Item 16 - Prioritization of Fiscal Year 2022-2023 Community Development Block Grant Projects/Programs

Agenda Item No. 16

CITY OF YUCAIPA

AGENDA REPORT
TO: Honorable Mayor and City Council
FROM: 0 Ryan Blackerby, Accounting Manager
FOR: City Council Meeting of February 14, 2022
SUBJECT: Prioritization of Fiscal Year 2022-2023 Community Development Block Grant Projects/Programs
RECOMMENDATION:

That City Council conduct a public hearing and prioritize eligible project proposals for submission to the San Bernardino County Board of Supervisors for Community Development Block Grant funding consideration.

BACKGROUND:

The City of Yucaipa, through a cooperative agreement with the County of San Bernardino, participates in the federal Community Development Block Grant (CDBG) funding program. On an annual basis, the City of Yucaipa receives an allocation of funds from CDBG, which are passed - through San Bernardino County, and can be used on eligible construction projects and public service programs. The purpose of this grant program is to address needs identified within the community and to assist specific target areas that qualify as low-income areas. Eligible target areas are those portions of the community that meet the low to moderate income level criteria, as determined by the U.S. Department of Housing and Urban Development (HUD). These resources primarily fund capital improvements within eligible target areas. In addition, up to 15% of the total County -wide allocation received may be spent on public service programs that primarily benefit residents that qualify pursuant to the low-income criteria established by HUD.

Every three years the County is required to re -qualify as an Urban County under the CDBG program and it is through this process that the annual CDBG entitlement funds are established for participating cities, including the City of Yucaipa. Every three years since 2014, the City of Yucaipa has been identified as a "Metropolitan City" per HUD guidelines, which includes a population figure in an amount greater than 50,000, and therefore is able to participate directly with HUD as an Entitlement City, should the City choose to do so. In 2014, 2017, and again in 2020, the City Council elected to continue its participation with the County. Staff will be reevaluating this arrangement and will in the future make a recommendation to City Council as to -150-

City Council Agenda Report
Prioritization of Fiscal Year 2022-2023 CDBG Projects
For Meeting of February 14, 2022
whether the City should continue as a participant in this cooperative agreement with the County or choose to interact directly with HUD as an Entitlement City, which would bring the management of this program "in-house." The next opportunity to make this election is anticipated to be in 2023.

Historically, the City has chosen to fund construction projects for improvements to City facilities for the elimination of barriers pursuant to the Americans with Disabilities Act (ADA), and to fund infrastructure improvements enhancing roadways, including storm drains, curbs, gutters and sidewalks. In addition to the eligible City project proposals, not-for-profit community-based organizations, serving various segments of Yucaipa, have also historically submitted project or program proposals in anticipation of funding. Annually, the City Council conducts a public hearing to provide an opportunity for community members and organizations to communicate with the City Council and to present and discuss requests for funding consideration regarding the City's annual CDBG allocation. At the conclusion of the public hearing, Council will be asked to prioritize the proposals for funding. The funding approved by Council will be finalized as a function of the Fiscal Year 2022-2023 (FY 23) budget process.

DISCUSSION:

Based on the most recent estimate from the County, the projected CDBG allocation for the City of Yucaipa for FY 23 is expected to be approximately $257,592. Regularly, the San Bernardino County Department of Community Development and Housing (CDH) updates its estimates used in determining the proportional share of qualifying eligibility factors among Cooperative Agencies in order to determine the level of funding to be allocable to each agency. While the actual allocation amount is not likely to change significantly from this preliminary figure, if additional funds become available, staff will return to Council with a recommendation for their disposition, as appropriate.

There are primarily two project classifications considered for CDBG funding. These include: 1) public service programs, and 2) construction projects. HUD restricts funding for public service programs to 15% of the total annual allocation. As a result, it is expected that Yucaipa's public service programs will be subject to a limit of $38,639, or 15% of Yucaipa's anticipated allocation of $257,592. If Council allocates the entire 15% to public service programs, then the remaining amount of $218,953 will be available for construction projects. While 15% may be spent on public service programs, there is no requirement to spend any amount on public service programs. As a result, the entire annual allocation may be used to fund construction projects.

FY 23 Project Proposals
The Notice of Funding Availability (NOFA) for FY23 was advertised by CDH, and it was also posted on the City website. Funding applications have been received by CDH, and CDH has reviewed the proposals submitted in order to determine their funding eligibility. Attachment 2 lists six programs/projects deemed eligible by CDH, including one City initiated construction project proposal, one City initiated public service program proposal and four public service program proposals submitted by outside non-profit organizations, each of which are discussed later in this report.

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City Council Agenda Report
Prioritization of Fiscal Year 2022-2023 CDBG Projects
For Meeting of February 14, 2022
Of the six eligible proposals, only the one City construction project proposal is considered a construction project. The remaining five proposals, including the City's scholarship program, are considered public service programs. The total amount requested for public service programs is $77,000, while the actual funding available to these programs is limited to the $38,639 previously mentioned.

In previous years, the minimum funding threshold was $10,000 for public service program allocations and $75,000 for construction projects. The County notified staff in Fiscal Year 2015- 2016 that there are no longer minimum project funding thresholds. However, the total allowable number of newly funded projects is based on the percentage of each City's share of the total CDBG allocation and the maximum number allowed is based on the City's CDBG Administrative Cap.

For FY 23, the County has determined that the City of Yucaipa may fund a total of seven projects, of which no more than two may be new construction projects.

City's Construction Projects
For FY 23, the City submitted one construction project proposal, as follows:

1. Adams Street (Avenue B to Yucaipa Blvd) and Avenue B (Adams Street to 1 st Street) — the project includes removing existing ADA barriers and designing and constructing sidewalk, curb/gutter, and associated street improvements in the Uptown area along the west and east side of Adams Street (between Avenue B and Yucaipa Boulevard) and north side of Avenue B (between Adams Street and 1st Street). The project includes ADA curb ramps, ADA accessible path/sidewalks, and minor drainage improvements to support the local overall proposed improvements. The application for the proposed project is being submitted in the amount of $216,358. At this time, staff anticipates the requested additional CDBG funding will fully fund the project with a total proposed CDBG allocation of $460,116 (with $243,758 in allocation from prior years).

If the project is prioritized by the City Council for FY 23 funding, then staff will include the budget for this project as part of the CIP Budget for City Council approval in the FY 23 Budget process.

City Public Service Proposal and Proposals Submitted by Not -for -Profit Organizations Staff is again recommending that a portion of the funds available for public service programs be used for the continuation of the Community Services Scholarship Program. The program offers scholarships for the City recreation activities to eligible participants. Eligibility is for low to moderate income level families, as determined pursuant to HUD criteria. It is estimated that the entire Fiscal Year 2021-2022 (FY 22) allocation of $15,326 will be spent during FY 22, with applications remaining unfunded by the City's allocation to the program. As a result, staff will be recommending funding in the amount of $17,000 for FY 23.

In addition to the City project/program proposals mentioned above, four proposals were received from not-for-profit community-based organizations within the greater San Bernardino area that met the submittal criteria, pursuant to the requirements established by HUD and CDH and,

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City Council Agenda Report
Prioritization of Fiscal Year 2022-2023 CDBG Projects
For Meeting of February 14, 2022
therefore, have been determined eligible for funding consideration. Below is a list of all the eligible proposals submitted by both the City and San Bernardino County area not-for-profit organizations. In addition to the City's scholarship program, the four non -City related proposals are considered public service proposals and, therefore, are collectively subject to the 15% funding restriction.

The City's allocation may be spent entirely on construction projects. However, if the Council determines to allocate a portion on public service programs, it may do so up to the maximum amount of 15%, or $38,639. The total allowable number of newly funded projects is based on the percentage of each City's share of the total CDBG allocation, and the maximum number allowed for newly funded construction projects is based on the City's CDBG Administrative Cap.

The lists of public service and construction project proposals below have not been prioritized by staff. For Council information, the table below also includes a column which reflects the allocation amounts and organizations that were recipients of Yucaipa's CDBG funds in the previous year. 2022-2023 Public Service Proposals
Amount City
Council
Amount
Applicant
Project Description
Allocated in
Requested for
2021-2022
2022-2023
1 San Bernardino County Library
Continuation and expansion of
6,500
10,000
Yucai a Adult Literacy Program
2 Boys & Girls Club of the
Summer Camp program at Dunlap
San Gorgonio Pass
Elementary
N/A
20,000
3 Family Service Association, dba
Continuation and expansion of Senior
FSA (Senior Nutrition Program)
Nutrition Program
6,500
10,000
4 Partners Against Violence
Supportive services for victims of
(formerly San Bernardino Sexual
violence
6,500
20,000
Assault Services
5 City of Yucaipa
Continuation of recreational
15,326
17,000
scholarship program
Total
$41,326 *
$77,000
Total Public Service Allocation Available (15%)
$38,639
*Pail of this total is $6,500 received by Family Services Association of Redlands in FY 22 but is not shown above, as they are not among the eligible project proposals for FY 23.

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City Council Agenda Report
Prioritization of Fiscal Year 2022-2023 CDBG Projects
For Meeting of February 14, 2022
2022-2023 Construction Project Proposals
$216,358
Total Public Service Proposals (from above)
Amount
77,000
Applicant
Project
Requested for
2022-2023
Removing existing ADA barriers and designing and
constructing sidewalk, curb/gutter, and associated street I
City of Yucaipa
improvements in the Uptown area along the west and
216,358
east side of Adams Street (between Avenue B and
Yucaipa Boulevard) and north side of Avenue B
between Adams Street and 1st Street).

Total
$216,358
Total Construction Projects Proposals (from above)
$216,358
Total Public Service Proposals (from above)
77,000
Total 2022-2023 CDBG Project/Program Proposals
$293,358

RECOMMENDATION
Public Service Programs
It is anticipated that the amount available for public service programs will be $38,639. This is equal to 15% of the total expected FY 23 allocation in the amount of $257,592. Three of the outside non-profit organizations that received funding in the prior fiscal year, plus one who did not, have project proposals eligible for funding for FY 23. The five requests for public service funds, including the City's Scholarship Program, total $77,000.

Council may choose an allocation strategy similar to the prior year or Council may choose to fund at different levels, subject to the funding constraints. Council may also choose to fund programs at different levels than the amounts specifically requested by the organizations or may choose not to fund any public service programs.

Organizations who do not receive full or partial funding of their CDBG requests may choose to participate in the City's FY 23 Community Activity Grant (CAG) program application process.

Construction Projects
Pending the decision to allocate funds to public service programs, the anticipated total FY 23 allocation amount available for construction projects is equal to $218,953. The funding request for the proposed construction project is $216,358.

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City Council Agenda Report
Prioritization of Fiscal Year 2022-2023 CDBG Projects
For Meeting of February 14, 2022
FISCAL IMPACT:

There is no anticipated fiscal impact on the General Fund at this time. This action only prioritizes the projects for the FY 23 allocation. The actual authorization to complete the projects will be accomplished through the normal budgeting, bidding and purchasing process. The expenses related to this item, when incurred in FY 23, will be spent from the CDBG Fund and subsequently reimbursed from the CDBG grant.

The total amount of anticipated CDBG funding for FY 23 is as follows:

Attachments:

1. Letter of award from County EDA

2. Eligible Project List

3. Actual Proposals for all Eligible Projects
Approved by:

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FY 2022-2023 CDBG Funding
Amount
Anticipated 2022-2023 CDBG Funding
$257,592
Less: Amount available to fund Public Service Proposals (38,639)
Total: Amount Available for Construction Projects
$218,953
Attachments:

1. Letter of award from County EDA

2. Eligible Project List

3. Actual Proposals for all Eligible Projects
Approved by:

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Attachment 1
From: Graham, Kelly
Sent: Tuesday, January 11, 2022 9:06 AM
To: [email protected]; 'Fermin Preciado' ; Megan Wolfe Cc: Bryan Anderson ; Kelly Graham ; 'Todd
Gutjahr'
Subject: CDBG Eligible Projects List and Request for Recommended Funding - Yucaipa Good Morning:

Each year, the County of San Bernardino (County) must prepare and submit to the U.S. Department of Housing and Urban Development (HUD) an Annual Action Plan that identifies the amount of funding it expects to receive from HUD and outlines the specific activities it anticipates to fund in pursuit of its Countywide housing and community development goals and objectives.

For the 2022-2023 Program Year (PY), the County anticipates receiving $7.4 million to support the activities to be listed in its 2022-2023 Annual Action Plan.

To ensure the timely submittal of the County's Annual Action Plan, an estimate has been used. It is important to note that it is possible that this estimate may change (+/-) between now and when the U.S. Congress approves the 2022-2023 federal budget. Once the final federal allocation is released, adjustments to the distribution of County funds may be necessary. For PY 2022-2023 your City's estimated annual allocation is $257,592.

This amount is based on U.S. Census poverty, overcrowded housing counts and population estimates, which means that your City's allocation could have an increase or a decrease to the estimate (City's estimated annual allocation above) . Please note that the allocation amounts are estimates and are subject to change based on HUD's actual allocation to the CDBG Program.

The County has received a number of proposals in response to its PY 2022-2023 Notice of Funding Availability (NOFA) and has evaluated each proposal for its conformance to the federal requirements. To involve your City in the decision-making process, please provide us with a prioritized list of those eligible proposals that best meet your City's goals and objectives.

To assist you in this effort, please use the bropbox link to access the following documents:

1. List of Eligible Project Applications

2. Copies of Eligible Project Applications

3. List of Ineligible Project Proposals (if any)

4. Cooperating City Recommended Projects Form
As a Cooperative City participating in the County's CDBG program, it is imperative that you complete your public hearing for your CDBG funding recommendations and submit the action made by your City Council on the attached Cooperating City Recommended Projects Form and a copy of your City Council minutes to our office by or before Thursday, February 24, 2022. After this date we may be unable to include your City Council recommendations in the list of projects for the County Board of Supervisor's consideration.

Grant Process and Funding Thresholds
The 15% Public Service Cap applies for cities that receive $150,000 or more in CDBG funding allocation. The total allowable number of newly funded projects is based on the percentage of each city's formula share of the CDBG allocation and the maximum number allowed for newly funded construction projects is based on the City's CDBG Administrative Cap. The cities of Big Bear Lake, Grand Terrace, Needles and the Town of Yucca Valley, which are receiving less than $150,000, may only fund four (4) projects. The remaining cities have the following funding opportunities:
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Attachment 1
City
Total Allowable Maximum Number of
Projects Construction
Projects
Estimated
15% Public
Service Cap
Adelanto
9 2
$53,003
Barstow
5 2
$42,198
Colton
11 5
$65,090
Highland
10 5
$66,588
Loma Linda
5 1
$23,192
Montclair
9 2
$43,724
Redlands
9 2
$54,791
Twentynine Palms
5 1
$26,249
Yucaipa
7 2
$38,639
Thank you for your past and continuing support in the CDBG program. We appreciate your assistance in returning your funding recommendations no later than Thursday, February 24, 2022. Should you have any questions or need additional assistance, please feel free to contact your Analyst.

Analyst
Phone Number
Email Address
Kelly Graham
(909) 387-4360
Kelly. Graham(a�cdh.sbcounty.gov
Tom Ramirez
(909) 387-4324
Tom. Ramirez(cbcdh.sbcount ..,gov
Your City Council -approved funding recommendations will be included in the County 2022-2023 Annual Action Plan and is anticipated to be approved by the County Board of Supervisors in early April.

Sincerely,
County of San Bernardino
Community Development and Housing Department
www.SB(; ountVCDHA.com
Phone: 909-387-4705
Fax: 909-387-4415
385 North Arrowhead Ave., 311 Floor
San Bernardino, CA 92415-0043
r,kN BERNARDINO—
COUNTY
0r
Our job is to create a county in which those who reside and invest can prosper and achieve well-being. www.SBCounty.gov
County of San Bernardino Confidentiality Notice: This communication contains confidential information sent solely for the use of the intended recipient If you are not the intended recipient of this communication, you are not authorized to use it in any manner. except to immediately destroy it and notify the sender -157-

San Bernardino County
Department of Community Development and Housing
2022-23 CDBG Project Proposals
Attachment 2
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Application
Request
Eligible:

Location
Applicant
Number
Project Title
Amount
Comments
Yes I No
Additional Eligible Funding for Construction Project - Improvements specifically to commercial Fermin Preciado, Director of Development
properties are ineligible. Street Improvements along the east side of Adams Street to include Services/City Engineer
design and construction of sidewalk, curb/gutter, and associated street improvements along City of Yucaipa
Yucaipa: Street Improvements - Adams
$ 216,358.00
Adams Street, between Avenue B and Yucaipa Blvd, and Avenue B between Adams Street Yes
Yucaipa
34272 Yucaipa Blvd.

YUCA22CN-012
Street
and First Street, within a low/mod target area in Yucaipa. 4520 residents in the local area, Yucaipa, CA 92399
2310 of which are low/mod income will benefit from infrastructure improvements. Eligibility is [email protected]
subject to City of Yucaipa funding participation and use of prevailing wage rates. 909-797-2489 ext.240
Expanding Eligible Public Service. Services are limited to low- and moderate -income clients and requires documentation of at least 51% of the clients are low- to moderate -income. Client Patricia Turley, Interim County Librarian
eligibility (for all clients including illiterate adults) must be evidenced by documentation and 777 East Rialto Avenue
data concerning beneficiary family size and income. This activity was funded in previous fiscal Yucaipa
San Bernardino, CA 92415-0770
YUCA22PS-007
Yucaipa: Adult Literacy Program
$ 10,000.00
years and is a continuing activity. Therefore a quantifiable increase in the level of service is Yes
[email protected]
required. CDBG funds will be used to pay for personnel services. Services are provided by 909-387-2220
San Bernardino County Library Department staff and volunteers. Service Location: 12040 5th Street, Yucaipa, CA 92399.

CDBG Funds are intended for yearly public service programs. Funds are not released until July 1, 2022, therefore any services provided in June are not eligible for repayment. Eligible Amy Herr, Chief Executive Officer
Public Service - The City of Yucaipa will contract with Boys and Girls Clubs of the San Boys & Girls Clubs of the San Gorgonio Pass
Gorgonio Pass to provide a Summer Youth Camp at Dunlap Elementary School to low and 240 W. Ramsey Street
Yucaipa: Boys & Girls Club - Youth
20 moderate income households in the City of Yucaipa and Surrounding areas. Approximately Yes
Yucaipa
Banning, CA 92220
YUCA22PS-016
Summer Camp
$ ,000.00
20 youth will participate in enriching, age appropriate programs of of America's Summer Brain [email protected]
Gain curriculum, receive a daily lunch and snack and will be mentored by caring, professional 951-692-6382
staff. Public Services are limited to low -and moderate -income households and require monthly documentation that at least 51%0 of the households served qualify as low -and moderate -income.

Expanding Eligible Public Service - Family Service Association (FSA) will provide a senior Cheryl -Marie Hansberger, Chief Executive
congregate and mobile meals program to seniors in the City of Yucaipa. Curbside pick-up of Officer
meals is also offered. FSA expects to serve 310 unduplicated clients throughout the program Family Service Association
year. Public Services are limited to low -and moderate -income persons and require monthly Yucaipa
21250 Box Springs Rd., Ste 212
YUCA22PS-023
Yucaipa: Senior Meals Program - Family
$ 10,000.00
documentation that at least 51% of the persons served qualify as low -and moderate -income.

Yes
Moreno Valley, CA 92557
Y
Service Association
Seniors are a presumed 51% low -to moderate -income population. However, documentation [email protected]
is still required. This activity was funded in previous years (less than 12 months) and is a 951-686-1096
continuing activity. Therefore, a quantifiable increase in the level of service or a new additional service is required in order to continue to be eligible for CDBG funding.

Expanding Eligible Public Service - Partners Against Violence (PAV), under contract with the City of Yucaipa, will provide crisis intervention and community prevention education services Michelle Cates, Executive Director
to 250 unduplicated persons who may be victims of abuse or domestic violence within the Partners Against Violence
City of Yucaipa and the surrounding area. Public Services are limited to low -and moderate - 444 N. Arrowhead Ave, Ste. 101
YUCA22PS-042
Yucaipa: Supportive Services for Victims
$ 20,000.00
income persons and require monthly documentation that at least 51% of the persons served Yes
Yucaipa
San Bernardino, CA 92401
of Violence - Partners Against Violence
qualify as low -and moderate -income. Battered and abused spouses are a presumed 51 % [email protected]
low -to moderate -income population. However, documentation is still required. Also, a 909-885-8884
quantifiable increase in the level of service or a new additional service is required in order to continue to be eligible for CDBG funding. This activity was funded in previous years (less than 12 months) and is a continuing activity.

Expanding Eligible Public Service - City of Yucaipa Community Services Department will provide scholarships to recreation and community service related programs (such as: karate, Megan Wolfe, Director of Community Services
swim lessons, spring camp, chair yoga and before and after school daycare) to approximately City of Yucaipa
175 persons from low -and -moderate -income households within the City of Yucaipa. Public Yucaipa
34272 Yucaipa Blvd.

YUCA22PS-062
Yucaipa: Recreational Scholarships
$ 17,000.00
Services are limited to low -and moderate -income persons and require monthly Yes
Yucaipa, CA 92399
documentation that at least 51 % of the persons served qualify as low -and moderate -income. [email protected]
This activity was funded in previous years (less than 12 months) and is a continuing activity. 909-797-2489 ext.241
Therefore, a quantifiable increase in the level of service or a new additional service is required in order to continue to be eligible for CDBG funding. -158-

Attachment 3 - Adams St.

Construction Program Application Fiscal Year 2022 — 2023 San Bernardino County
Fiscal Year 2022 - 2023
Construction Improvement Application
YUCA22CN-012
The following documents must be submitted in the order listed, please be sure to submit all attachments to your application.

Log Number
(Office Use Only)
❑✓
Exhibit 1:

Organization Information
ZExhibit
2:

Project Information
❑✓
Exhibit 3:

Project Characteristics
❑✓
Exhibit 4:

Priority Needs:
❑✓
Exhibit 5:

Project Budget & Sources
F7Exhibit
6:

Proposed Goals and Milestones
Exhibit 7:

Agency Capacity Narrative
17 Exhibit 8:

Civil Rights Laws Compliance And HUD Good Standing
W1Exhibit
9:

Signatures And Assurances
Maintenance
And Operations Agreement
Application Checklist
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Attachment 3 - Adams St.

Construction Program Application Fiscal Year 2022 - 2023 Exhibit 1
Organization Name:

City of Yucaipa
Organization Information
Organization Address:
34272 Yucaipa Blvd
City/State/Zip: JYucaipa / CA / 92399
Phone: 9097972489
Fax -.19097909203
Email: [email protected]
Applicant Type: Icity
Authorized Person Name: I Fermin Preciado
Authorized Person's Title: Director of Development Services/City Engineer Address: 134272 Yucaipa Blvd
City/State/Zip: JYucaipa / CA / 92399
Phone: 19097972489x240
Fax: 9097909203
Email: [email protected]
Application Contact Person's Name: Fermin Preciado
Application Contact Person's Title: IlDirector of Development Services/City Engineer Explain the Agency's 1) Mission, 2) Purpose, 3) Population Served, 4) Number of years serving population, 5) Supportive Services, their Funding Sources, and Start/End Dates.

The City of Yucaipa is a local agency serving the residents that live within the City and the City's sphere of influence. The City has been very active in planning, designing, and constructing infrastructure projects to meet the City's growing demands, specifically in theCDBG target areas. The City's overall population is approximately 55,000 people, with over 40% of the population living within the CDBG target area. The City incorporated in 1989. -160-

Attachment 3 - Adams St.

Construction Program Application Fiscal Year 2022 — 2023 Exhibit 2: Project Information
Project Title:

East Side of Adams St Improvements and Ave B
Address:

Adams St (Avenue B to Yucaipa Blvd) and Ave B (Adams St to 1st St) Citv/State/Zip:

Yucaipa / CA / 92399
County Supervisorial District where project will be located:
❑ 1St District ❑2nd District
N3 rd District: ❑ 4th District ❑ 5th District
Is this a new construction project, or a request for additional funding to an existing CDBG Project? Request for additional funding to an existing CDBG project If requesting additional funds for an existing CDBG project, provide prior CDBG project number? YUCA-19-1-03K/0174
Project Type (Description):

The project includes removing existing ADA barriers and designing and constructing sidewalk, curb/gutter, and associated street improvements in the Uptown area along the east side of Adams Street (between Avenue B and Yucaipa Boulevard) and Avenue B (between Adams Street and 1st Street). The project includes ADA curb ramps, ADA accessible path/sidewalks, and minor drainage improvements to support the local overall proposed improvements.

Eligible Block Group
Indicate eligible Block Group to be benefited by CDBG Funds requested.

Provide a map identifying the eligible census block as indicated in the Eligible Census Blocks.

The eligible Block Grant to be benefited as part of this application is 008800, Block Grant 2 and 3
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Attachment 3 - Adams St.

Construction Program Application Fiscal Year 2022 — 2023 EXHIBIT 2A: Countywide Vision
Indicate Yes/No in the table below which countywide vision goals are pertinent to the proposed project.

Countywide Vision
Countywide Vision Yes/ No
Implement the Countywide Vision.

Yes
Create. Maintain and Grow Jobs and Economic
Value in the County.

Yes
Improve County Government Operations.

No
Operate in a Fiscally -Responsible and Business -Like
Manner.

Yes
Ensure Development of a Well -Planned, Balanced,
and Sustainable County.

Yes
Maintain Public Safety.

Yes
Provide for the Health and Social Services Needs of
County Residents.

Yes
Pursue County Goals and Objectives by Working
with Other Governmental Agencies.

Yes
Provide a brief narrative of how your project meets the Countywide Vision:

The project meets the Countywide Vision by creating and improving access to several retail, business, and employment centers in the City of Yucaipa. This will also promote job growth and economic growth in the community and target area. The project will also improve public safety by providing ADA accessible paths along Adams Street and Avenue B within the target area.
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Attachment 3 - Adams St.

Construction Program Application Fiscal Year 2022 — 2023 Exhibit 3: Project Characteristics
Street address and nearest cross streets of the site where the program will be carried out:

Legal property owner:

City of Yucaipa
What is the current zoning?
Residential and commercial zoned properties. All properties are within the project limits area.

Is this use permitted in this zoning?
Fes7777
Is a conditional use permit required? Yes/No
No
Complete applicable items for all construction projects:
• Assessor's parcel number:

N/A
• Square footage of proposed building or building addition:

N/A
• Square footage of construction site parcel:

N/A
• Length of improvements if street, water or sewer project:
2100 Linear Feet
• Service capacity of existing facility:
• Improved service capacity of the facility:

N/A
• Age of structure:

N/A
• Is the structure registered as a historic landmark under state, federal or local Law? N/A
Describe the geographic boundaries of the neighborhood, community, or region to be served by this project. This description must include service area boundaries if land acquisition or structural improvements are proposed (attach a map):

Yucaipa Boulevard to the north, Avenue B to the south, 1 st Street to the west, and Adams Street to the east. See attached boundary map.
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Attachment 3 - Adams St.

Construction Program Application Fiscal Year 2022 - 2023 Exhibit 4: Priority Needs:

Complete the table below by answering "Yes" or "NO".

Public Facility's Needs:

Yes/ No:

Senior Center Improvements
No
Community Center Improvements
No
Child Care Center Improvements
No
Youth Center Improvements
No
Park & Recreation Improvements
No
Social Care Facility Improvements
No
Code Enforcement Needs
No
Code Enforcement
No
Demolition and Clearance
Yes
Blight Abatement
Yes
Infrastructure Needs
Yes
Water and Sewer Improvements
No
Drainage Improvements
Yes
Street Improvements
Yes
Sidewalk Improvements
Yes
Commercial/ Industrial Infrastructure Development
No
Accessibility Needs
Yes
Removal of Architectural Barriers
No
Historic Preservation Needs:

No
Historic Preservation Improvements
No
Other: Provide ADA access to existing bus stops
Yes
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Attachment 3 - Adams St.

Construction Program Application Fiscal Year 2022 — 2023 Exhibit 4: Priority Needs (continued)
HUD Demographics: (Please indicate Yes/No)
• Does this project help prevent homelessness?
No
• Does this project help the homeless?
No
• Does this project help those with HIV or AIDS?
No
• Does this project primarily help persons with disabilities? Yes
Why this project is considered a priority?
The City has prioritized infrastructure improvements in the CDBG target area of the City. The project will provide pedestrian access (specifically ADA access) to residential, retail, and employment centers within and adjacent to the target areas. vvny tnls project Is neeaea, 51te the evlaence to substantiate the neear< There are many ADA barriers in the target areas that limit access to residences, businesses, existing bus stops, and employment centers. In addition, the lack of walkways and sidewalks in the target areas restrict access in the target areas.

Why must this proposed project be funded now versus receiving funding in future years?
The City plans to complete several maintenance projects in the area to repair deteriorated asphalt in streets and drainage improvements that no longer function efficiently. The City will be able to construct a more complete project by completing the proposed ADA improvements.

What are the ramifications if this project is not recommended for funding in this fiscal If the proposed project is not recommended for funding this fiscal year, ADA barriers will remain and restrict access. In addition, if the maintenance projects are completed now, and the proposed ADA improvements are completed at a later date, improvements completed as part of the maintenance projects will need to be removed and replaced. 7 -165-

Attachment 3 - Adams St.

Construction Program Application Fiscal Year 2022 — 2023 What is the project's population to be served?
The population to be served is the people living, working, and shopping within the target area.

What is the projects accomplishment level?
The proposed projects accomplishment level is high, due to the importance of removing ADA barriers and improving overall pedestrian access in the target area.

Summarize the Scope of Work; include in your summary the number of units or activities the project will complete with CDBG funds.

The proposed project will complete several hundred feet of ADA accessible pathways, several hundred feet of sidewalk, approximately 4 ADA ramps, and ADA access to residences, businesses and employment centers.

Describe how the project preserves a low and moderate -income neighborhood, or rovlaes otner community Denetlts.

Low and moderate income neighborhoods in the target area will be preserved by the project, as a result of the proposed improvements, by creating new public infrastructure in an area that has not been improved in many years. The proposed improvements will be constructed based on news design and construction standards meeting revised codes and regulations.

The proposed improvements will preserve the neighborhood for many years due to the new infrastructure.
-166-

Attachment 3 - Adams St.

Construction Program Application Fiscal Year 2022 — 2023 Exhibit 5: Project Budget & Sources
Provide the estimated financial data for the project as requested below for the appropriate project group. Costs should be based on the best information available. When preparing this data, consider the following factors: (a) project should be completed in one phase if possible, or if phased, operational capability of the phases should be independent of each other: (b) a phased project should be prioritized and broken into distinct parts, with estimated cost and priority for each part; (c) apply federal prevailing wage rates to construction projects over $2,000.

Project Budget
SB County Share ($):

Other Source ($):

Architectural and
engineering services
$40,000.00
Site acquisition
Local Review application
Construction
$216,358.00
$147,000.00
Other: Construction Admin
$75,000.00
Total
$216,358.00
$262,000.00
Overall Total Project Cost: (CDBG Share + Other Source) $478,358.00
-167-

Attachment 3 - Adams St.

Construction Program Application Fiscal Year 2022 — 2023 Exhibit 5A: CDBG Funds Requested and Leveraging Information Indicate the amount being requested by the city.

City
Amount Requested ($)
Amount ($):
(This amount should match the grand
Funding:
total requested from CDBG Share)
Yucaipa
$216,358.00
Leveraging items may include any written commitments that will be used towards your cash match requirements in the project, as well as any written commitments for building, equipment, materials, services and volunteer time.

Source of
Type of Funding: (Grant Name,
Amount ($):

Date
Funding:

EFSP Money)
Available:
91122/2096
Federal
Funding
State
Air Quality Management District
Funding
(AQMD)
$25,000.00
12/12/2018
County
Funding
Private
Funding
Other:

Local Funding (PMP)
X50,000.00
12/12/2018
Total Leveraging Funds
$75,000.00

Attachment 3 - Adams St.

Construction Program Application Fiscal Year 2022 — 2023 Exhibit 6: Proposed Goals and Milestones
Explain how the project will meet contract goals and milestones. For example, project expenditures and performance/accomplishment goals of 40% by September 30`h, 50% by December 31s', 80% by March 31St, and 100% by June 30"'.

N/A
Fill-in the table below with dates for submission of reimbursement claims and the estimated amount of each.

Date of Amount (�):

Reimbursement:
12/09/2021 $58,048.00
Total Reimbursement: $58,048.00

Attachment 3 - Adams St.

Construction Program Application Fiscal Year 2022 - 2023 EXHIBIT 7: Agency Capacity Narrative
(Non -Profit Organizations Only)
• Describe the roles of key administrators, staff members, and volunteers within your agency that will implement the proposed project. In your description include experience, education, and licensing qualifications.

M
• Describe your agencv's experience in administering government and/or public funds. • Describe your method to sustain project viability over the multi-year process if funding decreases.

N/A
INSTRUCTIONS: Complete the table below by marking "YES' or "NO to the questions listed below.

Question:

Yes/ No
Example: Have you received federal funds in the past five years? Yes
In the past ten years, has your organization ever had its nonprofit status revoked or withheld by the IRS, the Secretary of State, the State Attorney No
General, or the Franchise Tax Board?
Has your organization been sued in the last five years? No
Are any of your managers or staff with fiscal responsibilities involved in litigation presently that has any bearing on fiduciary trust or employee No
relations?
Have any unfavorable rulings been handed down by any court against your organization or Executive Director the last five years? No
Does your organization currently have any unresolved fiscal, reporting, or program issues with any of its funding sources?
No
12 -170-

Attachment 3 - Adams St,
Construction Program Application Fiscal Year 2022 — 2023 Exhibit 8: Civil Rights Laws Compliance And HUD Good Standing Answer the following questions:

Has your organization been a past recipient of assistance under a HUD McKinney Act program or the HUD Single Family Property Disposition Homeless Program? Yes
If you have been a recipient under either of these programs, has your agency experienced any project or construction delay, HUD finding or outstanding audit that HUD deems serious regarding the administration of HUD McKinney Act programs or the HUD Single Family Property Disposition Homeless Program?
No
If you answered "Yes", please explain the circumstances and outcome below.

N/A
Applicants must be in compliance with applicable civil rights laws and Executive Orders. Applications will be rejected if your agency has any of the following: (1) Any pending civil rights lawsuit instituted by the U.S. Department of Justice; (2) Any noncompliance with civil rights statutes, Executive Orders or regulations as a result of formal administrative proceedings, unless the applicant is operating under a HUD -approved compliance agreement designed to correct the area of noncompliance or is currently negotiating such an agreement; (3) Any unresolved Secretarial charge of discrimination issues under Section 810(g) of the Fair Housing Act, as implemented by 24 CFR 103:400; (4) Any adjudication of a civil rights violation in a civil action brought against the Organization by a private individual, unless the applicant is operating in compliance with a court order designed to correct the area of noncompliance or the applicant has discharged any responsibility arising from such litigation; (5) Any deferral of the processing of applications from the sponsor imposed by HUD under Title VI of the Civil Rights Act of 1964, the Attorney General's Guidelines (28 CFR 50.3) or the HUD Title VI regulations (24 CFR 1.8) and procedures, or under Section 504 of the Rehabilitation Act of 1973 and HUD Section 504 regulations (24 CFR 8.57). If one or more of these situations exists with your Organization, please attach a brief description.

Attachment 3 - Adams St.

Construction Program Application Fiscal Year 2022 - 2023 COUNTY
E- Signature Authorization
San Bernardino County
Community Development and Housing
Community Development Block Grant
2022 - 2023 Application
Application Title: East Side of Adams St Improvements and Ave B Applicant Name: Todd Gutjahr
Dena Fuentes
Deputy Executive Officer
Gary Hallen
Director
In order to comply with all applicable federal grant regulations, a hard -copy of this E -Signature Authorization containing an original wet signature must be filed with the San Bernardino County, Community Development and Housing (CDH) in order for the applicant to electronically sign the Community Development Block Grant (CDBG) application documents online.

This authorization may only be completed by a registered owner, partner, executive officer, or authorized employee (with proof of authorization) of the applicant submitting this form and must contain an original signature to be submitted to the CDH.

Authorization Agreement
am an owner, partner, executive officer, or duly authorized employee of the below -listed applicant and have authority to enter into agreements on behalf of the below -listed applicant. CDH may rely on the receipt of such agreements executed and delivered by facsimile or other electronic means as if the original had been received. The undersigned agrees that the electronic signatures appearing on documents submitted from the below -listed applicant are the same as handwritten signatures for the purposes of validity, enforceability and admissibility. By signing this Electronic Signature Authorization Agreement, I authorize the CDH to accept, via electronic submission, documents submitted from the below -listed applicant as required by the CDH's Community Development Block Grant 2022 - 2023 Funding Application. understand that CDH may change the CDBG application system from time to time. I agree that the below - listed applicant will electronically sign all documents requiring a signature related to the CDBG funding application.

My signature on this form certifies that:
agree that entering my name in the CDBG funding application system constitutes my electronic signature. I understand that any information and documents submitted using my name is electronically certifying my signature. I understand that I am legally bound, obligated, and responsible by use of my electronic signature as much as I would be by my handwritten signature. I agree that I will protect my signature from unauthorized use, and that I will contact CDH immediately, upon discovery that my electronic signature has been compromised. I certify that my electronic signature is for my own use, and that I will not delegate it or share it with any individual.

I understand that it is my responsibility to update and/or cancel this request under all circumstances, including my departure or terminated association with the below -listed applicant.

By signing the E- Signature Authorization Form we certify that this agency will also comply with the following:

Non-discrimination:

This organization will, through all possible means, ensure equal opportunity for all persons to receive services, to participate in the volunteer structure, and to be employed regardless of age, handicap, national background, race, religion, or sex. An existing sectarian nature of the agency shall not suffer impairment under this agreement, but participation in religious observances, rituals or services will not be required as a condition of receiving food, services, or shelter paid for by this grant.

Accountability:

We commit this organization, if a grant is received, to provide all reports to the County as required; to expend monies only on eligible costs; to keep complete documentation (copies of all canceled checks, invoices, receipts, etc.) on all expenditures for a minimum of three years; to spend all funds and close out the program on the required date; to return any unused funds to the County to cooperate with monitoring or site visits, and; to provide complete documentation of expenses to the County, if requested, by the required date.
14 -172-

Attachment 3 - Adams St.

Construction Program Application
Fiscal Year 2022 - 2023
We affirm that all information in this application is true and correct to the best of our knowledge and that the applicant under our authority will execute its responsibility under the proposed contract and adhere to all other applicable rules and regulations to the fullest extent possible.

Non -collusion:

This proposal is genuine, and not sham or collusive, nor made in the interest or in behalf of any person not herein named; the proposer has not directly induced or solicited any other proposer to put in a sham proposal, or any other person, firm or corporation to refrain from submitting a proposal; the proposer has not in any manner sought by collusion to secure for him/ herself an advantage over any other proposer.

Applicant Information
Applicant Name: Todd Gufahr
Application Title: East Side of Adams St Improvements and Ave B Agency Name: City of Yucaipa
Federal Tax ID No.: 33-0383731
Mailing Address:
34272 Yucaipa Blvd
Phone No.:
(909) 797-2489
Email Address: f reciado ucai a.or
Fax No: (909) 790-9203
Authorized Signature
Print Name: Fermin Preciado
Print Title: Director of Development Services/Cit
Signature:

Date:

Please send the signed copy of this agreement to:

Community Development and Housing
385 North Arrowhead Ave. 3rd Floor, San Bernardino, CA 94215-0043 Attn: Community Development Block Grant Application
15 -173-

Construction Program Application
Attachment 3 - Adams St.

Maintenance and Operations Agreement
Fiscal Year 2022 - 2023
Please keep in mind the Maintenance and Operations cost is ineligible for CDBG funds.

All capital improvements or facilities will require a Maintenance and Operation (M & O) contract. The MAINTENANCE AND OPERATION COMMITMENT must be signed by a representative of the M & O entity with authority to obligate the organization.
1) MAINTENANCE AND OPERATION COMMITMENT: The governing body of the below named public, quasi -public, or non-profit entity has the financial capacity and is willing to assume the Maintenance and Operation (M & O) responsibility and costs associated with the indicated community development project. This body has reviewed the "Estimated Annual Maintenance and Operation Budget" part of this section. To the best of this body's ability, it has determined this budget to be a true and accurate estimate of the annual M & O costs for the proposed project.

It is understood that without a commitment for maintenance and operation, the indicated project may not be considered for funding under the Community Development Block Grant program. Should this project be funded, a formal M & O contract shall be written and signed before any funds can be released.

NOTE: The Maintenance and Operation cost for capital improvements and facilities are not eligible for CDBG funding.

Proposed Project:

East Side Adams Improvements (Ave B to Yucaipa Blvd) and Ave B (Adams St to 1st St) Le aU Incorporated Name of Prospective M&O Entity:

Citv of Yucaipa
Address:
34272 Yucaipa Blvd Yucaipa, CA 92399
Federal I.D. Number of M&O Entity:
33-0383731
Signature:

Print Name: Fermin Preciado
16 -174-
Title: Director of Development Servic
Date:

Construction Program Application
Attachment 3 - Adams St.

Maintenance and Operations Expenses
Fiscal Year 2022 - 2023
17 -175-
Utilities
Amount (S):

Electric
$0.00
Water
$0.00
Gas
$0.00
Telephone
$0.00
Disposal Service
$0.00
Other:
$0.00
Sub -Total
$0.00
Materials
Janitorial Supplies
$0.00
Office Supplies
$0.00
Recreational Supplies
$0.00
Ground Supplies
$0.00
Other:
$0.00
Sub -Total
$0.00
Maintenance
— Capital Improvements
Buildinq Repair
$0.00
Maintenance of Equipment
$0.00
Improvements to Property
$0.00
Other:
$0.00
Sub -Total
$0.00
Insurance
Liability
$0.00
Fire
$0.00
Other:
$0.00
Sub -Total
S 0.00
17 -175-

Attachment 3 - Adams St.

Construction Program Application
Fiscal Year 2022 - 2023
Personnel
Amount ($):

Maintenance
$23800.00
Secretary
$0.00
Administrator
$0.00
Program Staff
$0.00
Other:
$0.00
Sub -Total
$2,800.00
M& O Annual Expense Total
$2,800.00
List out all sources and liabilities such as budget sources, membership, user fees, etc.

Revenue Sources:

Amount ($):
$0.00
$0.00
$0.00
Budgeted Revenue Total
$0.00
Assets/ Liabilities
Amount $
Budgeted Revenue minus M&O Expense
($2,800.00)

Construction Program Application
Attachment 3 - Adams St.

CDBG Application Checklist
(Non -Profit Agency Only)
Fiscal Year 2022 - 2023
Community-based organizations are required to include one copy of the items listed below. If you are not submitting these items at this time, please notify Community Development and Housing at (909) 387-4705 to make other arrangements. The following information is required before any contract or reimbursement can be completed.
o Summary of agency's current year General Operating Budget o List of agency's Board of Directors; including names and addresses o Proof of existing non-profit/tax-exempt status (Letters from the Federal Internal Revenue Service and State Franchise Tax Board)
o Current certificate of insurance and amounts covered
o Organizational chart
o Minutes of last Board meeting
o Non- Profit agency's must be Registered in the System of Award Management (SAM) website. Agency cannot be funded if they have been debarred in the past. o Provide board minutes/letter that authorizes the executive director or program manager to run the project.

If your application is funded you will be required to provide a copy of your last audit and your Articles of Incorporation and Bylaws must be on file.
19 -177-

Attachment 3 - Library
Public Services Program Application Fiscal Year 2022— 2023 San Bernardino County
Fiscal Year 2022 - 2023
Public Services Program Application
YUCA22PS-007
The following documents must be submitted in the order listed, please be sure to submit all attachments with your application.

Log Number
(Office Use Only)
-178-
Exhibit 1:

Organization Information
Exhibit 2:

Project Information
Exhibit 3:

Community Needs and Target Population
Exhibit 4:

Project Budget & Sources
Exhibit 5:

Performance & Outcomes
Exhibit 6:

Agency Capacity Narrative
Exhibit 7:

Civil Rights Laws Compliance and HUD Good Standing
Exhibit 8:

Signature and Assurances
Application Checklist
-178-

Attachment 3 - Library
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 1: Organization Information
Organization Name:

San Bernardino County Library
Organization Address:
777 East Rialto Ave.

City/State/Zip: Isan Bernardino / CA / 92415
Phone: 909-387-2220
Fax: 909-387-2288
Email: 1Pattv.Turlev(@Iib.sbcoun
Applicant Type: JCDBG Fundi
Authorized Person Name: jPatricia Turley
Authorized Person's Title: llnterim County Librarian
Address: 1777 East Rialto Ave.

City/State/Zip: Isan Bernardino / CA / 92415
Phone: 909-387-2220
Fax: 909-387-2288
Email: [email protected]
Application Contact Person's Name: ILiz. Smith
Application Contact Person's Title: Library Events Coordinator Explain the Agency's 1) Mission, 2) Purpose, 3) Population Served, 4) Number of years serving population, 5) Supportive Services, their Funding Sources, and Start/End Dates.

The San Bernardino County Library System is a network of branch libraries that serve a diverse population or a vast geographic area. We strive to provide equal access to information, technology, programs, and services for all the people who call San Bernardino County home. Our Adult Literacy Program has been in place over 30 years, allowing us to help those struggling with illiteracy in our communities. We are supported with funds from the State and the County through this current Fiscal Year from July 2021 -June 2022. -179-

Attachment 3 - Library
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 2: Project Information
Project Title:

San Bernardino County Yucaipa Branch Library
Project Address:
12040 5th Street, Yucaipa, CA 92399
County Supervisorial District where project will be located:
❑ 1 st District ❑ 2nd District ® 3rd District ❑ 4th District ❑ 5th District Is this a New Public Service Project, or request to expand services to an existing CDBG project? Expansions of Service to an Existing Project
If this is an Expansion of Service to previously funded CDBG project, please explain how this is an expansion of service?. (i.e For 2015 we proposed 60 units of service, this year the agency is planning to serve 100 units of service)
We are expanding our goal of how many individuals will be serviced through our Adult Literacy Program. In the previous Fiscal Year of 20-21, we set the goal to serve 41 adult learners. In this current Fiscal Year, we have raised that goal to 42. Moving forward we hope to continually increase the number of learners that the Yucaipa Branch is able to provide services to.

If you are requesting funds for an existing CDBG project, provide prior CDBG project number.

YUCA-15-2-05Z/1646
Will this project provide an opportunity to hire minority-owned and women owned businesses? No
If YES, describe what actions will be completed to implement such subcontracting plans to monitor this component of the proposed project. If NO, discuss why and what actions are being taken to encourage minority -women businesses to apply for this project.

Attachment 3 - Library
Public Services Program Application Fiscal Year 2022— 2023 EXHIBIT 2A: Countywide Vision
Indicate Yes/No in the table below if any of these countywide vision goals are pertinent to the proposed project.

Countywide Vision
Countywide Vision
Yes/ No
Implement the Countywide Vision.

Yes
Create, Maintain and Grow Jobs and
Economic Value in the County.

Yes
Improve County Government Operations.

No
Operate in a Fiscally -Responsible and
Business -Like Manner.

No
Ensure Development of a Well -Planned,
Balanced, and Sustainable County.

No
Maintain Public Safety.

No
Provide for the Health and Social Services
Needs of County Residents.

Yes
Pursue County Goals and Objectives by
No
Working with Other Governmental
Agencies.

Provide a brief narrative of how your project meets the Countywide Vision:

By tutoring illiterate adults and providing them the tools to learn to read and write, we help them build self-confidence to accomplish many goals such as applying for jobs, being able to vote and much more. This results in them becoming more socially prepared to participate in all the County has to offer. Additionally the Adult Literacy program supports the county's Cradle to Career road map to achieve the Countywide vision. When we teach illiterate adults to read, we are not only helping them but are also helping their children, as parents who read are able to give the literacy support a child needs to succeed.
-181-

Attachment 3 - Library
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 3: Community Needs and Target Population
Community Needs
Target Population
Public Service
Yes/No
Proposed Community:

Yes/No
Needs:

Senior Services
Low and Moderate Persons
Yes
Yes
Handicapped
Low and Moderate
Services
No
Households
No
Youth Services
Abused Children
No
No
Child Care
Handicapped Persons
Services
No
No
Transportation
Illiterate Persons
Services
No
Yes
Substance Abuse
Homeless Persons
Services
No
No
Employment
Migrant Farm Workers
Training
No
No
Health Services
Elderly People
No
Lead Hazard
Screening
No
Crime
Awareness
No
City/Target Area of Project Beneficiaries
Participating Cities: ke Redlands. Colton. Yucaipa)
Yucaipa
-182-

Attachment 3 - Library
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 3: Community Needs and Target Population (continued) Describe the geographic boundaries of the neighborhood. community or area in which clients of the proposed program reside (attach a map if needed):
ucaipa
HUD Demographics: (Yes/No)
■ Does this project help prevent homelessness?
No
■ Does this project help the homeless?
Yes
■ Does this project help those with HIV or AIDS?
No
■ Does this project primarily help persons with disabilities? No
Summarize the description of your project to include 1) priority, 2) sub -activity, 3) population(s) to be served, and 4) accomplishment level, and 5) services to be provided.

The San Bernardino County Library (SBCL), Yucaipa Branch Adult Literacy Services Program will provide programming and instruction for low to moderate income illiterate adults and senior residents of Yucaipa. Individualized tutoring and one-on-one Literacy instruction (reading, spelling, and basic computer skills) will be provided to a minimum of 43 qualifying adult participants during Fiscal Year 22-23. Library Adult Literacy Services are provided free of charge to all learners participating in khe program. Direct services and assistance are provided by Library staff as well as a team of trained Literacy Tutors. Dedicated tutoring space and special Adult Literacy Program materials (leveled student readers, workbooks, dictionaries, GED Test Prep packets) are provided to participating learners at no charge.

Learners are strongly encouraged to attend free Basic Computer Skills Classes taught in the library. Those with young children are encouraged to attend Early Learning and Preschool Storytime Activities to foster a love of reading and ensure school-age readiness. The Yucaipa Branch is dedicated in improving the literacy rates in the Yucaipa Community. -183-

Attachment 3 - Library
Public Services Program Application Fiscal Year 2022— 2023 Describe how this project meets the priority population and activities selected.

The Adult Literacy Services Program assesses illiterate and presumed low income adults and senior residents of Yucaipa, and provides those that qualify with programming, tutoring, and instruction to aid them in meeting their literacy goals.

Explain why this project is needed and what evidence can you substantiate the need.

In the most recent U.S. National Assessment of Adult Literacy, one in seven adults have difficulty reading anything more challenging than a child's picture book. It is estimated that 3.4 million Californians fall at the "Below Basic" Literacy Level. In the County of San Bernardino alone, it is estimated that at least 500,000 adults cannot read at all. This service provides assistance to adults who all into this category.

Describe what gaps of service in the county this project fills.

This program focuses on adult individuals who are illiterate or who have low literacy skills. The County Library Adult Literacy Program provides a no cost alternative for adults to gain these skills.

What are the critical factors for the success of your project (include both financial and human resources)? For instance, is this the only funding for this project? What happens if funding decreases? Does this project rely on only one source of leveraging? Is there adequate staff involved with the project if there is project turnover? Please address any factor that is critical to project success.

The program is funded primarily through the Library Budget. Additional State and County funding helps the Library to expand the program and reach a larger audience than would be possible through internal funding alone. The Literacy Program is a multi -branch program, with branch staff interacting with learners and tutors while reporting is overseen by administrative staff. We have taken steps to ensure that any staff turnover will not impede the Literacy Program and that services would continue to be offered through the cross training of staff.

Attachment 3 - Library
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 4: Project Budget & Sources
Project Budget
SB County Share: ($)
Other Source: ($)
Personnel
$10,000.00
$27,500.00
Equipment (Rental, Lease or Purchase)
Consultant Services
(Auditing,Accounting or Payroll)
Space Rent
Insurance
Consumable Supplies
Other
Total Costs
$10,000.00
$27,500.00
Total Project Budget Cost: (CDBG Share + Other Source)
$37,500.00
-185-

Attachment 3 - Library
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 4A: CDBG Funds Requested and Leveraging Information Indicate the amount being requested by the city.

City
Amount Requested ($):

Amount ($):
(This amount should match the grand
Funding:
total requested from CDBG Share)
Yucaipa
$10,000.00
Leveraging items may include any written commitments that will be used towards your cash match requirements in the project, as well as any written commitments for building, equipment, materials, services and volunteer time.

Source of
Type of Funding: (Grant Name,
Amount ($):

Date
Funding:

EFSP Money)
Available:
(11/22/2016)
Federal
Funding
State
Funding
California State Library Literacy Servic
$5,000.00
08/01/2022
County
Funding
County
$22,500.00
07/01/2022
Private
Funding
Other:

Total Leveraging Funds
$27,500.00

Attachment 3 - Library
Public Services Program Application Fiscal Year 2022 — 2023 Exhibit 5: Performance and Outcomes
Definitions:

Unduplicated Clients: The number clients/persons projected to be served during the program year (e.g. 25 clients, 50 seniors):

Duplicated Clients: The estimated yearly units of service (duplicated, e.g. 25 clients x 10 visits=250 units of service):

Complete the chart below with the number of Duplicated and Unduplicated Clients to be served.
• In column 1 identify activities that will be completed (e.g. intervention, counseling, and case management).
• In column 2 indicate the number of Unduplicated Clients to be served. • In column 3 identify the number of Duplicated Clients to be served.

Activities to be Completed (1)
Unduplicated
Clients to be
Served (2)
Duplicated Clients
projected to be
served (3)
Literacy Tutoring
43 430
Performance and Outcomes, answer the following narrative questions using minimum funds request.

Indicate a timeline of services provided to client(s) in order to meet project outcome(s).

Learners are assessed by branch staff and matched with a tutor. They are scheduled for weekly tutoring sessions in order to meet individual goals set by the learner and plan new goals as the learner progresses.
uescrlDe now your agency aetermines client(s) success.

Learners set individual goals that they want to meet and tutors help learners meet those goals.

Regular assessments of the learner's progress are used to track improvement.

Describe your methodology to evaluate project outcomes.

We track the number of goals met in correlation to the numbers of goals set by the individual learners.
10 -187-

Attachment 3 - Library
Public Services Program Application Fiscal Year 2022 — 2023 Exhibit 5A: Proposed Goals & Milestones
Explain how the project will meet contract goals and milestones and be completed within 12 months (July 1, 2022 —June 30, 2023). For example, project expenditures and performance/ accomplishment goals of 40% by November30th, 50% by December 31St. 80% by March 31St and 100% by June 30th.

As mandated by the California State Library Literacy Services (CLLS), individual adult learners are required to list one or more personal Literacy goals via the Roles & Goals Intake Form. 75% of total Yucaipa Adult Literacy Program learners are anticipated to achieve one or more of their personal goals set during program year 21-22. Our plan is to meet 25% of our goal each quarter; 25% by October 1 st, 50% by January 1 st, 75% by April 1 st, and 100% by June 30th.

Fill-in the table below with dates for submission of reimbursement claims and the estimated amount of each.

Date of Reimbursement:

Amount ($):
10/01/2022
$2,500.00
01/01/2023
$2,500.00
04/01/2023
$2,500.00
06/30/2023
$2,500.00
Total Reimbursement:
($)
$10,000.00

Attachment 3 - Library
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 6: Agency Capacity Narrative
(Non -Profit Organizations Only)
Describe the roles of key administrators. staff members, and volunteers within your agency that will implement the proposed project. In your description include experience, education, and licensing qualifications.

Library Events Coordinator, Admin Librarian I, Branch Managers, Library Assistants, Volunteer Tutors. See Attachment for detailed answer.

Describe your agency's experience in administering government and/or public funds.

We have been funded for, and administrating, CDBG grants and funds for over ten years.

Describe your method to sustain project viability over the multi-year process if iunainq decreases.

This is a multi -branch program with a network of branch and administrative staff and a portion of the overall library budget set aside to improve and continue this program.

Instructions: Complete the table below by marking "YES" or "NO" to the questions listed below.

Question:

YES/ NO
Example: Have you received federal funds in the past
five years?
Yes
In the past ten years, has your organization ever had its nonprofit status revoked or withheld by the IRS, the
No
Secretary of State, the State Attorney General, or the
Franchise Tax Board?
Has your organization been sued in the last five years? No
Are any of your managers or staff with fiscal
responsibilities involved in litigation presently that has any No
bearing on fiduciary trust or employee relations?
Have any unfavorable rulings been handed down by any
court against your organization or Executive Director the last No
five years?
Does your organization currently have any unresolved
fiscal, reporting, or program issues with any of its funding No
sources?
12 -189-

Attachment 3 - Library
Public Services Program Application Fiscal Year 2022 — 2023 EXHIBIT 7: Civil Rights Laws Compliance and HUD Good Standing Answer the following questions.

Has your organization been a past recipient of assistance under a HUD McKinney Act program or the HUD Single Family Property Disposition Homeless Program? No
If you have been a recipient under either of these programs, has your agency experienced any project or construction delay, HUD finding or outstanding audit that HUD deems serious regarding the administration of HUD McKinney Act programs or the HUD Single Family Property Disposition Homeless Program?
No
If you answered "Yes", please explain the circumstances and outcome below.

Applicants must be in compliance with applicable civil rights laws and Executive Orders. Applications will be rejected if your agency has any of the following: (1) Any pending civil rights lawsuit instituted by the U.S. Department of Justice; (2) Any noncompliance with civil rights statutes, Executive Orders or regulations as a result of formal administrative proceedings, unless the applicant is operating under a HUD -approved compliance agreement designed to correct the area of noncompliance or is currently negotiating such an agreement; (3) Any unresolved Secretarial charge of discrimination issues under Section 810(g) of the Fair Housing Act, as implemented by 24 CFR 103:400; (4) Any adjudication of a civil rights violation in a civil action brought against the Organization by a private individual, unless the applicant is operating in compliance with a court order designed to correct the area of noncompliance or the applicant has discharged any responsibility arising from such litigation; (5) Any deferral of the processing of applications from the sponsor imposed by HUD under Title VI of the Civil Rights Act of 1964, the Attorney General's Guidelines (28 CFR 50.3) or the HUD Title VI regulations (24 CFR 1.8) and procedures, or under Section 504 of the Rehabilitation Act of 1973 and HUD Section 504 regulations (24 CFR 8.57). If one or more of these situations exists with your Organization, please attach a brief description.
13 -190-

Public Services Program Application Attachment 3 - Library Fiscal Year 2022— 2023

CC)UNTY
Application Title: YCP App
Applicant Name: Jennifer Jacobsmeyer
E- Signature Authorization
San Bernardino County
Community Development and Housing
Community Development Block Grant
2022 - 2023 Application
Dena Fuentes
Deputy Executive Officer
Gary Hallen
Director
In order to comply with all applicable federal grant regulations, a hard -copy of this E -Signature Authorization containing an original wet signature must be filed with the San Bernardino County, Community Development and Housing (CDH) in order for the applicant to electronically sign the Community Development Block Grant (CDBG) application documents online.

Authorization Agreement
I am an owner, partner, executive officer, or duly authorized employee of the below -listed applicant and have authority to enter into agreements on behalf of the below -listed applicant. CDH may rely on the receipt of such agreements executed and delivered by facsimile or other electronic means as if the original had been received. The undersigned agrees that the electronic signatures appearing on documents submitted from the below -listed applicant are the same as handwritten signatures for the purposes of validity, enforceability and admissibility. By signing this Electronic Signature Authorization Agreement, I authorize the CDH to accept, via electronic submission, documents submitted from the below -listed applicant as required by the CDH's Community Development Block Grant 2022 - 2023 Funding Application.

I understand that CDH may change the CDBG application system from time to time. I agree that the below -listed applicant will electronically sign all documents requiring a signature related to the CDBG funding application.

My signature on this form certifies that:

I agree that entering my name in the CDBG funding application system constitutes my electronic signature. I understand that any information and documents submitted using my name is electronically certifying my signature. I understand that I am legally bound, obligated, and responsible by use of my electronic signature as much as I would be by my handwritten signature. I agree that I will protect my signature from unauthorized use, and that I will contact CDH immediately, upon discovery that my electronic signature has been compromised. I certify that my electronic signature is for my own use, and that I will not delegate it or share it with any individual.

This request is effective immediately upon receipt by the CDH and will remain in effect until the end of the 2022 - 2023 CDBG funding cycle or I choose to cancel this request via written notification to the CDH. I understand that it is my responsibility to update and/or cancel this request under all circumstances, including my departure or terminated association with the below -listed applicant.

By signing the E- Signature Authorization Form we certify that this agency will also comply with the following:

Non-discrimination:

Accountability:

Attachment 3 - Library
Public Services Program Application Fiscal Year 2022— 2023 We affirm that all information in this application is true and correct to the best of our knowledge and that the applicant under our authority will execute its responsibility under the proposed contract and adhere to all other applicable rules and regulations to the fullest extent possible.

Non -collusion:

Applicant Information
-Applicant Name: Jennifer Jacobsmeyer
-Application Title: YCP App
-Agency Name:

Federal Tax ID No.: 95-6002748
Mailing Address:
777 East Rialto Ave.

Phone No.:
(909) 387-2220
Email Address: [email protected]
Fax No: 909 387-2288
Authorized Signature
Print Name: Patricia Turley
Print Title: Interim County Librarian
Signature:

Patricia Turley Interim County Librarian
Date:
11/05/2021
Please send the signed copy of this agreement to:

Community Development and Housing
385 North Arrowhead Ave. 3rd Floor, San Bernardino, CA 94215-0043 Attn: Community Development Block Grant Application
-1915

Attachment 3 - Library
Public Services Program Application Fiscal Year 2022— 2023 CDBG Application Checklist
(Non -Profit Organizations Only)
Community-based organizations are required to include one copy of the items listed below. If you are not submitting these items at this time, please notify Community Development and Housing at (909) 387-4705 to make other arrangements. The following information is required before any contract or reimbursement can be completed.
o Summary of agency's current year General Operating Budget o List of agency's Board of Directors, including names and addresses o Proof of existing non-profit/tax-exempt status (Letters from the Federal Internal Revenue Service and State Franchise Tax Board) o Current certificate of insurance and amounts covered
o Organizational chart
o Minutes of last Board meeting
o Non- Profit agencies must be Registered in the System of Award Management (SAM) website.

Agency cannot be funded if they have been debarred in the past. o Provide board minutes/letter that authorizes the executive director or program manager to run the project.

If your application is funded you will be required to provide a copy of your last audit and your Articles of Incorporation and Bylaws must be on file. 16 -193-

Attachment 3 - Boys & Girls Club
Public Services Program Application Fiscal Year 2022— 2023 San Bernardino County
Fiscal Year 2022 - 2023
Public Services Program Application
YUCA22PS-016
The following documents must be submitted in the order listed, please be sure to submit all attachments with your application.

Log Number
(Office Use Only)
❑✓
Exhibit 1:

Organization Information
❑✓
Exhibit 2:

Project Information
❑✓
Exhibit 3:

Community Needs and Target Population
❑✓
Exhibit 4:

Project Budget & Sources
❑✓
Exhibit 5:

Performance & Outcomes
Exhibit 6:

Agency Capacity Narrative
Exhibit 7:

Civil Rights Laws Compliance and HUD Good Standing
Exhibit 8:

Signature and Assurances
❑✓
Application Checklist
-194-

Attachment 3 - Boys & Girls Club
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 1: Organization Information
Organization Name:

Boys & Girls Clubs of the San Gorgonio Pass
Organization Address:
240 W. Ramsey Street
City/State/Zip: lBanning / CA / 92220
Phone: (951) 922-3259
Fax: (951) 922-0009
Email: [email protected]
Applicant Type: Non -Profit
Authorized Person Name: jAmy Herr
Authorized Person's Title: ICEO
Address: 1240 W. Ramsey Street
City/State/Zip: lBanning / CA / 92220
Phone: (951) 692-6382
Fax: (951) 922-0009
Email: [email protected]
Application Contact Person's Name: JRhonda Guaderrama
Application Contact Person's Title: IDirector of Advancement Explain the Agency's 1) Mission, 2) Purpose, 3) Population Served, 4) Number of years serving population, 5) Supportive Services, their Funding Sources, and Start/End Dates.

Boy & Girls Clubs of the San Gorgonio Pass (BGCSGP) has provided youth development programming in the areas of Character and Leadership Development, Education and Career Development, Health and Life Skills, the Arts, and Sports, Fitness and Recreation for almost 17 years. Founded in 2005 by current CEO, Amy Herr, the Club has grown from one Club to twelve, serving 750 youth in the Pass area, including Cabazon, Banning, Beaumont and Yucaipa. The Club also opened a standalone Teen Center in 2016, offering free after school programming to youth 13-18.The Club works to uphold its mission to inspire and enable all young people, especially those who need us most, to reach their full potential as responsible and caring citizens. The Club's enriching after school programs and out-of-school time camps are funded through grants, organizational fundraisers, and individual donors. -195-

Attachment 3 - Boys & Girls Club
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 2: Project Information
Project Title:

Summer Camp - Dunlap Elementary Club
Project Address:
32870 Avenue E, Yucaipa, CA 92399
County Supervisorial District where project will be located:
❑ 1st District ❑ 2nd District ® 3rd District ❑ 4th District 05 th District Is this a New Public Service Project, or request to expand services to an existing CDBG project? New Public Service Project
If this is an Expansion of Service to previously funded CDBG project, please explain how this is an expansion of service?. (i.e For 2015 we proposed 60 units of service, this year the agency is planning to serve 100 units of service)
If you are requesting funds for an existing CDBG project, provide prior CDBG project number.

N/A
Will this project provide an opportunity to hire minority-owned and wornen owned businesses? No
If YES, describe what actions will be completed to implement such subcontracting plans to monitor this component of the proposed project. If NO, discuss why and what actions are being taken to encourage minority -women businesses to apply for this project.

We are not sub -contracting the project, but utilizing our own staff. We are an equal opportunity employer and have staff that are representative of the diverse community that we serve. -196-

Attachment 3 - Boys & Girls Club
Public Services Program Application Fiscal Year 2022— 2023 EXHIBIT 2A: Countywide Vision
Indicate Yes/No in the table below if any of these countywide vision goals are pertinent to the proposed project.

Countywide Vision
Countywide Vision
Yes/ No
Implement the Countywide Vision.

Yes
Create, Maintain and Grow Jobs and
Economic Value in the County.

Yes
Improve County Government Operations.

No
Operate in a Fiscally -Responsible and
Business -Like Manner.

Yes
Ensure Development of a Well -Planned,
Balanced, and Sustainable County.

No
Maintain Public Safety.

Yes
Provide for the Health and Social Services
Needs of County Residents.

Yes
Pursue County Goals and Objectives by
Working with Other Governmental
Yes
Agencies.

Provide a brief narrative of how your project meets the Countywide Vision:

By providing a summer camp program at Dunlap Elementary, BGCSGP will give at -promise youth a place to learn and thrive, while their parents are able to work, having the peace of mind that their children are in a safe environment. BGCSGP's project supports the Countywide Vision by allowing parents to gain and maintain employment. The program increases public safety by providing youth with a safe place to go during out-of-school time. In fact, a study by Everytown for Gun Safety found that summer youth development programs provide young people with educational and mentorship opportunities, prepare them for the workforce and are proven to reduce violence.Additionally, by providing programming that focuses on the social/emotional needs of Club members, the Club is directly addressing their health and social service needs.
-197-

Attachment 3 - Boys & Girls Club
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 3: Community Needs and Target Population
Community Needs
Target Population
Public Service
Yes/No
Proposed Community:

Yes/No
Needs:

Senior Services
Low and Moderate Persons
Yes
Handicapped
Low and Moderate
Services
Households
Youth Services
Abused Children
Yes
Child Care
Handicapped Persons
Services
Yes
Transportation
Illiterate Persons
Services
Substance Abuse
Homeless Persons
Services
Employment
Migrant Farm Workers
Training
Health Services
Elderly People
Lead Hazard
Screening
Crime
Awareness
i
City/Target Area of Project Beneficiaries
Participating Cities: O.e Redlands. Colton. Yucaipa)
BGCSGP's proposed project targets elementary age youth in Yucaipa.

Attachment 3 - Boys & Girls Club
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 3: Community Needs and Target Population (continued) Describe the geographic boundaries of the neighborhood, community or area in which clients of the proposed program reside (attach a map if needed):

BGCSGP serves youth in the City of Yucaipa, specifically children that attend Dunlap Elementary School. Yucaipa is located 10 miles east of San Bernardino, in San Bernardino County.

HUD Demographics: (Yes/No)
■ Does this project help prevent homelessness?
Yes
■ Does this project help the homeless?
No
■ Does this project help those with HIV or AIDS?
No
■ Does this project primarily help persons with disabilities? Summarize the description of your project to include 1) priority, 2) sub -activity, 3) population(s) to be served.. and 4) accomplishment level, and 5) services to be provided.

BGCSGP is respectfully requesting grant funding to support a Summer Camp program at Dunlap Elementary. This program addresses the priority community needs for Youth Services and Child Care Services. The target population for the project is Low and Moderate persons.

The program will offer full day camp to 20 youth, K -5th, Monday through Friday, 7:00 a.m. to 6:00 p.m. Dates for the 8 week program are June 13, 2022, through August 5, 2022. Youth will participa�F: in enriching, age appropriate programs, receive a daily lunch and snack and will be mentored by caring, professional staff. Numerous studies show that most youth lose about two months of grade -level math skills over the summer months and low income youth also lose more than two months in reading achievement. To address this, BGCSGP will utilize Boys & Girls Clubs of America's Summer Brain Gain curriculum. Summer Brain Gain adds engaging, educational activities to the typical summer camp experience. While the average low-income U.S. student loses at least two months of learning in the summer, the average Summer Brain Gain participant does not experience learning loss. Sample Brain Gain activities include:SBG Classic -Around the World -Animal Habitats -Storytelling -Animation SBG STEM -Wacky Science•Inventions•Fun with Forensics -Food Scientist- Investigating Flight SBG Read •Superhero•Mystery Stories -My Family Plays Music -Grace for President -The Parker Inheritance
-199-

Attachment 3 - Boys & Girls Club
Public Services Program Application Fiscal Year 2022— 2023 Describe how this project meets the priority population and activities selected.

This project directly meets the needs for youth services and childcare services for Low and Moderate persons. "Summer slide" is the tendency for students, especially those from low- income families, to lose some of the achievement gains they made during the previous school year. By providing enriching summer camp programming, BGCSGP will prevent summer learning loss. Additionally, it meets the dire need for child care services.

Explain why this project is needed and what evidence can you substantiate the need.

Lack of childcare is a significant challenge in San Bernardino County. Currently, childcare is only available for 16.3% of working families, leaving 83.7% without options (KidsData.org). At Dunlap, 79.2of youth are eligible for free/reduced lunch, compared to the district average of

48.5% and the majority of our Club members are Black, Indigenous, People of Color (BIPOC) (CDE).

Describe what gaps of service in the county this project fills.

Lack of adequate childcare and youth services has been identified as a top community need in San Bernardino County.

The critical factors for success of our project are: -Facility access — the Yucaipa School District is providing campus access for our summer program -Trained, professional staff -Financial support -Adequate supplies and equipment
BGCSGP has a long history of providing successful summer programs and we are confident that we have the infrastructure, funding and staffing support to provide a quality summer program at Dunlap Elementary School.
-200-

Attachment 3 - Boys & Girls Club
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 4: Project Budget & Sources
Project Budget
SB County Share: ($)
Other Source: ($)
Personnel
$20,000.00
$630.00
Equipment (Rental, Lease or Purchase)
$500.00
Consultant Services
(Auditing,Accounting or Payroll)
$0.00
Space Rent
$16,000.00
Insurance
$1,700.00
Consumable Supplies
$4,000.00
Other IField trips
$2,000.00
Total Costs
$20,000.00
$24,830.00
Total Project Budget Cost: (CDBG Share + Other Source)
$44,830.00
-201-

Attachment 3 - Boys & Girls Club
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 4A: CDBG Funds Requested and Leveraging Information Indicate the amount being requested by the city.

City
Amount Requested ($):

Amount ($):
(This amount should match the grand
Funding:
total requested from CDBG Share)
Yucaipa
$20,000.00
Leveraging items may include any written commitments that will be used towards your cash match requirements in the project, as well as any written commitments for building, equipment, materials, services and volunteer time.

Source of
Type of Funding: (Grant Name,
Amount ($):

Date
Funding:

EFSP Money)
Available:
(11122/2016)
Federal
Funding
State
Funding
County
Funding
Private
Funding
Individual Donors
$8,830.00
06/01/2022
Other:

In-kind
$16,000.00
06/01/2022
Total Leveraging Funds
$24,830.00
-202-

Attachment 3 - Boys & Girls Club
Public Services Program Application Fiscal Year 2022 — 2023 Exhibit 5: Performance and Outcomes
Definitions:

Unduplicated Clients: The number clients/persons projected to be served during the program year (e.g. 25 clients, 50 seniors):

Duplicated Clients: The estimated yearly units of service (duplicated, e.g. 25 clients x 10 visits=250 units of service):

Complete the chart below with the number of Duplicated and Unduplicated Clients to be served.

In column 1 identify activities that will be completed (e.g. intervention, counseling, and case management).

In column 2 indicate the number of Unduplicated Clients to be served.

In column 3 identify the number of Duplicated Clients to be served.

Activities to be Completed (1)
Unduplicated
Clients to be
Served (2)
Duplicated Clients
projected to be
served (3)
Provide enriching daily camp program
20 780
Provide daily lunch and nutritious snac
20 780
Performance and Outcomes, answer the following narrative questions using minimum funds request.

Indicate a timeline of services provided to client(s) in order to meet project outcome(s).
5/31/22 — Begin enrollment for summer camp program 6/13/22 — 8/5/22 — Provide full day summer camp program for 20 youth6/13/22 — 8/5/22 — Provide nutritious, healthy lunch and snack to 20 youth each day
uescrlDe now your agency aetermines client(s) success.

Success is: 20 youth enrolled in camp 100% of youth participate in daily Summer Brain Gain program 100% of youth do not experience the "summer slide"100% of youth receive lunch and daily snack
Describe your methodology to evaluate project outcomes.

Outcomes will be measured through: daily attendance records, summer learning pre and posttests, meal tracking records, and staff observation M
-203-

Attachment 3 - Boys & Girls Club
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 5A: Proposed Goals & Milestones
Explain how the project will meet contract goals and milestones and be completed within 12 months (July 1, 2022 — June 30, 2023). For example, project expenditures and performance/ accomplishment goals of 40% by November 30th, 50% by December 31st, 80% by March 31st, and 100% by June 30th.

Project expenditures and performance accomplishment of goals of 80% by July 30th, 2022.

Project expenditures and performance accomplishment of goals of 100% by August 5, 2022 Fill-in the table below with dates for submission of reimbursement claims and the estimated amount of each.

Date of Reimbursement: Amount ($):
07/15/2022 $10,000.00
08/05/2022 $10,000.00
Total Reimbursement:
($) $20,000.00
11 -204-

Attachment 3 - Boys & Girls Club
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 6: Agency Capacity Narrative
(Non -Profit Organizations Only)
Describe the roles of key administrators; staff members, and volunteers within your agency that will implement the proposed project. In your description include experience, education, and licensing qualifications.

Megan Grisham, Director of Operations —has 10 years of experience in implementing successful summer camp programming.

Describe your agency's experience in administering government and/or public funds.

BGCSGP has extensive experience in administering government/public funds including CDBG, OJJDP and Asset Forfeiture.

Describe your method to sustain project viability over the multi-year process if funding decreases.

BGCSGP will continue to seek grant funds to provide this much needed program to at -promise youth in Yucaipa. We will utilize funds raised through fundraising events and from individual donors.

Instructions: Complete the table below by marking "YES" or "NO" to the questions listed below.

Question:

YES/ NO
Example: Have you received federal funds in the past
five years?
Yes
In the past ten years, has your organization ever had its nonprofit status revoked or withheld by the IRS, the
No
Secretary of State. tho State Attorney General, or the
Franchise Tax Board?
Has your organization been sued in the last five years? No
Are any of your managers or staff with fiscal
responsibilities involved in litigation presently that has any No
bearing on fiduciary trust or employee relations?
Have any unfavorable rulings been handed down by any
court against your organization or Executive Director the last No
five years?
Does your organization currently have any unresolved
fiscal, reporting, or program issues with any of its funding No
sources?
12 -205-

Attachment 3 - Boys & Girls Club
Public Services Program Application Fiscal Year 2022 — 2023 EXHIBIT 7: Civil Rights Laws Compliance and HUD Good Standing Answer the following questions.

Has your organization been a past recipient of assistance under a HUD McKinney Act program or the HUD Single Family Property Disposition Homeless Program? No
If you have been a recipient under either of these programs, has your agency experienced any project or construction delay, HUD finding or outstanding audit that HUD deems serious regarding the administration of HUD McKinney Act programs or the HUD Single Family Property Disposition Homeless Program?
INC,
If you answered "Yes", please explain the circumstances and outcome below.

Public Services Program Application Attachment 3 - Boys & Girls Club E- Signature Authorization
San Bernardino County
COU N TY Community Development and Housing
Community Development Block Grant
2022 - 2023 Application
Application Title: Boys & Girls Clubs of the San Gorgonio Pass - Summer Camp Applicant Name: Rhonda Guaderrama
Fiscal Year 2022 — 2023
Dena Fuentes
Deputy Executive Officer
Gary Hallen
Director
In order to comply with all applicable federal grant regulations, a hard -copy of this E -Signature Authorization containing an original wet signature must be filed with the San Bernardino County, Community Development and Housing (CDH) in order for the applicant to electronically sign the Community Development Block Grant (CDBG) application documents online.

My signature on this form certifies that:

This request is effective immediately upon receipt by the CDH and will remain in effect until the end of the 2022 - 2023 CDBG funding cycle or I choose to cancel this request via written notification to the CDH. understand that it is my responsibility to update and/or cancel this request under all circumstances, including my departure or terminated association with the below -listed applicant.

By signing the E- Signature Authorization Form we certify that this agency will also comply with the following:

Non-discrimination:

Accountability:

Attachment 3 - Boys & Girls Club
Public Services Program Application Fiscal Year 2022 — 2023 We affirm that all information in this application is true and correct to the best of our knowledge and that the applicant under our authority will execute its responsibility under the proposed contract and adhere to all other applicable rules and regulations to the fullest extent possible.

Non -collusion:

Applicant Information
-Applicant Name: Rhonda Guaderrama
-Application Title: Boys & Girls Clubs of the San Gorgonio Pass - Summer Camp Name:

Federal Tax ID No.: # 20-3812932
-Agency
Mailing Address:

P.O. Box 655, Beaumont, CA 92223
Phone No.:
(951) 922-3259
Email Address: [email protected]
Fax No: 951 922-0009
Authorized Signature
Print Name: Amy Herr
Print Title: CEO
Signature:

Original form with "wet" signature mailed in previously Date:
12/09/2021
Please send the signed copy of this agreement to:

Community Development and Housing
385 North Arrowhead Ave. 3rd Floor, San Bernardino, CA 94215-0043 Attn: Community Development Block Grant Application
-20p5

Attachment 3 - Boys & Girls Club
Public Services Program Application Fiscal Year 2022— 2023 CDBG Application Checklist
(Non -Profit Organizations Only)
Community-based organizations are required to include one copy of the items listed below. If you are not submitting these items at this time, please notify Community Development and Housing at (909) 387-4705 to make other arrangements. The following information is required before any contract or reimbursement can be completed.
o Summary of agency's current year General Operating Budget o List of agency's Board of Directors, including names and addresses o Proof of existing non-profit/tax-exempt status (Letters from the Federal Internal Revenue Service and State Franchise Tax Board) o Current certificate of insurance and amounts covered
o Organizational chart
o Minutes of last Board meeting
o Non- Profit agencies must be Registered in the System of Award Management (SAM) website.

Agency cannot be funded if they have been debarred in the past. o Provide board minutes/letter that authorizes the executive director or program manager to run the project.

If your application is funded you will be required to provide a copy of your last audit and your Articles of Incorporation and Bylaws must be on file. 16 -209-

Attachment 3 - FSA
Public Services Program Application Fiscal Year 2022— 2023 San Bernardino County
Fiscal Year 2022 - 2023
Public Services Program Application
YUCA22PS-023
The following documents must be submitted in the order listed, please be sure to submit all attachments with your application.

Log Number
(Office Use Only)
❑✓
Exhibit 1: Organization Information
Exhibit 2:

Project Information
Exhibit 3:

Community Needs and Target Population
Exhibit 4:

Project Budget & Sources
❑✓
Exhibit 5:

Performance & Outcomes
0✓
Exhibit 6:

Agency Capacity Narrative
❑✓
Exhibit 7:

Civil Rights Laws Compliance and HUD Good Standing
Exhibit 8:

Signature and Assurances
Application Checklist
-210-

Attachment 3 - FSA
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 1: Organization Information
Organization Name:

Family Service Association
Organization Address:
21250 Box Springs Road, Suite 212
City/State/Zip: IMoreno Valley / CA / 92557
Phone: 19516861096
Fax:

Email: lahlam.iadallah(a fsaca
Applicant Type: Non-profit Orqanization
Authorized Person Name: Cheryl -Marie Hansberger
Authorized Person's Title: IChief Executive Officer
Address: 121250 Box Springs Rd, Suite 212
City/State/Zip: Imoreno Valley / CA / 92557
Phone: 19516861096
Fax:

Email: I Cheryl. [email protected]
Application Contact Person's Name: jAhlam Jadallah
Application Contact Person's Title: IFund Development Specialist II Explain the Agency's 1) Mission, 2) Purpose, 3) Population Served, 4) Number of years serving population, 5) Supportive S.r-t%ices, their Funding Sources, and Start/End Dates.

Family Service Association has been a non-profit leader for 67 years now, and in times of unprecedented change and adversity, FSA has become a stabilizing force in the community.

Founded in 1953 by The Junior League of Riverside, community members have found comfort in FSA's legacy of providing high quality care through much needed services like Senior Nutrition, Childcare, Mental Health, and Child Abuse Prevention throughout the Inland Region. FSA's mission is "building community one family at a time, through compassion, advocacy and comprehensive model services, fostering self-sufficiency and sustainable impacts".
-211-

Attachment 3 - FSA
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 2: Project Information
Project Title:

Senior Nutrition Program
Project Address:
12202 1st St, Yucaipa, CA 92399
County Supervisorial District where project will be located:
❑ 1st District ❑ 2nd District ® 3rd District ❑ 4th District E15 th District Is this a New Public Service Project, or request to expand services to an existing CDBG project? Expansions of Service to an Existing Project
If this is an Expansion of Service to previously funded CDBG project, please explain how this is an expansion of service?. (i.e For 2015 we proposed 60 units of service, this year the agency is planning to serve 100 units of service)
For 2020, FSA proposed to serve 305 unduplicated clients. This year the Agency is planning to serve 310 unduplicated clients.

If you are requesting funds for an existing CDBG project, provide prior CDBG project number.

YUCA-20-1-05A/7518
Will this project provide an opportunity to hire minority-owned and women owned businesses? No
If YES, describe what actions will be completed to implement such subcontracting plans to monitor this component of the proposed project. If NO, discuss why and what actions are being taken to encourage minority -women businesses to apply for this project.

N/A
-212-

Attachment 3 - FSA
Public Services Program Application Fiscal Year 2022— 2023 EXHIBIT 2A: Countywide Vision
Indicate Yes/No in the table below if any of these countywide vision goals are pertinent to the proposed project.

Countywide Vision
Countywide Vision
Yes/ No
Implement the Countywide Vision.

Yes
Create, Maintain and Grow Jobs and
Economic Value in the County.

Yes
Improve County Government Operations.

Yes
Operate in a Fiscally -Responsible and
Business -Like Manner.

Yes
Ensure Development of a Well -Planned,
Balanced, and Sustainable County.

Yes
Maintain Public Safety.

Yes
Provide for the Health and Social Services
Needs of County Residents.

Yes
Pursue County Goals and Objectives by
Working with Other Governmental
Yes
Agencies.

Provide a brief narrative of how your project meets the Countywide Vision:

FSA's Senior Nutrition Program meets the Countywide Vision in the following ways: -Assists the County in creating a range of choices for its residents in how they live by offering senior services free of charge to qualified seniors. Aids the county in their vision of offering high quality community health programs. Facilitates in the County's vision of a model community where great ideas are shared and where collaborations are encouraged to reach shared interests and goals. -Supports the County's vision of a place that is a home for anyone seeking a sense of community and the best life has to offer. -213-

Attachment 3 - FSA
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 3: Community Needs and Target Population
Community Needs
Target Population
Public Service
Yes/No
Proposed Community:

Yes/No
Needs:

Senior Services
Low and Moderate Persons
Yes
Yes
Handicapped
Low and Moderate
Services
No
Households
Yes
Youth Services
Abused Children
No
No
Child Care
Handicapped Persons
Services
No
No
Transportation
Illiterate Persons
Services
No
No
Substance Abuse
Homeless Persons
Services
No
No
Employment
Migrant Farm Workers
Training
No
No
Health Services
Elderly People
Yes
Lead Hazard
Screening
No
Crime
Awareness
No
City/Target Area of Project Beneficiaries
Participating Cities: (i.e Redlands. Colton. Yucaipa)
Yucaipa
-214-

Attachment 3 - FSA
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 3: Community Needs and Target Population (continued) Describe the geographic boundaries of the neighborhood, community or area in which clients of the proposed program reside (attach a map if needed):

Yucaipa and surrounding communities.

HUD Demographics: (Yes/No)
■ Does this project help prevent homelessness?
No
■ Does this project help the homeless?
No
■ Does this project help those with HIV or AIDS?
No
■ Does this project primarily help persons with disabilities? No
Summarize the description of your project to include 1) priority, 2) sub -activity, 3) population(s) to be served, and 4) accomplishment level, and 5) services to be provided.

FSA's Senior Nutrition Program is dedicated to providing seniors with the necessary nutritional support to protect them against food insecurity, and to help them continue to live independent and fulfilling lives. For many seniors, Senior Nutrition is the first service that they seek for assistance to help them stay in their own homes and live independently. It is through funding from both San Bernardino CDBG program and San Bernardino County DAAS that we are able to provide this service to the residents in the City of Yucaipa. FSA provides nutritious meals to seniors 62 years of age and older in a group setting at the Yucaipa Senior Center.

Home -delivered meals are also delivered to homebound seniors who aren't mobile by reason of illness, disability, and a lack of transportation. The program also provides a range of services, including nutrition screening, assessment, and education. -215-

Attachment 3 - FSA
Public Services Program Application Fiscal Year 2022— 2023 Describe how this project meets the priority population and activities selected.

The Senior Nutrition Program serves as a critical and meaningful approach to tackle food insecurity, isolation, depression, and many other health and social issues that vulnerable seniors experience. FSA provides seniors with one nutritionally balanced meal Monday - Friday. By providing these meals we will continue to meet our goals of improving the overall health and wellbeing of those we serve.

Explain why this project is needed and what evidence can you substantiate the need.

The Outbreak of COVID-19 fueled the need for food services and an increased demand for meals. The demand continues to rise, and new participants are enrolling in the Senior Nutrition Program each day. FSA continues to exceed its program objectives and targets to meet the growth of the program.

Describe what gaps of service in the county this project fills.

Without the meals supplied by this program, many seniors would be prematurely placed in assisted living or nursing homes due to their inability to shop for food or prepare their own meals. Many seniors face the threat of hunger due to limitations in their daily living activities, such as difficulties with walking, meal preparation, eating, and memory. In addition, many seniors live alone and do not have family or neighbors to help shop for or prepare meals. For individuals in these challenging situations, the Senior Nutrition Program serves as a critical and valued program.

FSA's Senior Nutrition Program is scalable based on the amount of funding received from various funding sources. The more funds received, the more seniors are able to utilize the congregate and homebound nutrition services that FSA offers. FSA employs over 350 individuals and has a strong volunteer base of nearly 1,000 volunteers. Programs are staffed appropriately and our executive team is prepared to fill any vacancies should the need arise. -216-

Attachment 3 - FSA
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 4: Project Budget & Sources
Project Budget
SB County Share: ($)
Other Source: ($)
Personnel
$10,000.00
$1,350,437.00
Equipment (Rental, Lease or Purchase)
$11,478.00
Consultant Services
(Auditing, Accounting or Payroll)
$27,283.00
Space Rent
$26,929.00
Insurance
$95,474.00
Consumable Supplies
$1,718,078.00
Other
$975,794.00
Total Costs
$10,000.00
$4,205,473.00
Total Project Budget Cost: (CDBG Share + Other Source)
$4,215,473.00
-217-

Attachment 3 - FSA
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 4A: CDBG Funds Requested and Leveraging Information Indicate the amount being requested by the city.

City
Amount Requested ($):

Source of
Type of Funding: (Grant Name,
Amount ($):

Date
Funding:

EFSP Money)
Available:
(11/22/2016)
Federal
Funding
Older Americans Act Title III
$3,275,763.00
07/01/2022
State
Funding
Older Americans Act Title III
$259,000.00
07/01/2022
County
Funding
Older Americans Act Title I I I
$11,397.00
07/01/2022
Private
Funding
Individual Donations
$290,955.00
12/31/2022
Other:

In -Kind Gods & Services
$49,896.00
12/31/2022
Total Leveraging Funds
$3,887,011.00
-218-

Attachment 3 - FSA
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 5: Performance and Outcomes
Definitions:

Unduplicated Clients: The number clients/persons projected to be served during the program year (e.g. 25 clients, 50 seniors):

Duplicated Clients: The estimated yearly units of service (duplicated, e.g. 25 clients x 10 visits=250 units of service):

Complete the chart below with the number of Duplicated and Unduplicated Clients to be served.

In column 1 identify activities that will be completed (e.g. intervention, counseling, and case management).

In column 2 indicate the number of Unduplicated Clients to be served.

In column 3 identify the number of Duplicated Clients to be served.

Activities to be Completed (1)
Unduplicated
Clients to be
Served (2)
Duplicated Clients
projected to be
served (3)
Nutrition (Congregate & Homebound)
310
20000
Performance and Outcomes, answer the following narrative questions using minimum funds request.

Indicate a timeline of services provided to client(s) in order to meet project outcome(s).

September 31, 2022 - FSA will serve 310 unduplicated seniors with meals. We will continue to provide congregate and homebound meals til program end date in June 30, 2023. uescrine now vour aaencv aetermines ciient(s) success.

FSA determines client success through quantitative and qualitative measures. Quantitative measures includes the number of seniors served daily. Qualitative measures are client success stories and testimonials.

Describe your methodology to evaluate project outcomes.

FSA uses San Bernardino County Department on Aging and Adult Services Software to record the number of seniors that are served each day.

IN
-219-

Attachment 3 - FSA
Public Sen ices Program Application Fiscal Year 2022 — 2023 Exhibit 5A: Proposed Goals & Milestones
Explain how the project will meet contract goals and milestones and be completed within 12 months (July 1, 2022 — June 30, 2023). For example; project expenditures and performance/ accomplishment goals of 40% by November 30`", 50% by December 31St; 80% by March 31 Sr, and 100% by June 30``
FSA expects to serve 310 unduplicated clients throughout the program year. Since services will be conducted throughout the entire fiscal year, reimbursement claims will be issued each quarter.

Fill-in the table below with dates for submission of reimbursement claims and the estimated amount of each.

Date of Reimbursement:

Amount ($):
09/30/2022
$2,500.00
12/31/2022
$2,500.00
03/31/2023
$2,500.00
06/30/2023
$2,500.00
Total Reimbursement:
$10,000.00
11 -220-

Attachment 3 - FSA
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 6: Agency Capacity Narrative
(Non -Profit Organizations Only)
Describe the roles of key administrators, staff members, and volunteers within your agency that will implement the proposed project. In your description include experience, education, and licensing qualifications.

Tom Donahue is the Senior Nutrition Administrator and oversees the entire program, including budget preparation and policies/procedures.

Describe your agency's experience in administering government and/or public funds.

As a recipient of more than $750,000 in federal funds, FSA is subject to single audit requirements using appropriate professional standards.

Describe your method to sustain project viability over the multi-year process if runainq aecreases.

FSA consistently searches for funding opportunities that could be a match for all agency programs, including the Senior Nutrition Department's More than a Meal program funding opportunities.

Instructions: Complete the table below by marking "YES" or "NO" to the questions listed below.

Question:

Attachment 3 - FSA
Public Services Program Application Fiscal Year 2022 — 2023 EXHIBIT 7: Civil Rights Laws Compliance and HUD Good Standing Answer the following questions.

Applicants must be in compliance with applicable civil rights laws and Executive Orders. Applications will be rejected if your agency has any of the following: (1) Any pending civil rights lawsuit instituted by the U.S. Department of Justice; (2) Any noncompliance with civil rights statutes, Executive Orders or regulations as a result of formal administrative proceedings, unless the applicant is operating under a HUD -approved compliance agreement designed to correct the area of noncompliance or is currently negotiating such an agreement; (3) Any unresolved Secretarial charge of discrimination issues under Section 810(g) of the Fair Housing Act, as implemented by 24 CFR 103:400; (4) Any adjudication of a civil rights violation in a civil action brought against the Organization by a private individual, unless the applicant is operating in compliance with a court order designed to correct the area o noncompliance or the applicant has discharged any responsibility arising from such litigation; (5) Any deferral of the processing of applications from the sponsor imposed by HUD under Title VI of the Civil Rights Act of 1964, the Attorney General's Guidelines (28 CFR 50.3) or the HUD Title VI regulations (24 CFR 1.8) and procedures, or under Section 504 of the Rehabilitation Act of 1973 and HUD Section 504 regulations (24 CFR 8.57). If one or more of these situations exists with your Organization, please attach a brief description.
13 -222-

Public Services Program Application Attachment 3 - FSA Fiscal Year 2022— 2023 E- Signature Authorization
San Bernardino County
COUNTY Community Development and Housing
Community Development Block Grant
2022 - 2023 Application
Application Title: FSA Senior Nutrition Program - Yucaipa Applicant Name: Cheryl Marie Hansberger
Dena Fuentes
Deputy Executive Officer
Gary Hallen
Director
In order to comply with all applicable federal grant regulations, a hard -copy of this E -Signature Authorization containing an original wet signature must be filed with the San Bernardino County, Community Development and Housing (CDH) in order for the applicant to electronically sign the Community Development Block Grant (CDBG) application documents online.

My signature on this form certifies that:

By signing the E- Signature Authorization Form we certify that this agency will also comply with the following:

Non-discrimination:

Accountability:

Attachment 3 - FSA
Public Services Program Application Fiscal Year 2022— 2023 We affirm that all information in this application is true and correct to the best of our knowledge and that the applicant under our authority will execute its responsibility under the proposed contract and adhere to all other applicable rules and regulations to the fullest extent possible.

Non -collusion:

Applicant Information
Applicant Name: Cheryl Marie Hansberger
Application Title: FSA Senior Nutrition Program - Yucaipa Agency Name:

Federal Tax ID No.: 95-1803694
Mailing Address:
21250 Box Springs Rd, Suite 212
Phone No.:
(951) 686-1096
Email Address: [email protected]
Fax No:

Authorized Signature
Print Name: Cheryl -Marie Hansberger
Print Title: CEO
Signature:

Cheryl -Marie Hansberger
Date:
12/10/2021
Please send the signed copy of this agreement to:

Community Development and Housing
385 North Arrowhead Ave. 3rd Floor, San Bernardino, CA 94215-0043 Attn: Community Development Block Grant Application
-225

Attachment 3 - FSA
Public Services Program Application Fiscal Year 2022 — 2023 CDBG Application Checklist
(Non -Profit Organizations Only)
Community-based organizations are required to include one copy of the items listed below. If you are not submitting these items at this time, please notify Community Development and Housing at (909) 387-4705 to make other arrangements. The following information is required before any contract or reimbursement can be completed.
o Summary of agency's current year General Operating Budget o List of agency's Board of Directors, including names and addresses o Proof of existing non-profit/tax-exempt status (Letters from the Federal Internal Revenue Service and State Franchise Tax Board) o Current certificate of insurance and amounts covered
o Organizational chart
o Minutes of last Board meeting
o Non- Profit agencies must be Registered in the System of Award Management (SAM) website.

Agency cannot be funded if they have been debarred in the past. o Provide board minutes/letter that authorizes the executive director or program manager to run the project.

If your application is funded you will be required to provide a copy of your last audit and your Articles of Incorporation and Bylaws must be on file. 16 -225-

Attachment 3 - PAV
Public Services Program Application Fiscal Year 2022— 2023 N Ty
San Bernardino County
Fiscal Year 2022 - 2023
Public Services Program Application
YUCA22PS-042
The following documents must be submitted in the order listed, please be sure to submit all attachments with your application.

Log Number
(Office Use Only)
-226-
Exhibit 1: Organization Information
Exhibit 2: Project Information
❑
Exhibit 3: Community Needs and Target Population
Exhibit 4: Project Budget & Sources
Exhibit 5: Performance & Outcomes
Exhibit 6: Agency Capacity Narrative
Exhibit 7: Civil Rights Laws Compliance and HUD Good Standing Exhibit 8: Signature and Assurances
❑
Application Checklist
-226-

Attachment 3 - PAV
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 1: Organization Information
Organization Name:

San Bernardino Sexual Assault Services (Partners Against Violence) Organization Address:
444 N. Arrowhead Ave Ste 101, San Bernardino
City/State/Zip: Isan Bernardino / CA 192401
Phone: F9098858884
Fax:

Email: [email protected]
Applicant Type:

Authorized Person Name: IMichelle Cates
Authorized Person's Title: lExecutive Director
Address: 1444 N. Arrowhead Ave Ste 101
City/State/Zip: ISan Bernardino / CA / 92401
Phone: 19098858884
Fax:

Email: [email protected]
Application Contact Person's Name: ITerri Beltran
Application Contact Person's Title: [email protected] Explain the Agency's 1) Mission, 2) Purpose, 3) Population Served, 4) Number of years serving pct,k!iation, 5) Supportive Services, their Funding Sources, and Start/End Dates.

Partners Against Violence (formerly SBSAS') mission is, partnering to build healthy relationships, families, communities, and generations that are free from violence. Our purpose: we believe all persons should be able to live free of violence of any kind. We envision a cultural paradigm shift in which no one perpetuates violence. We work in partnership with our communities and Survivors to create a culture of respect and dignity for all persons through Institutional Advocacy, Prevention Education and Awareness Programming. All services are available to victims, their families, significant others, and friends at no charge, irrespective of socioeconomic status, gender, ethnic origin or sexual orientation. See Attachment 1.
-227-

Attachment 3 - PAV
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 2: Project Information
Project Title:

Supportive Services for Victims of Violence in Yucaipa
Project Address:
34144 Yucaipa Blvd, Yucaipa, CA 92399
County Supervisorial District where project will be located:
❑ 1st District ❑ 2nd District ® 3rd District E14 th District ❑ 5th District Is this a New Public Service Project, or request to expand services to an existing CDBG project? Expansions of Service to an Existing Project
If this is an Expansion of Service to previously funded CDBG project, please explain how this is an expansion of service?. (i.e For 2015 we proposed 60 units of service, this year the agency is planning to serve 100 units of service)
For 2020/2021 we proposed to serve 700 clients, 600 of those were community education/prevention services we have typically provided in the Yucaipa Community.With the challenges of COVID, we saw a significant decrease in accessible in-person services and referrals.While we did shift to providing secured telehealth services many of our referral sources decreased, with that in mind we propose to serve 250 residents for 2022-2023.

If you are requesting funds for an existing CDBG project, provide prior CDBG project number.

YUCA-19-1-05G/1681
Will this project provide an opportunity to hire minority-owned and women owned businesses? No
If YES, describe what actions will be completed to implement such subcontracting plans toinc- mitor this component of the proposed project. If NO, discuss why and what actions are being taken to encourage minority -women businesses to apply for this project.

N/A
-228-

Attachment 3 - PAV
Public Services Program Application Fiscal Year 2022— 2023 EXHIBIT 2A: Countywide Vision
Indicate Yes/No in the table below if any of these countywide vision goals are pertinent to the proposed project.

Countywide Vision
Countywide Vision
Yes/ No
Implement the Countywide Vision.

Yes
Create, Maintain and Grow Jobs and
Economic Value in the County.

No
Improve County Government Operations.

No
Operate in a Fiscally -Responsible and
Business -Like Manner.

Yes
Ensure Development of a Well -Planned,
Balanced, and Sustainable County.

No
Maintain Public Safety.

Yes
Provide for the Health and Social Services
Needs of County Residents.

Yes
Pursue County Goals and Objectives by
Working with Other Governmental
Yes
Agencies.

Provide a brief narrative of how your project meets the Countywide Vision:

This project will address the health and social service needs of the community through immediate emergency response, crisis intervention and supportive services. While also, focusing on maintaining public safety by providing community prevention education. SBSAS services will help implement the Countywide vision of a safe community come to light by providing supportive wraparound services to community residents for a safer, healthier community.
-229-

Attachment 3 - PAV
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 3: Community Needs and Target Population
Community Needs
Target Population
Public Service
Yes/No
Proposed Community:

Yes/No
Needs:

Senior Services
Low and Moderate Persons
No
Yes
Handicapped
Low and Moderate
Services
No
Households
Yes
Youth Services
Abused Children
Yes
Yes
Child Care
Handicapped Persons
Services
No
Yes
Transportation
Illiterate Persons
Services
No
Yes
Substance Abuse
Homeless Persons
Services
No
Yes
Employment
Migrant Farm Workers
Training
No
Yes
Health Services
Elderly People
Yes
Yes
Lead Hazard
Screening
No
Crime
Awarei iess
Yes
City/Target Area of Project Beneficiaries
Participating Cities: (i.e Redlands. Colton. Yucaipa)
ucaipa
-230-

Attachment 3 - PAV
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 3: Community Needs and Target Population (continued) Describe the geographic boundaries of the neighborhood. community or area in which clients of the proposed program reside (attach a map if needed):

We serve the entire City of Yucaipa
HUD Demographics: (Yes/No)
■ Does this project help prevent homelessness?
No
■ Does this project help the homeless?
No
■ Does this project help those with HIV or AIDS?
No
■ Does this project primarily help persons with disabilities? No
Summarize the description of your project to include 1) priority, 2) sub -activity, 3) population(s) to be served, and 4) accomplishment level, and 5) services to be provided.

The Yucaipa Outreach office is located in the Yucaipa Sheriff Department and provides services to victims of crime. Services primarily benefit low and moderate income persons who have been victimized by a violent crime within our target population. Our clients come from law enforcement referrals, local schools, self referrals, and community referrals. We have been operating this program for over 47 years and have seen services increase as the community grows. We have seen significant barriers to service implementation the last 2 years but remain committed to the Yucaipa community.ln order to address barriers we have begun offering additional services, such as, telehealth counseling and online teen prevention tool -kit. See Attachment 2.
-231-

Attachment 3 - PAV
Public Services Program Application Fiscal Year 2022— 2023 Describe how this project meets the priority population and activities selected.

This project serves victims of violent crimes through 24/7 emergency response, crisis hotline, crisis intervention services, counseling, advocacy, accompaniment, and wraparound supportive services. These activities are vital in the recovery and wellbeing of victims.

Through the project activities, clients will feel supported and better equipped to address their victimization.

Explain why this project is needed and what evidence can you substantiate the need.

Victimization severely impairs a survivor's life for months to years and at times may never recover. The trauma of the victimization can be revisited over the years and can remain lifelong. Through our research, we have found that the lack of counseling and supportive services is detrimental to a victim's wellbeing. This program is an invaluable community resource and is essential in addressing the aftermath of victimization.

Describe what gaps of service in the county this project fills.

There are limited resources and services for victims of violence. There are no other known service providers that respond 24/7 to provide crisis intervention and support services to victims of violence. The lack of immediate crisis intervention services and support a victim receives can impede the healing process for a survivor.

We have adequate staff to carry out this program. We currently have a Counselor onsite at the Yucaipa Sheriff Station providing supportive services and prevention education to the community as part of our current CDBG grant. Funding for this project is provided by Federal/State/City grants, Community Foundation grants, donations, and fundraising efforts. AI decrease in funding would result in a decrease in staffing and our capacity to provide vital extended services in the community.
-232-

Attachment 3 - PAV
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 4: Project Budget & Sources
Project Budget
SB County Share: ($)
Other Source: ($)
Personnel
$20,000.00
$93,500.00
Equipment (Rental, Lease or Purchase)
Consultant Services
(Auditing, Accounting or Payroll)Space
$2,200.00
Rent
Insurance
$2,000.00
Consumable Supplies
$4,500.00
Other
$2,400.00
Total Costs
$20,000.00
$104,600.00
Total Project Budget Cost: (CDBG Share + Other Source)
$124,600.00
-233-

Attachment 3 - PAV
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 4A: CDBG Funds Requested and Leveraging Information Indicate the amount being requested by the city.

City
Amount Requested ($):

Amount ($):
(This amount should match the grand
Funding:
total requested from CDBG Share)
Available:

Yucaipa
$20,000.00
Leveraging items may include any written commitments that will be used towards your cash match requirements in the project, as well as any written commitments for building, equipment, materials, services and volunteer time.

Source of
Type of Funding: (Grant Name,
Amount ($):

Date
Funding:

EFSP Money)
Available:
(11/22/2016)
Federal
Funding
CaIOES Rape Crisis and VOC Grants
$84,100.00
10/01/2022
State
Funding
County
Funding
Department of Behavioral Heath
$5,000.00
07/01/2022
Private
Funding
Other:

Private donations and fundraising
$15,500.00
07/01/2022
Total Leveraging Funds
$104,600.00
-234-

Attachment 3 - PAV
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 5: Performance and Outcomes
Definitions:

Unduplicated Clients: The number clients/persons projected to be served during the program year (e.g. 25 clients, 50 seniors):

Duplicated Clients: The estimated yearly units of service (duplicated, e.g. 25 clients x 10 visits=250 units of service):

Complete the chart below with the number of Duplicated and Unduplicated Clients to be served.

In column 1 identify activities that will be completed (e.g. intervention, counseling, and case management).

In column 2 indicate the number of Unduplicated Clients to be served.

In column 3 identify the number of Duplicated Clients to be served.

Activities to be Completed (1)
Unduplicated
Clients to be
Served (2)
Duplicated Clients
projected to be
served (3)
Crisis Response and Intervention
100
400
Community Awareness
150
300
Performance and Outcomes, answer the following narrative questions using minimum funds request.

Indicate a timeline of services provided to client(s) in order to meet project outcome(s).

July 1, 2022 through June 30, 2023, 100 residents will receive crisis intervention services and 150 community members will receive prevention/awareness education. uescrlDe now your agency aetermines ciient(s) success.

Client success is evaluated through client surveys, intake forms, counselor notes, multidisciplinary case reviews, Apricot Data System, and an independent outside study on feelings surveys.

Describe your methodology to evaluate project outcomes.

Counseling staff meets with the Program Director and Executive Director on a monthly basis to evaluate surveys and program management.
io
-235-

Attachment 3 - PAV
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 5A: Proposed Goals & Milestones
Explain how the project will meet contract goals and milestones and be completed within 12 months (July 1, 2022 —June 30, 2023). For example, project expenditures and performance/ accomplishment goals of 40% by November 301h, 50% by December 31ST, 80% by March 31st, and 100% by June 30th.

Project expenditures and performance goals will be as followed: 25% of goal will be met by September 30th, 50% of goal will be met by December 31 st, 75% of goal will be met by March 31st, and 100% of goal will be met by June 30th.

Fill-in the table below with dates for submission of reimbursement claims and the estimated amount of each.

Date of Reimbursement:

Amount ($):
07/31/2022
$1,666.00
08/31/2022
$1,666.00
09/30/2022
$1,666.00
10/31/2022
$1,666.00
11/30/2022
$1,667.00
12/31/2022
$1,667.00
01/31/2023
$1,667.00
02/28/2023
$1,667.00
03/31/2023
$1,667.00
04/30/2023
$1,667.00
05/31/2023
$1,667.00
06/30/2023
$1,667.00
Total Reimbursement:
($)
$20,000.00
11 -236-

Attachment 3 - PAV
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 6: Agency Capacity Narrative
(Non -Profit Organizations Only)
Describe the roles of key administrators, staff members, and volunteers within your agency that will implement the proposed project. In your description include experience, education, and licensing qualifications.

All staff are State Certified Sexual Assault Crisis Counselors successfully completing the State mandated training course. See Attachment 3
Describe your agency's experience in administering government and/or public funds.

For the past 47 years, we have managed various federal, state, and city grants in order to continue to provide vital services and programs.

Describe your method to sustain project viability over the multi-year process if iunainq decreases.

We continually seek new grants and funding sources. We also hold annual fundraisers and occasionally receive private donations throughout the year.

Instructions: Complete the table below by marking "YES" or "NO" to the questions listed below.

Question:

Attachment 3 - PAV
Public Services Program Application Fiscal Year 2022 — 2023 EXHIBIT 7: Civil Rights Laws Compliance and HUD Good Standing Answer the following questions.

Applicants must be in compliance with applicable civil rights laws and Executive Orders. Applications will be rejected if your agency has any of the following: (1) Any pending civil rights lawsuit instituted by the U.S. Department of Justice; (2) Any noncompliance with civil rights statutes, Executive Orders or regulations as a result of formal administrative proceedings, unless the applicant is operating under a HUD -approved compliance agreement designed to correct the area of noncompliance or is currently negotiating such an agreement; (3) Any unresolved Secretarial charge of discrimination issues under Section 810(g) of the Fair Housing Act, as implemented by 24 CFR 103:400; (4) Any adjudication of a civil rights violation in a civil action brought against the Organization by a private individual, unless the applicant is operating in compliance with a court order designe=d to correct the area of noncompliance or the applicant has discharged any responsibility arising from such litigation; (5) Any deferral of the processing of applications from the sponsor imposed by HUD under Title VI of the Civil Rights Act of 1964, the Attorney General's Guidelines (28 CFR 50.3) or the HUD Title VI regulations (24 CFR 1.8) and procedures, or under Section 504 of the Rehabilitation Act of 1973 and HUD Section 504 regulations (24 CFR 8.57). If one or more of these situations exists with your Organization, please attach a brief description.
13 -238-

Public Services Program Application Attachment 3 - PAV Fiscal Year 2022— 2023 E- Signature Authorization
San Bernardino County
S'�\ B1=1i\s1:I31:�C3
COUNTY Community Development and Housing
Community Development Block Grant
2022 - 2023 Application
Application Title: Supportive Services for Victims of Violence in Yucaipa Applicant Name: Michelle Cates
Dena Fuentes
Deputy Executive Officer
Gary Hallen
Director
In order to comply with all applicable federal grant regulations, a hard -copy of this E -Signature Authorization containing an original wet signature must be filed with the San Bernardino County, Community Development and Housing (CDH) in order for the applicant to electronically sign the Community Development Block Grant (CDBG) application documents online.

My signature on this form certifies that:

By signing the E- Signature Authorization Form we certify that this agency will also comply with the following:

Non-discrimination:

Accountability:

Attachment 3 - PAV
Public Services Program Application Fiscal Year 2022— 2023 We affirm that all information in this application is true and correct to the best of our knowledge and that the applicant under our authority will execute its responsibility under the proposed contract and adhere to all other applicable rules and regulations to the fullest extent possible.

Non -collusion:

Applicant Information
-Applicant Name: Michelle Cates
-Application Title: Supportive Services for Victims of Violence in Yucaipa -Agency Name:

Federal Tax ID No.: 95-3543081
Mailing Address:
444 N. Arrowhead Ave Ste 101, San Bernardino
Phone No.:
(909) 885-8884
Email Address: [email protected]
Fax No:

Authorized Signature
Print Name: Michelle Cates, MSW
Print Title: Executive Director
Signature:

Michelle Cates, Executive Director
Date:
12/13/2021
Please send the signed copy of this agreement to:

Community Development and Housing
385 North Arrowhead Ave. 3rd Floor, San Bernardino, CA 94215-0043 Attn: Community Development Block Grant Application
-2405

Attachment 3 - PAV
Public Services Program Application Fiscal Year 2022— 2023 CDBG Application Checklist
(Non -Profit Organizations Only)
Community-based organizations are required to include one copy of the items listed below. If you are not submitting these items at this time, please notify Community Development and Housing at (909) 387-4705 to make other arrangements. The following information is required before any contract or reimbursement can be completed.
o Summary of agency's current year General Operating Budget o List of agency's Board of Directors, including names and addresses o Proof of existing non-profit/tax-exempt status (Letters from the Federal Internal Revenue Service and State Franchise Tax Board) o Current certificate of insurance and amounts covered
o Organizational chart
o Minutes of last Board meeting
o Non- Profit agencies must be Registered in the System of Award Management (SAM) website.

Agency cannot be funded if they have been debarred in the past. o Provide board minutes/letter that authorizes the executive director or program manager to run the project.

If your application is funded you will be required to provide a copy of your last audit and your Articles of Incorporation and Bylaws must be on file. 16 -241-

Attachment 3 - CoY Scholarship Prgrm
Public Services Program Application Fiscal Year 2022— 2023 ,QTY
San Bernardino County
Fiscal Year 2022 - 2023
Public Services Program Application
YUCA22PS-062
Log Number
(Office Use Only)
The following documents must be submitted in the order listed, please be sure to submit all attachments with your application.
-242-
Exhibit 1: Organization Information
Exhibit 2: Project Information
❑
Exhibit 3: Community Needs and Target Population
Exhibit 4: Project Budget & Sources
Exhibit 5: Performance & Outcomes
Exhibit 6: Agency Capacity Narrative
Exhibit 7: Civil Rights Laws Compliance and HUD Good Standing Exhibit 8: Signature and Assurances
Application Checklist
-242-

Attachment 3 - CoY Scholarship Prgrm
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 1: Organization Information
Organization Name:

City of Yucaipa
Organization Address:
34272 Yucaipa Blvd.

City/State/Zip: JYucaipa / CA / 92399
Phone:9097972489
Fax:

Email: Imwolfe(d�vucaba.o
Applicant Type: IPublic Service Program
Authorized Person Name: Imegan Wolfe
Authorized Person's Title: IDirector of Community Services Address: 134272 Yucaipa Blvd
City/State/Zip: IYucaipa / CA / 92399
Phone: 19097972489
Fax:

Email: [email protected]
Application Contact Person's Name: Imegan Wolfe
Application Contact Person's Title: IDirector of Community Services Explain the Agency's 1) Mission, 2) Purpose, 3) Population Served, 4) Number of years serving population, 5) Supportive Services, their Funding Sources, and Start/End Dates.

Yucaipa is the jewel of the Inland Empire, with a population of 56,000; Residents live here for the distinctive amenities and quality of life. Few cities in California have such a natural environment, ample recreational parks, facilities, low crime, good schools, and are fiscally sound. These amenities distinguish Yucaipa as a premier community. Framed by the San Bernardino Mountains, Yucaipa's natural environment, with its clean air and unique topography, distinguishes its exceptional quality of life. Quality public facilities, schools, community services, and other amenities draw residents and visitors of all ages to live, work, and play in Yucaipa. The Yucaipa Scholarship Program is a City sponsored service which includes all recreation and community service related programs for Yucaipa youth, teens and seniors. Program begins July 1, 2022 to June 30, 2023.
-243-

Attachment 3 - CoY Scholarship Prgrm
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 2: Project Information
Project Title:

Yucaipa Scholarship Program
Project Address:
34272 Yucaipa Blvd
County Supervisorial District where project will be located:
❑ 1st District ❑ 2nd District ® 3rd District ❑ 4th District ❑ 5th District Is this a New Public Service Project, or request to expand services to an existing CDBG project? Expansions of Service to an Existing Project
If this is an Expansion of Service to previously funded CDBG project, please explain how this is an expansion of service?. (i.e For 2015 we proposed 60 units of service, this year the agency is planning to serve 100 units of service)
Due to COVID registration numbers were lower in 2021 than previous years'. With the continual growth of the population, and the release of vaccines, the City of Yucaipa is looking to expand services to 130 units of unduplicated residents.

If you are requesting funds for an existing CDBG project, provide prior CDBG project number.

YUCA-17-1-05Z-2784
Will this project provide an opportunity to hire minority-owned and women owned businesses? No
If YES, describe what actions will be completed to implement such subcontracting plans to monitor this component of the proposed project. If NO, discuss why and what actions are being taken to encourage minority -women businesses to apply for this project. -244-

Attachment 3 - CoY Scholarship Prgrm
Public Services Program Application Fiscal Year 2022— 2023 EXHIBIT 2A: Countywide Vision
Indicate Yes/No in the table below if any of these countywide vision goals are pertinent to the proposed project.

Countywide Vision
Countywide Vision
Yes/ No
Implement the Countywide Vision.

Yes
Create, Maintain and Grow Jobs and
Economic Value in the County.

Yes
Improve County Government Operations.

Yes
Operate in a Fiscally -Responsible and
Business -Like Manner.

Yes
Ensure Development of a Well -Planned,
Balanced, and Sustainable County.

Yes
Maintain Public Safety.

Yes
Provide for the Health and Social Services
Needs of County Residents.

Yes
Pursue County Goals and Objectives by
Working with Other Governmental
Yes
Agencies.

Provide a brief narrative of how your project meets the Countywide Vision:

The City of Yucaipa exemplifies the County's vision in providing a sustainable system for highquality education through the partnership with Yucaipa-Calimesa Joint Unified School District and Crafton Hills College, as well as, with the Healthy Yucaipa Program on various health programs available to residents, public safety -keeping all residents safe and secure, fiscal responsibility and transparency, City recreation services being offered for all ages, arts & cultural programming in partnership with local community groups (Vision Quest & Arts Association) and infrastructure, in which development complements our natural topography of Yucaipa. These elements are in line with the County Wide Vision and provide a road map for a quality of life for all Yucaipa residents.
-245-

Attachment 3 - CoY Scholarship Prgrm
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 3: Community Needs and Target Population
Community Needs
Target Population
Public Service
Yes/No
Proposed Community:

Yes/No
Needs:

Senior Services
Low and Moderate Persons
Yes
Yes
Handicapped
Low and Moderate
Services
Yes
Households
Yes
Youth Services
Abused Children
Yes
Yes
Child Care
Handicapped Persons
Services
Yes
Yes
Transportation
Illiterate Persons
Services
Yes
Yes
Substance Abuse
Homeless Persons
Services
No
No
Employment
Migrant Farm Workers
Training
No
Yes
Health Services
Elderly People
Yes
Yes
Lead Hazard
Screening
No
Crime
Awareness
No
City/Target Area of Project Beneficiaries
Participatinq Cities: (i.e Redlands. Colton. Yucaioa)
The City of Yucaipa's target area will be City wide and within the sphere of influence of City boundaries
-246-

Attachment 3 - CoY Scholarship Prgrm
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 3: Community Needs and Target Population (continued) Describe the geographic boundaries of the neighborhood, community or area in which clients of the proposed program reside (attach a map if needed):

The target geographic boundaries will be City-wide, within the sphere of influence of City boundaries and zip codes of Yucaipa.

The Yucaipa Scholarship Program (YSP) will provide Yucaipa youth, teens, and seniors, from low -to -moderate income families an opportunity to experience and participate in Community Services Department sponsored program and activities including, but not limited to: swimming lessons, sport related programming, various arts & crafts, dance classes, tennis lessons, computer/educational classes, gymnastics, karate/self-defense classes, music and preforming arts classes, kid camps, before and after school programs, teen services & activities, senior programs/classes, excursions & nutritional services, and senior and youth garden classes. Families/households living within the City limits would be eligible to apply for an YSP for youth who are 17 years and younger and seniors that are 55 years and older. Each applicant would complete and submit a scholarship application and written proof of City residency and annual income for the entire household members to determine if the applicant's income meets the HUD guidelines. Each applicant would receive a full and or partial scholarship for a Community Services Department recreation or community service program, depending on household income and the number of individuals in the family/household. Each eligible applicant would also be limited to funding availability in scholarship dollars dependent on the aid they qualified for (not to exceed $800 per year). -247-

Attachment 3 - CoY Scholarship Prgrm
Public Services Program Application Fiscal Year 2022— 2023 Describe how this project meets the priority population and activities selected.

This YSP project meets and exceeds the funding need each year. Families with elementary children whose parents commute request the need for child care/after school programs, and senior service assistance for 55 +, is in great demand. In the past several years, the need for assistance has increased among low -to -moderate income parents and seniors, who would not have had the ability to afford services otherwise
Explain why this project is needed and what evidence can you substantiate the need.

The YSP project need is measured by the number of applicants the City receives monthly/yearly. Supplemental assistance for families/seniors is growing rapidly. The growing need for two working parents has created the increased need for after school/child care programs, and the senior population growth has created limited resources for many. The YSP provides the need for services yearly through this scholarship opportunity.

Describe what gaps of service in the county this project fills.

YSP reduces the gap in City/County child care services/after school assistance and supplemental senior leisure services. Currently, YSP services the crucial need for the recipients for child care services, work -to -welfare and single/two parent incomes in need of supplemental assistance for one or more of their children. YSP assists participants to afford classes and/or services at a reduced rate to children, teens, youth and seniors 55+. The YSP project complements other services throughout the City/County and provides that increased quality of life for each participant.

Currently, this is the only means of funding for this project. If funding would be decreased and/or eliminated, that would have to be a policy decision on behalf of the City Council to allocate general fund dollars to supplement and/or budget for the entire amount of the project in the next fiscal year. Staffing is adequate for this project and will continue if any turnover would occur. Grant funding is crucial to the success of the project to continue the valuable services/resources the City provides to so many children, youth, teens, families and seniors

Attachment 3 - CoY Scholarship Prgrm
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 4: Project Budget & Sources
Project Budget
SB County Share: ($)
Other Source: ($)
Personnel
Equipment (Rental, Lease or Purchase)
Consultant Services
(Auditing,Accounting or Payroll)
Space Rent
Insurance
Consumable Supplies
Other
IScholarships
$17,000.00
Total Costs
$17,000.00
$0.00
Total Project Budget Cost: (CDBG Share + Other Source)
$17,000.00
-249-

Attachment 3 - CoY Scholarship Prgrm
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 4A: CDBG Funds Requested and Leveraging Information Indicate the amount being requested by the city.

City
Amount Requested ($):

Amount ($):
(This amount should match the grand
Funding:
total requested from CDBG Share)
Available:

Yucaipa
$17,000.00
Leveraging items may include any written commitments that will be used towards your cash match requirements in the project, as well as any written commitments for building, equipment, materials, services and volunteer time.

Source of
Type of Funding: (Grant Name,
Amount ($):

Date
Funding:

EFSP Money)
Available:
(11/22/2016)
Federal
Funding
State
Funding
County
Funding
Private
Funding
Other:

Total Leveraging Funds
$0.00
-250-

Attachment 3 - CoY Scholarship Prgrm
Public Services Program Application Fiscal Year 2022 — 2023 Exhibit 5: Performance and Outcomes
Definitions:

Unduplicated Clients: The number clients/persons projected to be served during the program year (e.g. 25 clients, 50 seniors):

Duplicated Clients: The estimated yearly units of service (duplicated, e.g. 25 clients x 10 visits=250 units of service):

Complete the chart below with the number of Duplicated and Unduplicated Clients to be served.

In column 1 identify activities that will be completed (e.g. intervention, counseling, and case management).

In column 2 indicate the number of Unduplicated Clients to be served.

In column 3 identify the number of Duplicated Clients to be served.

Activities to be Completed (1)
Unduplicated
Clients to be
Served (2)
Duplicated Clients
projected to be
served (3)
Health, sports AND welness
125
1000
Senior classes
50 500
Performance and Outcomes, answer the following narrative questions using minimum funds request.

Indicate a timeline of services provided to client(s) in order to meet project outcome(s).

The minimum funding requested has been $2 and the maximum allotment is $800 per participant. Due to the number of participants serviced, the funding limits were adjusted to meet the needs of increased requests.
uescrlpe now vour aclencv aetermines client(s) success.

The City measures successes by examples such as this: the City assisted one parent find child care/after school services, while the single father attended his scheduled job interview.

He was hired on the spot!
Describe your methodology to evaluate project outcomes.

The project is measured by the number of scholarships processed yearly. The City has exceeded and/or met its target goals yearly.
10 -251-

Attachment 3 - CoY Scholarship Prgrm
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 5A: Proposed Goals & Milestones
Explain how the project will meet contract goals and milestones and be completed within 12 months (July 1, 2022 — June 30, 2023). For example; project expenditures and performance/ accomplishment goals of 40% by November 30'h, 50% by December 31St, 80% by March 31Sr and 100% by June 301H
he YSP project will meet the current contract goals and milestones within the 12 months by ie following timelines: July 1 st - December 31, 2022 - 55%; January 1 - May 30, 2023-40%; une 1-30, 2023-5%. The funds are usually exhausted by early June Fill-in the table below with dates for submission of reimbursement claims and the estimated amount of each.

Date of Reimbursement:

Amount ($):
07/01/2022
$2,000.00
08/01/2022
$2,000.00
09/08/2022
$2,000.00
10/01/2022
$2,000.00
11/01/2022
$2,000.00
12/01/2021
$2,000.00
01/01/2023
$2,000.00
02/01/2023
$3,000.00
Total Reimbursement:
($�
$17,000.00
11 -252-

Attachment 3 - CoY Scholarship Prgrm
Public Services Program Application Fiscal Year 2022— 2023 Exhibit 6: Agency Capacity Narrative
(Non -Profit Organizations Only)
Describe the roles of key administrators, staff members, and volunteers within your agency that will implement the proposed project. In your description include experience, education, and licensing qualifications.

Describe your agency's experience in administering government and/or public funds.

Describe your method to sustain project viability over the multi-year process if IUllulllU UCUICdJCS.

Instructions: Complete the table below by marking "YES" or "NO" to the questions listed below.

Question:

YES/ NO
Example: Have you received federal funds in the past
five years?
Yes
In the past ten years, has your organization ever had its nonprofit status revoked or withheld by the IRS, the
Yes
Secretary of State, the State Attorney General, or the
Franchise Tax Board?
Has your organization been sued in the last five years? No
Are any of your managers or staff with fiscal
responsibilities involved in litigation presently that has any No
bearing on fiduciary trust or employee relations?
Have any unfavorable rulings been handed down by any
court against your organization or Executive Director the last No
five years?
Does your organization currently have any unresolved
fiscal, reporting, or program issues with any of its funding No
sources?
12 -253-

Attachment 3 - CoY Scholarship Prgrm
Public Services Program Application Fiscal Year 2022 — 2023 EXHIBIT 7: Civil Rights Laws Compliance and HUD Good Standing Answer the following questions.

Applicants must be in compliance with applicable civil rights laws and Executive Orders. Applications will be rejected if your agency has any of the following: (1) Any pending civil rights lawsuit instituted by the U.S. Department of Justice; (2) Any noncompliance with civil rights statutes, Executive Orders or regulations as a result of formal administrative proceedings, unless the applicant is operating under a HUD -approved compliance agreement designed to correct the area of noncompliance or is currently negotiating such an agreement; (3) Any unresolved Secretarial charge of discrimination issues under Section 810(g) of the Fair Housing Act, as implemented by 24 CFR 103:400; (4) Any adjudication of a civil rights violation in a civil action brought against the Organization by a private individual, unless the applicant is operating in compliance .pith a court order designed to correct the area of noncompliance or the applicant has discharged any responsibility arising from such litigation; (5) Any deferral of the processing of applications from the sponsor imposed by HUD under Title VI of the Civil Rights Act of 1964, the Attorney General's Guidelines (28 CFR 50.3) or the HUD Title VI regulations (24 CFR 1.8) and procedures, or under Section 504 of the Rehabilitation Act of 1973 and HUD Section 504 regulations (24 CFR 8.57). If one or more of these situations exists with your Organization, please attach a brief description.
13 -254-

Public Services Program Application Attachment 3 - CoY Scholarship Prgrm E- Signature Authorization
if\ARDINO
San Bernardino County
)AN I i
COUNTY Community Development and Housing
Community Development Block Grant
2022 - 2023 Application
Application Title: Yucaipa Recreation Scholarship
Applicant Name: Todd Gutjahr
Fiscal Year 2022— 2023
Dena Fuentes
Deputy Executive Officer
Gary Hallen
Director
In order to comply with all applicable federal grant regulations, a hard -copy of this E -Signature Authorization containing an original wet signature must be filed with the San Bernardino County, Community Development and Housing (CDH) in order for the applicant to electronically sign the Community Development Block Grant (CDBG) application documents online.

My signature on this form certifies that:

By signing the E- Signature Authorization Form we certify that this agency will also comply with the following:

Non-discrimination:

Accountability:

Attachment 3 - CoY Scholarship Prgrm
Public Services Program Application Fiscal Year 2022— 2023 We affirm that all information in this application is true and correct to the best of our knowledge and that the applicant under our authority will execute its responsibility under the proposed contract and adhere to all other applicable rules and regulations to the fullest extent possible.

Non -collusion:

Applicant Information
-Applicant Name: Todd Gutjahr
-Application Title: Yucaipa Recreation Scholarship
-Agency Name:

Federal Tax ID No.: 33-0383731
Mailing Address:
34272 Yucaipa Blvd
Phone No.:
(909) 797-2489
Email Address: [email protected]
Fax No:

Authorized Signature
Print Name: Megan Wolfe
Print Title: Director of Community Services
Signature:

Megan Wolfe Director of Community Services
Date:
12/14/2021
Please send the signed copy of this agreement to:

Community Development and Housing
385 North Arrowhead Ave. 3rd Floor, San Bernardino, CA 94215-0043 Attn: Community Development Block Grant Application
-259-

Attachment 3 - CoY Scholarship Prgrm
Public Services Program Application Fiscal Year 2022— 2023 CDBG Application Checklist
(Non -Profit Organizations Only)
Community-based organizations are required to include one copy of the items listed below. If you are not submitting these items at this time, please notify Community Development and Housing at (909) 387-4705 to make other arrangements. The following information is required before any contract or reimbursement can be completed.
o Summary of agency's current year General Operating Budget o List of agency's Board of Directors, including names and addresses o Proof of existing non-profit/tax-exempt status (Letters from the Federal Internal Revenue Service and State Franchise Tax Board) o Current certificate of insurance and amounts covered
o Organizational chart
o Minutes of last Board meeting
o Non- Profit agencies must be Registered in the System of Award Management (SAM) website.

Agency cannot be funded if they have been debarred in the past. o Provide board minutes/letter that authorizes the executive director or program manager to run the project.

If your application is funded you will be required to provide a copy of your last audit and your Articles of Incorporation and Bylaws must be on file. 16 -257-

Yucaipa City CouncilFebruary 14, 2022

Yucaipa City Council
February 14, 2022