Exhibit G: Application Matrix
Amount Requested
FY 21/22AllocationFY 20/21AllocationFY 19/20AllocationPersons ServedNational Objective DUNS
Workers CompLiability Insurance
Contact Info
Schedule of Performance
Proposed BudgetConflict of InterestAgency CertificationPlaying By the RulesCertificate of InsuranceArticles of IncorporationNon-Profit Determination Board of Directors
Resumes of Key Personnel
Job DescriptionsAudit / financials
Legal Name Program SAM
Comments
$23,700 $13,245 $21,000 $0 510 yes yes yes yes yes yes yes no conflict yes provided yes yes yes yes yes yes audit $40,000 $20,000 $0 $0 20 yes yes yes yes yes yes yes no conflict yes provided yes yes yes yes yes yes 990 $28,700 $13,245 $20,000 $11,376 40 yes yes concern (1) yes yes yes yes no conflict yes provided liability only yes yes yes yes yes concern (2) $42,000 $42,000 $40,417 $40,417 26 yes yes yes yes yes yes yes disclosed yes provided yes yes yes yes yes yes 990 $15,000 75 yes yes exempt exempt yes yes yes disclosed yes provided na na na na na na na $20,000 50 yes yes exempt exempt yes yes yes disclosed yes provided na na na na na na na $169,400 $88,490 $81,417
$32,000 $32,478 $29,061 $29,061 350 yes yes yes yes yes yes yes none yes provided yes yes yes yes yes yes yesInland Fair Housing and Mediation Board
Fair Housing
Services clear Services will be paid out of
adminsitration set aside.
Community Services
Department
Rialto Teen
Computer Lab clear
Public Services SubTotal
National Council of Negro
Women Inc
NCNW Bethune
Center concern (1) (1) Entity must register
Community Services
Department
Rialto Senior
Computer Lab clear
Easterseals Southern California Autism Services clear
Rialto Family Health Services Veterans
Program clear
(1) applicant indicated N/A
for workers comp however
they list paid staff in
application. WC will be
required. (2) Working with
applicant to submit chart
of accounts
Legal Aid Society of San
Bernardino
Legal Aid -
Rialto clear