HomeMy WebLinkAboutRES.2168.04-17-2006BILL NO. 06-84
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_.
Gayle L.f/gonrad, City Clerk
Jay Knudtson, Mayor
a4«9 <a4na APPLICATION
a a a n na°a
i
MISSOURI
2006 EMERGENCY SHELTER GRANT PROGRAM (ESGP)
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 Friday, April 28, 2006
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. `r -y n F Ca Ci.rar(In � iii
Street/Box Number 401 independence Street
City and Zip Code Cape Girardeau, MO 63703
Contact Person Steve Williams
Title Housing Assistance Coordinator
Phone Number 573-334-8326
E-mail
B. Service Provider Agency/Organization Responsible for Grant
Activities (Subgrantee): safe House for women, Inc.
Street/Box Number Po sox 1167
City and Zip Code Cape Girardeau MC 63702
Contact Person Linda GArner
Title Executive Director
Phone Number 573-335-7745
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.
D. Indicate type of organization carrying out the activity with an "x"
Public Agency
MO 886-2369 (Rev.3/2006)
Faith Based Non -Profit X Other Non -Profit
SPECIAL CHARACTERISTICS ACTIVITY LOCATION DEFINITIONS:
CDBG STRATEGY AREA -- A HUD approved Neighborhood or Community Revitalization
Strategy Area (NRSA or CRSA), identified in the State or Entitlement area Consolidated
Plan/Annual Action Plan under Section 91.215(e)(2) or Section 91.315(e)(2). (The State of
Missouri does not have a HUD approved NRSA or CRSA. If you are applying in a CDBG
Entitlement community please check with local CDBG staff.)
LOCAL TARGET AREA -- A locally designated non-CDBG Strategy area targeted for
assistance.
PRESIDENTIALLY DECLARED MAJOR DISASTER AREA — An Area declared a major disaster
under Subchapter IV of the Robert T. Stafford Disaster Relief and Emergency Assistance Act.
HISTORIC PRESERVATION AREA — An area designated for historic preservation by local,
state, or federal officials.
BROWNFIELD REDEVELOPMENT AREA — An abandoned, idled, or underused property
where expansion or redevelopment is complicated by real or potential environmental
comtamination.
Please indicate the Special Characteristics for area activity is located in.
Indicate type of project(s) and service(s) with "x". You may mark more than one:
X emergency shelter facilities
vouchers for shelters
drop-in center
food pantry
mental health
alcohol/drug program
child care
other (please list)
Mo 886-2369 (Rev.3/2006) 2
transitional shelter
outreach
soup kitchen/meal distribution
health care
HIV/AIDS services
employment
homeless prevention
Y
N
CDBG Strategy area
❑
Local Target Area
❑
�'
Presidentially Declared Major Disaster Area
❑
Historic Preservation Area
❑
B
Brownfield Redevelopment Area
❑
✓❑'
Indicate type of project(s) and service(s) with "x". You may mark more than one:
X emergency shelter facilities
vouchers for shelters
drop-in center
food pantry
mental health
alcohol/drug program
child care
other (please list)
Mo 886-2369 (Rev.3/2006) 2
transitional shelter
outreach
soup kitchen/meal distribution
health care
HIV/AIDS services
employment
homeless prevention
SECTION
II: ELIGIBILITY
A.
Funds will be obligated by 7g1u 01
, 2006.
(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, 2007.
(Circle YES,
NO, or Not Applicable (N/A) for the following questions)
C.
The proposed non-profit service provider agrees to not
YES NO
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
(YES,1 NO N/A
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
YES NO N/A
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
ES NO N/A
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 theirYES 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 NO N/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 than YES NO N/A
major rehabilitation or conversion, the building will be
used as a shelter for at least three years.
If statement is true, answer "YES."
The emergency shelter building will meet local YES 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 886-2369 (Rev.3/2006)
K. Homeless individuals will be given assistance YES 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 (NO)
N/A
YES QNO)
N/A
YES
YES
NO N/A
NO &
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.3/2006) 4
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 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.
o Outcome Performance Measurement System: will enable HUD to collect information
on the outcomes of activities funded with ESG monies and aggregate data at the
national and local level. A Final Notice was published March 7, 2006.
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.
MO 886-2369 (Rev.3/2006)
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
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.3/2006) 6
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
Description of
Expenditures
(A-)
(B-)
Total
Local
ESGP
Cash
Funds Funds
Requested ESG Match
(C.) (D.)
Local State or
Non -Cash Federal
Funds Grant Funds
ESG Match ESG Match
(E.) (F.)
All Grand
Other Total
Funds
REHAB, CONVERSION
And RENOVATION
Renovation
Major Rehab
Conversion
SUB TOTAL
OPERATIONS
Max 10% staff costs
Maintenance
400
0
0
0
0
$400
Insurance -property only
Utilities
$4500
0
0
0
0
$4500
Telephone
Furnishings/Appliances
Motel/hotel
Water,sewer,trash
o
0
0
0
$1600
HMIS
Other(Specify)
SUB TOTAL
6500
0
0
0
0
$6500
ESSENTIAL SUPPORT
SERVICE
Employment
Food
0
0
0
$1 0 0 0
Health
Mental Health Counsel
Substance/Ab Counsel
Education
Perm Housing Referral
Transportation
Child Care
HMIS
SUB TOTAL
$1000
0
0
0
0
$10
PREVENTION
Client Rent
Mortgage
Utilities
Security Deposit
SUBTOTAL
0
ADM 2% Local Gov only
GRAND TOTAL
7500
0
0
0
0
$7500 i
MO 886-2369 (Rev.3/2006) 7
1. List the source of all resources/funds identified on page 7.
A. Source of all ESGP Matching Funds available during the ESGP contract period.
1) Cash (Column B page 7)
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 7)
Not AppMicable
3) State and Federal (Column D page 7)
Not Applicable
B. Sources of all other resources/funds available during the contract period.
(Column E page 7)
Department of Public Safety
Victims of Crime Act (VOCA)
Stop Violence Against Women (VAWA)
State Services to Victims Fund (SSVF)
Local Area United Way allocation/donations
Cape County Mental Health Board Mill Tax Fund
Department of FAmily Services (DFS) DV Shelter & DV Victim
Assistance
Individual Contributions/Donations
MO 886-2369 (Rev.3/2006) 8
2. A letter of commitment is required when using State/Federal agency grant funds as a
match for ESG. 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 the attached Request for Waiver of 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.3/2006)
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?
Safe HOuse for Women, Inc. does not currently participate in the
HMIS because of our classification as a domestic violence shelter.
Personnel List is attached.
Safe House for Women provides emergency temporary shelter to
women and children who have experienced domestic violence. We
provide a safe haven from their abusive situation. Safe HOuse
provides the support system thatmeet their needs including their
physical, psychological, emotional, and mental health needs. All
services are provided free of charge. Our approximate costs to
provide shelter and care = $75/day.
2. Describe how ESGP funds for each category requested in the application will be used.
Notes ---List what kind of furnishings or appliances are purchased with ESGP funds.
---Emergency client motel/hotel lodging is only eligible in category of operations
even if service provider agency primarily offers Essential Services or Prevention.
ESGP funds will be used to assist with the costs of shelter
maintenance, utilities, water/sewer/trash pick up, and groceries.
3. The Department of Social Services is permitted to use 5% of the State's 2006 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.3/2006) 10
B. Describe how the following assistance will be provided to persons served by your
agency
1. Permanent Housing Referral Services
Safe House for Women is a member of the local Continuum of Care
Housing Committee. We make referrals regularly to the Housing
Assistance Program administered by Community Caring Council & East Mo.
2. Overnight Shelter Action Agency & Salvation Army.
We provide safe, secure, free & confidential shelter and services to
women and children who are victims of domestic violence.
3. Medical Services
We work collaboratively with Cross TRails Medical Center (FQHC), our
county public health department, Holistic Healthcare for Women, and
both hospitals in our county.
4. Children's Services (if applicable)
We employ a full-time child advocate/education coordinator who oversees
our shelter -based children's program & the school-based domestic violenc(
prevention education program. This person also works closely with the
wgm%l &i l9H99M_'Y 8A* Services
We employ a full-time licensed professional counselor who provides
individual and group counseling for women and children. We also make
referrals to the other mental health agencies in our area.
6. Referral to other State or Federal Programs
We employ a case manager who assists clients with referral to
appropriate services. Each resident completes an intake assessment
to identify their needs.
7. Employment Services
We work with local employment resources such as Missouri Workforce
Development, SEMO University, Three Rivers Community College, local
GED resouces and vocational agencies. The case manager assists each
resident with development of a vocational/job plan of action.
8. Transportation
Our residents use the local cab company to meet most of their daily
transportation needs. On occasion, we ask volunteers to transport
residents for job interviews or doctor appointments. Some residents
use a bicycle as their transportation while others walk.
9. Food We make available food at no -cost to the residents. They
are able to choose foods from our food pantry. We receive some
support from Bootheel Food Bank and government commodities. We also
receive support donated food items from churches and civic food drives.
10. Prevention Preventive services include a peer support group program
for residents & non-residents. Our counseling, children's, and schocbl
based programs also emphasize prevention heavily.
11. Other (specify)
P.A.W.S. - We provide resources to protect a won.anas
pet from violence in the home. We have an agreement with the local
humane society. That agency will arrange for pet foster care while
a woman resides in our shelter.
MO 886-2369 (Rev.3/2006) 11
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 capacity
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 with ESG funds. (Include ygur present shelter and activities).
SHELTER
1• Revival Center
2. Salvation Army
3
4
5
6
Vision House
Safe House for Women
CAPACITY POPULATION SERVICED
homeless
Hotel vouchers are provided to homeless
individuals and families
12 faith -based program for women
who are recovering from substance abuse
16 domestic violence shelter for
women & children
MO 886-2369 (Rev.3/2006) 12
E. Describe the NEEDS of projected service area. Please explain any requests
for funding increases.
See Attached Description
MO 886-2369 (Rev.3/2006) 13
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 2005, we responded to 638 hotline calls. We provided residential services to 107
women and children. The average length of stay for our residents is 22 days
A total of 214 women and children received services from the counselor. A total of 114
clients attended the weekly peer support group. Forty-six non-residents received one-on-
one counseling sessions. The counselor also responded to three emergency situations
within the shelter that required transport to a local hospital for inpatient mental health
care (1 drug overdose, 2 suicidal situations).
Safe House for Women, Inc. — Calendar Year 2005
Women Served with shelter
65
Children served with shelter
42
Turned away because we were full
48
Hotline calls
638
Ex Parte Orders assistance
30
Full Orders of Protection assistance
31
Cab service
235
Support services for non-residents
55
11 ���6 I
f-VO1VLL'rN Inc.
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 many times during 2005. We
turned away 48 women and children because we were full.
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.
Linda Garner, Executive Director
ON
u.�'.=. wey
3 o j a2 ools
March 30, 2006
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. i
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
Shelter Director or Volunteer Trainer
Date
Executive Director or Shelter Director Date
Date
have read and understand the policies and procedures presented to me in Safe House
volunteer training manual and handbook. I 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.
Safe House for Women
Personnel Roster as of March 30, 2006
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.
Gloria Voss, LPC, Counselor
Provides professional counseling on both an individual and group basis to
women and children.
Betty Brown, Court Advocate/Case Manager
BS Psychology with minor in Interpersonal & Small Group Communication
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.
Ellen Deirermann, Education Coordinator/Child Advocate
BS Elementary Education with minor in social studies
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;
answers Hotline calls.
Linda Schild, Part time Advocate
BS Education, Certified teacher
Same duties as Mindy Brown.
Kathy Woeltje, Part-time Advocate
BS Elementary Education, Certified teacher
Same duties as Mindy Brown
Kerrie Lintner, Part-time Advocate
Nearing completion of bachelor's degree in English as Second Language
Same duties as Mindy Brown
Lisa Quick, Part-time Advocate
BA Home Economics/Marketing
Same duties as Mindy Brown
Pam Wahlers, Part-time Advocate
RN Nursing Student Southeast Missouri State University
Same duties as Mindy Brown
Rebecca Thomas, Part-time Advocate
Nearing completion of Bachelor's degree in social work
Same duties as Mindy Brown
INSTRUCTIONS FOR ESG DATA COLLECTION
Please note the following items when completing the ESG Data Collection Form.
Report only on ESGP Services.
Complete each activity section that corresponds with the appropriate category.
Complete proposed data at time of application. At closeout actual numbers will be required.
Actual numbers should be used, not percentages or estimates based on census.
DEFINITIONS FOR COMPLETION OF ESG DATA COLLECTION FORM
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.3/2006) 14
MISSOURI FAMILY SUPPORT DIVISION
EMERGENCY SHELTER GRANT PROGRAM
FY2006 - DATA COLLECTION FOR ESG ACTIVITIES
Applicant: 544e POU.4. -(:0 r wpry 4.,A I Mnc . Date: Marcln a
Rehabilitation/Conversion/
Annual number of persons served
A, C
Renovation
(05
b. Children
Operations
c. Total
A, C
Essential Supportive Services
A, C
b. Unaccompanied 18 and Over Females
DATA
Prevention
�-
B, C Collected at time of
Annual Family Households with Children
Headed by...
Application
A. Emergency
and/or
Transitional
Shelters
Annual number of persons served
a. Adults
(05
b. Children
(42.
c. Total
19.7
Annual Individual/Single Households
a. Unaccompanied 18 and Over Males
b. Unaccompanied 18 and Over Females
2.6
c. Unaccompanied under 18 Males
�-
d. Unaccompanied under 18 Females
Annual Family Households with Children
Headed by...
....
a. Single 18 and Over Males
b. Single 18 and Over Females
3
c. Single under 18 Males
d. Single under 18 Females
e. Two Parent 18 and over
-�
f. Two Parents Under 18
...........................
...........................
...........................
...........................
Annual Famil Households with No Children ...::.:
.:.................
a. Family Household With No children
—�-
Annual Number of Persons Served for Each
Subpopulation (May include overlapping
numbers/duplicate persons.)
a. Chronically Homeless (Emergency Shelter
-Only)
b. Severely Mentally III
c. Chronic Substance Abuse
3q
d. Veterans
e. Persons With HIV/AIDS
Jr'
f. Victims of Domestic Violence
(07
DATA
Collected at time of
Closeout
Individuals d duals HousedBed Capacity) ( p ty) At Any
Given Time Through ESG Proaram
b. Group/Large House
d. Scattered Site Apartment
e. Single Family Detached House
J Single Room Occupancy
g. Mobile Home/Trailer
h. Hotel/Motel 9
Q
MO 886-2369 (Rev.3/2006) 15
Applicant: 6ct{e 14ouse, far U)Orylen,T C. Date: Mach a0o
B. Non -Residential Annual number of persons served
Services a. Adults
C. Ethnicity and
Race I Annual number of persons served
a. White
b. Black/African American
C. Asian
d. American Indian/ Alaskan Native
e. Native Hawaiian/Other Pacific Islander
f. American Indian/Alaskan Native & Whit
9. Asian & White
h. Black/ African American & White
i. American Indian/Alaskan Native & Black
African American
j. Other Multi -Racial
MO 886-2369 (Rev.3/2006) 16
MJ
b. Children
S'
c. Total
Annual Homeless Prevention
sIndicators
rs
a. Households that received emergency financial
assistance to prevent homelessness
b. Households that received emergency legal
assistance to prevent homelessness
C. Ethnicity and
Race I Annual number of persons served
a. White
b. Black/African American
C. Asian
d. American Indian/ Alaskan Native
e. Native Hawaiian/Other Pacific Islander
f. American Indian/Alaskan Native & Whit
9. Asian & White
h. Black/ African American & White
i. American Indian/Alaskan Native & Black
African American
j. Other Multi -Racial
MO 886-2369 (Rev.3/2006) 16
MJ
SECTION VII: LOCAL GOVERNMENT GRANTEE
EMERGENCY SHELTER GRANTS PROGRAM
CERTIFICATIONS BY THE CHIEF EXECUTIVE OFFICER
Chief Executive Officer
of , certify that
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 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/Compliance dealing 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
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).
MO 886-2369 (Rev.3/2006) 17
(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.
(14) HUD's Standards for Outcome Performance Measurement.
I certify that the submission of applications for emergency shelter grants is authorized
under state and/or local law and that the
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
of 1973 (29 U.S.C. 794) and implementing regulations at 24 CFR Part 8.
MO 886-2369 (Rev.3/2006) 18
(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
grant amounts by private non-profit organizations.
MO 886-2369 (Rev.3/2006) 19
(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 $500,000 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.
(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.
MO 886-2369 (Rev.3/2006) 20
(j) 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.3/2006) 21
(Date)
aeage a;na APPLICATION
o a n a aaaa
MISSOURI
y 2006 EMERGENCY SHELTER GRANT PROGRAM (ESGP)
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 Friday, April 28, 2006
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):
City of Cape Girardeau
Street/Box Number 401 Independence, P.O. 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 ma_iorin0l@aol.com
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.
D. Indicate type of organization carrying out the activity with an "x"
Public Agency Faith Based Non -Profit Other Non -Profit
MO 886-2369 (Rev.3/2006)
SPECIAL CHARACTERISTICS ACTIVITY LOCATION DEFINITIONS:
CDBG STRATEGY AREA -- A HUD approved Neighborhood or Community Revitalization
Strategy Area (NRSA or CRSA), identified in the State or Entitlement area Consolidated
Plan/Annual Action Plan under Section 91.215(e)(2) or Section 91.315(e)(2). (The State of
Missouri does not have a HUD approved NRSA or CRSA. If you are applying in a CDBG
Entitlement community please check with local CDBG staff.)
LOCAL TARGET AREA -- A locally designated non-CDBG Strategy area targeted for
assistance.
PRESIDENTIALLY DECLARED MAJOR DISASTER AREA —An Area declared a major disaster
under Subchapter IV of the Robert T. Stafford Disaster Relief and Emergency Assistance Act.
HISTORIC PRESERVATION AREA — An area designated for historic preservation by local,
state, or federal officials.
BROWNFIELD REDEVELOPMENT AREA — An abandoned, idled, or underused property
where expansion or redevelopment is complicated by real or potential environmental
contamination.
Please indicate the Special Characteristics for area activity is located in.
Y N
CDBG Strategy area ❑ f
Local Target Area ❑
Presidentially Declared Major Disaster Area ❑
Historic Preservation Area ❑'
Brownfield Redevelopment Area ❑
Indicate type of project(s) and service(s) with "x". You may mark more than one:
emergency shelter facilities transitional shelter
vouchers for shelters outreach
drop-in center A;o� soup kitchen/meal distribution
food pantry health care
mental health HIV/AIDS services
alcohol/drug program employment
child care homeless prevention LR ewd
other (please list) 0 (l -f
MO 886-2369 (Rev.3/2006) 2
SECTION II: ELIGIBILITY
A. Funds will be obligated by 2006.
(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, 2007.
(Circle YES, NO, or Not Applicable (N/A) for the following questions)
C. The proposed non-profit service provider agrees to not OYESNO
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 N/A
YES NO N/A
YES NO N/A
ES NO N/A
YES NO A
YES NO/A
J. The emergency shelter building will meet local YES NO
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.3/2006)
ON/A
K. Homeless individuals will be given assistance YES 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 YES NON 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 N 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 NO N/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 N (: N/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.3/2006)
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 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.
o Outcome Performance Measurement System: will enable HUD to collect information
on the outcomes of activities funded with ESG monies and aggregate data at the
national and local level. A Final Notice was published March 7, 2006.
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.
MO 886-2369 (Rev.3/2006)
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
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.3/2006)
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
Description of
Expenditures
(A.)
(B.)
Total
Local
ESGP
Cash
Funds Funds
Requested ESG Match
(C.) (D.) -
Local State or
Non -Cash Federal
Funds Grant Funds
ESG Match ESG Match
(E.) (F.)
All Grand
Other Total
Funds
REHAB, CONVERSION
And RENOVATION
Renovation
Major Rehab
Conversion
SUB TOTAL
OPERATIONS
Max 10% staff costs
$8,000.00 $10, 000.00
18 000.00
Maintenance
$7,000.00
7,000.00
Insurance -property only
Utilities
$13,500.00
13, 500.00
Telephone
4.500.00
4,500.00
Furnishings/Appliances
Motel/hotel TRANSIENT
$10,000.00
11, 000.00 10 743.00
31, 743.00
Water,sewer,trash
HMIS
Other(Specify)
SUB TOTAL
$10,000,00
$44,000.00 $10,000.00 $10,743.0)
$74,743.00
ESSENTIAL SUPPORT
SERVICE
Employment
Food
$5,000.00
$10.000.00
$15,000.00
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
$12,500.00
$13,000.00
Mortgage
Utilities
$12,500.00
$13,000.00
$25,500.00
Security Deposit
SUBTOTAL
$25,000.00
$26,000.00
$51,000.00
ADM 2% Local Gov only
GRAND TOTAL
$40,000.00
$80,000.00 $10,000.00 10,743.001
$140,743.001
MO 886-2369 (Rev.3/2006)
www.efsp.unitedway.org Emergency Food and Shelter Program
701 North Fairfax Street, Suite 310
Alexandria, VA 22314-2064
Phone 703-706-9660 Fax 703-706-9677
5306-00 Cape Girardeau County, MO
Maj. Mike Thomas
-
-- -- Salvation Army, The _ --- -
Post Office Box 802
Cape Girardeau, MO 63702
RE: Account Status for Phase 24 - LRO ID: 530600-003
24-5306-00 003 E1
02/23/06
LRO 003
LRO ID: 530600-003
The funds you are receiving are Federal funds as authorized under Public Law PL 109-90. The CFDA
number for the Emergency Food and Shelter Program is 97.024.
For access to the EFSP web site, you need a password. If you have not already set one, ;your temporary
password is your LRO ID without the hyphens, e.g./23456789 for LRO ID# 1234-56-789. You will have to
change_ this the first time you access the Local Board and LRO Information. page of the web site
As -of today, our records indicate that your LRO has received the following awards(s) under this phase of
the Emergency Food and Shelter National Board Program:
AYvard Amount 10,743.00
Award Adjustments 0.00
A -ward Total - - - - - - - - -- - .- 10,743 00- - -
Your LRO may begin charging expenses against this total as of 10/01105. Funds must be expended
prior to 09130/06.
To date, your LRO has received the following payment(s):
_ EFT E153076 paid on 02/23/06 5,371.50
Bank Account: ABA# 081000210 Acct# 4007149372
Deposited: 02/28/06 -
Payment Total 5,371.50
- Monies still due your LRO: - - $5,371.50 -
Sincerely; - - - -
Sharon M. Bailey _
Vice President
1. List the source of all resources/funds identified on page 7.
A. Source of all ESGP Matching Funds available during the ESGP contract period.
1) Cash (Column B page 7)
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 7)
The source of the non-cash are volunteers that work in the feeding
program and stocking of the food pantry and commodities. 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 7)
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 7)
Not Applicable.
MO 886-2369 (Rev.3/2006) 8
2. A letter of commitment is required when using State/Federal agency grant funds as a
match for ESG. 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 casework in complete confidentiality.
Each client is interviewed privately and all paperwork is kept in a locked
file cabinet and in a locked office.
Mo 886-2369 (Rev.3/2006)
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 9:00am to 5:00pm,
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 if the situation
warrants it. This is handled through the police department.
Tina Rodgers is the current caseworker. She has been the caseworker for 6 years.
The Salvation Army is currently participating in an HMIS called Rosie.
2. Describe how ESGP funds for each category requested in the application will be used.
Notes --List what kind of furnishings or appliances are purchased with ESGP funds.
—Emergency client motel/hotel lodging is 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 2006 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.3/2006) 10
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 Salvati-on 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 individual cases
and can be for more than one night. This service is also available for
families if need be.
3. Medical Services
The Salvation Army provides prescription assistance to the elderly, those just
released from the hospital who are financially unable to purchase their medicine
and families that are referred from their doctor's office.
4. Children's Services (if applicable)
Meals are provided through our feeding program. 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 need 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 the
temporary employment services available to them, also to JTPA, a training
service. We have job notices and classified ads available at the office
on occasion.
8. Transportation
The Salvation Army provides gas vouchers for individuals and/or families that
are standed in the Cape Girardeau area. These vouchers are also used for
doctor's visits or funeral transporation if needed. Proof of need is required
for this assistance. Individuals or families that get the gas vouchers have
to show a valid driver's license and proof of insurance.
9. Food - 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
served every day. At Christmas, food baskets are given to provide food for the
ho. ih'lyeVentlghh month, government commodities are distributed according to availability
The Salvation Army provides rent assistance where deemed necessary and
prevents families from becoming homeless.
11. Other (specify)
Not Applicable.
MO 886-2369 (Rev.3/2006) 11
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? NA
If expansion is planned within the next 12 months, what will be the new capacity
when project is completed? NA
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 with ESG funds. (Include your present shelter and activities).
SHELTER CAPACITY POPULATION SERVICED
1. 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 located on Interstate 55 and because
of this, we provide overnight lodging for families
5. that are transient.
Mo 886-2369 (Rev.3/2006) 12
E. 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, emergency lodging and prescription medicine.
Statistics for assisting the homeless individuals are already
over 10% of 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.
MO 886-2369 (Rev.3/2006) 13
MISSOURI FAMILY SUPPORT DIVISION
EMERGENCY SHELTER GRANT PROGRAM
t-YZUUb — UA I A t:ULLt:U 1 IUN t -UK LbU AU I IV11 Its _
Applicant: 'Tjj i�- --'&S Ilvvl `oAJ Date:
Rehabilitation/Conversion/
Renovation
Operations
Essential Supportive Services
Prevention
A. Emergency
and/or
Transitional
Shelters
A, C
Annual number of persons served
a. Adults
b. Children
c. Total
Annual Individual/Single Households
a. Unaccompanied 18 and Over Males
b. Unaccompanied 18 and Over Females
c. Unaccompanied under 18 Males
d. Unaccompanied under 18 Females
Annual Family Households with Children
Headed by...
a. Single 18 and Over Males
b. Single 18 and Over Females
c. Single under 18 Males
d. Single under 18 Females
e. Two Parent 18 and over
f. Two Parents Under 18
Annual Family Households with No Children
a. Family Household With No children
Annual Number of Persons Served for Each
Subpopulation (May include overlapping
numbers/duplicate persons.)
a. Chronically Homeless (Emergency Shelter
c. Chronic Substance Abuse
d. Veterans
e. Persons With HIV/AIDS
f. Victims of Domestic Violence
DATA DATA
Collected at time of Collected at time of
Application Closeout
Individuals Housed (Bed Capacity) At Any j
Given Time Through ESG Program
a. Barracks j
b. Group/Large House
d. Scattered Site Apartment
e. Single Family Detached House
f. Sinale Room
h. Hotel/Motel
MO 886-2369 (Rev.3/2006) 15
Applicant: a
(/,0ffl
Date: d
Irtfcrinan sihtd �rxv;Es�ed OfiIL>ti:P SeEvccesxr t
:..... .
ESOPQI[lCI Ipriod rEk:s 1lItrch.x7
DATA
DATA
Zil glikU 2t tim't f.
i:olfeCted:at'tn. , f .
g.
.....:<:...........................::::.::::::::::::::::::::.::::::
I seaut.::.,.::::..:.:
B. Non -Residential
Annual number of persons served
Services
a. Adults
Woty
b. Children
c. Total
ota
Annual Homeless Prevention
m I
e Indicato rs
..............................
a. Households that received emergency financial
assistance to prevent homelessness
b. Households that received emergency legal
assistance to prevent homelessness
C. Ethnicity and
_:;;>:;:.:>::>:::::>::>::>:::;;::::>::;::»:
Race
Annual number of persons served..}f[AIDf
'tI
<:
.......................................................................:::::::::::.........................
a. White
j
b. Black/African American
c. Asian
d. American Indian/ Alaskan Native
e. Native Hawaiian/Other Pacific Islander
f. American Indian/Alaskan Native & White
g. Asian & White
h. Black/ African American & White
i. American Indian/Alaskan Native & Black
African American
•. Other Multi -Racial
a`„<
MO 886-2369 (Rev.3/2006) 16
INSTRUCTIONS FOR ESG DATA COLLECTION
Please note the following items when completing the ESG Data Collection Form.
Report only on ESGP Services.
Complete each activity section that corresponds with the appropriate category.
Complete proposed data at time of application. At closeout actual numbers will be required.
Actual numbers should be used, not percentages or estimates based on census.
DEFINITIONS FOR COMPLETION OF ESG DATA COLLECTION FORM
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.3/2006) 14
I
` Internal Revenue Service
Department of the Treasury
WOhin92on, 00 20224
PgrsOn tq C,Gt1fACt:
- -Mrr ._ W - _Brool er - - -
i:►e SalvatiOA A=7 -Mr
Number,
Notiional Corparacian (e0Z) 556mber
799 s�l.aacu%.id Away Refer Reply -4
757
Vero" N3 070-44
8490.;Wt Z.2
_ JAN 14 1985
z=1;L1aytr IdetLE fication fiber: 22-2406433
- Kay Di1tte-z4 s 22 (3- riark)
- _ - ,1ccCutTt: ?ems
ng .._ hiding -r_ _54ptebeY -
�'atu�datiaa Status C1&sstSfiear.as Seatien
Dear Appucaat:
Lastd on 131sora[atlan suppliexi,_s d assuming your aperations W-11 bQ
43 stated in year $ppl=cation for rseogultiaa of axmptioa, tR have
date=4uc%i yvu Ar* er-se4c frcm ttdar l 1acr.-ao to =Aar section SQL(c)(3)
cf _th1e .-Iatarasi Rewt." - Code.-_ _ -
- - - - -�e have ffur.rher . do termed_ that gcu-xxe not - a- griva re-----
vitLim tfte Meaning az Code section SC9(a), bscuuse you are an orb-az3-
z4t1.va &3cr .bed in Lke 9ecticus of tbq Code abowa above..
I., your 4�urces of dupport* or yovx purposes, c.Uracter, or ;uethod
Of 0pt=3ti0u._than4c, please let Your key district know to that of_lce
-can consider the. e_fect of -tie chsabe ou -your-exempt srst— and fcurda- - - -- -
tion status. Also, -foa sbculd infnrr your ka7 District airactor of arX
taaugcs in your t=e and address.
TJnlcss 4peei_ics117 excepted, beginnitZ jara dry 1, 19C4, you must
pay tares under - the rcderal Y=axocace Cant=ibuuous "t (sorAml security
taxes) for ascii r..»;.]ayae whd is -paid $10.0 or move in a calendar year.
You era net re1Lu1r .d ca pav ta= v--zder rhe Fadaral 7neimplo7mert T=
Act (F:TA).
. Slue you are =t a priva:.e foy~Ydat:oa, you are not subject to the
t0hz Cod,... - - - .. -
axc�.ac t,:_�.cr. isruder �.tefitAt 4: of � � Hr�vzti^er, �u aze 4oC auto-
: aticnll z..Q; � from_ vzh= feria al MX -Mise gees. -i you hava quest ora
400%;t exeive, employment, or oClzer tederal taxas, Cantact your key
*District biracter.
You are aa[ raqul-ed to file faderal iacoxa tn-% return- uzaass you
are sub feat to the t" on 1-Z:eUted busineais iccome under Co4e aectioTj
511. T.F, yvu ase subject to thle tzr., yo:: -oust fila $a Sac_Mc C= rQtu-=
un Form 090-T., _zX2-4pt Ora4131zat+on 3u-31r►e3s fnc=% Ter serurj. In this
lat tar, we err zwt det'rti'.Uz; wbatLer any of your pre; oat or proposal
act1v4t!4o axe u.aralated trade or yusirness as def zed iu Code sactiou 513,
The s4vatifl : A --.y Nationa Corporation
ple se show Sour =yl*7er Idea t:Ufteatioa u=ber om all ret==z Tau
fila anti in all currsspondtmes with the internal Revenue Service.
We are infarming -your kap Distmiet DiYacta= of this ral.:-z4;. 5ecauaa
t'uis latter could help reaol-7e any quastlonn abeut -your R =pt scatu..s and
:au-
ndacion itac-zs' you should kaap It In your gs.r=Att records.
Z you 'savt any cwst±ons about tbAx =ding, pleaae contact the $ar-
sQa whose "rasa and telephone m= er are ahzwm is t Q heady of this
latter. Par Other Matterss 'imela3iaS questions coaceraiag reportir_g
agxdre=acs, pleas& aaataat your key Mstricc Director.
Site a rely_ yours,
_ J. E. Griffith - - - - -- --- - - -
Chit--,, Earapt Organ-' =tious _
isii.i�s $xancix
SECTION VII: LOCAL GOVERNMENT GRANTEE
EMERGENCY SHELTER GRANTS PROGRAM
CERTIFICATIONS BY THE CHIEF EXECUTIVE OFFICER
of
certify that
Chief Executive Officer
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 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/Compliance dealing 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
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).
Mo 886-2369 (Rev.3/2006) 17
(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.
(14) HUD's Standards for Outcome Performance Measurement.
I certify that the submission of applications for emergency shelter grants is authorized
under state and/or local law and that the
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 fol;owing
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
of 1973 (29 U.S.C. 794) and implementing regulations at 24 CFR Part 8.
MO 886-2369 (Rev.3/2006) 18
(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. 1701u (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
grant amounts by private non-profit organizations.
MO 886-2369 (Rev.3/2006) 19
(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 $500,000 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.
(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.
MO 886-2369 (Rev.3/2006) 20
(j) 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 Re ic�ster
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.3/2006) 21
(Date)