1 CITY OF VISALIA
COMMUNITY DEVELOPMENT BLOCK GRANT CARES ACT
(CDBG-CV) APPLICATION RFP 22-23-25
I. ORGANIZATION INFORMATION
A. Organization Name: ____________________________________________________________________________________ Physical Address: _______________________________________________________________________________________ Mailing Address: ________________________________________________________________________________________ CEO/Executive Director Name and Title: _____________________________________________________________ Email: ________________________________________________ Telephone: ______________________________________ CFO/Financial Manager Name and Title: _____________________________________________________________ Email: ________________________________________________ Telephone: ______________________________________ Project Manager Name and Title: ______________________________________________________________________ Email: _______________________________________________ Telephone: _______________________________________ DUNS Number: ___________________________________ Tax ID Number: ____________________________________ Organizational Type:
_____501(c)(3) _____ For Profit _____ Faith Based _____ Government or _____Other: __________________________________________
II. PROJECT INFORMATION
A. Project Name: ________________________________________________________________________________________ Project Address: ______________________________________________________________________________________ Project Purpose: ______________________________________________________________________________________ Funding Request: __________________________ Total Project Budget: __________________________________ Is this a CDBG-CV stand-alone project? _____Yes _____ No If not, list other project funding sources and amounts: _____________________________________________ ____________________________________________________________________________________________________________ Project History:
Has this project been funded by a HUD or HCD grant before: ______Yes ______ No If so, list type of fund(s): _______________________________________________________________________ Anticipated start date: ______________________ Anticipated end date: _______________________ Program Outcomes:
Indicate the total number of unduplicated households this project intends to serve during the contract. _______ Households
2 III. PROJECT DETAIL
A. Project Summary:
Project description as it related to be used to prevent, prepare for, and respond to the Coronavirus Pandemic. Please include the community need these services will address, target population, core services delivered, and average length of time of services.
3 B. Project Management:
Describe the management experience in delivering similar programs, especially HUD-funded.
C. Project Readiness:
Describe the management experience in delivering similar programs, especially HUD-funded.
Please describe steps that been completed or must be completed to initiate the project. These may include, but are not limited to community support, staffing, marketing, and networking.
4 D. Duplication of Benefit:
Does your organization currently receive funding for rental/mortgage assistance available to City of Visalia residents? ____Yes ____ No
If so, is it enough to meet the current demand due to the Coronavirus Pandemic in the City of Visalia? ____Yes ____ No
E. In-Person Assistance:
Will your organization provide in-person assistance to enrolling clients? ____Yes ____ No F. Public Services:
Is this a new public service? ____Yes _____ No
Is this an expansion of an existing service? ____Yes _____No IV. PROJECT BUDGET
A. Budget Matrix – Submit attached in excel format.
Administration maximum allowed budget is 20% of the total program funding. Client expenditure budget must be a minimum of 80% of the total program funding. The total program funding percentage calculation does take into consideration all program funding, including other funding sources to carry out the proposed project. Please identify all rental and mortgage assistance available to City of Visalia residents.
B. Budget Narrative – Submit attached in excel format.
The undersigned certifies the information contained herein is true and correct to the best of their knowledge. The applicant further understands that the application is a request and there is no guarantee that funds will be provided to the applicant. All organizations awarded federal funds will be subject to federal and local regulatory regulations.
Name and Title of Authorized Official: __________________________________________________________________ Signature: _______________________________________________________________ Date: _____________________________