HomeMy WebLinkAboutRES.2056.04-04-2005U
BILL NO. 05-73
RESOLUTION NO.
A RESOLUTION AUTHORIZING APPLICATIONS TO THE
MISSOURI DEPARTMENT OF SOCIAL SERVICES UNDER
THE EMERGENCY SHELTER GRANT PROGRAM, FOR SAFE
HOUSE FOR WOMEN, INC. AND THE SALVATION ARMY,
AND AUTHORIZING THE CITY MANAGER TO EXECUTE
ALL NECESSARY GRANT DOCUMENTS
BE IT RESOLVED BY THE COUNCIL OF THE CITY OF CAPE GIRARDEAU,
MISSOURI, AS FOLLOWS:
ARTICLE 1. The City Manager, for and on behalf of the City
of Cape Girardeau, Missouri, is hereby authorized to execute
grant applications to the Missouri Department of Social Services
under the Emergency Shelter Grant Program for the Safe House for
Women, Inc. and The Salvation Army and is hereby authorized to
execute all necessary grant documents. Copies of said
Applications are attached to this Resolution and made a part
hereof.
PASSED AND ADOPTED THIS �{DAY OF 20.
..0 14W-4001e�
fy B Knudtson, Mayor
APPLICATION
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MISSOURI
2005 EMERGENCY SHELTER GRANT PROGRAM (ESGP)
Contract Exhibit A
ti
+ The following information is to be provided by the Applicant
(local government) for each proposed service provider agency.
Application must be postmarked no later than Monday, April 18, 2005
and returned to:
MISSOURI DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
ATTN: BETH ROCKELMAN, ESG PROGRAM
P.O. BOX 2320
JEFFERSON CITY, MISSOURI 65103-2320
SECTION I: GENERAL INFORMATION
A. Name of City or County/(Grantee):
c'i.i-p' of
Street/Box Number 401 Independence Street
City and Zip Code Cape Girardeau, MO 63703
Contact Person Steve Williams
Title Housing Assistance Coordinator
Phone Number -334-5326
E-mail
B. Service Provider Agency/Organization Responsible for Grant
Activities (Subgrantee): safe House for women, Inc
Street/Box Number FU Box
116/
City and Zip Code Cape Girardeau, MO 63702
Contact Person Linda Garner
Title Executive Director
Phone Number -335-7745
E-mail director @semosafehouse.org
C. ESGP Funds Requested for total project $ 7500.00
Request must include total of all subgrantees.
Not more than $75,000 or less than $7,500 per grantee -- city/county entity.
ESGP Entitlement communities total awards will be limited to $65,000 each.
SECTION II: ELIGIBILITY
A. Funds will be obligated by July 1 , 2005.
(Must be obligated by local government no later than 180 days
after grant award by the State).
B. Obligated funds will be expended by MARCH 31, 2006.
MO 886-2369 (Rev.2/2005)
(Circle YES, NO, or Not Applicable (N/A) for the following questions)
C. The proposed non-profit service provider agrees to
not discriminate in the provision of assistance on
the basis of sex, race, color, religion, national
origin, age, handicap, veteran or resident status.
If statement is true answer "YES".
D. The amount of funds, value of services, buildings,
or materials to be provided locally for that project is
equal to or greater than that specified in Section I, C
of this application.
E. The amount of ESGP funds requested for
the provision of Essential Support Services,
(not including prevention services), does not
exceed 30% of the Total ESGP Grant requested.
If statement is true, answer "YES."
F. The applicant agrees that Emergency Shelter
funds will not be used to pay for acquiring a
building or land, mortgages, renting commercial
or transient accommodations, any administrative
costs for rehabilitation inspection services, loan
processing or other similar professional services.
If statement is true, answer "YES."
G. Local government will not use more than 2% of their
ESGP award for cost they incur to administer the
Emergency Shelter Grant Program. If statement
is true, answer "YES." (Service Provider Staff costs
included in category of operations)
H. If ESGP funds are used for shelter operations
and/or essential services the building will be used as
a shelter as long as Federal assistance is received.
If statement is true, answer "YES."
If ESGP funds are used for rehabilitation, other
than major rehabilitation or conversion, the building
will be used as a shelter for at least three years. If
statement is true, answer "YES."
YES NO
YES
NO
N/A
YES
NO
N/A
YES
NO N/A
NO N/A
YES NO N/A
YES NO N/A
J. The emergency shelter building will meet local ES NO N/A
government safety and sanitation standards, housing
and building codes after project completion. If statement
is true, answer "YES."
(Answer N/A if ESGP funds are not used for Rehab.)
Mo 886-236+ (Rev.2/2005)
K. Homeless individuals will be given assistance YE NO N/A
obtaining permanent housing, medical and
mental health treatment, counseling, and other
state and federal assistance. If statement is true,
answer "YES."
NOTE: If NO is the response to any of the above questions, stop here and do not
submit an application. (Exception: D, and E, a "NO" answer may be approved
by the State under special circumstances.
SECTION III: ELIGIBILITY OF REHABILITATION, CONVERSION AND
RENOVATION ACTIVITIES
A. Does rehabilitation, conversion, or renovation
activities involve a building on the National Register
of Historic Places, located in a Historical District,
immediately adjacent to a property listed on the
National Register, or deemed to be eligible for
inclusion on the National Register by the State
Historic Preservation Officer? Answer N/A if not
making improvements on a building with ESGP funds.
B. Is the building to be improved owned by an
organization with religious purposes stated in
By-laws, or Articles of Incorporation? Answer N/A
if not making improvements on the building with
ESGP funds.
C. Will the estimated value of the improvements
exceed 75% of the appraised value of the building
before the improvements are made? (Answer
N/A if not making improvements on the building
with ESGP funds)
D. If you answered YES to C, will your agency
provide assurances that the building will remain
emergency shelter for the next ten years?
(Answer N/A if not making improvements on
building with ESGP funds)
YES
YES
NO N/A
NO N/A
YES NO N/A
YES NO N/A
E. Will the applicant provide assurances that any (YES) NO N/A
building or rehabilitation or remodeling project
is in compliance with Environmental Protection
Requirements of 24 CFR 576.57(e) and
24 CFR Part 58.
NOTE: If you answered NO to D. or E., please do not submit an application.
MO 886-2369 (Rev.2/2005)
Definitions
Homeless: means an individual or family which lacks a fixed, regular,
and adequate nighttime residence: or an individual or family which has
a primary nighttime residence that is: a supervised publicly or privately
operated shelter, designed to provide temporary living accommodations
(including welfare hotels, congregate shelters, and transitional housing
for persons with mental illness): an institution that provides a temporary
residence for individuals intended to be institutionalized: or a public or
private place not designed for, or ordinarily used as, a regular sleeping
accommodation for human beings.
o ESGP: means Emergency Shelter Grant Program.
o Local Cash Funds: include all cash donated by the city, nonprofit organization,
or from other private sources. Do not include any funds derived from any state
or federal sources. Include only those funds spent on the emergency shelter
projects Ifor which grant monies are to be spent.
o Emergency Shelter: means any facility, the primary purpose of which is to
provide temporary or transitional shelter for the homeless in general or for
specific populations of the homeless.
o Local Non -Cash Resources: may include all public, private, and not-for-profit
donations made after the date of the grant award to the grantee, including the
value of any donated material or building, the value of any lease assigned on a
building, any salary paid to staff, the volunteer time valued at $5.00/hour,
or any other local resources.
o Other State/Federal Agency Funds: proposal must include a copy of a letter of
commitment from the agency administering the state or federal funds, if these
funds are used to meet matching requirements.
o Renovation: rehabilitation that involves costs of 75% or less than the appraised
value of the building before rehabilitation.
o Maior Rehabilitation: rehabilitation that involves costs in excess of 75% of the
appraised value of the building before rehabilitation.
o Conversion: a change in the use of a building to an emergency shelter for the
homeless, where the cost of conversion and any rehabilitation exceed 75% of
the value of the building before conversion.
o HMIS: means Homeless Management Information System. On July 30, 2004
HUD published the Federal Register, Homeless Management Information Systems
(HMIS); Data and Technical Standards Final Notice.
MO 886-2369 (Rev.2/2005) 4
o Essential Service: includes (but not limited to) services concerned with
employment, physical health, mental health, substance abuse, education,
food, or salary necessary to provide such services. Grant amounts
provided to grantee may be used to provide an essential service only if
the service is a new service or a quantifiable increase in the level of a
service above that which the grantee provided with local funds during
the 12 calendar months immediately before it received the initial grant.
o Homeless Prevention: means activities or programs designed to prevent
the incidence of homelessness, including (but not limited to): (a) Short-term
subsidies to defray rent and utility arrearages for families that have received
eviction or utility termination notices; (b) Security deposits or first month's
rent to permit a homeless family to move into its own apartment; (c)
Mediation programs for landlord -tenant disputes; (d) Legal services
programs for the representation of indigent tenants in eviction proceedings;
(e) Payments to prevent foreclosure on a home; and (f) other innovative
programs and activities designed to prevent the incidence of homelessness.
o Administration: includes administrative costs associated only with the
unit of local government incurred in administering the local ESG program.
These costs do not include any costs associated with operating,
maintaining, or providing support services for the emergency shelter.
The local government may use no more than 2% of their ESGP award
for this administrative cost.
o Operations: includes costs associated with operating, maintaining,
providing services for the emergency shelter, implementing or
operating a Homeless Management Information System (HMIS). In
addition, the Housing and Community Development Act of 1992
Section 1402(e) (Public Law 102-550, approved October 28, 1992)
amended Section 414(a)(3) to allow 10 percent of ESG allocation to be
spent on staff costs of operations related to emergency shelter. The
statute also requires you to involve, to the maximum extent
practicable, homeless individuals and families in constructing,
renovating, maintaining, and operating facilities assisted under the
ESG Program, in providing services for occupants of these
facilities (42 U.S.C. 11375(c)(7), as added by Section 1402(b) of
the Housing and Community Development Act of 1992.
Termination of Assistance: Section 1402(d) Housing and Community Development Act
of 1992 amends Section 415 of the Stewart B. McKinney Homeless Assistance Act by adding a
subsection that requires that termination of assistance to any individual or family be in
accordance with a formal termination process established by the recipient. This addition to the
statute states: "If an individual or family who receives assistance... from a recipient violates
program requirements, the recipient may terminate assistance in accordance with a formal
process established by the recipient that recognizes the rights of individuals affected, which
may include a hearing."
MO 886-2369 (Rev.2/2005) 5
INSTRUCTIONS FOR SECTION IV: COST SUMMARY Applicants must fill in items on the
Cost Summary Form. Include all available resources; cash, non cash, and other State or
Federal grant funds. ENTITLEMENT FUNDS NOT ALLOWED AS MATCHING FUNDS
(re: Procedures page 5, E.)
(A.) (B.)
Descript. of Expenditures Total Local
ESGP Cash
Funds Funds
Ppm iinCtAri FS(, Match
(C.) (D.) (E.) (F.)
Local State or All Grand
Non -Cash Federal Other Total
Funds Grant Funds Funds
FSG Match FSG Match
REHAB, CONVERSION
And RENOVATION
Renovation 7500.00
Major Rehab
Conversion
SUB TOTAL 7500.00
OPERATIONS
Max 10% staff costs
Maintenance
insurance -property
Utilities
Telephone
Furnishings/Appliances
Motel/hotel
Water,sewer,trash
HMIS
Other(Specify)
SUB TOTAL 0
ESSENTIAL SUPPORT
SERVICE
Employment
Food
Health
Mental Health Counsel
Substance/Ab Counsel
Education
Perm Housing Referral
Transportation
Child Care
HMIS
SUB TOTAL
PREVENTION
Client Rent
Mortgage
Utilities
Security Deposit
SUBTOTAL 0
Adm 2% Local Gov only
GRAND TOTAL T0
MO 886-2369 (Rev.2/2005) 6
1. List the source of all resources/funds identified on page 6.
A. Source of all ESGP Matching Funds available during the ESGP contract period.
1) Cash (Column B page 6)
Safe HOuse for Women is requesting a waiver for matched funds.
If the request for the waiver is denied, cash funds will come
from individual donations, corporate and civic organization
contributions.
2) Non Cash (value of any non cash resources including materials, salaries paid by
local agency, volunteer labor ($5.00/hour allowed), the appraised value of any
donated building, or other sort match. (Column C page 6)
Not Applicable
3) State and Federal (Column D page 6)
Not Applicable
B. Sources of all other resources/funds available during the contract period.
(Column E page 6)
Victims of Crime Act (VOCA) Department of Public Safety
Stop Violence Against Women (VAWA) Department of PUblic Safety
State Services to Victims Fund (SSVF) Department of Public Safety
Local Area United Way allocations/donations
Cape County Mental Health Board Mill Tax fund
Department of Family Services (DFS) DV shelter & DV victim
assistance
MO 886-2369 (Rev.2/2005) 7
2. Other State/Federal Agency Grant Funds. A letter of commitment is required when
using Other State/Federal agency grant funds. Please identify the letter(s) of
commitment that are attached. Entitlement funds cannot be used as matching
funds by Kansas City, St. Louis City and St. Louis County.
Not Applicable
Waiver. Section 832 of the Cranston -Gonzalez National Affordable Housing Act makes
substantial changes to the Emergency Shelter Grant Program (ESGP) regulations. One
change is the elimination of the first $100,000 of the Missouri ESGP match requirements.
The Missouri Dept. of Social Services intends to pass this benefit to units of local govern-
ment on behalf of the emergency shelter/service providers who demonstrate inability or
hardship in meeting the match requirement. Applicants wishing to be considered for
a waiver of the match requirement must furnish an explanation of need. Indicate the
amount of the match requested waived and the reason why a waiver is needed.
See attached Request for Waiver mf Matched Funds
Confidentiality. Section 832 of the Cranston -Gonzalez National Affordable Housing Act
changes require that grantees develop procedures to ensure confidentiality of victims of
family violence. Indicate below how this requirement will be met to protect victims of
family violence in your shelter provider organization.
See attached
MO 886-2369 (Rev.2/2005)
SECTION V: ACTIVITY DESCRIPTION NARRATIVE (Answer all items)
A. Activities.
1. Briefly describe the purpose and scope of the agency providing services to the
homeless. Include a list of all staff, their educational background and related
work experience. If homeless individuals are a part of this please so indicate.
Are you currently participating in an HMIS?
The Safe House For Women is not currently participating in an
HMIS because we are a domestic violence shelter.
See attached Personnel LIst.
The Safe HOuse for Women, Inc. provides emergency temporary
shelter to women and children who have experienced domestic
violence. We provide a safe haven from their abusive situation.
While in our shelter, residents have all of their physical,
psychological, emotional and mental health needs addressed.
All of our services are free of charge. It costs approximately
$70/day per person to provide shelter services.
2. Describe how ESGP funds for each category requested in the application will be used.
NOTES:
o Please list any furnishings or appliances purchased with ESGP funds.
o Emergency client motel/hotel lodging is now only eligible in category of
operations even if service provider agency primarily offers Essential
services or Prevention.
ESGP funds will be used for renovation purposes. Our shelter
is over 50 years old and in need of repair. Our specific use of
the funds will be used to renovate two bathrooms by replacing
old fixtures including the bath tubs, toilets, sinks and flooring
Plumbing will be updated to better meet the needs of 16 residents
We also intend to add a washing machine water line in the base-
ment so that we can accommodate two washing machines.
3. The Department of Social Services is permitted to use 5% of the State's 2004 ESGP
award for administrative purposes. Federal statute specifies that the State share
the amount available with local governments who receive ESGP awards from the
State. As a result, 2% of the amount awarded by the State will be provided to local
governments who are participating in the program for administering their grant.
Provide description of expected use for this request and the amount needed.
Not Applicable
MO 886-2369 (Rev.2/2005) 9
B. Describe how the following assistance will be provided to persons served by your
agency
1. Permanent Housing Referral Services
We work closely with social service agencies that can provide
help with housing such as the Community Caring Council and East
Missoula Action Agency.
2. Overnight Shelter
Safe House for Women provides safe, secure, free and confidential
shelter & services to women & children who are victims of
domestic violence.
3. Medical Services
Cross Trails Medical Center, Holitic Healthcare for Women, &
local hospital services are available to our residents.
4. Children's Services (if applicable) Our agency provides a children's
program & those services are supervised by a child advocate.
The children's program pro*ides a structured DV prevention
curriculum.
5. Mental Health and/or Drug Abuse and/or Counseling Services
The Safe House has a licensed professional counselor on staff
full time. We also work closely with mental health agencies
in our community. Rresidents with drug/alcohol issues are
6. Referral to other State or Federal Programs referred apprpriately.
Part of our intake process includes an assessment of what
state/federal programs may be helpful to oureresidents. We
make referrals as necessary.
7. Employment Services The case manager completes a vocational
assessment when the resident enters the shelter. We work
with local employment resources such as Mo workforce develop-
ment, SEMO University, 3 Rivers Community College, local GED
resources and vocational agencies.
8. Transportation We employ the services of the local cab
company for day-to-day transportation for the residents.
On occasion, we ask our volunteers to transport clients
for job interviews or other necessary appointments.
These transportation services are free of charge.
9. Food The shelter makes available food at no cost to
our residents. They are able to choose foods from our
food pantry. Nonresidents deceive food -upon -request.
We receive food from the Bootheel Food Bank & govt.
commodities & donations.
10. Prevention Preventive services include our peer support
program for residents/non-residents, counseling program,
children's program, and school-based educational programs.
11. Other (specify) P.A.W.S. - We provide resources to protect
a woman's pet from violence in the home. We have an agree-
ment with the local humane society who will arrange for
pet foster care while a woman resides in our shelter.
MO 886-2369 (Rev.2/2005) 10
INSTRUCTIONS FOR SECTION VI: HOMELESS NEEDS
o Homeless persons are defined as families and/or individuals who are poor and
have no access to either traditional or permanent housing (see definition on
page 4 of application.) "Poor" generally means persons below the poverty level,
below 50% of the median income for the area, and who have little savings.
Estimates of the number of homeless persons being, or planned to be, served
should be based on data available, experience, or an assessment of need in your
community for the particular homeless population to be served. The homeless
may include: homeless, neglected, and dependent children not under court
intervention, street people, abused persons who have left their home and abusers
with little money, little income, or persons with such low income that there is little
affordable housing available for them or their families.
o Under this program an emergency shelter should be a shelter that does not
provide assistance on a long-term basis. These shelters generally should
not provide accommodations for more than a few months to the same
person. Emergency shelters generally should provide services that will
sustain homeless persons through a period of hardship
A. Does the provider serve meals? YES NO
B. Does the provider serve food other than meals? YES NO
C. What is the present capacity of your shelter? 16
If expansion is planned within the next 12 months, what will be the new
when project is completed? N/A
D. List all existing emergency shelters in your city/county area. Show the capacity of
these shelters to serve the homeless population and characteristics of the
population served. (Include your present shelter and activities).
SHELTER
1. Revival Center
2. Salvation Army
3. Safe House for Women
4. Vision House
5
CAPACITY POPULATION SERVICED
.11
homeless
hotel vouchers are provided toy
homeless individuals/families
16 domestic violence
victims
12 substance abuse
faith -based program alcohol for women
E. Describe the NEEDS of projected service area. Please explain any requests
for funding increases.
Mo 886-2369 (Rev.2/2005)
E. Describe the NEEDS of projected service area. Please explain any requests for
funding increases.
The Safe House for Women, Inc. is not requesting an increase in funding over last
year's level.
The Safe House for Women, Inc. has been in existence since 1991 as an emergency,
temporary shelter for victims of domestic violence and abuse. We offer a comprehensive
slate of services including shelter, counseling services, case management, court
advocacy, and a children's program. All of our services are free and confidential.
In 2004, we responded to 639 hotline calls. We provided residential services to 194
women and children. A total of 279 women received counseling. The average length of
stay for our residents is 3 months. We also served 132 non-residents by providing food,
clothing, case management, or ongoing supportive assistance. 113 non-residents received
one-on-one counseling sessions.
The following graph represents a trend in our delivery of services.
140
120
100
c
(D
L 80
U
c
d
E 6o
0
40
20
0
Women & Children Census Trends
CY2000 CY2001 CY2002 CY2003 CY2004
Calendar Year
OWomen ■Children
3000
2500
2000
`s
$ lsoo
m
1000
500
0
Safe House For Women Bednight Trends
CY2001 CY2002 CY2003 CY2004
Calendar Yaw
OMB STANDARDS REVISED DEFINITIONS FOR ETHNIC AND RACIAL CATEGORIES
ETHNIC:
a) Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or origin, regardless of race. The term, "Spanish origin,"
can be used in addition to "Hispanic or Latino.
b) Not Hispanic or Latino. A person not of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or orgin, regardless of race.
RACE:
a) American Indian or Alaska Native. A person having origins in any of the original peoples
of North and South America (including Central America), and who maintains tribal affiliation
or community attachment.
b) Asian. A person having origins in any of the original peoples of the Far East, Southeast
Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan,
Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
c) Black or African American. A person having origins in any of the black racial groups of
Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black or African
American."
d) Native Hawaiian or Other Pacific Islander. A person having origins in any of the original
peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
e) White. A person having origins in any of the original peoples of Europe, the Middle East or
North Africa.
Mo 886-2369 (Rev.2/2005) 12
REPORTING INFORMATION REQUIRED BY FEDERAL GOVERNMENT
PLEASE COMPLETE THE FOLLOWING ITEMS BASED ON ONLY ESGP LOCAL
PROJECTED SERVICE DELIVERY FOR THE ESGP CONTRACT PERIOD.
ETHNICITY: (Report actual numbers) otal = /q
U Hispanic or Latino
/83 N)t Hispanic or Latino
Race of persons served by the Project: (Report actual numbers)
/q2- White 38 Black or African American
_— Asian / American Indian or Alaska Native
D Native Hawaiian or Other Pacific Islander O Asian & White
O American Indian or Alaska Native & White (_ Black or African American & White
American Indian or Alaska Native & Black or African American
Other Multi racial
I9 f TOTAL
70 Number of Female -headed households.
Indicate type of project(s) and service(s):
emergency shelter facilities
X— vouchers for shelters
_ drop-in center
food pantry
-8- mental health
alcohol/drug program
�- child care
c� other (please list)
Number of People Served for each activity:
Residential Services:
average number of adults daily �9
average number of children daily
average number served yearly I91
�9-
transitional housing
outreach
-8-
soup kitchen/meal distribution
-�
health care
-$
HIV/AIDS services
-e
employment
X
homeless prevention
Mo 886-2369 (Rev.2/2005) 13
Non-residential Services:
average number serviced daily �a
Homeless Prevention:
Total number served for year q�
On an average day in the immediately past reporting period, please provide approximate
percentages of the following project participants with total equal to 100 percent:
unaccompanied 18 and over.......... male _% female 40 %
unaccompanied under 18...............male % female 45 %
families with children headed by
single 18 and over ..........................male ZQ % female ( Q %
youth 18 and under ................................._%
two parents 18 and over .......................... c %
two parents under 18 ...............................
0/0o
families with no children ........................... /o
On an average day in the immediately past reporting period, provide the percentage of
the population served who are:
(Co % battered spouses
D runaway/throwaway youth
5 '/. chronically mentally ill
So/- developmentally disabled
Leo HIV/AIDS
30° o alcohol dependent individuals
drug dependent individuals
elderly
veterans
(% physically disabled
other
Please indicate the number of persons housed at any given time in each shelter type
funded through the ESG program.
Shelter
barracks
group/large house
scattered site apartment
single family detached house
single room occupancy
mobile home/trailer
hotel/motel
other (describe)
Mo 886-2369 (Rev.2/2005) 14
Number of bed capacity
n
1(0
-fes
�S3 because SA2He1 Uq5 I�al
SECTION VII: LOCAL GOVERNMENT GRANTEE
EMERGENCY SHELTER GRANTS PROGRAM
CERTIFICATIONS BY THE CHIEF EXECUTIVE OFFICER
1 DOUGLAS K. LESLIE, CITY MANAGER Chief Executive Officer
of UE CM OF cAPE GIRIRDF U, MMPI , certify that cny OF CAPE GIMpFAT1, Mngn1RT
city or county name city or county name
will provide the matching supplemental funds required by the regulation at 24 CFR 576.71.
1 have attached to this certification a description of the sources and amounts of such
supplemental funds.
I certify that the
CITY OF CAPE GIRARDEAU
city or county
will comply with:
(1) The requirements of 24 CFR 576.53, concerning the continued use of buildings for
which emergency shelter grants are used for rehabilitation or conversion of
buildings for use as emergency shelters for the homeless; or when funds are used
solely for operating costs or essential services, concerning the population to be
served.
(2) The building standards requirement of 24 CFR 576.55.
(3) The requirements of 24 CFR 576.56, concerning assurances on services and other
assistance to the homeless.
(4) The requirements of 24 CFR 576.57, other appropriate provisions of 24 CFR Part
576, and other applicable Federal law concerning non-discrimination and equal
opportunity; and
(5) The requirements of 24 CFR 576.57(e) concerns Environmental
Review/Compliancedealing with the provisions of, and regulations and procedures
applicable with respect to the environmental review responsibilities under the
National Environmental Policy Act of 1969 and related authorities as specified
in 24 CFR Part 58.
(6) The requirements of 24 CFR 576.59(b) concerning the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970.
(7) The requirements of 24 CFR 576.59 concerning minimizing the displacement of
persons as a result of a project assisted with these funds.
(8) The requirements of 24 CFR 576.56(a) and 576.65(b) that grantees develop and
implement procedures to ensure the confidentiality of records pertaining to any
individual provided family violence prevention or treatment services under any
project assisted under the Emergency Shelter Grant Program and that the address
or location of any family violence shelter project assisted with ESG funds will not
be made public, except with written authorization of the person or persons
responsible for the operation of the shelter.
(9) The requirement of that recipients involve, to the maximum extent practicable,
homeless individuals and families in constructing, renovating, maintaining, and
MO 886-2369 (Rev.2/2005) 15
operating facilities assisted under the ESG program, and in providing services for
occupants of these facilities as provided by 24 CFR 576.56(b)(2).
(10) The requirements of 24 CFR 576.21(a)(4) which provide that the funding of
homeless prevention activities for families that have received eviction notices or
notices of termination of utility services meet the following standards: (A) that the
inability of the family to make the required payments must be the result of a sudden
reduction of income; (B) that the assistance must be necessary to avoid eviction of
the family or termination of the services to the family; (C) that there must be a
reasonable prospect that the family will be able to resume payments within a
reasonable period of time; and (D) that the assistance must not supplant funding
for preexisting homeless prevention activities from any other source.
(11) The new requirement of the McKinney Act (42 USC 11301) to develop and
implement to the maximum extent practicable and where appropriate, policies
and protocols for the discharge of persons from publicly funded institutions or
systems of care (such as health care facilities, foster care or other youth facilities, or
correction programs and institutions in order to prevent such discharge from
immediately resulting in homelessness for such persons. I further understand that
State and local governments are primarily responsible for the care of these
individuals and that ESG funds are not to be used to assist such persons in place
of State and local resources
(12) The Drug Free Workplace requirements of 24 CFR Part 24 concerning the Drug
Free Workplace Act of 1988.
(13) HUD's standards for participation in a local Homeless Management Information
System (HMIS) and the collection and reporting of client level information. In
the event that state laws conflict with the HMIS Final Notice, as determined by an
appropriate state government entity, state law will prevail.
I certify that the submission of applications for emergency shelter grants is authorized
under state and/or local law and that the CITY OF CAPE GIRARDEAU
city / county name government
possesses legal authority to carry out emergency shelter grants activities in accordance with
applicable law and regulations of the Department of Housing and Urban Development including
other federal requirements and the State of Missouri.
Additionally, I certify that use of emergency shelter grant amounts will comply with the following
requirements:
(a) Non-discrimination and Equal Opportunity
(1) The requirements of Fair Housing Act (42 U.S.C. 3601-20) and
implementing regulations at 24 CFR Part 1001; 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. 2000d and
2000d-4) implementing regulations issued at 24 CFR Part 1.
(2) The requirements of 24 CFR 576.57, the prohibition against
discrimination on the basis of age under the Age Discrimination Act
of 1975 (42 U.S.C. 6101-07) and implementing regulations at
24 CFR Part 146 and the prohibitions against discrimination against
handicapped individuals under section 504 of the Rehabilitation Act
MO 886-2369 (Rev.2/2005) 16
of 1973 (29 U.S.C. 794) and implementing regulations at 24 CFR Part 8.
(3) The requirements of Executive Order 11246 and the regulations
issued under the Order at 41 CFR 60.
(4) The requirements of section 3 of the Housing and Urban Development
Act of 1968, 12 U.S.C. 1701 u (see 24 CFR 570.607(b).
(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; and
6) The requirement that the grantee make known that the use of the facilities
and services is available to all on a nondiscriminatory basis. Where the
procedures that a grantee or recipient intends to use to make known the
availability of such facilities and the ESGP services are unlikely to reach
persons with handicaps or persons of any particular race, color, religion,
sex, age or national origin who may qualify for such services, the recipient
or grantee must establish additional procedures that will ensure that
these persons are made aware of the facility and services. Adopt and
implement procedures designed to make available to interested persons
information concerning the existence and location of services and
facilities that are accessible to persons with a handicap.
Regulations of 24 CFR 576.57.
(b) Lead -Based Paint. The requirements, as applicable, of the Lead -Based
Paint Poisoning Prevention Act (42 U.S.C. 4821-4846) and implementing
regulations at 24 CFR Part 35; and of 24 CFR Part 576.57.
(c) Conflicts of Interest. In addition to conflict of interest requirements in OMB
Circulars A-102 and A-110, no person (1) who is an employee, agent,
consultant, officer, or elected or appointed official of the grantee, state
recipient, or non-profit recipient (or any designated public agency) that
receives emergency shelter grant amounts and who exercises or has
exercised any functions or responsibilities with respect to assisted activities
or (2) 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, or the proceeds
thereunder, 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 year thereafter.
HUD may grant an exception to this exclusion as provided in 570.611(d)
and (e) of this chapter.
(d) Applicability of OMB Circulars. The policies, guidelines, and
requirements of 24 CFR Part 85 and OMB Circular No. A-87, as they
relate to the acceptance and use of emergency shelter grant amounts
by states and units of general local government, and No. A-110 and
A-122 as they relate to the acceptance and use of emergency shelter
MO 886-2369 (Rev.2/2005) 17
grant amounts by private non-profit organizations.
(e) Use of Debarred, Suspended, or Ineligible Contractors.
The provision of 24 CFR Part 24 relating to the employment, engagement
of services, awarding of contracts, or funding of any contractors or
subcontractors during any period of debarment, suspension or
placement in ineligibility status.
(f) Uniform Federal Accessibility Standards. For major rehabilitation or
conversion, the Uniform Federal Accessibility Standards at
24 CFR Part 40, Appendix A.
(g) Illegal Use of Drugs and Alcohol. The recipient and project sponsor
conducting activities, funded in whole or in part with McKinney Act funds, to
assist the homeless population in this jurisdiction, will administer, in good
faith, a policy designed to ensure that the assisted homeless facility is free from
the illegal use, possession,or distribution of drugs or alcohol by its beneficiaries.
(h) Audit. Acceptance of an ESGP contract requires the grantee and
subgrantee(s) to comply with the audit requirements of the new Office of
Management and Budget (OMB) Circular A-133, and also acknowledges that
cognizant federal and state representatives shall have access to pertinent records
during normal business hours.
OMB Circular A-133 revised June 24, 1997, requires Federal award recipients to
have independent audits performed if they expend $300,000 or more in Federal
funds during their fiscal year. Revisions of OMB Circular A-133 published June
27, 2003 increases the threshold for audit from $300,000 to $500,000. The final
revisions are effective for fiscal years ending after December 31, 2003
Grant recipients who expend $300,000 ($500,000 for fiscal years ending after
December 31, 2003) or more in Federal funds during their fiscal year should
submit a data collection form and reporting package to the OMB Federal Audit
Clearinghouse (FAC). This information must be submitted to the FAC within the
earlier of:
(1) 30 days of receipt of the audit report or
(2) Nine months after the end of the audit period.
The information from the data collection form is entered into the FAC by the
recipient and/or the auditor. In addition, copies of the audits only need to be sent
to the cognizant or oversight agency, as designated by the FAC, and to any
Federal agency when a finding has been issued, only when findings exist. Local
governments are no longer required to send a copy of their audit to the ESG office
as audits will be reviewed through the Federal Audit Clearinghouse.
MO 886-2369 (Rev.2/2005) 18
,1 J IL � WOMEN
A safe place, day or night
P. O. Box 1167 • CAPE GIRARDEAU, MO 63702-1167
24 HOUR HOT LINE: 573-651-1614 • TOLL FREE HOTLINE: 1-800-341-1830
BUSINESS OFFICE: 573-335-7745 • FAX: 573:335-6435 • E-MAIL: safe@Idd.net
www.semosafehouse.org
Request for Waiver of Matched Funds
The Safe House for Women, Inc. requests that the match requirement be waived
for our agency. Our shelter operated at capacity during seven months in 2004.
We would like to continue to provide our needed services of emergency shelter
with no interruption to our clients. A waiver of the matched fund requirement will
better enable us to do so.
C��� ljaA� 301 000's-
Linda
00�Linda Garner, Executive Director March 30, 2005
Safe House for Women
Personnel Roster as of March 28, 2005
Linda Garner, RN, MSN, Executive Director
Master's degree in nursing; nearing completion of PhD in health education
Administrator of financial operations and general supervision of staff and clients.
Allison Leonard, Director of Operations
Bachelor's degree in psychology
Shelter manager, oversees staff and client relations. Supervises staff in
everyday business and case management.
Joy J. Bell, LPC, MSW; Counselor
Provides professional counseling on both an individual and group basis.
Jennifer St. Clair, Court Advocate/Case Manager
BA Interdisciplinary Studies
Assists residential/non-residential clients in obtaining ex -parte orders and full
orders of protection. Provides support throughout the criminal justice process.
Provides ongoing case management services for clients.
Lisa Niederkorn, Education Coordinator/Child Advocate
Nearing completion of Bachelor's degree in child development
Provides domestic violence prevention and awareness education to local schools
and community groups. Provides service to children while they are in the shelter
in a support group format. Also provides advocacy services at the child's school
with their mother.
Mindy Brown, Advocate, full-time night shift
Bachelor's degree in criminal justice
Provides for the clients needs, client case management, crisis intervention.
Linda Schild, Advocate
BS Education, Certified teacher
Same duties as Mindy Brown.
Kathy Woeltje, Advocate
BS Elementary Education, Certified teacher.
Same duties as Mindy Brown
Kerrie Lintner, Advocate
Nearing completion of bachelor's degree in English as Second Language
Same duties as Mindy Brown
Jaime Bollinger, Advocate
Bachelor's degree in Social Work May 2005
Same duties as Mindy Brown
Felicia Kennedy, Advocate
MA Counseling
Same duties as Mindy Brown
Kellie Tummins, Advocate
Nearing completion of Bachelor's degree in social work
Same duties as Mindy Brown
Rebecca Thomas, Advocate
Nearing completion of Bachelor's degree in social work
Same duties as Mindy Brown
Safe House for Women, Inc.
Confidentiality Agreement
I, the undersigned, make an oath that any information of personal and /or confidential nature
regarding agency clients, this or other agencies, or colleagues that I may obtain as a result of my
work/ association with the Safe House for women, Inc. will be held in the strictest confidence.
also understand that the location of the Safe House for Women, Inc. is strictly confidential. I also
understand that all client files are to be kept secured. Only the staff will have access to these
files. I understand that this confidentiality agreement extends past my employment or
association at the Safe House for Women, Inc. I further understand that violations in
confidentiality, is not only an ethical violation, but that it could jeopardize the safety of the clients
and staff at the shelter. Violations of confidentiality will be grounds for immediate dismissal from
service at the shelter.
Employee / Volunteer Date
Shelter Director or Volunteer Trainer
Executive Director or Shelter Director Date
Date
I have read and understand the policies and procedures presented to me in Safe House
volunteer training manual and handbook. 1 indicate my willingness and intent to abide by these
policies and programs.
Employee/volunteer Signature Date
Training staff signature Date
As a volunteer who will provide transportation for participants of the Safe House, I will maintain
and furnish proof of insurance. I take full responsibility for any participant whom I agree to
transport. I further understand that the Safe House will not be responsible for any lawsuits or
legal action that occurs as a result of my actions.
Volunteer Signature Date
Training staff signature Date
Any forms not dated, or dated prior to April 2000, are not to be used,
r- .0 E.OX A-3250 . DF•H 2` -
CHICAGO;: IL 60690
°ate: MAY 2 4 1991
SAFE HOUSE FOR ROMEN INC
2110 F1000HAYEN P 0 COX 1167
CAFE rPIRARDEAU, MO 63702
Dear Applicant:
Employer Identification Humbert
43-1557403
Contact Person:
MS. Y. AESTON
Contact Telephone Number:
(312) 806-1278
Q
Accounting Period Ending:
December 31
Form 990 Required:
Yes
Addendum Applies:
No
Eased on information supplieds and assuming your operations still be as
stated is your application for recognition of exemptions have determined
you are exempt from Federal income tax He under section 501(aof the Internal
Revenue Code as an organization described in section 501(8)(3).
We have further determined that you are not a private foundation within
th.e meaning of section 509(a) of the Code, because you are an organization
described in sections 509(a) (1) and 170(b) (1) (A) (vi) .
ll yvur hour"s vT support, or your purposes, character, or method of
operation change, please let u= knoH so we can consider the effect of the
change on your exempt status and foundation status. In the case cif an amend-
ment to your organizational o zbylawsl document or bylaws, please send us a copy of the
name or document or bylaws. Also, you should inform us of all changes in your
name or address.
As of January 11 1984, you are liable for taxes under the Federal
Insurance Contributions Act (social security tares) on remuneration of '1100
or more you pay to each of your employees during a calendar year. You are
not liable far the tar imposed under the Federal Unemployment Tax Act (FUTA).
Since you are not a private foundation, you are not subject to the excise
taxes under Chapter 42 of the Code. Houever,.you are not automatically exempt
from other Federal excise taxes. If you have any questions about excise,
ewplcryment, or other Federal taxes, please let us know.
Grantors and contributors may rely on this determination unless the
Internal Revenue Service publishes notice to
the contrary.
if
lase your section 509(a)(1) status, a grantor or contributor�mayvnot relyou
on this determination if he or she was in part responsible for, or ks aware
of, the act or failure to ac -t, or the substantial or material change an the
part of the organization that resulted in your loss of such status, or if he or
she acquired knowledge that the Internal Revenue Service had given notice that
You Hould no longer be classified as a section 509(a)(1) organization.
Letter 947(DO/CG)
7�:- Y 447—Q `T"T" `V7T'
- SAFE HOUSE FOR WOMEN INC
Donors may deduct contributions
Cade; Bequests, to you as provided in section 170 of the
legacies, devises, transfers, or gifts to
you are deductible for Federal estate and gift tax purposes if theyomeetrtheur
use
app4,icable provisions of Code sections 20551 2106, and 2522.
Contribution deductions are allocable to donors only to the extent that
their contributions
chases and siwilare gifts, kith no consideration received. Ticket par-
ar payments in conjunction kith fundraisina events may not
•necessarily quaffify as deductible contributions, depending on the circum-
stances. See Revenue Ruling 67-246, published in Cumulative Bulletin 1967-2,
on page 104, khich sets forth guidelines regarding the deductibility, as chari-
table contributions, of payments made by taxpayers for admission to or other
participation in fundraising activities for charity.
In the heading of this letter ke have indicated khether you must file Form
990i Return of Organization Exempt From Income Tax. If Yes is indicated, you
are required to file Form 990 only
normally more than if your grass receipts each year are
mail, pease file thheerreteturn •
.0. Hokever, if you receive a Form 990 package in the
reven if you do not exceed the gross receipts test.
If you are not required to file, simply attach the label provided, check the
box in the heading to indicate that your annual gross receipts are normally
$25,000 or less, and sign the return.
If a return is required, it must be filed by the 15th day of the fifths
month after the end of your annual accountin
is charged when a return is filed late, un[e5speriod. A penalty of $10 a day
Penathe delay. Hoy -sever, the maximummum thErr is reasonable cause for -
cent el ,� p' lty charged cannot exceed $50000 car 5 per-
t' ur gross receipts for the year, ilhichever is less. This penalty may
also be
before you file i t, charged if a return
complete is not complete, so please be sure your return is
You are not required to file Federal income tat; returns unless you are
subject to the tax on unrelated business income under
If you arc -section 511 of the Code,
subject to this tar,, you oust file an income tax return on Form
990-T, Exempt Organization Easiness I
not deterncome Tax Return. In this letter ke are
mining khether any of your present or proposed activities are unre-
lated trade or business as defined in section 513 of the Code.
You need an employer identification number even if you have no employees.
If an employer identification number uas not entered on your application, a
number dill be assigned to you and you kill be advised of it.
use
number on all returns you file and in all correspondence kith theease Internalthat
Revenue Service,
In accordance tiith section 50;(a) of the Code, .the
effective date of this
determination letter is August 22, 1990.
This determination is based on evidence that your funds are dedicated
to the purposes_listed in section 501(2)(;) of the Code. To assure your
Letter 947(00/CG)
SAFE HOUSE FOR WOMEN INC
continued exemption, You should
e):pended only for these purpoSeSmaintain records to show that funds are
her
organizations, your records should If You distribute funds to
section tions (yo show whether they are exemptunder.
under;section F In cases where the recipient organization is not exempt
01(c)(3), there should be evidence that {the funds Hill remain
dedicated to the required ur oses and that the
Purposes by the recipient.P P Y will be used for those
If distributions are made to individuals, case histories r
recipients should be
of selectes
ion: kept
showing naves, addresses, regarding the
funds to relationship (if�any) to members, Officers,strusteesaOrsdonorseof
You: so that any and all distributions made to individuals can be
substantiated upon request by the Internal Revenue
56-304, C.B. 1956-2, page 306.) Service.
. (Reven tte Ruling
If we have indicated 'in the heading of this letter
appl1esT the enclosed addendum is an rote ral that an addendum
9 part of this letter.
Because this letter could help
status and foundation status, resolve p it in any questio
You should kee ns about your exempt
If you hYour permanent records.
have any questions, pl
telephone number are shoran in the ease easecontact the
person whose name and
heading of this letter.
Sincerely yours,
�`- S• Wintrode, Jr_
District Director
Letter 947(00/CG)
APPLICATION
e�••^ ° °°8oaa
MISSOURI
2005 EMERGENCY SHELTER GRANT PROGRAM (ESGP)
y Contract Exhibit A
The following information is to be provided by the Applicant
(local government) for each proposed service provider agency.
Application must be postmarked no later than Monday, April 18, 2005
and returned to:
MISSOURI DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
ATTN: BETH ROCKELMAN, ESG PROGRAM
P.O. BOX 2320
JEFFERSON CITY, MISSOURI 65103-2320
SECTION I: GENERAL INFORMATION
A. Name of City or County/(Grantee):
Street/Box Number 401 Independence, P. 0. Box 617
City and Zip Code Cape Girardeau, MO 63702-0617
Contact Person Douglas K. Leslie
Title City Manager
Phone Number 573-334-1212
E-mail
B. Service Provider Agency/Organization Responsible for Grant
Activities (Subgrantee): The Salvation Army
Street/Box Number 701 Good Hope, P. 0. Box 802
City and Zip Code Cape Girardeau, MO 63702-0802
Contact Person Major Michael T. Thomas
Title Corps Officer
Phone Number 573-335=7000 _
E-mail majorin0l@aol om
C. ESGP Funds Requested for total project $ 40,000,00
Request must include total of all subgrantees.
Not more than $75,000 or less than $7,500 per grantee -- city/county entity..'
ESGP Entitlement communities total awards will be limited to $65,000 each.
SECTION II: ELIGIBILITY
A. Funds will be obligated by ulY 2005.
(Must be obligated by local governme t no later than 180 days
after grant award by the State).
B. Obligated funds will be expended by MARCH 31, 2006.
MO 886-2369 (Rev.2/2005)
(Circle YES, NO, or Not Applicable (N/A) for the following questions)
C. The proposed non-profit service provider agrees to YES NO
not discriminate in the provision of assistance on
the basis of sex, race, color, religion, national
origin, age, handicap, veteran or resident status.
If statement is true answer "YES".
D. The amount of funds, value of services, buildings, YES NO N/A
or materials to be provided locally for that project is
equal to or greater than that specified in Section I, C
of this application.
E. The amount of ESGP funds requested for OYESNO N/A
the provision of Essential Support Services,
(not including prevention services), does not
exceed 30% of the Total ESGP Grant requested.
If statement is true, answer "YES."
F. The applicant agrees that Emergency Shelter OYES NO N/A
funds will not be used to pay for acquiring a
building or land, mortgages, renting commercial
or transient accommodations, any administrative
costs for rehabilitation inspection services, loan
processing or other similar professional services.
If statement is true, answer "YES."
G. Local government will not use more than 2% of their S NO N/A
ESGP award for cost they incur to administer the
Emergency Shelter Grant Program. If statement
is true, answer "YES." (Service Provider Staff costs
included in category of operations)
H. If ESGP funds are used for shelter operations YES N0(:
/A
and/or essential services the building will be used as
a shelter as long as Federal assistance is received.
If statement is true, answer "YES."
I. If ESGP funds are used for rehabilitation, other YES NO N/A
than major rehabilitation or conversion, the building
will be used as a shelter for at least three years. If
statement is true, answer "YES."
J. The emergency shelter building will meet local YES NN/A
government safety and sanitation standards, housing
and building codes after project completion. If statement
is true, answer "YES."
(Answer N/A if ESGP funds are not used for Rehab.)
MO 886-2369 (Rev.2/2005)
K. Homeless individuals will be given assistance YES NO /A
obtaining permanent housing, medical and
mental health treatment, counseling, and other
state and federal assistance. If statement is true,
answer "YES."
NOTE: If NO is the response to any of the above questions, stop here and do not
submit an application. (Exception: D, and E, a "NO" answer may be approved
by the State under special circumstances.
SECTION III: ELIGIBILITY OF REHABILITATION, CONVERSION AND
RENOVATION ACTIVITIES
A. Does rehabilitation, conversion, or renovation YES NO N/A
activities involve a building on the National Register
of Historic Places, located in a Historical District,
immediately adjacent to a property listed on the
National Register, or deemed to be eligible for
inclusion on the National Register by the State
Historic Preservation Officer? Answer N/A if not
making improvements on a building with ESGP funds.
B. Is the building to be improved owned by an YES NO N/A
organization with religious purposes stated in
By-laws, or Articles of Incorporation? Answer N/A
if not making improvements on the building with
ESGP funds.
C. Will the estimated value of the improvements YES NON/A
exceed 75% of the appraised value of the building
before the improvements are made? (Answer
N/A if not making improvements on the building
with ESGP funds)
D. If you answered YES to C, will your agency YES N0(:
/A
provide assurances that the building will remain
emergency shelter for the next ten years?
(Answer N/A if not making improvements on
building with ESGP funds)
E. Will the applicant provide assurances that any YES NO N/A
building or rehabilitation or remodeling project
is in compliance with Environmental Protection
Requirements of 24 CFR 576.57(e) and
24 CFR Part 58.
NOTE: If you answered NO to D. or E., please do not submit an application.
Mo 886-2369 (Rev.2/2005)
Definitions
Homeless: means an individual or family which lacks a fixed, regular,
and adequate nighttime residence: or an individual or family which has
a primary nighttime residence that is: a supervised publicly or privately
operated shelter, designed to provide temporary living accommodations
(including welfare hotels, congregate shelters, and transitional housing
for persons with mental illness): an institution that provides a temporary
residence for individuals intended to be institutionalized: or a public or
private place not designed for, or ordinarily used as, a regular sleeping
accommodation for human beings.
o ESGP: means Emergency Shelter Grant Program.
o Local Cash Funds: include all cash donated by the city, nonprofit organization,
or from other private sources. Do not include any funds derived from any state
or federal sources. Include only those funds spent on the emergency shelter
projects for which grant monies are to be spent.
o Emergency Shelter: means any facility, the primary purpose of which is to
provide temporary or transitional shelter for the homeless in general or for
specific populations of the homeless.
o Local Non -Cash Resources: may include all public, private, and not-for-profit
donations made after the date of the grant award to the grantee, including the
value of any donated material or building, the value of any lease assigned on a
building, any salary paid to staff, the volunteer time valued at $5.00/hour,
or any other local resources.
o Other State/Federal Agency Funds: proposal must include a copy of a letter of
commitment from the agency administering the state or federal funds, if these
funds are used to meet matching requirements.
o Renovation: rehabilitation that involves costs of 75% or less than the appraised
value of the building before rehabilitation.
o Maior Rehabilitation: rehabilitation that involves costs in excess of 75% of the
appraised value of the building before rehabilitation.
o Conversion: a change in the use of a building to an emergency shelter for the
homeless, where the cost of conversion and any rehabilitation exceed 75% of
the value of the building before conversion.
o HMIS: means Homeless Management Information System. On July 30, 2004
HUD published the Federal Register, Homeless Management Information Systems
(HMIS); Data and Technical Standards Final Notice.
Mo 886-2369 (Rev.2/2005) 4
o Essential Service: includes (but not limited to) services concerned with
employment, physical health, mental health, substance abuse, education,
food, or salary necessary to provide such services. Grant amounts
provided to grantee may be used to provide an essential service only if
the service is a new service or a quantifiable increase in the level of a
service above that which the grantee provided with local funds during
the 12 calendar months immediately before it received the initial grant.
o Homeless Prevention: means activities or programs designed to prevent
the incidence of homelessness, including (but not limited to): (a) Short-term
subsidies to defray rent and utility arrearages for families that have received
eviction or utility termination notices; (b) Security deposits or first month's
rent to permit a homeless family to move into its own apartment; (c)
Mediation programs for landlord -tenant disputes; (d) Legal services
programs for the representation of indigent tenants in eviction proceedings;
(e) Payments to prevent foreclosure on a home; and (f) other innovative
programs and activities designed to prevent the incidence of homelessness.
o Administration: includes administrative costs associated only with the
unit of local government incurred in administering the local ESG program.
These costs do not include any costs associated with operating,
maintaining, or providing support services for the emergency shelter.
The local government may use no more than 2% of their ESGP award
for this administrative cost.
o Operations: includes costs associated with operating, maintaining,
providing services for the emergency shelter, implementing or
operating a Homeless Management Information System (HMIS). In
addition, the Housing and Community Development Act of 1992
Section 1402(e) (Public Law 102-550, approved October 28, 1992)
amended Section 414(a)(3) to allow 10 percent of ESG allocation to be
spent on staff costs of operations related to emergency shelter. The
statute also requires you to involve, to the maximum extent
practicable, homeless individuals and families in constructing,
renovating, maintaining, and operating facilities assisted under the
ESG Program, in providing services for occupants of these
facilities (42 U.S.C. 11375(c)(7), as added by Section 1402(b) of
the Housing and Community Development Act of 1992.
Termination of Assistance: Section 1402(d) Housing and Community Development Act
of 1992 amends Section 415 of the Stewart B. McKinney Homeless Assistance Act by adding a
subsection that requires that termination of assistance to any individual or family be in
accordance with a formal termination process established by the recipient. This addition to the
statute states: "If an individual or family who receives assistance... from a recipient violates
program requirements, the recipient may terminate assistance in accordance with a formal
process established by the recipient that recognizes the rights of individuals affected, which
may include a hearing."
Mo 886-2369 (Rev.2/2005) 5
INSTRUCTIONS FOR SECTION IV: COST SUMMARY Applicants must fill in items on the
Cost Summary Form. Include all available resources; cash, non cash, and other State or
Federal grant funds. ENTITLEMENT FUNDS NOT ALLOWED AS MATCHING FUNDS
(re: Procedures page 5, E.)
-- (A.)
(B.)
(C.)
(D.)
(E.) (F.)
Descript. of Expenditures Total
Local
Local
State or
All Grand
ESGP
Cash
Non -Cash
Federal
Other Total
Funds
Funds
Funds
Grant Funds
Funds
Requested
ESG Match
ESG Match
ESG Match
REHAB, CONVERSION
And RENOVATION
Renovation
Major Rehab
Conversion
SUB TOTAL
OPERATIONS
Max 10% staff costs
Maintenance 7,000.00 7,000.00
Insurance -property
Utilities 1�.500.00 13,5000.00
Telephone 4,500.004,500.00
Furnishings/Appliances
Motel/hotel TRANSIENT 1A011)GTXG 10,000.00 11 0 0 00 �8, 204. o
Water,sewer,trash
HMIS
Other(Specify)
SUB TOTAL
ESSENTIAL SUPPORT j
SERVICE
Employment
Food $15,000,001
Health
Mental Health Counsel
Substance/Ab Counsel
Education
Perm Housing Referral
Transportation
Child Care
HMIS
SUB TOTAL $5.000.00 10,000.00 $15,000.00
PREVENTION
Client Rent 2
Mort a e
Utilities $12.500.QQ
Security Deposit
SUBTOTAL $25,000.00 2
Adm 2% Local Gov only
GRAND TOTAL
MO 886-2369 (Rev.2/2005)
FEMA — PHASE 23
Total Allocation 527,348
East Missouri Action Agency (30%) — Rent
$8,204
FISH (14%) — Food
_
$3,829
Jackson Mfiistenal Alliance (6%} Food
-
- 1641 "'.. •ac icy
t�'1'
�...'
� .. _ `,"^e++J►. .i .i+c.. r _
Safe House for` Women (20%}`Shelter
Wiz; z y =
00
Salvation Almy (30%0) Other -Shelter -
_ :;$8,204
1. List the source of all resources/funds identified on page 6.
A. Source of all ESGP Matching Funds available during the ESGP contract period.
1) Cash (Column B page 6)
The source of these funds are entirely from local donations. The funds
are used for property upkeep, repairs, insurance for the building,
utilities, telephone and the caseworker's salary attributable to the
Emergency Assistance Program.
2) Non Cash (value of any non cash resources including materials, salaries paid by
local agency, volunteer labor ($5.00/hour allowed), the appraised value of any
donated building, or other sort match. (Column C page 6)
The source of the non-cash are volunteers that work in the feeding
program and stocking of the food pantry. We also use donated food
items in the feeding program and for distribution to needy
individuals and families.
3) State and Federal (Column D page 6)
The Salvation Army uses FEMA funds for other shelter, which is
categorized as transient lodging.
B. Sources of all other resources/funds available during the contract period.
(Column E page 6)
Not Applicable.
MO 886-2369 (Rev.2/2005) 7
2 Other State/Federal Agency Grant Funds. A letter of commitment is required when
using Other State/Federal agency grant funds. Please identify the letter(s) of
commitment that are attached. Entitlement funds cannot be used as matching
funds by Kansas City, St. Louis City and St. Louis County.
The answer to this is listed on page 7, under #3 - State and Federal.
Waiver. Section 832 of the Cranston -Gonzalez National Affordable Housing Act makes
substantial changes to the Emergency Shelter Grant Program (ESGP) regulations. One
change is the elimination of the first $100,000 of the Missouri ESGP match requirements.
The Missouri Dept. of Social Services intends to pass this benefit to units of local govern-
ment on behalf of the emergency shelter/service providers who demonstrate inability or
hardship in meeting the match requirement. Applicants wishing to be considered for
a waiver of the match requirement must furnish an explanation of need. Indicate the
amount of the match requested waived and the reason why a waiver is needed.
Not Applicable.
Confidentiality. Section 832 of the Cranston -Gonzalez National Affordable Housing Act
changes require that grantees develop procedures to ensure confidentiality of victims of
family violence. Indicate below how this requirement will be met to protect victims of
family violence in your shelter provider organization.
The Salvation Army conducts all its
Each client is interviewed privately
locked file cabinet and in a locked
casework in complete
and all paperwork is
office.
Mo 886-2369 (Rev.2/2005) 8
confidentiality.
kept in a
SECTION V: ACTIVITY DESCRIPTION NARRATIVE (Answer all items)
A. Activities.
1. Briefly describe the purpose and scope of the agency providing services to the
homeless. Include a list of all staff, their educational background and related
work experience. If homeless individuals are a part of this please so indicate.
Are you currently participating in an HMIS?
The Salvation Army maintains a social service office open at 9:00 am to
5:00 pm, Monday through Friday. The Salvation Army offers a round-the-
clock availability to provide emergency services to individuals needing
housing. The Salvation Army combines its efforts with other agencies and
landlords in the community to provide shelter to the homeless and The
Salvation Army also provides rental and utility assistance to keep families
in their homes during a time of crisis. If an emergency occurs and shelter
cannot be found or is not available, (such as the office is closed), The
Salvation Army provides temporary lodging through a local motel for up to
two nights and sometimes longer is the situation warrants it. This is
handled through the police station.
Tina Rodgers is the current caseworker. She has been the caseworker for
5 years.
The Salvation Arm is currently participating in an HMIS called Rosie.
2. Describe how E6GP funds for each category requested in the application will be used.
NOTES:
o Please list any furnishings or appliances purchased with ESGP funds.
o Emergency client motel/hotel lodging is now only eligible in category of
operations even if service provider agency primarily offers Essential
services or Prevention.
There will be no furnishings or appliances purchased with ESGP funds.
Essential Services -- Food assistance to help make sure that individuals
and families have enough food until their next income is received.
Prevention Services -- Utility assistance to keep families together.and
Rent assistance to keep families in their homes.
Operations -- Transient lodging program for the homeless and for use in
times of crisis for individuals and families:
3. The Department of Social Services is permitted to use 5% of the State's 2004 ESGP
award for administrative purposes. Federal statute specifies that the State share
the amount available with local governments who receive ESGP awards from the
State. As a result, 2% of the amount awarded by the State will be provided to local
governments who are participating in the program for administering their grant_
Provide description of expected use for this request and the amount needed.
Not Available.
MO 886-2369 (Rev.2/2005) 9
B. Describe how the following assistance will be provided to persons served by your
agency
1. Permanent Housing Referral Services
The Salvation Army works with landlords and other agencies in the community
to provide housing for families and individuals that have been evicted from
their homes or want to settle down in the Cape Girardeau area.
2. Overnight Shelter
The Salvation Army has a transient lodging program for individuals who require
a night's lodging. The individuals are screened through the police station
and then sent to a motel for one night. This service is based on indi-3idual
cases and can be for more than one night. This service is also available for
:3.msMea Ca)fs@NICese�
The Salvation Army provides prescription assistance to the elderly, those
just released from the hospital who are financially unable to get them,
and families that are referred from their doctor's office.
4. Children's Services (if applicable)
Meals are provided through our feeding programs. School supplies and a
summer day camp are also available to low income families.
5. Mental Health and/or Drug Abuse and/or Counseling Services
Counseling services are provided by the caseworker and/or the corps officer.
There is no fee for this service. If a client needs specific counseling
that we cannot offer, then the client will be referred elsewhere.
6. Referral to other State or Federal Programs
The Salvation Army refers individuals and families to other state and/or
federal programs based on their needs that are brought to our attention.
7. Employment Services
The Salvation Army refers individuals to the unemployment office and
temporary employment services, also to JTPA, a job training service.
We also have job notices and classified papers at the office on occasion.
8. Transportation
The Salvation Army provides gas and bus vouchers for individuals and/or
families that are stranded in the Cape Girardeau area. These vouchers are
also used for doctor's visits or funeral transportation if needed. Proof
of need is required for this assistance. Individuals or families that get
tl}ejzas vouchers have to show a valid drivers license and proof of insurance.
The Salvation Army provides Emergency food assistance which includes enough'
food for three nutritious meals for three days per person and more if needed.
The last week of each month a community meal is served. There is also a
Thanksgiving Community Dinner provided. If there is a need, hot meals are
v eac day. At Christmas, food baskets are given to (CONTINM ON NM PAGE)
PO".� Prevention
The Salvation Army provides rent assistance where deemed necessary and
prevents families from becoming homeless.
11. Other (specify)
Not Applicable.
MO 886-2369 (Rev.2/2005) 10
ANSWERS CONTINUED FROM PART B, NUMBER 9 -- PAGE 10
9. Food
families and individuals to provide food for the holidays. The
Salvation Army also distributes government commodities on a
monthly basis according to availability.
INSTRUCTIONS FOR SECTION VI: HOMELESS NEEDS
o Homeless persons are defined as families and/or individuals who are poor and
have no access to either traditional or permanent housing (see definition on
page 4 of application.) "Poor" generally means persons below the poverty level,
below 50% of the median income for the area, and who have little savings.
Estimates of the number of homeless persons being, or planned to be, served
should be based on data available, experience, or an assessment of need in your
community for the particular homeless population to be served. The homeless
may include: homeless, neglected, and dependent children not under court
intervention, street people, abused persons who have left their home and abusers
with little money, little income, or persons with such low income that there is little
affordable housing available for them or their families.
o Under this program an emergency shelter should be a shelter that does not
provide assistance on a long-term basis. These shelters generally should
not provide accommodations for more than a few months to the same
person. Emergency shelters generally should provide services that will
sustain homeless persons through a period of hardship
A. Does the provider serve meals? YES NO
B. Does the provider serve food other than meals? YES NO
C. What is the present capacity of your shelter? N/A
If expansion is planned within the next 12 months, what will be the new
when project is completed? N/A
D. List all existing emergency shelters in your city/county area. Show the capacity of
these shelters to serve the homeless population and characteristics of the
population served. (Include your present shelter and activities).
SHELTER CAPACITY POPULATION SERVICED
The Salvation Army does not have an emergency shelter.
There are no existing shelters in the city or in the
2' county. The Salvation Army provides the majority of
the emergency housing to the homeless people by lodging
3. transient families in a motel for one night or more,
and for families who want to seek permanent housing.
4. Cape Girardeau is on Interstate 55 and because of this,
we provide overnight lodging for families that are
5 transient.
E. Describe the NEEDS of projected service area. Please explain any requests
for funding increases.
The needs of projected service area are on following page.
MO 886-2369 (Rev.2/2005) 11
ANSWERS FOR NUMBER E ON PAGE 11
Describe the NEEDS of projected service area. Please
explain any requests for funding increases.
Each year, The Salvation Army in Cape Girardeau sees an
increased number of people requesting assistance for its
services.
The Salvation`,Army provides immediate help to families and
individuals in crisis situations. They may need help in
the following areas: Emergency food, Utility assistance, Rent
assistance, Emergency transportation, Clothing, Furniture/
Household items and Prescription medicine.
Statistics for assisting the homeless•individuals are
already 10% over last year.
If it weren't for the Emergency Shelter Grant, The
Salvation Army would not be able to assist as many
individuals and families as we; -do with Emergency food,
rent, utility assistance and emergency (transient) lodging.
The Salvation Army appreciates all assistance that it receives
to be able to continue helping individuals and families.
OMB STANDARDS REVISED DEFINITIONS FOR ETHNIC AND RACIAL CATEGORIES
ETHNIC:
a) Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or origin, regardless of race. The term, "Spanish origin,"
can be used in addition to "Hispanic or Latino.
b) Not Hispanic or Latino. A person not of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or orgin, regardless of race.
RACE:
a) American Indian or Alaska Native. A person having origins in any of the original peoples
of North and South America (including Central America), and who maintains tribal affiliation
or community attachment.
b) Asian. A person having origins in any of the original peoples of the Far East, Southeast
Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan,
Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
c) Black or African American. A person having origins in any of the black racial groups of
Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black or African
American."
d) Native Hawaiian or Other Pacific Islander. A person having origins in any of the original
peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
e) White. A person having origins in any of the original peoples of Europe, the Middle East or
North Africa.
MO 886-2369 (Rev.2/2005) 12
REPORTING INFORMATION REQUIRED BY FEDERAL GOVERNMENT
PLEASE COMPLETE THE FOLLOWING ITEMS BASED ON PROJECTED SERVICE
DELIVERY FOR THE ESGP CONTRACT PERIOD.
ETHNICITY: (Report actual numbers)
Hispanic or Latino
Not Hispanic or Latino
Race of persons served by the Project: (Report actual numbers)
0/0 White 3 lack or African American
Asian American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander Asian & White
American Indian or Alaska Native & White Black or African American & White
American Indian or Alaska Native & Black or African American
,'-SVD Balance of individuals reporting more than one race
(0,74 TOTAL
3T DD Number of Female -headed households
Indicate type of project(s) and service(s):
emergency shelter facilities transitional housing
vouchers for shelters outreach
drop-in center soup kitchen/meal distribution
food pantry health care
mental health HIV/AIDS services
alcohol/drug program e�mployment
iId care 1 t homeless prevention ,>
other (please list)
Number of People Served for each activity:
Residential Services:
average number of adults daily
average number of children daily
average number served yearly
,i
Y4 i
RRh-2369 (Rev.1/2004)
14
Non-residential Services:
average number serviced daily
Homeless Prevention:
Total number served for year
AJ07'
The following information is for residential services only: '
On an average day in the immediately past reporting period, please provide approximate
percentages of the following project participants:
unaccompanied 18 and over.......... male
% female %
unaccompanied under 18...............male
% female %
families with children headed by
single 18 and over ..........................male
% female %
youth 18 and under ...............................
%
two parents 18 and over .........................
%
.........
two parents under 18 ......................
%
families with no children ...........................
%
On an average day in the immediately ,past reporting period, provide the percentage of
the population served who are:
battered spouses
drug dependent individuals
runaway/throwaway youth
elderly
chronically mentally ill
veterans
developmentally disabled
physically disabled
HIV/AIDS
other
alcohol dependent individuals -
Please indicate the number of persons housed at any given time in each shelter type
funded through the ESG program.
Shelter
Number of persons housed
barracks
group/large house
scattered site apartment
single family detached house
single room occupancy
mobile home/trailer
hotel/motel
other (describe)
Qaa r,a tRoK7. i i?nndi
SECTION VII: LOCAL GOVERNMENT GRANTEE
EMERGENCY SHELTER GRANTS PROGRAM
CERTIFICATIONS BY THE CHIEF EXECUTIVE OFFICER
1, DOUGLAS K. LESLIE, CITY MANAGER , Chief Executive Officer
of UE = CF CAPE GIRARDFAU, MLSMM , certify that CTIY cp cAPE GTR4mj, MrS-ngr
city or county name city or county name
will provide the matching supplemental funds required by the regulation at 24 CFR 576.71.
1 have attached to this certification a description of the sources and amounts of such
supplemental funds.
I certify that the CITY OF CAPE GIRARDEAU will comply with:
city or county
(1) The requirements of 24 CFR 576.53, concerning the continued use of buildings for
which emergency shelter grants are used for rehabilitation or conversion of
buildings for use as emergency shelters for the homeless; or when funds are used
solely for operating costs or essential services, concerning the population to be
served.
(2) The building standards requirement of 24 CFR 576.55.
(3) The requirements of 24 CFR 576.56, concerning assurances on services and other
assistance to the homeless.
(4) The requirements of 24 CFR 576.57, other appropriate provisions of 24 CFR Part
576, and other applicable Federal law concerning non-discrimination and equal
opportunity; and
(5) The requirements of 24 CFR 576.57(e) concerns Environmental
Review/Compliancedealing with the provisions of, and regulations and procedures
applicable with respect to the environmental review responsibilities under the
National Environmental Policy Act of 1969 and related authorities as specified
in 24 CFR Part 58.
(6) The requirements of 24 CFR 576.59(b) concerning the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970.
(7) The requirements of 24 CFR 576.59 concerning minimizing the displacement of
persons as a result of a project assisted with these funds.
(8) The requirements of 24 CFR 576.56(a) and 576.65(b) that grantees develop and
implement procedures to ensure the confidentiality of records pertaining to any
individual provided family violence prevention or treatment services under any
project assisted under the Emergency Shelter Grant Program and that the address
or location of any family violence shelter project assisted with ESG funds will not
be made public, except with written authorization of the person or persons
responsible for the operation of the shelter.
(9) The requirement of that recipients involve, to the maximum extent practicable,
homeless individuals and families in constructing, renovating, maintaining, and
MO 886-2369 (Rev.2/2005) 15
operating facilities assisted under the ESG program, and in providing services for.
occupants of these facilities as provided by 24 CFR 576.56(b)(2).
(10) The requirements of 24 CFR 576.21(a)(4) which provide that the funding of
homeless prevention activities for families that have received eviction notices or
notices of termination of utility services meet the following standards: (A) that the
inability of the family to make the required payments must be the result of a sudden
reduction of income; (B) that the assistance must be necessary to avoid eviction of
the family or termination of the services to the family; (C) that there must be a
reasonable prospect that the family will be able to resume payments within a
reasonable period of time; and (D) that the assistance must not supplant funding
for preexisting homeless prevention activities from any other source.
(11) The new requirement of the McKinney Act (42 USC 11301) to develop and
implement to the maximum extent practicable and where appropriate, policies
and protocols for the discharge of persons from publicly funded institutions or
systems of care (such as health care facilities, foster care or other youth facilities, or
correction programs and institutions in order to prevent such discharge from
immediately resulting in homelessness for such persons. I further understand that
State and local governments are primarily responsible for the care of these
individuals and that ESG funds are not to be used to assist such persons in place
of State and local resources
(12) The Drug Free Workplace requirements of 24 CFR Part 24 concerning the Drug
Free Workplace Act of 1988.
(13) HUD's standards for participation in a local Homeless Management Information
System (HMIS) and the collection and reporting of client level information. In
the event that state laws conflict with the HMIS Final Notice, as determined by an
appropriate state government entity, state law will prevail.
I certify that the submission of applications for emergency shelter grants is authorized
under state and/or local law and that the CITY OF CAPE GIRARDEAU
city / county name government
possesses legal authority to carry out emergency shelter grants activities in accordance with
applicable law and regulations of the Department of Housing and Urban Development including
other federal requirements and the State of Missouri.
Additionally, I certify that use of emergency shelter grant amounts will comply with the following
requirements:
(a) Non-discrimination and Equal Opportunity
(1) The requirements of Fair Housing Act (42 U.S.C. 3601-20) and
implementing regulations at 24 CFR Part 1001; 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. 2000d and
2000d-4) implementing regulations issued at 24 CFR Part 1.
(2) The requirements of 24 CFR 576.57, the prohibition against
discrimination on the basis of age under the Age Discrimination Act
of 1975 (42 U.S.C. 6101-07) and implementing regulations at
24 CFR Part 146 and the prohibitions against discrimination against
handicapped individuals under section 504 of the Rehabilitation Act
MO 886-2369 (Rev.2/2005) 16
of 1973 (29 U.S.C. 794) and implementing regulations at 24 CFR Part 8.
(3) The requirements of Executive Order 11246 and the regulations
issued under the Order at 41 CFR 60.
(4) The requirements of section 3 of the Housing and Urban Development
Act of 1968, 12 U.S.C. 1701 u (see 24 CFR 570.607(b).
(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; and
6) The requirement that the grantee make known that the use of the facilities
and services is available to all on a nondiscriminatory basis. Where the
procedures that a grantee or recipient intends to use to make known the
availability of such facilities and the ESGP services are unlikely to reach
persons with handicaps or persons of any particular race, color, religion,
sex, age or national origin who may qualify for such services, the recipient
or grantee must establish additional procedures that will ensure that
these persons are made aware of the facility and services. Adopt and
implement procedures designed to make available to interested persons
information concerning the existence and location of services and
facilities that are accessible to persons with a handicap.
Regulations of 24 CFR 576.57.
(b) Lead -Based Paint. The requirements, as applicable, of the Lead -Based
Paint Poisoning Prevention Act (42 U.S.C. 4821-4846) and implementing
regulations at 24 CFR Part 35; and of 24 CFR Part 576.57.
(c) Conflicts of Interest. In addition to conflict of interest requirements in OMB
Circulars A-102 and A-110, no person (1) who is an employee, agent,
consultant, officer, or elected or appointed official of the grantee, state
recipient, or non-profit recipient (or any designated public agency) that
receives emergency shelter grant amounts and who exercises or has
exercised any functions or responsibilities with respect to assisted activities
or (2) 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, or the proceeds
thereunder, 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 year thereafter.
HUD may grant an exception to this exclusion as provided in 570.611(d)
and (e) of this chapter.
(d) Applicability of OMB Circulars. The policies, guidelines, and
requirements of 24 CFR Part 85 and OMB Circular No. A-87, as they
relate to the acceptance and use of emergency shelter grant amounts
by states and units of general local government, and No. A-110 and
A-122 as they relate to the acceptance and use of emergency shelter
MO 886-2369 (Rev.2/2005) 17
grant amounts by private non-profit organizations.
(e) Use of Debarred, Suspended, or Ineligible Contractors.
The provision of 24 CFR Part 24 relating to the employment, engagement
of services, awarding of contracts, or funding of any contractors or
subcontractors during any period of debarment, suspension or
placement in ineligibility status.
(f) Uniform Federal Accessibility Standards. For major rehabilitation or
conversion, the Uniform Federal Accessibility Standards at
24 CFR Part 40, Appendix A.
(g) Illegal Use of Drugs and Alcohol. The recipient and project sponsor
conducting activities, funded in whole or in part with McKinney Act funds, to
assist the homeless population in this jurisdiction, will administer, in good
faith, a policy designed to ensure that the assisted homeless facility is free from
the illegal use, possession,or distribution of drugs or alcohol by its beneficiaries.
(h) Audit. Acceptance of an ESGP contract requires the grantee and
subgrantee(s) to comply with the audit requirements of the new Office of
Management and Budget (OMB) Circular A-133, and also acknowledges that
cognizant federal and state representatives shall have access to pertinent records
during normal business hours.
OMB Circular A-133 revised June 24, 1997, requires Federal award recipients to
have independent audits performed if they expend $300,000 or more in Federal
funds during their fiscal year. Revisions of OMB Circular A-133 published June
27, 2003 increases the threshold for audit from $300,000 to $500,000. The final
revisions are effective for fiscal years ending after December 31, 2003
Grant recipients who expend $300,000 ($500,000 for fiscal years ending after
December 31, 2003) or more in Federal funds during their fiscal year should
submit a data collection form and reporting package to the OMB Federal Audit
Clearinghouse (FAC). This information must be submitted to the FAC within the
earlier of:
(1) 30 days of receipt of the audit report or
(2) Nine months after the end of the audit period.
The information from the data collection form is entered into the FAC by the
recipient and/or the auditor. In addition, copies of the audits only need to be sent
to the cognizant or oversight agency, as designated by the FAC, and to any
Federal agency when a finding has been issued, only when findings exist. Local
governments are no longer required to send a copy of their audit to the ESG office
as audits will be reviewed through the Federal Audit Clearinghouse.
MO 886-2369 (Rev.2/2005) 18
(i) Obligation of Grant Funds. The requirement that each State recipient
must have its grant amounts obligated (as that term is defined at
576.3 within 180 days of the date on which the State made the grant
amounts available to the State recipient. In the case of grants for
homeless prevention activities under 576.21(a)(4). State recipients are
required to obligate grant amounts within 30 days of the date on which
the State made the grant amounts available to the State recipient.
Q) Expenditure of Grant Funds. The requirement that each grantee
(city/county) recipient must spend all of its grant amounts within 24 months
of the date on which the State made the grant amounts available to the
State recipient. In the case of grants for homeless prevention activities,
State recipients must spend such sums within 180 days of the date on
which the State made the grant amounts available to the recipient.
(k) Provision of Assistance to Primary Religious Organization.
The limitation on assistance at section 576.23 will be met in the use
of ESGP funds.
(1) Relocation and Acquisition. The requirement that each grantee (city/county
government) must comply with acquisition regulations at 576.59 to
minimize displacement of persons businesses, nonprofit organizations as
a result of project assistance under this program, and to provide relocation
assistance for displaced persons.
(m) Participation by Faith -Based Organizations. The requirement that each grantee
(city/county government) and local sub -recipients must comply with
requirements of 24 CFR 576.23 and the Department of Housing and
Urban Development Final Rule which was published in the Federal Register
of September 30, 2003 concerning participation in HUD programs by faith
based organizations providing for equal treatment of all HUD
Program Participants.
Signature of Chief Executive Officer
(Local Government)
(SEAL)
MO 886-2369 (Rev.2/2005) 19
(Date)
Interna! Revenue Service
01 TU Slvatiazz Amy
U91CIO"I COrPQrat:ioA
793 Slaamfip04d AAranue
Verona, F•T 07044
Department of the Treasury
W4*hinpton, bo 20224
PVM*n to COAMM:
Mr. W. Broekaer
Telephone Number;
(202) 566-4757
Aeler Rgpty to:
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can consider the e.'fe_t of tie abauge on your axampt status and fa=dn-
tion status. Also, you sbculd infortr your key District Director of &II,
changes in yvur tine and address.
Vcsicss speCitIA"ly ft=eptad, begivaing January 1, 1334, you must
pay taus radar the radera.l. Essar=ee Cant.-ibucious Ace (sovAsl Seca«itr
taxes) for cmCh tm.7.ayae whO i s paid $10.3 or move is z calendar year.
Ydu ara net retro- :d co pad ts. wider the Fadaral 7,ae apXoy%wdt Tan
Act (FUTA) .
Since pan are rat a private fo.=datina, you are not sub jeca to ti:Q
_-. - -- - -
Q�Ca,.`J rL- �.7..�.�i-`:. t:.':rgji-- �•rr'.AC`.Azl. -.._4�1. ,� 7�-- � -
�var, �u are riot-auza-
rnat:�c311y ez pt itror at cr fed,a=n1 =seise was. •L you have questions
ddout oxc_ae, e=ployntnt, or ocher federal tames, ecntact your key,
District: Diractar:
You are nac rola ed to file fade:all irc=a ta.% returnz unlass you
are sub jaat to the tax an =ireUted buslaegs iceome trader Carlo section
511. T. you are Subject to thio ts.:, you gust filo in Sade tar. vertu= _
aA Form 390- tl 'at=pt Oraaaizat±on 3usirtas Aaar,ta zap Return4 xn this
• let tar, we arz n*t detarm4uiae vhather any of your present or propoged
eativityoo arc uarciated trade or business as dafs-Aed iu Code soctiou 313. ;µ
t
s .a
I
rafs u1vfj#c4 A=y of at? oral Corporation '
Ple a show pour -. player 7. deutilifteati.on mm-sar ea &II ratnrss you
file * snd is &U cvrrespurdsuas with th4 IAcoreaal lave=* SeYvie m.
We are Warming your hey District, Wracte; of t'sis m4ln • :444x=4
Us Latter could help re nalze aay, gTij*-j4aas ;ab.ftt your. sxe ga cstvui :aad
Sts dacicu ftacss, you mwuld xdsq it inyon peios��aaAt records..
Zt you have any gwsticue; about this ualiag. pleat* contact tba, filer-
son whose n=a and telep; s Ue rumbar ` are. shown iu- the �eodi� 8f ' tafs
letter. Por athar mattirs, 'i�ludIns gwxtioas eonegadus 7e'ago ing
:aquixents� ple�►ss aoataa: your kay Diarrice
vi=a tor.
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