FFY 2017 APPLICATION CYCLE
Community Development Block Grant (CDBG) Program
Public Services Application
Gwinnett County Community Development Program
One Justice Square
446 West Crogan Street, Suite 275
Lawrenceville, GA 30046
678-518-6008
gchcd@gwinnettcounty.com
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
Table of Contents
I.
FFY 2017 APPLICATION INSTRUCTIONS ............................................................................................ 3
II.
TAB A – COVER SHEET....................................................................................................................... 8
III.
TAB B – APPLICATION SUBMISSION REQUIREMENTS ........................................................................ 9
IV.
TAB C – PROJECT DETAILS ................................................................................................................11
V.
TAB D – BENEFICIARIES ....................................................................................................................13
VI.
TAB E – GOALS AND OBJECTIVES ......................................................................................................15
VII.
TAB F – SUSTAINABILITY ..................................................................................................................16
VIII.
TAB G – PROPOSED BUDGET SUMMARY ..........................................................................................17
IX.
SIGNATURE PAGE ............................................................................................................................18
X.
ATTACHMENTS ................................................................................................................................19
A. INCOME GUIDELINES ...........................................................................................................19
B. APPLICATION RATING FORM ................................................................................................20
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
Page 2 of 22
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
Gwinnett County, Georgia
Community Development Block Grant (CDBG) Program – Public Services
FFY 2017 Application Instructions
PLEASE READ CAREFULLY
INTRODUCTION
The United States Department of Housing and Urban Development (HUD), through the Community Development
Block Grant (CDBG) program, provides communities with resources to address a wide range of unique community
development needs. The CDBG program provides annual grants, on a formula basis to Entitlement Communities,
as a means to support viable communities by providing decent housing, a suitable living environment, and
opportunities to expand economic opportunities, principally for low and moderate-income persons.
The CDBG Program has three National Objectives:
 Provide a direct benefit(s) to low to moderate-income households;
 Prevent or eliminate slum or blight; and/or
 Address an urgent need or problem within the community.
Annually, the Gwinnett County Community Development Program Office requests local agencies and government
entities submit applications to participate as a subrecipient in the program. This funding application is for the period
beginning January 1, 2017 and ending December 31, 2017.
A Selection Committee will review all applications for compliance with minimum requirements and make funding
recommendations to the Gwinnett County Board of Commissioners.
Please note: Incomplete Applications will not be considered for funding; be sure to complete all sections of the
application and provide all requested documentation.
AVAILABLE FUNDING
This application is contingent upon the availability of HUD funding for the CDBG program. This program is funded and
regulated at the federal level by the U.S. Department of Housing and Urban Development (HUD) and administered
locally by the Gwinnett County Community Development Program Office. It is authorized under Title I of the Housing
and Community Development Act of 1974, as amended and regulatory compliance requirements are governed by the
following:
- Title I of the Housing & Community Development Act of 1974, as amended.
- Title 24 of the Code of Federal Regulations, Section 570 (24 CFR 570).
- Office of Management and Budget (OMB) Administrative Circular A-110, as amended.
- Office of Management and Budget (OMB) Administrative Circular A-122, as amended.
This funding is subject to availability and there is no guarantee that any funds will be allocated. Submission of an
application does not guarantee funding. Costs associated with the application preparation shall be the responsibility of
the applicant. Applications will become the property of Gwinnett County.
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
Page 3 of 22
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
ELIGIBILITY REQUIREMENTS
a. The application must be submitted by, or on behalf of, a nonprofit agency, public agency or governmental entity,
requesting CDBG funds to undertake eligible costs and activities.
b. A minimum of 51% of total expenditures must benefit low to moderate-income persons or clientele within Gwinnett
County municipal boundaries.
c. Proposed projects must address the program priorities outlined in the Program Priorities section of this application.
d. All proposed projects must serve one or more targeted populations: low-income households with incomes at or
below 80% (see Attachment A: Income Guidelines); abused/neglected children; abused spouses; adults with severe
disabilities; elderly (62+); homeless; illiterate adults; migrant farm workers; persons living with HIV/AIDS.
FFY 2017 CDBG PROGRAM PRIORITIES
Gwinnett County’s Consolidated Plan 2015-2019 established strategic priorities as a product of consultation with
community stakeholders, combined with data from the U.S. Census and other sources, which indicate specific housing
and community development needs in Gwinnett County. Combined with a needs assessment survey, under the Citizen
Participation Plan, Gwinnett County identified the following strategic priorities to address utilizing CDBG, HOME, and
ESG funds in conjunction with leveraging other public and private investments.
The priorities are based on the needs assessment, market analysis and public comments received. Gwinnett County will
focus its priorities on the types of projects and programs having long term impacts on low and moderate-income
residents, and help address other federal, state and local priorities, such as fair housing choice and sustainability.
The proposed program/project should be designed to address one or more of the priority needs listed below:
1. Increase Access to Affordable Housing
1.1 Provide Downpayment Assistance
1.2 Acquisition/Rehabilitation/Disposition of Single-Family Units
1.3 Acquisition/Rehabilitation of Transitional Housing
2. Increase Housing Options for Homeless and At Risk of Homelessness
2.1 Provide Support for Emergency Housing and Supportive Services for the Homeless
2.2 Provide Funding to Increase Permanent Supportive Housing to Homeless and At Risk of Homelessness
Populations
2.3 Support the Expansion of HMIS Use
3. Reduce Substandard Housing
3.1 Rehabilitation of Existing Housing
3.1.1 Rehabilitation of Existing Housing to Include Energy Conservation
3.1.2 Rehabilitation of Existing Housing to Include Weatherization
3.1.3 Rehabilitation of Existing Housing to Include Hazardous Materials Abatement/Removal
3.2 Homeowner Education
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
Page 4 of 22
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
4. Increase Housing and Supportive Services for Special Needs Populations
4.1
4.2
4.3
4.4
Acquire/Construct/Rehabilitate Housing for Special Needs Populations
Acquire/Construct/Rehabilitate Transitional Housing for Special Needs Populations
Acquire/Construct/Rehabilitate Public Facilities and Infrastructure for Special Needs Populations
Financial Assistance (Equipment and Operating Costs) for Agencies Serving Special Needs Populations
5. Increase the Capacity of Public Facilities and Public Services to Improve the Social, Economic, and Physical
Environment by Acquiring, Constructing, or Rehabilitating Public Facilities, Revitalizing Older Areas of the County,
Providing Equipment and Operating Support Through Public Service Activities, and Providing Overall Program
Administration and Management.
5.1 Construct New Public Facilities and Infrastructure
5.2 Improve Existing Deteriorated Public Facilities and Infrastructure
5.3 Provide Funding, Support, or Technical Assistance to Agencies Meeting the Public Services Needs of the
County
5.4 Provide Administrative Structure for the Planning, Implementation, and Management of the CDBG, HOME,
and ESG Grant Programs as well as Other Housing, Community Development and Homeless Programs.
6. Affirmatively Further Fair Housing Choice
6.1 Fair Housing Education
REQUIRED APPLICATION CONTENTS
The following information is required in each application and should be submitted and tabbed as follows:
Tab A. Cover Sheet
General information about the Applicant.
Tab B. Application Submission Requirements
A required documentation checklist.
Tab C. Project Details
This section should include all the specifications of the proposed project.
Program Description: The overall purpose of the project and how it addresses CDBG program priorities.
Implementation Schedule: The project implementation schedule identifies what you plan to achieve. Include any
major activities.
Tab D. Beneficiaries
This section includes information about the area and population to be served, including the method for
determining income eligibility.
National Objectives: National objectives established by the U. S. Department of Housing and Urban Development
(HUD) require that programs and projects target low to moderate-income clients. An activity is considered to
benefit low to moderate-income limited clientele when at least 51 percent of the residents served meet the low
to moderate-income persons in accordance with HUD’s national income guidelines (See Attachment “A” Income
Guidelines). In this section you must identify which national objective(s) will be met. There must be a description
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
Page 5 of 22
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
on how family size and income will be documented to verify that at least 51% of clientele are persons whose
family income does not exceed the low to moderate-income limits.
Proposed Need: This section should identify the need or problem to be addressed by the proposed project. Also,
this section should include methods used to identify the need. Include specifics as to documentation used and/or
meetings held to assess the needs.
Tab E. Goals and Objectives
This section identifies goals and objectives. Identify at least one (1) objective for each identified need/problem.
Identify the activities to be conducted to achieve the stated goals and objectives. Identify how the expected
outcomes would be measured. Lastly, identify any collaboration activities with other agencies to address the
identified need.
Performance: Reporting, Monitoring, & Record Keeping: The Gwinnett County Community Development
Program Office will require organizations to provide data and information for the submission of monthly,
quarterly, and annual reports pertaining to the administration and expenditure of CDBG-funded activities.
Tab F. Sustainability
Proposed Project Budget Summary: In Exhibit A, complete the table outlining the total expenses for the
proposed project, including source and amount of leveraged funds/matching funds (in-kind donations or service
costs).
Project Staffing: This section identifies the program staffing for the proposed project, including current
employees, new hires, and volunteers to be utilized in any capacity of the project.
Collaboration and Resource Leveraging: Collaboration and Resource Leveraging represents the resources the
proposing agency will bring to the project to supplement the funds being requested. Collaboration/resource
leveraging can be in the form of monetary resources or in-kind services. Please include other resources in the
budget summary.
Tab G. Proposed Budget Summary
Proposed Project Budget Summary: Complete the table outlining the total expenses for the proposed project,
including source and amount of leveraged funds.
Collaboration and Resource Leveraging: This represents the resources the proposing agency will bring to the
project to supplement the funds being requested. Collaboration/resource leveraging can be in the form of
monetary resources or in-kind services.
TECHNICAL ASSISTANCE
Technical assistance questions should be directed to Gwinnett County Community Development staff at:
One Justice Square
446 West Crogan Street, Suite 275
Lawrenceville, GA 30046
E-mail: gchcd@gwinnettcounty.com
Phone: 678-518-6008
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
Page 6 of 22
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
SUBMITTAL INSTRUCTIONS
Provide 1 ORIGINAL UNBOUND HARD COPY AND 1 DIGITAL COPY (flashdrive only) of your complete CDBG application
with attachments. All entities must meet the requirements set forth in this application including mandatory attendance
at one of the three application workshops to be held for the FFY 2017 Funding Cycle.
FFY 2017 Funding Cycle Application Workshop
Option #1:
Wednesday, February 10, 2016 at 10:00 AM
Option #2:
Wednesday, February 10, 2016 at 6:00 PM
Option #3:
Wednesday, February 17, 2016 at 2:00 PM
Location:
Gwinnett County Justice and Administration Center
Conference Center, Room C
75 Langley Drive, Lawrenceville, GA 30046
Applications must be submitted to the Gwinnett County Community Development Program
Office no later than Thursday, April 14, 2016 at 5:00 PM.
Applicant must receive a date/time-stamped receipt to confirm a timely submission.
Office/Mailing Address
Gwinnett County Community Development Program Office
One Justice Square
446 West Crogan Street, Suite 275
CDBG PUBLIC SERVICES APPLICATION
Lawrenceville, GA 30046
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
Page 7 of 22
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
TAB A - COVER SHEET
1. Legal Name of Applicant
2. Mailing Address
3. Telephone Number
4. Facsimile Number
5. Applicant Website Address
6. How long has the Applicant served Gwinnett
County residents?
7. Date of 501(c)(3) certification
(N/A government entity)
8. Applicant’s DUNS #:
9. Registered with SAM.gov?
yes
no
10. Applicant’s Federal Tax Identification #:
Name:
11. Chief Executive Officer or Chief Elected Official
Title:
Phone:
E-mail:
Name:
12. Contact person for this project (if different than
above)
Title:
Phone:
E-mail:
Name:
13. Current Board President or City Clerk
Title:
Phone:
E-mail:
14. Current Board Secretary or other city
representative
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
Page 8 of 22
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
TAB B – APPLICATION SUBMISSION REQUIREMENTS
Please properly label and place all required documentation in the Appendix
ALL APPLICANTS
SUBMISSION REQUIREMENTS
1. The applicant must have at least twelve (12)
months experience directly related to the
proposed project or program.
2.
The applicant must have audited financial
statements prepared by a qualified accountant
or accounting service, covering the last two
most recent reporting periods of operation.
3.
The applicant must submit a written copy of its
financial management procedures, including
staff responsibilities and required procedures.
DOCUMENTATION
Applicant
Office
Use
Only
Provide (1) funding commitments displayed on
letterhead; (2) resumes of principal staff and
personnel directly working on the project; and, (3)
descriptions of the applicant’s previous related
program activities.
One copy each of the audited financial statement that
meets the criteria described. Include management
letters if applicable.
Provide (1) a copy of the Applicant’s written financial
management procedures; and,
(2) current organizational chart.
4.
Identifying eligible project service areas and
eligible clientele to be served.
Provide a project map that includes Census Tracts
where services will take place; or
Provide a description of clientele to benefit from
project.
5.
Each applicant must submit one original hard
copy and one digital copy (flashdrive or disk
only) of their application.
Must submit an original hard copy and one digital
copy (flashdrive only).
6.
Participation in FFY 2017 Application Workshop
is Mandatory. Receipt from FFY 2017
Application Workshop attendance.
Must submit a receipt from one of three FFY 2017
Application Workshops.
In addition to the submission requirements detailed above, nonprofit organizations must also
meet the requirements detailed below and continued on the next page.
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
Page 9 of 22
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
TAB B – APPLICATION SUBMISSION REQUIREMENTS continued
Please properly label and place all required documentation in the Appendix
NONPROFIT ORGANIZATIONS
SUBMISSION REQUIREMENTS
DOCUMENTATION
1.
Submission Requirement Items 1 – 6 for ALL
APPLICANTS have been appended.
See items detailed above.
2.
Must have a minimum two-year operating
history after the date of receipt of its 501(c)(3)
classification from the Internal Revenue Service.
A copy of a 501(c) (3) designation letter from the
Internal Revenue Service if a non-profit applicant.
Must have an annual operating budget of more
than $100,000 as reflected in the most recently
filed IRS Form 990 or 990 EZ.
Most recent IRS Form 990 or 990EZ.
4.
Applicant must be registered to conduct
business in the State of Georgia at the time of
application.
A current certification from the GA Secretary of State.
For assistance, please visit: www.sos.ga.gov.
5.
Must have a Board of Directors with
representation from the community served and
committee structure that ensures the necessary
mix of skills to succeed. During the last fiscal
year, 100% of the members must have made a
personal cash donation or made financially
measureable in-kind contributions.
Provide (1) a list of board members and their
addresses; (2) your agency By-Laws; (3) a copy of
Conflict of Interest Statement; and (4) a brief narrative
confirming your agency meets the Board submission
requirements regarding representation and financial
contributions.
3.
6. Must have a current written strategic or
business plan for the whole organization that
covers at least 24 months which includes the
organization’s entire current fiscal year and
includes the following: mission statement,
evidence of an environmental scan, stakeholder
participation (staff, board, etc.), strategic goals
and measurable objectives, implementation
plan with assigned staff and/or board
responsibilities, on-going evaluation to keep
plan current, and addresses multiple years with
regular updates.
Applicant
Office
Use
Only
Current Business/Strategic Plan
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
Page 10 of 22
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
TAB C – PROJECT DETAILS
Add additional pages as needed and tab accordingly.
Legal Name of Applicant:
Project Name:
Project Location:
Applicant owns the property
Applicant leases the property
Minimum 15-year lease is attached in Appendix
1. Gwinnett County Commission District:
2. Will the project serve only Gwinnett County residents?
yes
no
If no, identify other counties/municipalities that will benefit. Explain the process for ensuring that Gwinnett is paying
only its fair share. (1,000 characters max; include additional pages as needed and label accordingly).
CDBG Public Services Funds Requested: $
Project Priority: Number
of
projects submitted.
Project Status:
New Project
Existing Project/Additional Funding
If an existing project, include the following information in the Project Description: year(s) and amount of awarded
CDBG funds; detailed information on how existing service will be expanded if CDBG funds are awarded; the estimated
increase of persons receiving the service and/or discussion of additional service to be provided through
project/program. The increased provision of services/beneficiaries is essential to qualify for additional funding.
Check the appropriate box for the type of activity to be supported with CDBG funding:
Childcare Services
Crime Awareness/Prevention
Employment Training
Fair Housing Activities
Food Banks
Health Services
Housing Services
Legal Services
Mental Health Services
Neighborhood Cleanups
Senior Services
Services for Abused/Neglected Children
Services for Battered Spouses
Services for Severely Disabled Adults
Substance Abuse Services
Tenant/Landlord Counseling
Transportation Services
Youth Services
Other Operating Service:
Equipment Purchase:
If purchasing equipment, attach at least one detailed price quote and a detailed description of the equipment; specify
quantities and estimated unit prices.
Equipment Details Attached in Appendix
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
Page 11 of 22
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
TAB C – PROJECT DETAILS continued
Add additional pages as needed and tab accordingly.
Describe experience with project/program for which funding is requested. (1,000 characters max; include additional
pages as needed and label accordingly).
Duration of Project:
Project Implementation Schedule:
Detail your project implementation schedule, including expenditure schedule, accomplishments, and all timelines.
(1,000 characters max; include additional pages as needed and label accordingly).
Project Description
Provide a detailed and comprehensive narrative about your project. Be sure to highlight any significant
partnerships/leveraging resources. Equipment purchase(s): provide a detailed description of the equipment; specify
quantities and estimated unit prices. At least one (1) price quote is required. (12,000 characters max; include additional
pages as needed and label accordingly).
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
Page 12 of 22
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
TAB D - BENEFICIARIES
Add additional pages as needed and tab accordingly.
Service Area of Project
1. Identify the geographic area to be served by the project activities.
Project Service Area Map Attached in Appendix (as requested in Tab B)
Project Beneficiaries
At least 51% of the total number of persons served by each project must be low to moderate-income for the project to be
eligible for Gwinnett County CDBG funds.
1. Indicate the number of beneficiaries this project has served/will serve in a 12-month period.
Persons Served in 2015 (if existing project) Proposed Persons Served in 2017
Total
Total
# Low to Moderate-income
# Low to Moderate-income
2. Identify any presumed benefit groups included in the target population.
Number Served in 2015
Proposed
Served in 2017
Abused/Neglected Children
Abused Spouses
Adults with Severe Disabilities
Elderly (62+)
Homeless Persons
Illiterate Adults
Migrant Farm Workers
Persons Living with HIV/AIDS
Other:
3. Identify the need(s) of the population to be served that are addressed by the proposed project. ((1,000 characters
max; include additional pages as needed and label accordingly).
4. How does the proposed project meet the identified need(s)? (1,000 characters max; include additional pages as
needed and label accordingly).
5. Describe how the Applicant collaborates with organizations that duplicate the services you offer, or those that serve
the same population. (1,000 characters max; include additional pages as needed and label accordingly).
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
Page 13 of 22
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
TAB D - BENEFICIARIES
Add additional pages as needed and tab accordingly.
6. At least 51% of the total number of persons served by each proposed project must be low to moderate-income for
the project to be eligible for Gwinnett County CDBG funds. Describe the Applicant’s process for verifying household
income or presumed benefit status (battered and abused spouses, homeless, etc.) of all persons served by the project
for which funding is requested. (1,000 characters max; include additional pages as needed and label accordingly).
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
Page 14 of 22
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
TAB E – GOALS AND OBJECTIVES
Add additional pages as needed and tab accordingly.
1. What performance measurement outcome does the proposed project best exemplify? (If all relevant, rank 1-3).
Improving Availability/Accessibility [Projects that make services, housing, etc. available or accessible to
low to moderate-income persons and/or persons with disabilities.]
Improving Affordability [Projects that make housing, services, transportation, etc. more affordable for
people with low to moderate-income.]
Improving Sustainability [Projects that help communities become more livable or viable by removing
slum/blight or providing services that can result in more sustainable communities.]
1.a. Discuss how the proposed project exemplifies the chosen performance measurement outcome(s). (1,000
characters max; include additional pages as needed and label accordingly).
2. What performance measurement objective does the proposed project best exemplify? (If all relevant, rank 1-3).
Suitable Living Environment [Projects that benefit communities, families or individuals by addressing
issues in their living environment, like poor-quality infrastructure and/or social issues.]
Decent Housing [Projects that include a housing program component.]
Creating Economic Opportunity [Projects related to economic development, commercial revitalization,
or job creation.]
2.a. Discuss how the proposed project exemplifies the chosen performance measurement objective(s). (1,000
characters max; include additional pages as needed and label accordingly).
3. Complete the table below to identify how expected outcomes will be measured to meet performance goals. Add
lines as needed.
[Refer to pages 4-5 of this application to determine the Priority Need]
Priority
Need
5.0; 2.1
Activity
Case Management
Number of
Persons Served
in 12-month
period
Example
25
Beneficiary Type
Homeless women with children
Performance: Reporting, Monitoring, and Record-Keeping
The Gwinnett County Community Development Program Office requires organizations to provide data and information
for the submission of monthly, quarterly, and annual reports pertaining to the administration and expenditure of CDBGfunded activities.
1. Describe and discuss the Applicant’s experience with reporting, monitoring, or record-keeping compliance
requirements with other funding agencies. Identify previous CDBG awards. (1,000 character max; include
additional pages as needed and label accordingly).
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
Page 15 of 22
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
TAB F - SUSTAINABILITY
Add additional pages as needed and tab accordingly.
Sustainability Requirements
1. What is the Applicant’s annual budget? $
2. How much of the Applicant’s annual budget is generated from grant revenue?
Less than 30%
31-50%
51-60%
61-70%
71-80%
More than 80%
3. What is the total budget for this project and how much funding does the Applicant already have in place for this
project? If this project is not awarded CDBG funding, does the Applicant have the financial means to support the
proposed services? (1,000 characters max; include additional pages as needed and label accordingly).
4. Is the Applicant willing and able to begin this project January 1, 2017 regardless of the date funding is made available?
yes
no
If yes, explain how the Applicant will cover program costs while awaiting the CDBG award allocation. (1,000
characters max; include additional pages as needed and label accordingly).
Project Staffing
1. Number of full-time staff employed by Applicant:
2. Number of years Applicant has employed full-time staff:
3. How many staff employed by the Applicant will work on the project? Provide position titles (case managers, program
staff, etc.) and qualifications, requirements for professional certification, etc. (Do not include Contractors or
Consultants(1,000 characters max; include additional pages as needed and label accordingly).
4. Do any family relationships (by blood or marriage) exist between staff and/or Agency Board members?
yes
no
If yes, please explain in detail. (1,000 characters max; include additional pages as needed and label accordingly).
5. Do any family relationships (by blood or marriage) exist between staff and/or Gwinnett County Board of
Commissioners? Please be sure to include organization Conflict of Interest Statement as indicated in the Application
Submission Requirements on page 10 of this application.
yes
no
If yes, please explain in detail. (1,000 characters max; include additional pages as needed and label accordingly).
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
Page 16 of 22
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
TAB G - PROPOSED BUDGET SUMMARY
Staff and overhead expenses must be directly related to carrying out the proposed project/activity.
Include leveraged funds (other non-CDBG agency resources) that are immediately accessible and firmly committed to
the project. Leveraged funds can include a blend of cash, loans, or in-kind resources available to finance the project
costs.
In-kind contributions must have a specific dollar value established in accordance with Generally Accepted Accounting
Principles. The basis of determining the value for personal services and donated materials and supplies must be
identified. Volunteer services may be counted if the service is an integral and necessary part of the project. To
determine in-kind volunteer contributions, use the estimated amount of what a paid worker would earn doing the same
type of work (verification documentation may be requested).
Community Development Block Grant – Public Services: OPERATING EXPENSES
Identify project staff costs (i.e. existing staff, new hires, volunteers, etc).
Staff and overhead expenses must be directly related to carrying out the proposed project/activity.
CDBG
Leveraged Funds
Total Project
Request
(Other Non-CDBG Funds)
Costs
1. Salaries & Benefits
$
$
Source(s):
$
2. Program Equipment Repairs & Maintenance
$
$
Source(s):
$
3. Office Supplies
$
$
Source(s):
$
4. Advertising
$
$
Source(s):
$
5. Postage
$
$
Source(s):
$
6. Printing/Copying
$
$
Source(s):
$
7. Telecommunications
$
$
Source(s):
$
8. Professional Services/Fees
$
$
Source(s):
$
9. Accounting Services
$
$
Source(s):
$
10. Audit Services
$
$
Source(s):
$
11. Reimbursable Travel [Mileage]
$
$
Source(s):
$
12. Insurance & Bonding [Facilities & Program] $
$
Source(s):
$
13. Volunteer/In-Kind
$
$
Source(s):
$
14. Other:
$
$
Source(s):
$
Total Request for Public Services - Operating
$
$
$
Community Development Block Grant – Public Services: EQUIPMENT PURCHASE(S)
Provide a detailed description of the equipment; specify quantities and estimated unit prices.
At least one (1) price quote is required per equipment type.
CDBG
Leveraged Funds
Total Project
Request
(Other Non-CDBG Funds)
Costs
1. Equipment Type:
$
$
Source(s):
$
2. Equipment Type:
$
$
Source(s):
$
Total Request for Public Services - Equipment
$
$
CDBG
Request
GRAND TOTAL
$
$
Leveraged Funds
(Other Non-CDBG Funds)
$
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
Total Project
Costs
$
Page 17 of 22
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
SIGNATURE PAGE
This page must be submitted with the application.
Letter from Authorized Certifying Official is attached
OR, the following is executed:
Resolution Authorizing Submission of application
Name of Applicant:
Be it resolved that the City Council/Commission/Board of Directors of the above referenced Applicant resolved at its
meeting date referenced below, to authorize the Applicant to submit an application to the Gwinnett County Community
Development Program office for grant funding. The individual referenced below is authorized to execute any
documents necessary for application submission and funding.
Meeting Date:
Amount Requested: $
Executor:
I hereby certify that the foregoing resolution was approved by our City Council/Commission/Board of Directors.
_______________________________________________________________________
Authorized Certifying Official (Signature, Name & Title)
_________________
Date
(Insert Corporate Seal)
I certify that I have completed the application for Gwinnett County Community Development Block Grant – Public
Services funding. All of the information contained in this submission has been completed as thoroughly and as
accurately as possible and a governing body resolution or letter from an authorized certifying official approving this
submission has been attached to this submission.
Prepared by:
Date:
Signature
Prepared by:
Printed Name & Title
Approved by:
Date:
Signature
Approved by:
Printed Name & Title
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
Page 18 of 22
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
ATTACHMENT A
Income Guidelines
MAXIMUM HOUSEHOLD INCOME LIMITS [GWINNETT COUNTY, GEORGIA]
FY 2015 Income Limits
Effective: March 6, 2015
NOTE: Gwinnett County is part of the Atlanta-Sandy Springs-Marietta, GA HUD Metro FMR Area, so all information
presented here applies to all of the Atlanta-Sandy Springs-Marietta, GA HUD Metro FMR Area. The Atlanta-Sandy
Springs-Marietta, GA HUD Metro FMR Area contains the following:
FY 2015
Income
Limit Area
Gwinnett
County
Median
Income
$68,300
FY 2015
Income Limit
Category
Persons in Family
1
2
3
4
5
6
7
8
Very Low
(50%) Income
Limits ($)
$23,900
$27,300
$30,700
$34,100
$36,850
$39,600
$42,300
$45,050
Extremely Low
(30%) Income
Limits ($)*
$14,350
$16,400
$20,090
$24,250
$28,410
$32,570
$36,730
$40,890
$38,200
$43,650
$49,100
$54,550
$58,950
$63,300
$67,650
$72,050
Low (80%)
Income Limits
($)
* The FY 2014 Consolidated Appropriations Act changed the definition of extremely low-income to be the greater of 30/50ths (60
percent) of the Section 8 very low-income limit or the poverty guideline as established by the Department of Health and Human
Services (HHS), provided that this amount is not greater than the Section 8 50% very low-income limit. Consequently, the extremely
low income limits may equal the very low (50%) income limits.
Source: U.S. Department of Housing & Urban Development [HUD] Datasets
http://www.huduser.gov/portal/datasets/il/il2015/2015summary.odn
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
Page 19 of 22
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
ATTACHMENT B
Total Score:
/100
FFY 2017 Application Cycle
Community Development Block Grant (CDBG) Program
Public Services Application Rating Form
Applicant:
Funding Request:
Proposed Project:
Reviewer:
Date:
APPLICATION COMPLETENESS
Yes
No
Eligible
Comments
TAB A – Cover Sheet
TAB B – Application Submission Requirements
TAB C – PROJECT DETAILS
Criteria
Score
Yes
No
Project only serves Gwinnett County residents.
Max
Points
Total
Received
2
Yes, 2 point; No, 0 points
If project serves non-Gwinnett residents, applicant provides a percentage of Gwinnett
residents to be served and a method for ensuring Gwinnett only pays its fair share.
2
Yes, both answered & 50%+ Gwinnett, 2 points; 50%+ but no method provided, 1 point; No, or
less than 50%, 0 points; N/A, 2 points
Applicant has experience with the project.
5
10+ years, 5 points; 5-10 years, 4 points; 3-5 years, 3 points; 1-3 years, 2 points; less than 1 year,
1 point; no experience, 0 points
Applicant provides the duration of the project.
4
Less than 6 months, 4 points; 6-9 months, 3 points, 9-12 months, 2 points; 12 months, 1 point;
More than 12 months, 0 points
The proposed implementation schedule is realistic and includes expenditure schedule,
accomplishments, and timelines.
4
Clear schedule provided, 4 points; some questions remain, 3 points; unclear and many questions
remain, 0 points
The project description provides a detailed and comprehensive narrative about the
project.
10
Yes and no questions remain, 10 points; Yes but a few questions remain, 8 points; Almost, but
many questions remain, 5 points; No, but further information needs to be provided, 3 points;
No, and all is unclear, 0 points
TAB C TOTAL
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
27
Page 20 of 22
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
TAB D - BENEFICIARIES
Criteria
Score
Yes
No
Applicant provides a Project Service Area Map in Appendix.
Max
Points
Total
Received
2
Yes, 2 points; no, 0 points
Applicant identified that 51% or more total population served as low and moderate
income.
5
Yes, 5 points; No, 0 points
Existing Projects: Total proposed to be served in 2017 is greater than in 2015.
4
51+% greater, 4 points; 30-50% greater, 3 points; 10-29% greater, 2 points; 1-10% greater, 1
point; 2017 equal to or less than 2015, 0 points; N/A, 4 points
New Projects:
Total proposed to be served in 2017 is realistic for a 12-month time frame.
4
Yes, 4 points; No, 0 points; N/A, 4 points
Applicant identifies need to be addressed by project.
Yes, more than one need identified and provides data/research provided, 4 points; Yes, and
provides anecdotal info, 3 points; Yes, more than one provided but no additional info, 2 points;
Yes, one provided but no additional info, 1 points; No, 0 points
4
Applicant’s design meets the identified need.
5
Yes, and includes data/research re: “best practices”, 5 points; Yes, and provides anecdotal data,
3 points; Yes, but no supportive data provided, 1 point; No, 0 points
Applicant describes collaborative efforts with other service providers.
2
Yes, clear description, 2 points; Yes, but vague, 1 point; No/unclear, 0 points
Applicant describes a procedure for verifying income.
3
Yes, and it is clear, 3 points; Yes, but vague, 1 point; No, 0 points
TAB D TOTAL
29
TAB E – GOALS AND OBJECTIVES
Criteria
Score
Yes
No
Applicant identifies the performance measurement outcomes/objectives best
exemplified.
Max
Points
Total
Received
2
Yes, 2 points; No, 0 points
Applicant provides descriptions of how project exemplifies chosen performance
measurements/outcomes.
4
Yes, and both are clear, 4 points; yes, but only one is clear, 3 points; Yes, but both are vague, 2
points; Yes, but both are unclear, 1 point; No, 0 points
Applicant provides clear and measurable performance goals as they relate to the
proposed project.
5
Yes, clear and measurable, 5 points; Yes, but some questions remain, 3 points; No, 0 points
Applicant’s proposed project meets one of more of the CDBG Program priorities as
detailed on page 4 of the application instructions.
5
More than one, 5 points; One, 3 points; No, 0 points.
Applicant provides sufficient evidence to suggest satisfactory reporting, monitoring,
and record-keeping systems are in place.
1
If yes, 1 point; if no zero points.
Applicant has experience in reporting, monitoring or record-keeping.
5
Yes, and extensive, 5 points; Yes, but limited (or unclear), 3 points; No, 0 points
TAB E TOTAL
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
22
Page 21 of 22
GWINNETT COUNTY, GEORGIA
COMMUNITY DEVELOPMENT PROGRAM
TAB F – SUSTAINABILITY
Score
Criteria
Yes
No
Max
Points
Total
Received
Percentage of applicant’s budget includes grant revenue.
0%, 12 points; Less than 30%, 10 points; 31-50%, 7 points; 51-60%, 5 points; 61-70%, 3 points
71-80%, 1 point; More than 80%, 0 points
12
Applicant has funding in place for the project.
5
100%, 5 points; 50 – 99%, 3 points; 30 – 50%, 2 points; 10 - 30%, 1 point
0-10%, 0 points
Applicant is willing and able to start the project January 1, 2017.
5
Yes, 5 points; No, 0 points
Applicant has employed at least one full-time staff member for at least one year prior
to the request for funding.
1
Yes, 1 point; No, 0 points
TAB F TOTAL
TAB C TOTAL
TAB D TOTAL
TAB E TOTAL
TAB F TOTAL
GRAND TOTAL
Max Points
Possible
27
29
22
22
100
22
Score
Received
Please provide any additional comments/feedback not covered in the scoring criteria that should be considered in the decision to
award funding. Please be sure to address any apparent or perceived conflicts of interest.
FINANCIAL ASSESSMENT OF APPLICATION COMPLETENESS
Application Completeness
Yes
No
Eligible?
Did applicant include most recent audit or financial statement?
Did the applicant include an audited financial statement that is clear of any
findings/concerns?
Did the agency include written financial management procedures along with current
applicant chart?
Did the applicant include their most recent IRS Form 990 or 990 EZ?
Please provide any additional comments/feedback not covered in the scoring criteria that should be considered in the decision to
award funding.
Gwinnett County Community Development Block Grant Program – FFY 2017 Public Services Application
Page 22 of 22