checklist:A. Resolution should be on official Administrative Entity letterhead.B. Resolution shows the date of the Board Action approving the Resolution. C. Generally, the Board Action must occur subsequent to the Department’s ESG NOFA

release date. Insert the date (or “projected to be released…”) of the Department’s ESG NOFA for the CoC Allocation in Paragraph A.

D. The exact wording of the sample Resolution is being used or HCD has approved alternative wording.

E. State the dollar amount being requested from the Department (e.g., in an amount not to exceed $ XXX,XXX).

F. Generally, at least one person, together with their title (or multiple persons, together with their titles), is (or are) authorized to sign the Standard Agreement and other documents referenced in the attached Sample Resolution. Note: The person authorized to sign the standard agreement cannot sign the Resolution, or attested the Resolution.

There are several options for entering name and title of authorized signor(s). However, the use of “and/or” is inherently ambiguous and is not acceptable. Below are acceptable options:

Option 1: Mr. Schultz, CEO and Charlie Brown, CEA

Option 2: Mr. Schultz, CEO or Charlie Brown, CEA

Option 3: Mr. Schultz, CEO, or designee(s). When choosing this option, if a delegation of authority will be made at some point by a named, authorized person, as a predicate to that delegation becoming effective, the Administrative Entity must provide an acceptable letter of delegation on official letterhead stating expressly both the name and title of the delegatee.

Department of Housing and Community Development 13 ESG Application - CoC Allocation

Option 4: Title of local government official. (It is acceptable for municipalities or other government localities to provide only the title of the person authorized to act on behalf of the entity. However, official supporting documentation demonstrating that the person currently holding this position will be required).

Note: Both the Name and Title of all Authorized Representatives (except as indicated in “Option 4” above) must be expressly provided in the Resolution. An Authorized Representative, expressly identified in the Resolution, must sign the Standard Agreement and other Program documents.

G. The actual vote must be shown on the Resolution: Ayes, Noes, Abstentions, Absent, and the affirmative Ayes must constitute a quorum and an acceptable majority, per the entity’s organizational documents. Indicate a “0” where no votes are cast.

Administrative Entities are encouraged to use the sample Authorizing Resolution format to avoid deficiencies that will require a new resolution. A deficiency may delay execution of the Standard Agreement and drawdown of ESG funds.

Department of Housing and Community Development 14 ESG Application - CoC Allocation

(Produce on AE Letterhead if applicable)

Insert Resolution Number:

   (Insert Name of State ESG Administrative Entity)    

AUTHORIZING RESOLUTION

   (Insert Name of State ESG Administrative Entity)    

[All, or a necessary quorum and majority] of [the directors, supervisors, members, council members, etc.] of [official name of entity, and type of entity: non-profit, county, municipality, etc.] (“State ESG Administrative Entity”) hereby consent to, adopt and ratify the following resolutions:

A. WHEREAS the State of California (the “State”), Department of Housing and Community Development (“Department”) issued a Notice of Funding Availability (NOFA) for the Continuum of Care Allocation dated (MM/DD/YYYY), under the Emergency Solutions Grants (ESG) Program (“Program”); and

B. WHEREAS   (Insert Name of State ESG Administrative Entity)     is an approved ESG Administrative Entity; and

C. WHEREAS the Department may approve funding allocations for the ESG Program, subject to the terms and conditions of the NOFA, Program guidelines and requirements, and the Standard Agreement and other contracts between Department and ESG grant recipients;

NOW THEREFORE BE IT RESOLVED THAT:

1. If    (Insert Name of State ESG Administrative Entity)     receives a grant of funds from the Department pursuant to a Department NOFA, it represents and certifies that it will use all such funds in a manner consistent and in compliance with all applicable state, federal, and other statutes, rules, regulations, guidelines and laws (“rules and laws”), including without limitation all rules and laws regarding the ESG Program, as well as any and all contracts    (Insert Name of State ESG Administrative Entity)     may have with the Department.

2.    (Insert Name of State ESG Administrative Entity)     is hereby authorized and directed to receive an ESG grant, in an amount not to exceed $ (Insert amount for CoC Service Area) in accordance with all rules and laws.

3.    (Insert Name of State ESG Administrative Entity)     hereby agrees to use the ESG funds for eligible activities as approved by the Department and in accordance with all Program requirements, and other rules and laws, as well as in a manner consistent and in compliance with the Standard Agreement and other contracts between the State ESG Administrative Entity and the Department.

Department of Housing and Community Development 15 ESG Application - CoC Allocation

4. (Insert and title of Authorized Signor(s)) [is/are] other signors may be included, as indicated in the checklist for preparing the resolution, and the term “or designees” may be included as well authorized to execute the Standard Agreement and any subsequent amendments or modifications thereto, as well as any other documents which are related to the Program or the ESG grant awarded to State ESG Administrative Entity, as the Department may deem appropriate.

PASSED AND ADOPTED at a regular meeting of the    (Insert Name of State ESG Administrative Entity)     this ____ day of __________, ____ by the following vote:

AYES: ____ ABSTENTIONS: ____

NOES: ____ ABSENT: ____

__________________________________Signature of Approving Officer

(Insert Name and Title of Approving Officer)Printed Name and Title of Approving Officer (Generally cannot be person authorized above or the Treasurer)

ATTEST: ________________________________ Signature

(Insert Name and Title of Attesting Officer)Printed Name and Title

Department of Housing and Community Development 16 ESG Application - CoC Allocation

FORM X: ADMINISTRATIVE ENTITY (AE) COMPLIANCE CERTIFICATION

On behalf of the    (Insert Name of State ESG Administrative Entity),     I certify that funding recommendations being made for use of ESG funds meet federal and State ESG requirements pursuant to 25 CCR Sections 8403, 8408, and 8409 and Sections 103, 108, and 109 of the CA ESG Guidelines.

The CoC used a process that meets the following requirements:

A. Is fair and open, and avoids conflicts of interest in project selection, implementation, and the administration of funds.

B. Considers the State application eligibility and rating criteria in the Department’s 2017 ESG NOFA for the BoS allocation.

C. Complies with the Core Practice requirements in 25 CCR 8408 and 8409 and the CA ESG Guidelines Section 109 .

D. Incorporates the performance standards set forth in the Department’s Annual Action Plan.

E. Complies with federal ESG and CA ESG requirements.

F. Considers any other practices promoted or required by HUD.

G. Ensures the funded homeless service provider will maintain documentation of satisfactory match pursuant to the requirements of 24 CFR 576.201.

A E C O M P L I A N C E C E R T I F I C A T I O N

           PRINTED NAME OF AUTHORIZED REPRESENTATIVETITLE

_________________________________________________AUTHORIZED REPRESENTATIVE SIGNATURE

      DATE

Department of Housing and Community Development 17 ESG Application - CoC Allocation