Public Services Program Application Fiscal Year –
San Bernardino County
Fiscal Year -
PublicServices ProgramApplication
The following documents must be submitted in the order listed, please be sure to submit all attachments with your application.
Exhibit 1: Organization Information
Exhibit 2: Project Information
Exhibit 3: Community Needs and Target Population
Exhibit 4: Project Budget & Sources
Exhibit 5: Performance & Outcomes
Exhibit 6: Agency Capacity Narrative
Exhibit 7: Civil Rights Laws Compliance and HUD Good Standing Exhibit 8: Signature and Assurances
Application Checklist
_______________
Log Number
(Office Use Only)
1 ✔
✔
2022 ✔
BARS22PS-028 2022 ✔
2023 ✔
✔
✔
✔
2023 ✔
Public Services Program Application Fiscal Year –
Exhibit 1: Organization Information
Organization Name:
Organization Address:
City/State/Zip:
Phone:
Fax:
Email:
Applicant Type:
Authorized Person Name:
Authorized Person’s Title:
Address:
City/State/Zip:
Phone:
Fax:
Email:
Application Contact Person’s Name:
Application Contact Person’s Title:
Explain the Agency’s 1) Mission, 2) Purpose, 3) Population Served, 4) Number of years serving population, 5) Supportive Services, their Funding Sources, and Start/End Dates. 2 BARSTOW, CA / CA / 92311 [email protected] New Hope Village Inc Executive Director 100 W Fredricks St Executive Director 2022 Our mission is to provide subsidized housing and wraparound supportive services to homeless families and individuals in order to empower them to break out of homelessness, food insecurity, and poverty. Our vision is a community where our alumni are active citizens who use the skills learned in our program to create new lives of hope. Our purpose is to provide safe, sanitary, affordable housing to assist motivated homeless families and individuals to gain self-sufficiency. We have been serving our homeless population since 1999. Our life skills programs are employment, goals, education, weekly group meetings, tenant meetings, recovery, health and safety. We also include clients' saving their money in their credit report savings to pay off debts and saving their money to a general savings account. Our funding sources include HUD, DBH, CDBG, private donations and foundation grants. Our fiscal year is July thru June of each year.
Public Service Project 17602561900 Angela M Pasco 2023 Angela M Pasco [email protected] BARSTOW, CA / CA / 92311 17602561900 17608184446 100 W Fredricks St 17608184446 Public Services Program Application Fiscal Year –
Exhibit 2: Project Information
Project Title:
Project Address:
County Supervisorial District where project will be located:
1 st District 2nd District 3
rd District 4th District 5th District
If you are requesting funds for an existing CDBG project, provide prior CDBG project number.
Will this project provide an opportunity to hire minority-owned and women owned businesses? If YES, describe what actions will be completed to implement such subcontracting plans to monitor this component of the proposed project. If NO, discuss why and what actions are being taken to encourage minority-women businesses to apply for this project. 3 If this is an Expansion of Service to previously funded CDBG project, please explain how this is an expansion of service?. (i.e For 2015 we proposed 60 units of service, this year the agency is planning to serve 100 units of service)
Is this a New Public Service Project, or request to expand services to an existing CDBG project? X
2022 2023 Housing & Services for Unsheltered Neighbors 100 W Fredricks St Barstow, CA 92311 Public Services Program Application Fiscal Year –
EXHIBIT 2A: Countywide Vision
Indicate Yes/No in the table below if any of these countywide vision goals are pertinent to the proposed project.
Countywide Vision
Countywide Vision Yes/ No
Implement the Countywide Vision.
Create, Maintain and Grow Jobs and
Economic Value in the County.
Improve County Government Operations.
Operate in a Fiscally-Responsible and
Business-Like Manner.
Ensure Development of a Well-Planned,
Balanced, and Sustainable County.
Maintain Public Safety.
Provide for the Health and Social Services
Needs of County Residents.
Pursue County Goals and Objectives by
Working with Other Governmental
Agencies.
Provide a brief narrative of how your project meets the Countywide Vision:
4 Our project meets the Countywide Vision by helping to create a county in which those who reside and invest can prosper and achieve well-being. We believe by providing housing and services to our motivated unsheltered population they will use the skills gained to sustain gainful employment, pay off debts, and maintain a substance free lifestyle and achieved a better quality of life. By providing self-sufficient members of our community, it helps our city and our county be a better place to live, work, and play! No 2022 Yes Yes 2023 Yes Yes NoYes Yes
Public Services Program Application Fiscal Year –
Exhibit 3: Community Needs and Target Population
Community Needs Target Population
Public Service
Needs:
Yes/No Proposed Community: Yes/No
Senior Services Low and Moderate Persons
Handicapped
Services
Low and Moderate
Households
Youth Services Abused Children
Child Care
Services
Handicapped Persons
Transportation
Services
Illiterate Persons
Substance Abuse
Services
Homeless Persons
Employment
Training
Migrant Farm Workers
Health Services Elderly People
Lead Hazard
Screening
Crime
Awareness
5 City/Target Area of Project Beneficiaries
Participating Cities: (i.e Redlands, Colton, Yucaipa)
No Yes Yes No Yes Yes Yes Yes No 2022 No Yes 2023 No No No No No NoYes City of Barstow
Public Services Program Application Fiscal Year –
Exhibit 3: Community Needs and Target Population (continued) Describe the geographic boundaries of the neighborhood, community or area in which clients of the proposed program reside (attach a map if needed):
HUD Demographics: (Yes/No)
Does this project help prevent homelessness?
Does this project help the homeless?
Does this project help those with HIV or AIDS?
Does this project primarily help persons with disabilities? Summarize the description of your project to include 1) priority, 2) sub-activity, 3) population(s) to be served, and 4) accomplishment level, and 5) services to be provided. 6 Yes Yes No 2022 2023
We provide safe, sanitary, decent, and affordable housing for unsheltered families and individuals since 1999. Our 10 apartments and 2 houses are fully furnished with everything they need to rebuild and begin life over again. We are the only transitional housing and permanent supportive housing program in the High Desert that serves our homeless population. We serve all populations of homeless: single men, single women, single parent families, two parent families, veterans, seniors, and our disabled population recovering from substance and alcohol abuse. They have weekly case management and life skill meetings.
Life skills include but are not limited to budgeting, time management, health, safety, goals, education, and employment. We have our Hope Hut Thrift Store in which our clients gain valuable employment skills. We volunteer in our community as we feel it is important to give back to our community. We have the clients save their money into their credit report savings to pay off evictions and outstanding utility bills. They also save money into their general savings account so they have a little nest egg to take with them. We pay for employment clothes so they may seek employment, create resume's and conduct mock interviews to assist them. We pay for their identification card or driver's license to help reduce the barriers to employment. We still are at an 96% success rate of clients increasing income and securing their own place to live!
No
City of Barstow
Public Services Program Application Fiscal Year –
Describe how this project meets the priority population and activities selected.
Explain why this project is needed and what evidence can you substantiate the need.
Describe what gaps of service in the county this project fills.
What are the critical factors for the success of your project (include both financial and human resources)? For instance, is this the only funding for this project? What happens if funding decreases? Does this project rely on only one source of leveraging? Is there adequate staff involved with the project if there is project turnover? Please address any factor that is critical to project success.
7 As stated before, we are the only transitional and permanent housing project in the High Desert that serves homeless families and individuals!
2022
Our priority population is homeless. All of our activities noted above are given to help our clients have a greater self-determination. We hope they use all the skills learned and gained in our program so they never have to be homeless again. 2023
We have two page pre-applications that are completed and kept on file. We have at least 30 pre-applications of families and individuals whom are waiting to be able to take advantage of our program.
We have secured different funding sources to help us continue our mission. We began new collaborations and new sources of funding. We are supported by our community. We have great relationships with our City of Barstow, County of San Bernardino, HUD, private donors and foundations, businesses, and services organizations. We have learned that we cannot only rely on one source of funding/leveraging
Public Services Program Application Fiscal Year –
Exhibit 4: Project Budget & Sources
Project Budget
SB County Share: ($) Other Source: ($)
Personnel
Equipment (Rental, Lease or Purchase)
Consultant Services
(Auditing, Accounting or Payroll)
Space Rent
Insurance
Consumable Supplies
Other
Total Costs
Total Project Budget Cost: (CDBG Share + Other Source)
8 $15,000.00 $2,000.00 $0.00 $0.00 $30,000.00 $80,000.00 $0.00 $5,000.00 $65,000.00 $0.00 2022 $0.00 $0.00 2023 $0.00 $1,000.00 $15,000.00 $0.00 $27,000.00 Public Services Program Application Fiscal Year –
Exhibit 4A: CDBG Funds Requested and Leveraging Information Indicate the amount being requested by the city.
City Amount Requested ($):
(This amount should match the grand
total requested from CDBG Share)
9 Leveraging items may include any written commitments that will be used towards your cash match requirements in the project, as well as any written commitments for building, equipment, materials, services and volunteer time.
Source of
Funding:
Type of Funding: (Grant Name,
EFSP Money)
Amount ($): Date
Available:
(11/22/2016)
Federal
Funding
State
Funding
County
Funding
Private
Funding
Other:
Total Leveraging Funds
$65,000.00 $17,000.00 04/01/2022 07/01/2022 $15,000.00 McKinney Vento 2022 DBH $30,000.00 2023 Mojave Valley United Way $3,000.00 Foundation $15,000.00 04/01/2022 07/01/2022 Barstow Public Services Program Application Fiscal Year –
Exhibit 5: Performance and Outcomes
Definitions:
Unduplicated Clients: The number clients/persons projected to be served during the program year (e.g. 25 clients, 50 seniors):
Duplicated Clients: The estimated yearly units of service (duplicated, e.g. 25 clients x 10 visits=250 units of service):
Complete the chart below with the number of Duplicated and Unduplicated Clients to be served.
• In column 1 identify activities that will be completed (e.g. intervention, counseling, and case management).
• In column 2 indicate the number of Unduplicated Clients to be served. • In column 3 identify the number of Duplicated Clients to be served.
Activities to be Completed (1) Unduplicated
Clients to be
Served (2)
Duplicated Clients
projected to be
served (3)
Performance and Outcomes, answer the following narrative questions using minimum funds request.
Indicate a timeline of services provided to client(s) in order to meet project outcome(s).
Describe how your agency determines client(s) success.
Describe your methodology to evaluate project outcomes. 10 32 770
Our outcomes are individualized and structured with our clients' input. We enter all of our information into HMIS data system.
Employment Services 4040 770 2022 2023 770
We enter all of our case notes and use weekly goal sheets to determine our clients' successes. Verification is documented and filed in their case to ensure they are completed in a timely fashion.
Case Management
Our timeline of services provided to clients in order to meet project outcomes is normally one year.
Life Skills
Public Services Program Application Fiscal Year –
Exhibit 5A: Proposed Goals & Milestones
Explain how the project will meet contract goals and milestones and be completed within 12 months (July 1, – June 30, ). For example, project expenditures and performance/ accomplishment goals of 40% by November 30th, 50% by December 31st, 80% by March 31st, and 100% by June 30th.
Fill-in the table below with dates for submission of reimbursement claims and the estimated amount of each.
Date of Reimbursement: Amount ($):
Total Reimbursement:
($)
11 $1,250.00 08/15/2022 $1,250.00 $1,250.00 $1,250.00
We will accomplish our project expenditures and performance by 100% by June 30, 2021 and reported by July 31, 2021.
$1,250.00 02/15/2023 11/15/2022 07/15/2022 $1,250.00 03/15/2023 10/15/2022 2022 2022 12/15/2022 $1,250.00 $1,250.00 2023 2023 04/15/2023 $1,250.00 $15,000.00 $1,250.00 09/15/2022 06/15/2023 $1,250.00 $1,250.00 05/15/2023 01/15/2023 Public Services Program Application Fiscal Year –
Exhibit 6: Agency Capacity Narrative
(Non-Profit Organizations Only)
Describe the roles of key administrators, staff members, and volunteers within your agency that will implement the proposed project. In your description include experience, education, and licensing qualifications.
Describe your agency’s experience in administering government and/or public funds.
Describe your method to sustain project viability over the multi-year process if funding decreases.
Instructions: Complete the table below by marking “YES” or “NO” to the questions listed below.
Question:
Example: Have you received federal funds in the past
five years? Yes
In the past ten years, has your organization ever had its nonprofit status revoked or withheld by the IRS, the
Secretary of State, the State Attorney General, or the
Franchise Tax Board?
Has your organization been sued in the last five years? Are any of your managers or staff with fiscal
responsibilities involved in litigation presently that has any bearing on fiduciary trust or employee relations?
Have any unfavorable rulings been handed down by any
court against your organization or Executive Director the last five years?
Does your organization currently have any unresolved
fiscal, reporting, or program issues with any of its funding sources?
YES/ NO
12 No No No
Executive Director has over 21 years' experience/capacity with New Hope Village Our board/staff has been involved with non-profits for years No
We aggressively seek out and apply for grants that are in line with our mission. We must do so in order to sustain our organization. Our organization has major experience in administering government and or public funds for over 21 years.
2022 2023 No
Public Services Program Application Fiscal Year –
EXHIBIT 7: Civil Rights Laws Compliance and HUD Good Standing Answer the following questions.
Has your organization been a past recipient of assistance under a HUD McKinney Act program or the HUD Single Family Property Disposition Homeless Program? If you have been a recipient under either of these programs, has your agency experienced any project or construction delay, HUD finding or outstanding audit that HUD deems serious regarding the administration of HUD McKinney Act programs or the HUD Single Family Property Disposition Homeless Program?
If you answered “Yes”, please explain the circumstances and outcome below.
Applicants must be in compliance with applicable civil rights laws and Executive Orders. Applications will be rejected if your agency has any of the following: (1) Any pending civil rights lawsuit instituted by the U.S. Department of Justice; (2) Any noncompliance with civil rights statutes, Executive Orders or regulations as a result of formal administrative proceedings, unless the applicant is operating under a HUD-approved compliance agreement designed to correct the area of noncompliance or is currently negotiating such an agreement; (3) Any unresolved Secretarial charge of discrimination issues under Section 810(g) of the Fair Housing Act, as implemented by 24 CFR 103:400; (4) Any adjudication of a civil rights violation in a civil action brought against the Organization by a private individual, unless the applicant is operating in compliance with a court order designed to correct the area of noncompliance or the applicant has discharged any responsibility arising from such litigation; (5) Any deferral of the processing of applications from the sponsor imposed by HUD under Title VI of the Civil Rights Act of 1964, the Attorney General’s Guidelines (28 CFR 50.3) or the HUD Title VI regulations (24 CFR 1.8) and procedures, or under Section 504 of the Rehabilitation Act of 1973 and HUD Section 504 regulations (24 CFR 8.57). If one or more of these situations exists with your Organization, please attach a brief description.
13 Yes 2022 2023 No
Public Services Program Application Fiscal Year –
14 E- Signature Authorization
San Bernardino County
Community Development and Housing
Community Development Block Grant
- Application
Dena Fuentes
Deputy Executive Officer
Gary Hallen
Director
Application Title:
Applicant Name:
In order to comply with all applicable federal grant regulations, a hard-copy of this E-Signature Authorization containing an original wet signature must be filed with the San Bernardino County, Community Development and Housing (CDH) in order for the applicant to electronically sign the Community Development Block Grant (CDBG) application documents online.
This authorization may only be completed by a registered owner, partner, executive officer, or authorized employee (with proof of authorization) of the applicant submitting this form and must contain an original signature to be submitted to the CDH.
Authorization Agreement
I am an owner, partner, executive officer, or duly authorized employee of the below-listed applicant and have authority to enter into agreements on behalf of the below-listed applicant. CDH may rely on the receipt of such agreements executed and delivered by facsimile or other electronic means as if the original had been received. The undersigned agrees that the electronic signatures appearing on documents submitted from the below-listed applicant are the same as handwritten signatures for the purposes of validity, enforceability and admissibility. By signing this Electronic Signature Authorization Agreement, I authorize the CDH to accept, via electronic submission, documents submitted from the below-listed applicant as required by the CDH's Community Development Block Grant - Funding Application.
I understand that CDH may change the CDBG application system from time to time. I agree that the below-listed applicant will electronically sign all documents requiring a signature related to the CDBG funding application.
My signature on this form certifies that:
I agree that entering my name in the CDBG funding application system constitutes my electronic signature. I understand that any information and documents submitted using my name is electronically certifying my signature. I understand that I am legally bound, obligated, and responsible by use of my electronic signature as much as I would be by my handwritten signature. I agree that I will protect my signature from unauthorized use, and that I will contact CDH immediately, upon discovery that my electronic signature has been compromised. I certify that my electronic signature is for my own use, and that I will not delegate it or share it with any individual.
This request is effective immediately upon receipt by the CDH and will remain in effect until the end of the - CDBG funding cycle or I choose to cancel this request via written notification to the CDH. I understand that it is my responsibility to update and/or cancel this request under all circumstances, including my departure or terminated association with the below-listed applicant.
By signing the E- Signature Authorization Form we certify that this agency will also comply with the following:
Non-discrimination:
This organization will, through all possible means, ensure equal opportunity for all persons to receive services, to participate in the volunteer structure, and to be employed regardless of age, handicap, national background, race, religion, or sex. An existing sectarian nature of the agency shall not suffer impairment under this agreement, but participation in religious observances, rituals or services will not be required as a condition of receiving food, services, or shelter paid for by this grant.
Accountability:
We commit this organization, if a grant is received, to provide all reports to the County as required; to expend monies only on eligible costs; to keep complete documentation (copies of all canceled checks, invoices, receipts, etc.) on all expenditures for a minimum of three years; to spend all funds and close out the program on the required date; to return any unused funds to the County to cooperate with monitoring or site visits, and; to provide complete documentation of expenses to the County, if requested, by the required date.
2022 Housing & Services for Unsheltered Neighbors 2022 2022 2022 2022 2023 2023 2023 2023 Angela Pasco 15 Please send the signed copy of this agreement to:
Community Development and Housing
385 North Arrowhead Ave. 3rd Floor, San Bernardino, CA 94215-0043 Attn: Community Development Block Grant Application
Public Services Program Application Fiscal Year –
We affirm that all information in this application is true and correct to the best of our knowledge and that the applicant under our authority will execute its responsibility under the proposed contract and adhere to all other applicable rules and regulations to the fullest extent possible.
Non-collusion:
This proposal is genuine, and not sham or collusive, nor made in the interest or in behalf of any person not herein named; the proposer has not directly induced or solicited any other proposer to put in a sham proposal, or any other person, firm or corporation to refrain from submitting a proposal; the proposer has not in any manner sought by collusion to secure for him/ herself an advantage over any other proposer.
Applicant Information
Applicant Name:
Application Title:
Agency Name: Federal Tax ID No.:
Mailing Address: Phone No.:
Email Address: Fax No:
Authorized Signature
Print Name: Print Title:
Signature: Date:
12/10/2021 Executive Director [email protected] 100 W Fredricks St (760) 818-4446 01-0653116 2022 Housing & Services for Unsheltered Neighbors (760) 256-1900 2022 2023 Angela Pasco Angela M Pasco Angela M Pasco Public Services Program Application Fiscal Year –
CDBG Application Checklist
(Non-Profit Organizations Only)
Community-based organizations are required to include one copy of the items listed below. If you are not submitting these items at this time, please notify Community Development and Housing at (909) 387-4705 to make other arrangements. The following information is required before any contract or reimbursement can be completed.
o Summary of agency’s current year General Operating Budget o List of agency’s Board of Directors, including names and addresses o Proof of existing non-profit/tax-exempt status (Letters from the Federal Internal Revenue Service and State Franchise Tax Board) o Current certificate of insurance and amounts covered
o Organizational chart
o Minutes of last Board meeting
o Non- Profit agencies must be Registered in the System of Award Management (SAM) website.
Agency cannot be funded if they have been debarred in the past. o Provide board minutes/letter that authorizes the executive director or program manager to run the project.
If your application is funded you will be required to provide a copy of your last audit and your Articles of Incorporation and Bylaws must be on file. 16 2022 2023