Attachment 3 — Burbank City Council, June 7, 2022

FY 2022-2023 CDBG

APPLICATIONS
Attachment 3-1
FISCAL YEAR 2022-23
CDBG

PUBLIC SERVICE

PROPOSALS
Attachment 3-2
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CITY OF BURBANK
FISCAL YEAR 2022-23

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

REQUEST FOR FUNDING PROPOSALS
Project/Program Summary
Operating Agency: Armenian Relief Society of Western USA, Social Services Project/Program Name: Community Social Services Program Type of Program/Project Public Service
Duration of Program/Project Multi-year Program
Type of Operating Agency: Non-Profit or For-Profit Organization Total Amount Requested for FY 2022/23: $30,340

1. Project/Program Description:

Briefly describe the primary objective of the project/program y ou intend to operate including all major activities to be undertaken:

The Community Social Services Program will provide comprehensive social services to benefit low and moderate- income residents of the City of Burbank, who comprise an underserved population including those with limited English capability. The program will help address priority need areas by offering public services, creating economic opportunities, offering employment services, services for homeless persons, ongoing covid recovery and relief efforts, linkages with public benefits, and improving the general welfare of residents. Funding would allow for a part- time case manager to be staffed at the Burbank Youth Center (75 E. Santa Anita Ave., Burbank, CA 91502) to provide direct service delivery. Major activities include public services focusing on case management, senior services, Covid-19 outreach, awareness, and engagement, completion of forms for housing and transportation issues, employment services inclusive of job search, referrals and placement, assistance with telecommunications and utility issues, access and linkages with public benefits (i.e. CalFresh, Medi-Cal, etc.), etc. The program will also address Strategy 5 of the Burbank Homelessness Plan (Continuing Outreach, Coordinate Care System, and Community Awareness). The staff person will also place focus on connecting homeless persons to benefits (i.e.

Social Security, Medi-Cal, etc.), making referrals to counseling and mental health services as needed, providing employment services, extensive case management, completion of forms for public assistance and expanding opportunities to receive aid, accessing vital records, and more. The organization is currently a recipient of City of Glendale Emergency Solutions Grant (ESG-CV2) providing homelessness prevention and rapid re-housing services. As a reputable provider of social services for 43 years, ARS Social Services has extensive experience in the provision of services to hard-to-reach and vulnerable populations and staff is capable of providing services in a linguistically and culturally competent manner.

2. Staff and Program/Project Location
Executive Director
Executive Director: Talar Aintablian Title: Director of Operations Phone: (818) 241-7533 x101 Email: [email protected] Program Manager
Program Manager: Tamar Mlikyan Title: Case Manager
Phone: '(818) 241-7533 x134 Email: [email protected] Application Contact
Application Contact: Talar Aintablian Title: Director of Operations Phone: (818) 241-7533 x101 Email: [email protected] Project Addresses
Project Address: 517 W GLENOAKS BLVD
City, State Zip: GLENDALE, CA 91202
Phone: (818) 241-7533
Website: Not Applicable
Mailing Address: 517 W GLENOAKS BLVD
City, State Zip: GLENDALE, CA 91202
For Public Service or Economic Development activities, please identify if the project address is the same location where program services will be provided?
Yes
Program Address: 517 W. Glenoaks Blvd.

City, State Zip: Glendale, CA 91202
Attachment 3-3
4/19/22, 11:22 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C560&prop=156 2/5 If your program is not located in the City of Burbank, please describe how you intend to provide services in the Burbank community
Services are currently provided to Burbank residents through the ARS Social Services main headquarters in Glendale, California. Funding for 2022-2023 would allow to expand services by staffing a part-time case manager at the Burbank Youth Center (75 E. Santa Anita Ave.) for direct service delivery in the City of Burbank.

DUNS Number:
60-511-3570 Federal EIN/TIN Number: 95-3928295
SAM Number: 5FNH6
City of Burbank Business License Number:

3. If awarded CDBG funding, describe the location(s) of where the services will be provided:
a. Grant Amount $30,340
Same as above
Other(address/areas/clubs/associations,
etcs.):Full funding would allow for services to be
delivered through an office space at the Burbank
Youth Center in Burbank.

4. Has your organization encountered challenges in administering your program due to COVID 19 Public Health Orders? Yes No
a. If yes, explain the challenges and if they were resolved:

5. (CDBG 2021-22 grant subrecipients only) Provide a progress update on your project or program. Please provide the following:
a. 2021 CDBG Grant Amount: $7,000
b. Do you expect to expend your grant prior to June 30 Yes No c. If no, please explain your reason(s).
d. Has your organization submitted timely quarterly reports to the City? Yes No

6. Project/Program Beneficiaries:

Please specify the Primary Beneficiary group, persons, families, or individuals your program or project intends to target.

Other - Seniors; Homeless or At-Risk; Unemployed/Underemployed; Disabled Adults; Immigrants; Families with Children

7. Describe how you determined this project or program will assist low to moderate income residents.

Please describe your system of collecting the data (i.e inrake applications, web-based applications, etc.).

ARS Social Services maintains files for clients served. Client files include intake forms and supporting documentation to verify eligibility by both residence and income. Income level is verified by collecting proof of income (i.e. pay stubs for earned income (if any), unemployment insurance benefit check stubs, eligibility letter for CalWORKs or General Relief, award letter for SSA/SSI, etc.). For the program, the organization adheres to the City of Burbank Gross Income Limits published by the U.S. Department of Housing and Urban Development.

8. Project/Program Delivery Area:

Please include any other communities or residents living outside of Burbank that will be eligible to receive services from your program/project. Provide the overall percentage of resident vs. non-resident.

This program will specifically be available to Burbank residents. 100% of the clients served through the program will be residents of Burbank.

9. Measurable Outcomes:

Please provide proposed outcomes and performance measures for your proposed project/program. Please provide a quantifiable/measurable outcome that can be evaluated by staff. In addition, describe how your organization will achieve successful outcomes.

Goal

240 Total unduplicated low to moderate income clients to be served.

Attachment 3-4
4/19/22, 11:22 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C560&prop=156 3/5 240 Unduplicated City of Burbank low to moderate income clients to be served.

Please list between 1 and 5 additional Measurable Goals that your program/project will deliver.

Goal Measure of
Service Description
Increase in economic
opportunity
Number of
clients placed
in
employment
Clients will receive employment services to regain or gain employment and improve their economic security through assistance with job searches, guidance, workshops, referrals, and placement Linkages with public benefits Number of
clients served
Clients will be provided with direct assistance in accessing and obtaining public benefits
Stability of Senior and
Disabled Adults
Number of
clients served
Clients will be provided with case management and general social services to help live independently and meet their public service needs
Coordinate and Provide
Services to Homeless Persons
or those at risk of
homelessness
Number of
clients served
Address the needs of homeless or at-risk of homelessness populations, conduct community outreach and direct service delivery

10. What amount of private/public funds will be leveraged with CDBG to administer the program/project. Do not any funds that are committed to other programs/projects or in-kind services, or volunteer hours. $2,910 will be leveraged with CDBG to administer the program.

11. On a level of sustainability (program longevity), has your organization or Board approved applying, collaborating, or accepted any State, Federal, County, or philanthropic grants, benefits, or other non-CDBG funding in 2022?
Yes No
Fund/Grant Name Amount
State of California Emergency Rental Assistance Program $33,375

12. Please indicate the funds your organization will consider or pursue, if applicable (Do not include fundraising campaigns).

Our organization would pursue any amount of funding awarded through the CDBG program and would make necessary adjustments to staffing, location, and scope of services accordingly.

13. Does your project or program provide a direct service as an operator, service provider, developer, or owner in supporting the City’s homelessness strategies (see below)? Yes No N/A
Please indicate the primary delivery area.

Developing Storage Facilities and Transportation
Enhancing the Quality of Life, Mental Health and Healthcare Awareness Building Temporary Housing
Creating Affordable Housing
Continuing Outreach, Coordinated Care System and Community Awareness Increased Homeless Prevention and Rapid Re-housing
Enforcing Public Health & Safety and Ordinances

For Public Service or Economic Development
activities, please indicate the number of persons of
each income level that your program will assist:

Extremely Low: under 30% 220
Very Low: 30% to <50% 20
50% to <60%
Low: 60% to <80%
Total Low Income Served: 240
Attachment 3-5
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Budget
Budget Line Item Burbank Other Funding Program Total
Personnel Lines needed: 3
Program Coordinator 0.50 FTE $17,100 $0 $17,100
Director of Operations 0.03 FTE $1,836 $1,836
Financial Controller 0.03 FTE $1,332 $1,332
Benefits (11%) $143 $143
Taxes $1,879 $0 $1,879
Subtotal Personnel $22,290 $0 $22,290
Non-Personnel
Move-In Assistance $0
Supplies & Materials $350 $450 $800
Equipment $210 $210
Communications $2,400 $2,400
Meetings & Convenings $0
Travel & Transportation $50 $0 $50
Training $0
Consulting $0
Evaluation $0
Other Lines needed: 4
Use Allowance $3,600 $3,600
Professional Services (Accounting) $1,010 $1,450 $2,460 Liability Insurance $480 $560 $1,040
Misc. Exp.(Dues, Courier, Equip.

Maint.) $160 $240 $400
Subtotal Non-Personnel $8,050 $2,910 $10,960
Total Personnel & Non-Personnel $30,340 $2,910 $33,250
Indirect Costs $0
TOTAL $30,340 $2,910 $33,250
Number of Persons Served: 240
Cost per Individual $126

Other Funding Sources
Other Funding Sources
Committed Amount
Committed Sources Lines needed:

Total Committed $0
Projected Funding Sources
Individuals
Corporate
Foundations
Projected Sources Lines needed: 1
Armenian Relief Society $2,910
Number of Volunteers:

Total Volunteer Hours:

Volunteer Rate ($/hour):

Volunteer In-Kind Value $0
Total Projected $2,910
Total Other Funding (must match budget total) $2,910

Attachment 3-6
4/19/22, 11:22 AM City Data Services - Burbank
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(Upload Instructions)
Checked attachments below are REQUIRED in order to submit your application, and your application WILL NOT be able to be submitted with missing attachments! Please take this into consideration when timing your submission of this application. The documents you need to upload are checked below. If you have other attachments you would like to include, please check the box and, if Other, identify the Attachment in the box. If you are unable to upload any of the attachments, contact Marcos Gonzalez at 818-238-5212 or [email protected] at least
one day prior to the deadline.

Attachment Link or Explanation for Missing Attachments
Articles of Incorporation and Bylaws
Organization Chart
Non-Profit Determination Letters, IRS & State
(501.3.c)

Most Recent Financial Statements Scan_Mar_01_2022.pdf
Most Recent Audit & Findings, if any ARS_final_audit_21.pdf Program Intake Policies
Client Intake Form
Other -
Other -
Submitted By: Talar Aintablian
Date Signed 03/01/2022

Initially submitted: Mar 1, 2022 - 13:37:16
Attachment 3-7
4/19/22, 11:22 AM City Data Services - Burbank
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CITY OF BURBANK
FISCAL YEAR 2022-23

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

REQUEST FOR FUNDING PROPOSALS
Project/Program Summary
Operating Agency: Believe in Big Change, Inc.

Project/Program Name: Next Level of Care (NLOC) Empowerment Type of Program/Project Public Service
Duration of Program/Project New Program
Type of Operating Agency: Non-Profit or For-Profit Organization

Total Amount Requested for FY 2022/23: $30,000

1. Project/Program Description:

Briefly describe the primary objective of the project/program you intend to operate including all major activities to be undertaken:

Mission of Believe in Big Change, to empower single, at-risk, and endangered mothers with the best tools and skills necessary for healing, life, leadership, and business skills to lead their families and communities in the future. All the at-risk single mothers served by BIBC have faced either domestic violence, substance abuse, and/or mental health issues, which increases their anxiety and gaining their trust is the challenge that we are equipped to handle.

A recent assessment of the urgent need and gender inequity revealed there are only 2 programs in Los Angeles providing longer term temporary housing, transportation, meals, childcare, with daily programming to single at-risk mothers and children beyond a “90-day period”. Our 8-month ‘no charge’ Next Level of Care program bridges the gap in the continuum of care by providing the following:

Providing individual therapy to our mothers and their children that helps facilitate the healing process by using a trauma informed care approach with our program participants as 100% of our participants have experienced some form of abuse and neglect while being homeless. Our mindfulness-based program incorporates individual therapy and group classes designed to raise our participants level of emotional intelligence which is key to relapse prevention and a well-balanced life. We strongly believe this program is a model for what the next level of care looks like and will catapult change in high economic instability in many of our traditional systems.

Expected program outcomes comprise permanent supportive housing, income growth, job advancement, family reunification, entrepreneurship, leadership, and self-improvement are designed for a severely underserved group.

BIBC provides the intensive 8-month Next Level of Care Program with on-site, sober living, childcare, life skills, family, leadership, and business skills, including counseling, trauma-informed care, and interventions structured for each family. Education is fostered through vocational training assignments, work therapy, an assessment of career goals, and employment workshops. Accomplishments in our first year of full operations reflected:
• Graduation rate 30% vs industry rate of 10% in an 8-month program • Graduating mothers all achieved 1 year of continuous sobriety • Graduates found job full time jobs @ 30% above minimum wage and secured housing • Average savings for a graduate was $3,800
• Provided 25 hours per week of programming plus therapy and case management.

During the month of February, BIBC reviewed 15 applications for services, which is higher than normal. Additional staff is needed to expand our outreach in the community. The total cost to allow the hiring of a F.T. Substance Abuse/Mental Health Counselor is estimated at $50,000. Funds in the amount of $30,000 is requested from the CDBG Program RFP, and $20,000 is committed from our organization. BIBC will provide 10 hours per week (2 hours per day) to support the City of Burbank in substance abuse/mental health evaluation and counseling, as part of our outreach program.

BIBC has existing working relationships with several entities to help advance efforts to meet the emergency needs of endangered single mothers and women. These include the Los Angeles Mission, Claire/Matrix Recovery, Didi Hirsh Community Mental Health Center, Prototypes, Hope of the Valley, Homeboy Industries, and the Downtown Women’s Center.

2. Staff and Program/Project Location
Executive Director
Executive Director:

Stephen E. Pomeroy Title: Founder/CEO
Phone: 8596093095 Email: [email protected] Attachment 3-8
4/19/22, 11:22 AM City Data Services - Burbank
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Program Manager: Alllen Ceravolo Title: Operations Director Phone: '8185627096 Email: [email protected] Application Contact
Application Contact: Stephen E. Pomeroy Title: Founder/CEO Phone: 8596093095 Email: [email protected] Project Addresses
Project Address: 1150 S. Westlake Blvd. Unit B
City, State Zip: Westlake Village, CA 91361
Phone: 8185627096
Website: www.believeinbigchange.com
Mailing Address: 1150 S. Westlake Blvd. Unit B
City, State Zip: Westlake Village, CA 91361
For Public Service or Economic Development activities, please identify if the project address is the same location where program services will be provided? No
Program Address: 828 S. Sunset Canyon Drive-Confidential Site City, State Zip: Burbank, CA 91501
If your program is not located in the City of Burbank, please describe how you intend to provide services in the Burbank community

DUNS Number: 027658636 Federal EIN/TIN Number: 85-0610499 SAM Number: TA in process
City of Burbank Business License Number: N/A

3. If awarded CDBG funding, describe the location(s) of where the services will be provided:
a. Grant Amount
Same as above
Other(address/areas/clubs/associations,
etcs.):

4. Has your organization encountered challenges in administering your program due to COVID 19 Public Health Orders? Yes No
a. If yes, explain the challenges and if they were resolved:

5. (CDBG 2021-22 grant subrecipients only) Provide a progress update on your project or program. Please provide the following:
a. 2021 CDBG Grant Amount:
b. Do you expect to expend your grant prior to June 30 Yes No c. If no, please explain your reason(s).
d. Has your organization submitted timely quarterly reports to the City? Yes No

6. Project/Program Beneficiaries:

Please specify the Primary Beneficiary group, persons, families, or individuals your program or project intends to target.

At-risk of homelessness

7. Describe how you determined this project or program will assist low to moderate income residents.

Please describe your system of collecting the data (i.e inrake applications, web-based applications, etc.).

The average W2 earnings for women entering the program upon intake has been around $16,000 or less for a family of 3 persons. A comprehensive Intake Form is utilized by the Intake Coordinator, progress notes are tracked weekly that allow for effective tracking, monitoring and assessment of each client by management to determine the level of supportive services required.

8. Project/Program Delivery Area:

Attachment 3-9
4/19/22, 11:22 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C568&prop=154 3/5 Please include any other communities or residents living outside of Burbank that will be eligible to receive services from your program/project. Provide the overall percentage of resident vs. non-resident.

BIBC serves the Greater Los Angeles communities based on urgent need with an estimated 50% Burbank residents and 50% non-Burbank residents.

9. Measurable Outcomes:

Goal

Total unduplicated low to moderate income clients to be served.

Unduplicated City of Burbank low to moderate income clients to be served.

Please list between 1 and 5 additional Measurable Goals that your program/project will deliver.

Goal Measure of Service Description
Achieve 1 year of
sobriety
100% of graduates will achieve 1 year of
continuous sobriety.

Client attendance at weekly group, substance
abuse counseling and life coach sessions.

Create a family
savings in 8
months
100% of graduates saving a minimum of
$3,000 .

Client attendance at weekly budgeting and
money management classes.

Job Placement
and Assistance 100% of graduates will obtain employment Resume Writing/Job interview preparation workshops, Vision Boards
Family
Reunification
100% of graduates completing Family Therapy
sessions and connecting with their families
Attendance at weekly parenting, family
therapy classes

10. What amount of private/public funds will be leveraged with CDBG to administer the program/project. Do not any funds that are committed to other programs/projects or in-kind services, or volunteer hours. $20,000 of private funds will be utilized to help administer the program.

11. On a level of sustainability (program longevity), has your organization or Board approved applying, collaborating, or accepted any State, Federal, County, or philanthropic grants, benefits, or other non-CDBG funding in 2022?
Yes No
Fund/Grant Name Amount
Elizabeth A Lynn Foundation $5,000
Irmas Charitable Investments Foundation $12,000
Marlisa Foundation $10,000
Carrie E. Doheny Foundation $15,000
Wells Fargo Foundation $8,000
Lennar Foundation $0

12. Please indicate the funds your organization will consider or pursue, if applicable (Do not include fundraising campaigns).

The need is great, ant the Board has approved applying for private grants as listed. BIBC is up to the challenge of competing for other funding options as they become available to assist single mothers and single women at-risk of homelessness.

Fund: Los Angeles County Homeless Prevention Initiative

Developing Storage Facilities and Transportation
Enhancing the Quality of Life, Mental Health and Healthcare Awareness Building Temporary Housing
Creating Affordable Housing
Attachment 3-10
4/19/22, 11:22 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C568&prop=154 4/5 Continuing Outreach, Coordinated Care System and Community Awareness Increased Homeless Prevention and Rapid Re-housing
Enforcing Public Health & Safety and Ordinances

For Public Service or Economic Development
activities, please indicate the number of persons of
each income level that your program will assist:

Extremely Low: under 30% 30
Very Low: 30% to <50%
50% to <60%
Low: 60% to <80%
Total Low Income Served: 30

Budget
Budget Line Item Burbank Other Funding Program Total
Personnel Lines needed: 1

1.0 FT Substance Abuse/Mental
Health Counselor $30,000 $17,500 $47,500
Benefits (11%) $0 $2,500 $2,500
Taxes $0
Subtotal Personnel $30,000 $20,000 $50,000
Non-Personnel
Move-In Assistance $0
Supplies & Materials $0
Equipment $0
Communications $0
Meetings & Convenings $0
Travel & Transportation $0
Training $0
Consulting $0
Evaluation $0
Other Lines needed:

Subtotal Non-Personnel $0 $0 $0
Total Personnel & Non-Personnel $30,000 $20,000 $50,000 Indirect Costs $0
TOTAL $30,000 $20,000 $50,000
Number of Persons Served: 30
Cost per Individual $1,000

Other Funding Sources
Other Funding Sources
Committed Amount
Committed Sources Lines needed: 1
BIBC Fund $20,000
Total Committed $20,000
Projected Funding Sources
Individuals
Corporate
Foundations
Projected Sources Lines needed:

Number of Volunteers:

Total Volunteer Hours:

Attachment 3-11
4/19/22, 11:22 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C568&prop=154 5/5 Volunteer Rate ($/hour):

Volunteer In-Kind Value $0
Total Projected $0
Total Other Funding (must match budget total) $20,000

Attachments
(Upload Instructions)
Checked attachments below are REQUIRED in order to submit your application, and your application WILL NOT be able to be submitted with missing attachments! Please take this into consideration when timing your submission of this application. The documents you need to upload are checked below. If you have other attachments you would like to include, please check the box and, if Other, identify the Attachment in the box. If you are unable to upload any of the attachments, contact Marcos Gonzalez at 818-238-5212 or [email protected] at least
one day prior to the deadline.

Attachment Link or Explanation for Missing Attachments
Articles of Incorporation and Bylaws BIBC_Articles_Incorporation_and_Bylaws.pdf Organization Chart BIBC_Organization_Chart_-_March_2022.pdf Non-Profit Determination Letters, IRS & State
(501.3.c)
BIBC_IRS_Tax_Exemption_Letter.pdf
Most Recent Financial Statements BIBC_Financial_Statements_2021_.xlsx Most Recent Audit & Findings, if any Single_Audit_Statement-_Non_Profit_.docx Program Intake Policies
Client Intake Form
Other -
Other -
Submitted By: Stephen E. Pomeroy
Date Signed 03/01/2022

Initially submitted: Mar 1, 2022 - 15:51:25
Attachment 3-12
4/19/22, 11:25 AM City Data Services - Burbank
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CITY OF BURBANK
FISCAL YEAR 2022-23

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

REQUEST FOR FUNDING PROPOSALS
Project/Program Summary
Operating Agency: Burbank Coordinating Council Dba Bcc Project/Program Name: Camperships
Type of Program/Project Public Service
Duration of Program/Project Multi-year Program
Type of Operating Agency: Non-Profit or For-Profit Organization

Total Amount Requested for FY 2022/23: $11,600

1. Project/Program Description:

Briefly describe the primary objective of the project/program you intend to operate including all major activities to be undertaken:

Burbank Coordinating Council Camperships is a scholarship program for low to extremely low income children between the ages of 6 and 18 to experience a week at a resident camp or day camp that will provide both respite from home situations and a sense of normalcy. This year we are using Brave Trails a designated LGBTQ camp for gay and trans teens in a leadership program and continuing to use Camp Edwards for our low income and borderline at risk homeless. The LGBTQ campers are identified through PFLAG and the BUSD. Homeless children are referred from Family Promise, Family Service Agency, Kids Community Dental Clinic and BUSD Intervention Specialists and Special Education Department. Last summer due to covid we only sent 7 children to virtual camp.

These families were at high risk for homelessness. For our homeless campers we also provide sleeping bags and duffle bags and assist with the family co-pay. A variety of other camps both in town and away are utilized for the program.

We provide Camperships (camp scholarships) in the summer to children in low income families so they can attend a week at a resident camp or day camp. New applicants are given priority and homeless families will receive preference. Allowing them a learning experience and respite from home, they are able to participate in healthy outdoor activities, leadership and team building that otherwise would be impossible due to the high cost of camps.

The average week of resident camp costs between $550 and $950 per week. Day camps run from $350 to $550 per week. For these programs, each family contributes $10 to $25 per child attending camps and that money is included with our payment to the camp. The Campership Program provides the camp funding only, (transportation to only one camp, YMCA Camp Edwards). The resident camps or their contractor (ie. the church), and day camps hold their own liability insurance. The parents provide their own transportation to and from camp sites We are only the match/payment agency with no office to insure. Camps are not sure yet about opening for in-person programs.

We will continue to utilize virtual or online programs until the pandemic sanctions are lifted.

Providing the opportunity for children ages 6-18 to experience a camping experience in a positive and outdoor setting, is a basis for building better adults. The children learn about leadership, cooperative living, nature, self reliance and self confidence. They come home with a feeling of self worth that perhaps their homes and schools did not provide. In later years, many come back and tell us that the one week away made such a major difference in their lives that things changed for them. Life took a different turn, from a negative one, to a more “I can do anything” one. In providing this assistance, the whole family benefits, as does the neighborhood and community as a whole. More positive residents provide a lower crime rate, less homelessness, better work ethic, and more positive life for all. It encourages the extremely low income families to better themselves.

Since there has been a rise in the number of teen suicides, we need to focus on mental health and care for our teenagers. This is one way to support them. We are hoping more teens will apply this year.

2. Staff and Program/Project Location
Executive Director
Executive Director:

Mary Anne Been Title: President
Phone: 818-266-9766 Email: [email protected]
Program Manager
Program Manager: Sandra Thompson Title: Treasurer
Attachment 3-13
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Application Contact
Application Contact: Title:

Phone: Email:

Project Addresses
Project Address: PO BOX 10126
City, State Zip: BURBANK, CA 91510
Phone: 818-266-9766
Website: burbankcc.org
Mailing Address: PO BOX 10126
City, State Zip: BURBANK, CA 91510
For Public Service or Economic Development activities, please identify if the project address is the same location where program services will be provided? No
Program Address:

City, State Zip:

If your program is not located in the City of Burbank, please describe how you intend to provide services in the Burbank community
We are located in Burbank and only serve Burbank residents or children who attend school in Burbank; however, some of the resident camp programs are located outside of Burbank area. Most of the day camps are located within the City of Burbank. We purchase insurance and provide transportation to the out of Burbank resident camps.

DUNS Number:
067436407 Federal EIN/TIN Number: 95-6116051
SAM Number: R9NLJMN2KUJ5
City of Burbank Business License Number:

3. If awarded CDBG funding, describe the location(s) of where the services will be provided:
a. Grant Amount $8,352
Same as above
Other(address/areas/clubs/associations,
etcs.):The services will be performed at various
camps. These would include day camps, away
camps and virtual camps.

4. Has your organization encountered challenges in administering your program due to COVID 19 Public Health Orders? Yes No
a. If yes, explain the challenges and if they were resolved:

Yes. Many of the camps that we used were no open due to Covid. However, we were able to work with camps to provide a virtual experience or last summer in some cases where the children could be socially distanced to be able to participate in person. We are hoping that this summer all camps can be in person, but if not, we will again provide some virtual camps. Y

5. (CDBG 2021-22 grant subrecipients only) Provide a progress update on your project or program. Please provide the following:
a. 2021 CDBG Grant Amount: $8,754
b. Do you expect to expend your grant prior to June 30
Yes No
c. If no, please explain your reason(s).

Our program has been completed.
d. Has your organization submitted timely quarterly reports to the City? Yes No

6. Project/Program Beneficiaries:

Please specify the Primary Beneficiary group, persons, families, or individuals your program or project intends to target.

Youth or young adults

7. Describe how you determined this project or program will assist low to moderate income residents.

Please describe your system of collecting the data (i.e inrake applications, web-based applications, etc.).

Attachment 3-14
4/19/22, 11:25 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C547&prop=106 3/6 Families are targeted by their inclusion in the free and reduced price lunch program at Burbank Unified Schools, meaning that they meet guidelines and qualify for federal lunch fund for extremely low income families. They are requested to provide proof of participation in the lunch program by obtaining a letter from the food services department at the Burbank Unified School District main office. We also review tax statements, paychecks, Calfresh, welfare documentation or whatever other income information the family can produce to prove their financial status.

The information is provided by the family directly to us so as not to violate HIPPA laws. 100% of the recipients meet the 50% or below median income 'poverty' level for low to extremely low income. We identify the homeless population through sources of referral from Family Promise, Family Service Agency, School District, and through the interview process.

8. Project/Program Delivery Area:

This is a City wide program. Applications are available to all children attending schools in Burbank, whether they live within city boundaries or not. We distribute applications to the focus neighborhoods (at risk of homelessness, and lowest income) in Burbank. We distribute applications to our partner agencies including Family Promise, Family Service Agency, Kids Community Dental Clinic, Boys and Girls Club, BTAC, PFLAG, and Burbank Housing Corp. Forms may be filled out online at our website Burbankcc.org or printed out, completed and returned to the school district office, who sends them to BCC, mailed directly to Coordinating Council, or emailed to the BCC email address ([email protected]). Applications are also available in English, Spanish, and Armenian, from our website at www.burbankcc.org. Announcements and applications are shared with all BCC member organizations, City Council and School Board to distribute as well. Contact information is on social media and newspaper websites.

9. Measurable Outcomes:

Goal

50 Total unduplicated low to moderate income clients to be served. 50 Unduplicated City of Burbank low to moderate income clients to be served.

Please list between 1 and 5 additional Measurable Goals that your program/project will deliver.

Goal Measure of Service Description
50 children ages
6-18 various
income levels to
attend day and
resident camps.
100% low or extremely
low income. Number of
participants must equal
number on camp
contract.

Children will attend day camps and resident camps and experience out of doors, leadership skills, peer cooperation and a sense of self confidence to carry them on through their home, school and neighborhood. We review letters from campers to see what they gained from the camp experience!

Schedule and send 75 to 100 low-income children attending BUSD to camp. Of those children we plan to send 50 children to in person camps using CDBG funds. We will review to see where we obtained most participants to plan our outreach for future years. We want to offer this opportunity to all children at risk.

Priority will be given to new applicants.

12. Please indicate the funds your organization will consider or pursue, if applicable (Do not include fundraising campaigns).

We have applied for grants; entered into a partnership with H&R Block; collect money from Smile Amazon, and engage on Facebook and GoFundMe campaigns. We post donation information (in English, Spanish and Attachment 3-15
4/19/22, 11:25 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C547&prop=106 4/6 Armenian), on our website, in local newsletters, and both hard-copy and online newspapers. Announcements are made at School Board, City Council meetings, organization meetings, and donor forms are distributed at Chamber of Commerce events and throughout the city.

For Public Service or Economic Development
activities, please indicate the number of persons of
each income level that your program will assist:

Extremely Low: under 30% 25
Very Low: 30% to <50% 13
50% to <60% 7
Low: 60% to <80% 5
Total Low Income Served: 50

Budget
Budget Line Item Burbank Other Funding Program Total
Personnel Lines needed:

Benefits (11%) $0
Taxes $0
Subtotal Personnel $0 $0 $0
Non-Personnel
Move-In Assistance $0
Supplies & Materials $600 $400 $1,000
Equipment $0
Communications $0
Meetings & Convenings $0
Travel & Transportation $0 $870 $870
Training $0
Consulting $0
Evaluation $0
Other Lines needed: 2
Day Camps $6,000 $7,000 $13,000
Residential Camps $5,000 $6,000 $11,000
Subtotal Non-Personnel $11,600 $14,270 $25,870
Total Personnel & Non-Personnel $11,600 $14,270 $25,870 Indirect Costs $0 $200 $200
TOTAL $11,600 $14,470 $26,070
Number of Persons Served: 50
Cost per Individual $232

Other Funding Sources
Attachment 3-16
4/19/22, 11:25 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C547&prop=106 5/6 Other Funding Sources
Committed Amount
Committed Sources Lines needed: 1
Community $1,500
Total Committed $1,500
Projected Funding Sources
Individuals $5,000
Corporate $0
Foundations $0
Projected Sources Lines needed: 2
Camp Discounts $4,475
Community Organizations $500
Number of Volunteers: 8
Total Volunteer Hours: 100
Volunteer Rate ($/hour): $29.95
Volunteer In-Kind Value $2,995
Total Projected $12,970
Total Other Funding (must match budget total) $14,470

Attachment Link or Explanation for Missing Attachments
Articles of Incorporation and
Bylaws
2021_BYLAWS_OF_THE_BURBANK_COORDINATING_COUNCIL_09-08-
2021_-_CLEAN.pdf
Organization Chart BCC_Org_Chart_2021.pptx
Non-Profit Determination Letters,
IRS & State (501.3.c)
BCC.irs.990Nproof.2018.docx
Tax_Status.pdf
BCC.franchisetax.entityletter.2.2020.pdf
Most Recent Financial
Statements
Treasurer_Report_1-03-22.xlsx
Most Recent Audit & Findings, if
any
BCC_2020-2021_Audit_Report_Form.pdf
Program Intake Policies BCC.CDBGintake.policies.2020_1.docx Client Intake Form BCC.camper.wksheet_intake.docx
Other - Organization Insurance bcc_do_policy.PDF
BCC_GL_policy.PDF
bcc_GL_endt_adding_BUSD_adult_school_WITH_NOTES.pdf
Other - Workers Comp Waiver BCC.CDBG.workers.compwaiver.2022-3_1.doc Submitted By: Mary Anne Been
Date Signed 02/28/2022
Approved By: Marcos Gonzalez
Date Signed 03/04/2021
Approval Modified By CDS for Melania K.

Date Signed 05/20/2021
Attachment 3-17
4/19/22, 11:25 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C547&prop=106 6/6

Initially submitted: Mar 4, 2019 - 17:01:23

Returned to Draft 03-02-2021 by Burbank
Reason: Hi Sandy,
Please make the requested edits to the narrative. As per Marcos' instructions.

Attachment 3-18
4/19/22, 11:23 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C540&prop=152 1/7

CITY OF BURBANK
FISCAL YEAR 2022-23

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

REQUEST FOR FUNDING PROPOSALS
Project/Program Summary
Operating Agency: Burbank Housing Corporation
Project/Program Name: BHC Summer Camp
Type of Program/Project Public Service
Duration of Program/Project Multi-year Program
Type of Operating Agency: Non-Profit or For-Profit Organization

Total Amount Requested for FY 2022/23: $34,331

1. Project/Program Description:

Briefly describe the primary objective of the project/program you intend to operate including all major activities to be undertaken:

The Burbank Housing Corporation (BHC) is a private, non-profit developer that, in partnership with the City of Burbank, creates affordable housing opportunities in Burbank, CA.

BHC’s mission is to develop, improve, and preserve housing for low to moderate income households and to provide community and family support services to our residents. Through our youth programs, we have been able to change the trajectory of our neighborhoods by improving community safety, supporting the education of our residents, and helping families reach economic stability.

In 1998, the original purpose of the program was to establish and operate a gang diversionary initiative for the younger Elmwood residents. The existence and operation of the award-winning Elmwood Achievement Center was undoubtedly pivotal in changing the environment on the street and reclaiming the street from gang and criminal activities. The goal of the program was:
- to provide a safe space for students to engage in after-school activities, - to provide positive interactions and role models,
- to support their academic and social performance through homework assistance and tutoring - to create a sense of community involvement and responsibility.

Since then, BHC has continued this legacy by designing programs that consist of schoolwork assistance, college preparation, social-emotional skill building, and promotion of healthy decision-making. Instead of turning towards negative support structures like gangs, our youth can have their developmental and mental health needs better met through mentoring in the BHC Activity Centers. Through our camps, we aim to keep children occupied and safe during the school breaks when low-income children are more susceptible to summer learning loss, nutritional deficiency, and mental health issues.

The mental and physical health benefits are well-established, children need interaction, stimulation, and company to maintain good mental health. Our Activity Centers create a close-knit environment to allow for youth to grow positive relationships with the neighborhood children during their time away from school. During the school breaks, our camp also offers field trips that focus on outdoor connections, self-discovery, and mindfulness. The children can develop their social-emotional skills, reduce their stress, and improve their mental health.

In November 2018, BHC and the Boys & Girls Club (BGC) of Burbank & Greater East Valley entered into a collaborative partnership to design and operate our very own youth programs. BGC continues to be our sole service provider at two (2) Activity Centers located in our Elmwood and Peyton-Grismer Focus Neighborhoods. On a monthly basis, BHC is invoiced for the following expenses: staff reimbursement for the Youth Van Drivers, Unit Directors, and Youth Development Professionals, program supplies, Youth Van loan payment, cellphone and transportation expenses. The programs are available to low-income families residing in all BHC Focus Neighborhoods.

In addition to our free after-school program, our Elmwood and Peyton-Grismer Activity Centers offer three additional programs to the children who live in the designated Focus Neighborhoods:
1) a low-cost, all-day summer program
2) a free all-day, one-week youth program for the spring break Attachment 3-19
4/19/22, 11:23 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C540&prop=152 2/7 3) a free all-day, two-week youth program for the winter break.

The BHC & BGC Burbank Summer Camp is a 10-week low-cost program (Summer 2022) and will operate at the Elmwood Achievement Center and Peyton-Grismer Activity Center beginning May 31, 2022. The hours of operation will be Monday through Friday from 7:30 am to 6:00 pm. The Elmwood site will have a maximum of 30 spaces available and the Peyton-Grismer site will have a maximum of 20 spaces available. There will be a total of 50 children served.

As part of the summer program, BGC provides educational enrichment activities including fine arts, STEM, leadership, outdoor play, and field trips. On a weekly basis, the campers will go on educational field trips that cultivate the children’s interests and talents. Weekly visits to public pools are also implemented to strengthen the children’s water safety skills. Each afternoon, the summer camp participants will visit local public parks to engage in physical activity that promotes their growth and development. Additionally, BHC organizes special community events, such as our Summer Kickoff Party, End of Summer Carnival, Tie-Dye Day Event, and an Interactive Reptile Show.

2. Staff and Program/Project Location
Executive Director
Executive Director:

Sylvia Moreno Title: Executive Director
Phone: (818) 559-2336 Email: [email protected] Program Manager
Program Manager: Emily Lopez Title: Community Outreach & Special Program Manager
Phone: '(818) 319-5612 Email: [email protected] Application Contact
Application Contact: Emily Lopez Title: Community Outreach & Special Program Manager
Phone: (818) 559-2336 Email: [email protected] Project Addresses
Project Address: 1819 Grismer Ave.

City, State Zip: Burbank, CA 91504
Phone: (818) 559-2336
Website: https://burbankhousingcorp.org/
Mailing Address: 1819 Grismer Ave.

City, State Zip: Burbank, CA 91504
For Public Service or Economic Development activities, please identify if the project address is the same location where program services will be provided? No
Program Address: 153 W. Elmwood Ave.

City, State Zip: Burbank, CA 91502
If your program is not located in the City of Burbank, please describe how you intend to provide services in the Burbank community

DUNS Number: 61-984-2078 Federal EIN/TIN Number: 95-2627136 SAM Number:

City of Burbank Business License Number:

3. If awarded CDBG funding, describe the location(s) of where the services will be provided:
a. Grant Amount
Same as above
Other(address/areas/clubs/associations,
etcs.):1819 Grismer Ave. Back Bldg. Burbank, CA
91504

4. Has your organization encountered challenges in administering your program due to COVID 19 Public Health Orders? Yes No
a. If yes, explain the challenges and if they were resolved:

BHC and all its organizational activities are solely funded through the rental income of our residential properties.

Our financial model works as follows:

Attachment 3-20
4/19/22, 11:23 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C540&prop=152 3/7 1) First, the income revenue is applied to all operational expenses related to the upkeep and maintenance of our properties.
2) Secondly, funds are then distributed to our corporate office to pay for staff and administrative costs; and 3) Lastly, the remaining funds allow for resident services and Activity Centers expenses.

In the last two years, since the COVID-19 pandemic began, BHC has seen a substantial loss of rental revenue and a steady increase in operational expenses. A portion of our households have experienced financial hardships due to the pandemic and have struggled to pay their entire rent each month. At this time, there is approximately $138,000 in outstanding back-rent owed to BHC.

Our property management staff have directed these households to apply for the California COVID-19 Rent Relief Program, however the approval process can take up to nine months. This delay has caused instability in our primary funding source, and it has been a struggle to budget for our “mission” based enrichment services. For this reason, BHC has limited its summer camp to only its Elmwood location this year, even though we operated two locations at maximum capacity in 2020 and 2021. At this time, our organization does not have sufficient funds to operate the all-day summer program at our Peyton-Grismer Activity Center site.

5. (CDBG 2021-22 grant subrecipients only) Provide a progress update on your project or program. Please provide the following:
a. 2021 CDBG Grant Amount:
b. Do you expect to expend your grant prior to June 30
Yes No
c. If no, please explain your reason(s).
d. Has your organization submitted timely quarterly reports to the City? Yes No

6. Project/Program Beneficiaries:

Please specify the Primary Beneficiary group, persons, families, or individuals your program or project intends to target.

Youth or young adults

7. Describe how you determined this project or program will assist low to moderate income residents.

Please describe your system of collecting the data (i.e inrake applications, web-based applications, etc.).

With the assistance of the City of Burbank, our Activity Centers were created to bring services to marginalized communities in Burbank. BHC’s Focus Neighborhoods were identified by the City of Burbank as needing special attention and programs due to the area’s overcrowding, low per capita income, lack of open space, and limited access to public amenities. Since many of the summer programs offered in the City of Burbank are extremely competitive and costly, BHC offers a subsidized youth program for our families.

BHC verifies the income of all adult household members who reside in our residential properties through a city- audited income certification process. All residents of Burbank Housing Corporation must complete an annual income certification with our property management office that requires income documents, such as bank statements, paystubs, and tax returns. After the submittal of the required documents, staff determines the annual gross income of the household and identifies the household’s income level as set by the State of California Income Limits of Los Angeles County.

For our all-day summer camp, families are only responsible for a $25 weekly fee per child and households with multiple children are offered a reduced weekly rate. For households earning less than 50% of the average median income, BHC provides further financial aid to assist families that are most in need and are unable to pay this fee.

To receive financial aid, households submit an application form, which includes their current household income and a letter of circumstance, to BHC’s Director of Operations for review and approval. Once the scholarship is approved, the families are notified in writing of their award. Please note that a full scholarship for our summer program is $225 per child.

While there are other youth summer programs in Burbank, there is an importance in providing these services near BHC properties. Of 322 BHC households, over 40% either have no vehicle or only one, which is primarily used by the working parent. Low-income families with limited transportation will find it difficult to drop their children off at other summer programs in the city. We believe our low-income families should have the opportunity and accessibility to send their children to an affordable, enrichment-based camp during the summer break.

To enroll in our youth program, families must register their children and provide their address on the Boys & Girls Club (BGC) Parent Online Portal, parentportal.bgcburbank.org. The BGC membership department receives this information and then communicates with our Special Program Manager to confirm that the family’s address is Attachment 3-21
4/19/22, 11:23 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C540&prop=152 4/7 within a BHC Focus Neighborhood. Through these methods, BHC can ensure that this program is limited to disadvantaged communities in Burbank.

8. Project/Program Delivery Area:

The BHC Summer Camps are limited to Burbank residents only.

9. Measurable Outcomes:

Goal

50 Total unduplicated low to moderate income clients to be served. 50 Unduplicated City of Burbank low to moderate income clients to be served.

Please list between 1 and 5 additional Measurable Goals that your program/project will deliver.

Goal Measure of Service Description
50 Low-Income
Children Served Children will be identified within the BHC Focus Neighborhoods 10 Full Summer Camp
Scholarships
Awarded
Through an application process, scholarship awards will be granted to families unable to pay the $25 weekly fee ( 5 scholarships per Center). 10 Educational Field
Trips During Summer
Camp
Field trips will be organized by the Boys & Girls Club of Burbank. These field trips are included in the weekly fee and there will be no additional charge to families.

Burbank Housing Corporation has allocated $49,089 of its 2022 budget to pay for the 2022 Summer Camp. With these funds, we will be able to provide one Summer Camp location with 30 spaces at our Elmwood Activity Center.

The $49,089 we have allocated will include the following:
- Salary of our Special Program Manager for 10 weeks
- Four (4) contracted personnel from the Boys & Girls Club of Burbank (including payroll and administrative related expenses)
- One Youth Van driver for fields trips from Boys & Girls Club of Burbank - Youth Van vehicle insurance and associated transportation costs - Janitorial services
- Utility costs
- Miscellaneous expenses (supplies/materials, training, and equipment) Please note that the nominal weekly fee collected is reinvested into the Program by funding Special Events such as the summer kick-off party, ice-cream socials, reptile shows, and the end of summer carnival.

BHC’s operational expenses have increased to the point that our net rental income can no longer sustain year- round youth services, which includes the BHC After-School Program and Summer, Spring, and Winter All-Day Camps. To continue these resident services, BHC must seek additional grants and donations to offer this valuable resource to our families. If the organization is not awarded any external funding, BHC will be forced to cut segments of our youth program. Moving forward, our efforts may only be able to provide free after-school care to our families.

11. On a level of sustainability (program longevity), has your organization or Board approved applying, collaborating, or accepted any State, Federal, County, or philanthropic grants, benefits, or other non-CDBG funding in 2022?
Yes No
Fund/Grant Name Amount
$0
Attachment 3-22
4/19/22, 11:23 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C540&prop=152 5/7

12. Please indicate the funds your organization will consider or pursue, if applicable (Do not include fundraising campaigns).

BHC continues to pursue grant opportunities for our Youth Programs and Activity Center services. In the past, we have applied to the Albert & Elaine Borchard Foundation for our youth programs. Although our previous letter of intent was rejected, BHC is willing to revisit this grant opportunity in the following years.

In 2020, the Wells Fargo Foundation supported our COVID Care Package Program, and the following year, the foundation reached out for a potential partnership. Due to time and resource constraints, we were unable to proceed with the application process in 2021. If necessary, we may need to consider the partnership once again.

This year, Burbank HealthCare Foundation awarded us a grant for our After-School Program. BHC utilized these funds for our 2022 Spring Semester expenses. BHC strives to maintain the support of our community partners so that we can continue providing enrichment services to our families.

For Public Service or Economic Development
activities, please indicate the number of persons of
each income level that your program will assist:

Extremely Low: under 30% 3
Very Low: 30% to <50% 7
50% to <60% 3
Low: 60% to <80% 7
Total Low Income Served: 20

Budget
Budget Line Item Burbank Other Funding Program Total
Personnel Lines needed: 1
Program Coordinator Salary $0 $12,495 $12,495
Benefits (11%) $0
Taxes $0 $0 $0
Subtotal Personnel $0 $12,495 $12,495
Non-Personnel
Move-In Assistance $0
Supplies & Materials $480 $480
Equipment $1,058 $1,058
Communications $0
Meetings & Convenings $0
Travel & Transportation $85 $85
Training $460 $460 $920
Consulting $0
Evaluation $0
Attachment 3-23
4/19/22, 11:23 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C540&prop=152 6/7 Other Lines needed: 10
Summer Program Costs-2 Centers $4,706 $7,717 $12,423
Contractor-Unit Director (2 per site) $8,000 $7,200 $15,200 Contractor-Youth Development
Professional $7,500 $6,750 $14,250
Contractor-Transportation Driver $2,520 $2,268 $4,788
Utilities-2 Centers $700 $700 $1,400
Janitorial $3,654 $3,654 $7,308
Auto Insurance-Van to transport
children $240 $240 $480
Contractor - Administrative
Program Exps $3,188 $2,877 $6,065
Contractor - Payroll Related
Expenses $2,772 $2,502 $5,274
$0
Subtotal Non-Personnel $33,740 $35,991 $69,731
Total Personnel & Non-Personnel $33,740 $48,486 $82,226 Indirect Costs $591 $603 $1,194
TOTAL $34,331 $49,089 $83,420
Number of Persons Served: 20

Cost per Individual $1,717

Other Funding Sources
Other Funding Sources
Committed Amount
Committed Sources Lines needed: 1
Burbank Housing Corp $49,089
Total Committed $49,089
Projected Funding Sources
Individuals
Corporate
Foundations $0
Projected Sources Lines needed:

Number of Volunteers:

Total Volunteer Hours:

Volunteer Rate ($/hour):

Volunteer In-Kind Value $0
Total Projected $0
Total Other Funding (must match budget total) $49,089

Attachment Link or Explanation for Missing Attachments
Articles of Incorporation and Bylaws
Organization Chart
Non-Profit Determination Letters, IRS & State
(501.3.c)

Most Recent Financial Statements Burbank_Housing_Corporation-2020_FS_FINAL_2.pdf Attachment 3-24
4/19/22, 11:23 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C540&prop=152 7/7 Most Recent Audit & Findings, if any 2020_Audit_response_ltr.pdf Program Intake Policies
Client Intake Form
Other -
Other -
Submitted By: Chris Welker
Date Signed 02/28/2022

Initially submitted: Feb 28, 2022 - 13:44:58
Attachment 3-25
4/19/22, 11:25 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C539&prop=107 1/5

CITY OF BURBANK
FISCAL YEAR 2022-23

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

REQUEST FOR FUNDING PROPOSALS
Project/Program Summary
Operating Agency: Burbank Noon Lions Charity Foundation Project/Program Name: Indigent Eye Care & Ear of the Lion Type of Program/Project Public Service
Duration of Program/Project Multi-year Program
Type of Operating Agency: Non-Profit or For-Profit Organization

Total Amount Requested for FY 2022/23: $4,996

1. Project/Program Description:

Briefly describe the primary objective of the project/program you intend to operate including all major activities to be undertaken:

Burbank Noon Lions is a Non-profit, all volunteer service organization, serving Burbank for over 50 years with NO paid staff. For the INDIGENT EYE CARE program, we provide free, comprehensive eye exams and prescription glasses for low-income/homeless in Burbank in coordination with local eye care professionals. Pre-COVID, Burbank Temporary Aid Center (BTAC) has served as our screening center to determine eligibility for eye care services, but during COVID, we experienced an almost complete shutdown of BTAC referrals. As a result, we coordinated with other non-profits in the community that could verify the eligibility of clients they were referring.

Applications for EAR OF THE LION are received/reviewed for completeness by a Lion volunteer and forwarded to the Lions Hearing Foundation in central CA. Ear of the Lion committee members/audiologists review the application, determining financial eligibility (using Federal guidelines) and hearing needs of the applicant. If approved, audiology services are often provided by the Burbank applicant's personal audiologist in conjunction with the Ear of the Lion program.

2. Staff and Program/Project Location
Executive Director
Executive Director:

Title:

Phone: Email:

Program Manager
Program Manager: Title:

Phone: ' Email:

Application Contact
Application Contact: Marva Murphy Title: Project Volunteer Chair Phone: 818-955-8018 Email: [email protected]
Project Addresses
Project Address: 911 E CYPRESS AVE
City, State Zip: BURBANK, CA 91501
Phone:

Website:

Mailing Address: 911 E CYPRESS AVE
City, State Zip: BURBANK, CA 91501
For Public Service or Economic Development activities, please identify if the project address is the same location where program services will be provided? No
Program Address: BTAC 1304 W. Burbank Blvd.

City, State Zip: Burbank CA 91506
If your program is not located in the City of Burbank, please describe how you intend to provide services in the Burbank community

DUNS Number: Federal EIN/TIN Number:

SAM Number: MJC2BJ1T9BR3 More than likely, the program would not be sustainable without CDBG funding. If we could be guaranteed of funding from other sources, we would probably be able to serve a very limited number vs. our capabilities with a CDBG.

City of Burbank Business License Number:

N/A
Attachment 3-26
4/19/22, 11:25 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C539&prop=107 2/5

3. If awarded CDBG funding, describe the location(s) of where the services will be provided:
a. Grant Amount $5,000
Same as above
Other(address/areas/clubs/associations,
etcs.):

4. Has your organization encountered challenges in administering your program due to COVID 19 Public Health Orders? Yes No
a. If yes, explain the challenges and if they were resolved:

Due to COVID- 19; COVID-Delta and COVID-Omicron surges, people were reluctant to seek eye care services, which require close, inside contact with the eye care providers. In between variant surges, some people took advantage of the program, but not all the individuals requesting a Referral for the program did so.YYN

5. (CDBG 2021-22 grant subrecipients only) Provide a progress update on your project or program. Please provide the following:
a. 2021 CDBG Grant Amount: $5,000
b. Do you expect to expend your grant prior to June 30
Yes No
c. If no, please explain your reason(s).

Because of the Delta and Omicron surges, there is a possibility that our entire grant may not be expended, although we are hoping people with Referrals for eye care, who have yet to move forward in the process, will do so as COVID numbers decrease.
d. Has your organization submitted timely quarterly reports to the City? Yes No

6. Project/Program Beneficiaries:

Please specify the Primary Beneficiary group, persons, families, or individuals your program or project intends to target.

At-risk of homelessness

7. Describe how you determined this project or program will assist low to moderate income residents.

Please describe your system of collecting the data (i.e inrake applications, web-based applications, etc.).

Formerly, Burbank Temporary Aid Center utilized their 'Intake ' form and screened eye care referrals for eligibility. In the absence of this service, we have modified the BTAC 'Intake' form enabling the various non-profits with whom we are coordinating, to modify the document for their organization and provide the same necessary data demonstrating eligibility. Ear of the Lion applications are reviewed in Burbank by a volunteer for completeness and forwarded to the Hearing Foundation. A committee and audiologist review the application, determining financial eligibility based on tax returns and Federal guidelines, along with hearing needs of the applicant.

8. Project/Program Delivery Area:

Burbank city boundaries are the geographical areas served.

9. Measurable Outcomes:

Goal

Total unduplicated low to moderate income clients to be served. 34 Unduplicated City of Burbank low to moderate income clients to be served.

Please list between 1 and 5 additional Measurable Goals that your program/project will deliver.

Goal Measure of Service Description
34 Comprehensive Eye Exams &
glasses Unduplicated at-risk Burbank residents
Attachment 3-27
4/19/22, 11:25 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C539&prop=107 3/5

We have approximately $500 in undesignated, private donations, which can be applied to this eye care program.

12. Please indicate the funds your organization will consider or pursue, if applicable (Do not include fundraising campaigns).

Given the opportunity, we will apply for the Mother Joseph grant in 2023 in order to expand our eye care program via collaboration with other non-profits as well as serving non-Burbank residents. The aforementioned funding received (Item 11) is designated to assist the City of Burbank homeless by providing health screening services and professional eye care, as needed, in partnership with SAFE Storage, City of Burbank and the Salvation Army.

For Public Service or Economic Development
activities, please indicate the number of persons of
each income level that your program will assist:

Extremely Low: under 30% 22
Very Low: 30% to <50% 10
50% to <60% 2
Low: 60% to <80%
Total Low Income Served: 34

Budget
Budget Line Item Burbank Other Funding Program Total
Personnel Lines needed:

Benefits (11%) $9,344 $9,344
Taxes $1,797 $1,797
Subtotal Personnel $0 $11,141 $11,141
Non-Personnel
Move-In Assistance $0 $0
Supplies & Materials $1,750 $1,750
Equipment $0 $0
Communications $0 $0
Attachment 3-28
4/19/22, 11:25 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C539&prop=107 4/5 Meetings & Convenings $0 $0
Travel & Transportation $0 $0
Training $0
Consulting $0
Evaluation $0
Other Lines needed: 3
Eye Care Optics $2,516 $711 $3,227
Dr. Lilit $2,380 $2,020 $4,400
Ear of the Lion Foundation $100 $2,050 $2,150
Subtotal Non-Personnel $4,996 $6,531 $11,527
Total Personnel & Non-Personnel $4,996 $17,672 $22,668
Indirect Costs $0
TOTAL $4,996 $17,672 $22,668
Number of Persons Served: 34
Cost per Individual $147

Other Funding Sources
Other Funding Sources
Committed Amount
Committed Sources Lines needed:

Total Committed $0
Projected Funding Sources
Individuals
Corporate
Foundations
Projected Sources Lines needed: 1
Vendor-discount, supplies $6,650
Number of Volunteers: 2
Total Volunteer Hours: 368
Volunteer Rate ($/hour): $29.95
Volunteer In-Kind Value $11,022
Total Projected $17,672
Total Other Funding (must match budget total) $17,672

Attachment Link or Explanation for Missing Attachments
Articles of Incorporation and Bylaws
Organization Chart
Non-Profit Determination Letters, IRS & State
(501.3.c)

Most Recent Financial Statements BurbankNoonLions-BalanceSheet_2-28-22.pdf Most Recent Audit & Findings, if any N/A
Program Intake Policies
Client Intake Form
Other -
Other -
Attachment 3-29
4/19/22, 11:25 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C539&prop=107 5/5 Submitted By: Marva Murphy
Date Signed 03/01/2022
Approval Modified By CDS for Melania K.

Date Signed 05/20/2021

Initially submitted: Mar 5, 2021 - 00:06:04
Attachment 3-30
4/19/22, 11:25 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C567&prop=110 1/5

CITY OF BURBANK
FISCAL YEAR 2022-23

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

REQUEST FOR FUNDING PROPOSALS
Project/Program Summary
Operating Agency: Burbank Temporary Aid Center
Project/Program Name: Burbank Temporary Aid Center
Type of Program/Project Public Service
Duration of Program/Project Multi-year Program
Type of Operating Agency: Non-Profit or For-Profit Organization

Total Amount Requested for FY 2022/23: $53,000

1. Project/Program Description:

Briefly describe the primary objective of the project/program you intend to operate including all major activities to be undertaken:

BTAC's rental and utility assistance programs, as well as distribution of groceries helps local residents at risk of becomoing homeless, remain successfully housed and fed. BTAC's free laundry facilities and showers help homeless maintain a higher level of hygiene, which relfects in thier overall health and well being.

2. Staff and Program/Project Location
Executive Director
Executive Director:

Barbara Howell Title: Executive Director/CEO
Phone: 818-848-2822 Email: [email protected]
Program Manager
Program Manager: Title:

Phone: '818-848-2822 Email:

Application Contact
Application Contact: Barbara Howell Title: Executive Director/CEO Phone: 818-848-2822 Email: [email protected]
Project Addresses
Project Address: Burbank Tempoary Aid Center
City, State Zip: Burbank
Phone: 8188482822
Website: www.theBTAC.org
Mailing Address: 1304 W. Burbank Blvd.

City, State Zip: Burbank, CA
For Public Service or Economic Development activities, please identify if the project address is the same location where program services will be provided?
Program Address:

City, State Zip: Burbank, CA
If your program is not located in the City of Burbank, please describe how you intend to provide services in the Burbank community

DUNS Number: 786773408 Federal EIN/TIN Number: 95-3309130 SAM Number: FADXFJH1PKM8
City of Burbank Business License Number: BT 90340

3. If awarded CDBG funding, describe the location(s) of where the services will be provided:
a. Grant Amount $53,500
Same as above
Other(address/areas/clubs/associations,
etcs.):

Attachment 3-31
4/19/22, 11:25 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C567&prop=110 2/5

4. Has your organization encountered challenges in administering your program due to COVID 19 Public Health Orders? Yes No
a. If yes, explain the challenges and if they were resolved:

BTAC was heavily impacted in a few ways. There was a rapid and marked increase in requests for services.

BTAC's volunteer workforce of over 80 individuals dropped to approximately 18, almost over night. Two years later, it has only grown to approximately 25. BTAC had to cancel the March 2020 gala the day before the event. The two subsequent years, BTAC has not been able to hold the gala due to surges in the Delta and Omicron variants at the time of the event.�Y�Y

5. (CDBG 2021-22 grant subrecipients only) Provide a progress update on your project or program. Please provide the following:
a. 2021 CDBG Grant Amount: $28,000
b. Do you expect to expend your grant prior to June 30 Yes No c. If no, please explain your reason(s).
d. Has your organization submitted timely quarterly reports to the City? Yes No

6. Project/Program Beneficiaries:

Please specify the Primary Beneficiary group, persons, families, or individuals your program or project intends to target.

At-risk of homelessness

7. Describe how you determined this project or program will assist low to moderate income residents.

Please describe your system of collecting the data (i.e inrake applications, web-based applications, etc.).

BTAC uses the CDBG financial guidelines when vetting all requests for assistance. Only those meeting those levels are eligible for the financial assistance of rental and utility assistance from CDBG funds.. The information is collected in a database, and is reconfirmed annually.

8. Project/Program Delivery Area:

BTAC serves members of the Burbank community, or those who are currently homeless in the area.

9. Measurable Outcomes:

Goal

410 Total unduplicated low to moderate income clients to be served. 400 Unduplicated City of Burbank low to moderate income clients to be served.

Please list between 1 and 5 additional Measurable Goals that your program/project will deliver.

Goal Measure of Service Description
1 Rental Assistance and utility
assistance
10 households at risk of becoming homeless will maintain housing
2 Provide more healthful food options Approximately 100 households will received two grocery orders each month
3 Maintain reliable pick up vehicle BTAC
4 BTAC will maintain LA County Health
Standards
BTAC will be cleaned and managed in a way to maintain
the A rating

Funds to help medically fragile and/or low income seniors with rent and utility assistance have been provided.

Attachment 3-32
4/19/22, 11:25 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C567&prop=110 3/5

12. Please indicate the funds your organization will consider or pursue, if applicable (Do not include fundraising campaigns).

BTAC continues to apply for funding from new and existing funders. In addition, has received funding from the Mother Joseph Fund and SoCal Gas to assist with rent and utility assistance.

For Public Service or Economic Development
activities, please indicate the number of persons of
each income level that your program will assist:

Extremely Low: under 30% 425
Very Low: 30% to <50% 275
50% to <60% 75
Low: 60% to <80% 50
Total Low Income Served: 825

Budget
Budget Line Item Burbank Other Funding Program Total
Personnel Lines needed: 1
Driver, Case Manager, Finance and
ED $0 $295,800 $295,800
Benefits (11%) $0 $18,000 $18,000
Taxes $0 $30,000 $30,000
Subtotal Personnel $0 $343,800 $343,800
Non-Personnel
Move-In Assistance $0
Supplies & Materials $1,000 $1,250 $2,250
Equipment $400 $400
Communications $50 $50
Meetings & Convenings $50 $50
Travel & Transportation $0 $0
Training $0 $0
Consulting $0 $0
Evaluation $0
Other Lines needed: 7
Attachment 3-33
4/19/22, 11:25 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C567&prop=110 4/5 Rental Assistance $14,500 $5,000 $19,500
Utility Assistance $5,000 $4,000 $9,000
Vehicle gas and maintenance $2,500 $2,500 $5,000
Utility Bills (for showers,
refrigeration, etc. $18,000 $18,000 $36,000
Trash removal & Janitorial $9,500 $15,000 $24,500
Pest Control $2,500 $2,500 $5,000
Groceries $0 $1,000,000 $1,000,000
Subtotal Non-Personnel $53,000 $1,048,750 $1,101,750
Total Personnel & Non-Personnel $53,000 $1,392,550 $1,445,550 Indirect Costs $0 $285,000 $285,000
TOTAL $53,000 $1,677,550 $1,730,550
Number of Persons Served: 825
Cost per Individual $64

Other Funding Sources
Other Funding Sources
Committed Amount
Committed Sources Lines needed: 5
Fundraising $200,000
Groceries (in-kind $1,000,000
Corporate $55,000
Individuals $100,000
Foundations $35,000
Total Committed $1,390,000
Projected Funding Sources
Individuals $95,000
Corporate $45,000
Foundations $33,800
Projected Sources Lines needed:

Number of Volunteers: 25
Total Volunteer Hours: 6,500
Volunteer Rate ($/hour): $17.50
Volunteer In-Kind Value $113,750
Total Projected $287,550
Total Other Funding (must match budget total) $1,677,550

Attachment Link or Explanation for Missing Attachments
Articles of Incorporation and
Bylaws

Organization Chart
Non-Profit Determination Letters,
IRS & State (501.3.c)

Most Recent Financial
Statements
Burbank_Temporary_Aid_Center_Inc._Financial_Statements_063021.pdf The findings, if any are included in the attached financial statements Attachment 3-34
4/19/22, 11:25 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C567&prop=110 5/5 Most Recent Audit & Findings, if
any
Program Intake Policies
Client Intake Form
Other -
Other -
Submitted By: Barbara Howell
Date Signed 02/24/2022
Approved By: Marcos Gonzalez
Date Signed 03/02/2021
Approval Modified By cdscds
Date Signed 05/20/2021

Initially submitted: Feb 28, 2020 - 15:46:47
Attachment 3-35
4/19/22, 11:23 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C563&prop=157 1/6

CITY OF BURBANK
FISCAL YEAR 2022-23

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

REQUEST FOR FUNDING PROPOSALS
Project/Program Summary
Operating Agency: Family Service Agency Of Burbank
Project/Program Name: FSA- Residential Therapeutic Care for Special Homeless Populations
Type of Program/Project Public Service
Duration of Program/Project Multi-year Program
Type of Operating Agency: Non-Profit or For-Profit Organization

Total Amount Requested for FY 2022/23: $45,000

1. Project/Program Description:

Briefly describe the primary objective of the project/program you intend to operate including all major activities to be undertaken:

Family Service Agency of Burbank (FSA), founded in 1953, has been providing multi-disciplinary, therapeutically supported, long-term transitional housing to families for over 15 years. This began as a natural and very needed outgrowth to our long established domestic violence services. Our first program, the CARE Cottages at Puerta Nueva shelters 5 families with an unheard of 3 year stay which allows them the necessary time needed to work on both healing and self-sufficiency. This program was followed by Homefront, our residential program that assists 7 additional families, who had found themselves homeless or on the verge of homelessness. Two years later, we established yet another residential program, supporting 6 transitional age youth.

As you are certainly well aware, family violence is the greatest cause of homelessness for women and children, which we have seen evidenced in both of our transitional housing programs for families, our focus of this grant request. FSA believes that all individuals and families should live a life that is safe, healthy, and meaningful and that is what we strive to accomplish through our residential programs. All of our programs provide not only housing, but also; comprehensive and individualized, intervention and preventions services, counseling and advocacy, all vital to a family's longterm success and to ensure they never again face homelessness or violence.

PRIMARY OBJECTIVE for our Homeless Prevention Programs:

To end violence in the lives of these families and to ensure their transition to safe, stable, permanent housing.

To date, FSA's programs have seen NO RETURN TO A BATTERER after successful completion from our programs.

Domestic Violence is the primary cause of homelessness for women and children in the United States. According to the National Network to end Domestic Violence, between 22 and 57 percent of women and children are homeless due to domestic violence, and 38 percent of Victims experiencing homelessness in their lives due to domestic violence. Victims leaving abusers often experience homeless events multiple times.

When a victim of domestic Violence chooses to leave their abusive partner, safe and affordable housing is one of the primary barriers they will face. In a one day survey conducted in 2018, more than 56,000 adults and children fleeing violence found refuge in shelters. Out of 18,771 unmet requests for domestic violence services, 68 percent were for housing and shelter. In another nationwide study, more than half of victims needing housing did not receive them. Though emergency shelter can be a source of immediate short-term safety, transitional housing programs offer victims a stable housing option and supportive services. Transitional housing offers a safe options that empowers survivors to begin to rebuild their lives. Our programs give survivors and their children the services they need to achieve their goals for long-term safety and stability, and prevent the need to return to a batterer.

MAJOR ACTIVITIES: Treatment, Intervention, Advocacy
Assessment
All long-term residents have previously participated in FSA’s CARE Program for families. The Care Program for Families is a comprehensive Domestic Violence Outreach Program, founded 1991, in collaboration with the City of Attachment 3-36
4/19/22, 11:23 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C563&prop=157 2/6 Burbank’s then municipal court and local Police Department.

Prior to and throughout our client’s residency, Burbank’s Family Service Agency currently relies on 13 major activities/strength indicators (see Attachment I) as a focus of care/intervention/advocacy widely found to increase the probability of positive outcomes for traumatized individuals and families residing in therapeutically supported long-term transitional housing.

Of course, these are “just indicators” and therefore cannot account for all that is human – but we have found them to be a highly reliable general assessment/guidance tool.

Implementation – Treatment Plan (TP)
All Burbank Family Service Agency clients work with a multi-disciplinary therapeutic team to create their Individualized Mental Health Treatment Plan (TP). Currently, all entering one of FSA’s three long-term therapeutic residential communities will also work with their team to design an Autonomy Plan (AP). This plan serves as an additional focus for specific care/intervention/advocacy and as a measurement of progress towards their desired autonomy – self-sufficiency – towards a violence-free future – new personal healthy empowerment! Autonomy Plan (AP)
The AP is utilized as a daily guide and is formally reviewed monthly. Each adult resident and age-appropriate minor meets with their assigned Program Director and/or Lead Advocate to review and reflect on their individual and/or family’s current strengths and/or challenges. It is time spent honoring growth while identifying existing or emerging challenges.

All homeless prevention program clients are provided with the following:

Long-term, up to 3 years, safe, confidential housing
Transitional life coaching
Clinical Case Management
Mental Health Services- Individual, Family, and Group
Career and Education Planning
Peer Support- DV Program
Legal Advocacy/ Coordination
Restraining order preparation
Social Service Advocacy
Financial Planning and Education (long and short term goals) as well as individualized interventions, and supports

2. Staff and Program/Project Location
Executive Director
Executive Director:

Laurie Bleick Title: Executive Director
Phone: 818-845-7671 Email: [email protected]
Program Manager
Program Manager: Christine Ramos Title: Director of Operations Phone: '818-845-7671 Email: [email protected] Application Contact
Application Contact: Christine Ramos Title: Director of Operationa Phone: 818-845-7671 Email: [email protected] Project Addresses
Project Address: 2721 W. Burbank Blvd
City, State Zip: Burbank, CA 91505
Phone: 818-845-7671
Website: familyserviceagencyofburbank.org
Mailing Address: 2721 W. Burbank Blvd
City, State Zip: Burbank, CA 91505
For Public Service or Economic Development activities, please identify if the project address is the same location where program services will be provided?
Program Address: Held in confidence
City, State Zip: Held In confidence
If your program is not located in the City of Burbank, please describe how you intend to provide services in the Attachment 3-37
4/19/22, 11:23 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C563&prop=157 3/6 Burbank community
N/A
DUNS Number: 806766143 Federal EIN/TIN Number: 95-6118623 SAM Number: NU9HF3FV19A7
City of Burbank Business License Number:

3. If awarded CDBG funding, describe the location(s) of where the services will be provided:
a. Grant Amount $50,000
Same as above
Other(address/areas/clubs/associations,
etcs.):Confidential Residential Communities in
Burbank held in confidence

4. Has your organization encountered challenges in administering your program due to COVID 19 Public Health Orders? Yes No
a. If yes, explain the challenges and if they were resolved:

Though COVID has been an ongoing challenge, especially for this population, there have been no delays in meeting program/ project goals. The program is progressing as designed, meeting its daily, weekly and monthly goals. �Y�Y�Y

5. (CDBG 2021-22 grant subrecipients only) Provide a progress update on your project or program. Please provide the following:
a. 2021 CDBG Grant Amount: $32,500
b. Do you expect to expend your grant prior to June 30 Yes No c. If no, please explain your reason(s).
d. Has your organization submitted timely quarterly reports to the City? Yes No

6. Project/Program Beneficiaries:

Please specify the Primary Beneficiary group, persons, families, or individuals your program or project intends to target.

At-risk of homelessness

7. Describe how you determined this project or program will assist low to moderate income residents.

Please describe your system of collecting the data (i.e inrake applications, web-based applications, etc.).

As a part of our comprehensive intake and assessment process, applicants provide initial income data at the time of application, selected applicants must provide income verification at the time they are selected for the program in the form of three months of paystubs, as well as 6 months of bank statements. Participants also complete the CDB Applicant Self-Certification of income form, which is kept on file, Additionally, Incomes are continually monitored via program components and annually through Burbank Housing Corporations annual recertification process.

8. Project/Program Delivery Area:

N/A, all program participants are Burbank residents.

9. Measurable Outcomes:

Goal

14 Total unduplicated low to moderate income clients to be served. 14 Unduplicated City of Burbank low to moderate income clients to be served.

Please list between 1 and 5 additional Measurable Goals that your program/project will deliver.

Goal Measure of Service Description
Attachment 3-38
4/19/22, 11:23 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C563&prop=157 4/6 14 #of families progressing toward goals All Families working toward successful attainment of goals
all # of graduating families successfully
transitioned into perm housing
All graduating families moving to permanent
housing
6000 Units of support services provided Support Services provided to families to assist with program achievement

The funds received from CDBG, along with other funders have provided the funding needed to operate this program for over 15 years.

12. Please indicate the funds your organization will consider or pursue, if applicable (Do not include fundraising campaigns).

FSA continually seeks both public and private funding to support the needs of Burbank's transitional housing communities. FSA strives to keep a diverse funding stream to ensure financial solvency for this and all of its community supporting work. This past year, FSA has held 2 fundraising events, received 4 private grants, and has applied for 4 additional grants.

For Public Service or Economic Development
activities, please indicate the number of persons of
each income level that your program will assist:

Extremely Low: under 30% 6
Very Low: 30% to <50% 7
50% to <60% 1
Low: 60% to <80%
Total Low Income Served: 14

Budget
Budget Line Item Burbank Other Funding Program Total
Personnel Lines needed: 5
Director, Trainer, Advocate $45,000 $41,500 $86,500
Program Coordinator, Lead $0 $26,000 $26,000
Attachment 3-39
4/19/22, 11:23 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C563&prop=157 5/6 Therapist
Therapist/Clinical Supervisor $0 $57,500 $57,500
Parent Educator $0 $4,600 $4,600
Support staff $0 $4,900 $4,900
Benefits (11%) $0 $0 $0
Taxes $0 $0 $0
Subtotal Personnel $45,000 $134,500 $179,500
Non-Personnel
Move-In Assistance $0 $0
Supplies & Materials $1,600 $1,600
Equipment $700 $700
Communications $500 $500
Meetings & Convenings $0 $0
Travel & Transportation $700 $700
Training $300 $300
Consulting $0 $0
Evaluation $0 $0
Other Lines needed: 0
Subtotal Non-Personnel $0 $3,800 $3,800
Total Personnel & Non-Personnel $45,000 $138,300 $183,300 Indirect Costs $0
TOTAL $45,000 $138,300 $183,300
Number of Persons Served: 14
Cost per Individual $3,214

Other Funding Sources
Other Funding Sources
Committed Amount
Committed Sources Lines needed: 2
Batterers Treatment Program $38,300
Mother Joseph Fund/ Providence $25,000
Total Committed $63,300
Projected Funding Sources
Individuals $10,000
Corporate $30,000
Foundations $35,000
Projected Sources Lines needed:

Number of Volunteers:

Total Volunteer Hours:

Volunteer Rate ($/hour):

Volunteer In-Kind Value $0
Total Projected $75,000
Total Other Funding (must match budget total) $138,300

Attachment Link or Explanation for Missing Attachments
ByLaws_Family_Service_Agency_June____2018.doc
Attachment 3-40
4/19/22, 11:23 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C563&prop=157 6/6 Articles of Incorporation and Bylaws
Organization Chart oORG_CHART.pdf
Non-Profit Determination Letters, IRS &
State (501.3.c)
501_c3.pdf
Most Recent Financial Statements Dec_2021_-_Income_Statement.pdf Most Recent Audit & Findings, if any AUDIT_2020.pdf
Program Intake Policies
Client Intake Form
Other - Attachment 1 ATTACHMENT_I.pdf
Other -
Submitted By: Christine Ramos
Date Signed 03/01/2022

Initially submitted: Mar 1, 2022 - 15:41:42
Attachment 3-41
4/19/22, 11:23 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C569&prop=158 1/5

CITY OF BURBANK
FISCAL YEAR 2022-23

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

REQUEST FOR FUNDING PROPOSALS
Project/Program Summary
Operating Agency: Family Service Agency Of Burbank
Project/Program Name: FSA- Homeless Transitional Stabilization Fund Type of Program/Project Public Service
Duration of Program/Project New Program
Type of Operating Agency: Non-Profit or For-Profit Organization

Total Amount Requested for FY 2022/23: $45,000

1. Project/Program Description:

Briefly describe the primary objective of the project/program you intend to operate including all major activities to be undertaken:

PRIMARY OBJECT: To establish a Transitional/Stabilization Fund for the 2022-23 fiscal year that will provide for the unique transitional support of our special populations/residences as they transition into residential care and, on occasion, when transitioning into permanent housing.

The pandemic did not create, but has significantly complicated, the lives of those we serve at The CARE Cottages at Puerta Nueva (Est. 2007) - adults victims of intimate violence and their children, HOMEfront (Est. 2009) - our therapeutic community providing vital support for homeless families, and for the young adult residents, ages 18-24, of Linden House -(Est. 2011) homeless as a result of abuse/trauma.

Today, the need for quality effective community-focused prevention, intervention, and mental healthcare programs for our homeless has exploded. In the past 15 years, FSA’s residential model of care has proven highly effective for our community’s special residents. Our intention was to create safe intimate residential communities offering quality mental healthcare and comprehensive social services for those homeless as a result of trauma/abuse. Offering each resident 24/7/365 access to quality life-changing life-saving advocacy and care - peer and clinically supported environments where each resident could grow stronger, healthier - self-sufficient.

This was our intention; this has been our result. Worthy of 1-year - 1-time CDBG support.

MAJOR ACTIVITIES:

Activity (1)
FSA intends to establish a Transitional/Stabilization Fund for the 2022-23 fiscal year to support the special transitional needs of our homeless families and young adult residences of The CARE Cottages at Puerta Nueva, HOMEfront, and Linden House during these critical times of transition and instability.

Activity (2) Long-term Strategic Planning
FSA is fiercely committed to the development of a long-term strategic plan reflecting current and projected future needs of our residents and program partners. During the fiscal year (July 22- June 23) FSA intends to establish a small, highly qualified, volunteer study/work group to research and develop a long-term strategic plan designed to preserve the integrity and efficacy of our existing program support services for the special needs homeless we have come to serve.

FSA- Overview
FSA is a Burbank-based - Burbank-focused nonprofit 501© 3 organization, founded in 1953 by a few visionary leaders, now sustained by the many, to provide counseling, prevention, education, and advocacy to empower Burbank’s children, adults, and families, to achieve psychological, emotional, and social wellness.

It is FSA’s intention to do everything within our capacity to protect, preserve and strengthen Burbank’s 3 therapeutic Attachment 3-42
4/19/22, 11:23 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C569&prop=158 2/5 residential communities The CARE Cottages at Puerta Nueva, HOMEfront, and Linden House.

2. Staff and Program/Project Location
Executive Director
Executive Director: Laurie Bleick Title: Executive Director Phone: 818-845-7671 Email: [email protected]
Program Manager
Program Manager: Christine Ramos Title: Director of Operations Phone: '818-845-7671 Email: [email protected] Application Contact
Application Contact: Christine Ramos Title: Director of Operations Phone: 818-845-7671 Email: [email protected] Project Addresses
Project Address: 2721 W. Burbank Blvd
City, State Zip: Burbank, CA 91505
Phone: 818-845-7671
Website: familyserviceagencyofburbank.org
Mailing Address: 2721 W. Burbank Blvd
City, State Zip: Burbank, CA 91505
For Public Service or Economic Development activities, please identify if the project address is the same location where program services will be provided? Yes
Program Address: 2721 W. Burbank Blvd.

City, State Zip: Burbank, CA 91505
If your program is not located in the City of Burbank, please describe how you intend to provide services in the Burbank community

DUNS Number: 806766143 Federal EIN/TIN Number: 95-6118623 SAM Number: NU9HF3FV19A7
City of Burbank Business License Number:

3. If awarded CDBG funding, describe the location(s) of where the services will be provided:
a. Grant Amount $45,000
Same as above
Other(address/areas/clubs/associations,
etcs.):3 Residential communities in Burbank (sites
held confidential)

4. Has your organization encountered challenges in administering your program due to COVID 19 Public Health Orders? Yes No
a. If yes, explain the challenges and if they were resolved:

Yes, we have experienced capacity challenges, both in the depth and breathe of critical services needed in our community.

New project
d. Has your organization submitted timely quarterly reports to the City? Yes No

6. Project/Program Beneficiaries:

Please specify the Primary Beneficiary group, persons, families, or individuals your program or project intends to target.

Attachment 3-43
4/19/22, 11:23 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C569&prop=158 3/5 At-risk of homelessness

7. Describe how you determined this project or program will assist low to moderate income residents.

Please describe your system of collecting the data (i.e inrake applications, web-based applications, etc.).

As a part of our comprehensive intake and assessment process, applicants provide initial income data at the time of application, selected applicants must provide income verification at the time they are selected for the program in the form of three months of paystubs, as well as 6 months of bank statements. Participants also complete the CDBG Applicant Self-Certification of income form, which is kept on file, Additionally, Incomes are continually monitored via program components and annually through Burbank Housing Corporations annual recertification process.

8. Project/Program Delivery Area:

All residents of Burbank

9. Measurable Outcomes:

Goal

11 Total unduplicated low to moderate income clients to be served. 11 Unduplicated City of Burbank low to moderate income clients to be served.

Please list between 1 and 5 additional Measurable Goals that your program/project will deliver.

Goal Measure of Service Description
11 Successful/supported transition- overcoming all obstacles to residential care 11 Successful/supported transition overcoming all obstacles to stabilization to permanent housing

It is FSA’s objective to establish this fund for the 2022-23 fiscal year only. This is a 1-time request for support. We do not have any other sources of funding to report at this time.

12. Please indicate the funds your organization will consider or pursue, if applicable (Do not include fundraising campaigns).

Developing Storage Facilities and Transportation
Enhancing the Quality of Life, Mental Health and Healthcare Awareness Building Temporary Housing
Attachment 3-44
4/19/22, 11:23 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C569&prop=158 4/5 Creating Affordable Housing
Continuing Outreach, Coordinated Care System and Community Awareness Increased Homeless Prevention and Rapid Re-housing
Enforcing Public Health & Safety and Ordinances

For Public Service or Economic Development
activities, please indicate the number of persons of
each income level that your program will assist:

Extremely Low: under 30% 6
Very Low: 30% to <50% 5
50% to <60%
Low: 60% to <80%
Total Low Income Served: 11

Budget
Budget Line Item Burbank Other Funding Program Total
Personnel Lines needed:

Benefits (11%) $0
Taxes $0
Subtotal Personnel $0 $0 $0
Non-Personnel
Move-In Assistance $0
Supplies & Materials $0
Equipment $0
Communications $0
Meetings & Convenings $0
Travel & Transportation $0
Training $0
Consulting $0
Evaluation $0
Other Lines needed: 1
Transition and stabilization
assistance $45,000 $45,000
Subtotal Non-Personnel $45,000 $0 $45,000
Total Personnel & Non-Personnel $45,000 $0 $45,000
Indirect Costs $0
TOTAL $45,000 $0 $45,000
Number of Persons Served: 0

Cost per Individual

Other Funding Sources
Other Funding Sources
Committed Amount
Committed Sources Lines needed:

Total Committed $0
Projected Funding Sources
Individuals
Corporate
Foundations
Projected Sources Lines needed:

Number of Volunteers:

Total Volunteer Hours:

Attachment 3-45
4/19/22, 11:23 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C569&prop=158 5/5 Volunteer Rate ($/hour):

Volunteer In-Kind Value $0
Total Projected $0
Total Other Funding (must match budget total) $0

Attachment Link or Explanation for Missing Attachments
Articles of Incorporation and Bylaws ByLaws_Family_Service_Agency_June____2018.doc Organization Chart oORG_CHART.pdf
Non-Profit Determination Letters, IRS &
State (501.3.c)
501_c3.pdf
Most Recent Financial Statements Dec_2021_-_Income_Statement.pdf Most Recent Audit & Findings, if any AUDIT_2020.pdf
Program Intake Policies
Client Intake Form
Other -
Other -
Submitted By: Christine Ramos
Date Signed 03/01/2022

Initially submitted: Mar 1, 2022 - 15:18:37
Attachment 3-46
4/19/22, 11:24 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C559&prop=155 1/5

CITY OF BURBANK
FISCAL YEAR 2022-23

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

REQUEST FOR FUNDING PROPOSALS
Project/Program Summary
Operating Agency: Home Again L.A.

Project/Program Name: Homeless Outreach Services
Type of Program/Project Public Service
Duration of Program/Project New Program
Type of Operating Agency: Non-Profit or For-Profit Organization

Total Amount Requested for FY 2022/23: $50,000

1. Project/Program Description:

Briefly describe the primary objective of the project/program you intend to operate including all major activities to be undertaken:

Home Again L.A., formerly known as Family Promise of the Verdugos, is respectfully requesting Public Services funding under the Community Development Block Grant to implement a Homeless Outreach Services program for the unsheltered in the city of Burbank.

Since opening in 2010 and throughout our history, Home Again L.A. has developed and implemented innovative and award-winning programs that support various segments of the homeless population. This includes offering temporary shelter for homeless families, rapid rehousing programs that aim to get the unsheltered back into permanent housing and community education workshops that focus on homeless prevention services.

The development of this program presented itself as our organizational leaders identified a need to strengthen homeless outreach services citywide. The primary objective of these measures is to create an outreach program that addresses community needs and provides supportive services to the unsheltered in our community. We are currently facing a homeless crisis; something that was a huge dilemma pre-pandemic, has only been fueled by COVID19. While out in the field communicating with the unsheltered, Home Again L.A. will leverage our diverse programs and resources, including those of our partnering organizations, and in an effort to encourage participation, demonstrate how those programs operate. We intend to provide aid to those experiencing homelessness, whether they are living on the street, living in a parked vehicle, or living in an apartment with inadequate space for the total number of occupants. Our organization has made significant partnerships within the region and through our outreach efforts we can go beyond providing food, clothing, and essential items; we can connect households with community partners that provide mental health services and temporary shelter.

This funding will aid Home Again L.A. to bear the cost of two outreach workers on staff full time. While we need support for salaries, our organization will utilize other funding sources to provide food, clothing, and essential items, plus create print media with our contact information to be shared with both the greater community and the unsheltered. In addition to canvassing the community and responding to referrals from our community partners we intend to conduct intakes and assessments of the unsheltered so we can monitor the progress of the households and the program success or lack of.

We feel passionately that the development and implementation of a Homeless Outreach Service program will provide aid to the unsheltered but also provide our businesses and residents with clear direction on who to contact regarding the unsheltered in their specific neighborhood. Our Staff serve on various committees throughout the city, including the Chamber of Commerce, Coordinating Council, Service Clubs, etc., and through those relationships and our marketing efforts we can work towards building this program to best serve the needs of the community and the unsheltered.

In summary, the program will focus solely on those in our city. The objectives of the program are to:

1. Build trust among those experiencing homelessness,

2. Secure resources that will provide access to shelter, housing, and employment, building connections to local programs,

3. Provide tangible items that will help the overall health and well-being of the unsheltered, this includes, food, clothing, blankets, etc.

4. Provide business owners and residents with concise information on point of contact.

Attachment 3-47
4/19/22, 11:24 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C559&prop=155 2/5

2. Staff and Program/Project Location
Executive Director
Executive Director: Albert Hernandez Title: CEO
Phone: 8185627778 Email: [email protected] Program Manager
Program Manager: Carrie Prado Title: Director of Programs Phone: '8188471547 Email: [email protected] Application Contact
Application Contact: Albert Hernandez Title: CEO
Phone: 8185627778 Email: [email protected] Project Addresses
Project Address: 2406 N NAOMI STREET Unit A
City, State Zip: BURBANK, CA 91504
Phone: 8188471547
Website: FamilyPromiseVerdugos.org
Mailing Address: P.O. Box 7151
City, State Zip: BURBANK, CA 91510
For Public Service or Economic Development activities, please identify if the project address is the same location where program services will be provided? Yes
Program Address: 2406 North Naomi Street, Unit A
City, State Zip: Burbank, CA 91504
If your program is not located in the City of Burbank, please describe how you intend to provide services in the Burbank community
We are located in the city of Burbank.

DUNS Number: 965118560 Federal EIN/TIN Number: 262458342 SAM Number: 7NX20
City of Burbank Business License Number: BT1003793

3. If awarded CDBG funding, describe the location(s) of where the services will be provided:
a. Grant Amount $50,000
Same as above
Other(address/areas/clubs/associations,
etcs.):

4. Has your organization encountered challenges in administering your program due to COVID 19 Public Health Orders? Yes No
a. If yes, explain the challenges and if they were resolved:

Our organization has not encountered challenges administering our program due to COVID 19 Public Health Orders.Y

5. (CDBG 2021-22 grant subrecipients only) Provide a progress update on your project or program. Please provide the following:
a. 2021 CDBG Grant Amount: $44,000
b. Do you expect to expend your grant prior to June 30
Yes No
c. If no, please explain your reason(s).

N/A
d. Has your organization submitted timely quarterly reports to the City? Yes No

6. Project/Program Beneficiaries:

Please specify the Primary Beneficiary group, persons, families, or individuals your program or project intends to target.

Other - General Homeless Population

7. Describe how you determined this project or program will assist low to moderate income residents.

Please describe your system of collecting the data (i.e inrake applications, web-based applications, etc.).

Attachment 3-48
4/19/22, 11:24 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C559&prop=155 3/5 Our organization collects data by completing intake applications during our initial assessment of each household served. Upon completing the intake, we secure supporting documentation for the information provided by the client, i.e., identification card, benefits award letter, etc. We place that data in client file folders, and we upload data into our internal system. Some programs operated in partnership with the City of Burbank allow for documentation to be uploaded into the Homeless Management Information System. This system collects and generates information regarding outcomes, # of households served, ethnicity, etc. If this program is funded, we would utilize this system to store data. In closing, Home Again LA has been operating government funded programs since 2015 and is accustomed to submitting quarterly and annual reports to government partners.

8. Project/Program Delivery Area:

If successfully funded, the Homeless Outreach Services program will only target the unhoused population in the city of Burbank. This means 100% of clients will be residents in Burbank. Our goal is to create a dedicated city of Burbank outreach services team, solely devoting their time, resources, and skills to Burbank.

9. Measurable Outcomes:

Goal

50 Total unduplicated low to moderate income clients to be served. 50 Unduplicated City of Burbank low to moderate income clients to be served.

Please list between 1 and 5 additional Measurable Goals that your program/project will deliver.

Goal Measure of Service Description
50 Total number of unduplicated
households served. Households provided resources.
20 Total of unduplicated
households transitioned to
shelter.

Secured access to shelter or other housing opportunities.

Home Again L.A. will leverage private funds for 75% of the total annual cost of this project. These funds will be raised by private foundations, fundraisers and individual contributions.

11. On a level of sustainability (program longevity), has your organization or Board approved applying, collaborating, or accepted any State, Federal, County, or philanthropic grants, benefits, or other non-CDBG funding in 2022?
Yes No
Fund/Grant Name Amount
Edelstein Family Foundation $14,000
Continuum of Care (CoC) $35,000
SoCalGas $2,000
Disney Co. $20,000
Venable Foundation $7,500
B of A $20,000

12. Please indicate the funds your organization will consider or pursue, if applicable (Do not include fundraising campaigns).

We are continue working on soliciting funds to support this project. We are considering Dignity Health Foundation at $25,000 and Providence Health Systems at $25,000.

13. Does your project or program provide a direct service as an operator, service provider, developer, or owner in supporting the City’s homelessness strategies (see below)? Attachment 3-49
4/19/22, 11:24 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C559&prop=155 4/5 Yes No N/A
Please indicate the primary delivery area.

For Public Service or Economic Development
activities, please indicate the number of persons of
each income level that your program will assist:

Extremely Low: under 30% 40
Very Low: 30% to <50% 10
50% to <60% 0
Low: 60% to <80% 0
Total Low Income Served: 50

Budget
Budget Line Item Burbank Other Funding Program Total
Personnel Lines needed: 2
Outreach Coordinator (1FTE) $34,712 $11,570 $46,282
Outreach Specialist (1FTE) $5,000 $41,282 $46,282
Benefits (11%) $0
Taxes $0
Subtotal Personnel $39,712 $52,852 $92,564
Non-Personnel
Move-In Assistance $0 $0 $0
Supplies & Materials $2,500 $5,000 $7,500
Equipment $2,000 $3,000 $5,000
Communications $600 $600 $1,200
Meetings & Convenings $0 $0 $0
Travel & Transportation $1,200 $2,500 $3,700
Training $0 $2,500 $2,500
Consulting $0 $0 $0
Evaluation $0 $0 $0
Other Lines needed: 5
Vehicle $0 $35,000 $35,000
Facility Rental $1,488 $19,200 $20,688
Food $0 $15,000 $15,000
Clothing/Blankets/Essential Items $0 $10,000 $10,000
Client Needs $2,500 $12,500 $15,000
Subtotal Non-Personnel $10,288 $105,300 $115,588
Total Personnel & Non-Personnel $50,000 $158,152 $208,152 Indirect Costs $0 $10,000 $10,000
TOTAL $50,000 $168,152 $218,152
Number of Persons Served: 50
Cost per Individual $1,000

Other Funding Sources
Attachment 3-50
4/19/22, 11:24 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C559&prop=155 5/5 Other Funding Sources
Committed Amount
Committed Sources Lines needed: 6
Edelstein Family Foundation $14,000
SoCalGas $2,000
Vaneable Foundation $10,000
Disney Co. $20,000
HUMI Foundation $25,000
Total Committed $71,000
Projected Funding Sources
Individuals $4,652
Corporate $12,500
Foundations $80,000
Projected Sources Lines needed:

Number of Volunteers: 0
Total Volunteer Hours: 0
Volunteer Rate ($/hour): $0.00
Volunteer In-Kind Value $0
Total Projected $97,152
Total Other Funding (must match budget total) $168,152

Attachment Link or Explanation for Missing Attachments
Articles of Incorporation and Bylaws
Organization Chart
Non-Profit Determination Letters, IRS & State
(501.3.c)

Most Recent Financial Statements Family_Promise_06-30-2021_Financial_Statements.pdf Family_Promise_06-30-2021_Financial_Statements.pdf
Most Recent Audit & Findings, if any Family_Promise_06-30-2021_Financial_Statements.pdf Program Intake Policies
Client Intake Form
Other -
Other -
Submitted By: Albert Hernandez
Date Signed 02/18/2022

Initially submitted: Feb 18, 2022 - 11:47:19
Attachment 3-51
4/19/22, 11:24 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C545&prop=153 1/5

CITY OF BURBANK
FISCAL YEAR 2022-23

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

REQUEST FOR FUNDING PROPOSALS
Project/Program Summary
Operating Agency: Jacaranda Housing
Project/Program Name: Residential Program
Type of Program/Project Public Service
Duration of Program/Project New Program
Type of Operating Agency: Non-Profit or For-Profit Organization

Total Amount Requested for FY 2022/23: $50,000

1. Project/Program Description:

Briefly describe the primary objective of the project/program you intend to operate including all major activities to be undertaken:

Jacaranda Housing is a two-year residential program for transition-age (17-22) young women who are at risk of becoming homeless and/or are aging out of the foster system. Our primary objective is to keep these young women from becoming or remaining homeless. We accomplish this by providing them with a stable home, teaching them essential life skills, assisting them with furthering their education, and assisting them with obtaining employment.

While in our program, our House Manager will provide these young woman with individualized case management and five-year plan. Once their plan is in place, each one will then continue with their education while learning practical life skills such as: budgeting, cooking, time management, computer skills, and self-defense. They will also attend career building workshops in which they will learn how to create a resume and cover letter, fill out job applications, interview, and fill out new hire paperwork. And finally, they will receive regular counseling sessions that will monitor their mental health progress throughout their time in our program.

We believe that once these young women leave our program, they will have the tools, education, and employment they need to break the cycles of poverty and homelessness.

2. Staff and Program/Project Location
Executive Director
Executive Director:

Ali Bodager Title: Executive Director
Phone: 3309073616 Email: [email protected]
Program Manager
Program Manager: Ali Bodager Title: Executive Director Phone: '3309073616 Email: [email protected]
Application Contact
Application Contact: Ali Bodager Title: Executive Director Phone: 3309073616 Email: [email protected]
Project Addresses
Project Address: 263 W Olive Ave #177
City, State Zip: Burbank, CA 91502
Phone: 8189340778
Website: www.jacarandahousing.org
Mailing Address: 263 W Olive Ave #177
City, State Zip: Burbank, CA 91502
For Public Service or Economic Development activities, please identify if the project address is the same location where program services will be provided? No
Program Address: TBD
City, State Zip: Burbank, CA
If your program is not located in the City of Burbank, please describe how you intend to provide services in the Burbank community
Once funds have been raised, Jacaranda Housing will rent a 4-bedroom house in Burbank where the program services will be provided.

DUNS Number: 103860345 Federal EIN/TIN Number: 86-2772676 Attachment 3-52
4/19/22, 11:24 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C545&prop=153 2/5 SAM Number:

City of Burbank Business License Number:

3. If awarded CDBG funding, describe the location(s) of where the services will be provided:
a. Grant Amount $50,000
Same as above
Other(address/areas/clubs/associations,
etcs.):N/A - Same as above

4. Has your organization encountered challenges in administering your program due to COVID 19 Public Health Orders? Yes No
a. If yes, explain the challenges and if they were resolved:

6. Project/Program Beneficiaries:

Please specify the Primary Beneficiary group, persons, families, or individuals your program or project intends to target.

At-risk of homelessness

7. Describe how you determined this project or program will assist low to moderate income residents.

Please describe your system of collecting the data (i.e inrake applications, web-based applications, etc.).

Each young woman who applies for our program has to be at-risk of homelessness, whether they have been kicked out of their home, they are aging out of the foster system, their family is currently homeless, etc. Our online application/client intake form requests information regarding their current living situation, whether they receive CalFresh or MediCal benefits, and whether or not they are currently employed. They will then undergo an in depth interview in which we review their application with them and request more information as needed.

8. Project/Program Delivery Area:

We anticipate that many of our referrals will come from BUSD's homeless liaison, Village Family Services Drop-in Center in North Hollywood, and Family Services Agency in Burbank. Therefore, it is reasonable to expect that at least 50% of our participants will come from the Burbank community.

9. Measurable Outcomes:

Goal

8 Total unduplicated low to moderate income clients to be served. 4-6 Unduplicated City of Burbank low to moderate income clients to be served.

Please list between 1 and 5 additional Measurable Goals that your program/project will deliver.

Goal Measure of
Service Description
Savings
6 months of
living
expenses in
savings
Each young woman at the end of our program will have a detailed monthly budget and 6 months worth of living expenses in a savings account. Throughout their time in our program, they will be required to set aside a budgeted portion of their income into a savings account each month.

Attachment 3-53
4/19/22, 11:24 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C545&prop=153 3/5 Employment Full-Time
Employment
Each young woman will leave our program with full-time employment. During their time in our program, they will attend career building workshops to assist them with creating a resume, filling out an application, interviewing, and filling out new hire paperwork. Their last 6 months in our program is spent obtaining full-time employment.

Housing Stable
Housing
Each young woman will leave our program with stable housing. The last 6 months of our program is spent teaching them how to search and apply for apartments.

During their time in our program, they are taught how to live with roommates in order to make housing more affordable once they leave.

Approximately $203,800 will be raised through private donors, corporate donations, and foundation grants. We have already raised $25,000 through individual and corporate donations.

12. Please indicate the funds your organization will consider or pursue, if applicable (Do not include fundraising campaigns).

Ralph M Parsons Foundation for $10,000
Hilda and Preston Davis Foundation for $10,000
Leo Buscaglia for $5,000
Dew Foundation for $10,000
Pacific Power for $5,000
Nordstrom for $10,000
Hagen Family Foundation for $1,200

For Public Service or Economic Development
activities, please indicate the number of persons of
each income level that your program will assist:

Extremely Low: under 30% 8
Very Low: 30% to <50% 0
50% to <60% 0
Low: 60% to <80% 0
Total Low Income Served: 8

Budget
Attachment 3-54
4/19/22, 11:24 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C545&prop=153 4/5 Budget Line Item Burbank Other Funding Program Total
Personnel Lines needed: 3
Executive Director - Full Time $33,600 $33,600
House Manager - Full Time $33,600 $33,600
House Monitors - 5 Part Time $66,150 $66,150
Benefits (11%) $7,400 $7,400
Taxes $10,200 $10,200
Subtotal Personnel $0 $150,950 $150,950
Non-Personnel
Move-In Assistance $15,500 $10,000 $25,500
Supplies & Materials $0
Equipment $0
Communications $0
Meetings & Convenings $0
Travel & Transportation $0
Training $0
Consulting $0 $14,000 $14,000
Evaluation $0
Other Lines needed: 3
Program Expenses $10,000 $9,750 $19,750
Office Expenses $0 $2,100 $2,100
Fundraising $0 $1,500 $1,500
Subtotal Non-Personnel $25,500 $37,350 $62,850
Total Personnel & Non-Personnel $25,500 $188,300 $213,800 Indirect Costs $24,500 $40,500 $65,000
TOTAL $50,000 $228,800 $278,800
Number of Persons Served: 8
Cost per Individual $6,250

Other Funding Sources
Other Funding Sources
Committed Amount
Committed Sources Lines needed: 2
Individuals $23,000
Corporate $2,000
Total Committed $25,000
Projected Funding Sources
Individuals $73,300
Corporate $15,000
Foundations $95,000
Projected Sources Lines needed: 1
In-Kind $8,000
Number of Volunteers: 20
Total Volunteer Hours: 500
Volunteer Rate ($/hour): $25.00
Volunteer In-Kind Value $12,500
Total Projected $203,800
Total Other Funding (must match budget total) $228,800

Attachments
(Upload Instructions)
Checked attachments below are REQUIRED in order to submit your application, and your application WILL NOT Attachment 3-55
4/19/22, 11:24 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C545&prop=153 5/5 be able to be submitted with missing attachments! Please take this into consideration when timing your submission of this application. The documents you need to upload are checked below. If you have other attachments you would like to include, please check the box and, if Other, identify the Attachment in the box. If you are unable to upload any of the attachments, contact Marcos Gonzalez at 818-238-5212 or [email protected] at least
one day prior to the deadline.

Attachment Link or Explanation for Missing Attachments
Articles of Incorporation and Bylaws Articles_of_Incorporation_Filed.pdf Amendment_Filed.pdf
Bylaws_Executed.pdf
Organization Chart JH_Organizational_Chart.pdf
Non-Profit Determination Letters, IRS & State
(501.3.c)
501c3_Approval_Letter_12-10-2021.pdf
Most Recent Financial Statements PL_2021.pdf
Balance_Sheet_12-2021.pdf
Most Recent Audit & Findings, if any PL_2021.pdf
990N_FILED_1-14-22.pdf
Program Intake Policies
Client Intake Form https://form.jotform.com/210235910679153 Other -
Other -
Submitted By: Alison Bodager
Date Signed 02/25/2022

Initially submitted: Feb 25, 2022 - 13:53:36
Attachment 3-56
4/19/22, 11:26 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C558&prop=105 1/5

CITY OF BURBANK
FISCAL YEAR 2022-23

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

REQUEST FOR FUNDING PROPOSALS
Project/Program Summary
Operating Agency: Kids Community Clinic of Burbank
Project/Program Name: Dental Treatments for Low Income Children Type of Program/Project Public Service
Duration of Program/Project Multi-year Program
Type of Operating Agency: Non-Profit or For-Profit Organization

Total Amount Requested for FY 2022/23: $19,210

1. Project/Program Description:

Briefly describe the primary objective of the project/program you intend to operate including all major activities to be undertaken:

In partnership with non-profit organizations, parks, schools, preschools, and other agencies that serve low-income and homeless families in Burbank, KCDC will offer oral health education, treatment, and toothbrushes (goodie bags) to help raise the oral health literacy and to help this population prevent tooth decay and gain access to dental care. With unexpected COVID restrictions, each agency will be able to select from a variety of delivery options including: face-to-face dental services; virtual oral health lectures and toothbrushes; toothbrushes and oral health information along with food distribution; drive-thru fluoride, walk-up fluoride, education and toothbrushes.

2. Staff and Program/Project Location
Executive Director
Executive Director:

Dale Gorman Title: Executive Director
Phone: 8183991373 Email: [email protected]
Program Manager
Program Manager: Ana Gomez, RDA Title: Dental Programs Administrator Phone: '8188418010 Email: [email protected]
Application Contact
Application Contact: Dale Gorman Title: Executive Director Phone: 8183991373 Email: [email protected]
Project Addresses
Project Address: 400 W. Elmwood Ave.

City, State Zip: Burbank
Phone: 8188418010
Website: www.kidsclinic.org
Mailing Address: 400 W. Elmwood Ave.

City, State Zip: Burbank
For Public Service or Economic Development activities, please identify if the project address is the same location where program services will be provided? Yes
Program Address: 400 W. Elmwood Ave.

City, State Zip: Burbank, CA 91506
If your program is not located in the City of Burbank, please describe how you intend to provide services in the Burbank community

DUNS Number: 037915704 Federal EIN/TIN Number: 95-4791296 SAM Number:

City of Burbank Business License Number:

3. If awarded CDBG funding, describe the location(s) of where the services will be provided:
a. Grant Amount $0
Same as above
Other(address/areas/clubs/associations,
Attachment 3-57
4/19/22, 11:26 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C558&prop=105 2/5 etcs.):Miller Elementary School 720 E Providencia
Ave, Burbank, CA 91501, Boys & Girls Club of
Burbank and East Valley, 300 E Angeleno Ave,
Burbank, CA 91502, Burbank Parks & Recreation
programs for children at Ovrom Park, 601 S San
Fernando Blvd, Burbank, CA 91502, Burbank
Housing Corp. 1819 Grismer Ave. Burbank, 91504

4. Has your organization encountered challenges in administering your program due to COVID 19 Public Health Orders? Yes No
a. If yes, explain the challenges and if they were resolved:

Each school district, school group, and agency differs in policy regarding visiting outside organizations. We must follow CDC, OSHA, California State and LA County Health guidelines for the most stringent policy along with the school or agency's request for administering the program, so compliance and policy changes happen frequently so staff training, signage, and testing and protection materials change. A compliance analyst was added to oversee this facet of operations. Cost of operations has increased due to compliance demands.

5. (CDBG 2021-22 grant subrecipients only) Provide a progress update on your project or program. Please provide the following:
a. 2021 CDBG Grant Amount: $14,000
b. Do you expect to expend your grant prior to June 30
Yes No
c. If no, please explain your reason(s).
d. Has your organization submitted timely quarterly reports to the City? Yes No

6. Project/Program Beneficiaries:

Please specify the Primary Beneficiary group, persons, families, or individuals your program or project intends to target.

Families with children

7. Describe how you determined this project or program will assist low to moderate income residents.

Please describe your system of collecting the data (i.e inrake applications, web-based applications, etc.).

The Kids’ Community Dental Clinic offers a “sliding scale” of cost for care in 3 categories: 1) Free to families whose children are covered by Medi-Cal; 2) low-cost treatments ($30 per visit) for low-income/uninsured patients (who do not qualify for Medi-Cal, but still meet CDBG income guidelines). 2) free treatments for Homeless children and at- risk youth as referred by anti-trafficking partners;
Patient eligibility procedures include: 1) Parents present a Medicaid or Medi-Cal Dental Program card for every child to be enrolled as a new patient and at every subsequent visit; 2) If the child is not covered by Medi-Cal benefits but wants to become a patient, the parent completes the attached Eligibility Application Form, presents a copy of a recent tax return, and provides a government-issued photo identification card of the parent or guardian.

Once the form is complete and the income level, dependents, and parent’s photo identification are verified, they are approved by the Director or by the Programs Administrator, and services begin. The staff verify that the income level falls at or below the Gross Income Limits (Los Angeles County Area - current year; 3) An exception for payment and eligibility arises if a case manager from a shelter contacts us to make appointments. Each case is reviewed and all fees are waived and minimal paperwork is completed. In our experience, many homeless individuals lose Medi-Cal eligibility because they lack a stable address and the paperwork required to maintain benefits therefore, we waive paperwork to be able to admit the child for immediate treatment and the parent completes an income affidavit form that serves as documentation for eligibility.

Eligibility at outreach events: KCDC is committed to addressing healthcare inequity and exclusively serves low- income families by attending elected official-sponsored resource events in low income communities, by working with non-profit agencies serving the same population, by going to Title I funded schools and Federal Head Start program preschools to ensure we are reaching and accessing low-income families to provide access to comprehensive oral healthcare that they might not have resources to pursue.

All data for patients in the clinic are scanned and captured into different files within a dental practice management system. All outreach data is collected for input into our digital records and utilized for grant reporting and data analysis for programs management.

Attachment 3-58
4/19/22, 11:26 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C558&prop=105 3/5

8. Project/Program Delivery Area:

This program is primarily for Burbank schools, multiple City of Burbank based non-profits and Burbank residents including those residing in zip codes 91501, 91502, 91503, 91504, 91505, 91506. Our intent is to deliver to Burbank residents.

9. Measurable Outcomes:

Goal

100 Total unduplicated low to moderate income clients to be served. 1500 Unduplicated City of Burbank low to moderate income clients to be served.

Please list between 1 and 5 additional Measurable Goals that your program/project will deliver.

Goal Measure of Service Description
500 Individuals receive fluoride
treatment
At partnering organizations, provide important preventative treatment
1600 Individuals receive
toothbrushes
Through strategic partnerships, toothbrushes will go to low income children
1600 Receive access to dental care
with follow up Children become patients and receive needed treatments 1600 Individuals educated on tooth
decay prevention Oral Health Lectures will provide lifelong learning experience 30 Children will be fully restored
to health
A portion of children will become patients and follow through with all treatment to become cavity free

KCDC constantly manages its income and expenses to ensure sustainability of its long term, evidence-based programs. Over the years, KCDC has been able to secure partners and funders who recognize the unique service and healthcare that KCDC provides. Our evidence based programs draw continued support as we work to address disparities in access to comprehensive oral healthcare for under-served and at risk populations. Private funding will ensure that children who gain access will be able to benefit from a Pediatric Specialist, as needed. Private funding will ensure that JBHS/BHS student interns will participate in these programs to see the benefit of a City-funded program that helps their neighbors. Mentoring dentists who volunteer will work with dental students, pre-dental college students, and high school interns.

11. On a level of sustainability (program longevity), has your organization or Board approved applying, collaborating, or accepted any State, Federal, County, or philanthropic grants, benefits, or other non-CDBG funding in 2022?
Yes No
Fund/Grant Name Amount
Dignity Health Community Partnership $21,000
Ralph M. Parsons Foundation $30,000
Dental Trade Alliance Foundation $25,000
NCOHF, America $5,000
Medi-Cal Dental reimbursements to date $24,388

12. Please indicate the funds your organization will consider or pursue, if applicable (Do not include fundraising campaigns).

On a monthly basis, staff and volunteers research and reach out to prospective funders. In 2021, we hired a part time grant writer in response to a growing need to sustain operational costs, to cover general operating expenses, to replace aging equipment, and for future planning. Also, we will be pursuing government funding focused on health capacity expansion in order to expand operations and operatory space.

Attachment 3-59
4/19/22, 11:26 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C558&prop=105 4/5

For Public Service or Economic Development
activities, please indicate the number of persons of
each income level that your program will assist:

Extremely Low: under 30% 100
Very Low: 30% to <50% 1,000
50% to <60% 400
Low: 60% to <80% 100
Total Low Income Served: 1,600

Budget
Budget Line Item Burbank Other Funding Program Total
Personnel Lines needed: 2
Licensed/Certified Dental
Professionals $7,000 $441,180 $448,180
In Kind Volunteers $0 $657,222 $657,222
Benefits (11%) $660 $14,340 $15,000
Taxes $850 $40,970 $41,820
Subtotal Personnel $8,510 $1,153,712 $1,162,222
Non-Personnel
Move-In Assistance $0 $0 $0
Supplies & Materials $8,000 $117,000 $125,000
Equipment $0 $2,000 $2,000
Communications $200 $1,300 $1,500
Meetings & Convenings $0 $3,000 $3,000
Travel & Transportation $125 $1,975 $2,100
Training $0 $5,500 $5,500
Consulting $0 $0
Evaluation $8,000 $8,000
Other Lines needed: 4
Barrier lifting expenses $500 $2,500 $3,000
Insurance $1,875 $22,125 $24,000
Permits & Licenses $5,922 $5,922
$0 $0
Subtotal Non-Personnel $10,700 $169,322 $180,022
Total Personnel & Non-Personnel $19,210 $1,323,034 $1,342,244 Indirect Costs $35,500 $35,500
TOTAL $19,210 $1,358,534 $1,377,744
Number of Persons Served: 1,600

Cost per Individual $12
Attachment 3-60
4/19/22, 11:26 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C558&prop=105 5/5

Other Funding Sources
Other Funding Sources
Committed Amount
Committed Sources Lines needed: 1
$0
Total Committed $0
Projected Funding Sources
Individuals $36,016
Corporate $24,640
Foundations $280,000
Projected Sources Lines needed: 4
Medi-Cal Dental Reimbursement $235,612
Service Fee Income $30,000
Fundraising events $50,000
In Kind dental supplies, occupancy $45,000
Number of Volunteers: 212
Total Volunteer Hours: 9,016
Volunteer Rate ($/hour): $72.90
Volunteer In-Kind Value $657,266
Total Projected $1,358,534
Total Other Funding (must match budget total) $1,358,534

Attachment Link or Explanation for Missing Attachments
Articles of Incorporation and Bylaws KCDC_ByLaws.pdf
Organization Chart 2022_KCDC_Org_Chart.xlsx
Non-Profit Determination Letters, IRS & State
(501.3.c)
KCDC_IRS_Determination.pdf
Most Recent Financial Statements KCDC_Treasurers_Report_12-2021.pdf Most Recent Audit & Findings, if any KCDC-Audited-Financial-Statement.pdf Program Intake Policies KCDC_Eligibility_Procedures_2021.pdf Client Intake Form Intake_Eligibility_Form_2021.xls
Other -
Other -
Attachment 3-61
FISCAL YEAR 2022-23
CDBG

CAPITAL AND

ECONOMIC

DEVELOPMENT

PROPOSALS
Attachment 3-62
4/19/22, 11:26 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C571&prop=160 1/4

CITY OF BURBANK
FISCAL YEAR 2022-23

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

REQUEST FOR FUNDING PROPOSALS
Project/Program Summary
Operating Agency: Burbank Library Dept
Project/Program Name: Library Consultation Spaces
Type of Program/Project Capital Project
Duration of Program/Project New Project
Type of Operating Agency: City Department/Public Agency

Total Amount Requested for FY 2022/23: $50,000

1. Project/Program Description:

Briefly describe the primary objective of the project/program you intend to operate including all major activities to be undertaken:

More than 750,000 individuals visit Burbank Public Library annually. Of this population, a significant portion is low income and often has low educational attainment, creating the need for access to learning and social services. As a result, libraries become ideal locations for both local and regional service providers to meet with clients onsite.

Over the past several years, Burbank Public Library has expanded these services internally and through partnerships. Since 2021, the Library has had a social worker on staff and has operated the City’s workforce development center, supplementing existing services in adult basic literacy and digital literacy. Partnerships include onsite registration for Calfresh and Medi-cal through the LA County Department of Public Social Services and enhanced job connections through the Verdugo Jobs Center. To date, the Library’s ability to expand these services is hampered by the lack of suitable space for staff to meet with clients.

The Library Consultation Spaces project will refresh and refurnish rooms at the Central and Buena Vista libraries into spaces that can be scheduled for one-on-one meetings to introduce individuals to learning resources, provide print and digital literacy tutoring, offer job coaching, and more. Funds will be used to update spaces, purchase appropriate furniture, add technology, and create comfortable and private areas. Between the two locations, services can be offered seven days a week, including evenings, in two areas of Burbank, improving access for low- income residents who often have transportation challenges. Rather than requiring individuals to start obtaining service at one agency and then travel to another, services can be brought to the clients who already utilize the libraries for internet access and work space. This project will benefit the targeted individuals, who will gain access to services that will improve their prospects for stable work, health and housing and economic gain. In addition, it will introduce efficiencies and expanded impact in the delivery of services by regional social services agencies.

2. Staff and Program/Project Location
Executive Director
Executive Director:

Elizabeth Goldman Title: Library Services Director
Phone: 8182385551 Email: [email protected]
Program Manager
Program Manager: Lusine Arutyunyan Title: Senior Administrative Analyst Phone: '818-238-5567 Email: [email protected] Application Contact
Application Contact: Elizabeth Goldman Title: Library Services Director Phone: 8182385551 Email: [email protected]
Project Addresses
Project Address: 110 N Glenoaks Blvd.

City, State Zip: Burbank, CA 91502
Phone: 818-238-5551
Website: www.burbanklibrary.org
Mailing Address: 110 N Glenoaks Blvd.

Attachment 3-63
4/19/22, 11:26 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C571&prop=160 2/4 City, State Zip: Burbank, CA 91502
If your program is not located in the City of Burbank, please describe how you intend to provide services in the Burbank community

DUNS Number: Federal EIN/TIN Number:

SAM Number:

City of Burbank Business License Number:

3. If awarded CDBG funding, describe the location(s) of where the services will be provided:
a. Grant Amount $50,000
Same as above
Other(address/areas/clubs/associations,
etcs.):

4. Has your organization encountered challenges in administering your program due to COVID 19 Public Health Orders? Yes No
a. If yes, explain the challenges and if they were resolved:

6. Project/Program Beneficiaries:

Please specify the Primary Beneficiary group, persons, families, or individuals your program or project intends to target.

At-risk of homelessness

7. Describe how you determined this project or program will assist low to moderate income residents.

Please describe your system of collecting the data (i.e inrake applications, web-based applications, etc.).

While the Library does not collect income data on users, many of the programs that would be supported by this project are targeted to low-income individuals. For example, the Verdugo Jobs Center and its affiliate, Burbank Employment Connection, received federal funds targeted at workforce re-entry by those with barriers to employment. Calfresh and Medi-Cal are income restricted by state law. The Library’s Adult Literacy Services are funded through a state grant targeted at adults who have employment challenges due to reading below an 8th grade level. The Library’s social worker primarily supports individuals who are unsheltered or at risk of experiencing homelessness.

8. Project/Program Delivery Area:

Non-residents are able to use Burbank Public Library services but generally use services of their local library. An estimated 75% of services will be provided to Burbank residents.

9. Measurable Outcomes:

Goal

300 Total unduplicated low to moderate income clients to be served. 225 Unduplicated City of Burbank low to moderate income clients to be served.

Please list between 1 and 5 additional Measurable Goals that your program/project will deliver.

Attachment 3-64
4/19/22, 11:26 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C571&prop=160 3/4 Goal Measure of Service Description
100
Number of individuals
referred to partner
agencies
Referrals made by social worker to social services agencies will be tracked
50 Number of individuals
registered for CalJOBS
Library staff assist with CalJOBS registration; registrants then qualify for job services from the Verdugo Jobs Center, which will also work onsite

12. Please indicate the funds your organization will consider or pursue, if applicable (Do not include fundraising campaigns).

N/A

For Public Service or Economic Development
activities, please indicate the number of persons of
each income level that your program will assist:

Extremely Low: under 30%
Very Low: 30% to <50%
50% to <60%
Low: 60% to <80%
Total Low Income Served: 0

Budget
Budget Line Item Burbank Other Funding Program Total
Personnel Lines needed: 0
Benefits (11%) $0
Taxes $0
Subtotal Personnel $0 $0 $0
Non-Personnel
Move-In Assistance $0
Supplies & Materials $15,000 $0 $15,000
Attachment 3-65
4/19/22, 11:26 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C571&prop=160 4/4 Equipment $35,000 $35,000
Communications $0
Meetings & Convenings $0
Travel & Transportation $0
Training $0
Consulting $0
Evaluation $0
Other Lines needed:

Subtotal Non-Personnel $50,000 $0 $50,000
Total Personnel & Non-Personnel $50,000 $0 $50,000
Indirect Costs $0
TOTAL $50,000 $0 $50,000
Number of Persons Served: 0
Cost per Individual

Other Funding Sources
Other Funding Sources
Committed Amount
Committed Sources Lines needed:

Total Committed $0
Projected Funding Sources
Individuals
Corporate
Foundations
Projected Sources Lines needed:

Number of Volunteers:

Total Volunteer Hours:

Volunteer Rate ($/hour):

Volunteer In-Kind Value $0
Total Projected $0
Total Other Funding (must match budget total) $0

Attachment Link or Explanation for Missing Attachments
Attachments 1-6 not required for Public Agencies
Submitted By: Elizabeth Goldman
Date Signed 03/01/2022

Initially submitted: Mar 1, 2022 - 13:07:39
Attachment 3-66
4/19/22, 11:26 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C562&prop=148 1/5

CITY OF BURBANK
FISCAL YEAR 2022-23

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

REQUEST FOR FUNDING PROPOSALS
Project/Program Summary
Operating Agency: Burbank Temporary Aid Center
Project/Program Name: Burbank Temporary Aid Center
Type of Program/Project Capital Project
Duration of Program/Project New Project
Type of Operating Agency: Non-Profit or For-Profit Organization

Total Amount Requested for FY 2022/23: $152,980

1. Project/Program Description:

Briefly describe the primary objective of the project/program you intend to operate including all major activities to be undertaken:

After years of wear and tear, BTAC's roof has developed several leaks. There are three areas of the roof and two of the areas are experiencing a growing number of leaks each time it rains. The leaks are not only inconvenient, but are in places that could cause damage to wiring, computer equipment, and could cause physical injury on stairs and polished concrete floors. Core samples have been taken and BTAC is fortunate that black mold has not developed. Due to the type of roof, which was widely used when it was installed, it is almost impossible to determine the origins of each leak. The type of roof has multiple layers, allowing water to travel laterally and emerge a distance from the original point of entry. Due to this, patching the roof is not an option for ensuring the leaks are sealed.

2. Staff and Program/Project Location
Executive Director
Executive Director:

Barbara Howell Title: Executive Director
Phone: 818-848-2822 ext. 110 Email: [email protected] Program Manager
Program Manager: TBD Title:

Phone: '818-848-2822 Email:

Application Contact
Application Contact: Barbara Howell Title: Executive Director Phone: 818-848-2822 ext. 110 Email:

Project Addresses
Project Address: 1304 W. Burbank Blvd.

City, State Zip: Burbank, CA
Phone: 818-848-2822
Website: www.theBTAC.org
Mailing Address: 1304 W. Burbank Blvd.

City, State Zip: Burbank, CA 91506
For Public Service or Economic Development activities, please identify if the project address is the same location where program services will be provided? Yes
Program Address: 1304 W. Burbank Blvd.

City, State Zip: Burbank, CA 91506
If your program is not located in the City of Burbank, please describe how you intend to provide services in the Burbank community

DUNS Number: 786773408 Federal EIN/TIN Number: 95-3309130 SAM Number: FADXFJH1PKM8
City of Burbank Business License Number: BT 90340

3. If awarded CDBG funding, describe the location(s) of where the services will be provided:
a. Grant Amount $152,980
Attachment 3-67
4/19/22, 11:26 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C562&prop=148 2/5 Same as above
Other(address/areas/clubs/associations,
etcs.):

4. Has your organization encountered challenges in administering your program due to COVID 19 Public Health Orders? Yes No
a. If yes, explain the challenges and if they were resolved:

BTAC was heavily impacted in a few ways. There was a rapid and marked increase in requests for services.

5. (CDBG 2021-22 grant subrecipients only) Provide a progress update on your project or program. Please provide the following:
a. 2021 CDBG Grant Amount: $0
b. Do you expect to expend your grant prior to June 30 Yes No c. If no, please explain your reason(s).

N/A
d. Has your organization submitted timely quarterly reports to the City? Yes No

6. Project/Program Beneficiaries:

Please specify the Primary Beneficiary group, persons, families, or individuals your program or project intends to target.

Other - All of the above

7. Describe how you determined this project or program will assist low to moderate income residents.

Please describe your system of collecting the data (i.e inrake applications, web-based applications, etc.).

In order to operate within the Los Angeles County Health Dept. guidelines, BTAC's facility must be maintained to prevent mold and other issues that could impact the quality of the food. It also needs to be a safe place for employees, volunteers and guests to inhabit.

8. Project/Program Delivery Area:

BTAC services are primarily restricted to residents of Burbank. However, in partnership with Family Promise and Ascencia, groceries can be provided for a limited time to homeless households who become housed outside of but near Burbank.

9. Measurable Outcomes:

Goal

410 Total unduplicated low to moderate income clients to be served. 400 Unduplicated City of Burbank low to moderate income clients to be served.

Please list between 1 and 5 additional Measurable Goals that your program/project will deliver.

Goal Measure of Service Description
1 The roof will not leak when it
rains
After the repair/replacement of the roof, water leaks will cease to be an issue.

Because this has only recently reached the point of necessity, we are still exploring and pursuing other funding Attachment 3-68
4/19/22, 11:26 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C562&prop=148 3/5 option to help with this project. Our hope is that the City of Burbank will support this project, either in whole or in part. If the project is funded in whole, all other grant requests will be focused on direct service or operational funding requests. If the project is partially funded, the City's support will show leadership and be an asset in pursuing additional funding.

12. Please indicate the funds your organization will consider or pursue, if applicable (Do not include fundraising campaigns).

Parsons Foundation, Ahmanson Foundation, cash reserves, specialized direct mail or funding appeal to general public, etc.

For Public Service or Economic Development
activities, please indicate the number of persons of
each income level that your program will assist:

Extremely Low: under 30% 45
Very Low: 30% to <50% 25
50% to <60% 20
Low: 60% to <80% 10
Total Low Income Served: 100

Budget
Budget Line Item Burbank Other Funding Program Total
Personnel Lines needed: 3
Executive and Facility Staff $30,000 $30,000
Accounting Staff $10,000 $10,000
Program Manager $25,000 $25,000
Benefits (11%) $71,500 $71,500
Taxes $7,150 $7,150
Subtotal Personnel $0 $143,650 $143,650
Non-Personnel
Move-In Assistance $0
Supplies & Materials $2,500 $2,500
Equipment $0
Communications $750 $750
Meetings & Convenings $250 $250
Attachment 3-69
4/19/22, 11:26 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C562&prop=148 4/5 Travel & Transportation $0
Training $0
Consulting $5,000 $5,000
Evaluation $500 $500
Other Lines needed: 3
Roof Area 1 Replacement $57,555 $5,000 $62,555
Roof Area 2 Replacement $47,965 $5,000 $52,965
Roof Area 3 Replacement $47,460 $5,000 $52,460
Subtotal Non-Personnel $152,980 $24,000 $176,980
Total Personnel & Non-Personnel $152,980 $167,650 $320,630 Indirect Costs $0
TOTAL $152,980 $167,650 $320,630
Number of Persons Served: 0
Cost per Individual

Other Funding Sources
Other Funding Sources
Committed Amount
Committed Sources Lines needed: 1
Cash Reserves $15,000
Total Committed $15,000
Projected Funding Sources
Individuals $50,000
Corporate $25,000
Foundations $77,650
Projected Sources Lines needed: 0
Number of Volunteers:

Total Volunteer Hours:

Volunteer Rate ($/hour):

Volunteer In-Kind Value $0
Total Projected $152,650
Total Other Funding (must match budget total) $167,650

Attachment Link or Explanation for Missing Attachments
Articles of Incorporation and
Bylaws

Organization Chart
Non-Profit Determination Letters,
IRS & State (501.3.c)

Most Recent Financial
Statements
Burbank_Temporary_Aid_Center_Inc._Financial_Statements_063021.pdf Most Recent Audit & Findings, if
any
Burbank_Temporary_Aid_Center_Inc._Financial_Statements_063021.pdf Program Intake Policies
Client Intake Form
Attachment 3-70
4/19/22, 11:26 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C562&prop=148 5/5 Other -
Other -
Submitted By: Barbara Howell
Date Signed 02/24/2022

Initially submitted: Feb 24, 2022 - 15:46:56
Attachment 3-71
4/19/22, 11:27 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C572&prop=162 1/5

CITY OF BURBANK
FISCAL YEAR 2022-23

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

REQUEST FOR FUNDING PROPOSALS
Project/Program Summary
Operating Agency: City of Burbank
Project/Program Name: Santa Anita Playlot Renovation Project Type of Program/Project Capital Project
Duration of Program/Project New Project
Type of Operating Agency: City Department/Public Agency

Total Amount Requested for FY 2022/23: $350,000

1. Project/Program Description:

Briefly describe the primary objective of the project/program you intend to operate including all major activities to be undertaken:

The project includes the renovation of Santa Anita Playlot, a pocket park serving the area located in the former Verdugo-Lake Focus Area Neighborhood, in Census Tract 3118, where 72.89% of the population meet Housing and Urban Development (HUD) low-moderate income levels. The existing playground, installed in 2011, has exceeded its useful life and while safe, the renovation will ensure compliance with the new Consumer Product Safety Commission (CPSC) guidelines and current Americans with Disability Act (ADA) requirements.

The project includes: site work and demolition of the existing playground and installation of: (1) play structure designed for 2-5 year olds; (1) play structure designed for 5-12 year olds, shade structure, swings, and rubberized safety surfacing.

When approaching the replacement of playground equipment, the Parks and Recreation Department (Department) prides itself on creating unique play areas that are unique in design and offerings. The Department's goal is to ensure that each and every park or playground has a unique element, look, and feel. Playgrounds that promote different types of play are vital for a child's cognitive, emotional, physical and social development. The playground equipment selected at Santa Anita Playlot will provide children with an innovative play area to exercise and develop other critical social skills. In addition, the Playground improvements will enhance the Santa Anita Playlot area and its existing amenities.

2. Staff and Program/Project Location
Executive Director
Executive Director:

Marisa Garcia Title: Parks and Recreation Director
Phone: 818-238-5310 Email: [email protected]
Program Manager
Program Manager: Michael del Campo Title: Landscape and Forestry Superintendent
Phone: '818-238-5343 Email: [email protected]
Application Contact
Application Contact: Graciela Coronado Title: Administrative Officer Phone: 818-238-5305 Email: [email protected]
Project Addresses
Project Address: 275 E. Olive Avenue
City, State Zip: Burbank, CA 91502
Phone: 818-238-5300
Website: www.BurbankCA.gov/ParksandRecreation
Mailing Address: 275 E. Olive Ave.

City, State Zip: Burbank, CA 91502
For Public Service or Economic Development activities, please identify if the project address is the same location where program services will be provided? No
Program Address: 250 W. Santa Anita Avenue
City, State Zip: Burbank, CA 91502
If your program is not located in the City of Burbank, please describe how you intend to provide services in the Attachment 3-72
4/19/22, 11:27 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C572&prop=162 2/5 Burbank community

DUNS Number: 071906432 Federal EIN/TIN Number: 95-6000683 SAM Number: N/A
City of Burbank Business License Number: N/A

3. If awarded CDBG funding, describe the location(s) of where the services will be provided:
a. Grant Amount
Same as above
Other(address/areas/clubs/associations,
etcs.):250 W. Santa Anita Avenue, Burbank, CA
91502

4. Has your organization encountered challenges in administering your program due to COVID 19 Public Health Orders? Yes No
a. If yes, explain the challenges and if they were resolved:

6. Project/Program Beneficiaries:

Please specify the Primary Beneficiary group, persons, families, or individuals your program or project intends to target.

Families with children

7. Describe how you determined this project or program will assist low to moderate income residents.

Please describe your system of collecting the data (i.e inrake applications, web-based applications, etc.).

The Santa Anita Playlot is located in a dense neighborhood surrounded by multi-family housing, McKinley Elementary School (Title 1 School), the Burbank Channel, and located south of the Interstate-5 Highway. The Census Tract includes: 1,210 residents (or 72.89%) of residents in the low- to moderate-income category (American Community Survey, 2014-2018).

Since 1997, the City has partnered with nonprofit Burbank Housing Corporation to proactively revitalize areas and develop affordable housing in five Focus Neighborhood Revitalization areas (Elmwood, Verdugo/Lake, Golden State, Peyton/Grismer, and Lake/Alameda neighborhoods). The Santa Anita Playlot Project is located in the Verdugo/Lake neighborhood, in a HUD‐designated Low and Moderate Income (LMI) area within a census tracts with high minority concentration. Within the Focus Neighborhoods, the City and its former Redevelopment Agency provided funding to BHC to acquire, rehabilitate, and manage rental properties as long‐term affordable housing.

Within the neighboring area are over 5 units designated for affordable housing and operated by BHC.

Serving the Primary Beneficiary group 'Families with Children', the majority of Burbank households are comprised of families (60.3%), including 41% of families with children. Other Project/Program Beneficiaries include: Seniors (12% of the population), Unemployed and Underemployed, Youth or Young Adults, Immigrant Individuals/Families, and Distressed Homeowner's/Renter's.

Within the City of Burbank, 11% of residents live further than a half mile from a park. In contrast, 24% of California residents live further than half a mile from a park. While the City is 'built-out', the renovation of this park will greatly improve the recreational opportunities for those that live in the area, enhance safety, provide access to green space, and provide overall community enhancing benefits.

Using environmental, health, and socioeconomic information from CalEnviroScreen, the area nearest the Interstate 5 highway are identified as disadvantaged communities within the City of Burbank. The neighborhoods ones that are most affected by many sources of pollution, and where people are often especially vulnerable to pollution’s Attachment 3-73
4/19/22, 11:27 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C572&prop=162 3/5 effects. An area with a high percentile score is one that experiences a higher pollution burden than areas with low scores. In the City of Burbank, disadvantaged communities lie along Interstate-. Using the California Healthy Places Index (HPI), which uses 25 individual indicators to measure a community’s health and predict its life expectancy, the same communities appear to be the most unhealthy in the City.

The Project was selected over other parks for proposed renovations, because of its condition and eligibility to CDBG funding.

The City utilizes data from The Trust from Public Land Park Score Index, California Department of Parks and Recreation Community FactFinder, the California Healthy Places Index, the American Community Survey, US Census, EPA’s CalEnviroScreen, and City-commissioned reports to collect demographic data. In addition, the City incorporates community input for Capital Improvement Programs and Park planning.

8. Project/Program Delivery Area:

The City of Burbank's Parks and Recreation Department (Department) strives to be the heart of the community by providing enriching opportunities through dedicated people, beautiful parks and inspiring programs. The Department is responsible for providing well-maintained recreational facilities, as well as programs and activities designed to meet the recreational, cultural, social and human services needs of the Burbank community, including residents and visitors. The park generally serves the neighboring community at approximately 95% usage, with approximately 5% of usage attributed to non-residents.

9. Measurable Outcomes:

Goal

43840 Total unduplicated low to moderate income clients to be served. 43840 Unduplicated City of Burbank low to moderate income clients to be served.

Please list between 1 and 5 additional Measurable Goals that your program/project will deliver.

Goal Measure of Service Description
Renovation of
Santa Anita Playlot
Design, Construction and installation of
project within budget.

The Project includes the replacement of the
antiquated playground equipment and recycled
rubber surface cover, and replacement of the
existing shade structure over the playground
area.

Create or Expand
Parks in Areas that
Lack Sufficient Park
Space
Number of Park Acres The Project will expand park acreage within a half mile of an underserved community
Safety,
Beautification, and
Environmental
Benefits to New and
Existing Parks
Number of Landscape and Beautification
Improvements, Numbers of Trees Planted,
Number of Greenhouse Gases
Sequestered, Number of New Amenities
The Project includes the use of recycled
materials under the playground equipment and
use of shade trees to reduce the urban heat
island effect, promote park use, and reduce
greenhouse gas emissions.

Creating Multi-use
Parks designed for
all age groups and
provide Equitable
Park Access
Number of Amenities Serving All Age
Groups; Utilizing Community Input in Project
Design, Americans with Disabilities (ADA)
Compliance, Number of Community
Engagement Participants
The Project will enhance the park area for all
user groups and will incorporate community
input in the Project design

The Department receives an annual allocation of funds from the Los Angeles County Measure A program and a portion of these funds will be dedicated to enhancing and improving the Park.

11. On a level of sustainability (program longevity), has your organization or Board approved Attachment 3-74
4/19/22, 11:27 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C572&prop=162 4/5 applying, collaborating, or accepted any State, Federal, County, or philanthropic grants, benefits, or other non-CDBG funding in 2022? Yes No
Fund/Grant Name Amount
Los Angeles County Safe, Clean Neighborhood Parks and Beaches Measure (Measure A) $125,000

12. Please indicate the funds your organization will consider or pursue, if applicable (Do not include fundraising campaigns).

The Department will pursue additional Federal, State, and County funding opportunities, specifically for capital grants.

For Public Service or Economic Development
activities, please indicate the number of persons of
each income level that your program will assist:

Extremely Low: under 30% 0
Very Low: 30% to <50% 0
50% to <60%
Low: 60% to <80% 43,840
Total Low Income Served: 43,840

Budget
Budget Line Item Burbank Other Funding Program Total
Personnel Lines needed:

Benefits (11%) $0
Taxes $0
Subtotal Personnel $0 $0 $0
Non-Personnel
Move-In Assistance $0
Supplies & Materials $0
Equipment $125,000 $220,000 $345,000
Communications $0
Meetings & Convenings $0
Travel & Transportation $0
Training $0
Consulting $0
Evaluation $0
Other Lines needed: 1
Site Work, Demolition and
Installation $225,000 $225,000
Subtotal Non-Personnel $350,000 $220,000 $570,000
Total Personnel & Non-Personnel $350,000 $220,000 $570,000 Attachment 3-75
4/19/22, 11:27 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C572&prop=162 5/5 Indirect Costs $0 $0
TOTAL $350,000 $220,000 $570,000
Number of Persons Served: 43,840
Cost per Individual $8

Other Funding Sources
Other Funding Sources
Committed Amount
Committed Sources Lines needed:

Total Committed $0
Projected Funding Sources
Individuals
Corporate
Foundations
Projected Sources Lines needed: 1
Measure A Funding $220,000
Number of Volunteers: 0
Total Volunteer Hours: 0
Volunteer Rate ($/hour): $0.00
Volunteer In-Kind Value $0
Total Projected $220,000
Total Other Funding (must match budget total) $220,000

Attachment Link or Explanation for Missing Attachments
Attachments 1-6 not required for Public Agencies
Submitted By: Marisa Garcia
Date Signed 03/01/2022

Initially submitted: Mar 1, 2022 - 16:28:25
Attachment 3-76
4/19/22, 11:27 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C371&prop=151 1/5

CITY OF BURBANK
FISCAL YEAR 2022-23

COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM

REQUEST FOR FUNDING PROPOSALS
Project/Program Summary
Operating Agency: Community Development Department
Project/Program Name: Facility Renovation and Accessibility Improvements Type of Program/Project Capital Project
Duration of Program/Project New Project
Type of Operating Agency: City Department/Public Agency

Total Amount Requested for FY 2022/23: $500,000

1. Project/Program Description:

Briefly describe the primary objective of the project/program you intend to operate including all major activities to be undertaken:

The City of Burbank Community Development Department is proposing to rehabilitate the former Boys and Girls Clubhouse located at 2244 N. Buena Vista Street by utilizing Community Development Block Grant (CDBG) Capital Improvement funds. The objective is to rehabilitate and modernize the property based on an assessment conducted by the City. The condition of the existing structural, electrical, mechanical, plumbing, roofing and fire life safety aspects of the property require, at a minimum, to be brought up to code. The modernization will help overcome any apparent deficiencies with regard to safety, functionality, efficiency, and ADA accessibility. As a publicly owned facility, the City intends to release a Request for Funding Proposal (RFP) to bid for use of the building as their primary office. Eligible proposals will be accepted from Burbank nonprofits that will primarily serve low to moderate income people. The RFP is anticipated to be released in 2022.

In general, the main building is a one-story structure, approximately 4,500 SF with a 3 stall parking lot, and adjacent to an alley way on the north and single-family residence on the south. The exterior walls are concrete, with an aluminum storefront entry. The main building has a flat roof with a parapet. The site also includes two temporary structures; one structure of approximately 850 SF and the other of approximately 280 SF. The temporary structures are not part of the modernization.

As the applicant of CDBG funding, the Community Development Department will work in conjunction with Public Works to solicit proposals for construction of the project. Although the cost of rehabilitation and modernization is expected to be greater than the amount of CDBG funding requested, the nonprofit selected under the RFP will be required to leverage other non-CDBG funds to complete the renovations. The cost of the improvements is estimated over $1.4 million.

2. Staff and Program/Project Location
Executive Director
Executive Director:

Justin Hess Title: City Manager
Phone: 818-238-5800 Email: [email protected]
Program Manager
Program Manager: Marcos Gonzalez Title: Housing Development Manager Phone: '8185551212 Email: [email protected]
Application Contact
Application Contact: Marcos Gonzalez Title: Housing Development Manager Phone: 818-238-5212 Email: [email protected]
Project Addresses
Project Address: 2244 N. Buena Vista Street
City, State Zip: Burbank, CA 91504
Phone: 818-238-5212
Website:

Mailing Address: 150 N. Third Street
City, State Zip: Burbank, CA 91502
For Public Service or Economic Development activities, please identify if the project address is the same location where program services will be provided? Yes
Attachment 3-77
4/19/22, 11:27 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C371&prop=151 2/5 Program Address: 2244 N. Buena Vista Street
City, State Zip: Burbank, CA 91504
If your program is not located in the City of Burbank, please describe how you intend to provide services in the Burbank community
Yes. The subject property is owned by the City of Burbank and is located at 2244 N. Buena Vista Street, in a low- income census tract 310501.

DUNS Number: 113670967 Federal EIN/TIN Number: 95-6000683 SAM Number: R2ABP7NMRUG7
City of Burbank Business License Number: N/A

3. If awarded CDBG funding, describe the location(s) of where the services will be provided:
a. Grant Amount $500,000
Same as above
Other(address/areas/clubs/associations,
etcs.):The areas serviced will be consistent with
the operations of the service provider that include
Burbank residents.

4. Has your organization encountered challenges in administering your program due to COVID 19 Public Health Orders? Yes No
a. If yes, explain the challenges and if they were resolved:

No. This is a new grant application for a new project.

5. (CDBG 2021-22 grant subrecipients only) Provide a progress update on your project or program. Please provide the following:
a. 2021 CDBG Grant Amount: $500,000
b. Do you expect to expend your grant prior to June 30
Yes No
c. If no, please explain your reason(s).

The City of Burbank applied for CDBG in FY 2021 to prepare, design, and pre-develop interim housing on a public owned parcel of land. To date, the City has taken steps to identify other funding sources for the construction prior to expending any CDBG funding. The City is preparing to present a report to City Council in the spring of 2022 on our due diligence of identifying a site and releasing an Request For Proposals for an interim housing operator. This project will require CDBG funds to be carried-over to Fiscal Year 2022-23. d. Has your organization submitted timely quarterly reports to the City? Yes No

6. Project/Program Beneficiaries:

Please specify the Primary Beneficiary group, persons, families, or individuals your program or project intends to target.

Other - Beneficiaries will be associated with the organization utilizing the site, which is limited to low-income households.

7. Describe how you determined this project or program will assist low to moderate income residents.

Please describe your system of collecting the data (i.e inrake applications, web-based applications, etc.).

Upon the completion of the project renovations and RFP announcement, the nonprofit will primarily serve low to moderate income people and comply with all reporting requirements to the City.

8. Project/Program Delivery Area:

The project's location is in a low-income census tract (310501) that will serve low to moderate income people in order to qualify for CDBG funding. The percentage of residents that are low to moderate income in and around the neighborhood is over 51%.

9. Measurable Outcomes:

Attachment 3-78
4/19/22, 11:27 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C371&prop=151 3/5 Please provide proposed outcomes and performance measures for your proposed project/program. Please provide a quantifiable/measurable outcome that can be evaluated by staff. In addition, describe how your organization will achieve successful outcomes.

Goal

1,995 Total unduplicated low to moderate income clients to be served. 1,995 Unduplicated City of Burbank low to moderate income clients to be served.

Please list between 1 and 5 additional Measurable Goals that your program/project will deliver.

Goal Measure of Service Description
1 Develop a scope of work Meet with Public Works, Building, and CDD to develop a scope of work
2 Bid the project Solicit proposals from licensed and insured contractors 3 Begin Construction and
Improvements Award and and commence construction
4 Nonprofit Lease Agreement Enter into a lease agreement with a nonprofit to use the property

As requirement under the 2244 N. Buena Vista RFP, the applicant will be required to leverage other non-CDBG funding to support the renovations of the building. The City expects the $500,000 from CDBG to be a one-time capital cost investment for the renovations.

12. Please indicate the funds your organization will consider or pursue, if applicable (Do not include fundraising campaigns).

See response to question 10.

For Public Service or Economic Development
activities, please indicate the number of persons of
each income level that your program will assist:

Extremely Low: under 30% 0
Very Low: 30% to <50%
50% to <60%
Low: 60% to <80% 1,995
Total Low Income Served: 1,995
Attachment 3-79
4/19/22, 11:27 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C371&prop=151 4/5

Budget
Budget Line Item Burbank Other Funding Program Total
Personnel Lines needed: 3
$0
$0
$0
Benefits (11%) $0
Taxes $0
Subtotal Personnel $0 $0 $0
Non-Personnel
Move-In Assistance $0
Supplies & Materials $0
Equipment $0
Communications $0
Meetings & Convenings $0
Travel & Transportation $0
Training $0
Consulting $0 $0
Evaluation $0
Other Lines needed: 1
Construction $500,000 $0 $500,000
Subtotal Non-Personnel $500,000 $0 $500,000
Total Personnel & Non-Personnel $500,000 $0 $500,000
Indirect Costs $0
TOTAL $500,000 $0 $500,000
Number of Persons Served: 1,995

Cost per Individual $251

Other Funding Sources
Other Funding Sources
Committed Amount
Committed Sources Lines needed:

Total Committed $0
Projected Funding Sources
Individuals $0
Corporate $0
Foundations $0
Projected Sources Lines needed:

Number of Volunteers:

Total Volunteer Hours:

Volunteer Rate ($/hour):

Volunteer In-Kind Value $0
Total Projected $0
Total Other Funding (must match budget total) $0

Attachments
(Upload Instructions)
Checked attachments below are REQUIRED in order to submit your application, and your application WILL NOT be able to be submitted with missing attachments! Please take this into consideration when timing your submission of this application. The documents you need to upload are checked below. If you have other attachments you Attachment 3-80
4/19/22, 11:27 AM City Data Services - Burbank
https://www.citydataservices.net/cities/burca/app2022arc.pl?rpt=C371&prop=151 5/5 would like to include, please check the box and, if Other, identify the Attachment in the box. If you are unable to upload any of the attachments, contact Marcos Gonzalez at 818-238-5212 or [email protected] at least one day prior to the deadline.

Attachment Link or Explanation for Missing Attachments
Attachments 1-6 not required for Public Agencies
Submitted By: Marcos Gonzalez
Date Signed 03/01/2022
Approved By: Melania Kuredjian
Date Signed 03/05/2021
Approval Modified By CDS for Melania K.

Date Signed 05/20/2021

Initially submitted: Mar 4, 2021 - 17:09:10
Attachment 3-81

Burbank City CouncilJune 7, 2022

Burbank City Council
June 7, 2022