CITY OF POMONA
EMERGENCY SOLUTIONS GRANTS (ESG)
PROGRAM
HOMELESS ASSISTANCE PROGRAMS
REQUEST FOR PROPOSALS (RFP)
PROGRAM YEAR 2013-2014
APPLICATION PACKET
Mark Lazzaretto, Director
Community Development Department
505 South Garey Avenue
Box 660, Pomona, Ca 91769
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
TABLE OF CONTENTS
SECTION 1 – APPLICATION INTRODUCTION ..................................................................... 3
A. ESTIMATED AVAILABLE FUNDING .................................................................................. 4
B. ELIGIBILITY FOR APPLICATION ....................................................................................... 4
C. MANDATORY MATCH REQUIREMENTS ......................................................................... 5
D. MANDATORY TRAINING REQUIREMENTS ..................................................................... 6
SECTION 2 - ESG PROGRAM OVERVIEW ........................................................................... 7
A. AUTHORITY ....................................................................................................................... 7
B. DEFINITION OF HOMELESS ............................................................................................. 7
C. ELIGIBLE ACTIVITIES ....................................................................................................... 9
D. ESTIMATED FUNDING CAPS FOR EMERGENCY SOLUTIONS GRANTS (ESG) ....... 10
PROGRAM ............................................................................................................................ 10
E. INELIGIBLE ACTIVITIES ................................................................................................. 10
SECTION 3 - RFP APPLICATION AND SELECTION CRITERIA ........................................ 11
A.
RFP GENERAL APPLICATION REQUIREMENTS ....................................................... 11
B.
RFP EVALUATION - SELECTION CRITERIA ............................................................... 14
C.
RFP REVIEW AND APPEALS PROCESS .................................................................... 14
D.
BASIC INSTRUCTIONS FOR SUBMITTING A REQUEST FOR FUNDING ................. 15
E.
WORKSHOP ANNOUNCEMENT .................................................................................. 16
SECTION 4 - RFP APPLICATION PACKAGE...................................................................... 17
A.
APPLICATION COVER SHEET ..................................................................................... 18
B.
APPLICATION CHECKLIST .......................................................................................... 19
C.
APPLICATION................................................................................................................ 20
D.
PROGRAM BUDGET ..................................................................................................... 23
E.
BUDGET PROTOCAL .................................................................................................... 35
F.
MATCHING SHARE: ...................................................................................................... 38
G. PERFORMANCE MEASUREMENT SYSTEM AND OUTCOMES STATEMENT .......... 42
ATTACHMENT A: BOARD OF DIRECTORS AFFIDAVIT .................................................... 43
ATTACHMENT B: STATEMENT OF CERTIFICATIONS ...................................................... 44
ATTACHMENT C: OTHER FEDERAL REQUIREMENTS .................................................... 47
APPLICANT AGENCY _________________________________
1
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
ATTACHMENT D: STATEMENT OF CONFIDENTIALITY .................................................... 50
ATTACHMENT E: CERTIFICATION OF RELIGIOUS COMPLIANCE .................................. 51
ATTACHMENT F: APPEALS PROCESS FOR CLIENT TERMINATIONS ........................... 52
APPLICANT AGENCY _________________________________
2
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
SECTION 1 – APPLICATION INTRODUCTION
INVITATION TO APPLY
WEDNESDAY, JANUARY 23, 2013
NOTICE OF FUNDING AVAILABILITY
FOR
THE EMERGENCY SOLUTIONS GRANTS (ESG) PROGRAM
PROGRAM YEAR 2013-2014
The City of Pomona is seeking proposals from organizations with specific skills in providing
street outreach, emergency shelter, homeless prevention, or rapid re-housing to implement the
Emergency Solutions Grants components of the City's Continuum of Care System. Only
homeless provider organizations that meet the "Minimum Requirements" and "General Program
Requirements" (see Section 3 of application) will be considered at this time.
RFP AVAILABILITY:
The Request for Proposal (RFP) Application Packet will be available at 12:00 noon, January 23,
2013 at the following location:
PURCHASING DIVISION (basement)
505 SOUTH GAREY AVENUE
POMONA, CA 91766
City Hall hours of operation are: Monday – Thursday, 7:30 a.m. – 6:00 p.m.
City Hall is closed every Friday.
RFP WEB INFORMATION:
Visit our website at www.ci.pomona.ca.us and click on any one of the following links to access
and download the RFPS in word format:
www.ci.pomona.ca.us/index.php/businesses/current-bids-and-rfps
www.ci.pomona.ca.us/index.php/community-development-home/housing-division
www.ci.pomona.ca.us/index.php/government/city-departments/community-development
www.ci.pomona.ca.us/index.php/housing-division-home/homeless-services
The Purchasing Division must receive all completed submissions no later than:
4:00 p.m., Thursday, February 21, 2013
POMONA CITY HALL HOURS:
City Hall is open Monday – Thursday, 7:30 AM-6:00 PM. City Hall is closed every Friday.
APPLICANT AGENCY _________________________________
3
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
A. ESTIMATED AVAILABLE FUNDING
The total amount of ESG funds anticipated to be awarded to the City for Program Year 20132014 is $220,994. This amount is estimated and dependent on the amount ultimately awarded
by the Federal government. Eligible activities that have established funding limits or caps will be
adjusted in accordance with final awarded amount.
B. ELIGIBILITY FOR APPLICATION
The following eligibility criteria will be used in considering ESG applications for funding in
Program Year 2013-2014:
1. Only eligible project activities that meet the following will be considered:
a) Must meet City of Pomona’s strategic goals to end homelessness as outlined in
the City’s Consolidated Plan
b) Must be eligible under the definitions of the Homeless Emergency Assistance and
Rapid Transition to Housing (HEARTH) Act.
c) Under the HEARTH Act, must coordinate activities with the Continuum of Care
process to carry out ESG eligible activities.
d) Must demonstrate the capacity to participate in/and meet the performance and
reporting requirements under the Homeless Management Information System
(HMIS).
e) Strengthening the City's Continuum of Care by addressing gaps in residential and
non-residential services and/or ;
f) Developing and implementing a plan of homeless prevention that emphasizes
“housing stabilization”;
g) Goals and actions that specifically target chronic homeless, veterans, families with
children and unaccompanied youth;
h) Cultivate collaboration between the recipient agency and the Continuum of Care
process;
2. Projects that show collaborative effort with at least one other agency to provide stated
services.
APPLICANT AGENCY _________________________________
4
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
3. Projects from service providers that have at least two years experience in successfully
providing at least one of the following eligible Emergency Solutions Grant (ESG)
components:
a) Street Outreach serves unsheltered homeless persons.
Essential Services included in street outreach include: Engagement, Case
Management, Emergency health and mental health services, transportation and
services for special populations including homeless youth, homeless persons with
HIV/AIDS, and Homeless Victims of Domestic Violence, Sexual Violence and
Stalking.
b) Emergency Shelter serves people staying in emergency shelters.
Essential Services include case management, childcare, education, employment
and life skills services, legal services, health, mental health and substance abuse
services, transportation, and services for special populations. Operations include
maintenance, utilities, furniture, and food. Renovations include major rehab or
conversions.
c) Homeless Prevention activities are available to persons below 30% Area Median
Income (AMI) and are homeless or at risk of becoming homeless.
Homeless prevention assistance, including (but not limited to): can be used to
prevent and eligible individual or family from becoming homeless or to help and
individual or family regain stability in current housing or other permanent housing.
Eligible activities include housing relocation and stabilization services as well as
short and medium-term rental assistance.
d) Rapid Re-Housing is available to help those who are literally homeless move into
permanent housing and achieve housing stability. Activities include housing
relocation and stabilization services as well as short and medium term rental
assistance.
C. MANDATORY MATCH REQUIREMENTS
The Emergency Solutions Grants (ESG) Program requires a 100% matching grant equal to the
amount of the requested funds. All Applicants must provide documentation of the cash or in-kind
match with the RFP:
Funding Match: A 100% percent (100%) funding match is required. A nonprofit recipient
selected through this RFP process must provide this match, equal to the grant award.
APPLICANT AGENCY _________________________________
5
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
In calculating the amount of matching funds, a subrecipient may include the documented
value of any donated material or building, and the time and services contributed by
volunteers and staff to carry out a homeless services program or shelter, determined at
the rate of $5.00 per hour. The City’s Homeless Services Coordinator will determine the
value of any donated material or building, or any lease, using any method reasonably
calculated to establish a fair market value.
D. MANDATORY TRAINING REQUIREMENTS
An Applicant Technical Assistance Workshop will be held to provide an opportunity for all
potential applicants to ask questions about the overall Emergency Solutions Grant program,
evaluation criteria, Continuum of Care (CoC) strategies and ESG proposal process.
The workshop is mandatory for all agencies applying for funding, regardless of current of past
ESG funding.
TECHINICAL ASSISTANCE WORKSHOP:
A mandatory RFP Workshop will be held on Thursday, February 7, 2013, 11:00 a.m. – 1:00 p.m.,
at the City Council Chambers, 505 South Garey Avenue, Pomona, CA.
Please note: An Agency representative must be present at the workshop for the application to
qualify. One person cannot represent multiple agencies. RFP’s submitted by agencies that do
not attend the workshop will not be considered for funding and will be returned unopened
TECHNICAL ASSISTANCE
Please contact the City’s Homeless Services Coordinator, Jan Cicco at (909) 620-2571 if you
have any additional questions.
RFP SUBMISSIONS
Submit one (1) original plus two (2) copies (one with original signature and corporate seal) in a
sealed envelope with the words “ESG PROJECT 2013-2014” written on the envelope. Proposals
must not be bound or stapled; secure proposals with a binder clip. Number pages and label each
section with identifying tabs utilizing RFP section and paragraph titles.
THE CITY RESERVES THE RIGHT TO THE FOLLOWING:
1. Waive defects or irregularities in the presentation of an application.
2. Incomplete applications will not be processed unless the City grants a waiver, in writing.
3. Proposals that are disqualified will not be reviewed or evaluated by the RFP review team.
OTHER:
Questions regarding this notice may be directed to Jan Cicco at (909) 620-2571. Questions
regarding the City’s purchasing procedures should be referred to the Purchasing Division,
Kennie Nicomedie at (909) 620-2039.
APPLICANT AGENCY _________________________________
6
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
SECTION 2 - ESG PROGRAM OVERVIEW
A. AUTHORITY
The ESG Program was established by the McKinney – Vento Homeless Assistance
Amendments Act of 1987 (Public Law 100-628) and Section 832 of the 1990 Affordable Housing
Act (Public Law 101-625). This Program is governed by Title 24, Code of Federal Regulations
(CFR), Part 576. The Pomona City Council, in its capacity as a metropolitan City eligible for a
formula grant under the ESG regulations, has authorized participation as described in the City's
Comprehensive Housing Affordability Strategy.
HOMELESS ASSISTANCE REAUTHORIZATION
On May 20, 2009, Congress adopted S.896, The Homeless Emergency Assistance and Rapid
Transition to Housing (HEARTH) Act of 2009. The HEARTH Act amends and reauthorizes the
McKinney – Vento Homeless Assistance Act of 1987. On November 15, 2011, HUD released the
interim regulation for the new Emergency Solutions Grants (ESG) program and the
corresponding amendments to the Consolidated Plan regulations and published the final rule on
the definition of homelessness, which changed as legally defined in Public Law 100-628.
The HEARTH Act also consolidates HUD’s homeless assistance programs, created a Rural
Housing Stability Program; simplified match requirement; increased prevention resources; and,
increased the emphasis on performance by requiring participation in HMIS.
PREVENTION AND REHOUSING ASSISTANCE: The New Emergency Solutions Grant
ESG, formerly known as the “Emergency Shelter Grant” is renamed the “Emergency Solutions
Grant”, signifying a shift to funding homelessness prevention and re-housing, as well as
emergency shelter.
B. DEFINITION OF HOMELESS
On November 15, 2011, HUD published the final rule on the definition of homelessness, which
integrates the regulation for the definition of "homeless," and the corresponding recordkeeping
requirements, for the Emergency Solutions Grants program, the Shelter Plus Care program, and
the Supportive Housing Program.
The proposed rule was released and provided necessary clarification on terms within the
statutory definitions of "homeless," "homeless individual," "homeless person," and "homeless
individual with a disability" and contained proposed recordkeeping requirements designed to
assist communities appropriately document an individual or family's homeless status in the case
file.
APPLICANT AGENCY _________________________________
7
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
Only programs serving homeless persons or families as defined under HUD's Federal regulation
will be considered. A homeless person is defined under Federal regulations as:
1. Individuals and families who lack a fixed, regular, and adequate nighttime residence and
includes a subset for an individual who resided in an emergency shelter or a place not meant
for human habitation and who is living in an institution where he or she temporarily resided;
2. Individuals and families who will imminently lose their primary nighttime residence;
3. Unaccompanied youth and families with children and youth who are defined as homeless
under other federal statutes who do not otherwise qualify as homeless under this definition; and
4. Individuals and families who are fleeing, or are attempting to flee, domestic violence, dating
violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to
violence against the individual or a family member.
BACKGROUND AND FINAL RULES
The City is making available $220,994 in federal ESG funds to one or more providers of
homeless services in the City.
The ESG exists under the Homeless Emergency Assistance and Rapid Transition to Housing
(HEARTH ACT) of 2009, which consolidated three of the separate homeless assistance
programs, administered by HUD under the McKinney-Vento Homeless Assistance Act into a
single grant program, and revised the Emergency Shelter Grants program and renamed it as the
Emergency Solutions Grant program. The City is soliciting proposals from nonprofit providers of
homeless services that will effectively utilize all or part of the funds as subrecipients.
Once funds are awarded by the City, professional service agreements with homeless agencies
may be renewed for a second year, depending on future HUD funding levels and satisfactory
compliance with program regulations.
Major priorities for program year 2013-2014 are Homeless Prevention, Eviction Prevention and
Rapid Re-housing. The federal government has taken a very proactive stance in keeping
families housed, and also in trying to reduce the incidences of family homelessness.
Agencies participating in ESG or other HEARTH Act, McKinney Vento funding are encouraged to
seek ongoing education and guidance through www.HUDHRE.info and the HUD Help Desk
located on this site.
APPLICANT AGENCY _________________________________
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COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
CONTINUATION OF FUNDING
Pursuant to the terms of the grant agreement between the Department of Housing and Urban
Development (HUD) and the City of Pomona, implementation of the City's Continuum of Care
Plan will take place over a five-year period, with regular performance evaluations by HUD.
Continuation of funding for each year is contingent upon the satisfactory fulfillment of the stated
goals of the grant agreement with HUD and between the City and the subrecipients.
Organizations must expect to make a significant difference in breaking the cycle of
homelessness and hold to high standards of effort and accomplishment. Failure to achieve
contracted goals and comply with contract provisions will lead to potential de-obligation and
termination of funds to homeless providers unable to meet goals.
C. ELIGIBLE ACTIVITIES
a. Street Outreach
Essential Services related to reaching out to unsheltered homeless individuals and
families, connecting them with emergency shelter, housing, or critical services, and
providing them with urgent, non-facility-based care. Eligible costs include engagement,
case management, emergency health and mental health services, and transportation.
b. Emergency Shelter
Major Rehabilitation, Conversion, or Renovation of a building to serve as a homeless
shelter. Site must serve homeless persons for at least 3 or 10 years, depending on the
cost. Note: Property acquisition and new construction are ineligible ESG activities.
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.
c. 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 family
income.
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.
APPLICANT AGENCY _________________________________
9
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
d. 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 also 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.
e. Data Collection (HMIS)
Grant funds may be used for the costs of participating in an existing HMIS of the
Continuum of Care where the project is located. HMIS is available for staff travel for
training and program participant intake and participation fees that may be charged by the
HMIS Lead agency, the Los Angeles Homeless Services Authority (LAHSA). At the time
of release of this request for proposals, LAHSA does not charge participation fees.
D. ESTIMATED FUNDING CAPS FOR EMERGENCY SOLUTIONS GRANTS (ESG)
PROGRAM
At the time of the release of this request for proposals, funding amounts have not been
published. All funding is projected and awards may be modified to reflect actual awards
made by the Department of Housing and Urban Development.
The total estimated amount of ESG funds anticipated to be awarded to the City for
Program Year 2013-2014 is $220,994. This amount is estimated and dependent on the
amount ultimately awarded by the Federal government. Eligible activities that have
established funding limits or caps will be adjusted in accordance with final awarded
amount.
E. INELIGIBLE ACTIVITIES
The following activities are prohibited:
 Acquisition of a facility for use as an emergency shelter for the homeless.
 Rehabilitation services such as preparation of work specifications, loan processing, or
inspections.
 Renovation or conversion of buildings owned by primarily religious organizations or
entities. All services must be free from religious influences.
APPLICANT AGENCY _________________________________
10
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
CONTINUED SHELTER USE REQUIREMENTS
A shelter assisted with ESG funds must be maintained as a shelter for the homeless for a
specific minimum time period. The time period begins on the date of initial use as an emergency
shelter for the homeless or the date that grant amounts are first obligated by the grantee for the
shelter, whichever is later. The specific time frames, according to the specific activity assisted,
are as follows:
1. Conversion or Major Rehabilitation: 10 Years
2. Renovation: 3 Years
3. Homeless Prevention: No continued use requirement
4. All Other Activities: The period during which ESG assistance is provided, up to 2 years.
PROGRAM FEE POLICY
The Federal regulations do not address the issues of fee payment by Shelter clients.
1. Requirements regarding payment of fees by clients may be established by subrecipients
subject to the grantee's concurrence, so long as any fees charged do not exceed 30% of
the client's documented monthly income from all sources. If the family unit consists of
more than one (1) person, income of all family members 18 years of age and older can
be considered in making the 30% calculation.
2. Assisted clients must provide an appropriate budget management/savings plan to enable
an independent living transition.
SECTION 3 - RFP APPLICATION AND SELECTION CRITERIA
A.
RFP GENERAL APPLICATION REQUIREMENTS
The following criteria must be included in the RFP application to be considered a qualified
application:
1. The scope of Program Services must be City-based.
2. Proposed program and activities must be of direct benefit to homeless persons as
defined by HUD in Federal regulations. Homeless prevention programs must benefit
homeless persons or those at risk of becoming homeless.
3. All applications must include a performance measurement system to track productivity
and program impact clearly reflecting the extent to which the activities produce the
desired outcomes in the community or in the lives of persons assisted. All goals must
be linked with outcomes.
4. Evidence of a 100% match must be submitted. Match may be cash or in-kind and
must be used or counted towards eligible ESG activities.
APPLICANT AGENCY _________________________________
11
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
5. All submitted projects must be considered eligible activities under ESG as required by
HUD regulations and should be planned for a maximum of 12 months.
6. Agency must be a legally incorporated non-profit organization or government entity
and operational before submission.
7. Must provide 501 (c) (3) tax-exempt IRS status.
8. Must provide current IRS Determination Letter.
9. Must provide Articles of Incorporation and Organization By-laws.
10. Must provide current Dun and Bradstreet Number
11. Applicant must provide current documentation that it possesses adequate fiscal and
management systems and legal certifications to implement the proposed project:
 Must provide current 990’s
 Must provide copy of Annual Report with Financial Data.
 Must provide copy of last Independent Audit, results and copy of management
letter.
 Must provide copy of current business license, local and/or State permits.
 Must provide copy of Affirmative Action Plan.
12. Applicant must submit verification of Insurance Coverage. Minimum certifications are:
 Commercial General Liability, minimum limit $1,000,000 per occurrence,
$2,000,000 aggregate.
 Automobile Liability (hired and non-owned vehicles), minimum limit $1,000,000 per
occurrence.
 Additional Insured Endorsements, regardless of form, must be signed by an
authorized representative of the insurance carrier or its broker.

Fidelity Bond (Employee Dishonesty Coverage)

Employee Benefits Liability – Worker’s Compensation (statutory) Insurance

The City (Grantee) must be named as an additional insured, and must include the
endorsement page and the following language:
1) The additional insured is, “The City of Pomona including elected or appointed
officials, directors, officers, agents, employees, volunteers, or contractors.”
2) “This insurance provided by this policy shall be primary as respects any
claims related to the (name and dates of program). Any insurance, pooled
coverage or self-insurance maintained by the City of Pomona, its elected or
appointed officials, directors, officers, agents, employees, volunteers, or
contractors shall not contribute to it.”
APPLICANT AGENCY _________________________________
12
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING

Additional Insured Endorsements, regardless of form, must be signed by an
authorized representative of either the insurance carrier or its broker. A signature
of the insured is not considered an authorized signature.
13. Must demonstrate a minimum of twenty-four (24) months previous experience as of
the application deadline of Wednesday, February 8, 2012.
14. A qualified Fiscal Officer/Bookkeeper, preferably certified by AICPA, must be listed in
the proposed budget and a resume included as part of the application.
15. Agencies that have not submitted performance reports and those with past
compliance and performance problems may not be considered for funding.
16. Program activities must be available to serve all religious, race and ethnic groups, in
accordance with Title VI of the Civil Rights Act of 1964, and Section 109 of Title I, of
the Housing and Community Development Act of 1974.
17. Program activities must comply with Section 504 of the Rehabilitation Act of 1973,
which states: “No qualified individual with handicaps can be excluded from
participation in or denied the benefits of any activity receiving Federal financial
assistance.
18. Board and/or advisory board should be representative of the community, your
organization's service population, and homeless or formerly homeless persons.
Homeless persons must be involved in planning and/or operation of project.
19. Awarded agencies must be represented at the Pomona Continuum of Care Coalition
(PCOCC) monthly meetings on a regular and consistent basis.
20. Agency must be able to demonstrate bilingual capacity through paid or volunteer staff
on-site or on-call.
GENERAL PROGRAM REQUIREMENTS
Providers funded with ESG program funds will be expected to adhere to the following to be
considered in good program standing:

Make themselves familiar with and adhere to all program requirements of the
EMERGENCY SOLUTIONS GRANTS, as stated in Title 24 of the Code of Federal
Regulations, Part 576;

Work with City staff in developing and implementing the City's Continuum of Care
Plan;

Collaborate with other homeless providers in the operation of the project;

Adhere to Pomona's reporting and monitoring requirements;
APPLICANT AGENCY _________________________________
13
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING

Use common reporting software as specified by the City of Pomona;

Participate in training and coordination meetings;

Cooperate with related research and evaluation activities;

Prioritize referrals from homeless service providers within the City's Continuum of
Care System;
B.

Meet high standards of professionalism in implementing the project;

Conform to all fiscal accountability standards required by the City of Pomona and
by the Federal government (see attached 24 CFR, Part 84);
RFP EVALUATION - SELECTION CRITERIA
The following scoring system will be applied in evaluating the proposals:
Program design ...................................................... 12
Program experience and qualifications .. .................. 5
Performance Measurement Tool ........... ................ 17
Documentation and Recordkeeping ....... ................ 17
Collaborative Effort ................................ .................. 5
Community and Service Population Representation 17
Fiscal capacity ....................................... ................ 17
Budget and source of matching funds ... ................ 10
Total Points Available:
100
C.
RFP REVIEW AND APPEALS PROCESS
The City’s review process entails four levels of review prior to final authorization of a federally
assisted project:
1) Staff Evaluation Team reviews applications for responsiveness to RFP requirements
2) Determine ESG Eligibility of proposed activities
3) Eligible activities are reviewed and evaluated by the City’s Budget Ad Hoc Committee
and Staff Evaluation Team.
4) Funding is approved by the City Council
An organization that has sought funding may appeal to the City Council at any of the Public
Hearings held to obtain citizen comments. Written appeals may also be submitted to the
Community Development Department prior to adoption of the final budget in May 2013.
Public hearings will be noticed in local newspapers in the Legal Notice section.
APPLICANT AGENCY _________________________________
14
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
D.
BASIC INSTRUCTIONS FOR SUBMITTING A REQUEST FOR FUNDING
The following tips provide basic technical guidance for preparation and final submittal of an
ESG RFP application to the City for funding a proposed project:
1) The RFP application forms should be typewritten or printed for clarity of information
and numbered to ensure RFP evaluators and reviewers do not misread information.
2) Only one RFP application is submitted for each proposed project or program proposed
in an application (1 project for 1 application). This will ensure compliance with federal
requirements and also ensures that the project budget and staffing is adequate to
carryout a project.
3) The RFP Application Checklist of requested documents is provided to help the
applicants organize the application properly.
4) Completion of the RFP Application in the order requested will make the proposal more
competitive for the funding grant you are seeking. Utilize the headings in the RFP for
your proposal in order to assist the reviewers in evaluating your application. Tab key
headings and sections for easy reference. The original and copies must be secured
with a large binder clip only. Do not staple, mechanically bind, or use notebook
binders. Provide index tabs for each section and major paragraph section using the
RFP titles.
5) Proposed program activities should have a clearly written scope of services that links
goals with program outcomes: “Need” + “Design” + “Performance Measures” =
Proposed Outcomes. Be sure to indicate the number of individuals and families to be
served.
6) If you are not sure about any section of the RFP Application, contact Jan Cicco at
(909) 620-2571 early in the application process to obtain a clear understanding of
what is required to properly complete the contents of the application.
7) Verify that all items listed with the application checklist have been answered to ensure
that the proposal can be properly evaluated and understood by its readers.
INCOMPLETE APPLICATIONS OR NON-RESPONSIVENESS
Incomplete applications will not be evaluated and will be returned to applicant. In order to be
considered complete and responsive to RFP requirements, your application must include all
items listed in the “Application Checklist”, regardless of whether or not any of these items
have been submitted in prior years.
APPLICANT AGENCY _________________________________
15
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
E.
WORKSHOP ANNOUNCEMENT
A Request for Proposal Application Workshop is offered to guide the approach to and
answer questions regarding the ESG application. Because of significant changes in the rules
and regulations governing the Emergency Solutions Grants, attendance at this workshop is
absolutely mandatory for all agencies wishing to submit an ESG application.
REGISTER NOW!
DATE:
THRUSDAY, FEBRUARY 7, 2013
LOCATION: CITY OF POMONA, COUNCIL CHAMBERS
505 S. GAREY AVENUE
POMONA, CA 91769
To register, contact Cecilia Munoz at (909) 620-2198 or by e-mail at
cecilia_munoz@ci.pomona.ca.us.
Please indicate that you are interested in the ESG Application.
WORKSHOP SESSION WILL BE HELD:
TIME
WORKSHOP TOPIC
11:15 a.m. – 12:15 p.m.
ESG Applications
THE WORKSHOP WILL COVER:




Review of Application
Minimum Eligibility Requirements
HUD’s Eligibility Requirements
Technical Assistance
Visit our website at www.ci.pomona.ca.us and click on “download forms and docs” to
download the RFP in word format.
APPLICANT AGENCY _________________________________
16
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
SECTION 4 - RFP APPLICATION PACKAGE
The City of Pomona ESG Program Year 2013-2014 request for proposals consists of the
following elements:
⌂
⌂
⌂
⌂
⌂
⌂
⌂
APPLICATION CHECKLIST
APPLICATION with cover sheet
ATTACHMENTS
REQUIRED DOCUMENTATION
INSURANCE COVERAGE
OVER-ARCHING FEDERAL REQUIREMENTS
AGENCY CERTIFICATIONS
APPLICATION PACKAGES ARE DUE
BY:
4:00 p.m., Thursday, February 21, 2013
APPLICATIONS MUST BE SUBMITTED TO:
CITY OF POMONA
ATTENTION: PURCHASING DEPARTMENT (basement)
505 SOUTH GAREY AVENUE
P.O. BOX 660
POMONA, CA 91766
Please submit one (1) ORIGINAL AND two (2) unbound copies.
LATE, FAXED, E-MAILED OR APPLICATIONS HANDWRITTEN IN SCRIPT
will not be accepted.
APPLICANT AGENCY _________________________________
17
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
A. APPLICATION COVER SHEET
CITY OF POMONA
COMMUNITY DEVELOPMENT DEPARTMENT
EMERGENCY SOLUTIONS GRANTS (ESG)
FY 2013 - 2014
SUBMIT TO:
CITY OF POMONA (909) 620-2361
Purchasing Division
P.O. Box 660
Pomona, California 91766
DEADLINE:
SUBMIT ONE (1) ORIGINAL, SIGNED WITH CORPORATE SEAL and TWO
(2) UNBOUND COPIES BEFORE 4:00 P.M. Thursday, February 21, 2013
______________________________________
Legal Name of Agency
_______________________________________
Federal Identification Number (9- Digit #)
__________________________
Project Name
_______________________
DUNS # (Dunn & Bradstreet)
________________________________________________________________________
Agency Address
City
Zip Code
TYPE OF ACTIVITIES
AMOUNT
HOMELESS PREVENTION
$______________
STREET OUTREACH (May not exceed 60% of total award)
$ _____________
EMERGENCY SHELTER (May not exceed 60% of total award)
$______________
RAPID RE-HOUSING
$ _____________
HMIS
$ _____________
TOTAL REQUESTED
$ _____________
A separate proposal must be submitted for each activity with the exception of HMIS.
Grant Contact Person and Title: _____________________________
Phone No: _________________________
Fax No: _________________________
E-mail: ____________________________
APPLICANT AGENCY _________________________________
18
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
Designated Representative responsible for job performance, negotiations, contractual matters,
and coordination with the City:
Name & Title: ________________________
Mailing Address: ______________________
Email Address: ______________________
____________________________________
Legally Authorized Signatory
B.
Telephone No: ____________________
_______________________________
Typed or Printed Name
APPLICATION CHECKLIST
The Application Checklist must be completed to verify that all required documents are completed
for submission. Incomplete applications will be rejected with a written justification of items
missing. No opportunity will be given to provide additional information after the Submittal
Deadline. If further assistance is needed, contact Jan Cicco, Homeless Services at (909) 6202571.
CHECK WHEN COMPLETED
Program Experience and Qualification
Program Design
Performance Measurement – Program Goals with Outcomes
Collaborative Effort
Fiscal Administration
Proposed Budget Summary
Personnel Budget Form
Detailed Breakdown of Costs Form(s) (use applicable form(s))
Match Requirements
Shelter Facility Information (if applicable)
ATTACHMENTS
A: Board of Directors Affidavit
B: Statement of Certification
C: ESG Compliance Requirements
D: Statement of Confidentiality (if applicable)
E: Certification of Religious Compliance (if applicable)
F: Appeals Process for Termination
REQUIRED DOCUMENTATION
501 (c) (3) Tax-exempt status
Current 990’s
Copy of Audited Financial Data with Statement of Opinion
Copy of Articles of Incorporation and By-laws
Business License
Dun and Bradstreet (DUNS) Number
APPLICANT AGENCY _________________________________
19
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
INSURANCE COVERAGE – City must be named as co-insured
Current General Liability
Automobile Liability
Fidelity Bond
Employee Benefit Liability (Worker’s Compensation)
Additional Insured Endorsement (signed)
OTHER
Affirmative Action Plan
Attach resume of fiscal officer
Organization By-Laws
Articles of Incorporation
Memorandum(s) of Understanding for collaborative services
C.
APPLICATION
1. PROGRAM DESIGN
a.
b.
c.
d.
ESG Activity Type and Number of Clients to be served.
Purpose of the proposed project.
Need for the project and how was the need for the proposed activity identified?
Target Population: Identify any unique characteristics of the population that you
propose to serve. Be specific (e.g. families with children, males with substance
abuse problems, chronic mentally ill).
e. Provide information on the types of services that will be offered and how they will
be provided.
f. Outreach Plan: Describe the methods to be used to ensure that the target
population and community residents will find out about the services provided by
the project. What are the possible referral sources for this project? How will they
be used?
2. ORGANIZATION AND STAFF QUALIFICATIONS AND EXPERIENCE
a. Provide a summary of the qualifications of your organization to carry out the
proposed project.
b. Provide a summary of the experience of your organization. Include any program
that your agency has administered that is most similar to the proposed activity.
c. Describe your agency’s bi-lingual capacity. List all languages in which your agency
has capability.
APPLICANT AGENCY _________________________________
20
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
3. PERFORMANCE MEASUREMENT
a. List the measurable goals of the proposed project. Include the number of
individuals and families to be served.
b. List the proposed outcomes for each goal.
c. Evaluation Plan: The evaluation process is designed as a planning and
measurement tool. Evaluation is the analysis of data for the purpose of
determining if and how the planned activities were carried out, if objectives/goals
were achieved.
i. What data will be collected to identify the events that take place, when, with
whom? Include who will be responsible for collecting the information and at
what intervals it will be collected.
ii. Outcome Evaluation: Describe your process for evaluating outcomes? How
will outcomes be measured? How will you build objective analysis into your
outcome evaluation process?
4. PROGRAMMATIC DOCUMENTATION AND RECORDKEEPING
a. Does the agency current record client information in the Los Angeles Continuum of
Care HMIS? If yes, how long has the agency utilized the system.
b. If no, does the agency intend to implement HMIS during the 2013 – 2014 fiscal
year?
i. Describe the status of HMIS implementation:
1. not yet started,
2. status of obtaining equipment and software
3. status of training
4. status of installing HMIS and obtaining passwords
ii. Describe the process for documenting client intake, goals, progress,
success and exit. Include responsible parties and time allocated for
documentation.
5. COLLABORATIVE EFFORT
a. Please list any coalitions, consortiums, or any other community meetings that your
agency participates in on a regular and consistent basis.
b. Is this project conducted in collaboration with other agencies? Please describe.
c. Attach Memorandum of Understandings, Letter of Support, and any other
documentations showing collaboration between the applicant agency and other
local agencies.
6. COMMUNITY AND SERVICE POPULATION REPRESENTATION
a. Board and/or advisory board should be representative of the community, your
organization's service population, and homeless or formerly homeless persons.
Homeless persons must be involved in planning and/or operation of project.
APPLICANT AGENCY _________________________________
21
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
i. All organizations funded by this RFP must ensure the maximum feasible
participation of the homeless persons in project planning, implementation
and evaluation processes. Specify the methods used for recruitment and
hiring, if appropriate. Indicate whether those involved are paid staff or
volunteers.
ii. Describe the membership on your Board of Directors, Advisory Board or
other advisory and decision-making bodies within the applicant agency the
includes representation of community members and member, or former
members, of the population served.
iii. If your organization does not currently have a Board of Directors or
Advisory Board whose membership includes a reasonable percentage of
service recipients and/or homeless individuals, what steps will be taken,
and when, to ensure representation of the poor and very low income
persons on the Board of Directors or Advisory Board?
7. FISCAL ADMINISTRATION
a. Name of Financial Management System. Describe your organization's accounting
and financial reporting system. Does the agency use accrual or cash accounting
basis? Does the accounting system accounting system provide for the control of
revenues as well as expenditures. Please discuss briefly.
b. Identify Finance Staff positions. Describe roles of staff positions discussing the
internal controls used to ensure the safeguarding of funds and proper classification
of expenditures to ensure that a thorough record of expenditures can be provided
for purposes of monthly billing, providing reports and of an annual audit.
c. Identify the agencies three most recent federal grants by grant title and dollar
amount. If fewer than three, identify non-federal grants. If Does the applicant
agency have any past due obligations with any other funding source? Did the
applicant agency fully expend the three most recent grants that have closed out
terms? If not, why not and how much was not expended?
d. Does the agency have an unearned grant from a previous contract, which has not
been returned to the funding source?
i. If you answered yes to any of the above please submit the following
information:
a. Name of funding source and program title:
b. Reason for past due obligations, and the amount of such
obligation:
e. In the past three years, has the agency had an Internal Revenue Service (IRS) or
State levy? If so, is the agency on a repayment schedule? How was the matter
resolved?
APPLICANT AGENCY _________________________________
22
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
D.
PROGRAM BUDGET
The Emergency Solutions Grant will cover a portion of the eligible expenses for funded
programs. ESG requires 100% match and this must be calculated into the budget. Match can
be cash or in-kind and must be applied to eligible activities.
Staff working all, or in part, providing direct client services for eligible activities must be included
in the budget. The administration has the flexibility to determine what portion, if any, of the
eligible salary will be billed to ESG.
Example: A case manager provides services to ESG Street Outreach Program clients 50%
of the time that she works. The program budget may treat this in the following fashions:
1) Split cost between ESG and other source to go toward match requirement. In this case, the
administrator decided to split 50/50.
2) Case manager $100 salary .5 to program = $50 to program. The program may split this
salary $25 ESG, $25 other source for match.
3) The program may full expense $100 to ESG. The other percentage of time that the case
manager works with other programs or clients may not be allocated to match. No match is
credited.
4) Because the case manager’s time is shown in the budget and is an eligible expense, the
entire $100 could be allocated toward meeting the match requirement, with none of this
expense billed to ESG in the billing period.
Expenses for services, equipment, etc. required to implement the program should be included
in the budget. Applicant may determine what portion will be billed to ESG and what portion will
be billed to other funding sources and applied to match. If the equipment, space, or service is
shared by other programs, the amount must be pro-rated and only the portion utilized by the
ESG funded program may be billed to ESG and/or allocated towards match.
Adequate management and administration is also required for the program, but is not funded
by ESG. The Executive Director and Accountant must be shown in the initial Personnel Budget
form, demonstrating capacity to implement the program. The job descriptions must be included
with the proposal.
Expenditure Limits placed upon the City of Pomona for the total ESG award
Combined street outreach and emergency shelter combined awards to all programs from
each fiscal year's ESG grant cannot exceed the greater of:
1. 60% of that federal fiscal year's total ESG grant award
2. The amount of FY 2013-2014 grants funds committed to homeless assistance
activities.
APPLICANT AGENCY _________________________________
23
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
INDIRECT COSTS
ESG grant funds may only be used to pay indirect costs in accordance with OMB Circular A87 (2 CFR part 225), or A-122 (2 CFR part 230), as applicable. Indirect costs may be applied
to each eligible activity using the direct cost base specified in the approved cost allocation
plan.
Indirect costs charged to an activity with an expenditure limit
Indirect Costs + Direct Costs = Total Costs
Total Costs are then compared to the Expenditure Limit
Applicants wishing to include indirect costs in the proposal budget must attach a copy
of the HUD approved cost allocation plan with the application.
APPLICANT AGENCY _________________________________
24
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
The Eligible Costs for each of the ESG Components are provided below. Utilize this detailed
information to properly formulate the program budget for the proposal.
Eligible Costs Category#1: Street Outreach
Engagement; Activities to locate, identify and build relationships with unsheltered homeless
Case management, Emergency Health Services, Emergency Mental Health Services,
transportation, services to special populations. Staff salaries related to carrying out street
outreach activities is also eligible.
Activities to locate, identify and build relationships with unsheltered homeless people for the
purpose of providing immediate support, intervention, and connections with homeless assistance
programs and/or mainstream Eligible Initial assessment of needs and eligibility
social services and housing programs. Providing crisis counseling, Addressing urgent physical
needs, actively connecting and providing info and referral, Cell phone costs of outreach workers.
Emergency Health Services
Outpatient treatment of urgent medical conditions by licensed medical professionals in
community-based settings (e.g., streets, parks, and campgrounds) to those eligible participants
unwilling or unable to access emergency shelter or an appropriate healthcare facility.
Assessing participants' health problems and developing treatment plans
Assisting participants to understand their health needs
Providing or helping participants obtain appropriate emergency medical treatment
Providing medication and follow-up services
Case Management
Assessing housing service needs, arranging /coordinating/ monitoring the delivery of
individualized services. Using the or centralized coordinated assessment system, Initial
evaluation / verifying and documenting eligibility, Counseling, Developing / securing /
coordinating services, Helping obtain Federal, state, and local benefits; Monitoring / evaluating
participant progress; Providing information and referral to other providers; Developing an
individualized housing / service plan.
Emergency Mental Health Services
Outpatient treatment of urgent mental health conditions by licensed professionals in communitybased settings (e.g., streets, parks, and campgrounds) to those eligible participants unable or
unwilling to access emergency shelter or an appropriate healthcare facility.
Crisis interventions
Prescription of psychotropic medications
Explain the use and management of medications
Combinations of therapeutic approaches to address multiple problems
APPLICANT AGENCY _________________________________
25
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
Transportation
Travel by outreach workers, social workers, medical professionals or other service providers
during the provision of eligible street outreach services.
Transporting unsheltered people to emergency shelters or other service facilities
Cost of a participant’s travel on public transit
Mileage allowance for outreach workers to visit participants
Purchasing or leasing a vehicle for use in conducting outreach activities, including the cost
of gas, insurance, taxes and maintenance for the vehicle
Costs of staff to accompany or assist participants to use public transportation
Services to Special Populations
Otherwise eligible Essential Services that have been tailored to address the special needs of
homeless youth, victims of domestic violence and related crimes/threats, and/or people
living with HIV/AIDS who are literally homeless.
Engagement
Case Management
Emergency Health Services
Emergency Mental Health Services
Transportation
Eligible Costs Category #2: Emergency Shelter
Overarching Principles
⌂ Eligible Program Participants: Individuals and families who are homeless.
⌂ Overview of Eligible Activities: Essential services to Individuals and families who are
persons in emergency shelters*, renovating buildings to be used as emergency shelters,
and operating emergency shelters. Staff costs related to carrying out emergency shelter
activities are also eligible.
Essential Services
Services provided to individuals and families who are in
an emergency shelter.
Case Management Life Skills
Child Care
Education Services
Mental Health Services
Substance Abuse Treatment Services
Employment Assistance and Job Training
Outpatient Health Services
Transportation
Services for Special Populations
Legal Services
APPLICANT AGENCY _________________________________
26
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
Case Management
Assessing, arranging, coordinating, monitoring individualized services.
Using the centralized or coordinated assessment system
Initial evaluation including verifying and documenting eligibility
Counseling
Developing, securing and coordinating services including Federal, state, and local benefits
Monitoring and evaluating program participant progress
Providing information and referrals to other providers
Providing ongoing risk assessment and safety planning with victims of domestic violence,
dating violence, sexual assault, and stalking
Developing an individualized housing and service plan
Child Care
Licensed child care for program participants with children under the age of 13, or disabled
children under the age of 18:
Child care costs
Meals and snacks
Comprehensive and coordinated sets of appropriate developmental activities
Education Services
Instruction or training to enhance participants' ability to obtain and maintain housing: literacy,
English literacy, GED, consumer education, health education, and substance abuse prevention.
Educational services / skill-building
Screening, assessment and testing
Individual or group instruction
Tutoring
Provision of books, supplies and instructional material
Counseling
Referral to community resources
Employment Assistance and Job Training
Services assisting participants secure employment and job training programs. Classroom
online and/or computer instruction:
Employment screening, assessment, or testing
On the-job instruction
Job finding, skill-building
Structured job-seeking support
Reasonable stipends in employment assistance and job training programs
Books and instructional material
Special training and tutoring, including literacy training and pre-vocational training
Counseling or job coaching
Referral to community resources
APPLICANT AGENCY _________________________________
27
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
Outpatient Health Services
Direct outpatient treatment of medical conditions provided by licensed medical professionals:
Assessing health problems and developing a treatment plan
Assisting program participants to understand their health needs
Providing or helping participants obtain appropriate medical treatment, preventive medical
care, and health maintenance services, including emergency medical services
Providing medication and follow-up services
Providing preventive and non-cosmetic dental care
Legal Services
Necessary legal services regarding matters that interfere with the program participant’s ability
to obtain and retain housing.
Hourly fees for legal advice and representation by licensed attorneys and certain other
fees-for-service
Client intake, preparation of cases for trial, provision of legal advice, representation at
hearings, and counseling
Filing fees and other necessary court costs
Legal representation and advice to resolve legal problems that prevent participants from
obtaining or retaining permanent housing:
Child support
Guardianship
Appeal of veterans and public benefit claim denials
Paternity
Emancipation
Orders of protection and other civil remedies for victims of domestic violence, dating
violence, sexual assault, and stalking
Legal separation
Resolution of outstanding criminal warrants
Life Skills Training
Critical life management skills necessary to assist the program participant to function
independently in the community.
Budgeting resources
Managing money
Managing a household
Resolving conflict
Shopping for food and needed items
Improving nutrition
Using public transportation
Parenting
APPLICANT AGENCY _________________________________
28
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
Mental Health Services
Direct outpatient treatment of mental health conditions by licensed professionals.
Crisis interventions
Individual, family or group therapy sessions
Prescription of psychotropic medications or explanations about the use and management
of medications
Combinations of therapeutic approaches to address multiple problems
Substance Abuse Treatment Services
Substance abuse treatment services provided by licensed or certified professionals,
designed to prevent, reduce, eliminate or deter relapse of substance abuse or addictive
behaviors.
Client intake and assessment
Outpatient treatment for up to thirty days
Group and individual counseling
Drug testing
Transportation
Costs of travel by program participants to and from medical care, employment, child care, or
other facilities that provide eligible essential services; and cost of staff travel to support provision
of essential services.
Cost of a program participant’s travel on public transportation
Mileage allowance for service workers to visit participants
Purchasing or leasing a vehicle used for transport of participants and/or staff serving
participants, including the cost gas insurance 34 of gas, insurance, taxes and maintenance for
the vehicle
Travel costs of staff to accompany or assist program participants to use public transportation
Services for Special Populations
Otherwise eligible essential services tailored to address the special needs of homeless
youth, victims of domestic violence and related crimes/threats, and people living with
HIV/AIDS in emergency shelters.
Case Management
Legal Services
Child Care
Education Services
Employment Assistance and Job Training
Life Skills Training
Mental Health Services
Substance Abuse Treatment Services
Outpatient Health Services
Transportation
APPLICANT AGENCY _________________________________
29
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
Rehabilitation and Renovation
Renovating buildings to be used as emergency shelter for homeless families and individuals.
Minimum use periods apply for buildings that are rehabilitated, converted or renovated.
Labor
Materials
Tools
Other costs for renovation, including soft costs
Major rehabilitation of an emergency shelter
Conversion of a building into an emergency shelter
Shelter Operations
Costs to operate and maintain emergency shelters and also provide other emergency lodging
when appropriate. *Hotel or motel vouchers are only eligible when no appropriate emergency
shelter is available.
Maintenance ( including minor or routine repairs)
Food
Rent
Security
Furnishings
Equipment
Supplies necessary for the operation of the emergency shelter
Fuel
Insurance
Utilities
Hotel or motel voucher for family or individual*
APPLICANT AGENCY _________________________________
30
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
Eligible Costs Category #3: Homeless Prevention
&
Eligible Costs Category #4: Rapid Re-Housing
Overarching Principles
Eligible Program Participants:
Rapid Re-housing: Individuals and families who are literally homeless, meaning those who
qualify under paragraph (1) of the definition of homeless.
Homelessness Prevention: Individuals and families who are at imminent risk, or at risk,
of homelessness, meaning those who qualify under paragraph (2) and (3) of the homeless
definition or those who qualify as at risk of homelessness. Individuals and families must have
an income at, or below, 30% of AMI.
Overview of Eligible Activities: Short- and medium-term rental assistance and housing
relocation and stabilization services. Staff salaries related to carrying out rapid re-housing
and homelessness prevention activities are also eligible.
Housing Relocation and Stabilization Services
Financial Assistance
Moving costs –such as truck rental, hiring a moving company, certain temporary storage
fees
Rent application fees - as charged by the owner to all applicants
Security deposit – no more than 2 months rent
Last month's rent – paid to owner at time of security deposit and first months rent are paid
Utility deposit – as required by utility company for all customers
Utility payments – up to 24 months per participant per service including up to 6 months or
arrearages, per service
Services
Housing search & placement
Housing Stability Case Management
Mediation
Legal Services
Credit repair
APPLICANT AGENCY _________________________________
31
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
Housing Search and Placement
Assessment of housing barriers, needs and preferences
Development of an action plan for locating housing
Housing search and outreach to and negotiation with owner
Assistance with submitting rental applications and understanding leases
Assessment of housing for compliance with ESG requirements for habitability, lead based
paint, and rent reasonableness
Assistance with obtaining utilities and making moving arrangements
Tenant counseling
Housing Stability Case Management
Assessing, arranging, coordinating, and monitoring the delivery of individualized services to
facilitate housing stability.
Using the centralized or coordinated assessment system, conduct the initial evaluation and
re-evaluation
Counseling
Developing, securing and coordinating services including Federal, state, and local benefits
Monitoring and evaluating program participant progress
Providing information and referrals to other providers
Developing an individualized housing and service plan
Mediation
Mediation between the program participant and the owner or person(s) with whom the
program participant is living, to prevent the program participant from losing permanent
housing in which they currently reside.
Time and/or services associated with mediation activities
Legal Services
Legal services that are necessary to resolve a legal problem that prohibits the program
participant from obtaining or maintaining permanent housing.
Hourly fees for legal advice and representation
Fees based on the actual service performed (i.e., fee for service), but only if the cost
would be less than the cost of hourly fees
Client intake, preparation of cases for trial, provision of legal advice, representation at
hearings, and counseling
Filing fees and other necessary court costs
Subrecipient’s employees’ salaries and other costs necessary to perform the services, if
the subrecipient is a legal services provider and performs the services itself
Legal representation and advice may be provided for:
Landlord/tenant matters Orders of protection and other civil remedies for victims of
domestic violence, dating violence, sexual assault, and stalking
APPLICANT AGENCY _________________________________
32
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
Child support
Guardianship
Paternity
Emancipation
Legal separation
Resolution of outstanding criminal warrants
Appeal of veterans and public benefit claim denials
The services must be necessary to resolve a legal problem that prevents a participant from
obtaining or maintaining permanent housing.
Credit Repair
Services necessary to assist program participants with critical skills related to household
budgeting, managing money, accessing a free personal credit report, , and resolving
personal credit problems. **Assistance cannot include the payment or modification of a debt.
Credit Counseling
Other related services
Short- and Medium-Term Rental Assistance
Short term up to 3 months,
Medium term 4 – 24 months
Rental arrearages may be a one-time payment of up to 6 months, including any late fees
on those arrearages
Any combination of the three types of rental assistance listed above, not to exceed 24
months during any 3-year period, including any payment for last month’s rent.
Tenant Based Rental Assistance – program participants select a housing unit in which to
live (may be within a specified service area) and receive rental assistance
Project Based Rental Assistance – recipients or subrecipients identify permanent housing
units that meet ESG requirements and enter into a rental assistance agreement with the
owner to reserve the unit and subsidize its rent so that eligible program participants have
access to the units.
Discretion to Set Cap
The applicant agency may set a maximum dollar amount and maximum period for which
a program participant may receive any of the types of assistance or services described within
the regulatory maximums.
APPLICANT AGENCY _________________________________
33
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
Eligible Costs Category #5: HMIS
Overarching Principles
• Recipients and subrecipients: All recipients and subrecipients may pay the costs of
contributing data to the CoC’s HMIS.
• Recipients and subrecipients that use comparable databases: Victim service providers
and legal service providers may use ESG funds to pay the costs of establishing and
operating a comparable database.
Participation Requirement - The HEARTH Act makes HMIS participation a statutory
requirement for ESG recipients and subrecipients. Victim service providers cannot, and Legal
Services Organizations may choose to not, participate in HMIS. These providers must use a
comparable database that produces unduplicated, aggregate reports, instead.
Hardware, Equipment and Software Costs
- Purchasing or leasing computer hardware
- Purchasing software or software licenses
- Purchasing or leasing equipment, including telephones,
faxes and furniture
Staffing: Paying salaries for operating HMIS, including:
- Data collection
- Completing data entry
- Monitoring and reviewing data quality
- Completing data analysis
- Reporting to the HMIS Lead
- Training staff on using the HMIS or comparable database
- Implementing and complying with HMIS requirements
Training and Overhead
- Obtaining technical support
- Leasing office space
- Paying charges for electricity, gas, water, phone service and high-speed data transmission
necessary to operate or contribute data to the HMIS
- Paying costs of staff to travel to and attend HUD-sponsored and HUD-approved training on
HMIS and programs authorized by Title IV of the McKinney-Vento Homeless Assistance Act
- Paying staff travel costs to conduct intake
- Paying participation fees charged by the HMIS Lead, if the recipient or subrecipient is not
the HMIS Lead.
Comparable Database Costs for Victim Services Providers or Legal Services Providers
If the subrecipient is a victim services or a legal services provider that use a comparable
database, it may use ESG funds to establish and operate a comparable database that
collects client-level data over time and generates unduplicated aggregate reports based on
the data.*
APPLICANT AGENCY _________________________________
34
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
Activities already defined under this component that allow for the establishment and
operation of a comparable database
E.
BUDGET PROTOCAL
Provide detail to clearly identify expenses. Categories may be changed or eliminated to properly
address the program budget. Identify the ESG Component for which funding is requested at the
top of the budget: (i.e. - Street Outreach, Emergency Shelter, Homeless Prevention or Rapid ReHousing. Applicant may only submit for one component plus HMIS per application).
Categories of Expense: Utilize the Category Headers and detail language in the
Eligible Expense Section for the ESG Component to be implemented (Subtotal Categories
(personnel, operations, services, capital costs, etc.) highlight subtotal lines
Example:
(Eligible Activity/Component: Street Outreach)
Expense Categories: Engagement, Case Management, Emergency Health Services,
Emergency Mental Health Services, Transportation, Services to Special Populations
Detail provided under each category will be the specific expense items to carry out that
function.
Personnel Costs – Must be the first line items of your budget (Regardless of Category)
Identify full or part-time, % of time to program: Example 1FTE Case Manager .5. Provide
fringe benefits at the bottom of personnel as a separate line item.
Other expenses – Specifically identify expense type i.e.: Utilities define by type: gas,
electricity. Telephone break out equipment, service, cell phones, etc.
Administration Expenses – Include administration expenses on the separate Personnel
Budget form to demonstrate capacity. Administration expenses are not an eligible cost under
this RFP.
APPLICANT AGENCY _________________________________
35
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
PERSONNEL BUDGET FORM
Staff providing direct client service for the ESG eligible activity proposed must be included on this form. The Executive Director and Lead Accountant,
are not eligible for ESG funding as administrative positions, but must be included on this budget table, demonstrating agency capacity to implement the
program.
Cost Category: Personnel Costs
NOTE: Job Descriptions for Must Be Attached To Budget Detail Form
Agency Name:____________________________________________ Project Name:__________________________________________
A
B
# OF
POSITIONS
POSITION TITLE
C
MONTHLY
SALARY
D
ANNUAL
SALARY
E
% OF TIME
TO PROGRAM
F
AMOUNT
OF SALARY
FOR
PROGRAM
IMPLEMENT
ATION (DxE)
G
H
AMOUNT
OF
PROGRAM
IMPLEMENT
ATION
SALARY
BILLED TO
ESG
AMOUNT OF
PROGRAM
IMPLEMENTATI
ON SALARY
ALLOCATED
TO MATCH
(IF ANY)
Executive Director
Accountant
TOTALS
Funding sources for Executive Director ______________________________________________________________________________________
Funding sources for Accountant / Bookkeeper ________________________________________________________________________________
Administrative and organizational staff time not eligible match. Use additional sheets as needed.
APPLICANT AGENCY _________________________________
36
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
Name of Program _________________________________________________________________________
PROGRAM BUDGET
Fiscal Year – Twelve Month Budget
ESG Eligible Component _________________________________________
ESG Eligible Expense
ESG Expense Other
Total Cost
Funding
Source
PERSONNEL
Fringe
Personnel
subtotal
Eligible ESG
Component
Expenses
TOTALS
(Sum each
column)
APPLICANT AGENCY _________________________________
37
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
Use additional sheets if required. Column 3, ESG Expense, must total the entire amount requested. Utilize a
separate sheet HMIS budget, if also requesting HMIS funding.
F.
MATCHING SHARE:
Identify any non-McKinney-Vento Act funds and in-kind funds for matching share to be
contributed in support of the proposed project.
Matching Funds: Identify an amount equal to or the requested amount of ESG funds.
The amount of these supplemental funds may include the value of any donated material
or building; the value of any lease on a building; any salary paid to staff in carrying out
the emergency shelter program; and the time and services contributed by volunteers to
carry out the program based upon a $5 per hour rate, in-kind donations, Shelter
Partnership or Food Bank contributions to the program. Funds must be contributed to
and used by the ESG funded program for ESG eligible activities between July 1, 2012
and June 30, 2013.
Source Match
Amount
Cash or In-Kind
Period Available
From
To
TOTAL MATCH, SUM of
Column 2 (must be equal to
the amount of ESG funds
requested.)
APPLICANT AGENCY _________________________________
38
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
SITE CONTROL
(1)
Site currently occupied by Applicant? ___Yes ___ No
(2)
Does the applicant/shelter: Own, Rent, Lease, Lease with option?
$____________Per month
If Lease, Term of Lease: From _______ To _________
If Lease, are any of the items below included in the Lease?
Electricity
Gas
Water
Garbage
___Yes
___Yes
___Yes
___Yes
__No
__No
__No
__No
$_______________________
$_______________________
$_______________________
$_______________________
Total Rent/Lease/Utility
$_______________________
(3) Project Zoning:
Zoning Designation:
General Plan Designation:
Designation Permit Shelter Use: __Yes __No
If not, Entitlement Requirement:
__ Zoning Variance
__ Conditional Use Permit Waiver, granted
by:______________________
__ Standard "R" Zoning
___________Number of persons
Certificate of Occupancy
APPLICANT AGENCY _________________________________
39
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
OBJECTIVES, OUTCOMES AND OUTPUTS
HUD has prescribed a specific menu of objectives and outcomes to be used for all funded
projects to standardize achievements reporting on a local, state and national level. Please
evaluate your proposed projects according to the following definitions. Identify which objectives
your project will address; then identify the proposed outcome your project will achieve. Please
choose 1 objective and 1 outcome per project. Place a check mark indicating your choice. Keep
in mind, if your project is funded, this information will be utilized in preparation the FY2013-2014
Annual Plan and in reporting your accomplishments in the year-end Consolidated Annual
Performance and Evaluation Report (CAPER).
Objectives:
Suitable Living Environment. Includes activities that benefit communities, families, or individuals
by addressing issues in their living environment such as public services, emergency essential
services, capital improvements, neighborhood revitalization, etc.
Decent Affordable Housing. Includes the wide range of housing programs possible under
HOME, CDBG or ESG where the purpose of the program is to meet individual family or
community needs and not programs where housing is an element of a larger effort (such as
would be captured above in Suitable Living Environment).
Creating Economic Opportunities: Includes activities related to economic development,
commercial revitalization, or job creation.
Outcomes:
Availability/Accessibility. Activities that make services, infrastructure, housing or shelter
availability or accessible to low-income people, including persons with disabilities. Accessibility
includes making the affordable basics of daily living available and accessible to low-income
people.
Affordability. Activities that provide affordability in a variety of ways in the lives of low-income
people. Includes the creation or maintenance of affordable housing, basic infrastructure, or
services such as transportation or day care.
Sustainability: Promoting Livable or Viable Communities. Projects where the activity or activities
are aimed at improving communities or neighborhoods, helping to make them livable or viable by
providing benefit to low-income people or by removing or eliminating slums or blighted areas,
through multiple activities or services that sustain communities or neighborhoods
APPLICANT AGENCY _________________________________
40
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
Objective and Outcomes: Check one box in each table below that best reflects your projects
and outcomes. If your agency was funded for more than one project, please submit a separate
form for each project that indicates the objectives and outcomes for that project. See sections
above for projects applicable to each objective and outcome.
Objective
Suitable Living
Environment
Decent Affordable
Housing
Creative Economic
Opportunities
Check One
Outcome
Availability/Accessibility
Check One
Affordability
Sustainability: Promoting
Livable or Viable
Communities
APPLICANT AGENCY _________________________________
41
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
G. PERFORMANCE MEASUREMENT SYSTEM AND OUTCOMES STATEMENT
Agency Name:
Program Name:
Benchmarks
Eligible
Category:
Essential
Services,
Operations or
Homeless
Prevention
Service or Activity
to fill Need
Indicate benchmarks
with numerical values
Output Goal (units of
service)
Outcomes
Indicate outcomes
with percentages
Achievement Outcome
goal (difference to the
community)
Measurement
Reporting Tools
Evaluation Process
Short Term
Intermediate
Long Term
Eligible Category – show which ESG eligible component the project will implement
Service or Activity- name the ESG eligible service or activity that will be delivered (e.g. life skills workshops, employment placement
assistance, utility bill payment)
Output Goal – Set specific, quantifiable goals, including time frames. This will allow the City to monitor program progress.
Achievement Outcome – State the proposed outcome for the actual impact you hope to achieve (i.e. 30% are able to renew and
maintain positive family relationships, 10% achieve employment, 72% achieve housing stability)
Measurement Reporting Tools- list the tools you will use to track output and/or outcome information (e.g. case reports, pre- and
post-tests, etc.)
Evaluation Process- identify the methodology you will use to assess success in meeting outputs goals and outcomes.
APPLICANT AGENCY _________________________________
42
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
ATTACHMENT A (1 OF 1)
ATTACHMENT A: BOARD OF DIRECTORS AFFIDAVIT
All applicant agencies must complete this affidavit listing the members of the Board of Directors. If there are
changes in the Board Membership after the proposal is submitted, the Grants Administration Division of the City of
Pomona must be notified in writing of the changes. Note with an asterisk (*) any Board members that are City of
Pomona residents, or consumers or previous consumers of homeless, at-risk of homelessness or low income
services.
I, ___________________________________________________________ (please print), depose and say that
I
am_______________________________________________,
(President,
Vice
President,
etc.)
of
_____________________________________________________________, (Name and address of organization),
which submits this proposal. The only other members of the Board of Directors and other officers of this
organization are:
Board Member Name
Address
Use an additional sheet if necessary. Deposer must sign all Director’s Affidavit pages.
Signature of Deposer and date _______________________________________________________________
Name of deposer (print or type) ______________________________________________________________
APPLICANT AGENCY _________________________________
43
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
ATTACHMENT B (1 OF 3)
ATTACHMENT B: STATEMENT OF CERTIFICATIONS
(a)
It possesses the legal authority to apply for the grant, and to execute the proposed
program;
(b)
Its governing body has duly adopted or passes as an official act or resolution, motion, or
similar action authorizing the fining of the application, including all understandings and
assurances contained therein, and authorizing the applicant's chief executive officer or
other designee to act in connection with the application and to provide such additional
information as may be required;
(c)
It will comply with the policies, guidelines and requirements of OMB Circular A-87 and A102 as they relate to the acceptance and use of EMERGENCY SOLUTIONS GRANTS
amounts by local governments, and A-110 and A-122 as they relate to the acceptance
and use of EMERGENCY SOLUTIONS GRANTS amounts by private non-profit
organizations.
(d)
It will comply with the following regarding non-discrimination:
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
Title VIII of the Civil Rights Act of 1968 and implementing regulations;
Executive Order 11063 and implementing regulations;
Title VI of the Civil Rights Act of 1964 and implementing regulations;
The Age Discrimination Act of 1975 and Section 5043 of the Rehabilitation Act of
1973;
Executive Order 11246 and implementing regulations;
Section 3 of the Housing and Urban Development Act of 1968;
Executive Orders 11625, 12432, and 12138 regarding encouragement of minority
and women's business participation;
The prospective contractor's signature affixed hereon and dated shall constitute a
certification under penalty of perjury under the laws of the State of California that
the bidder has, unless exempted , complied with the non-discrimination program
requirements of Government Code Section 12990 and Title 2, California
Administrative Code, Section 8103;
(e)
For major rehabilitation or conversion, it will comply with the Uniform Federal Accessibility
Standards (24 CFR Part 40, Appendix A);
(f)
No person who is an employee, agent, consultant, officer, or elected or appointed official
of the non-profit recipient that receives EMERGENCY SOLUTIONS GRANTS amounts
and who exercises or has exercised any functions or responsibilities with respect to
assisted activities or who is in a position to participate in a decision-making process or
gain inside information with regard to such activities, may obtain a personal or financial
interest or benefit from the activity, or have an interest in any contract, subcontract, or
agreement
APPLICANT AGENCY _________________________________
44
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
ATTACHMENT B (2 OF 3)
with respect hereto, or the proceeds there under, either for him or herself or those with
whom he or she has family or business ties, during his or her tenure or for one (1) year
thereafter;
(g)
It will comply with the applicable requirements of the Lead Based Paint Poisoning
Prevention Act and implementing regulations;
(h)
It will not comply, award contracts to, or otherwise engage the services of any contractor
while that contractor is in a period of debarment, suspension, or placement in ineligibility
status under the provision of 24 CFR Part 24;
(i)
It will maintain records necessary to document compliance with applicable requirements
and will give HUD, the City of Pomona, or any of their authorized representatives access
to and the right to examine all records related to the grant;
(j)
It will supplement its grant amount with an equal amount of funds from sources other that
this grant after the date of grant award;
(k)
Reports required by the City or HUD shall be submitted in a timely manner and contain all
required information as can reasonably be made available;
(l)
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 not supplant funding for pre-existing homeless
prevention activities from any other source;
(m)
The requirements of 24 CFR 576.51(b)(2)(iii) concerning the submission by non-profit
organizations applying for funding of a certification of approval of the proposed project(s)
from the unit of local government in which the proposed project is located;
(n)
The requirements of 24 CFR 576.51(b)(2)(v) concerning the funding of emergency shelter
in hotels or motels or commercial facilities providing transient housing;
(o)
The requirements of 24 CFR 576.73 concerning the continued use of buildings for which
EMERGENCY SOLUTIONS GRANTSs or 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;
(p)
The building standard requirements of 24 CFR 576.75;
APPLICANT AGENCY _________________________________
45
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
ATTACHMENT B (3 OF 3)
(q)
The requirements of 24 CFR 576.77, concerning assistance to the homeless;
(r)
The requirements of 24 CFR 576.79, other appropriate provision of 24 CFR Part 576, and
other applicable Federal laws concerning non-discrimination and equal opportunity;
(s)
The requirements of 24 CFR 576.80 concerning the Uniform Relocation Assistance and
Real Property Acquisition Policies Act of 1970; and,
(t)
The requirement of 24 CFR 576.80 concerning minimizing the displacement of persons
as a result of a project assisted with these funds.
This certification is made under penalty of perjury.
CERTIFYING OFFICIAL:
____________________________________
(Print Name)
____________________________________
(Signature)
____________________________________
(Date)
APPLICANT AGENCY _________________________________
46
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
ATTACHMENT C (1 OF 3)
ATTACHMENT C: OTHER FEDERAL REQUIREMENTS
Use of the EMERGENCY SOLUTIONS GRANTS Program requires compliance with the
following additional requirements:
(a)
Non-discrimination and Equal Opportunity.
(1)
The requirements of Title VIII of the Civil Rights Act of 1968, 42 U.S.C. 3601-19
and implementing regulations; Executive Order 11063 and implementing
regulations at 24 CFR Part 107; and Title VI of the Civil Rights Act of 1964 (42
U.S.C. 2002d-1) and implementing regulations issued at 24 CFR Part 1.
(2)
The prohibitions against discrimination on the basis of age under the Age
Discrimination Act of 1975 (42 U.S.C. 6101-7) and the prohibitions against
discrimination against handicapped individuals under Section 504 of the
Rehabilitation Act of 1973 (29 U.S.C. 794);
(3)
The requirements of Executive Order 11246 and the regulations issued under
the Order at 41 CFR Chapter 60; and,
(4)
The requirements of Section 3 of the Housing and Urban Development Act of
1968, 12 U.S.C. 1801u (see 570.607 (b) of this Chapter); and,
(5)
The requirements of Executive Orders 11625, 12432, and 12138. Consistent
with HUD's responsibilities under these Orders, the grantee must make efforts
to encourage the use of minority and women's business enterprises in
connection with activities funded under this part.
(b)
Applicability of OMB Circulars. The policies, guidelines, and requirements of OMB
Circulars Nos. A-87 and A-102, as they relate to the acceptance and use of
EMERGENCY SOLUTIONS GRANTS amounts by States and units of general local
government, and nos. A-110 and A-122 as they relate to the acceptance and use of
EMERGENCY SOLUTIONS GRANTS amounts by private non-profit organizations.
(c)
Uniform Federal Accessibility Standards. For major rehabilitation or conversion, the
Uniform Federal Accessibility Standards at 24 CFR Part 40, Appendix A.
(d)
Lead-Based Paint. The requirements, as applicable, of the Lead-Based Paint
Poisoning Prevention Act (42 U.S.C. 570.611(d) and (e) of this chapter).
APPLICANT AGENCY _________________________________
47
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
ATTACHMENT C (2 OF 3)
(e)
Conflicts of Interest. In addition to conflict of interest requirements in OMB Circulars A102 and A-110, no person who is an employee, agent, recipient, officer, or elected or
appointed official of the grantee, State recipient, or non-profit recipient (or of any
designated public agency) that receives EMERGENCY SOLUTIONS GRANTS amounts
and who exercises or has exercised any functions or responsibilities with respect to
assisted activities or who is in a position to participate in a decision making process or
gain inside information with regard to such activities, may obtain a personal or financial
interest or benefit from the activity, or have an interest in any contract, subcontract or
agreement with respect thereto, those with who he or she has family or business ties,
during his or her tenure or for one year thereafter. HUD may grant an exception to this
exclusion as provided in 570.611(d) and (e) of this chapter.
(f)
Use of debarred, suspended, or ineligible contractors. The provisions of 24 CFR Part 24
relating to the employment, engagement of services, awarding of contract, or funding of
any contractors or subcontractors funding any period of debarment, suspension, or
placement in ineligibility status.
(g)
Flood Insurance. No site proposed on which renovation, major rehabilitation, or
conversion of a building is to be assisted under this part, other than by grant amounts
allocated to State, may be located in an area that has been identified by the Federal
Emergency Management Agency (FEMA) as having special flood hazards, unless the
community in which the area is situated is participating in the National Flood Insurance
Program and the regulations there under (44 CFR Parts 59-79 or less than a year has
passed since FEMA notification regarding such hazards), and the grantee will ensure that
flood insurance on the structure is obtained in compliance with section 102(a) of the
Flood Disaster Protection Act of 1973 (42 U.S.C. 4001 et seq.
(h)
Audit. The financial management system used by a State or unit of local government that
is a grantee or State recipient shall provide for audits in accordance with 24 CFR Part 44.
A private non-profit organization is subject to the audit requirements of OMB Circular A110.
In addition to, and not in substitution for, other provisions of this agreement, the Recipient:
1.
Represents that if it is, or may be deemed to be a religious or denominational
institution or organization or an organization operated for religious purposes which
is supervised or controlled by or in connection with a religious or denominational
institutional or organization; and,
APPLICANT AGENCY _________________________________
48
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
ATTACHMENT C (3 OF 3)
2.
Agrees that, in connection with such essential services and operational costs
a.
it will not discriminate against any employee or applicant for employment on
the basis of religion and will not limit employment or give preference in
employment to persons on the basis of religion;
b.
it will not discriminate against any persons seeking emergency shelter and
related services on the basis of religion and will not limit such services or
give preference to persons on the basis of religion;
c.
it will provide no religious instruction or counseling, conduct no religious
worship or services, engage in no religious proselytizing, and exert no other
religious influence in the provision of housing or emergency services; and,
d.
the portion of the facility used as an emergency shelter assisted in whole or
part under this agreement shall contain no sectarian or religious symbols or
decorations.
(i).
Building Standards (subpart 576.75) Any building for which EMERGENCY SOLUTIONS
GRANTS amounts are used for renovation, conversion, or major rehabilitation must meet
local government safety and sanitation standards.
(j).
Relocation and Acquisition (subpart 576.80) Minimizing displacement - Consistent with
other goals and objectives of this Part, grantees and recipients must assure that they
have taken all reasonable steps to minimize the displacement of persons (families,
individuals, businesses, non-profit organizations, and farms) as a result of a project
assisted under this part.
(k).
Drug-Free Workplace Act of 1988. The sub-recipient will comply with maintaining a drugfree work site by enforcing the requirements of 24 CFR Part 24, subpart F.
CERTIFYING OFFICIAL:
____________________________________
(Print Name)
____________________________________
(Signature)
____________________________________
(Date)
APPLICANT AGENCY _________________________________
49
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
ATTACHMENT D: STATEMENT OF CONFIDENTIALITY
FOR
VICTIMS OF FAMILY VIOLENCE
____________________________________________(Agency Name)
Assures that it will adopt policies which meet at least the minimal standards for protecting the
confidentiality of information as set forth in the State Information Practices Act (Civil Code 1798,
et. seq.).
__________________________________________
(President, Board of Directors
__________________________________________
(Date)
__________________________________________
(Executive Director)
__________________________________________
(Date)
APPLICANT AGENCY _________________________________
50
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
ATTACHMENT E: CERTIFICATION OF RELIGIOUS COMPLIANCE
________________________________________, agrees to provide all eligible activities under
this program in a manner that is free from religious influences and in accordance with the
following principles:
A. It will not discriminate against any employee or applicant for employment on the
basis of religion and will not limit employment or give preference in employment to
person on the basis of religion.
B. It will not discriminate against any person applying for shelter or any of the eligible
activities under this program on the basis of religion and will not limit such housing
or other eligible activities or give preference to person on the basis of religion; and
C. It will provide no religious instruction or counseling, conduct no religious worship or
services, engage in no religious proselytizing, and exert no other religious
influence in the provision of shelter and other eligible activities under this program.
_________________________________________
(Signature of Executive Director)
____________________________
(Date)
APPLICANT AGENCY _________________________________
51
COMMUNITY DEVELOPMENT DEPARTMENT
CITY OF POMONA
FY 2013-2014 ESG REQUEST FOR PROPOSAL (RFP) FULL APPLICATION FOR FUNDING
ATTACHMENT F: APPEALS PROCESS FOR CLIENT TERMINATIONS
An organization requesting funds under the EMERGENCY SOLUTIONS GRANTS Program
must state its formal appeal process for the termination of any homeless families or individuals
assisted, who may violate established program requirements of the project. This process must
recognize the rights of the affected individuals and may include a hearing. The formal process
must be stated below or attached.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
APPLICANT AGENCY _________________________________
52