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2016-02-24 e-packet
SPECIAL MEETING yo��R OF THE COMMUNITY DEVELOPMENT BLOCK o GRANT (CDBG) SUBCOMMITTEE c'QLlgpptl OF THE CITY OF SOUTH SAN FRANCISCO P.O. Box 711 (City Hall, 400 Grand Avenue) South San Francisco, California 94083 Meeting will be held at: BETTY WEBER ROOM 33 ARROYO DRIVE SOUTH SAN FRANCISCO, CA WEDNESDAY, FEBRUARY 24, 2016 2:00 P.M. NOTICE IS HEREBY GIVEN, pursuant to Section 54956 of the Government Code of the State of California, the Community Development Block Grant (CDBG) Subcommittee of the City of South San Francisco will hold a Special Meeting on Wednesday, the 24' day of February, at 2:00 P.M., at the Betty Weber Room, Municipal Services Building, 33 Arroyo Drive, South San Francisco, California 94080. Purpose of the meeting: 1. Call to Order. 2. Roll Call. 3. Public Comments. CONSENT 4. Motion to Approve the Minutes of the meeting of March 12, 2015. ADMINISTRATIVE BUSINESS: 5. Review of Community Development Block Grant (CDBG) process, FYI 6-17 Budget Allocation and Grantee Applications. i. Introduction - Review Provided Materials ii. Funding available - Funding Overview - Proposed Breakdown of Funding Allocations iii. Applications CDBG - Category 1: Public Service Grants - Two Year Grant Cycle - One Year Check -In - Minimum Grant Amount- $10,000 - Received 11 applications CDBG - Category 2: Minor Home Repair Programs - Two Year Grant Cycle - One Year Check -In - Minimum Grant Amount- $10,000 - Received 4 applications CDBG - Category 3: City Sponsored Projects - One Year Grant Cycle HOME FUNDS - Fair Housing Activities - Two Year Grant Cycle - One Year Check -hi - Minimum Grant Amount- N/A - Received 1 application 6. Upcoming subcommittee meeting schedule. ADJOURNMENT a� Gabriel odriguez Deputy City Clerk CDBG MEETING FEBRUARY 24, 2016 AGENDA PAGE2 March 9, 2016 Needs Assessment Public Hearing March 14, 2016 CDBG Subcommittee to finalize funding recommendations April 27, 2016 Final Public Hearing, Funding Allocations, & Adoption of Cit)/s 2016 -2017 Action Plan May 13, 2016 City s 2016 -2017 Annual Action Plan is submitted to HUD ADJOURNMENT a� Gabriel odriguez Deputy City Clerk CDBG MEETING FEBRUARY 24, 2016 AGENDA PAGE2 MINUTES o�Tx sAt SPECIAL ",AN OF THE E ...: U o COMMUNITY DEVELOPMENT c'�LIF0 BLOCK GRANT (CDBG) SUBCOMMITTEE OF THE CITY OF SOUTH SAN FRANCISCO P.O. Box 711 (City Hall, 400 Grand Avenue) South San Francisco, California 94083 Meeting will be held at: ECD CONFERENCE ROOM 400 GRAND AVENUE SOUTH SAN FRANCISCO, CA THURSDAY, MARCH 12, 2015 11:00 A.M. 1. Call to Order. 11:05 A.M. 2. Roll Call. PRESENT: Mayor Garbarino, Councilwoman Matsumoto. ABSENT: None. 3. Public Comments. None. 4. Approval of Minutes of the February 5, 2015 Meeting. Approved. 5. Presentation of 2015 -2016 Community Development Block Grant applications and formulation of funding recommendations (Alin Lancaster, Community Development Coordinator), Community Development Coordinator Alin Lancaster provided staff with a handout of the Fiscal Year 2015 -2016 Applications Fund Request Summary which detailed the various organizations, programs, and amount of funding each received last Fiscal Year, the amount requested for this Fiscal Year, and the Subcommittee recommendations for review. Subcommittee members provided direction regarding the following funding allocations: (1) the provision of additional funding to Samaritan House for Safe Harbor; (2) rounding up the funding for El Concilio and the Center for Independence Housing Programs so they receive an amount closer to what was initially allocated; and (3) a request that Project Sentinel Fair Housing Program accomplish two (2) outreach programs a year instead of one (1) in return for increased funding. Committee members requested to see CDBG funding allocation information for other cities and towns in the County once available for viewing. 6. Presentation of the updated design concept for the Grand Avenue Pedestrian Improvement Project (Alin Lancaster, Community Development Coordinator). Committee members discussed funding allocations and expressed that they would like to cancel a Right of Way Improvement Contract due to budget cuts, subsequent funding restrictions, and high costs, but wanted to keep the design plans for a future opportunity. The Subcommittee decided to recommend reallocation of funding toward Downtown Fapade and Tenant Improvement Programs as well as Right of Way Improvements, emphasizing opportunities to expand the Downtown dynamic to include businesses on peripheral streets. The remaining funds were also distributed to housing rehabilitation programs. Committee members presented recommendations for additional projects such as decorative pieces and bio treatment landscaping. 7. Adjournment. Being no further business, the meeting was adjourned at 11:55 A.M. Submitted by: Deputy CDBG Su City of South San Approved by: CDBG Subcommittee Member Clerk City of South San Francisco CDBG SUBCOMMITTEE MEETING MARCH 12, 2015 MINUTES PAGE Community Development Block Grant [CDBG] Subcommittee Meeting AGENDA February 16, 2016 INTRODUCTION - Review Provided Materials FUNDING AVAILABLE - Funding Overview - Proposed Breakdown of Funding Allocations APPLICATIONS CDBG- Category 1: Public Service Grants -Two Year Grant Cycle -One Year Check -In - Minimum Grant Amount- $10,000 - Received 11 applications CDBG- Category 2: Minor Home Repair Programs -Two Year Grant Cycle -One Year Check -In - Minimum Grant Amount- $10,000 - Received 4 applications CDBG- Category 3: City Sponsored Projects -One Year Grant Cycle HOME FUNDS- Fair Housing Activities -Two Year Grant Cycle -One Year Check -In - Minimum Grant Amount- N/A - Received 1 application UPCOMING SCHEDULE March 9, 2016 Needs Assessment Public Hearing March 11, 2016 CDBG Subcommittee to finalize funding recommendations April 27, 2016 Final Public Hearing, Funding Allocations, & Adoption of City's 2016 -2017 Action Plan May 15, 2016 City's 2016 -2017 Annual Action Plan is submitted to HUD CITY OF SOUTH SAN FRANCISCO INTER - OFFICE MEMORANDUM DATE: Monday, February 8, 2016 TO: Community Development Block Grant (CDBG) Subcommittee Councilmember Liza Normandy and Councilmember Richard Garbarino FROM: Alex Greenwood, Director of Economic & Community Development SUBJECT: Community Development Block Grant (CDBG) Applications and Subcommittee Review Process This memorandum serves to notify the CDBG Subcommittee about the FY 2016 -2017 Community Development Block Grant (CDBG) allocation process. BACKGROUND /DISCUSS ION The United States Department of Housing and Urban Development (HUD) requires local jurisdictions to prepare an Annual Action Plan ( "Action Plan") in order to receive funds through the CDBG Program. The City has begun the development process of the CDBG Action plan for the upcoming 2016 -2017 fiscal year and as part of this process, the City is required to hold two public hearings. The first public hearing is to assess the needs of the community and the second public hearing is to hear public comments on the draft Action Plan. Additionally, the City must determine how CDBG funds will be allocated. FY 2016 -2017 marks the first year of the two -year funding cycle. The City has not yet received notification from HUD regarding its estimated CDBG entitlement allocation for FY 2016 -2017. However, combining the anticipated entitlement with some unspent FY 2015 -2016 funds, the City has estimated the FY 2016 -2017 allocation to be $545,364. This budget will cover four categories: Public Services, Minor Home Repair Programs, City Sponsored Programs, and Administration Expenses. CDBG Funding Distrubition 12% 17% 61% 10% ■ PUBLIC SERVICES ■ ADMINISTRATION MINOR HOME REPAIR PROGRAMS CITY SPONSORED ACTIVITIES In addition to CDBG funding, the City also receives HOME funds from the County of San Mateo ( "the County ") HOME consortium. CDBG regulations require that the City use HOME funding to affirmatively further fair housing and, these activities can only be funded from administration or public service funds. The City has not yet received notification from HUD or the County regarding the entitlement amount but has estimated the FY 2016 -2017 allocation to be $9,000. ACTIVITIES In January, the City invited public service agencies to apply for CDBG grant funding. These applications were due on Friday, January 22, 2015 and the City received 16 applications. Economic and Community Development staff has reviewed the applications for eligibility and completeness. Binders containing these applications and pertinent information have been created for the City Council to review. The binders will be available in the City Council's office, with all applications and summaries, starting on Monday, February 8, 2016. The CDBG Subcommittee will meet on Tuesday, February 16, 2016 to evaluate the 16 grantee applications and discuss funding allocations. During this meeting, Economic and Community Development staff will discuss the overall process, provide a funding overview, and review the grantee applications. Based on the information, the CDBG subcommittee will make preliminary recommendations about the CDBG and HOME funding allocations to the City Council. The first required City Council public hearing will take place on March 9, 2016. The purpose of this hearing is to assess community need and to provide applicants an opportunity to present their proposals. The CDBG Subcommittee will meet again on March 11, 2016 (date to be confirmed) to finalize recommendations. The second and final public hearing, to adopt the 2016 -2017 Annual Action Plan and approve funding allocations, will be on April 27, 2016. The City Council has the option to accept or revise these recommendations at this public hearing. The final adopted FY 2016 -2017 Annual Action Plan must be submitted to HUD for approval by May 13, 2016. Attachment A outlines critical path process and deadlines to the City's Annual Action Plan approval. If you have any further questions, please feel free to contact me at (650) 829 -6620 or email me alex.greenwooda,ssf net. Attachment A CDBG Allocation Timeline FY 2016 -2017 January 7, 2016 South San Francisco Application Available (online only) January 22, 2016 APPLICATION DEADLINE at S:OOpm January 23 to March 8, 2016 Application Review Period February 8, 2016 Needs Assessment Hearing notice period begins February 16, 2016 CDBG Subcommittee Meeting to review process March 9, 2016 City Council Community Needs Assessment Public Hearing March 11, 2016 CDBG Subcommittee meeting to finalize funding recommendations. March 28, 2016 Public Notice of Availability of the City's FY 2016 -17 Annual Action Plan Start of the 30 day public comment period April 27, 2016 City Council Meeting: Final funding allocations and public hearing on the adoption of the City's 2016 -17 Annual Action Plan End of 30 day public comment period May 13, 2016 City's 2016 -17 Annual Action Plan is submitted to HUD July 1, 2016 FY 2016 -17 commences Community Development Block Grant [CDBG] Program Funding Overview ESTIMATED AVAILABLE COMMUNITY DEVELOPMENT BLOCK GRANT FY 15 -16 FY 16 -17 (Estimate) Entitlement Amount 415,864 415,864 Prior Years Uncommitted Funds 226,000 94,500 Estimated Program Income 35,000 35,000 TOTAL CDBG FUNDS 1 HOME FUNDS 676,8641 FY 15 -16 545,364 FY 16 -17 (Estimate) HOME Administrative Funds 8,762 9,000 ESTIMATED FUNDS FROM ALL SOURCES BUDGET 685,626 FY 15 -16 554,364 FY 16 -17 (Estimate) CDBG- PUBLIC SERVICES (15% of Entitlement & Prior Year's Program Income) Non - profits TBD Subtotal 69,7501 67,629 CDBG -MINOR HOME REPAIR PROGRAMS TBD TBD Subtotal 57,000 57,000 CDBG -CITY SPONSORED PROGRAMS Public Improvements 159,500 120,562 Downtown Fa ;ade Improvement Program 200,000 60,000 City Sponsored Housing Rehabilitation Program 100,000 150,000 Subtotal 419,500 330,562 CDBG - ADMINISTRATION (20% of Entitlement & Prior Year's Program Income) CDBG Administration 90,172 90,173 TOTAL CDBG BUDGET 1 636,4221 545,364 HOME FUNDS: FAIR HOUSING ACTIVITIES Project Sentinel 8,762 9,000 TOTAL HOME FUNDS BUDGET 8,762 9,000 TOTAL BUDGET 645,184 554,364 _Community Development Block Grant Program FY 16 -17 Applications Fund Request Summary Organization Program FY 15 -16 Amount Received FY 16 -17 Amount Requested CDBG Subcommittee Recommendation CDBG- Category 1: PUBLIC SERVICE GRANTS CORA CORA Emergency Shelter Program $ 9,250 $ 10,000 HIP Housing Home Sharing Program $ 9,250 $ 10,000 John Papan Memorial John's Closet $ 4,750 $ 5,000 Legal Aid Society Homesavers $ 5,000 $ 10,000 Parca Family Support Services $ 6,500 $ 6,500 Rape Trauma Services Center Sexual Assault Services $ 9,250 $ 10,000 Samaritan House Safe Harbor $ 10,000 $ 12,000 StarVista Transitional Housing Placement Plus $ 6,500 $ 10,000 Ombudsman Services of San Mateo County, Inc. Advocacy services to elderly and developmentally disabled individuals N/A $ 15,000 Health Mobile Dental Care for Children $ 9,250 $ 10,000 Biotech Partners Biotech Academy at South San Francisco N/A $ 50,000 Subtotal 1 $ 69,750 $ 148,500 Estimated CDBG Funds Available for Public Service Activities: $ 67,629 CDBG- Category 2: MINOR HOME REPAIR PROGRAMS CID Housing Accessibility Modification $ 10,000 $ 10,000 El Concilio of San Mateo County Peninsula Minor Home Repair $ 10,000 $ 10,000 Rebuilding Together Peninsula National Rebuilding Day $ 12,000 $ 12,000 Rebuilding Together Peninsula Safe at Home $ 25,000 $ 25,000 Subtotal $ 57,000 $ 57,000 Estimated CDBG Funds Available for Minor Home Repair Programs: $ 57,000 CDBG - Category 3: CITY- SPONSORED PROGRAMS City of South San Francisco Public Improvements ** $ 159,500 $ 120,562 City of South San Francisco Fagade Improvement Program $ 200,000 $ 60,000 City of South San Francisco City- Sponsored Housing Rehab Prog * ** $ 100,000 $ 150,000 Subtotal $ 275,000 $ 330,562 Estimated CDBG Funds Available for City Sponsored Programs: $ 330,562 CDBG ADMINISTRATION City of South San Francisco CDBG Administration $ 90,172 $ 90,173 Estimated CDBG Funds Available for CDBG Administration: 90,173 Total CDBG Funds Requested: 626,235 Total Estimated CDBG Funds Available: $ 545,364 HOME FUNDS: FAIR HOUSING ACTIVITIES Project Sentinel Fair Housing $ 8,762 $ 8,762 Total Estimated HOME Funds Available for Fair Housing Activities: $ 9,000 Total Funds Requested $ 634,997 Total Estimated Funds Available $ 554,364 *159 of Estimated Entitlement Amount (FY 16 -17) = $62,379; 15% of Estimated Prior Year Program Income (FY 15 -16) _ $5250 ** The amount requested for Public ROW Improvements does not included staffing costs to manage the projects * ** The amount request for the City-Sponsored Housing Rehabilitation Program does include staffing costs to administer the program Community Development Block Grant [CDBG] Program FY 2016 -2017 TABLE OF CONTENTS: APPLICATIONS & BUDGETS Organization Program # CDBG- Category 1: PUBLIC SERVICE GRANTS 1 CORA CORA Emergency Shelter Program 2 HIP Housing Home Sharing Program 3 John Papan Memorial John's Closet 4 Legal Aid Society Homesavers 5 Parca Family Support Services 6 Rape Trauma Services Center Sexual Assault Services 7 Samaritan House Safe Harbor 8 StarVista Transitional Housing Placement Plus Ombudsman Services of San Mateo Advocacy services to elderly and 9 County, Inc. developmentally disabled individuals 10 Health Mobile Dental Care for Children 11 Biotech Partners Biotech Academy at South San Francisco # CDBG- Category 2: MINOR HOME REPAIR PROGRAMS 12 CID Housing Accessibility Modification 13 El Concilio of San Mateo County Peninsula Minor Home Repair 14 Rebuilding Together Peninsula National Rebuilding Day 15 Rebuilding Together Peninsula Safe at Home # HOME FUNDS: FAIR HOUSING ACTIVITIES 16 Project Sentinel Fair Housing COMMUNITY DEVELOPMENT BLOCK GRANT SUMMARY OF APPLICATIONS; FY 2016 -2017 CilyMSordh Can FrencaM 2dig016 Individuals Served %M Ccsl Pm (Tamed Program) Individuals Served (Trust Program) Program %of Proposed Individual Proposed Cost Per FY 14-15 FT How Budget COBG Individuals for for Individuals Individual Actual Served Proposed SSE Paid by Grant 201 &2017 FY 161] for for YTB(only Proposed Agency Program GOES CDBG oaedfor (ToMI (TOhI 2016201] FY 1617 includes OlrI Al Organization Pr Butl Bud tlTNel Re wad (SSE) Selectee Program) Pro re SSE SSF Pro nd Actual % Proposed 8003 % Proed Narrative Observations PUBLIC SERVICE ACTIVITIES This project provides metric assistance for CORA's safe Muni (emergency ¢MBem) into ding claims and surmors M common cleaned eM tlrair immen win a confidential eM Safe 2014: 8 PST beMiclerbs for wing environment for up to sp months. CORA's safe horses the .hater program Does net are pad of Me agencys overall eHal m prrgreasiveN engage Muni the raw¢ at the citrus CORA Emergency clams at risk of Homeowners and supped WweN¢ arsons iMybka lrom 88F I CORA SHeXat Pro tam $ 411574 $ 60.000 $ 10.000 t]% t00Ye 65 8]0598 6 $ 16666] fl 102 194% ]] 26 34% ecM1NN svXOUMicienc Resbems HIP Housing 8 Home $M1arhq Program matches People from mods mom in man boom to Andre with kdlvEwb who west e place W I" at an eRrrtlebb paw. By al log etlNing mad". the Home Sharing Program Mods eRrmeba busing for mw- worms, Voodoo. eM provides a ranked aolcom Met ambles Human Indictment Home SMnng aanbre, and prier wM spatial medals maintain Mom lair 2 Proed HIP Housin Pro mm $ 304.632 $ 10,000 $ 1cow 10% 100% 153 $ 886.27 13 $ 769231 143 152 103% 134 Be 63% home and than independence Johns Closet provides NEW CLOTHES to neatly s imoHged 3 John Peen Memorial John's Conrad $ 55,000 $ id coo $ 50M 9% 0% 100 $ 5000 100 $ Woo 155 91 59% 120 36 30% cNWmn. The Legal AN Society of Son Mateo Coumyworka to bring fairness to the Muni housing adult, helps to keep low - me tendnt In the n Mme¢, and can mnlgma IM aliens the formal Woods We do this by maii legal advice and wMUs to AWN 100 undWrf ed MuseMks each month st 4 eIAId SaGH Home Severe E 2391112 $ 311,963 10.00 3% i0G% 750 S W67 75 $ 133.33 1225 1682 137% 1680 WE 58% IMeaweak Mu¢I quit. Pane '¢ Family Support Servers program pmvke¢ support groups, Nrrmi and reform, community o till adweacy, a pmferica l modern Eaiea, and mcluaua recreation opportunitieam bvrimoms families dealing with devabpmentl dimbigde¢. The program addresses aduwllon. Family Support health, bout P savior rg, employment, public irempodeUnd 5 Perce Bedew¢ $ 280]19] $ 75525 $ 6500 9% 72% 120 $ 50]8 128 $ 50.78 126 148 118% 128 105 82% r tlallva ¢ meld mMrissw¢eRedi the a et Population . TM Sewn) Abuse Services Farmers for CFMren and Youth pmNtlae menial health receive to address the nodded beelirg reads of vita ¢urviwn of dead Noanm including do m kdmenlidn. MdiNaual and gmap wumling, advocuri m ocklif egal and fore see accompaniment, and dnformawn and referni RTS' padres rJaedy matches many HUD mode oby prochdirg Basic Human Needs Abused Chiral RTS provided chidf abuse mMwra with Advocacy $ Raps Trauma Seward Audi Awampanlmard. Cdab Intervention, Connecting, lrformelbn. 6 3ervlw, Center SeMw¢ $ 798700 E 3&5000 E 10000 1 3% 1 100% 190 1 $ 21053 50 S 200.00 166 193 104% 166 W 52% Rarmis Community Outreach and Violence crewman. Safe Harbor provided emergency end trenshanal shelter for ] Sememan House Safe Herder $ 11267045 $1034]65 $12000 1% 100% 461 $ 279.83 63 $ 19048 461 643 139% 461 494 107X homeless adults door age 18 in San Mateo Count. SuhtlOed claimants In South San Francisco and tear management covers foremandipara foster W nth aged ion TrereNonal Houung 25, In AccSbn r awarded ISe Are "Waig and assistance 8 Stil Pammemplus $ 12936800 S 374143 10000 3% im% 15 It 668.67 15 $ 66667 15 15 100% 15 16 107% Ifl lumarkermarrat crattemliked school. OSSMC "forma advocacy wont with the 8,863 Fall elderly and drwbpmemallydaebkd IMMduals Mat dike IniM mul527long term Mine rc3Nes. We advocate for Me Weth, safety and dlgnay M law madden and for brown AtlwcacyamclM¢ charged In IM sysrm. We work W combat mgligen a and Ombudsmen to are fly eM abuse, Vaud, violations of residents' rights, and other wricw BerWwaof San developmentally home paquirg the LTC inlLady by wing hgbly no land, cold d 9 Mateo Cc unw. Ile.' dsaBad iMiNtlwk E 845411 $ 842,411 $15000 2% 100% 259 $ 173.75 74 $ 202]0 165 284 143% 185 119 64% returners W me add rcilXwo aim advocate co maker TM HMION Moble provtlesfree, orcXe, compreMnsM dmdal srvblrmtinwme cM1lltlmnel pefrrdpefmg xMOl ¢Xe¢. The IntM2MgwM[Healh Oats Carefrr Health Mobile preems; core W children wM ere ant algid for MobIH CeMA pereMel Mraem 10 Heafthfill Children S 10000 $ loom S loom 100% 0% 140 $ 7143 140 $ 71.43 105 120 123% 105 0 0% freshmen lMrrel ib9X aecreerredb tom ¢cbool homebbrai mob rams Bbmcb Partners will pMer with South San Francisco Hgh Hart Time Accidents; Biotech STEM pm`"mrs"g SNsol to provide up to 761Ith12M Ml bwlnwme}ewn Academy Program lunched In &employment of color with iMenafw ewtlamk bbacance mining, elorg wryry 20152018 e18oNrySan Ireinkg for bw- ma Wont, pea wenwbsMd imemships In scene mo gam as FmncAM High Sense and 11 Bisacapafren a In $ 1200289 $ 126963 $ 50000 39% 79% ]5 $ 666.6] 75 $ 6666] N/A N/A N/A 100 stain se maMegermnewre mundsu oR wivetl100e Ymnt 'NOTE, 1516 does not include SSF' Mis is the first time this non ofit isa n Iw SSF hadmicti . CilyMSordh Can FrencaM 2dig016 COMMUNITY DEVELOPMENT BLOCK GRANT SUMMARY OF APPLICATIONS: FY 2016 -2017 Cirri South Son Frenoew 2/03016 Households Served' (Total Program) Households Served- Rohl Program) %o1 Fy 10-15 FY 15.16 Program %a Proposed Cast Per Budget COBS Households for Household Prepoaed Actual Served Prollo+etl SSF Paid by Grant 201 6,2017 for FY1 &1] Households Cost Per Yeer- To-gete enamored Agency Progr¢m CDBG CDBG Used for (Total Rohl for20163017 Household (only lnduM¢ % O iutlan Pna re m Budget Butl et Tmat Re neat (SSM Salaries Final Program) SSF for FY 1314 Pro Deed Ac[uel % Pro clad SIr1 BOtr2 % Protect Handled MINOR HOME REPAIR PROGRAMS TM Homing Adversities ModRiwWn (HAM) program All Housing Admissibility Provide modifications as homes of permrs "In tlbWllreasW 12 CIO MotlR ®tics HAM $ 1166322 $ 132500 $ 10,000 8% al 83 $ 1248.99 B $ 1250.00 133 62 47% 91 25 27% msslbilll and lnrmese safety ECSMC proposss to continue providing; minor Some npeir as to residents of San Meho County ambling extremely low, wry low, low and Fmtl norms reakmM whose Mme¢ do net inXUlly quality for the Energy Soviets AmMence program to El COncil'e of San Palmera Minor became eligible So benefit from energy eM water wnwrwMn 13 Mateo Count Home aides $ 140.000 $ 14000 $ 10,000 ]% 100% 320 $ 437.50 30 $ 333.33 105 54 51% 105 14 13% merger National Rebuilding Day A wlurlleaNTpn 1 1 Mme rapes rental IMt bangs thousands of wlunhers Rebuilding Together Ne1Mal RebuMlrg together m beM6 of bw -income 14 anneu I ad $1200 2% 0% 21 $ 4333.33 3 If 4000.00 1 21 22 105% 1 21 0 0% Mmeowran each war. Volunteer minor home lepelr and nmva0on services hr row - Income somewhere; Safe el Home is minor Some repair Program redresses the repair mode of low- income Robuirdiig Together Mmeownam before the needs became serious deferred 15 Peninsula Safe at Home $ 1]18346 $ 482198 $25000 5% ]O% 117 $ 1624.]9 16 $ 1.50250 99 93 94% 99 13 13% menisci Issues. 'Note that binding activities import 0 households served NOT individuals "Nate that Rebuilding To idher's National Rebuilding Day is a we day event held Me last weekerM in April. Theragme, Rebuilding Together dmeenY report clients served until Quarter 4 FAIR HOUSING ACTIVITIES To wmbet Illegal housing discmnlrallon end ensure civil rylMa premise, Project Sawirwl per corn=ets iva h0 Musing services of complaint inwsti n. consulates. information eM refeml, and community oWreech and 16 Pro'etSentinel Fair Hip and $ 692951 $ 364057 $ 6762 2% 64% 553 15242 ]] 114 57 107 108% 78 47 80% education. Cirri South Son Frenoew 2/03016 1/25/2016 City Data Services - South San Francisco Consolidated Community Funding Application Redwood City, San Mateo County, and S. San Francisco Application for New Funding for FY 2016 -17 GENERAL INFORMATION 1. Organization Name: Community Overcoming Relationship Abuse (CORA) 2. Project Tide: CORA Safe House (Emergency Shelter) Program We are applying for funding from: 0 Redwood City City of San Mateo d South San Francisco 0 County of San Mateo Budoet /Client Surnmary (Auto- oonulateri frnm Ri idnat hainwi Jurisdictions receiving this application Amount % of Program Requested Budget Proposed # of Persons Served % of Persons Served Total $ Per Persons Redwood City $20,00 7% 24 28% $833.3 County of San Mateo $30,00 10% 551 65% $545.4 South San Francisco $10,0 3% 7% $1,666.6 otal $60,021. 20% 8g 100°/ $705.8 Grant Funded Programs: We are applying for a Public Services Program CDBG National Objective Eligibilit t - How are you serving low income populations? Service to "presumed benefit" groups listed below (income verification not required, but verification of presumed benefit status is required): Abused children v* Homeless persons Victims of domestic violence Illiterate adults Elderly persons /seniors (age 62 +) Persons living with AIDS Severely disabled adults Migrant farm workers Income Verification: Describe how you obtain, verify, and maintain proof of income and presumed benefit status. Third party documentation or client signatures on the certification forms must be available on file for review at all times. All of our clients are survivors of domestic violence and, as such, have a presumed benefit status. 3. Project Suppressed City: Zip: 94403 -1814 Address: 4. Provide a one sentence project summary: This project provides operating assistance for CORA's safe houses (emergency shelters) providing victims and survivors of domestic violence and their children with a confidential and safe living environment for up to six months. Organization 2211 Palm Avenue City: San Mateo Zip: 94403 -1814 Address: Organization 650 -652 -0800 Website: Phone: http: / /www.corasupport.org/ Type of Applicant: For Profit Our agency serves: Persons 5. Contact Person Title: Grants & Contracts / Project Name: Lynn Schuette Officer Telephone: 650 -522 -3937 Administrator: LynnS @corasupport. org; Contact Email: michaelo @corasupport.org; Fax: 650 -652 -0808 cherylem@corasupport.org 6. Name of http: /Mww.citydataservices. net / cities/ smatca/ app2016arc.pl ?rpt= C4561&prop =11 1n V25/2016 Agency Director: Melissa Lukin 7. Fiscal Officer: Name: Lynn Schuette; Cheryle Matteo Fiscal Officer 2211 Palm Ave. Address: City Data Services - South San Francisco Email: ly nn S @ coras u pport. org; cherylem@corasupport.org City: San Mateo Telephone: 650 -652 -0800 Zip: 94403 -1814 S. Authorized Name: Melissa Lukin Email: Telephone: 650 -652 -0800 Signatory: MelissaL @corasupport.org Authorized 2211 Palm Ave. City: San Mateo Zip: 94403 -1814 Signatory Address: 9. Please provide days and hours of regularly scheduled operation: The safe house is open 24 hours a day, seven days a week, year -round. 10. DUNS Number: 015862386 Federal EIN/TIN Number: 942481188 11. HUD Activity: Choose the HUD activity that most closely matches your service: 05G - Battered and Abused Spouses 12. Project Specific Narrative: Provide a narrative description of the specific activities to be carried out with the requested funds. This should also include program objectives and key priorities for each specific jurisdiction. This project requests continued support for CORA's safe houses serving survivors of domestic violence and their children. CORA's safe houses are part of the agency's overall effort to progressively engage clients at risk of homelessness. From hotel vouchers to 3- year housing vouchers, CORA prevents homelessness, providing customized levels of assistance that preserve the most expensive interventions for households with the most severe barriers to housing. Funds will support CORA's client advocates who provide clients at the safe houses with the support and opportunities they need to set and attain their goals. A primary goal of safe house staff is to help clients build into their lives safety and self- sufficiency so they are less likely to need emergency services. Toward this end, staff use a trauma - informed model of service, which means incorporating an understanding of the impact of trauma into all aspects of service. Using a trauma - informed approach provides a proven framework for assisting survivors in strengthening their own psychological capacities so they can rebuild their lives. PROGRAM OBJECTIVES: -90% of CORA's Safe House Program clients will receive referrals to services that will help them achieve greater self - sufficiency. -90% of Safe House clients will exit with safety plans so they know how to keep themselves and their families safe. -80% of clients that complete the safe house program will transition to safe, alternative housing. 13A. Assessment of Need - Redwood City: Briefly describe how you determined the need for your program for each specific jurisdiction that you are apgjying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. Our target population to be served are victims and survivors of domestic violence, including the children of those who have been subjected to domestic violence. Our clients are San Mateo County residents. Domestic violence continues to be a pervasive social problem impacting all social, economic, and cultural groups and has life- changing consequences in the lives of victims and their families. One way CORA determines the need by City /Jurisdiction is through its most recent data on requests for service. For example, during the program year 201415, CORA received more than 14,333 calls for domestic violence assistance from San Mateo County residents, including through our local police departments and legal hotline, an increase of 24% from 2012 -2013. Among clients, 10% came from Redwood City. The actual number of residents from specific cities that will ultimately be housed in a CORA safe house in any given year is dependent on a number of factors outside of CORA's control, including the willingness of the survivor to leave his /her home for CORA's safe house, openings in the CORA safe houses when a resident from a particular city calls, and the clients' need for a CORA safe house. We also look at historical trends at the agency; understanding that safe house statistics vary from year -to -year, estimates for services are based on a reasonable assessment of these factors. The results of these considerations are listed in our answer to question 18. 13B. Assessment of Need - County of San Mateo: Briefly describe how you determined the need for your program for each s ecifrc jurisdiction that you are aRRlying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. Our target population to be served are victims and survivors of domestic violence from San Mateo County, including the children of those who have been subjected to domestic violence. Domestic violence continues to be a pervasive social problem impacting all social, economic, and cultural groups and has life- changing consequences in the lives of victims and their families. One way CORA determines the need by City /Jurisdiction is through its most recent data on requests for service. For example, during the program year 2014 -15, CORA received more than 14,333 calls for domestic violence assistance from San Mateo County residents, including through our local police departments and legal hotline, an increase of 24% from 2012 -2013. Among clients, 46.5% came from the County of San Mateo's non - entitlement cities. The actual number of residents from specific cities that will ultimately be housed in a CORA safe house in any given year is dependent on a number of factors outside of CORA's control, including the willingness of the survivor to leave his /her home for CORA's safe house, openings in the CORA safe houses when a resident from a particular city calls, and the clients' need for a CORA safe house. We also look at historical trends at the agency; understanding that safe house statistics vary from year -to -year, estimates for services are based on a reasonable assessment of these factors. The results of these http: /M ww.citydataservices. nett citesl smatea/ app2Ol6arc.pl?rpt= C4561&prop =l1 W 1/2542016 City Data Services - South San Francisco considerations are listed in our answer to question 18. 13C. Assessment of Need - South San Francisco: Briefly describe how you determined the need for your program for each specific jurisdiction tha: you are apRIving for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. Our target population to be served are victims and survivors of domestic violence, including the children of those who have been subjected to domestic violence. Our clients are San Mateo County residents. Domestic violence continues to be a pervasive social problem impacting all social, economic, and cultural groups and has life- changing consequences in the lives of victims and their families. One way CORA determines the need by City /Jurisdiction is through its most recent data on requests for service. For example, during the program year 2014 -15, CORA received more than 14,333 calls for domestic violence assistance from San Mateo County residents, including through our local police departments and legal hotline, an increase of 24% from 2012 -2013. Among clients, 13.1 % came from South San Francisco. The actual number of residents from specific cities that will ultimately be housed in a CORA safe house in any given year is dependent on a number of factors outside of CORA's control, including the willingness of the survivor to leave his/her home for CORA's safe house, openings in the CORA safe houses when a resident from a particular city calls, and the clients' need for a CORA safe house. We also look at historical trends at the agency; understanding that safe house statistics vary from year - to-year, estimates for services are based on a reasonable assessment of these factors. The results of these considerations are listed in our answer to question 18. 14. Timeline: Provide a brief timetable for project implementation and achievement of projected goals and how you plan to expend your funds in a timely manner by the end of the fiscal year. CORA has operated its Safe House continuously since 1978, therefore the program will continue into the new CDBG program year without interruption. As we requested significantly less funding than what it costs to serve each jurisdiction, we anticipate invoicing for funds within the first two to three quarters for each jurisdiction. 15. Evaluation: Briefly describe how you will determine and measure the success of your program and whether or not program goals were met? If your program is currently receiving grant funds please describe accomplishments of goals to date. CORA's goal is to make sure that when someone calls in need, we are able to provide appropriate services. For safe house clients, success is determined by assessing how clients are able to commit to the self- sufficiency and safety plan they develop with safe house staff and are able to access appropriate resources to move into a safe and secure environment. Assessments are taken during intake and exit. We will track the populations served as listed in our answer to question 18 through our agency's database. CORA is in the process of transferring databases since the company that developed and supported CORA's ALICE database closed. While this was an unexpected change, CORA's new relational database, Apricot, will be able to generate more automated reports than ALICE. CORA recently completed a third party evaluation project that examined the impact and effectiveness of its programs. This project developed outcome tools that were aligned with the Domestic Violence Evidence Project's theory of change, implementable in CORA's program structures, and compatible with the agency's database; while also increasing CORA's ongoing capacity to conduct evaluation of its programs. Two new tools were implemented to collect quantitative data on safe house clients, the Self- Sufficiency Matrix and the PTSD Checklist. Following implementation, 77% of safe house clients showed an overall increase in self - sufficiency, with the average clients improving in 5 areas. 16. Collaboration: Describe partnerships with other organizations /agencies, the nature of the partnership, and how it relates to the proposed project. CORA's collaborative work spans three categories: Adjunct Services: To ensure clients have the best opportunity to heal and rebuild a violence -free life, CORA works closely with individuals, other non - profits, government entities, and the private sector to increase the effectiveness and impact of its work with clients in the safe houses to provide food, clothing, medical services, access to mainstream benefits, legal services, life skills, transportation, and more. CORA has also created partnerships with local landlords by cultivating relationships with those amenable to renting their properties to CORA clients. Advocacy and Systems Change: CORA is part of a larger network of domestic violence agencies named the California Partnership to End Domestic Violence (CPEDV). In fact, our Director of Programs, Cori Manthome, serves on the board of directors for CPEDV. CORA staff also represent us on various County committees including: the Domestic Violence Council, the Death Review Team, the Legislative Committee, the Legal Process Committee, Coordinated Response Committee, and the Continuum of Care Steering Committee. Community Education: CORA partners with local schools through presentations and activities to engage students and teachers in how to identify and prevent domestic (and dating) violence. CORA coordinates its outreach through a number of other agencies, including community centers, doctors' offices, and legal aid agencies. 17. Impact:: Discuss any general trends and conditions that have affected or impacted your service levels or service populations. For New Applicants — describe what these funds would allow your agency to do that you may not be able to do now. For Continuing Applicants — describe how your program would be impacted without these funds. Clients coming to CORA for services since 2008 have exhibited a higher degree of need than previously, such as requiring more mental health services for post -traumatic stress. With seven years of this trend completed — and barring any unforeseen large -scale and enduring improvements to the economy — it seems we are experiencing the "new normal." Many clients report they have chosen to stay in homes where they were subjected to domestic violence due to financial considerations (e.g., needing two salaries to make ends meet or not being able to secure a job in this economic climate). Consequently, by the time they come to CORA for services, they are in dire circumstances that require quicker responses, longer term services and a more complex array of services. http: //www.citydataservices.rieU cities/ smateal app20l6are.pl ?rpt= C4561&prop =11 W 1/25/2016 City Data Services - South San Francisco Without receiving these CDBG funds, consequences could include reducing safe house staff hours for services such as on -site mental health counseling. Given the impact of the continuing financial challenges in the public and private sectors, the demand for CORA's services continues to exceed the agency's capacity to provide beds for all who request it while funding has become more difficult to secure and in some cases has decreased. In addition, we have heard from certain foundations of their intention to reduce funding levels for safety net services as they have given at a rate higher than they can sustain and must now return to a lower level of giving. 18. Project BenefrclariesiQuartifrable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. 19. Project Benefrclaries/Quantifable Measurement: Indicate the expected number of. beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. a. Indicate the total number of low- income beneficiaries you expect to serve with this program for each jurisdiction application for funding. 'Low- income is 80% of Area Median Income or below. See AMI table b. Indicate the total number of beneficiaries you expect to serve with this program in each jurisdiction - regardless of income. Jurisdicticr; a. Number of low-income beneficiaries to be served per grant jurisdiction ,, application. Low- income is 80% of Area Median Income or below. b. All beneficiaries to be served per grant jurisdiction application regardless of income Low Income by Ethnicity served b our P ram Persons _ Persons Daly City 12 12 Redwood City 24 24 City of San Mateo 17 17 County of San Mateo 55 55 South San Francisco 6 6 otals 114 114 19. Populations Served: Check the boxes below if they describe a significant population served by your program. These categories are not considered "presumed benefit" by HUD, and require income verification. ' Persons exiting incarceration Low- income youth Other Survivors of Domestic Violence 20. Affirmative Outreach: a. Use the demographics from your previous program year to provide an analysis of the population you serve relative to the demographics in the table. NOTE: ff ou area new applicant please provide your best estimation Race &Ethnicity Redwood City Pop p Redwood City % b Ethnicit y y Low Income by Ethnicity served b our P ram Your Program % by Ethnicity Total 74,40 100% 17 1000/0 White and not Hispanic 40, 54.64% 2 0.00°/ White and Hispanic 23,55 31.66% 161 94.12°/ Sian 6,7151 9.03% q 0.000yo African American 1,916 2.58% 01 0.00% Pacific Islander 663 0.89% 0000 Native American 384 0.52% 0000 Other 1,511 2.03% 1 5.880 Race & Ethnicity South San Francisco Population South San Francisco % by Ethnicity Low income by Ethnicity served b our P ram Your P ° /0 by Ethnicity Total 63,63 100% 100% White and not Hispanic 23,7 37.340/c 2 25.00% -White and Hispanic 21,641 34.02% 41 50.00% sian 23,291 36.61% 11 12.50% ri can American 1,62 2.55% 0.00% rPIE cific Islander 1,111 1.75 % 0.00% http:Uwww.citydataservices.neV cities/ smatca/ app2016arc.pl?rpt= C4561&prop =11 417 1/25/2016 City Data Services - South San Francisco b. Based on the percentages that you indicate your organization served describe your efforts to improve affirmative outreach to groups that may be underserved by your program and the result of your efforts: CORA uses a range of outreach strategies to reach the diverse population of San Mateo County including distributing and /or displaying pamphlets /posters in public places such as bus stops, community centers, doctors' offices, courthouses, and legal aid agencies. CORA's community education team conducts presentations, workshops, and tables events in a variety of community settings around the County. CORA's bilingual website provides resources and contact information to its bilingual support groups and other programs. 21. Leveraging: Describe your fundraising efforts and additional sources of revenue for this project and your organization. Please state whether any of these fund sources are already committed and in what amount. CORA depends upon a broad base of support from city and county agencies, grants from foundations and corporations, and individual donations to maintain its services. In addition, we partner with several state and federal agencies to cover costs of our programs. CORA has been successful in the past at leveraging funds from the County of San Mateo, the California Govemor's Office of Emergency Services, and the Department of Justice. We expect continued support from these sources. CORA recently received new funding from the California Govemor's Office of Emergency Services for a child abuse treatment program, which will start later this year. As is typical for this time of the year, about half of the funding CORA requires for this program is already committed for 2016 -17, another third of the funding needed is out for consideration and is expected to yield needed support and the balance of funds are still to be raised. Concerning CORA's fundraising efforts, the agency has added 1.5 FTE in the past year to now include a Director of Development and Communications, Grants & Contracts Officer, Grants & Contracts Writer, Development Officer, and Marketing Officer, and Database and Events Coordinator. Accordingly, total donation income increased 67% from $410,984.02 for FY2014 to $688,278.54 for FY15. Seeds of Hope, CORA's annual fundraising event, netted $166,101 last fiscal year compared to $89,670 in 2014, an increase of 85.2 %. We anticipate these trends to continue. Staff List List below key staff members who work on this provirarn Position Titre Name of Staff Person Job Responsibilities Qualifications Total Jurisdictions Budget Line Item ATota 1pgm%l 0 years of experience in domestic Director of Programs Cori Manthome Support and oversite of management staff . violence; trained therapist, crisis Requested ° Requested tervention, staff training and Requested Labor Client Advocates ervision anager of $15,62 0% $1 6 °/ years of experience in social risis ntervention anisha Hughes Support and oversite of safe house rvices; r esidential treatment, $90,03 5% $4,37 0% $01 0% pportive housing, supervisory ervices Materials erience PROPOSED PROGRAM BUDGET FOR FY 2016 -17 http: //www.citydataservices.raV cities/ smateat app2016arc.pl ?rpt= C4561&prop =11 Y7 Redwood City ty of San Mateo South San Francisco Total Jurisdictions Budget Line Item ATota 1pgm%l P Totalm 7° 1 Requested % Requested ° Requested Pgm% Requested Labor Client Advocates $162,294 100% $162,29 10% $15,62 0% $1 6 °/ $10,00 16% $25,62 axes /Benefits $90,03 100 ° / $90,03 5% $4,37 0% $01 0% Materials Office Su lies $23,001- 23,00 $3,4 $2,001 1 $2 00 rations/Maintenance Utilities $45,67 93°/ $17,52 0%1 50% $10,0 0°/ 143% $10, Emergency Lodging $7,50 21% $7, 0% 79% $3,50 0°/ 43% $3, Service /Maintenance Costs $39,10 100 ° / $8,2 0% 75% $6, 0% 162% $6 Sewer Assessment $4,00 23% $4, 0% 54% $3,00 0% 33 °k; $3, Tele hone $39,96 $9,2 $5,0 dministration 0% TOTA $411,57 73`i° $301,66 7% $20,00 10% $30,00 3% $10,00 20 °f@ $60,0 - Number of Individual Beneficiaries 2 54 E ori Cost per Individual $833.331 $545. $1 Rffi-671 $705.8 http: //www.citydataservices.raV cities/ smateat app2016arc.pl ?rpt= C4561&prop =11 Y7 1/25/2016 City Data Services - South San Francisco For the City of Redwood City ONLY, answer the following: For the City of Redwood City ONLY, answer the following: 1. Funding Criteria: 2. Homeless Assistance Activities: Provision of fair housing counseling services, provision of legal intervention to prevent homelessness, provision of operation funds for shared housing, emergency shelter and transitional housing and related services for homeless and those at risk of homelessness, youth and single persons. 2. Itlarketi ng /Advertising a. Check all of the following methods your agency utilizes to promote and advertise your programs and services: . Flyers /brochures .4 Website Phone book listing CIP (Handbook /Database) Outreach presentations to service providers Outreach presentations to public b. Which of the above marketing/advertising materials are available in multi - langual form and which languages are they available in? Our flyers /brochures and outreach presentations to service providers and the public are provided in both Spanish and English. The presentations are provided in English or Spanish, depending on the needs of the group requesting our presentation. c. How and where are the materials distributed? Materials are distributed through CORA's family of partners (some of whom are identified above in our answer to question 16). Another main way of distributing materials is through San Mateo County's Kaiser facilities. As Kaiser is committed to ending domestic violence, it stocks CORA's brochures in its facilities and partners very closely with CORA in providing outreach to its staff about domestic violence and CORA's services. 3. Program Outcomes: a. Please describe the accomplishments of program goals for FY /15. In FY14/15, CORA provided emergency safe house to 111 adults and 79 children. One hundred percent of CORA's safe house clients received referrals to services to help them achieve greater self- sufficiency. 82% of safe house clients exited the program to transitional or permanent housing. All of these results exceeded the goals of the safe house program. In addition to these goals, the safe house saw many program enhancements throughout the year. The safe houses focused on building capacity utilizing volunteer support. Three additional volunteers were successfully trained to provide support to existing staff with routine tasks on site. The safe house increased its number to 5 dedicated volunteers providing consistent assistance with the hotline, safe house operations, and facility maintenance. Additionally, safe house client advocates were trained on a new assessment tool to measure PTSD symptoms upon intake and exit. This tool is being used as a way to triage referrals to the mental health department, to inform services provided during case management, and as an overall program outcome measure. The new assessment tool was implemented in Q4. Additionally, the safe house program increased staffing by .5 FTE. There are now a total of 4 full -time advocates providing case management support and splitting their time at the two CORA emergency safe house locations. b. In what ways has your program made a difference in the lives of the people you serve? Please provide at least one concrete example from the people served in FY /15: In Q3, Jasmine* was referred to CORA by the National Domestic Violence Hotline. She reported she left her abusive relationship with her 9 month old daughter, Rene *. This was the first time she attempted to leave and was very fearful of her partner locating her. She made an effort to contact the local shelter in her county, but there was no availability. Due to the concerns for her safety, Jasmine felt it would be best to leave the county. Jasmine disclosed that she was in her relationship for over 2 years and under duress due to ongoing verbal and emotional abuse. The night she decided to leave, her partner became physical and had kicked and slapped her multiple times. Law enforcement had been involved in the past, but Jasmine never pressed any charges out of fear. Her partner http: /Mrww.citydataservices. net / cities/ smatca/ app2Ol6arc.pl?rpt= C4561&prop =11 68 1/25/2016 City Data Services - South San Francisco would often threaten her by saying, "you better not call /yell or you're dead ". Her partner also had access to weapons and was affiliated with a gang which made the threats very real and paralyzed her in a way. CORA's Crisis Counselor understood the level of lethality involved in the case and conducted an assessment and completed an intake for CORA's emergency safe house. Jasmine was provided support and connected to resources by the safe house staff for safe arrival in San Mateo County. Jasmine was admitted into the 8 -week safe house program where she and her daughter received additional support and guidance. * Names have been changed to maintain confidentiality - Attachments ,m 1. Resolution authorizing application and designation of signatory, by the Board of Directors 2. Proof of 501(c)3 / tax -exempt status 3. By -laws 4. Articles of Incorporation V 5. Board roster, including: • Name, Company, Years on Board • Meeting dates for previous 12 months Number of years allowed for each board term 1. Resolution of the Board of Directors - Safe House pdf 501 c3letter. Ddf Bylaws as Adopted by CORA Board of Directors 0212 doc Articles of incorooration.pdf 5. Board Names Company Years on Board Ddf STBOD Meeting_ Schedule 2015.Ddf 5. BOD Term of Office.Ddf 6. Organizational chart for entire organization 6. CORA Ora Chart 1- 12- 16.pdf 4� 7. Certified financial audit no more that 1 fiscal 7. FY 13-14 AUDIT.pdf year old, prepared by a CPA, and: Management letters (if applicable) A -122 and A -133 Single Audit (for entities that receive more than $500,000 in federal funding) OR A letter from your Executive Director or Chief Financial Officer certifying that agency does not receive more than $500,000 in federal funds and is not subject to the Single Audit. d 8. The following are required: • Current (FY15 -16) Agency Operating Budget • Proposed (FY16 -17) Agency Operating Budget 8. Agency Budget 15- 16.pdf 8. Projected FY16 -17 Agency Budget 12 -15 Ddf 9. Mission Statement Mission Statement.docx ' 10. Nondiscrimination policy for Staff and Clients Nondiscrimination policy.doc 11. Reasonable Accommodations Policy for Staff Reasonable Accomodation - Client. doc and Clients Reasonable Accommodations - STAFF docx 12. Conflict of Interest Policy. (If not available, Code of Conduct - Conflict of Interest Hig_hlyht doc please indicate when you will submit) 13. Other - Download All Attachments Program Manager Signature Kate Walrath Date Signed 01/19/2016 Initially submitted: Jan 19, 2016 - 17:24:28 http: /Mrww.citydataservices. net/ citieslsmatca /app2016arc.pl ?rpt= C4561&prop =l 1 717 CORA (Community Overcoming Relationship Abuse) Agency Operating Budget - Detail Fiscal Year 2015 -16 Approved Budget Jul 15 - Jun 16 INCOME Contributions Individuals $651,550 Legacies and Bequests $0 Organizations /Corporations $40,000 DVAM $50,000 Spring Event $175,000 Contributions $916,550 Foundations Other Foundations $600,000 Foundations $600,000 Government Grants and Contracts $1,500 Cities $34,200 Burlingame $3,300 South SF $9,250 Menlo Park $5,000 Redwood City $15,000 ERP Funding $126,000 Cities $158,550 County of San Mateo CCAT $45,000 ERP Funding (Sheriffs Office) $157,000 Emergency Shelter Grant $24,000 Marriage Fees $90,000 Probation Trust Fund $27,000 PBA $198,000 Human Services Agency $75,000 Measure A $41,500 First Five $26,702 Collaboration with Riley Center $5,000 County of San Mateo $689,202 State of California Cal EMA (DVAP Grant) $669,051 State of California $669,051 Federal Department of Justice -LAV $15,000 FESG 3 $15,325 OVW TH $120,000 FEMA $6,000 HUD $229,000 Federal $385,325 Government Grants and Contracts $1,902,128 Other Revenue Court- Ordered Fines $21,000 Victim Witness $10,000 Fees for Service (Vol Trg) $1,500 Other Revenue $34,200 Loan Forgiveness $0 Other Revenue $66,700 Investment Earnings $40,000 Donated Materials & Services $275,000 TOTAL INCOME $3,800,378 EXPENSES Payroll Salaries and Wages $1,989,800 Vacation $21,300 Payroll $2,011,100 Payroll Taxes and Benefits P/R Benefits $251,000 P/R Taxes $189,000 P/R Workers Comp $30,000 Retirement $50,000 Payroll Taxes and Benefits $520,000 CORA (Community Overcoming Relationship Abuse) Agency Operating Budget - Detail Fiscal Year 2015 -16 Approved Budget Jul 15 - Jun 16 Travel Airfare $1,600 Lodging /Meals $100 Mileage Client Work $8,500 Other $4,400 Mileage $12,900 Parking/Trans /Auto Rental $3,250 Travel $17,850 Training /Education $700 Staff Training $11,900 Registration Fees $8,300 Airfare $500 Lodging /Meals $2,650 Mileage $1,050 Parking/Transportation $300 Other Staff Training $0 Total Staff Training $12,800 Volunteer Training $700 Other Training $11,900 Materials $4,700 Training /Education $30,100 Meals and Entertainment Client Meals $800 Other $9,200 Meals and Entertainment $10,000 Rent Other Rent $390,800 Rent $390,800 Janitorial $14,100 Utilities $43,500 Emergency Lodging $5,000 Repairs and Maintenance $18,400 Office Expense Computer Supplies $9,300 Office Supplies $17,000 Service /Maintenance Costs $34,100 Other Office Expenses $p Office Expense $60,400 Telephone $38,060 Postage $8,700 Printing $19,400 Program Activities Children $1,800 Family $1,100 Community $2,100 Program Activities $000 Program Supplies Basic Needs $11,200 Children's Supplies $1,300 Other $3,300 Program Supplies $15,800 Bank Charges $4,000 Insurance $22,000 Taxes Sewer Assessment $4,000 Taxes $4,000 Interest Expense Mortgage Interest $62,400 Credit Line Interest $10,000 Other Interest $2,000 Interest Expense $74,400 Dues and Subscriptions $111000 Advertising and Promotion $4,000 Professional Fees Consulting $40,000 Consulting Psych $47,300 Outside /Contract Services $153,205 CORA (Community Overcoming Relationship Abuse) Agency Operating Budget - Detail Unrealized Gain(Loss)- Investments Fiscal Year 2015 -16 Approved Budget $80,000 Jul 15 - Jun 16 Audit and Tax Fees $17,000 Professional Fees $257,505 Other Fees $0 Depreciation $141,900 Special Event Expense $85,000 DVAM $24,000 Spring Event $57,600 Other Events $3,400 Miscellaneous Expenses $300 Donated Expenses Adopt -A- Family $25,000 Auction Expenses $20,000 Donated Materials & Supplies $66,000 Donated Services $55,000 Volunteers $109,000 Donated Expenses $275,000 TOTAL EXPENSES $4,087,315 Operating Gain/(Loss) ($286,937) Realized Gain(Loss)- Investments $0 Unrealized Gain(Loss)- Investments $80,000 $80,000 Net Gain /(Loss) ($206,937) Non -Cash Items ** Add Back Depreciation $141,900 Add Back Unreal /Real. Gain /Loss on Invest. ($80,000) Add Back Pledge Receivable $75,000 Total Non -Cash Items $136,900 Operating Gain /(Loss) Adjusted for Major Non -Cash Items ($70,037) CORA (Community Overcoming Relationship Abuse) Agency Operating Budget - Detail Fiscal Year 2015 -16 Government Grants and Contracts Estimated Cities Budget Burlingame Jul 16 - Jun 17 INCOME $9,250 Contributions $5,000 Individuals $751,550 Legacies and Bequests $0 Organizations /Corporations $40,000 DVAM $60,000 Spring Event $200,000 Contributions $1,051,550 Foundations $24,000 Other Foundations $600,000 Foundations $600,000 Government Grants and Contracts Cities Burlingame $3,300 South SF $9,250 Menlo Park $5,000 Redwood City $15,000 ERP Funding $126,000 Cities 158,550 County of San Mateo CCAT $45,000 ERP Funding (Sheriffs Office) $157,000 Emergency Shelter Grant $24,000 Marriage Fees $90,000 Probation Trust Fund $27,000 PBA $210,000 Human Services Agency $75,000 Measure A $0 First Five $0 Collaboration with Riley Center $0 County of San Mateo $628,000 State of California Cal EMA (DVAP Grant) $869,051 CHAT $135,000 State of California $1,004,051 Federal Department of Justice -CDS $0 Department of Justice -LAV $0 FESG 3 $0 OVW TH $120,000 FEMA $0 HUD $229,000 Federal $349,000 Government Grants and Contracts $2,139,601 Other Revenue Court- Ordered Fines $21,000 Victim Witness $10,000 Fees for Service (Vol Trg) $1,500 Other Revenue $39,300 Loan Forgiveness $0 Other Revenue $71,800 Investment Earnings $40,000 Donated Materials & Services $275,000 TOTAL INCOME $4,177,951 EXPENSES Payroll Salaries and Wages $2,177,950 CORA (Community Overcoming Relationship Abuse) Agency Operating Budget- Detail Fiscal Year 2015 -16 Training /Education Estimated Staff Training Budget Registration Fees Jul 16 -Jun 17 Vacation $21,300 Payroll $2,199,250 Payroll Taxes and Benefits $1,050 P/R Benefits $288,650 P/R Taxes $192,780 P/R Workers Comp $30,000 Retirement $60,000 Payroll Taxes and Benefits $571,430 Travel $14,805 Airfare $1,600 Lodging /Meals $100 Mileage $24,400 Client Work $8,500 Other $4,400 Mileage $12,900 Parking/Trans /Auto Rental $3,250 Travel $17,850 Training /Education $700 Staff Training $11,900 Registration Fees $8,300 Airfare $500 Lodging /Meals $2,650 Mileage $1,050 Parking/Transportation $300 Other Staff Training $6,000 Total Staff Training $18,800 Volunteer Training $700 Other Training $11,900 Materials $4,700 Training /Education $36,100 Meals and Entertainment Client Meals $800 Other $9,200 Meals and Entertainment $101000 Rent Other Rent $406,432 Rent $406,432 Janitorial $14,805 Utilities $45,675 Emergency Lodging $7,500 Repairs and Maintenance $24,400 Office Expense Computer Supplies $19,300 Office Supplies $23,000 Service /Maintenance Costs $39,100 Other Office Expenses $0 Office Expense 81,400 Telephone $39,963 Postage $8,700 Printing $20,370 Program Activities Children $1,800 Family $1,100 Community $2,100 Program Activities $51000 Program Supplies Basic Needs $16,200 Children's Supplies $1,300 Other $3,300 CORA (Community Overcoming Relationship Abuse) Agency (Operating Budget - Detail Fiscal Year 2015 -16 Realized Gain(Loss)- Investments Estimated Unrealized Gain(Loss)- Investments Budget Jul 16 - Jun 17 Program Supplies $20,800 Bank Charges $4,000 Insurance $24,200 Taxes ($80,000) Sewer Assessment $4,000 Taxes $4,000 Interest Expense Mortgage Interest $62,400 Credit Line Interest $10,000 Other Interest $2,000 Interest Expense $74,400 Dues and Subscriptions $11,550 Advertising and Promotion $4,000 Professional Fees Consulting $40,000 Consulting Psych $47,300 Outside /Contract Services $168,205 Audit and Tax Fees $18,000 Professional Fees $273,505 Other Fees $0 Depreciation $141,900 Special Event Expense $99,000 DVAM $38,000 Spring Event $57,600 Other Events $3,400 Miscellaneous Expenses $300 Donated Expenses Adopt -A- Family $25,000 Auction Expenses $20,000 Donated Materials & Supplies $66,000 Donated Services $55,000 Volunteers $109,000 Donated Expenses $275,000 TOTAL EXPENSES $4,421,530 Operating Gain /(Loss) ($243,579) Realized Gain(Loss)- Investments $0 Unrealized Gain(Loss)- Investments $80,000 $80,000 Net Gain /(Loss) ($163,579) Non -Cash Items - Add Back Depreciation $141,900 Add Back Unreal /Real. Gain /Loss on Invest. ($80,000) Add Back Pledge Receivable $0 Total Non -Cash Items $61,900 1/25/2016 City Data Services - South San Francisco Consolidated Community Funding Application Redwood City, San Mateo County, and S. San Francisco Application for New Funding for FY 2016A7 CE14ERAL INFORMIATION 1. Organization dame: Human Investment Project (HIP Housing) 2. Project Title: Home Sharing Program [We are applying for funding from: "-1 ! `✓ Redwood City 4* City of San Mateo Q' South San Francisco m County of San Mateo Aud[IQt/Cliant Summer /Autn_nnnulatarl frnm Ri irinc+ Kdai ..,x Jurisdictions ceiving this application Amount % of Program Requested Budget _ Proposed # of Served % of Served Total $ s Per dwood City iouth $15,00 14% _ �s 1 12% $833.3 of San Mateo $15,00 14%— . 3 21% $468.7 unt of San Mateo $65,00 62% 9 59% $722.2 San Francisco 1 $10,00 10% 11 80/ $769.2 [Total $105,00 100%1 1531 100 ° / $686.2 Grant Funded Programs: We are applying for a Public Services Program CDBG National Objective Eligibility - How are you serving low income populations? Service to low income clients verified through income documentation. Income Verification: Describe how you obtain, verify, and maintain proof of income and presumed benefit status. Third party documentation or client signatures on the certification forms must be available on file for review at all times. HIP Housing's Home Share counselors obtain and verify data through personal interviews with every potential client. Applicants are required to provide identification and written verification of income, such as pay stubs, public assistance verification, as well as bank statements and tax returns. This information confirms to each client's counselor that they meet low income requirements. Clients sign and complete an income verification documentation form which is available for review by housing monitors. 3. Project Address: 364 South Railroad Avenue City: San Mateo Zip: 94401 -4024 4. Provide a one sentence project summary: The Home Sharing program interviews and screens clients for housing, provides housemate, alternative housing, and community resources to clients with the potential of matching persons in affordable home sharing arrangements. Organization 364 South Railroad Avenue Address: Organization Phone: 650 - 348 -6660 Type of Applicant: Our agency serves: 5. Contact Person / Project Name: Laura Farucchi Administrator: Contact Email: Ifanucchi @hiphousing.org 6. Name of Agency Kate Comfort Harr Director: 7. Fiscai Officer: Name: Norma Quiroz Fiscal Officer 364 South Railroad Avenue Address: 8. Authorized Name: Kate Comfort Harr Signatory: Authorized 364 South Railroad Avenue City: San Mateo Zip: 94401 -4024 Website: http://www.hiphousing.org/ Title: Associate Director Telephone: 650 - 348 -6660 Fax: Email: Telephone: 650-48 -6660 nquiroz @hiphousing.org City: San Mateo Zip: 94401 -4024 Email: Telephone: 650-348 -6660 kcomfort@hiphousing.org City: San Mateo Zip: 94401 -4024 httpJ/www.citydataservices.net/ cities / smatca /app2016arc.pl?rpt= C45738 pry 12 1/8 1/25/2016 Signatory Address: City Data Services - South San Francisco 9. Please provide days and hours of regularly scheduled operation: M -F 8:30 AM -5:00 PM 10. DUNS Number: 120811997 Federal EIN /TIN Number: 942154614 11. HUD Activity: Choose the HUD activity that most closely matches your service: 05 - Public Services 12. Project Specific Jklarrative: Provide a narrative description of the specific activities to be carried out with the requested funds. This should also include program objectives and key priorities for each specific jurisdiction. HIP Housing's Home Sharing Program matches people who have room in their home to share with individuals who need a place to live at an affordable price. By utilizing existing housing, the Home Sharing Program finds affordable housing for low- income residents, and provides a realistic solution that enables seniors, and persons with special needs to maintain both their home and their independence. Every year, the Home Sharing Program interviews, screens, and provides housing assistance to over 2,000 persons a year, while placing 250 in home sharing situations and providing support to an additional 400 (individuals matched in previous fiscal years). We field close to 4,000 calls from persons searching for affordable housing. Clients complete a detailed application to make sure that they are matched in compatible living arrangements. Counselors then conduct interviews to establish each client's specific needs and carry out local background checks. When clients are matched, Counselors facilitate a discussion between both parties to help them outline their expectations and to agree on rights and responsibilities. This information is then documented in a Living Together Agreement, which is signed by both parties. The Home Sharing Program also arranges rent exchanges, in which one person provides household chores, such as cooking, cleaning, and companionship, for seniors and /or persons with disabilities, in exchange for lower or no rent. 13A. Assessment of Need -Redwood City: Briefly describe how you determined the need for your program for each specific jurisdiction that you are applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. The 2013 American Community Survey sites that in the City of Redwood City, over 45% of residents spend more than 30% of their income toward housing. Bearing the brunt of this situation are some of the most vulnerable members of our communities: seniors living on a fixed income, persons with disabilities, single parent families, and those with special needs. All are especially impacted by the extremely high cost of housing, both in Redwood City and throughout the County. The unfortunate reality is that some may become homeless, while many will be at risk of homelessness. Others will find that they are forced to leave their home and community, moving away from their place of employment, as well as family, friends and critical support networks. According to Zillow, the average rent price in Redwood City is $3,315. This is beyond the means of many residents: seniors living on a fixed income, low- income individuals and families, and persons with disabilities. Unless these community members have an affordable housing option, they are at risk of becoming homeless, or of being forced to move far from their place of work, creating potentially serious commuting problems for those who rely on public transportation. 13B. Assessment of Need - City of San Mateo: Briefly describe how you determined the need for your program for each specific jurisdiction that you are applying for funds Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. The 2013 American Community Survey sites that in the City of San Mateo, over 40% of residents spend more than 30% of their income toward housing. Bearing the brunt of this situation are some of the most vulnerable members of our communities: seniors living on a fixed income, persons with disabilities, single parent families, and those with special needs. All are especially impacted by the extremely high cost of housing, both in San Mateo and throughout the County. The unfortunate reality is that some may become homeless, while many will be at risk of homelessness. Others will find that they are forced to leave their home and community, moving away from their place of employment, as well as family, friends and critical support networks. According to Zillow, the average rent price in the City of San Mateo is $2,463. This is beyond the means of many residents: seniors living on a fixed income, low- income individuals and families, and persons with disabilities. Unless these community members have an affordable housing option, they are at risk of becoming homeless, or of being forced to move far from their place of work, creating potentially serious commuting problems for those who rely on public transportation. 13C. Assessment of Need - County of San Mateo: Briefly describe how you determined the need for your program for each specific jurisdiction that you are applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. The San Mateo County Housing Indicators released in September 2015 cites that the average rent for a one - bedroom apartment in San Mateo County is now: $2,575 /month, a 52% increase from 2011. Based on the National Low Income Housing Coalition's formula, a person or family would need to earn $96,000 a year to be able to afford this rent. More than half of San Mateo's population eams less than this each year. This is devastating news for anyone looking for affordable rental housing and comes on the heels of other unsettling trend data for the County. Rental rates in Silicon Valley have increased by 8.7 %. During the same time period, median incomes have increased by 3.6 %. The rate of rent increase is not being offset by the rate of income increase. 40% of Silicon Valley residents are burdened by their rent. This httpJMrww. citydataservices. neVcibes/ smatcalapp2016arc .pl ?rpt= C45738prop= l2 218 1/25/2016 City Data Services - South San Francisco means that 40% of residents pay more than 30% of their income toward housing. 32.4% (more than one - third) of Silicon Valley young adults (ages 18 -34) live with one or both of their parents. Unfortunately, with a 97% occupancy rate, inventory for rental housing in San Mateo County has never been lower. As a result, for those living on a low income, finding affordable housing is virtually impossible. 13D. Assessment of Deed - South San Francisco: Briefly describe how you determined the need for your program for each specific jurisdiction that you are applying for funds Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. The 2013 American Community Survey sites that in the City of South San Francisco, over 44% of residents spend more than 30% of their income toward housing. Bearing the brunt of this situation are some of the most vulnerable members of our communities: seniors living on a fixed income, persons with disabilities, single parent families, and those with special needs. All are especially impacted by the extremely high cost of housing, both in South San Francisco and throughout the County. The unfortunate reality is that some may become homeless, while many will be at risk of homelessness. Others will find that they are I orced to leave their home and community, moving away from their place of employment, as well as family, friends and critical support networks. According to Zillow, the average rent price in South San Francisco is $2,139. This is beyond the means of many residents: seniors living on a fixed income, low- income individuals and families, and persons with disabilities. Unless these community members have an affordable housing option, they are at risk of becoming homeless, or of being forced to move far from their place of work, creating potentially serious commuting problems for those who rely on public transportation. 14. Tirneline: Provide a brief timetable for project implementation and achievement of projected goals and how you plan to expend your funds in a timely manner by the end of the fiscal year. HIP Housing's Home Sharing Program is ongoing. HIP Housing will provide expenditures from July 1, 2016 — June 30, 2017 and will expend the funds by June 30, 2017. The following is the timeline perjurisdiction: - Interviewing, screening and processing of client applicants (RWC 13 -17 monthly, SSF 7 -10 monthly, City SM 13 -17 monthly, SMCo. 36-48 monthly) - Providing housemate referrals and connection to community and other housing resources (weekly contact with clients to provide resources) - Matching clients in home sharing (RWC 1 -2 monthly, SSF 1 -2 monthly, City SM 2 -3 monthly, SMCo. 8 -9 monthly) - Bilingual services including English, Spanish, Cantonese, German, and Tagalog (ongoing) - Home visits to homebound or hospital bound seniors and persons with disabilities (all jurisdictions 1 -2 home visits per month) - Maintain weekly office hours at Fair Oaks Community Center (Tuesdays and Thursdays), San Mateo (Monday - Friday), South San Francisco (Tuesdays), Daly City (Thursdays) - Sign language interpretation facilitated through the Center for the Independence of the Disabled (as needed) - Facilitation of Living Together Agreements (RWC 1 -2 monthly, SSF 1 -2 monthly, City SM 2 -3 monthly, SMCo. 8 -9 monthly) - Follow up support with home sharing matched clients including mediation as needed (quarterly contact with matches involving seniors; ongoing contact with other matches as needed) - Community outreach to raise awareness of the program (ongoing 15. Evaluation: Briefly describe how you will determine and measure the success of your program and whether or not program goals were met? If your program is currently receiving grant funds please describe accomplishments of goals to date. The Home Sharing Program is evaluated based on the following criteria: • The number of clients served, intake calls, and referrals provided. • The number of clients placed in home sharing arrangements, and income level of clients matched. • Affordability of housing, measured by the percentage of income spent on housing costs. • The length of time a client remains in a home sharing arrangement. The following are accomplishments achieved for FY 15-16 to date July 1. 2015 - December 31, 2015: 1. Number of residents contacting HIP Housing for affordable housing information: (RWC 186, San Mateo 265; San Mateo County 1,086; SSF 117) 2. Number of clients interviewed, screened and provided housing resources on a weekly basis: (RWC 123; San Mateo 213; San Mateo County 379; SSF 121) 3. Number of residents placed in home sharing arrangements: (RWC 10; San Mateo 21; San Mateo County 44; SSF 9) 4. Income levels of clients matched in home sharing: Poverty: RWC 50 %, San Mateo 43 %, San Mateo County 34 %, SSF 0% Very Low Income: RWC 30 %, San Mateo 33 %, San Mateo County 34 %, SSF 78% Low Income: RWC 20 %, San Mateo 24%, San Mateo County 32 %, SSF 22% 5. Percentage of income spent on housing costs after moving in with a housemate: Home Providers: RWC 25 %, San Mateo 22 %, San Mateo County 27 %, SSF 20% Home Seekers: RWC 18 %, San Mateo 30 %, San Mateo County 31 %, SSF 16% 6. Average length of time client remains in home sharing arrangement is 3 16. Coliaboration: Describe partnerships with other organizations /agencies, the nature of the partnership, and how it relates to the proposed project. The Home Sharing Program collaborates with a variety of organizations who refer clients to our Home Sharing Program and we in turn refer clients to theirs. These organizations include: 1. Community centers: refer clients for rental assistance, shelter referral and basic human needs. Interview clients at the Daly City Community Center, SSF Senior Center and at the Fair Oaks Community Center. http: /Avww.citydataservices.neV cities/ smatea tapp2016arc.pl?rpt= C4573&prop =12 318 1/25/2016 City Data Services - South San Francisco 2. InnVision /Shelter Network: conduct presentations to shelter residents about Home Sharing as requested 3. Safe Harbor Shelter. conduct presentations to shelter residents about Home Sharing as requested 4. Rebuilding Together Peninsula (RTP): refers homeowners to the Home Sharing program and often rehabilitates property in order to make it more feasible to rent out to a home sharer. 5. www.smchousingsearch.org: HIP Housing posts active rooms for rent on this site weekly 6. Star Vista: work closely with staff to help place emancipated foster youth in home sharing arrangements. 7. San Mateo County Housing Authority: refers Moving To Work recipients to the Home sharing program to locate a room to rent with their housing voucher. 8. Other organizations we refer clients to include: Aging and Adult Services; County Mental Health; Mental Health Access Team; Oasis; CORA; Peninsula Works; Center for the Independence of the Disabled; Legal Aid; Peninsula Family Service; PCRC; Senior Centers; San Mateo County Housing Authority; United Way's 211; JobTrain; Veterans programs 17. Impact:: Discuss any general trends and conditions that have affected or impacted your service levels or service populations. For New Applicants — describe what these funds would allow your agency to do that you may not be able to do now. For Continuing Applicants — describe how your program would be impacted without these funds. San Mateo County is experiencing an unprecedented housing crisis stemming from the culmination of skyrocketing rents, extraordinarily low housing inventory, and booming demand. The San Mateo County Housing Indicators released in September 2015 cites that the average rent for a one- bedroom apartment in San Mateo County is now: $2,575 /month, a 52% increase from 2011. This crisis has left those at the lowest income levels with few, if any, housing choices. As a result, many hard working, low- income people are facing homelessness for the first time in their lives. Additionally, our region is severely challenged by a uniquely constrained housing market that has turned developing, finding, and keeping affordable rental housing into a battlefield. The market forces created by this dynamic makes San Mateo and the entire Bay Area the most expensive place to live in the country shutting out low -paid people from access to critical housing options and upward mobility. Finding creative and practical affordable housing solutions like Home Sharing and deepening their impact, has never been more important. The Home Sharing Program reaches out to those in the greatest need throughout San Mateo County: low- income individuals, seniors, families, and struggling homeowners. Without CDBG funds, HIP Housing will not have enough resources to meet the ever -growing demand for affordable housing services. 18. Project Beneficiaries /Quantifiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. 19. Project Beneficiaries/Quantffiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. a. Indicate the total number of low-income beneficiaries you expect to serve with this program for each jurisdiction application for funding. 'Low-income is 80% of Area Median Income or below. See AMI table b. Indicate the total number of beneficiaries you expect to serve with this program in each jurisdiction - regardless of income. Jurisdiction a. Number of low-income beneficiaries to be served per grant jurisdiction application. **Low-income'* is 80% of Area Median Income or below. b. All beneficiaries to be served per grant jurisdiction application regardless of income Low Income by Ethnicity served by our P ram Persons Persons Daly City 13 14 Redwood City 17 18 City of San Mateo 30 32 County of San Mateo 76 90 South San Francisco 11 13 [Totals 147 167 19. Populations Served: Check the boxes below if they describe a significant population served by your program. These categories are not considered "presumed benefit" by HUD, and require income verification. Persons exiting incarceration Low- income youth Other 1. At -risk of homelessness, 2. Persons with disabilities, 3. Elderly persons, 4. Chronically homeless persons 20. Affirmative Outreach: a. Use the demographics from your previous program year to provide an analysis of the population you serve relative to the demograohics in the table. NOTE If veu are a new ann►inanr nipasp nmvirla h..f Race 8 Ethnicity Redwood City Population Redwood City % by Ethnicity Low Income by Ethnicity served by our P ram ....._.._... ° Your Program /° by Ethnicity Total 74,40 100% 35 1000/0 Whit e and not Hispanic 40,656 54.64% 11 31.43% http : //www.citydataservices.net/ cities/ smatca/ app2016arc.pl?rpt= C4573&prop =12 4/8 1/25/2016 City Data Services - South San Francisco hite and Hispanic 23,554 31.66% i 37.14% ian 6,7151 9.03% 1 2.86% frican American _ 1,91 2.58% White and not Hispanic 0.00% Pacific Islander _ 6631 0.89% 34.21% 0.00% Native American 3 0.52 °k 11 11.437 he 1,5111 2.03% 18.67% 31 Race & Ethnicity City of San Mateo Po ulation City o .San Mateo /o by Ethnicity Low Income by Ethnicity served b our Program Your Program by Ethnicity Total 97,20 100% 38 100% White and not Hispanic 45,240 46.54% 13 34.21% hite and Hispanic 25,81 26.56% 11 28.95% sian 18,15 18.67% 31 7.89% frican American 2,0991 2.16% 13.16% Pacific Islander 1,9371 1.99% 1 0.00% Native American 1 0.14% 0.00°7. her 3,82 15.08% 15.79% Race & Ethnicity South San Francisco Population South San Francisco /o by Ethnicity Low Income by Ethnicity served b our Program Your Program % by Ethnicity Total 63,63 100% 22 100% White and not Hispanic 23,76 37.34% 13 59.097/6 hite and Hispanic 21,64 34.02% provides counseling for clients and 13.64% Sian 23,29 36.61% Social Work from San Francisco State 0.00% frican American 1,62 2.55% 22,73 %0 Pacific Islander 1,111 1.75% 1 4.55% Native American 39 0.62% 0,00% her 9,59 15.08% 0100% b. Based on the percentages that you indicate your organization served describe your efforts to improve affirmative outreach to groups that may be underserved by your program and the result of your efforts: Four of the staff who work on the Home Sharing Program are bilingual in Spanish. Other staff at HIP Housing are also bilingual in Tagalog, Cantonese, Mandarin, and German. Outreach materials are translated into Spanish, Tagalog, and Cantonese. HIP Housing also conducts a variety of outreach activities to reach out to different ethnic groups. Staff participates in committees such as the African American Health Initiative; Coastside Collaborative; Daly City Peninsula Partnership, Redwood City Interagency Forum; Housing Operations and Policy Committee. Networking events are also attended throughout the year including resource events through ALLICE (Alliance for Community Empowerment), Department of Rehabilitation Spanish resource fair; Sana Sana Colita de Rana resource fair; Commission on Disabilities resource fair; North Fair Oaks community fair. During the last fiscal year, we were approached by Telemundo which ran two stories about our home sharing program on their networks. 21. Leveraging: Describe your fundraising efforts and additional sources of revenue for this project and your organization. Please state whether any of these fund sources are already committed and in what amount. HIP Housing's Home Sharing Program is the only home sharing program offered in San Mateo County, is one of the largest programs in the US, and one of the few sources of readily available affordable housing in the County. For many individuals who are struggling to find affordable housing, it is the only option. It is because of this that the program enjoys support from a variety of sources. 20 out of the 21 municipalities in San Mateo County funded the Home Sharing Program in FY 2015 -16. The program is also supported by prominent community and family foundation. This includes the San Francisco Foundation, Mills Peninsula Foundation, the Atkinson Foundation, Genentech Foundation, Hitachi America Foundation, San Mateo Association of Realtors, and Citi. We are diversifying our income sources by maximizing income from major donor sources. More recently, we have launched a Moves Management and Legacy Giving campaign that increases and deepens support from major donors and encourages long -time HIP supporters to include the organization in their legacy plans.HIP Housing is fortunate to earn "income" through property development. Through the help of government funding and private loans, we purchase underutilized, sometimes dilapidated multi - family properties in San Mateo County. We renovate these properties and rent them out to low- income families for a lower rate. Thanks to this earned income model, every single dollar we raise goes directly toward our services. Staff List List halnurr kov staff mamhars whn work nn this nrnnrnm Position Titre Name of Staff Person Job Responsibilities Qualifications Coordinates North County home Shirley has twelve years of experience North sharing activities as well as working creating home sharing matches, has a degree ounty Shirley Fok with other county residents, is Sociology with an emphasis in Law and oordinato provides counseling for clients and Society from UC Davis and a Masters in conducts outreach for North San Social Work from San Francisco State Mateo County. JUniversity. http: /Mrww.citydataservices. net / cities/ Smatcalapp2016arc .pl ?rpt= C4573&prop =12 5/8 1/25/2016 City Data Services - South San Francisco PI20113®RI =117) PROir. lAllll R1111[:FT FnIQ Vv 9MR -47 RedwoodClty Coordinates MidCounty home Debra has fifteen and a half years experience Total Jurisdictions Budget Line Item sharing activities as well as working s a Home Sharing Counselor_ She is a Mid County Debra Smith with other county residents, raduate of the San Coordinator provides counseling for clients and ateo /Burlingame /Hillsborough /Foster City Re nested q Labor conducts outreach in the MidCounty 002 Leadership Program. Debra is also the 39% $20,2001 area. o -chair of the Minori!X Elders Committee. 11 % $2,200162%, -Coordinates South County home Barbara has twenty five years experience in South $6,700L_1 haring activities as well as working social work, holds a BA degree from San ounty Barbara Liedtke with other county residents, Francisco State University, and completed oordinato $1,4001 provides counseling for clients and graduate courses from Universidad Iberameric % $15 00 conducts outreach for the South San in Santa Domingo. She is trilingual, including 100% $20,05 Mateo Countv area. German and Spanish. 50% $30,95C Coordinates home sharing activities Dania has a Bachelor's degree in Social Work Home Dania Delgadillo as well as working with other county residents and provides counseling to from San Jose State University. She was hired by HIP Housing in May 2015 and Lanng rdinato $35 clients. currently works full time as a home sharing Dania Del adillo $46,35 47% coordinator. She is bilin ual in Spanish._ PI20113®RI =117) PROir. lAllll R1111[:FT FnIQ Vv 9MR -47 For the City of Redwood City ONLY, answer the following: For the City of Redwood City ONLY, answer the following: 1. Funding Criteria: 1. Affordable Housing: Acquisition of sites for affordable housing, new construction of affordable housing, conversion of existing housing to affordable, acquisition and rehabilitation of rental housing (includes special needs housing). 2. Marketing /Advertising a. Check all of the following methods your agency utilizes to promote and advertise your programs and services: w Flyers /brochures Website e: Phone book listing CIP (Handbook/Database) Outreach presentations to service providers ?; Outreach presentations to public PSA's b. Which of the above marketing/advertising materials are available in multi4angual form and which languages are they available in? Spanish c. How and where are the materials distributed? Materials are distributed via presentations, tabling events and fairs, flyering, door -to -door outreach to business, and http: //www.citydataservices.nett cities/ smatca lapp20l6arc.pl ?rpt= C4573&prop= l2 618 RedwoodClty CitycfSanMateo Cuth San ancisco Total Jurisdictions Budget Line Item Agency Total gmo� Program Total EL uested % Requested Re uested q P rn 9 Re nested q Labor Shirley Fok $51,3731 39% $20,2001 4% $80 11 % $2,200162%, $10 50 33% $6,700L_1 00% $20,2001 Debra Smith $51,37 39% $20,05 7% $1,4001 15% $3,000175 % $15 00 3% $65 100% $20,05 Barbara Liedtke $61,80 50% $30,95C 35% $10,80 12% $3,800162% $16,00 1°1 $35 100% $30,95 Dania Del adillo $46,35 47% $22,00 5% $1 00 19% $4,200 68% $15,00 8% $1,80 100 ° /0 $22,00 Housing Management $93,73 13°/0 $11,80 8% $1,00 15% $1,80 72% $8,50 4% $50C 100% $11,80 Employee Taxes/Benefits $ Administration 0% TOTA $304,6321 340/6 $105,00 14% $15,00 14% $15,00 62% $65,00 10% $10,00 100°/0 $105,00 Number of Individual Beneficiaries 1 3 99 13 15 ost per Individual (ftwva qd $468.7 $722.2 $769.23 $686.2 For the City of Redwood City ONLY, answer the following: For the City of Redwood City ONLY, answer the following: 1. Funding Criteria: 1. Affordable Housing: Acquisition of sites for affordable housing, new construction of affordable housing, conversion of existing housing to affordable, acquisition and rehabilitation of rental housing (includes special needs housing). 2. Marketing /Advertising a. Check all of the following methods your agency utilizes to promote and advertise your programs and services: w Flyers /brochures Website e: Phone book listing CIP (Handbook/Database) Outreach presentations to service providers ?; Outreach presentations to public PSA's b. Which of the above marketing/advertising materials are available in multi4angual form and which languages are they available in? Spanish c. How and where are the materials distributed? Materials are distributed via presentations, tabling events and fairs, flyering, door -to -door outreach to business, and http: //www.citydataservices.nett cities/ smatca lapp20l6arc.pl ?rpt= C4573&prop= l2 618 1/2512016 City Data Services - South San Francisco TV appearances. 3. Program Outcomes: a. Please describe the accomplishments of program goals for FY /15. During the grant period, Home Sharing staff continued to prevent homelessness, processing 3,860 calls from individuals inquiring about HIP Housing's programs. Each caller received vital housing information and resources that matched their specific needs. Of these individuals, 2,038 were interviewed and screened by program staff, receiving referrals to potential home sharing placements as they became available. Program staff placed 240 individuals in new affordable home sharing arrangements, while maintaining 457 clients it Home Sharing matches made in previous years, Housing costs for home providers before home sharing were 53% of their incomes on housing but after finding a housemate it was reduced to 29 %. For seekers before home sharing they spent 32% of their incomes on housing and then after moving in with a housemate it was reduced to 25% With a focus on attracting new Home Providers to the program, staff have distributed 2,367 pieces of outreach material, conducted 18 presentations, attended 11 Resource / Health Fairs, while continuing to grow our social media presence. With your help, these individuals have significantly reduced their housing costs. Home Seekers have finally found stable and affordable place to live. While the Home Providers now have the additional income they need to remain independent in their homes. b. In what ways has your program made a difference in the lives of the people you serve? Please provide at least one concrete example from the people served in FY /15: The Home Sharing Program is not simply a quick -fix, nor is it a band aid - this program is a long -term strategy, designed to bring about lasting change in the lives of those we serve. John, a senior living on a fixed income from a small pension and social security, has lived in his home for 15 years. When John's dear friend was diagnosed with cancer, he wanted to support her in any way he could, and help to ease the financial burden of the medical bills that followed her ongoing chemotherapy treatments. Unfortunately, he began to struggle to meet his rent each month. Worried about what the future might hold, a Social Worker referred John to HIP Housing. HIP Housing's Home Sharing staff conducted a home visit with John, and within a very short time, he was matched with Rose. Rose and her 10 year old daughter had lived in their apartment for more than a year, when the landlord raised the rent way beyond her means. Even though Rose worked full time as an Administrative Assistant, she could not find another apartment that was within her budget. Luckily, she contacted HIP Housing for help. Rose pays John $800 a month rent, which includes utilities. This is $900 a month less than she was paying for her old apartment. Rose and her daughter now have a decent, stable, and affordable place to live. While John now has the additional income he needs so that he can pay his rent, remain in his home, and continue to support his friend through a difficult time. Attachments !d: 1. Resolution CDBGBoardResolution20l6- 17.pdf authorizing application and designation of signatory, by the Board of Directors '' 5. Board roster, HIPHousingBoardRoster December2015 odf including: Name, Company, Years on Board * Meeting dates for previous 12 months • Number of years allowed for each board term 6. Organizational 2016-17 HIPHousingOraChart odf chart for entire organization 'v 7. Certified financial HIP Inc. Financial Statements and Independent Auditors Report FYE June 30 2014 pdf audit no more that 1 fiscal year old, prepared by a CPA, and: httpJ/www.citydataservices.rL,V cities/ smatca /app20l6arc.pi ?rpt- C4573&prop =l2 7/8 1/25/2016 • Management letters (if applicable) • A -122 and A -133 Single Audit (for entities that receive more than $500,000 in federal funding) OR • A letter from your Executive Director or Chief Financial Officer certifying that agency does not receive more than $500,000 in federal funds and is not subject to the Single Audit. . 8. The following are 2015- 16HIPBudoet.pdf required: • Current (FY15- 16) Agency Operating Budget Proposed (FY16- 17) Agency Operating Budget City Data Services - South San Francisco �� 9. Mission Mission Statement.pdf Statement Cd 10. Non- Non- discdminationPolicyHIPHousina odf discrimination policy for Staff and Clients 11. Reasonable ReasonableAccornodationsPolicv odf Accommodations Policy for Staff and Clients ^!' 12. Conflict of HIPHousingConflictoflnterestPolicy pdf Interest Policy. (If not available, please indicate when you will submit) i 13. Other - Download All Attachments Program Manager Signature Clarice Veloso Date Signed 01/20/2016 InitiaNy submitted: Jan 20, 2016 - 17:04:63 http: //w m.citydataservices.neV cities/ smatca/ app2016arc.pi ?rpt= C4573&prop =12 &$ Projected Program Budget Projected Budget HiP HOUSING APPROVED BUDGET FOR 20154016 APPROVED BY THE BOD ON JUNE 16, 2015 HS Approved UP Approved manag BGeneral Approved Fundraising Approved Total /1/2014- 613012015 Budget 2015/2016 Budget 2015/2016 Budget 201612016 budget 2015/2016 Programs Budget In e: San Mateo Countv CDBG Cities within the County =,a vents i , Grants Contribution Indivivals Wment Fess & developer fees from Affiliates Other Misc Income Total Income $ 57 063 373,250 76,500 15,395 328,315 850 523 47,081 20,595 94,000 234,169 __$39568" 135,000 14,500 20,000 113,257 15,831 5,162 ____$_30.3A760 89,905 126.000 12 0 000 22,080 $357 985 $ 57,063 555,331 125,000 296,500 140,000 128,652 250,000 355 557 $11,ifflo 3 Ex sea• Direct Cost Salaries - Direct Payroll Taxes & Benefits - Direct Total Direct Salary & Benefits $418,170 $117,508 535 678 $ 161,528 37,21 $198&7 8 33 670 6,610 $40 280 $ 179,049 19,265 198 314 $792,417 $180.593 973 010 Salaries - Indirect Payroll Taxes & Benefits - Indirect Total Administration $ 71,673 $ 30,259 101 832 $ 99,280 26,064 $125 344 $ 80,694 26,126 $101 $ 19,447 5,537 $24,984 $ 271,094 $ e7,986 $359080 ADMINISTRATION P ram Service Expenses: Bonus Office Supplies Rent - Office Calendar ex nses Audit ense Accounting & Bookkeeping Automobile Expense Telephone Office Equipment Bank Service Charges Training professional Fees Printin Co in /Re reduction Dues and Subscriptions Postage and Delivery Computer Expense Office Expenses Adv./Promo/Mkt . Communications Office Maintenance/Janitor /Garb Gas & Electric Property & Uability Insurance Hop Workshop expenses Miscellaneous S at Events Fremont & Measure "A" Management fees Total Program Services 4,050 2,696 34,450 4,609 720 2,030 2,235 4,589 2,957 5,000 2,609 6,587 1,522 8,174 2,483 1,674 2,8361 3,870 1,565 2,014 113,568 $212.9131 1350 1,707 22,790 2,919 991 1,286 1,415 2,906 1 872 1,950 1,652 4,172 964 1,696 5,177 1,572 1,060 1,796 2,451 991 9,773 1,275 71 763 2250 359 6,890 614 209 270 298 612 397 4,500 348 1 878 202 357 1,090 331 223 7,260 378 515 209 4,769 98,517 $131 476 1350 1,438 31,610 9,000 2.458 1.680 1,083 1,192 2,448 1,574 1,650 1,391 3,513 812 1,427 4,359 1,324 893 1,512 2,064 835 1,074 60,000 134 687 9,000 6 200 95,740 9,000 10,6001 3.600 4,669 5,140 10,555 6,800 13,100 6,000 15,150 3,500 6,155 18,800 5,710 3,850 7,260 6.520 8,900 3,600 9.773 9,132 60,000 113 568 98,517 550,838 Total Expenses 850,523 395,845 2357,9 5 ,929 OI 0 0 5,174 Projected Program Budget Projected Budget HIP MOUSING PROJECTED BUDGET FOR 2016.2017 1112016- 6/3012017 HS Approved Budget 201612017 UP Approved Budget 201612017 &General Approved Budget 201612017 Fundraising Approved budget 2016/2017 Total Programs Budget Income: San Mateo County CDBG $ 59 573.77 $ $ $ $ 59 573.77 Cfts within the County 389,673 49,153 140,940 578,766 Special events 21,501 15,138 93,861 130,500 Fundraising, Grants 79,866 98,136 131,544 309,546 Contribution Indivivals 20,880, 125,280 146,160. Management Foss & developer tees 16,072 118,240 134,313 Support from Affiliates 241,461 16,528 257,989 Other Misc income 336 764 9,409 19,032 365,205 Total Income 881,949.15 410,251.18 321 135.00 389 718.94 1 983,051.67 Ex nses: Direct Cost Salaries - Direct $ 430,715 $ 166,374, $ 34,680 $ 184,420 $ 816,190 Payroll Taxes & Benefds - Direct 125,734 39,815 7,073 20,614 193 235 Total Direct Salary & Benefits $ 556 208189 $ 41,753 205,034 1 009 Salaries - Indirect $ 73,823 $ 102,258'-$ -83,115 $ 20,030 $ 279,227 Pa II Taxes & Benefits - Indirect 32 377 27 888 27,955 5 925 94.145 Total Administratlon 106,200 130147 ; 111 070 $ 25 955 373,372 ADMINISTRATION Program Service Expenses: Bonus $ 4 172 $ 1 391 $ 2,318 $ 1,391 $ 9,270 Office Supplies 2,777 1,758 370 1,481 6,386 Rent - Office 35,484 23,474 7,097 32,558 98,612 Calendar expenses 9,270 9,270 Audit Expense 4,747 3,007 632 2,532 10,918 Accounting & Bookkeeping 742 1,021 215 1,730 3,705 Automobile Expense 2,091 1,325 278 1,116 4,809 Telephone 2,302 1,457 307 1 228 5,294 Office Equipment 4,727 2,993 630 2,521 1072 Bank Service Charges 3,046 1,928 409 1,621 7 004 Training 5,150 2,009 4,635 1,700 13,493 professional Fees 2,687 1,702, 358 1,433 6,180 Printing/Copying/Reproduction 6,785 4,297 904 3,618 15,605 Dues and Subscriptions 1,568 993 208 836 3,605 Postage and Delivery 2,756 1,746 368 1,470 6,340 Computer Expense 8,419 5 332 1,123, 4,490 19,364 Office Expenses 2,567 1,619 341 1,364 5,881 AdvJPromo/Mkt . 1,724 1,092 230 920 3,966. Communications -w 7,478 7,478 Off Maintenance/Janitor /Garb 2,920 1,849 389 1,557 6,716 Gas & Electric 3,986 2,525 530 2,126 9,167 Property & Liability Insurance 1,612 1,021 215 860 3,708 Hop VYbrkshop expenses 10,066 10,066 Miscellaneous 2,074 1 313 4,912 1,106 9,406. Special Events 61,800 61,800 Fremont & Measure "A" 116,975 116,975 Mana ementfees 101473 101,473 Total Program Services 219,300 73,916 135,4 0 138,728 7,364 Total Expenses $81,949 410, 1 T 286,243 3 1,850, 60 I 0 ,8 2 0 32, 1/25✓2016 City Data Services - South San Francisco Consolidated Community f=unding Application Redwood City, San Mateo County, and S. San Francisco Application for New Funding for FY 2016 -17 GENERAL INFORMATION 1. Organization Name: John Papan Memorial 2. Project Title: Johns Closet We are applying for funding from: Redwood City City of San Mateo e South San Francisco County of San Mateo Budaet/Ciient Surnrnary (Auto- DODUiated from Budoet_ halew) Jurisdictions receiving this application Amount Requested % of Program Budget Proposed # of Served % of Served Total $ Per South San Francisco $5,00 9% 10 100% $50. Total $5,00 9% 10 100% $50. Grant Funded Programs: We are applying for a Public Services Program CDBG National Objective Eligibili - How are you serving low income populations? Service to low income clients verified through income documentation. Income Verification: Describe how you obtain, verify, and maintain proof of income and presumed benefit status. Third party documentation or client signatures on the certification forms must be available on file for review at all times. We obtain and verify income by an initial screening and through certification on client in -take forms. The initial screening is either by phone or by another agency in completing a referral form. Over the phone, we ask for household income and the source of the income. Our screening includes questions about the type of employment and employer or the type and source of aid received. A referring agency such as a social woke, headstart teacher, other agency director, school staff, teachers or principals must complete income information on our referral form, If a potential client's income is within the guidelines, we will schedule an appointment. Upon arriving for an appointment, a client must complete an intake form and certify his /her income. 3. Project Address: 444 E. Market St., Rm. 2 City: Daly City Zip: 94014-2101 4. Provide a one sentence project summary: Johns Closet provides NEW CLOTHES to needy school -aged children. Organization Address: 440 Green Hills Drive City: Millbrae Zip: 94030 -1663 Organization Phone: 650 - 871 -7440 Website: johnscloset.org Type of Applicant: Non - Profit Our agency serves: 5. Contact Person / Project Name: Diane and Gina Papan Title: director Telephone: 650 - 871 -7440 Administrator: Contact Email: dianepapan @gmaii.com Fax: 6. Name of Agency Diane and Gina Papan Director: 7. Fiscal Officer: Name: Diane Papan Email: Telephone: 650 - 871 -7440 dianepapan@gmaii.com Fiscal Officer Address: 440 Green Hills Drive City: Millbrae Zip: 94030 -1663 8. Authorized Email: Signatory: Name: Diane Papan dianepapan @gmail.comTelephone: 650 - 871 -7440 http: //www.citydataservices.neV cities/ smatcalapp2016arc .pl ?rpt= C45988,prop =77 1/4 1/25/2016 City Data Services - South San Francisco Authorized Signatory 440 Green Hills Drive City: Millbrae Zip: 94030 -1663 Address: 9. Please provide days and hours of regularly scheduled operation: Monday through Friday 9:30 - 12:00. August through June. 10. BUNS Number: 926757311 Federal EiN/TIN Number: 942826366 11. HUD Activity: Choose the HUD activity that most closely matches your service: 05D - Youth Services 12. Project Specific Narrative: Provide a narrative description of the specific activities to be carried out with the requested funds. This should also include program objectives and key priorities for each specific jurisdiction. All funds received by John's Closet will be used to purchase new clothing for needy school children. We distribute the clothing at our rent -free space at Ben Franklin Middle School. John's Closet is a 100% volunteer program, with no salaries or fixed costs. All the work is done by about 30 volunteers, who answer the phones, schedule appointments, assist children at the Closet five days -a -week, keep shelves organized and stocked, mend distressed items, shop for needed clothing not supplied by in -kind donations, account for documentation, maintain the books and prepare grant requests. There is no similar program in the community. 13. Assessment cf Need - South San Francisco: Briefly describe how you determined the need for your program for each specific jurisdiction that you are applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. We are addressing the ever - growing needs of low- income families to provide clothing for their children. Our clients range from single mothers living on TANF, elderly grandparents who have become primary caregivers of their children's children, and intact. families with parents eaming very little. After these families pay rent, utilities, transportation and food, there is very little money left for clothing. The high cost of living in San Mateo County greatly impacts the number of families needing help to survive. John's Closet is the only program in the area to provide NEW CLOTHING to needy children. We receive some in -kind donations of new clothes, but we must still purchase a great deal. This is particularly true given that the GAP has greatly reduced its donations. Jackets and shoes are expensive items for families and for us to buy and the prices are rising. The source of our information comes from intake toms and a telephonic screening process we conduct prior to setting an appointment. There is no similar program in the community. 14. Timeline: Provide a brief timetable for project implementation and achievement of projected goals and how you plan to expend your funds in a timely manner by the end of the fiscal year. The money will be spent to purchase NEW CLOTHES as needed to distribute to needy children throughout the school year. We are open from August through June. Our biggest demand is from August through December. 15. Evaluation: Briefly describe how you will determine and measure the success of your program and whether or not program goals were met? If your program is currently receiving grant funds please describe accomplishments of goals to date. Our goal is to build self - esteem and to eliminate the alienation and discrimination children feel at school when they are poorly dressed. Adequate clothing will make them feel as though they belong and enable them to be full participants in the academic experience. This participation will motivate them to stay in school and reach their full potential. Staying in school is crucial to preventing involvement in the criminal justice system. Statistics shaw that 80% of those in jail dropped out of school. An additional goal is to alleviate the economic pressure and subsequent emotional stress on poor families by providing NEW CLOTHING for their children. 16. Collaboration: Describe partnerships with other organizations /agencies, the nature of the partnership, and how it relates to the proposed project. John's Closet receives referrals from the schools, San Mateo County Health and Human Services Agency, Headstart, Shelter Network, Edgewood, Kinship Program, and various family resource centers. V. Impact:: Discuss any general trends and conditions that have affected or impacted your service levels or service populations. For New Applicants — describe what these funds would allow your agency to do that you may not be able to do now. For Continuing Applicants — describe how your program would be impacted without these funds. These funds are essential to allow us to purchase new clothing for kids. While we sometimes receive in -kind donation from the GAP, the donations are infrequent and usually limited in size to certain sample sizes. WE must purchase all other sizes and all of the new shoes and new jackets that we distribute. Over one -third of our clients come from South San Francisco. 18. Project Benefrciasies/Quantifrable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income limits. 19. Project Beneficiaries/Quantifiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. a. Indicate the total number of low4ncome beneficiaries you expect to serve with this program for each jurisdiction application for funding. *Low- income is 80% of Area Median Income or below. See AMI table b. Indicate the total number of beneficiaries you expect to serve with this program in each jurisdiction - regardless of income. http:Uwww.citydataservices.rieV cities/ smatca/ app2016arc.pl?rpt= C4598&prop =77 2/4 1/25/2016 City Data Services - South San Francisco .! urisdiction a. Number of low4rccme beneficiaries to be served per grant jurisdiction application. **Low-income* is 800/6 of Area Median Income or below. b. All beneficiaries to be served per I grant jurisdiction application regardless of income Low Income by Ethnicity served by our Program P_ _ersons � Persons DaIv Citv 125 125 Redwood City White and not Hispanic 23,7601 City of San Mateo 1 1.10% Cou!Lty of San Mateo 21,6451 34.02% South San Francisco 100 100 otals 225 225 19. Populations Served: Check the boxes below if they describe a significant population served by your program. These categories are not considered "presumed benefit" by HUD, and require income verification. �J Persons exiting incarceration Low- income youth i Other 20. Affirmative Outreach: a. Use the demographics from your previous program year to provide an analysis of the population you serve relative to the demographics in the table. NOTE: If you are a new annlicant nlease nmvirlp vnr,r hart petimatinn Race & Ethnicity South San Francisco Population South San Francisco % by. Ethnicitv Low Income by Ethnicity served by our Program Program % Your by Ethnicity Total 63,63 I 100% 91 100% White and not Hispanic 23,7601 37.34% 1 1.10% White and Hispanic 21,6451 34.02% 73 80.22% Asian 23,2931 36.61% $55,000 0.00% African American 1,62 2.55% H iene Items 0.00% Pacific Islander 1,1111 1.75% 11 12.09% Native American 3951 0.62%1 1.10070 10—ther 77 9,5981 15.08°/ 5.49% b. Based on the percentages that you indicate your organization served describe your efforts to improve affirmative outreach to groups that may be underserved by your program and the result of your efforts: The vast majority of the clients we serve are Hispanic. As this group appears to make up a significant percentage of the residents in South San Francisco, John's Closet believes it is reaching a large ethnic group with significant need. 21. Leveraging: Describe your fundraising efforts and additional sources of revenue for this project and your organization. Please state whether any of these fund sources are already committed and in what amount. John's Closet applies for CDBG funds from Daly City and South San Francisco. We also apply for grants from private foundations including the Carl and Celia Berta Gellert Foundation and the Wyss Foundation. Staff List List below key staff members who work on this Droaram Position Title ]Diane Name of Staff Person .fob Responsibilities Qualifications Director Pa an 1grants , screening, appointments, shop non- rofit director since 2000 PROPOSED PROGRAM BUDGET FOR FY 2016 -17 http : //www.citydataservices.net/ cities/ smatcal app2016arc.pl ?rpt= C4598&prop =71 314 South San Francisco Total Jurisdictions Budget Line Item ATota 1Pgm 0 P Togalm % Requested Pgm% Requested Taxes/Benefits $ aterials New Clothing & $55,00 $55,000 $5,000 $ H iene Items http : //www.citydataservices.net/ cities/ smatcal app2016arc.pl ?rpt= C4598&prop =71 314 1/25/2016 City Data Services - South San Francisco Attachments 1. Resolution authorizing application and designation of signatory, by the Board of Directors 2. Proof of 501(c)3 / tax - exempt status ' 3. By -laws 4. Articles of Incorporation 5. Board roster, including: • Name, Company, Years on Board • Meeting dates for previous 12 months • Number of years allowed for each board term Johns Closet CDBG Attachment 1 pdf Johns Closet SSF Attchment 2 for 2015 501c3groof pdf Johns Closet By -laws pdf Johns Closet Articles of Inc pdf Johns Closet CDBG Attachment 5-6 pdf ✓-i 6. Organizational chart for entire organization Johns Closet CDBG Attachment 5-6.pdf 7. Certified financial audit no more that 1 fiscal Johns Closet SSF CDBG App Attachment 7-8 2016 odf year old, prepared by a CPA, and: • Management letters (if applicable) • A -122 and A -133 Single Audit (for entities that receive more than $500,000 in federal funding) OR • A letter from your Executive Director or Chief Financial Officer certifying that agency does not receive more than $500,000 in federal funds and is not subject to the Single Audit. 8. The following are required: • Current (FY15 -16) Agency Operating Budget • Proposed (FY16 -17) Agency Operating Budget 9. Mission Statement 10. Non - discrimination policy for Staff and Clients 11. Reasonable Accommodations Policy for Staff and Clients Johns Closet SSF CDBG App Attachment 7-8 2016.0d Johns Closet Mission Statement pdf Johns Closet Non - Discrimination Policy pdf Johns Closet CDBG Reasonable Accommodation Policy doc sf , 12. Conflict of Interest Policy. Of not availabie, Johns Closet Conflict of Interest Policy pdf please indicate when you will submit) }. ; 13. Other - Download All Attachments Program Manager Signature Diane Papan Date Signed 01/13/2016 Initially submitted: Jan 13, 2016 - 12:02:35 http: //www.citydataservices. net / cities/ Smatcalapp20i6arc .pl?rpt= C4598&prop =77 4/4 JOAN'S CLOSET STATEMENT OF REVENUES AND EXPENDITURES 1 -01 -2015 TO 12 -31 -2015 Cash balance: 12/31/2014 Cash Donations: Carl Gellert Foundation Daly City C.D.B.G. Demos, John & Virginia Miscellenous Donors Outreach Holy Cross Church South San Francisco Block Grant Daly City Retired Employees Michael Dolan Wyss Foundation Wilchie Crump Total Cash Donations: Interest earned: Wells Fargo Bank Donations in Kind: Jefferson Schoold District.(Rent) Presyterian Women 50 Handmade Seaters 100 pairs of new socks Total Donations in Kind: EXPENDITURES: Clothing Loan to John Papan Memorial Fund for interim loan from John's Closet TOTAL CASH EXPENDITURES: Cash Balance: 12/31/2015 $ 59,215.94 $5,000.00 $5,000.00 $200.00 $980.00 $1,109.00 $4,750.00 $200.00 $500.00 $20,000.00 1 000.00 Total: $38,739.00 $ 38 739.00 $ 97,954.94 $6.83 $ 6.83 $10,000.00 $300.00 100.00 Total: $10,400.00 ($17,291.78) 2 500.00 ($19,791.78) 19 791.78 $ 78,169.99 BPoon, Yvonne oen: Diane Papan <dianepapan @gmail.com> zient: Monday, February 01, 2016 1:15 PM To: Poon, Yvonne Subject: Re: Attention Requested: Missing Items from CDBG Funding Application with City of South San Francisco We have always used the previous year as an estimate for the corning year. DIANE D. PAPAN ATTORNEY AT LAW Tel.: 650 -952 -3885 Mobile: 415- 377 -4462 Fax: 650- 875 -7743 Email: Dianepapan@gmail.com 440 Green Hills Drive, Millbrae, CA 94030 is transmission is intended only for the addressee, and may contain privileged and /or confidential information. If you are not the intended recipient, please do not use, disseminate, or copy this material. If you have received this transmission in error, please notify us immediately by telephone, return this transmission, and delete or destroy any copies (digital or paper). Thank you. On Mon, Feb 1, 2016 at 1:04 PM, Poon, Yvonne <Yvonne.Poon6Dssf net> wrote: Dear Ms. Diane Papan, Thank you for submitting your application for CDBG funding through the City of South San Francisco on 01/13/2016. Upon initial review of the application, we noted that the following information was missing: 1. A more detailed, proposed agency budget for the year of 2016 — We completely understand that this would largely be an estimate. The 2015 Statement of Revenues & Expenditures is a good format and overviews, perhaps the 2016 -2017 proposed/projected budget can have a similar format. Please kindly submit these documents to me by Thursday, 2/4/2016 at 2:OOPM. If there are any questions or concerns, please let me ,ow how I can be of assistance. 1/25/2016 City Data Services - South San Francisco Consolidated Community Funding Application Redwood City, San Mateo County, and S. San Francisco Application for New Funding for FY 2016 -17 GENERAL. INFORMATION 1. Organization Name: Legal Aid Society of San Mateo County 2. Project Title: HomeSavers: Preserving Affordable Housing in our Community We are applying for funding from: t' Redwood City ** City of San Mateo a South San Francisco e. County of San Mateo Budaaet/Client Summary (Auto- nooulated from Rudaet hPlnwl Jurisdictions receiving this application Amount Requested % of Program Budget Proposed # of Served % of Served Total $ Per Redwood City $20,00 6% 25 33% $80.0 City of San Mateo $17,50 5% 12f 17% $140.0 County of San Mateo $25,00 8% 30 40% $83.3 outh San Francisco $10,00 3%1 79 10% $133.3 Ofal $72,50 • 22% 7501 100%l $96.6 Grant Funded Programs: We are applying for a Public Services Program CDBG National Objective Eligibility - How are you serving low income populations? Service to low income clients verified through income documentation. Income Verification: Describe how you obtain, verify, and maintain proof of income and presumed benefit status. Third party documentation or client signatures on the certification forms must be available on file for review at all times. Every client served by the HomeSavers program completes a self - certification of income and household composition at the outset of the interview, regardless of the nature or duration of the legal services provided. In some instances, where court documents are prepared for the client, an application for waiver of court fees is also prepared, including a statement of the client's household income and expenses which is verified under penalty of perjury for filing with the Court. The original signed self- certification of income and, where applicable, a copy of the application for waiver of court fees is maintained in each client file. Pursuant to California State Bar requirements, all client files are secured and stored for a period of five years after completion of legal services. 3. Project Address: 330 Twin Dolphin Drive, City: Redwood City Zip: 94065 -1455 Suite 123 4. Provide a one sentence project summary: Legal assistance to people threatened with losing their homes or living in substandard conditions with the goals of keeping people in their homes; preventing homelessness through the enforcement of legal rights, in and out of court; and remedying substandard living conditions through advocacy. Organization Address: 330 Twin Dolphin Drive, City: Redwood City Zip: 94065 -1455 Suite 123 Organization Phone: 650 -558 -0915 Website: http://www.legalaidsmc.org/ Type of Applicant: Non - Profit Our agency serves: 5. Contact Person / Name: Shirley Gibson Title: Directing Attorney Project Administrator: Contact Email: S Gibson@ legalaids mc. orgFax: 650 -017 -8973 6. Name of Agency M. Stacey Hawver Director: 7. Fiscal! Officer: Name: Susan Stortini Email: SStortini @legalaidsmc.org Fiscal Officer Address: 330 Twin Dolphin Drive, City: Redwood City Suite 123 Telephone: 650- 517 -8911 Telephone: 650- 517 -8913 Zip: 94065 http: //www.citydataservices.net/ cities/ smatealapp2016arc .pl?rpt= C4768&prop =542 1n 1/25/2016 City Data Services - South San Francisco 8. Authorized Signatory:Name: M. Stacey HawverEmail: Telephone: 650 - 517 -8917 mshawven@legalaidsmc.org Authorized Signatory 330 Twin Dolphin Drive, City: Redwood City Zip: 94065 Address: Suite 123 9. Please provide days and hours of regularly scheduled operation: The Legal Aid Society office is open from 9:00 a.m. to 12:00 noon, and from 1:00 p.m. to 5:00 p.m., Monday through Friday (except legal holidays). Client intakes at off -site legal clinics occur on the following days and times: Mondays, 8:30 a.m. to 11:30 a.m.; Tuesdays, 1:00 p.m. to 4:00 p.m.; and Fridays, 9:00 a.m. to 12:00 noon. 10. DUNS Number: 0342377270000 Federal EIN /TIN Number: 94- 1451894 11. HUD Activity: Choose the HUD activity that most closely matches your service: 05C - Legal Services 12. Project Specific Narrative: Provide a narrative description of the specific activities to be carried out with the requested funds. This should also include program objectives and key priorities for each speck jurisdiction. Program Objective: The Legal Aid Society of San Mateo County works to bring fairness to the county's housing courts, helps to keep low- income tenants in their homes, and can mitigate the effects of a potential eviction. We do this by providing legal advice and services to about 100 unduplicated households each month at three weekly housing clinics. Last year, of the 660 Answers to unlawful detainers (eviction lawsuits) filed in San Mateo County Court, 386 — nearly 60% — were prepared by Legal Aid staff and volunteers in these clinics. Key Priorities: Legal Aid strives to provide low- income clients with the knowledge and practical assistance they need to more effectively advocate for themselves and their families in housing court. Specific Activities: Legal Aid attorneys, project staff, and trained pro bono attorneys meet one -on -one with clients at the housing clinics where they answer questions, provide legal advice, help with the completion of legal paperwork, and explain to clients what to expect in the county's housing courts. Clients leave our housing clinics with an understanding of their legal rights, as well as completed paperwork, letters to landlords, and /or clear instructions and next steps. 13A. Assessment of Need - Redwood City: Briefly describe how you determined the need for your program for each specific jurisdiction that you are applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. According to the National Low Income Housing Coalition, approximately 41% of San Mateo County's households are renters, and the county has some of the highest rents in the nation with a market average rent of $2,575 for a one - bedroom apartment (SMC Housing Indicators 9/30/15). Using total housing costs of 30% of gross income as an index of affordability, even households making the city's median household income of $81,955 are cost - burdened by their rental housing (2010 -2014 American Community Survey 5 -Year Estimates). The average annual income of Legal Aid's Redwood City housing clients last year was just $16,910. For these families, a market -rata apartment is out of reach, and the cost of moving prohibitive. It is critical that these families maintain their current housing whenever possible, and the primary factor that influences this outcome is timely legal help in defending an eviction. It is important to note that not all tenants who are evicted have fallen behind in rent payments or violated their rental agreements. Forced moves can be caused by a number of factors including landlord foreclosure, tenant - landlord disputes, and other external factors unrelated to tenant behavior. In San Mateo County, it is not uncommon for a change in ownership or property upgrades to result in no -fault evictions of tenants, sometimes displacing entire buildings. 13B. Assessment of Need - City of San Mateo: Briefly describe how you determined the need for your program for each specific jurisdiction that you are applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. According to the National Low Income Housing Coalition, approximately 41% of San Mateo County's households are renters, and the county has some of the highest rents in the nation with a market average rent of $2,575 for a one - bedroom apartment (SMC Housing Indicators 9/30/15). Using total housing costs of 30 %p of gross income as an index of affordability, even households making the City of San Mateo's median household income of $90,087 are cost - burdened by their rental housing (2010 -2014 American Community Survey 5 -Year Estimates). The average annual income of Legal Aid's City of San Mateo housing clients last year was just $19,668. For these families, a market -rate apartment is out of reach, and the cost of moving prohibitive. It is critical that these families maintain their current housing whenever possible, and the primary factor that influences this outcome is timely legal help in defending an eviction. It is important to note that not all tenants who are evicted have fallen behind in rent payments or violated their rental agreements. Forced moves can be caused by a number of factors including landlord foreclosure, tenant - landlord disputes, and other external factors unrelated to tenant behavior. The rise of no fault evictions in the City of San Mateo is a trend that needs monitoring. Legal Aid has been and will continue to contribute data to the review of tenant policies by the city council. 13C. Assessment of Need - County of San Mateo: Briefly describe how you determined the need for your program for each 8128cific jurisdiction that You are apRllyina for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. According to the National Low Income Housing Coalition, approximately 41% of San Mateo County's households are renters, and the county has some of the highest rents in the nation with a market average rent of $2,575 for a one - bedroom apartment (SMC Housing Indicators 9!30/15). Using total housing costs of 30% of gross income as an index of affordability, even households making the county's median household income of $91,421 are cost - burdened by their rental housing (2010 -2014 American Community Survey 5- Year Estimates). The average annual income of Legal Aid's housing clients last year was just $18,000. For these families, a market - rate apartment is out of reach, and the cost of moving prohibitive. It is critical that these families maintain their current housing whenever possible, and the primary factor that influences this outcome is timely legal help in defending an eviction. The evolution of legal protections for mobile home residents with recent amendments to the county mobile home rent ordinance will provide new opportunities to engage and educate low- income residents of these parks. We will work to contribute data from our contacts with mobile home clients to help inform the county's review and implementation of the ordinance. httpJ/ www. citydataservices. neVcities/ smatca lapp2016arc.pl ?rpt= C4768&prop =542 2(7 1/25/2016 City Data Services - South San Francisco 13D. Assessment of Need - South San Francisco: Briefly describe how you determined the need for your program for each specific jurisdiction that you are a plying for fronds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. According to the National Low Income Housing Coalition, approximately 41% of San Mateo County's households are renters, and the county has some of the highest rents in the nation with a market average rent of $2,575 for a one - bedroom apartment (SMC Housing Indicators 9/30/15). Using total housing costs of 30% of gross income as an index of affordability, even households making South San Francisco's median household income of $78,101 are cost - burdened by their rental housing (2010 -2014 American Community Survey 5-Year Estimates). The average annual income of Legal Aid's South San Francisco housing clients last year was just $18,000. For these families, a market -rate apartment is out of reach, and the cost of moving prohibitive. It is critical that these families maintain their current housing whenever possible, and the primary factor that influences this outcome is timely legal help in defending an eviction. It is important to note that not all tenants who are evicted have fallen behind in rent payments or violated their rental agreements. Forced moves can be caused by a number of factors including landlord foreclosure, tenantaandlord disputes, and other external factors unrelated to tenant behavior. In San Mateo County, it is not uncommon for a change in ownership or property upgrades to result in no -fault evictions of tenants, sometimes displacing entire buildings. 14. Timeline: Provide a brief timetable for project implementation and achievement of projected goals and how you plan to expend your funds in a timely manner by the end of the fiscal year. Legal Aid already hosts three weekly housing clinics which are a well -known point of service for low income tenants in the county. Legal Aid can begin utilizing CDBG and HSFA funds immediately to support these clinics. Staffing and infrastructure for these clinics is already in place, with capacity to improve our outreach and efficacy with added financial support. During FY15 -16, Legal Aid proposes to assist 950 low- income tenant households during its weekly housing clinics. This goal is reasonable based on client demographic information from past programmatic years, and given the demonstrated need for these services. 15. Evaluation: Briefly describe how you will determine and measure the success of your program and whether or not program goals were met? If your program is currently receiving grant funds please describe accomplishments of goals to date. Legal Aid is committed to utilizing both internal and external data to evaluate its programs. We measure success by the number of households we are able to serve during our housing clinics, as well as by the number of cases that result in a favorable outcome for the client. We also work to address the number of unlawful detainer (UD) cases that result in a default judgment by the court. A default judgment is entered when a tenant fails to respond, responds incorrectly, or responds too late to a LID, and can mean that that the tenants are rapidly displaced from their home. In some cases, a household may be evicted in as little as five days after a default judgment. We will track the number of housing clinic clients who come to us with unlawful detainers, the number of Answers to UDs that we prepare for clients, and compare it to the total number of UD Answers and defaults throughout the County. 16. Collaboration: Describe partnerships with other organizations /agencies, the nature of the partnership, and how it relates to the proposed project. Legal Aid partners with San Mateo Superior Court and Community Legal Services of East Palo Alto to ensure that self- represented litigants in eviction proceedings have access to pro bono assistance at essential points of the legal process, including preparation of paperwork by Legal Aid at the outset of the case and assistance with settlement negotiations by Community Legal Services at subsequent court dates. Legal Aid also collaborates with Fair Oaks Community Center and Daly City Community Services Center to provide on -site housing assistance at these core service agencies. We work with other community organizations like Rebuilding Together, the San Francisco Organizing Project/Peninsula Interfaith Action (SFOP /PIA), and Project Sentinel to provide outreach and comprehensive services to low- income individuals and families facing housing issues. Through active collaboration, client referrals, and targeted partnerships that address specific needs in the community, Legal Aid and its partners work to maximize resources and community impact while eliminating duplication of services. 17. Impact.: Discuss any general trends and conditions that have affected or impacted your service levels or service populations. For New Applicants — describe what these funds would allow your agency to do that you may not be able to do now. For Continuing Applicants — describe how your program would be impacted without these funds. The frequency of 'no fault' evictions throughout the county has seen a dramatic increase. The state law permits landlords to terminate a tenancy that is not under a fixed -term lease by serving the tenant with a thirty -day or sixty-day notice, with no requirement that the landlord state any reason for the termination. There is currently no legal barrier to a landlord deciding to evict a tenant for his own business reasons, even if the tenant has followed every requirement of the rental terms. Since the prior fiscal year the Legal Aid clinics are seeing about an 88% increase in the number of clients with "no fault" eviction notices. We have reason to believe this is indicative of a broad trend in the San Mateo County housing market. Although tenants seeking assistance from Legal Aid represent but a fraction of the tenants receiving eviction notices (we estimate fewer than 10% of tenants who are served with eviction notices seek legal advice), the population that does come to Legal Aid housing clinics has traditionally matched the composition of the tenant population within the city. Furthermore, over 60% of the "no fault" terminations seen in the past twelve months were served to households that identify as Hispanic, a clear indication that Hispanic tenants are being disproportionately impacted and displaced in San Mateo County. 18. Project Beneficiaries/Quantifiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. 19. Project Beneficiaries /Quantifiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. a. Indicate the total number of lownincome beneficiaries you expect to serve with this program for each jurisdiction application for funding. *Low4ncome is 80% of Area Median Income or below. See _AM[ table b. Indicate the total number of beneficiaries you expect to serve with this program in each jurisdiction - regardless of income. httpJMrww.citydataservices. net / cities/ smatca /app2016arc.pl ?rpt= C476UKop =542 3/7 1/25/2016 City Data Services - South San Francisco Jurisdiction �- a. Number of low{ncome beneficiaries to be served per grant jurisdiction application. * *Low- income ** is 80% of Area Median Income or below. b. All beneficiaries to be served per grant jurisdiction application regardless of income Low Income by - Ethnicity served by our Program Persons -- Persons Daly 200 200___ Redwood City- 250 250 City of San Mateo 125 125 oun of San Mateo 300 300 South San Francisco 75 75 otals 1 950 950 19. Populations Servad: Check the boxes below if they describe a significant population served by your program. These categories are not considered "presumed benefit" by HUD, and require income verification. , . Persons exiting incarceration i.a Low- income youth Other 20. Affirmative Outreach: a. Use the demographics from your previous program year to provide an analysis of the population you serve relative to the demograDhics in the table. NOTE: if you are a naw ann6cant n /aaca nmvirfa vnur hoof oofi -firm Race & Ethnici Redwood City Population Redwood City % by Ethnicity Low Income by - Ethnicity served by our Program ° Your Program /o by Ethnicity Total 74,40 100% 267 100% White and not Hispanic 40,656 54.64% 65 24.34% hite and His nic 23,55 31.66% 15 58.43% sign 6,71 9.03% 5.48% 3.37% frican American 1,91 2.58% e American 2.25% Pacific Islander 66 0.89% 3,82 3.93%1 2.25% Native American 3 0.52% 1 1.50% ther 1,511 2.03%1 211 7.87% Race & Ethnicity City of San City of San Mateo Mateo % by Population Ethnicity Low Income by Ethnicity served b our P ram Your P / � Ethnicity Total 97,20 100% 146 100% White and not Hispanic 45,24C 46.54% 41 28.08% and His anic 25,81 26.56% 6 45.21% 21,64 18,15 18.67% 1 8.90% Vffiie'ej n American 2,09 2.16% 36.61% 5.48% Islander 1,93 1.99% 1,62 1.37% e American 14 0.14% Pacific Islander 1.37% 3,82 3.93%1 141 9.590/0 Race &Ethnicity South San Francisco Population South San Francisco /o by Ethnicity Low Income by Ethnicity served tLx2ur Prouram Your Program % by Ethnicity Total 63,63 100% 101 1000/0 White and not Hispanic 23,76 37.34% 21 20.79% hite and Hispanic 21,64 34.02% 51 50.50% Sian 23,29 36.61% 1 13.86% frican American 1,62 2.55% 0.00% Pacific Islander 1,111 1.75% 1.98% Native American 39 0.62% 1 0.99% ther 9,5981 15.08%1 121 11.88% b. Based on the percentages that you indicate your organization served describe your efforts to improve affirmative outreach to groups that may be underserved by your program and the result of your efforts: Legal Aid serves low- income residents of San Mateo County. Our client demographics closely resemble that of individuals at or below 125% of the poverty level living in San Mateo County (as listed in the Census's 2014 American Community Survey 5 -Year Estimates) rather than the demographics of each city's population. Legal Aid continues to work to provide services for low- income residents of all races and ethnicities, but specifically focuses on providing culturally and linguistically appropriate services to serve the significant low- income Hispanic populations in Redwood City, City of San Mateo, and South San Francisco. http:// www. citydataservices. neticities/ smatca lapp2016arc.pl ?rpt= C4768&prop= 542 417 1/25/2016 City Data Services - South San Francisco 21. Leveraging: Describe your fundraising efforts and additional sources of revenue for this project and your organization. Please state whether any of these fund sources are already committed and in what amount. Legal Aid has a successful development program that has allowed it to secure program funding from an annual donor campaign, targeted major donor solicitations, and an annual luncheon and golf tournament. In addition, Legal Aid has been successful in obtaining grants and contracts to support its work from a number of foundations and local government agencies. For the FY 2016 -2017 fiscal year, in addition to any CDBG /HSFA funding awarded, we anticipate receiving support for the HomeSavers program from the State Bar of California Trust Fund Program ($17,725 committed, $17,725 anticipated based on statutory allocation formula), Genentech Foundation (renewal application to be submitted for $30,000), The San Francisco Foundation (renewal application solicited January 2016 for $30,000), and the Silicon Valley Community Foundation ($5,000 committed, renewal application to be submitted in July 2016 for $15,000). Staff List List helew kPv staff mamhpm whn wnrk nn this nannram Position Tits Name of Staff Person Job Rosponsibilities Qualifications Total Jurisdictions Budget Line Item Oversee project; provide Member of the California State Bar (15 Directing Attorney Shirley Gibson direct legal services to ears); Directing Attorney at Legal Aid (4 % Requested housing clients. ears) Director of Litigation David Carlucci Provide direct legal services Member of the California State Bar 24 $92,00 100% to housing clients ears); 20 ears' civil litigation experience $8,20 7% Screen clients, complete intakes, provide bilingual Paralegal Certificate; bilingual in Spanish Intake Coordinator leli Caballero support to Shirley and and English; 5 years' experience at Legal Director ofLitigation $86,00 David. id as Housing Intake Coordinator PROPOSED PROGRAM BUDGET FOR FY 2016 -17 For the City of Redwood City ONLY, answer the following: For the City of Redwood City ONLY, answer the following: 1. Funding Criteria: 2. Homeless Assistance Activities: Provision of fair housing counseling services, provision of legal intervention to prevent homelessness, provision of operation funds for shared housing, emergency shelter and transitional housing and related services for homeless and those at risk of homelessness, youth and single persons. 2. Marketing /Advertising a. Check all of the following methods your agency utilizes to promote and advertise your programs and services: .e Flyers /brochures .d Website http: /twww.dtydataservices.neU cities/ smatca lapp2016arc.pi ?rpt= C4768&prop =542 y7 Redwood City City of San Mateo County of San Mateo South San Francisco Total Jurisdictions Budget Line Item Agency I Total Pgm% Program To % Requested % Requested % Requested % Requested Pgm% Requested Labor Directing Attorney $92,00 100% $92,00 9% $8,20 7% $6,00 10% $9,50 3% $2,60 29% $26,30 Director ofLitigation $86,00 100% $86,00 8 °/ $7,10 9% $8,00 12% $10,50 6% $5,00 36% $30,60 Intake Coordinator $41,00 100% $41,00 1% $50 1% $35 1% $60 0% $20 4 °/ $1,65 Other Staff $1,357,96 0% $ Taxes/Benefits $477,00 14% $65,70 0 °/ $4,20 0% $3,15 0 °!0 $4,40 0% $2,20 0°! $ Supplies Office Supplies $30,0001 1 $4,1 $ Materials Books /Publications 1 $12,0 1 $1,6 $ rations /Maintenance Rent $69,14 14% $9,60 0% 0% 0% 0% 0 $ Technology $30,00 25% $4,16 0% 0% 0% 0% 0% $ Court fees $4,00 14% $1,0 0% 0% 0% 0% 0% $ Telephone /Intemet $8,00 $1,11( $ Administration $184,00 14% $25,55 0% 0% 0% 0% 0% TOTA $2,391,11 14% $331,96 6°/ $20,00 5% $17,500 8% $25,00 3% $10,00 q 22 °/ $72,50 Number of Individual Beneficiaries 254 1251 304 74 75 ost per Individual $80.001 $140. $83.331 $133.3 $96.6 For the City of Redwood City ONLY, answer the following: For the City of Redwood City ONLY, answer the following: 1. Funding Criteria: 2. Homeless Assistance Activities: Provision of fair housing counseling services, provision of legal intervention to prevent homelessness, provision of operation funds for shared housing, emergency shelter and transitional housing and related services for homeless and those at risk of homelessness, youth and single persons. 2. Marketing /Advertising a. Check all of the following methods your agency utilizes to promote and advertise your programs and services: .e Flyers /brochures .d Website http: /twww.dtydataservices.neU cities/ smatca lapp2016arc.pi ?rpt= C4768&prop =542 y7 1/2512016 City Data Services - South San Francisco .I Phone book listing ' CIP (Handbook /Database) Outreach presentations to service providers .� Outreach presentations to public b. Which of the above marketing /advertising materials are available in multi - langual form and which languages are they available in? Flyers/brochures (Spanish); website (Spanish); outreach presentations (Spanish) c. How and where are the materials distributed? Flyers and brochures are available at our office; core service agencies; other community agencies at which we give presentations; local government agencies; health fairs; and the Legal Aid website. 3. Program Outcomes: a. Please describe the accomplishments of program goals for FY /15. Legal Aid conducted 149 legal services clinics between July 1, 2014 and June 30, 2015, where more than 1200 tenant households received assistance with evictions, rent increases, repairs, housing discrimination, security deposits, and other landlord /tenant issues. Approximately 33% of those households received assistance with contesting an eviction case through a court proceeding (unlawful detainer), with services ranging from preparation of legal pleadings for the tenants to file themselves to full legal representation in litigation of the case. The other most commonly needed service at Legal Aid clinics was advice regarding eviction notices (pre- unlawful detainer) for about 40% of the households served. The remaining 27% of households sought advice regarding other tenancy issues, including rent increases, repairs to the premises, and security deposits. The Legal Aid staff dedicated to conducting these clinics and providing these services include two full -time attorneys and one bi- lingual paralegal. On average, volunteers and pro bono attorneys contributed about 120 hours per month, staffing 12 clinics serving 100 households, which helped to leverage the time of Legal Aid staff and enabled the program to serve a large number of people while maintaining a high quality of service. b. In what ways has your program made a difference in the lives of the people you serve? Please provide at least one concrete example from the people served in FY /15: CASE PROFILE (City of San Mateo): Zara is a single mother who lives with her two children in an apartment which she rents with the help of her Section 8 housing voucher, a federal subsidy that pays a portion of the total rent. Zara relies on the help of friends and family to care for her children, and often Zara's adult cousin will come to the apartment when bringing the children to or from school. However, Zara's landlord objected to having the cousin at the apartment and accused Zara of allowing him to live there without permission. Despite Zara's assurance that her cousin did not live there, and had his own residence nearby, the landlord served Zara with an eviction notice stating that the presence of her cousin constitutes a 'nuisance' on the premises. The notice was quickly followed by an eviction case (unlawful detainer). Zara came to the Legal Aid housing clinic for help, where a volunteer attorney reviewed the eviction case and prepared an Answer for Zara to file with the Court. Legal Aid staff recruited a local law firm to represent Zara in defending her case. After mounting a vigorous defense, Zara's pro bono lawyers were able to negotiate an agreement with the landlord in which the eviction case would be dismissed, and Zara would be able to resume her tenancy and keep her apartment. Attachments sd 1. Resolution authorizing application and designation of signatory, by the Board of Directors 1�i 2. Proof of 601(c)3 / tax - exempt status 3. By-laws 4. Articles of Incorporation 5. Board roster, including: Name, Company, Years on Board Meeting dates for previous 12 months Number of years allowed for each board tern 6. Organizational chart for entire organization 7. Certified financial audit no more that 1 fiscal year old, prepared by a CPA, and: Legal Aid Funding Resolution for Cities pdf Legal Aid 501c3 Letter.pdf Legal Aid ByLaws.pddf Legal Aid Articles of Incorporation.pdf Legal Aid Board Rosterdf Legal Aid Organization Chart.p_df Legal Aid Audit Report_FY- 2015.pdf httpJt ww.citydataservices.net/ cities/ smatcalapp2016arc .pl ?rpt= C4768&prop =542 6N 1/25/2016 Management letters (if applicable) • A -122 and A -133 Single Audit (for entities that receive more than $500,000 in federal funding) OR A letter from your Executive Director or Chief Financial Officer certifying that agency does not receive more than $500,000 in federal funds and is not subject to the Single Audit. City Data Services - South San Francisco 8. The following are required: Legal Aid Budget FY2016 pdf Legal Aid Proposed Budget FY2017 pdf • Current (FY15 -16) Agency Operating Budget • Proposed (FY16 -17) Agency Operating Budget ' 9. Mission Statement Legal Aid Mission Statement pdf " 10. Non - discrimination policy Legal Aid Non - Discrimination Policy for Staff and Clients pdf for Staff and Clients 11. Reasonable Legal Aid Equal Opportunity Policy Including Reasonable Accommodations D ddff Accommodations Policy for Staff and Clients 12. Conflict of Interest Policy. Legal Aid Conflict of Interest Policy pdf (If not available, please indicate when you will submit) 13. Other- Download All Attachments Program Manager Signature M. Stacey Hawver Date Signed 01/22/2016 Initially submitted: Jan 22, 2016 - 15:19:35 http: //www.citydatoservices.neV cities / smatca lapp2016arc.pl ?rpt= C4768&prop =542 7n 4/1/2015 LEGAL AID SOCIETY OF SAN MATEO COUNTY FY 2016 (April ?, 2015 - March 31, 201.6) $2,357,067 EXPENSES Budget REVENUES FY 2015 Private Foundations $533,067 Government Contracts & Grants $604,484 Corporate & Law Firm $175,500 Foundations $162,500 Events $661,500 Annual Campaign $262,500 Investment Income & Other $133,016 $2,357,067 EXPENSES Salaries $1,442,820 Benefits $445,420 Occupancy $69,145 Operating Expenses $175,500 Contract Services $135,300 Fundraising Expenses $84,872 $2,353,057 1/21/2016 LEGAL AID SOCIE'T'Y OF SAN MATEO COUNTY FY 2017 (April 1, 2016 - March 31, 2017) EXPENSES Budget REVENUES FY 2017 Private Foundations $627,765 Government Contracts & Grants $692,366 Corporate & Law Firm $181,000 Foundations $193,000 Events $585,000 Annual Campaign $230,000 Investment Income & Other $164,000 $2,492,131 EXPENSES Salaries $1,576,967 Benefits $477,000 Occupancy $69,145 Operating Expenses $181,000 Contract Services $101,000 Fundraising Expenses $87,000 $2,492,112 1/25/2016 City Data Services - South San Francisco Consolidated Community Funding Application Redwood City, San Mateo County, and S. San Francisco Application for New Funding for FY 2016 -17 GENERAL INFORMATION 1. Organization Name: Peninsula Association for Retarded Children and Adults (Parca) 2. Project Title: Family Support Services We are applying for funding from: Redwood City City of San Mateo �_d South San Francisco `l County of San Mateo Budaet/Client Summary (Auto- nonulated frnm Rurtnimf halnuvl Jurisdictions receiving this application Amount Requested % of Program Budget Proposed # of Served % Of Served Total $ Per South San Francisco $6,50 9% 12 100% $50.7 Total $6,50 9% 1281 10011/0 $50.7 Grant Funded Programs: We are applying for a Public Services Program CDBG National Objective Ellgibililty - How are you serving low income populations? Service to low income clients verified through income documentation. Income Verification: Describe how you obtain, verify, and maintain proof of income and presumed benefit status. Third party documentation or client signatures on the certification forms must be available on file for review at all times. Income data is obtained through demographic profiles submitted by each family served. Family Support Services are provided free of charge and Parca does not discriminate on the basis of income or any other element. 3. Project Address: 800 Airport BI., Suite 320 City: Burlingame Zip: 04010 -1919 4. Provide a one sentence project summary: Parca's Family Support Services program provides support groups, information and referral, community outreach, advocacy, a professional speaker series, and inclusive recreation opportunities to low- income families dealing with developmental disabilities. The program addresses education, health, housing, employment, public transportation, the service delivery system, and other issues affecting the target population. Organization Address: 800 Airport BI., Suite 320 Organization Phone: 650 -312 -0730 Type of Applicant: Non- Profit Our agency serves: 5. Contact Person / Project Name: Beth Brown Administrator: Contact Email: 6. Name of Agency Director: 7. Fiscal Officer: Fiscal Officer Address: 8. Authorized Signatory: Authorized Signatory bethb @parca.org Diana Conti Name: Brad Pence 800 Airport BI., Suite 320 Name: Diana Conti 800 Airport BI., Suite 320 City: Burlingame Zip: 94010 -1919 Websfte: www.parca.org Title: Development Telephone: 650 -312 -0730 Officer Fax: 650 -312- 0737 Email: Telephone: 650 - 312 -0730 bradp @parca.org City: Burlingame Zip: 94010 -1919 Email: Telephone: 650 - 312 -0730 dianac@parca.org City: Burlingame Zip: 94010 -1919 http:Uwww.citydataservices. net/ citieslsmatca lapp2016arc.pl?rpt= C4754&prop =535 1l5 1/25@016 Address: City Data Services - South San Francisco 9. Please provide days and hours of regularly scheduled operation: Monday through Friday, 9 am to 5 pm 10. DUNS Number: 020009510 Federal EINMN Number: 94- 1650851 11. HUD Activity: Choose the HUD activity that most closely matches your service: 05 - Public Services 12. Project Spp3clfic Narrative: Provide a narrative description of the specific activities to be carried out with the requested funds. This should also include program objectives and key priorities for each specific jurisdiction. The requested funds will be used to continue Parca's Family Support Services' one-on -one and family support, information and referral, and advocacy and community outreach to low- income SSF families with one or more child or adult members who are affected by developmental disabilities (mental retardation, Down syndrome, autism, epilepsy, cerebral palsy and other neurological disorders). These services are provided through one- on-one and family meetings, as well as through advocacy /community outreach events. Program goal #1: Hold a minimum of 20 individual and family meetings per year with SSF families during fiscal year 2016 -2017. Program goal #2: Hold 10 advocacy /community outreach meetings and events per year to include SSF families. These services are aligned with the identified needs within the county for various supports concerning rights, education, housing, employment and inclusive recreation among affected, underserved families. Parca's Family Support Services program is unique in that its services are provided free of charge; all age groups are served; and it offers professional speakers to inform, education, and empower families, as well as inclusive recreational opportunities to encourage socialization and community building. The program is headed by Sue Digre, who has an adult son with Down syndrome, and who is truly heroic in her efforts to help families like hers. We serve 128 people in 31 households in SSF. Of these, 123 people and 30 households are low- income 13. Assessment of Need - South San Francisco: Briefly describe how you determined the need for your program for each s ific jurisdiction that you are applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. Due to the lifelong, complex and far - reaching effects of developmental disabilities, families of people who have them are often overwhelmed by and ill- prepared for the challenges they face. In a world where it is difficult enough to navigate health, education, housing, employment and support systems for those without disabilities, it can be extremely stressful on the family when disabilities are involved. In fact, according to Lucile Packard Children's Hospital, recent studies have shown that 57% of children with special needs have clinically- significant stress as compared to just 8% of other parents. Parca has provide Family Support Services since 1952 and serves the largest portion of clients of any program within our organization. The City of SSF has a population of 67,009 (2014 est.). According to the ARC, the number of people affected is 14% of any population; therefore 9,381 South San Franciscans are affected by one or more developmental disabilities. This number is rapidly growing as autism cases are as high as 1 in 68 (CDC). These families need continuous, ongoing, comprehensive supports. Parca provides vital services and supports free of charge, which are critical to the low- income SSF clients we serve. Family Support serves San Mateo County. One similar program is Community Gatepath. 14. Timeline: Provide a brief timetable for project implementation and achievement of projected goals and how you plan to expend your funds in a timely manner by the end of the fiscal year. Family Support Services is an ongoing, year -round program. Goals stated above will be achieved in fiscal year 2016 -2017 with grant funds from the City directed toward program support and expended in full during that time. 15. Evaluation: Briefly describe how you will determine and measure the success of your program and whether or not program goals were met? If your program is currently receiving grant funds please describe accomplishments of goals to date. Evaluation is performed by means of grant reports, conversation logs, client records, client emails, and program activity calendars. If the client and his or her family does not express satisfaction with the services they have received, changes are made to ensure the attainment of desired results. 16. Collaboration: Describe partnerships with other organizations /agencies, the nature of the partnership, and how it relates to the proposed project. Community Gatepath, Hope Services, Kainos, The ARC, Life Steps, Janet Pomeroy Center, Square Peg, Skyline College, First Five, Legal Aid, CCS, SMCOE, Lucile Packard Children's Hospital, County Office of Housing, County Behavioral Health, County Office of Transportation, School Districts, Resource Centers, Samaritan House, Kaiser - Permanente 17. Impact:: Discuss any general trends and conditions that have affected or impacted your service levels or service populations. For New Applicants — describe what these funds would allow your agency to do that you may not be able to do now. For Continuing Applicants — describe how your program would be impacted without these funds. Continued City funding would enable us to continue to meet the needs of families coming to Parca for assistance in dealing with the challenges posed by developmental disabilities. http: //www.citydataservices.neV cities/ smatca /app2016arc.pt ?rpt= C4754&prop =535 215 1/25/2016 City Data Services - South San Francisco According to a CDC study, developmental disabilities (DDs) are common: about 1 in 6 children in the U.S. had a DD in 2006 -2008. These data also showed that prevalence of parent - reported DDs has increased 17.1% from 1997 to 2008. This study underscores the increasing need for health, education and social services, and more specialized health services for people with DDs. The prevalence of any DD in 1997-2008 was 13.87% Prevalence of learning disabilities was 7.66 %; Prevalence of attention deficit hyperactivity disorder (ADHD) was 6.69 %; Prevalence of other developmental delay was 3.65 %; and, Prevalence of autism was 0.47 %. Over the last 12 years: Prevalence of DDs has increased 17.1% that's about 1.8 million more children with DDs in 2006 -2008 compared to a decade earlier; Prevalence of autism increased 289.5 %; Prevalence of ADHD increased 33.0 %; and, Prevalence of hearing loss decreased 30.9 %. To better understand why the prevalence has increased, future research should focus on understanding the influence of increases in the prevalence of known risk factors, changes in acceptance and awareness of conditions, and benefits of early intervention services. 18. Project BeneficiadeslQuantifiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. 19. Project Beneficiaries/Quantifiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. a. Indicate the total number of low4ncome beneficiaries you expect to serve with this program for each jurisdiction application for funding. "Low- income is 80% of Area Median Income or below. See AMI table b. Indicate the total number of beneficiaries you expect to serve with this program in each jurisdiction - regardless of income. Jurisdiction a. Number of low-income beneficiaries to be served per grant jurisdiction application. "Low- income"" is 80% of Area Median Income or below. b. All beneficiaries to be d served grant jurisdiction application regardless of income Your P ° by Ethnicity /° Persons Persons Cit 100% Re and not Hispanic wood City 3C 20.27% of San Mateo P 21,6451 34.02%1 371 st of San Mateo sian 23,293 36.61%1 h San Francisco 123 128 Is 123 128 19. Populations Served: Check the boxes below if they describe a significant population served by your program. These categories are not considered "presumed benefit" by HUD, and require income verification. Persons exiting incarceration Low- income youth Other people with developmental disabilities and their family members 20. Affirmative Outreach: a. Use the demographics from your previous program year to provide an analysis of the population you serve relative to the demographics in the table. NOTE: If you am anew awlicant Please provide your best estimation Race & Ethnicity South San South San Francisco Francisco % by Po uiation Ethnicity Low Income by Ethnicity served b our P ram Your P ° by Ethnicity /° Total 63,63 100°/ 14 100% Re and not Hispanic 23,7 37.34%1 3C 20.27% ite and Hispanic 21,6451 34.02%1 371 25.00°/ sian 23,293 36.61%1 431 29.05°/ frican American 1,626 2.55%1 01 0,000 Pacific Islander 1,111 1.75°/ 5.41 Native American 396 0.6246 4 0.00% Other 9,5981 15.08%1 301 20.270 http: /Mrww.citydataservices.neU citiesi smatca /app2016arc.pl ?rpt= C47548prop =535 316 1/25/2016 City Data Services - South San Francisco b. Based on the percentages that you indicate your organization served describe your efforts to improve affirmative outreach to groups that may be underserved by your program and the result of your efforts: We continue to conduct outreach to various ethnic groups at our parent support group. Parents and some Parca staff have volunteered to act as translators for other parents in Spanish, Chinese. 21. Leveraging: Describe your fundraising efforts and additional sources of revenue for this project and your organization. Please state whether any of these fund sources are already committed and in what amount. Parca derives revenue for this program and for the agency through grants, individual donations, special events proceeds and salvage resale. Grant funds received to date for the Family Support Services program for FY2015 -2016 total $10,300. Staff List List below kev staff members who work on this urooran Position Title Name of Staff Job Qualifications Pgrn% Person Responsibilities Requested Pgm% Requested Oversees all 18 years in position at Parca; BA Notre Dame de Director Sue Digre aspects of Namur; professional educator, well -known and Taxes/Benefits 1 $236,07 22%1 Family Support ighly- respected authority on developmental $ Supplies Services program isabilities; tireless advocate PROPOSED PROGRAM 'BUDGET FOR FY 2016 -17 Attachments South San Francisco Total Jurisdictions Budget Line Item Agency Pgrn% Program % Requested Pgm% Requested Labor Personnel $1,380,82 4% $61,184 8% $4,70 8% $4,7 Taxes/Benefits 1 $236,07 22%1 $4,2181100%1 $01 0% $ Supplies Office Supplies/Room lies /Room Rental $8,14 and: $1,80 • Management letters (if applicable) $1,80 • A -122 and A -133 Single Audit (for entities that receive more than $500,000 $1,80 Operations/Maintenance $856,981 $ that agency does not receive more than $500,000 in federal funds and is $ http: /Aw. w.citydataservices.r eV cities/ Smatcalapp2Ol6arc .pl ?rpt= C4754Wop =535 $ Administration $125,17 7% $8,32 0% $01 0% TOTA $2, 607,19 3% $75,525 9% $6,5001 9% $6,50 Number of Individual Beneficiaries 124 12 Post per Individual $50.781 $50.7 Attachments 1. Resolution authorizing application and designation of signatory, by the city of ssf bd res 1 -16 pdf Board of Directors ''!0 2. Proof of 501(c)3 / tax - exempt status 501c3.odf 3, By-laws bylaws 1- 12.doc 4. Articles of Incorporation art of inc 1- 12.odf 5. Board roster, including: board list fy15 -16 pdf • Name, Company, Years on Board o Meeting dates for previous 12 months • Number of years allowed for each board term 6. Organizational chart for entire organization oro chart 2016.pdf ° 7. Certified financial audit no more that 1 fiscal year old, prepared by a CPA, 13 -14 audited fid stmt_pdf and: • Management letters (if applicable) • A -122 and A -133 Single Audit (for entities that receive more than $500,000 in federal funding) OR A letter from your Executive Director or Chief Financial Officer certifying that agency does not receive more than $500,000 in federal funds and is http: /Aw. w.citydataservices.r eV cities/ Smatcalapp2Ol6arc .pl ?rpt= C4754Wop =535 4/5 1/2512016 City Data Services - South San Francisco not subject to the Single Audit, 8. The following are required: parca fY15-16 budget.pdf • Current (FY15-16) Agency Operating Budget parca proposed fy16-17 .xIs • Proposed (FY16-17) Agency Operating Budget 9. Mission Statement 10. Non-discrimination policy for Staff and Clients 11. Reasonable Accommodations Policy for Staff and Clients 9' 12. Conflict of Interest Policy. (if not available, please indicate when you wil: submit) 13. Other - Download All Attachments Program Manager Signature Beth Brown Date Signed 01/21/2016 Initially submitted: Jan 21, 2016 - 11:37:16 mission statement.docx non-disc 1-12.doc reason accomm.Ddf http:IANww.citydataservices.reVcitieslsmatcalapp2Ol6arc.pi?rpt--C4754&prop=535 5/5 aARCA REI IMINARY uRArT. BUDGET ASSUMPTIONS r-YE JUNE 36, 2016 REVENUE & EXPENSE: 1. Regional Center revenue is budgeted based on current rates. 9. Counselor wages rase from WAD to $16.00 per hour effective Jan 1, 2015. Manager salaries remain unchanged from last year. Executive Assistant salary removed. 3. Unrestricted Funds to be used to support operating expenses are projected to total $236,500 In addition, $66,000 of Restricted Grants are projected and are allocated to various programs as listed below. These amountr. are comparable to funds received this fiscal year and are allocated as follows: Auxiliary $ 160,000 Family Support $ 10,000 Individuals $ 25,000 Horizons $ 2,600 Memorials $ 5,000 Raji $ 7,500 Cities & Counties $ 6,800 Reach $ 20,000 Foundations S Corporations $ 40,000 Ceder St. $ 20,000 $ - Page Mill $ 5,000 GRANTS FOR OPERATING EXPENSES $ 236,600 ILS $ 1,000 GRANTS ALLOCATED TO PROGRAMS $ 66,000 a The major difference relates to the Auxiliary donation which was budgeted at $190,000 last year and an Increase of $25,000 expected Foundation donations. jA. Auxiliary contribution of $160,000 is $49,000 less than was received last year. The Gala on 06/13115 Is projected to yield $160,000 this year. 3B. DSR projected to net $20,000 consistent with last year's net. 4. Solicitation (CGS) annual net profit of $330,988 (based on achieving 80% of the revised quota from Severe) and expanding Into the Fast Bay. Net profit in the current fiscal year through April 30 is $260,000. Projected net profit through June 30, 2014 is $300,000 6. We anticipate operating Alameda House all year providing ILS services to 6 clients. Monthly rent Increased from $1,083 to $1,094. There has been over a 30% decrease In ILS hours. 6. Cedtr Street its budgeted for 8 clients for 12 months. Manager now In staff rotation to reduce staff hrs. Slight decrease of RHCP monthly Income by $3,000 per year. Monthly rent budgeted to remain at $1,003 per client San Mateo County will forgive the $93,725 note payable on Cedar Street in Nov 2015 resulting In a recognition of income. Foundation donations of $20,0000 are Included In budget 7. Respite service revenues are projected based on actuals. Foundation grants are budgeted at $7,500 which Is $2,600 more then last year. 6 San Andras day care program client 6 no longer with Parse resulting in lower revenue and salaries S. Reach revenue is projected to be at 80% of full capacity. The portable has been moved to the new location. Moving costs were capitalized and depreciated over portables remaining useful life. Foundation donations of $20,0000 are Included In budget 10. Page Mill ILS hours have stabilized 11. Projected increase in ILS hours provided to J Engell. 42. Rent Increase of $25,000 as a revult of signing a 5 year lease. Executive Assistant salary removed. Peninsula Associati ®n for Retarded Children & Adults Profit & Loss Budget Overview Alameda House July 2015 through Juno 2016 0.00 5317 • Festa Revenue Jul '15 - June 16 roc- - «.... -� •�- -°_ -�� Income 0.00 5000 • Earned Income 0.00 5100 - Solicitations Reveue 0.00 5200 . Regional Centers 0.00 5201 GGRC 26,700.00 5202 East Bay regional 0.00 6203 San Andreas 0.00 5204 Sacramento 0.00 6205 Kom 0.00 5300 • Special Events 0.00 5311 • Annual Dinner 0.00 5300 • Special Events - Other 0.00 Total 5300 • Spacial Events 0.00 5502 • Client Revenue -Rent 14,952.00 5503 • HUD Tenant Assistance Payments 52,800.00 5512 • Client Revenue - Certified 0.00 5514 • Client Revenue -Full Fee 0.00 5515 • Self Pay 4,195.20 5770 - Management Fee 0.00 Total 5000 • Earned Income 98,647.20 5400 • Contibuted Income 0.00 5317 • Festa Revenue 0.00 5401 • Grants 0.00 5405 • Foundations 0.00 5406 • Corporate 0.00 5401 . Grants - Other m��.. 0.00 Total 6401 • Grants 0.00 5402 - Indivdual Donations 0.00 5403 • Trust/Endowment 0.00 5404 Auto Donations 0.00 5408 Clubs/Organizations 0.00 5606 Government 5610 • State Government 5611 • RHCP Subsidies 0.00 5612 • CDE 0.00 Total 5610 • State Government 0.00 5615 - Local Government 0.00 Total 5606 • Government _ 0.00* 5740 - Memorials 0.00 Total 5400 • Condbuted Income 0.00 Total Income 98,847.20 Expense 7110 • Salaries Page 1 of 4 Peninsula Association for Retarded Chlilfren & Adults Profit & Loss Budget Overview Alameda House July 2015 through June 2015 7120 - Payroll Taxes 7121 - Payroll Expenses -FICA 4,190.90 7122 • Unemployment Insurance 500.00 7120 • Payroll Taxes - Other 0.00 Totes 7120 • Payroll Taxes - 4,690.90 7160 • Depreciation Jul 95 -June 1R 7250 • Equipment Rental / Lease 0.00 7111 - Salarift -Admin 0.00 7112 • Salaries- Program Director 12,528.00 7113 • Salaries -Site Supervisor 23,400.00 7114 • Salaries- Counselor 18,855.00 7115 - Salaries- Driver 0.00 7116 • Mod 125 Reimb 0.00 7117 . Allocated Admin Salaries 8,202.88 7132 - Benel=Its 0.00 Total 7110 - Salaries 62,985.88 7120 - Payroll Taxes 7121 - Payroll Expenses -FICA 4,190.90 7122 • Unemployment Insurance 500.00 7120 • Payroll Taxes - Other 0.00 Totes 7120 • Payroll Taxes - 4,690.90 7160 • Depreciation 37,650.88 7250 • Equipment Rental / Lease 0.00 7260 - Insurance 1,500.00 7130 • Workers Compensation 939.90 7261 - General Liability 564.00 7262 • Property Insurance 1,509.00 7263 - Vehicle Insurance 2,058.00 7268 • Directors & Of ers 165.00 Total 7260 . Insurance 5,235.90 7280 - Interest Expenses 7281 - Credit Card Interest 0.00 7282 • Mortgage Interest 23,537.56 7285 • LT Interest 1,500.00 7284 • Interest-Lines of Credit 0.00 Total 7280 - Interest Expenses 25,037.56 7300 - Maintenance & Repairs 7301 - Vehicle Maintenance 0.00 7302 - Vehicle Repair 0.00 7303 - Grounds Maintenance 1,740.00 7304 • Maintenance Supplies 0.00 7305 • House Repair 1,500.00 7305 - House Maintenance 2,700.00 7307 • Exterminator 660.00 7308 - Equipment Machine Repair 600.00 7309 - Equipment Maintenance Contract 0.00 7310 - General Maintenance & Repair 2,160.00 weaw.aa.ei z�,. Total 7300 - Maintenance & Repairs 9,360.00 7315 - Miscellaneous Expenses 0.00 7340 -Office Supplies 120.00 7360 • Postage 0.00 7380 - Printing Page 2 of 4 Peninsula Association for Retarded Children & Adults Profit & Loss Budget Overview Alameda House July 2016 through June 2016 1400 • Professional Contractual 480.00 7401 • Accounting Jul 16 -June 16 7381 • Newsletter 0.00 7382 • Business Cards 0.00 7383 • boor Hangers 0.00 7384 - Stationary 0.00 7385.Other Printing F =� Total 7360 - Printing. _0.00 0.00 1400 • Professional Contractual 480.00 7401 • Accounting 5,300.00 7402 • Audit 7,500.00 7403 • Behavioral 0.00 7404 • Management 0.00 7405 • Fundraising 0.00 7406 •Other Professional Contractual 0.00 7407 • Computer 0,00 7408 • Temp workers 0.00 7463 • Legal 0.00 7464 • Payroll services 0.00 Total 7400 - Professional Contractual 12,800.00 7420 • Program Operating Expenses 7422 • Program Food 480.00 7423 Client Recreation 120.00 7424 Program Supplies 1,200.00 7425 • Maint Supplies 0.00 Total 7420 • Program Operating Expenses 1,800.00 7430 • Advertising 0.00 7440 • Rent 0.00 7460 - Taxes, Licenses & Fees 0.00 7461 - Management Fees 0.00 7462 • Bank Service Fees 0.00 7465 • Physical Fees 0.00 7461 • Real Estate Taxes 0.00 7467 • Ouse 0.00 74all - License Fees 0.00 7470 • Fringerprinting Fees 0.00 Total 7460 - Taxes, Licenses & Fees 0.00 7480 • Telephone 660.00 7500 • Travel & Fuel Costs (Employee) 1,440.00 7510 • Board Expense 0.00 7520 • Staff Appreciation 0.00 7530 • Staff Recruitment 120.00 7540 , Training 420.00 7550 - Fuel Costs (Company) 0.00 7560 - Bridge Tolls 0.00 7600 • Utilities 7601 • Electric 2,160.00 7602 - Gas 780.00 Page 3 of 4 Peninsula Association for Retarded Children & Adults Profit & Lose Budget Overview Alameda House July 2015 through June 2016 7603 Trash Removal 7604 Water 7605 • Sewer Total 7600 • Utilities 7610 • Vehicle Operating Expense Total Expense Net Income Jul 16 -June 16 1,860.00 2,760.00 _360.00 7,920.00 _ 0.00 170,241.11 - 71,693,91 Page 4 of 4 Peninsula Association for Retarded Children & Aduita Profit & Loss Budget Overview Cedar St July 2015 through June 2015 0.00 5512 - Client Revenue - Certified Jul t4 -June 15 5514 - Client Revenue -Full Fee 0.00 Income 0.00 6000 - Earned Income 0.00 5100 - Solicitations Reveue 0.00 6200 - Regional Conters 158,280.00 5201 GGRC 0.00 5202 East Bay regional 0.00 6203 San Andreas 0.00 5204 Sacramento 0.00 5206 Kern 0.00 5300 - Special Events 0.00 5311 • Annual Dinner 0.00 5300 • Special Events - Other 0.00 of !� Total 5300 - Special Events 0.00 5502 - Client Revenue -Rent 83,288.00 5503 - HUD Tenant Assistance Payments 0.00 5512 - Client Revenue - Certified 0100 5514 - Client Revenue -Full Fee 0.00 5515 - Self Pay 0.00 6770 - Management Fee 0.00 Total 5000 - Earned Income 254,568.00 5400 - Contibuted Income 5317 - Fests Revenue 0.00 5401 • Grants 5405 - Foundations 20,000.00 5406 • Corporate 0.00 5401 . Grants - Other _ 93,725.00 Total 5401 - Grants 113,725.00 5402 • Indhrdual Donations 0.00 5403 . Trust/Endowment 0.00 5404 - Auto Donations 0.00 5408 • Clubs/Organizations 0.00 5606 • Government 5610 - State Government 5811 • RHCP Subsidies 27,720.00 5612 - CDE 0.00 Total 5610 - State Government 27,720.00 5615 • Local Government 0.00 Total 5606 • Government 27,720.00 5740 • Memorials 0.00 Total 5400 - Condbuted Income 141,445.00 Total Income 396,013.00 Expanse 7110 - Salaries Page 1 of 4 Peninsula Association f ®r Retarded Children & Adults Profit & boss Budget Overview Cedar St July 2015 through June 2015 7120 • Payroll Taxes 7121 • Payroll Expenses -FICA Jul '% 4 -June 15 7122 • Unemployment Insurance 2,940.00 7111 • Salaries -Admin 0.00 7112 • Salaries- Program Director 9,048.00 7113 - Salaries -Site Supervisor 26,679.67 7114 - Salaries - Counselor 162,394.75 7115 • Salaries -Driver 0.00 7116 Mod 125 Reimb 16,600.00 7117 Allocated Admin Salaries 8,202,88 7132 - Benefits 0,00 Total 7110 • Salaries 223,125.29 7120 • Payroll Taxes 7121 • Payroll Expenses -FICA 15,156.36 7122 • Unemployment Insurance 2,940.00 7120 • Payroll Taxes - Other _ 0.00 Total 7120 - Payroil Taxes _ 18,098.36 7160 • Depreciation 20,890.75 7230 - Equipment Rental / Lease 0.00 7260 • Insurance 0.00 7130 • Workers Compensation 26,986.91 7261 • General Liability 579.96 7262 • Property Insurance 1,932.00 7263 • Vehicle Insurance 2,058.00 7268 • Directors 6 Officers 170.04 Total 7260 • Insurance 31,706.91 7280 • Interest Expenses 7281 • Credit Card Interest 0.00 7282 • Mortgage Interest 0.00 7283 • Lease interest 0.00 7284 • Interest -Lines of Credit 0.00 Total 7280 • Interest Expenses 0.00 7300 - Maintenance A Repairs 7301 • Vehicle Maintenance 240.00 7302 • Vehicle Repair 480.00 7303 • Grounds Maintenance 2,400.00 7304 - Maintenance Supplies 240.00 7305 - House Repair 240.00 7306 • House Maintenance 300.00 7307 - Exterminator 600.00 7308 - Equipment Machine Repair 0.00 7309 - Equipment Maintenance Contract 0.00 7310 - General Maintenance & Repair 360.00 Total 7300 - Maintenance S Repairs 4,860.00 7316 - Miscellaneous Expenses 0.00 7340.Office Supplies 360.00 7360 - Postage 0.00 7360 - Printing Page 2 of 4 Peninsula Association for Retarded Children & Aduits Profit & Loss Budget Overview Cedar St July 2015 through June 2016 7400 • Professional Contractual Jul 14 -June 15 7381 - Newuletter 0.00 7382 • Business Lards 0.00 7383 • Door Hangers 0.00 7384 • Stationary 0.00 7385. Other Printing 0.00 Total 7380 • Printing 0.00 7400 • Professional Contractual 12,000.00 7401 • Accounting 2,850.00 7402 • Audit 2,200.00 7403 • Behavioral 0.00 7404 - Management 0.00 7405 • Fundralsing 0.00 7406 - Other Professional Contractual 0.00 7407 - Computer 0.00 740E - Temp wrorker€ 0.00 7463 - Legal 0.00 7464 • Payroll services 0.00 Total 7400 • Professional Contractual 4,850.00 7420 • Program Operating Expenses 7422. Program Food 12,000.00 7423 - Client Recreation 2,940.00 7424 • Program Supplies 3,600.00 7425 • Maint Supplies 120.00 Total 7420 • Program Operating Expenses 18,660.00 7430 • Advertising 0.00 7440 • Rent 0.00 7460 - Taxes, Licenses & Fees 0.00 7461 - Management Fees 0.00 7462 • Bank Service Fees 0.00 7466 • Physical Fees 0.00 7466 • Real Estate Taxes 0.00 7467 - Dues 0.00 7468 • License F• 0.00 7470 • Fringerprinting Fees 0.00 Total 7460 • Taxes, Licenses & Fees $� 0.00 7480 • Telephone 1,440.00 7500 • Travel & Fuel Costs (Employee) 660.00 7510 . Board Expense 0.00 7520 - Staff Appreciation 240.00 7530 • Staff Recruitment 0.00 7540 • Training 480.00 7560 • Fuel Costs (Company) 2,400.00 7560 • Bridge Tolls 0.00 7600 - Utilities 7601 • Electric 1,920,00 7602- Gas 1,200.00 Page 3 of 4 Peninsula Association for Retarded Children & Adults Profit & Loss Budget Overview Cedar St Jui► 2015 through June 2016 7603 • Trash Removal 7604 • Water 7605 • Sewer Total 7600 - Utilities 7610 - Vehicle Operating Expense Total Expense Net Income Jul 14 - June 15 1,960.00 3,060.00 0.00 8,160.00 _ 0.00 335,929.31 60,063.69 Page 4 of 4 Peninsula Association for Retarded Children & Adults Profit & Loss Budget Overview Raji House July 2015 through June 2016 5512 • Client Revenue - Certified 0.00 T 0.00 Jul 14 -June 15 Income 5770 • Management Fee 5000 • Earned Income Total 5000 • Earned Income 5100 - Solicitations Reveue 0.00 5200 • Regional Centers 0100 5201 GGRC 30,000.00 5202 East Bay regional 0.00 5203 San Andreas 0.00 5204 Sacramento 0.00 5205 Kern 0.00 5300 • Special Events 0.00 5311 • Annual Dinner 0.00 5300 • Special Events - Other 0.00 Total 5300 • Special Events 0.00 5502 • Client Revenue-Rent 0.00 5503 • HUD Tenant Assistance Payments 0.00 5512 • Client Revenue - Certified 0.00 5514 Client Revenue -Full Fee 0.00 6515 Self Pay 0.00 5770 • Management Fee 0.00 Total 5000 • Earned Income 30,000.00 5400 • Contibuted Income 0.00 6317 • Fasts Revenue 0.00 5401 • Grants 0100 5405 • Foundations 7,500.00 5405 • Corporate 0.00 5401 • Grants - Other 0.00 Total 6401 - Grants 7,500.00 5402 • Indivdual Donations 0.00 5403 • Trust/Endowment 0.00 5404 • Auto Donations 0100 5408 • Clubs/Orgenizations 0,00 5606 • Government 5610 - State Government 5611 • RHCP Subsidies 0.00 5612 - CDE �! 0,00 Total 5610 - State Government X0.00 5655 • Local Government 0.00 Total 5606 • Government 0.00 5740 • Memorials _ _0.00 Total 5400 • Contibuted Income o 7,500.00 Total Income 37,500.00 Expense 7110 • Salaries Page 1 of 4 Peninsula Association # ®r Retarded Children & Adults Profit & Loss Budget Overview , T.Zeji Ho. use July 2616 through June 2016 7120 • Payroll Taxes 7121 • Payroll Expenses -FICA 4,673.08 7122 • Unemployment Insurance 1,000.00 7120 - Payroll Taxes - Other _ 0.00 Total 7120 • Payroll Taxes 5,673.081 7160 • Depreciation Jul A 4 - June 15 714,1 - Salaries -Adman 0.00 7112 - Salaries- Program Director 6,960.00 7113 - Salaries -Site Supsrvk or 19,320.00 7114E • Salaries - Counselor 34,806.00 7115 - Salaries - Driver 0.00 7116 - Med 125 Reimb 1,200.00 7117 • Allocated Admin Salaries 8,202.88 7132 - Benefits - _0.00 Totai 7110 • Salaries 70,488.88 7120 • Payroll Taxes 7121 • Payroll Expenses -FICA 4,673.08 7122 • Unemployment Insurance 1,000.00 7120 - Payroll Taxes - Other _ 0.00 Total 7120 • Payroll Taxes 5,673.081 7160 • Depreciation 23,227.00 7230 - Equipment Rental I Lease 0.00 7260 - Insurance 0.00 7130 - Workers Compensation 5,288.68 7261 - General Liability 628.20 7262 • Property Insurance 2,154.00 7263 - Vehicle Insurance 2,424.00 7268 • Directors & Officers 183.96 Total 7260 • Insurance 10,678.84 7280 • Interest Expenses 7281 Credit Cana Interest 0.00 7282 Mortgage Interest 0.00 7283 Lease Interest 0.00 7284 Interest -Lines of Credit 0.00 Total 7280 • Interest Expenses 0.00 7300 • Maintenance & Repair 7301 - Vehicle Maintenance 360.00 7302 - Vehicle Repair 0.00 7303 • Grounds Maintenance 1,200.00 7304 - Maintenance Supplies 0.00 7305 - House Repair 0.00 7306 - House Maintenance 500.00 7307 - Exterminator 600.00 7308 - Equipment Machine Repair 0.00 7309 • Equipment Maintenance Contract 876.00 7310 • General Maintenance & Repair _ 0.00 Total 7300 - Maintenance & Repairs 3,636.00 7315 - Miscellaneous Expenses 0.00 7340 - Office Suppllos 0.00 7360 - Postage 0.00 7380 - Printing Page 2 of 4 Peninsula Association for Retarded Children & Adults Profit & IL-nss Budget Overview Raji mouse July 2015 through June 2016 7400 • Professional Contractual Jul 14 - June 15 7381 • Ne"Ietter 0.00 7382 • Business Cards 0.00 7383 • Door Hangers 0.00 7384 • Stationary 0.00 7385 •Other Printing = _ - 0.00 Tot217380 • Printing II0.00 7400 • Professional Contractual 900.00 7401 • Accounting 2,650.00 7402 - Audit 0100 7403 - BehmAcral 0.D0 7404 • Management 0.00 7405 • Fundralsing 0.00 7406 •Other Professional Contractual 0.00 7407 • Computer 0,00 7408 • Temp workers 0.00 7463 - Legal 0.00 7464 - Payroll services 0.00 Total 7400 . Professional Contractual 2,650.00 7520 - Program Operating Expenses 7422 . Program Food 900.00 7423 • Client Recreation 1,860.00 7424 • Program Supplies 480.00 7425 • Maint Supplies 120.00 Total 7420 • Program Operating Expanses 3,360.00 7430 • Advertising 0.00 7440 • Rent 0.00 7460 • Taxes, Licenses & Fees 0.00 7461 • Management Fees 0.00 7462 • Bank Service Fees 0,00 7465 • Physical Fees 0.00 7466 • Real Estate Taxes 0.00 7467 • Dues 0.00 7468 • License Fees 1,080.00 7470 • Fringerprinting Fees 0.00 Total 7460 • Taxes, Licenses & Fees 1,080.00 7480 • Telephone and Cable 1,500.00 7500 - Travel & Fuel Costs (Employee) 240.00 7510 - Board Expense 0.00 7520 - Staff Appreciation 0.00 7530 • Staff Recruitment 0.00 7540 • Training 120.00 7650 • Fuel Costs (Company) 120.00 7560 • Bridge Tolls 0.00 7600 •Utilities 7601 • Electric 240.00 7602 • Gas 300,00 Page 3 of 4 Peninsula Association for Retarded Children & Adults Profit & Lose, Budget Overview Reji House July 2011 through June 2016 Jul 14 - Junta 96 7603 - Trash Removal 960.00 7604 - Water 900.00 7605 . Sewer 1,080.00 Total 7600 - Utilities 3,480.00 7610 • Vehicle Operating Expense 0.00 Total Expense 126,253.79 Net Income - 85,763.79 Page 4 of 4 Peninsula Association for Retarded Children & adults Profit & Loss Budget Overview I1-8 0.00 July 2010 through June 2016 0.00 Joel 15 - June 16 income 5408 - Clubs/Organizations 5000 - Earned Income 5606 • Government 5100 • Solicitations Reveue 0.00 5200 • Regional Centers 0.00 5201 GGRC 120,000.00 5202 East Bay regional 0.00 5203 San Andreas 0.00 5204 Sacramento 0.00 5205 Kern 0.00 5300 • Special Events 0.00 5311 • Annual Dinner 0.00 5300 • Special Events - Other i 0.00 Total 5300 • Special Events 0.00 5502 - Client Revenue -tent 0.00 5503 - HUD Tenant Assistance Payments 0.00 5512 - Client Revenue - Certified 0.00 5614 • Client Revenue -Full Fee 0.00 5516 - Self Pay 5,208.00 5770 - Management Fee 0.00 Total 5000 - Earned Income 125,208.00 6400 • Contibuted Income 5317 • Feats Revenue 0.00 5401 - Grants 5405 • Foundations 1,000.00 5406 • Corporate 0.00 5401 - Grants - Other 0.00 Total 6401 - Grants 1,000.00 5402 • Indivdual Donations 0.00 5403 • Trust/Endowment 0.00 5404 - Auto Donations 0.00 5408 - Clubs/Organizations 0.00 5606 • Government 5610 • State Government 5611 • RHCP Subsidies 0.00 5612 • CDE 0.00 Total 5610 - State Government 0.00 5615 - Local Government 0.00 Total 5606 • Government 0.00 5740 Memorials 0.00 Total 5400 • Condbuted Income 1,000.00 Total Income 126,208.00 Expense 7110 - Salaries Page 1 of 4 Peninsula Association for Retarded Children d Adults Profit & Loss Budget Overview ILL JWy 2015 through June 2015 7120 • Payroll Taxes 7121 • Payroll Expenses -FICA 6,668.62 7122 • Unemployment Insurance 2,750.00 7120 - Payroll Taxes - Other 0.00 Total 7120 • Payroll Taxes 9,418.62 7160 - Depreciation Jul 15 -June 16 7230 - Equipment Rental I Lease 0.00 7111 - Salaries - Admin 0.00 7112 • Salaries - Program Director 12,528.00 7113 - Salaries -Site Supervisor 21,600.00 7114 - Salaries- Counselor 53,043.50 7115 - Salaries -Driver 0.00 7116 • Mod 125 Reimb 6,000,00 7117 • Allocated Admin Salaries 8,202.88 7132 - Benefits 0.00 Total 7110 - Salaries 101,374.36 7120 • Payroll Taxes 7121 • Payroll Expenses -FICA 6,668.62 7122 • Unemployment Insurance 2,750.00 7120 - Payroll Taxes - Other 0.00 Total 7120 • Payroll Taxes 9,418.62 7160 - Depreciation 0100 7230 - Equipment Rental I Lease 0.00 7260 • Insurance 0.00 7130 Workers Compensation 1,927,10 7261 General Liability 0,00 7262 • Property Insurance 0.00 7263 • Vehicle Insurance 0.00 7268 - Directors & Officers 4 —� _ _0.00 Total 7260. Insurance 1,927.10 7280 - Interest Expenses 7281 • Credit Card Interest 0.00 7282 - Mortgage Interest 0.00 7283 • Lease Interest 0.00 7284 - Interest -Lines of Credit 0.00 Total 7280 • Interest Expenses 0.00 7300 - Maintenance & Repairs 7301 - Vehicle Maintenance 0.00 7302 • Vehicle Repair 0.00 7303 - Grounds Maintenance 0.00 7304 - Maintenance Supplies 0.00 7305 . House Repair 0.00 7306 - House Maintenance 0.00 7307 - Exterminator 0.00 7308 - Equipment Machine Repair 0.00 7309 - Equipment Maintenance Contract 0,00 7310 - General Maintenance & Repair 0.00 Total 7300 - Maintenance & Repairs 0.00 7315 - Miscellaneous Expenses 0.00 7340 -Office Supplies 120.00 7380 - Postage O.00 7380 - Printing Page 2 of 4 Peninsula Association for Retarded Children & Adults Profit & Loss Budget Overview IL.S July 2016 through June 2016 7400 - Professional Contractual Jul 15 - June 18 7381 • Wevnietter 0.00 7382 - Business Cards 0.00 7383 - Door Hangers 0.00 7384 - Stationary 0.00 7385.Other Printing 0.00 Total 7380 • Printing 0.00 7400 - Professional Contractual 240.00 7401 - Accounting 2,650.00 7402 • Audh 0.00 7403 - Behavioral 0.00 7404 - Management 0.00 7405 - Fundraising 0.00 7406 •Other Professional Contractual 0.00 7407 - Computer 0.00 7408 • Temp workers 0.00 7463 Legal 0.00 7464 Payroll services 0.00 Total 7400 - Professional Contractual 2,650.00 7420 • Program Operating Expenses 7422 - Program Food 240.00 7423 • Client Recreation 115.00 7424 - Program Supplies 120.00 7425 - Maint Supplies 0.00 Total 7420 • Program Operating Expenses 475.00 7430 • Advertising 0.00 7440 • Rent 0.00 7460 - Taxes, Licenses S Fees 0.00 7461 • Management Fees 0.00 7462 • Bank Service Fees 0.00 7465 - Physical Fees 275.00 7466 • Real Estate Taxes 0.00 7467 • Dues 0.00 7468 - License Fesc 0.00 7470 • Fringerprinting Few 200.00 Total 7460 - Taxes, Licenses & Fees 475.00 7480 - Telephone 2,400.00 7500 • Travel & Fuel Costs (Employee) 6,840.00 7510 • Board Expense 0.00 7620 - Staff Appreciation 200.00 7530 • Staff Recruitment 300.00 7540 • Training 480.00 7550 • Fuel Costs (Company) 0.00 7560 - Bridge Tolls 0.00 7600 - Utilities 7601 • Electric 0.00 7602 - Gas 0.00 Page 3 of 4 Peninsula Association for Retarded Children & Adults Profit & boss Budget Overview IL July 205 through June 2016 7808 • Trash Removal 7604 Water 7605 sevret. Total 7600 • Utilities 7610 • Vehicle Operating Expense Total Expense Not Income - x _ RII Jul 115- June 16 0.00 0.00 0.00 0.00 _ 0.00 3126,660.09 - 452.09 Page 4 of 4 Peninsula Association for Retarded Children & Adults Profit & Loss Budget Overview Reach July 2015 through June 2016 5402 • Indivdual Donations 0.00 5403 • Trust/Endowment Jul 16 - June 16 5404 • Auto Donations 0.00 Income 0.00 5000 - Earned Income 0.00 5100 - Solicitations Reveue 0.00 5200 • Regional Centers 0.00 5201 GGRC 0.00 5202 East Bay regional 0.00 5203 San Andreas 0.00 5204 Sacramento 0.00 6205 Kern 0.00 5300 • Special Events 0.00 5311 • Annual Dinner 0.00 5300 • Special Events - Other Total 5300 - Special Events _0.00 0.00 5502 - Client Revenue -Rent 0.00 5503 • HUD Tenant Assistance Payments 0.00 5512 - Client Revenue - Certified 0.00 5514 • Client Revenue -Full Fee 127,101.00 5516 . Self Pay 0.00 5770 • Management Fee 0.00 ______T27,101.00 Total 5000 - Earned Income 5400 - Contibuted Income 5317 - Feats Revenue 0.00 5401 • Grants 5405 . Foundations 20,000.00 5406 • Corporate 0.00 5401 . Grants - Other 0.00 Total 5401 - Grants 20,000.00 5402 • Indivdual Donations 0.00 5403 • Trust/Endowment 0.00 5404 • Auto Donations 0.00 5408 - Clubs/Organizations 0.00 5606 • Government 5610 - State Government 5611 - RHCP Subsidies 0.00 5612 • CDE 0.00 Total 5610 • State Government 0.00 5615 • Local Government 0.00 Total 5606 • Government F 0.00 5740 • Memorials _ 0.00 Total 5400 • Contibuted Income 20,000.OD Total Income 147,101.00 Expense 7110 • Salaries Page 1 of 4 Peninsula Association for Rote, rded Children & Adults Profit & Loss Budget Overview Ruch July 2015 through June ?.010 7120 - Payroll Taxes 7121 - Payroll Expenses -FICA 11,008.31 7122 • Unemployment Insurance 2,500.00 7120 • Payroll Taxes - Other 0,00 Total 7120 • Payroll Taxes 13,508.31 7160 • Depreciation Jul 16 -June 16 7111 • SLILriea Admin 8,352.00 7112 - Salaries- Program Director 50,544.00 7114 • Salaries - Counselor 85,003.50 7115 • Salaries- Driver 0.00 7116 Mod 125 Reimb 6,600.00 7117 Allocated Admin Salaries 8,202.88 7132 • Benefits 0.00 Total 7110 • Salaries 158,702.38 7120 - Payroll Taxes 7121 - Payroll Expenses -FICA 11,008.31 7122 • Unemployment Insurance 2,500.00 7120 • Payroll Taxes - Other 0,00 Total 7120 • Payroll Taxes 13,508.31 7160 • Depreciation 7,428.58 7230 - Equipment Rental I lease 0.00 7260 • Insurance 0.00 7130 • Workers Compensation 12,050.58 7261 • General Liability 1,994.04 7262 • Property Insurance 141.96 7263 • Vehicle Insurance 2,703.00 7268 • Directors & Officers 584.04 Total 7260 • Insurance 17,473.62 7280 - Interest Expenses 7281 Credit Card Interest 0.00 7282 Mortgage interest 0.00 7283 Lease Interest 0.00 7284 • Interest -Lines of Credit 0.00 Total 7280 • Interest Expenses _0.00 0.00 7300 - Maintenance & Repairs 7301 -Vehicle Maintenance 60.00 7302 - Vehicle Repair 0.00 7303 • Grounds Maintenance 0.00 7304 - Maintenance Supplies 0.00 7306 - House Repair 0.00 7306 • House maintenance 200.00 7307 • Exterminator 0.00 7308 - Equipment Machine Repair 0.00 7309 • Equipment Maintenance Contract 0.00 7310 • General Maintenance & Repair � � 1,050.00 Total 7300 • Maintenance IL Repairs 1,310.00 7315 • Miscellaneous Expenses 0.00 7340 -Office Supplies 240.00 7360 - Postage 30.00 7380 • Printing 7381 • Newsletter D.00 Page 2 of 4 Peninsula Association for Retarded Children & Adult's Profit 41-oss Budget Overview Reach July 2015 through .tune 2016 7,400 • Professional Contractual Jul 15 -.tune 15 7382 - Business Cards 0.00 7383 • Door Hangars 0.00 7384 - Stationary 0.00 7385.Other Printing 50.00 Total 7380 - Printing 50.00 7,400 • Professional Contractual 2,700.00 7401 • Accounting 2,650.00 7402 - Audit 0,00 7403 • Behavioral 0.00 7404 • Management 0.00 7406 • Fundralsing 0.00 7406 •Other Professional Contractual 0.00 7407 • Computer 300.00 7406 - Temp workers 0.00 7463 • Legal 0.00 7464 - Payroll services 0.00 Total 7400 • Professional Contractual 2,950.00 7420 • Program Operating Expenses 7422 • Program Food 2,700.00 7423 • Client Recreation 1,655.00 7424 • Program Supplies 1,900.00 7425 - Vaint Supplies - 720.00 Total 7420. Program Operating Expenses 6,975.00 7430 • Advertising 0.00 7440 - Rent 0.00 7460 • Taxes, Licenses & Fees 0.00 7461 • Management Fees 0.00 7462 - Bank Service Fees 0.00 7465 - Physical Fees 240.00 7466 • Real Estala Taxes 0.00 7467 • Dues 225.00 7468 • License Fees 480.00 7470 - Friingerprinting Fees 120.00 Total 7460 - Taxes, Licenses & Fees 1,065.00 7480 • Telephone 2,100.00 7500 - Travel & Fuel Costs (Employee) 1,080.00 7510 - Board Expense 0.00 7520 • Staff Appreciation 150.00 7530 • Staff Recruitment 980.00 7540 • Training 0.00 7550 • Fuel Costs (Company) 420.00 7560 - Bridge Tolls 45.00 7600 - Utllitles 7801 - Electric 0.00 7602 . Gas and Garbage 480.00 7603 • Trash Removal 0.00 Page 3 of 4 Peninsula Association for Retarded Children & adults Profit & Loss Budget Overview Reach July 2016 through June 2016 7604 - Water 7605 - Sewer Total 7600 - Utilities 7610 • Vehicle Operating Expense Total Expense Net Income Jul 15 -June 16 360.00 _0.00 840.00 _0.00 215,507.89 - 58,406.69 Page 4 of 4 Peninsula Association for Retarded Children & Adults Profit & L �is Budget Overview Horizons July 2015 through June 2016 5512 - Client Revenue - Certified 0.00 ukw 0.00 Jui 15 -June 16 Income 5770 - Management Fee 6000 • Earned Income Total 5000 - Earned Income 5100 - Solicitations Reveus 0.00 5200 • Regional Centers 0.00 5201 GGRC 148,532.00 5202 East Bay regional 0.00 5203 San Andreas 0.00 5204 Sacramento 0.00 5205 Fern 0.00 5300 - Special Events 0.00 5311 • Annual Dinner 0.00 5300 • Special Events - Other _ 0.00 Total 5300 - Special Events 0.00 5502 - Client Revenue -Rent 0.00 5503 • HUD Tenant Assistance Payments 0.00 5512 - Client Revenue - Certified 0.00 6514 - Client Revenue -Full Fee 0.00 5515 - Self Pay 0.00 5770 - Management Fee 9,704.04 Total 5000 - Earned Income 158,236.04 5400 - Contibuted Income 5317 - Festa Revenue 0.00 5401 • Grants 0.00 5405 - Foundations 2,500.00 5406 • Corporate 0.00 5401 • Grants - Other _ 0.00 Total 5401- Grants 2,500.00 5402 Indivdual Donations 0.00 5403 TrusVEndowment 0.00 5404 Auto Donations 0.00 5406 Clubs/Organizations 0.00 5606 • Government 5610 • State Government 5611 • RHCP Subsidies 0.00 5612 - CDE 0.00 Total 5610 - State Government 0.00 5615 • Local Government 0.00 Total 5606 • Governments 0.00 5740 - Memorials 0.00 Total 5400 - Contibuted Income 2,500.00 Total Income 160,736.04 Expense 7110 • Salaries Page 1 of 4 Peninsula) Association for Retarded Children & Adults Profit & Loss Budget Overview Horizons July 2015 through June 2016 7120 • Payroll Taxes 7121 • Payroll Expenses -FICA 8,925.48 7122 • Unemployment Insurance 1,300.00 7120 - Payroll Taxes - Other 0.00 Total 7120 - Payroll Taxes 10,225.48 7160 • Depreciation Jul 15 -June 16 7111; • Saiaries -adman 0.00 7112 - Salaries- Program Dimtor 8,352.00 7113 - Salaries -Site Superviuor 27,OD0.00 7114 • Salaries - Counselor 81,321.00 7116 - Salaries -Driver 0.00 7116 Med 125 Reimb 6,000.00 7117 Allocated Admin Salaries 8,202.88 7132 - Benefits 0.00 Total 7110 • Salaries 130,875.88 7120 • Payroll Taxes 7121 • Payroll Expenses -FICA 8,925.48 7122 • Unemployment Insurance 1,300.00 7120 - Payroll Taxes - Other 0.00 Total 7120 - Payroll Taxes 10,225.48 7160 • Depreciation 2,519.45 723D • Equipment Rental f Lease 0.00 7260 - Insurance 0.00 7130 - Workers Compensation 3,145.89 7261 - General Liability 4,431.00 7262 - Property Insurance 48.96 7263 • Vehicle Insurance 1,117,56 7268 • Directors & Officers 1,296.96 Total 7260 - Insurance 10,040.37 7280 • Interest Expenses 7281 Credit Card Interest 0.00 7282 Mortgage Interest 0.00 7283 Lease Interest 0.00 7284 - Interest -Lines of Credit 0.00 Total 7280 - Interest Expenses 0.00 7300 - Maintenance & Repairs 7301 - Vehicle Maintenance 100.00 7302 - Vehicle Repair 0.00 7303 - Grounds Maintenance 0.00 7304 - Maintenance Supplies 0.00 7306 - House Repair 0.00 7306 • House Maintenance 0.00 7307 • Exterminator 0.00 7308 - Equipment Machine Repair 0.00 7309 - Equipment Maintenance Contract 0.00 7310 - General Maintenance & Repair 0.00 Total 7300 - Maintenance & Repairs 100.00 7316 - Miscellaneous Expenses; 0.00 7340.Office Supplies 0.00 7360 - Postage 60.00 7380 - Printing Page 2 of 4 Peninsula Association for Retarded Children a adults Profit & Loss Budget Oventiew Horizons July 2015 through June 2016 7400 • Professional Contractual Jul 15- June 16 7361 • Nemletter 0.00 7382 • Bu0ness Cards 0.00 7383 • Door Hangers 0.00 7384 • Stationary 0.00 7366. Other Printing 0,00 Total 7380 • Printing s= m0.00 7400 • Professional Contractual 1,440.00 7401 - Accounting 2,650.00 7402 • Audit 0.00 7403 • Behavioral 0.00 1404• • Management 0.00 7405 • Fundraising 0.00 7406 • Other Professional Contractual 0.00 7407 • Computer 0.00 7408 • Temp workers 0.00 7463 • Legal 0.00 7464 • Payroll services 0.00 Total 7400 • Professional Contractual 2,650.00 7420 • Program Operating Expenses 7422 . Program Food 1 1,440.00 7423 - Client Recreation 5 540.00 7424 • Program Supplies 9 900.00 7425 • Maint Supplies 0 0,00 Total 7420, P rogram Operating Expenses 7430 • Advertising 0,00 7440 • Rent 0.00 7460 • Taxes, Licenses & Fees 7461 • Management Fees 0,00 7462 • Bank Service Fees 0.00 7466 • Physical Fees 0,00 7466 Real Estate Taxes 000 7467 • Dues 0.00 7468 • License Few 0.00 7470 • Fringerprinting Fees 0.00 Total 7460 • Taxes, Licenses & Fees 0,00 7480 • Telephone 2,220.00 7600 • Travel & Fuel Costs (Employee) 2,400.00 7510 • Board Expense 0,00 7520 • Staff Appreciation 120,00 7630 • Staff Recruitment 240.00 7540 • Training 420.00 7550 • Fuel Costs (Company) 960.00 7580 • Bridge Tolls 0.00 7600 • Utilities 7601 - Electric 0,00 7602 • Gas 0.00 Page 3 of 4 7480 • Telephone 2,220.00 7600 • Travel & Fuel Costs (Employee) 2,400.00 7510 • Board Expense 0,00 7520 • Staff Appreciation 120,00 7630 • Staff Recruitment 240.00 7540 • Training 420.00 7550 • Fuel Costs (Company) 960.00 7580 • Bridge Tolls 0.00 7600 • Utilities 7601 - Electric 0,00 7602 • Gas 0.00 Page 3 of 4 Page 3 of 4 Peninsula Association for Retarded Children & Adults Profit & Loos Budget Overview Horizons Julys 2015 through June 2016 7610 • Vehicle Operating Expense 0.00 Totcl Expense _165,711.18 Net Income - 4,975.14 Page 4 of 4 «:._ Jul 15 - June 16 -r 7605 • Trash Removal 0.00 7604 • Water 0.00 7605 • Sewar 0.00 Total 7600 - Utilities � O.00 7610 • Vehicle Operating Expense 0.00 Totcl Expense _165,711.18 Net Income - 4,975.14 Page 4 of 4 Peninsula Association for Retarded Children & Adults Profit & Loss Budget Overview Page >ir±°1E11 July 2015 through June 2016 Jul 14 - June 16 Income 5000 - Eamed Income 5100 - Solicitations Reveue 5200 • Regional Centers 5201 GGRC 5202 East Bay regional 5203 San Andras 5204 Sacramento 5205 Item 5300 • Special Everts 5311 • Annual Dinner 5300 • Special Events - Other Total 5300 , Special Events 5502 - Client Revenue -Rent 5503 - HUD Tenant Assistance Payments 5512 - Client Revenue- Cartifled 5514 . Client Revenue -Full Fee 5515 - Self Pay 6770 - Management Fee Total 5000 • Earned Income 5400 - Contibuted Income 6317 - Fasts Revenue 5401 • Grants 5405 • Foundations 5406 - Corporate 5401 - Grants - Other Total 5401 - Grants 5402 . Indtvdual Donations 5403 - Trust/Endowment 5404 • Auto Donations 5408 - Clubs/Organizations 5606 - Government 5610 - State Government 5611 • RHCP Subsidies 5812 - CDE Total 5810 - State Government 5615 - Local Government Total 5606 - Government 5740 • Memorials Total 6400 - Contibuted Income Total Income Expense 7110 - Salaries 0.00 0.00 0.00 0.00 59,715.36 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8,101.08 67,816.44 0.00 5,000.00 0.00 _ 0.00 5,000.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5,000.00 72,816.44 Page 1 of 4 Peninsula Association for Retarded Children & Adults P1 et & Loss Budget Overview Nag& Mill July 2015 through June 2010 7120 • Payroll Taxes 7121 • Payroll Expenses -FICA 4,291.19 7122 - Unemployment Insurance 1,200.00 7120 • Payroll Taxes - Other 0.00 Total 7120 • Payroll Taxes 5,491.19 7160 - Depreciation Jul 14 - June 15 7111 • Salaries -Admin 0.00 1112 - Salaries- Program Director 7,656.00 7113 - Salaries -Site Supervisor 18,000.00 7114 - Salaries- Counselor 30,438.00 7115 - Salaries -Driver 0,00 7116 • Mod 125 Reimb 1,200.00 7117 - Allocated Admin Salaries 8,202.88 7132 - Benefits 0.00 Total 7110 , Salaries ,496 65.88 7120 • Payroll Taxes 7121 • Payroll Expenses -FICA 4,291.19 7122 - Unemployment Insurance 1,200.00 7120 • Payroll Taxes - Other 0.00 Total 7120 • Payroll Taxes 5,491.19 7160 - Depreciation 2,405.01 7230 • Equipment Rental / Lease 0.00 7260 • Insurance 0.00 7130 • Workers Compensation 1,457.22 7261 • General Liability 4,431.00 7262 • Property Insurance 48.96 7263 - Vehicle Insurance 1,117.56 7268 • Directors & Officers 0.00 Total 7260 - Insurance _1,296.96 - 8,351.70 7280 • Interest Expenses 7281 • Credit Card Interest 0.00 7282 • Mortgage Interest 0.00 7283 • Lease Interest 0.00 7284 • Interest -Lines of Credit 0100 Total 7280 • Interest Expenses 0.00 7300 - Maintenance & Repairs 7301 - Vehicle Maintenance 0.00 7302 - Vehicle Repair 0.00 7303 - Grounds Maintenance 0.00 7304 - Maintenance Supplies 0,00 7305 - House Repair 0.00 7306 - House Maintenance 0.00 7307 - Exterminator 0.00 7308 - Equipment Machine Repair 0.00 7309 - Equipment Maintenance Contract 0.00 7310 . General Maintenance & Repair 0.00 Total 7300 • Maintenance & Repairs 0.00 7315 - Miscellaneous Expenses 0.00 7340 - ofllce Supplies 0.00 7360 - Nntage 0.00 7360.13vinting Page 2 of 4 Penineulp Association for Retarded Children &. Adults Profit & Loss Budget Overview, Page !'et7ill July 2015 through June 2016 7400 • Professional Contractual 7401 • Accounting Jul 14 -June 15 7361 • Ne"lefter 0.00 7382 • Buslnesc Cords 0.00 7383 • Door Hangers 0.00 7384 • StOlonary 0.00 7386.Other Printing 0.00 Total 7380 • Printing 0.00 7400 • Professional Contractual 7401 • Accounting 2,650.00 7402 • Audit 0.00 7403 - Behavioral 0.00 7404 • Management 0.00 7405 • Fundraising 0.00 7406 -Other Professional Contractual 0.00 7407 • Computer 0.00 7408 • Temp workers 0.00 7453 • Legal 0.00 7464 • Payroll services 0.00 Total 7400 • Professional Contractual _0.00 •��Y�{� 2,650.00, 7420 • Program Operating Expenses 7422 - Program Food 3,600.00 7423 • Client Recreation 540.00 7424 • Program Supplies 540.00 7425 • Maint Supplies 70.00 Total 7420 • Program Operating Expenses 4,750.00 7430 • Advertising 0.00 7440 • Rent 0.00 7460 • Taxes, Licenses S Fees 0.00 7461 • Management Fees 0.00 7462 Bank Service Fees 0.00 7465 • Physical Fees 0.00 7466 • Real Estate Taxes 0.00 7467 • Dues 0.00 7468 • License Fees 0.00 7470 • Fringerprinting Fees 0.00 Total 7460 • Taxes, Licenses & Fees 0.00 7480 • Telephone 4,080.00 7500 • Travel & Fuel Coats (Employee) 1,800.00 7510 • Board Expense 0.00 7520 • Staff Appreciation 60.00 7530 - Staff Recruitment 240.00 7540 • Training 580.00 7550 • Fuel Costs (Company) 640.00 7560 • Bridge Toils 0.00 7800 • Utilities 7601 • Electric 0.00 7602 • Gas 0100 Page 3 of 4 Peninsula Association for Refarded Children & Adults Pl ant & Loss Budget Overview Page Mill Judy 2015 through June 2016 7003 • Trash Removal 7004 - Water 7505 - Sewer Total 7600 - Utilities 7610 - Vehicle Operating Expense Total Expense Not Income Jul 14 - June 15 0.00 0.00 0.00 0.00 0.00 96,544.77 - 23,776.33 Page 4 of 4 Peninsula Association f ®r retarded Children & Adults Profit & Loss Budged Overview Family Support Services July 2015 through June 2016 5400 - Contibuted Income 6317 • Feats Revenue EK Jul 14 -June 16 5401 - Grants 0.00 Income 10,000.00 6000 • Eamed Income 0.00 5100 • Solicitations Reveue 0.00 6200 • Regional Centers 0.00 6201 GGRC 0.00 5202 East Bay regional 0.00 5203 San Andreas; 0.00 5204 Sacramento 0.00 5205 item 0.00 5300 • Special Events 0.00 5311 • Annual Dinner 0.00 5300 - Special Events - Other 0.00 Total 6300 • Special Events 0.00 5502 • Client Revenue-Rent 0 -00 5503 • HUD Tensai Assistance Payments 0.00 5512 • Client Revenue - Certified 0.00 5514 • Client Revenue -Full Fee 0.00 6515 • Self Pay 0.00 5770 - Management Fee 0.00 Ti�'+L'SS Total 5000 - Earned Income -4•. 0.00 5400 - Contibuted Income 6317 • Feats Revenue 0.00 5401 - Grants 0.00 5405 • Foundations 10,000.00 5406 • Corporate 0.00 5401 • Grants - Other 0.00 Total 5401 • Grants 10,000.00 5402 • Indivdual Donations 0.00 5403 • TrustlEndowment 0.00 5404 • Auto Donations 0.00 5406 - Clubs/Organizations 0.00 5606 • Government 5610 • State Governmsnt 5611 - RHCP Subsidies 0.00 5612 • CDE 0.00 Total 5610 • State Government 0.00 5615 • Local Government 0.00 Total 5606 • Government 0.00 5740 • Memorials 0.00 Total 5400 • Contibuted Income 10,000.00 Total Inane 10,000.00 Expense 7110 • Salaries Page 1 of 4 Peninsula) Association to Retarded Children & Adults Profit & Dose Budget Overview Family Support Services July 2015 through June 2016 7120 - Payroll Taxes 7121 • Payroll Expenses -FICA 4,007.07 7122 • Unemployment Insurance 211.09 7120 • Payroll Taxes - Other 0.00 Total 7120 - Payroll Taxes 4,218.16 7160 • Depreciation Jul 14 - June 15 7230 - Equipment Rental / Lease 0.00 7111 - Salerles -Admin 0.00 7152 • Salaries- Program Director 4,176.00 7113 - Salaries -Site Supervisor 48,204.00 7114 • Salarres- Counselor 0.00 7115 - Salaries- Driver 0.00 7116 - Mad 125 Reimb 2,400.00 7117 • Allocated Admin Salaries 8,202.88 7132 • Benefits 0.00 Total 7110 - Salaries 62,982.88 7120 - Payroll Taxes 7121 • Payroll Expenses -FICA 4,007.07 7122 • Unemployment Insurance 211.09 7120 • Payroll Taxes - Other 0.00 Total 7120 - Payroll Taxes 4,218.16 7160 • Depreciation 0,00 7230 - Equipment Rental / Lease 0.00 7260 • Insurance 0.00 7130 • Workers Compensation 674.13 7261 • General Liability 0.00 7262 • Property Insurance 0.00 7263 • Vehicle Insurance 0.00 7268 • Directors & Officers 0.00 Total 7260 • Insurance 8674.13 7280 • Interest Expenses 7281 • Credit Card Interest 0.00 7282 • Mortgage Interest 0.00 7283 • Lease Interest 0.00 7284 • interest -Lines of Credit 0.00 Total 7280 • Interest Expenses 0.00 7300 - Maintenance & Repairs 7301 - Vehicle Maintenance 0.00 7302 • Vehicle Repair 0.00 7303 • Grounds Maintenance 0.00 7304 • Maintenance Supplies 0.00 7305 - House Repair 0.00 7305 • House Maintenance 0.00 7307 • Exterminator 0.00 7308 • Equipment Machine Repair 0.00 7309 • Equipment Maintenance Contract 0.00 7310 . General Maintenance S Repair 0.00 Total 7300 • Maintenance Its Repairs 0.00 7315 . Miscellaneous Expenses 0.00 7340 -Office Supplies 0.00 7350 • Postage 0.00 7380 - Printing Page 2 of 4 Peninsula Association for Retarded Children & Adults Profit & Does Budget Overview Family Support Services July 2015 through June 2016 7400 • Professional Contractual 7401 • Accounting Jul 14- June 15 ter= 7381 • Newaletter 'l�Tg�a+x+ 0.00 7382 • Business Cards 0.00 7363 • Door Hangars 000 7384 • Stationary 0.00 7385 •Other Printing 0.00 Total 7380 • Printing 0.00 7400 • Professional Contractual 7401 • Accounting 2,650.00 7402 • Audit 0.00 7403 • Behavioral 0.00 7404 • Management 0.00 7405 • Fundraising 0.00 7406 •Other Professional Contractual 4,000.00 7407 • Computer 0.00 7408 • Temp workers 0.00 7463 • Legal 0.00 7464 • Payroll services 0._00 Total 7400 • Professional Contractual �ys~6,650.00 7420 • Program Operating Expenses 7422 • Program Food 0.00 7423 • Client Recreation 0.00 7424 • Program Supplies 0.00 7425 • Maint Supplies 0.00 Total 7420 • Program Operating Expenses_ 0.00 7430 • Advertising 0.00 7440 • Rent 1,000.00 7460 • Taxes, Licenses & Fees 0.00 7461 • Management Fees 0.00 7462 • Bank Service Fees 0.00 7465 • Physical Fan 0.00 7466 Real Estate Taxes 0.00 7467 Dues 0.00 7468 License Fees 0.00 7470 • Fringerprinting Fees 0.00 Total 7460 • Taxes, Licenses & Fees 0.00 7400 • Telephone 0.00 7500 • Travel & Fuel Costa (Employee) 0.00 7510 • Board Expense 0.00 7520 • Staff Appreciation 0.00 7530 • Staff Recruitment 0,00 7540 • Training 0.00 7560 • Fuel Costs (Company) 0.00 7560 • Bridge Tolls 0.00 7600 • Utilities 7601 • Electric 0.00 7602 • Gas 0.00 Pago 3 of 4 Peninsula Association for Retarded Children & Adults Profit & Loss Budget Overview Family Support Services July 2015 through June 2016 g *.MXM.UaEwAU Jul 14 - June 15 7603 • Trash Removal 0.00 7604 • Water 0.00 7605 •Sewer 0.00 Total 7600 • utilities 0.00 7610 • Vehicle Operating Expense 0.00 Tatal Expense 75,525.17 Not Income - 65,525.17 Page 4 of 4 Penlnsuia Association for Retarded Children Adults Administration Budget Ovemiew Jody 2015 through June 2015 OPERATION EXPENSES Depreciation $ Jul 15 June 16 - REVENUE $ 8,175 Donations $ - Memberships $ - Investment Income $ _ Management fees $ 161 TOTAL REVENUE $ _ PERSONNEL EXPENSES $ 1,500 Salaries $ 131,246 FICA $ 20,081 WIC $ 3,003 Unemployment $ 1,000 Benefits $ 7,200 TOTAL PERSONNEL EXPENSES $ - 162,530 OPERATION EXPENSES Depreciation $ 10,291 Equip. Rental/Lease $ 8,175 Equip. improvements $ - General Liability Insurance $ 750 Property Insurance $ 580 D & 0 Insurance $ 161 Interest Expense $ 500 Maintenance/Repairs $ 1,500 Maintenance supplies $ - Miscellaneous $ 100 Contingency Fund Office Supplies $ 4,500 Postage $ 1,750 Printing $ 500 Audit $ 33,800 Software Support $ - Professional contractual $ 45,500 Advertising $ 500 Client Recreation $ - Program Food $ - Program Supplies $ - Management Fees $ - Rent $ 81,761 Bank Charges $ 4,000 Taxes/ Licenses/Dues & Mgmt F $ 3,000 Telephone $ 25,000 Board Expense $ 1,000 Staff Appreciation $ 1,000 Staff recruitment $ 500 Training $ 3,000 Travel $ 500 Meeting Expense $ 500 Vehicle Operating $ - Capital Asset _- - Total Program Operating Expenses $ 232,869 TOTAL OPERATING EXPENSES $ 395,398 EXCESS REVENUE OVER (UNDER) EXPENSES $ (395,398) Peninsula Association air Retarded Children Adults Development Budget Overview July 2015 through June 2016 ----7- Ul is. June 164rF REVENUE Auxiliary $ 150,000 Individuals $ 25,000 Trust/Endowment Foundations $ 35,000 Corporate $ 5,000 Clubs Organizations $ 1,500 Cities/Courdies $ 6,500 Memorials $ 5,000 Investment Income $ - Giro Pacifica $ 45.000 TOTAL REVENUE $ 283,000 PERSONNEL EXPENSES Salaries $ 51,636 Contract Position FICA $ 3,950 W/C $ 591 Unemployment $ 250 Benefits $ 2,400 Admin Salaries $ 39,374 TOTAL PERSONNEL EXPENSES $ 98,201 OPERATION EXPENSES Depreciation $ - Dues & Subscription $ - Equip. Rental/Lease $ - Maintenance/Repairs $ - Grounds maintenance $ - Maintenance supplies $ Miscellaneous $ 1,000 Office Supplies $ 1,000 Postage $ 3,000 Printing $ 5,000 Audit $ - Software Support $ - Professional contractual $ 39,700 Advertising Program Supplies (Giro) $ 25,000 Management Fees $ - Rent Bank Charges $ Taxes & Licenses $ - Payroll Fees $ - Telephone $ - Board Expense $ - Stall Appreciation $ - Staff recruitment $ - Training $ - Travel $ 500 Fuel $ - ElectrirJlltiilties $ - Gas $ Trash removal $ - Water $ - Vehiale Operating $ - TOTAL PROGRAM EXPENSES $ 75,200 TOTAL OPERATING EXPENSES $ 173,401 EXCESS REVENUE OVER (UNDER) EXPENSES $ 109,599 Peninsula Association for Retarded Children Adults Solicitations Budget Draft July 2016 through June 2016 Jul 16 -June 16 6 Trucks - S Drfvera REVENUE Salavage Revenues $ 1,194,300 Auto Donations $ 38,875 E Waste $ 42,03 Management fees $ - 'OTAL REVENUE $ 1,275,175 PERSONNEL EXPENSES Salaries $ 321,£6 FICA $ 24,626 1IM /C $ 15,2125 Unemployment $ 1,607 Benefits $ 19,200 Admin Salaries $ 26,249 TOTAL PERSONUEL EXPENSES $ 408,803 OPERATION EXPENSES Depreciation $ - Dues & Subscription $ - Egpt. Rental /Lease $ 60,744 Equip. improvements $ - Vehlcie Insurance $ 14,010 Liability Insurance $ 181 Property Insurance $ 48 Officers& Directors $ 50 Umbrella $ 21 Maintenanoa/Repairs $ 6,000 Truck GPS system $ 1,440 Grounds maintenance $ 1,020 Maintenance supplies $ - Miscelleneeus $ 500 Office Supplies $ 11800 Postage $ 255,000 Printing $ 2,000 Audit Software Support Professional contractual $ 17,474 Advertising $ 2,500 Client Recreation Program Food Program Supplies Management Fees Rent $ 35,904 Taxes & Licenses $ 2,750 Payroll Fees Telephone $ 7,824 Board Expense Staff Appreciation $ 300 Staff recruitment $ 500 Training $ 1,000 Travel $ 1,000 Fuel $ 85,840 Bridge Tolls $ 3,600 Direct Cloth Purchase $ 14,000 Trash removal $ 2,500 Utilities $ 3,000 Vehicle Operating $ 8,640 Total Program Operating Expenses $ 529,646 TOTAL OPERATING EXPENSES $ 938,450 EXCESS REVENUE OVER JUNDER) EXPENSES $ 336,725 PARCA SUMMARY BUDGET FYE JUNE 30, 2017 ALAMEDA' CEDAR STREET" RAJI HOUSE ILS" REACH10 HORIZONS PAGE MILL" FAMILY SUPPORT SERVICES ADMINISTRATION DEVELOPMENTS' 3A 111 SOLICITATION TOTAL Depreciation FYE June 30, 2017 2017 2017 Revenue Expense Budget Budget Net Profit (Loss) $ 158,800 $ 82,151 $ 76,650 $ 282,805 $ 255,620 $ 27,185 $ 34,917 $ 83,131 $ (48,214) $ 129,994 $ 106,492 $ 23,503 $ 151,514 $ 117,006 $ 34,508 $ 134,518 $ 145,531 $ (11,013) $ 66,656 $ 72,750 $ (6,093) $ 10,300 $ 58,079 $ (47,779) $ 416,879 $ (416,879) $ 332,690 $ 187,467 $ 145,223 $ 1,313,430 $ 972,513 $ 340,918 $ 2,615,625 $ 2,497,618 $ 118,007 $ 103,873 Net Loss After Adding Back Depreciation $ 221,880 1/27/2016 2016 2016 Revenue Expense Budget Budget Net Profit (Loss) 154,175 79,758 74,417 274,568 248,175 26,393 33,900 80,710 (46,810) 126,208 103,390 22,818 147,101 113,598 33,503 130,600 141,292 (10,692) 64,715 70,631 (5,915) 10,000 56,387 (46,387) 404,737 (404,737) 323,000 182,007 140,993 1,275,175 944,187 330,988 2,539,443 2,424,870 114,572 PARCA SUMMARY BUDGE` F`t'E JUNE 30, 2016 ALAWEDA5 CEDAR STREET° RAJI HOUSE' cL qe rmAml HORIZONS" PAGE IWILL10 FAMILY SUPPORT SERVICES ADMINISTRATION 12 DEVELOPtAEN-r -% 3a 3 39 SOLICITATIOW TOTAL Depreciation FYE June 30, 2010 2016 2010 Revenue Expense Budget Budget Net Profit (Loss) $ 90,647 $ 170,241 $ (71,594) $ 396,013 $ 335,929 $ 60,084 $ 37,500 $ 126,254 $ (88,754) $ 126,208 $ 126,660 $ (452) $ 147,101 $ 215,508 $ (68,407) $ 160,736 $ 165,711 $ (4,975) $ 72,816 $ 96,545 $ (23,728) $ 10,000 $ 75,525 $ (65,525) $ 395,398 $ (395,398) $ 283,000 $ 173,401 $ 109,599 $ 1.275.175 $ 938,450 $ 336.725 $ 2,607,197 $ 2,819,622 $ (212,425) $ 103,873 Net Loos After Adding Back Depreciation $ (108,552) 6/8/2015 2018 2015 Rvienue Expanse Budget Budget Ust Profit (Loss) 112,482 174,628 (62,146) 281,032 328,184 (47,152) 39,800 127,812 (88,012) 151,200 154,528 (3,328) 139,564 209,966 (69,602) 139,349 141,323 (1,974) 73,101 103,002 (29,901) 10,000 77,718 (67,718) - 404,737 (404,737) 286,000 182,007 103,993 1,240,975 934,245 306,730 2,473,503 2,837,350 (363,847) 1/25/2016 City Data Services - South San Francisco Consolidated Community Funding Application Redwood City, San Mateo County, and S. San Francisco Application for New Funding for FY 2016-17 GENERAL. INFORMATION 1. Organization Name: Rape Trauma Services: A Center for Healing and Violence Prevention 2. Project Title: Sexual Abuse Services for Children and Youth We are applying for funding from: :,e Redwood City City of San Mateo 1 South San Francisco County of San Mateo tsua em.ment -apt a (Auto - o Mated trorn Bud et, below Jurisdictions receiving this application Amount Requested % of Program Budget Proposed # of Served % Served Total $ Per Redwood City $15,0 4% 7 37% $214.2 Cit of San Mateo $15,0 4% 7 37% $214.2 South San Francisco Ow $10,00 $40, 0 3% 10°/ 5 19 26% 100% $200.0 $210.5 Grant Funded Programs: We are applying for a Public Services Program CDBG National Objective Eligibility - How are you serving low income populations? Service to "presumed benefit" groups listed below (income verification not required, but verification of presumed benefit status is required): Abused children Homeless persons Victims of domestic violence Illiterate adults Elderly persons /seniors (age 62 +) Persons living with AIDS Severely disabled adults Migrant farm workers Income Verification: Describe how you obtain, verify, and maintain proof of income and presumed benefit status. Third party documentation or client signatures on the certification forms must be available on file for review at all times. The Sexual Abuse Services Program for Children and Youth provides direct services to child abuse survivors from infancy through 17 years of age. As abused children is a'presumed benefit' group income verification is not required. RTS verifies the presumed benefit status by completing a Client Contact Data Form for each child served. The form is used to collect detailed information about the types of traumatabuse suffered, the services requested and provided, follow -up services provided and the age, gender, and ethnicity of each survivor. Client Contact Data forms are kept in a locked cabinet. RTS has kept all data forms from the beginning of the agency (21 years). RTS reports by 'individuals' rather than 'households' as to comply with our legal responsibilities to confidentiality. Due to legal restrictions, RTS is unable to actively seek and record information regarding personal affiliations between clients; we are therefore unable to report victims who share living spaces as 'households' as to preserve the confidentiality of all clients. 3. Project 1860 El Camino Real, Suite 406 City: Burlingame Zip: 94010 -3117 Address: 4. Provide a one sentence project summary: The Sexual Abuse Services Program for Children and Youth provides mental health services to address the multiple healing needs of child survivors of sexual violence including: crisis intervention, individual and group counseling, advocacy, medical /legal and forensic accompaniment, and information and referrals. Organization 1860 El Camino Real, Suite 406 City: Burlingame Zip: 94010 -3117 Address: http: //www.citydataservices.net/ cities/ smatca /app2016arc.pl ?rpt= C463BWop =359 1/9 1/252016 City Data Services - South San Francisco Organization 650 -652 -0598 Website: rapetraumaservices.org Phone: Type of Appilcant: Non - Profit Our agency serves: 5. Contact Person / Name: Emily Abrams Title: Executive Director Telephone: 650-652 -0598 x14 Project Administrator: Contact Emaii: emily@rapetraumaservices.org Fax: 650 - 652 -0596 6. Name of Agency Emily Abrams Director: `, Fiscal Name: Amanda Freeman Email: Telephone: 650 -652 -0598 O�ce_r. amanda@rapetraumaservices.org Fiscal Officer 1860 El Camino Real, Suite 406 City: Burlingame Zip: 94010 Address: P 8. Authorized Name: Emil y Abrams Email: Signatory: : emily@rapetraumaservices.org Telephone: 650 -652 -0598 Authorized Signatory 1860 El Camino Real, Suite 406 City: Burlingame Zip: 94010 Address: S. Please provide days and hours of regularly scheduled operation: RTS' crisis intervention services (crisis counseling, advocacy, accompaniment, information and referrals) are available 24 -hours a day. Counseling is scheduled to meet the needs of clients and families. In addition to Monday - Friday 9:OOam - 5:00 pm hours, sessions are available in the early momings, evenings and on weekends. 10. DUNS Number: 876425245 Federal EIN /TIN Number: 943215045 11. HUD Activity: Choose the HUD activity that most closeiy matches your service: 05N - Abused and Neglected Children 12. Project Specific Narrative: Provide a narrative description of the specific activities to be carried out with the requested funds. This should also include program objectives and key priorities for each specific jurisdiction. RTS aims to help child abuse survivors learn the skills they need to heal from sexual abuse or assault(s) they have experienced, decrease the likelihood of developing Post - Traumatic Stress Disorder, develop the tools to be supportive of their healing, and prevent continued or future abuse. RTS' program clearly matches many HUD activities by providing Basic Human Needs to Abused Children. RTS provides child abuse survivors with Advocacy & Accompaniment, Crisis Intervention, Counseling, Information, Referrals, Community Outreach and Violence Prevention. During 2015, RTS provided 261 child abuse victims with accompaniment services during forensic medical exams & forensic interviews. RTS provides children with emotional support, answers questions, and makes sure young survivors understand what is happening and that his /her rights are protected under the law. Counselors are trained to provide services to youth of all ages. RTS works with police to ensure victims receive verbal and written information about ongoing RTS services. RTS provides children with individual counseling as well as group counseling to continue the healing process with others who have had similar experiences & help break the isolation that is common among survivors — especially children. RTS provides on- campus services including crisis intervention, counseling, and prevention of future sexual violence to "At -Risk" youth at middle and high schools throughout the cities of SM, RWC, & SSF. 13A. Assessment of Need - Redwood City: Briefly describe how you determined the need for your program for each specific jurisdiction that you are angllying for funds Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. The San Mateo County Grand Jury discovered "everyday a child in SM County is sexually abused ... over half the reported sexually abused children are under 12 years." 1 -in -3 females & 1 -in -6 males will be sexually abused by the time they are 18 (National Crime Survey). More than half of rapes of women occur before 18; 22% before age 12. For men, 75% of rapes occur before age 18, 48% before age 12 (rjaden & Thoennes) Many sexually abused children also experience other traumas - physical & emotional abuse, exposure to violence & parental substance abuse. (Child Abuse & Neglect, 2007). Intervention is especially important for child & adolescent victims to prevent re- victimization over their lifetimes. http: //www.citydataservi ces.neV cities/ smatca /app2016arc.pl ?rpt= C4638&prop =359 2l9 1/25/2016 City Data Services - South San Francisco Last year, RTS (the only Rape Crisis Center serving SM County) provided crisis intervention to 485 victims of child sexual abuse, 75 of these children live in RWC. Children range in age from infancy to 17 yrs. Funding allows us to provide a larger percentage of children with comprehensive ongoing services. Children who are sexually abused often exhibit emotional, cognitive, and behavioral problems, such as depression, suicidal behavior, difficulty in school, use of alcohol & drugs, & early sexual activity. RTS is a place where survivors can find the support they deserve. The ability to heal from past trauma is fundamental to a child's safety and well- being. The target group is child victims of sexual abuse. At Risk Teen Counseling & workshops are provided in 13B. Assessment of Deed - City of San Mateo: Biefly describe how you determined the need for your program for each specific jurisdiction that you are aRRI1ing for funds Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. The San Mateo County Grand Jury discovered "everyday a child in SM County is sexually abused ... over half the reported sexually abused children are under 12 years." 1 -in -3 females & 1-in -6 males will be sexually abused by the time they are 18 (National Crime Survey). More than half of rapes of women occur before 18; 22% before age 12. For men, 75% of rapes occur before age 18, 48% before age 12 (fjaden & Thoennes) Many sexually abused children also experience other traumas - physical & emotional abuse, exposure to violence & parental substance abuse. (Child Abuse & Neglect, 2007). Intervention is especially important for child & adolescent victims to prevent re- victimization over their lifetimes. Last year, RTS (the only Rape Crisis Center serving SM County) provided crisis intervention to 485 victims of child sexual abuse, 71 of these children live in SM. Children range in age from infancy to 17 yrs. Funding allows us to provide a larger percentage of children with comprehensive ongoing services. Children who are sexually abused often exhibit emotional, cognitive, and behavioral problems, such as depression, suicidal behavior, difficulty in school, use of alcohol & drugs, & early sexual activity. RTS is a place where survivors can find the support they deserve. The ability to heal from past trauma is fundamental to a child's safety and well- being. The target group is child victims of sexual abuse. At Risk Teen Counseling & workshops are provided in c 13C. Assessment of Need - South San Francisco: Briefly describe honor you determined the need for your program for each specific 0urisdiction that you are applying for funds., Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. The San Mateo County Grand Jury discovered "everyday a child in SM County is sexually abused... over half the reported sexually abused children are under 12 years." 1 -in -3 females & 1 -in-6 males will be sexually abused by the time they are 18 (National Crime Survey). More than half of rapes of women occur before 18; 22% before age 12. For men, 75% of rapes occur before age 18, 48% before age 12 (fjaden & Thoennes) Many sexually abused children also experience other traumas - physical & emotional abuse, exposure to violence & parental substance abuse. (Child Abuse & Neglect, 2007). Intervention is especially important for child & adolescent victims to prevent re- victimization over their lifetimes. Last year, RTS (the only Rape Crisis Center serving SM County) provided crisis intervention to 485 victims of child sexual abuse, 47 of these children live in SSF. Children range in age from infancy to 17 yrs. Funding allows us to provide a larger percentage of children with comprehensive ongoing services. Children who are sexually abused often exhibit emotional, cognitive, and behavioral problems, such as depression, suicidal behavior, difficulty in school, use of alcohol & drugs, & early sexual activity. RTS is a place where survivors can find the support they deserve. The ability to heal from past trauma is fundamental to a child's safety and well- being. The target group is child victims of sexual abuse. At Risk Teen Counseling & workshops are provided in 14. Timellne: Provide a brief timetable for project implementation and achievement of projected goals and how you plan to expend your funds in a timely manner by the end of the fiscal year. The Sexual Abuse Services Program for Children and Youth is an ongoing program in which individuals seek needed services at any time throughout the year. Activities and staff are in place to implement all aspects of the program. By the end of the Fiscal Year, RTS will provide: 70 Child Abuse survivors in Redwood City with - Advocacy and Accompaniment services - In person counseling (individual or group) - Crisis Intervention, counseling and /or support services on their school campus 70 Child Abuse survivors in the City of San Mateo with - Advocacy and Accompaniment services - In person counseling (individual or group) - Crisis Intervention, counseling and /or support services on their school campus http:/ Mvww .citydataservices.neVcibes /sm atcalapp2ol6arc.pl ?rpt= C463UWop =359 319 U2520116 City Data Services - South San Francisco 50 Child Abuse survivors in the City of South San Francisco with - Advocacy and Accompaniment services - In person counseling (individual or group) - Crisis Intervention, counseling and/or support services on their school campus 15. Evaluation: Briefly describe how you will determine and measure the success of your program and whether or not program goals were met? If your program is currently receiving grant funds please describe accomplishments of goals to date. A variety of measures are used to evaluate services. The Client Contact Data Form is completed for all clients. It collects detailed information about the services requested and provided, types of trauma/abuse suffered, demographics, and follow -up services provided. RTS holds weekly meetings to review individual cases, provide assessment, and assign cases. This process allows us to track the number of services provided to city residents and evaluate a client's ability to identify and address immediate and long -term trauma needs as well as gauge if a client has gained skills needed for healing, an understanding of services, and/or received appropriate referral information. 16. Collaboration: Describe partnerships with other organizations /agencies, the nature of the partnership, and how it relates to the proposed project. Children and teens who have suffered sexual trauma have a high likelihood of needing other services. RTS works with organizations throughout the County to assure survivors receive all necessary services (teen pregnancy prevention, substance abuse, housing needs, Child Protective Services). RTS is a member of the County Sexual Assault Task Force & Multidisciplinaiy Interview Team to create better understanding regarding child victim issues: provide training, and enhance the coordination and cooperation of all parties involved (law enforcement, medical personnel, DA, and Victim Witness). RTS works with City and County Police Departments. We are called in during an investigation to facilitate useful communication, supporting the creation of an environment that minimizes re- traumatization. RTS' role is to support the child victim, provide basic legal - medical information, and answer questions. RTS addresses prevention by providing education programs in high schools. 40% of students reach out for further information, advocacy, and/or counseling. As a current recipient of the San Mateo County Human Service Agency Child Abuse Prevention Grant, RTS has become an active member of the Children's Collaborative Action Team and attends rnonthly meetings to discuss different issues of Child Abuse and Child Abuse Prevention throughout San Mateo County. 17. Impact:: Discuss any general trends and conditions that have affected or impacted your service levels or service populations. For New Applicants — describe what these funds would allow your agency to do that you may not be able to do now. For Continuing Applicants — describe how your program would be impacted without these funds. Each year, new children reach out in need of victim services. Funding allows us to meet this demand. RTS provides a large percentage of direct services to Latino /a children. We continue to implement expanded counseling & advocacy to children by providing additional counseling groups. Our numbers indicate a high percentage of low - income clients. Additionally, funding allows RTS to provide outreach campaigns to at -risk communities. Through our Programa Para Latinos, RTS focuses outreach to underserved populations actively targeting people that have limited resources to receive services elsewhere. An ongoing trend is the increasing number of children seeking services who are victims of CSEC (Commercial Sexual Exploitation of Children). CSEC includes the prostitution of children, child pornography, child sex tourism & other forms of transactional sex where a child engages in sexual activities to have key needs fulfilled, such as food, shelter or access to education. Providing services to these children is often difficult, it is very time consuming and often hard to coordinate due to the presence of the justice system. Without funds, RTS would initiate a waiting list for counseling, fewer school communities would receive on campus services making it necessary for youth to travel to RTS' office, some child victims may not receive accompaniment support during forensic exams /interviews, & fewer residents would receive information needed to make important & informed decisions. 18. Project Benefciaries/Quantifrable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. 116. Project Beneficiaries/Quantiflable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. a. Indicate the total number of low4ncome beneficiaries you expect to serve with this program for each jurisdiction application for funding. *Low- income is 80% of Area Median Income or below. See AMI table h. Indicate the total number of beneficiaries you expect to serve with this program in each jurisdiction - regardless of income. Jurisdiction a. Number of low-income beneficiaries to be served per gram jurisdiction application. Low- income is 80% of Area Median Income or below. b. All beneficiaries to be served per grant jurisdiction application regardless of income Persons Persons Daly City 20 20 Redwood City 70 70 http:/A ww.citydataservices.reV cities/ smatca tapp2016are.pi ?rpt= C4638&prop =359 4/9 U252016 City Data Services - South San Francisco City of San Mateo _ 70 70 County of San Mateo 80 80 South San Francisco z 50 50 oWs 290 290 19. PopuEafFOns Served: Check the boxes below if they describe a significant population served by your program. These categories are not considered "presumed benefit" by HUD, and require income verification. Persons exiting incarceration Low- income youth Other 20. Affirmative Outreach: a. Use the demographics from your previous program year to provide an analysis of the population you serve relative to the demographics in the table. NOTE. If you aie a new annlicant nlaase nmvirla vrnir ►met p&t;mat ;.,. Race &Ethnicity Redwood City Population Redwood City % by Ethnicity Low Income by Ethnicity served by our PTgrarn Your Program by Ethnicity Total 74,40 100% 7 100% Re and not Hispanic 40,6561 54.64% 1E 20.007. ite and His nic 23,55 31.66% 291 38.67% sian 6,71 9.03% 1 1.33% frican American 1,91 2.58% 2.78% 4.00% Pacific Islander 66 0.89% 1 1.33% Native American 0.14% 0.520 1 1.33% her 1,511 2.03%1 251 33.33% Race & Ethnicity City of San Mateo Population City of San Mateo % by Ethnicity Low Income by Your Program ° Ethnicity served Ethn /° Ethnicity by our P ram Total 97,20 100% 72 1000/0 White and not Hispanic 45,2 46.54% 13 18.06% Re and Hispanic 25,8151 26.56% 2 34.72% sian 18,1531 18.67 % 171 23.61% frican American 2, 2.16% 21 2.78% Pacific Islander 1,93 1.99% 1.75% 4.17% Native American 1 0.14% 0.62% 0.00% her 3, 82 3.93%1 14 16.67% Race S Ethnicity South San Francisco Population South San Francisco % by Ethnicity Low Income by Ethnicity served b our Programi Your P ° /° by Ethnicity Total 603,63 1 47 1000/0 White and not Hispanic 23,7 37.34% 14 29.79% White and Hispanic 21,64 34.02% 1 38.30% Sian 23,2931 36.61% 51 10.64% African American 1,62 2.55% 4.26% Pacific Islander 1,111 1.75% 1 2.13% Native American 39 0.62% 0.00% Other 9,59 15.08% 14.890/6 b. Based on the percentages that you indicate your organization served describe your efforts to improve affirmative outreach to groups that may be underserved by your program and the result of your efforts: RTS is committed to making programs accessible by minimizing cultural, geographic, and economic barriers to participation. Staff is trained to be culturally sensitive to the needs of individuals and groups that have experienced oppression. Bilingual multicultural staff provides outreach to residents and specifically to the Latino immigrant community. Presentations are given where there is a high likelihood of contact with survivors or potential victims. Whites are underrepresented in RTS client pool because as a nonprofit agency with no cost counseling and support services, low - income and other underserved communities (i.e., non -White populations) overwhelmingly utilize RTS' programs due to a lack of resources to receive support elsewhere. RTS has a community outreach plan which targets underserved communities and sends program materials to over 75 agencies http :! /www.citydataservices.neV cities/ smatcalapp2016arc .pl ?rpt= C46388,prop =359 519 1/25/2016 City Data Services - South San Francisco throughout San Mateo County and beyond, for example Native American Health Center, LGBT Community Center, Bayshore Prevention Project, Pyramid Alternatives, Kaiser Permanente (Redwood City, South San Francisco and San Mateo Medical Office) San Mateo County Human Services Agencies, and Asian American Recovery Services. 21. Leveraging: Describe your fundraising efforts and additional sources of revenue for this project and your organization. Please state whether any of these fund sources are already committed and in what amount. RTS receives an ongoing Rape Crisis Grant from CalOES - the funding amount is $130,000 for the Sexual Abuse Services Program for Children and Youth. RTS will receive $51,500 in FY 2016 -17 from The San Mateo County Human Service Agency for Child Abuse Prevention and Intervention. RTS has received current funding from Kaiser Permanente ($15,000), Palo Alto Medical Foundation ($10,000), Mills Peninsula Foundation ($7,500) , Atkinson Foundation ($5,000) and the Bella Vista Foundation ($15,000). We will re -apply to these sources for the upcoming fiscal year and apply to additional Corporations and Foundations, including: The Intero Foundation and The Bothin Foundation. A financial commitment from San Mateo, Redwood City, and South San Francisco lends additional credibility to our requests from all types of funders. When approaching business owners and city residents it has been helpful to discuss ongoing city support. RTS has continued its Non - profit membership of the RWC /SM Chamber of Commerce and speaks to and receives support from several service organizations (Rotary, Kiwanis, Lions, Soroptimist) throughout the county. Staff List List below kev staff members who work on this Proaram Position Tide Name of Staff Person Job Responsibilities Qualifications Provides training and mentoring to staff and volunteers, provides crisis intervention, individual counseling, Founding member of RTS. 20+ years experience Executive Director Emily Abrams and facilitates direct working in Sexual Assault Movement. CA State services to chidren Certified Sexual Assault Counselor. and families. Provides oversight of all program activities. Provides Direct Services (counseling, advocacy, accompaniment, Has worked in the field of sexual assault and information and domestic violence for 18 years. Advocate and Program Director Amanda Freeman referrals) and Educator specially trained to work with youth and coordinates and families. CA State Certified Sexual Assault implements services Counselor. and programs to At Risk Youth. Provides crisis Bicultural immigrant who has both personal and intervention, individual rofessional experiences navigating and accessing and group counseling, as well as issues of domestic and sexual Program para and facilitates direct [ervices olence in the Latino /a communities. She Latinos Cindy Marroquin services to Spanish nderstands the cultural dynamics and needs that oordintor/Traum speaking residents. atino/as have in accessing services and is sensitive ounselor Trains staff and these challenges. 10+ years experience providing volunteers an issues workshops, case management, advocacy, and of trauma and culture. support to Latino /a families. CA State Certified Sexual Assault Counselor. Therapist provides crisis intervention, individual and group therapy, and facilitates t MFTI who has worked for RTS for 3 years. As a ounseling direct services to counseling intern she has provided group and rogram Sheree Polonsky children and youth. individual therapy to children in San Mateo County for ana er/Thera ist g p rains staff and Years. CA State Certified Sexual Assault volunteers on issues Counselor. of trauma and counseling. http:l/www.citydataservices, net / cities/ smatcalapp20i6arc .pl ?rpt= C463Uprop =359 6/9 1/25=16 City Data Services - South San Francisco PROPOSED PROGRAM BUDGET FOR FY 2016 -17 For the City of Redwood City ONLY, answer the following: For the City of Redwood City ONLY, answer the following: 1. Funding Criteria: 3. Human Services: Basic Human Needs are activities that are vital for survival and not just an improvement to the quality of life, regardless of income. For example, emergency food programs are essential to survival. Coordination of a volunteer program is an improvement to the quality of life. 2. Marketing /Advertising a. Check all of the following methods your agency utilizes to promote and advertise your programs and services: httpJ/www.citydataservices.rL -V cities/ smatcalapp2016arc .pl ?rpt= C46388prop =359 7/9 Redwood City City of San Mateo South San Francisco Total Jurisdictions Budget Line I item Agency Total Pgm% Program Total % Requested % Requested % _ Requested Pgra %' Requested Labor j Executive hector $110,00 36% $40,0 8% $3,00 8% $3,00 5% $2, 20% $8,00 Program hector $90,0 39% $35,00 7% $2,50 9% $3,00 6 % $2, 21 % $7,50 Counseling Program Manager (50% $25,0 40% $10, 20% $2,00 15% $1,50 15%' $1,5 50 °/ $5,0 FTE) _ Programa Para Latinos $52,00 29% $15,00 13% $2,000 13% $2,00 13 % $2,00 40 °/ ounselor _'0 Volunteer oordinator $50,00 50% $25,00 0% $0 0% $ 0 °l0 $C p°/ $ Post Graduate ounseling $50,000 70% $35,0 0% $0 0% $C 0 °/ i $C p°/ $ Intems I I Trauma Counselor $51,0 ° 43/0 $22,00 ° 11 /o $2,50 11% $2,50 11 °, $2,50 34 % $7,50 Clinical Supervisor $15,0 67% $10,00 ° 0% $ ° OJo $ OIo p °/ $ Counseling irector $88,00 85% $75,00 0% $ 0 ° /0 $ 0 o $ 0% $ Prevention ducator $46,0 33% $15,00 0% $ ° 0 Jo $ 0% $ 0% $ axes /Benefits $72,0 60% $35,00 0% $ 0% $ 0% 0% $ upplies Office upplies $2,5 50% $1,5 o 0% $ 0 0% $ 0 Ol° $ p% $ Equipment $3,00 $1,5 $ $ $ $ Materials Postage and Delivery $5,50 65°/ $3,00 0% $ 0% $ o% $ 0% $ Printing and $8,5 $5,50 $ $ $ Re roduction Operations/Maintenance Occupancy $63,0 45% $31,OOC 0% $3, 0% $3,00 0°I $ 100% $6,00 Telephone and $13,20 39% $6,00 0% $ 0% $ 0% $ p°/ $ Communication Local Travel $9,0 $3,50 $ $ $ $ Administration $45,0 36% $16,00 00/6 $ 0% $ 0 °/ p°/ TOTA $798,70 48% $385,00 4% $15,00 4% $15,00 3% $10,00 10°/ $40,00 Number of Individual Beneficiaries 7 74 24 1 Cost per Individual $214.2 $214.2 $200. $210. For the City of Redwood City ONLY, answer the following: For the City of Redwood City ONLY, answer the following: 1. Funding Criteria: 3. Human Services: Basic Human Needs are activities that are vital for survival and not just an improvement to the quality of life, regardless of income. For example, emergency food programs are essential to survival. Coordination of a volunteer program is an improvement to the quality of life. 2. Marketing /Advertising a. Check all of the following methods your agency utilizes to promote and advertise your programs and services: httpJ/www.citydataservices.rL -V cities/ smatcalapp2016arc .pl ?rpt= C46388prop =359 7/9 1/25/2016 4 Flyers /brochures Website J Phone book listing CIP (Handbook /Database) Outreach presentations to service providers Outreach presentations to public id PSA's City Data Services - South San Francisco b. Which of the above marketingladvertising materials are available in multi-langual form and which languages are they available in? All RTS materials are printed two sided in English and Spanish. Outreach presentations are provided in either English or Spanish. Radio and TV announcements are provided on English and Spanish stations. c. How and where are the materials distributed? Materials are sent to over 75 agencies that target underserved populations, for example Native American Health Center, LGBT Community Center, Bayshore Prevention Project, Pyramid Alternatives, Kaiser Permanente (Redwood City, South San Francisco and San Mateo Medical Office) San Mateo County Human Services Agencies, and Asian American Recovery Services. Materials are distributed at each Police Station in the county, The District Attorney's office, The Keller Center, schools, libraries, and other social service agencies. Outreach presentations are provided throughout San Mateo County with a concentrated effort in low- income communities. 3. Program Outcomes: a. Please describe the accomplishments of program goals for FY /15. In FY 14/15, RTS provided crisis intervention, counseling, advocacy, accompaniment, prevention and community outreach to residents of Redwood City. RTS provided 75 children ages 3 -17 (living in Redwood City) with direct support during Forensic Medical Legal exams. As the only Rape Crisis Center serving residents of Redwood City these children would not have received support if not for our program. RTS continues to supports children seeking services who are victitns of CSEC. RTS provided services to 7 children who identified being victimized by commercial sexual exploitation while residing in Redwood City. RTS provided on campus "At Risk" youth services at Redwood High School, Sequoia High School and Garfield Community School and RTS Educators provided Ending Cycles of Violence workshops to students throughout Redwood City. RTS staff provided a professional training for members of the Multidisciplinary Interview Committee; police officers, nurses, social workers, deputy district attorneys, and victim witness advocates were provided with the latest research on teen dating violence and were given tips on how to engage youth in dialogue about healthy sexuality and sexual and dating violence prevention. RTS provided training to Redwood City Police Officers aimed at working specifically with child survivors of sexual abuse. b. In what ways has your program made a difference in the lives of the people you serve? Please provide at least one concrete example from the people served in FY /15: I first met Ave at the Keller Genter. Ava was an anxious 16 -year old who had been raped the night before by a friend of a friend. Having heard about RTS at school, Ave called our 24 -hour hotline. Serving as her victim advocate, I met Ave at the hospital. I told her I was there to support her & to ensure she had accurate information to make the best decisions for herself. I explained that a specially trained forensic interviewer was going to ask her questions. She would speak to a police officer & receive a medical exam, which would include collecting evidence from her body & clothing. She handed me a paper bag containing the clothes she wore the night before, I held her hand during the interview & medical exam, answered her questions, & comforted her as she cried. Two days after the rape, Ave decided to tell her family. I sat with her while she found the words. Through her tears, she told her parents about the assault. They felt angry, sad, helpless. i listened to their feelings, offered understanding & ideas on haw to support their daughter's healing. Ave called to talk about how she felt: she couldn't sleep, she had trouble concentrating, she was having nightmares. She felt afraid. I assured her these were common responses to the trauma of being raped, that she wasn't alone. Ave receives one -on -one counseling at RTS & has joined a support groups to help with her feelings of isolation. Ava recently said she feels like a weight has been lifted off of her. Attachments http:lAvww.citydataservices.neV cities/ smatcalapp2016arc .pl ?rpt= C4638&prop =359 8/9 1/25/2016 City Data Services - South San Francisco l 1. Resolution authorizing application and designation of signatory, by the Board of Directors 2. Proof of 501(c)3 / tax - exempt status 3. By-laws W� 4. Articles of Incorporation ,' S. Board roster, including: • Name, Company, Years on Board • Meeting dates for previous 12 months • Number of years allowed for each board tern RTS Board Resolution 16.doc Rape Trauma Services IRS Tax Exempt Letterpdf RTS BYLAWS.pdf RTS articles of incorooration.Ddf RTS Board List 16.doc RTS Board Meeting Dates.doc 6. Organizational chart for entire organization Ora Chart 1 16.docx 7. Certified financial audit no more that 1 fiscal year old, RTS Audit 6 30 14.Ddf prepared by a CPA, and: RTS Financial Audit Ug_date FY2015 doc • Management letters (if applicable) A -122 and A -133 Single Audit (for entities that receive more than $500,000 in federal funding) OR • A letter from your Executive Director or Chief Financial Officer certifying that agency does not receive more than $500,000 in federal funds and is not subject to the Single Audit. 8. The following are required: • Current (FY15 -16) Agency Operating Budget • Proposed (FY16 -17) Agency Operating Budget RTS Current Agency Budget 15 16 Ddf RTS Proposed Agency Budget 16 17.D& 9. Mission Statement RTS Mission Statement 16.doc 10. Non - discrimination policy for Staff and Clients RTS Non Discrimination Policy 16.doc 11. Reasonable Accommodations Policy for Staff and RTS Reasonable Accommodations Policy 16.doc Clients d; 12. Conflict of Interest Policy. (If not available, please RTS Conflict of Interest Policy 16.doc indicate when you will submit) 13. Other - Download All Attachments Program Manager Signature Emily Abrams Date Signed 01/22/2016 Initially submitted: Jan 22, 2016 - 12:20:25 http: //www.citydataservices.r*V cities/ smatcalapp2016arc .pl ?rpt= C46388prop =359 N Rape *Trauma Services AGENCY BUDGET FY 2015 -2016 July 1, 2015 - June 30, 2016 Inter 4000• Grards Clubs and Service Organizations 1,500.00 School Contracts 30,440.00 Foundation Grants 75,000.00 Toted 4000 • Grants - 1• 06�� 4100 - Govsrmment Contracts 4,131.00 C1lkw 38,750.00 COAT 51,500.00 Federal & County. YSC GIRLS 39,000.00 Dept of Health Services: Prev. Educ. 85,000.00 Cal -OES: Rape Crisis Grant 267,217.00 Total 4100 • Government Contracts 481,467.00 4200 • Individual Contributions 2,5507 Total 4200 • Individual Contributions 80.000.00 4300 • Service Palated Contributions Donations 10,000.00 Honorariums 1,000.00 TmW^gs 2,250.00 Total 4300 • Service Related Contrib. 13,250.00 4400. Interest Irmine 46W Other Income: FITS Workshops 0.00 4700 • Corporate Contributions (match) 2,500.00 Total Income 884,157.00 Etmens� 6000 • Wages & Salaries Total 6000 • Wages & Salaries 401,0837 6050 • Employee Benefits Health Insurance 40,200.00 Payroll Taxes@ 9.122% 36,586.00 Worker's Comp Insurance@.0103 4,131.00 Total 6050 • Employee Benefits 80,917.00 7000 Bank Service Charges Bank Service Charge 250.00 Credit Card Fees 600.00 Payroll Processing Fees 1,500.00 7000 • Bank Service Charges - Other 200.00 Total 7000 • Bank Service Charges 2,5507 7080 • Dues & Subscriptions Cal CASA membership 1,500.00 7120 • Equipment & Fumishings Equipment Leases 2,500.00 Equipment & Furnishings Purchase 2,000.00 7120 • Equipment & Furnishings - Maint 1,500,00 Total 7120 • Equipment & Furnishings 6,000.00 7140 - Insurance General Liability Insurance 3,200.00 Total 7140 • Insurance 3,200.00 7160 • Interest, Fingerprinting, filing fees 500.00 7180 • Miscellaneous Expense 300.00 7200.Occupancy 5mo x 5051.40 - 7mo x 5303.95 Total 7200 -Occupancy: 62,394.65 7220.Office Supplies 2,500.00 7240 - Postage & Delivery 5,500.00 7260 • Printing and Reproductions 8,500,00 7280 - Professional Development Conferences, Trainings, Inservices 6,000.00 Educational Materials & Books 500.00 Volunteer Training 500.00 Total 7280 • Professional Development 7,000.00 7300 Professional Services Raps Trauma Services AGENCY BUDGET Fit 2015 -2016 July 1, 2015 - June 30, 2016 Audit Accounting & Finance Metis Clinical Supervision & Consultation Trauma Training - Mentoring Development: Contract Wk, Grants, marketing Organizational Development Other Support Services (SAC & other) Total 7300 • Professional Services 7320 Promotion /Outreach 7325 Development Software 7340 • Recruitment Staff & Vol Recruitment Total 7340, Recruitment 7380 - Supplies & Materials (food & water) 7400, Telephone & Communications Answering Service Business Telephone Internet and Website Other Communication Total 7400 • Telephone & Communications 7420 • Travel Local Travel - Mileage (.505 per mile) Total 7420 - Travel Tote) E manse Not Income Rape Trauma Services PROPOSED AGENCY BUDGET FY 2016 -2017 July 1, 2016 - June 30, 2017 Income 4000 • Grarnis aube and Service Orpanisations 1,500.00 School Contracts 35,000.00 Foundation Gfsnts 85,000.00 Total 4000 • Graft 121,500.00 4109 • Govemment contracts 7,237.00 tee: 40,000.00 COAT 51,500.00 Federal & Couruy. YSC GIRLS 39,000.00 Dept of Heakh Services: Prev. Educ. 85,000.00 Cak)ES- CHAT 225,000.00 Cd-OES: Rape crisis Grant 384,615.00 Total 4100 • Government Contracts 8525,115.00 4200 • Individual contributions 1,500.00 Total 4200 • Individual Contributions 801000.00 4300 • Service Related contributions 2,500.00 Donation 12,500.00 Honorariums 1,000.00 Training Fees 2,250.00 Total 4300 - Service Related Conlrib. 15.750.00 4400 • Interest Irncorrne 3,200.00 4600 Other Incorm: RTS Workshops 0.00 4700 • Corporate Contributions (match) 2,500.00 Total Income 1.044,665.00 6000 • Wages & Salaries Total 6000 • Wages & Salaries 702,691.00 6050 - Employee Benefits Health Insurance 70,269.00 Payroll Taxes@ 9.122% 64,099.00 Worker's Comp Insurance@.0103 7,237.00 Total 6050 • Employee Benefits 141,60570 7000 • Bank Service Charges Bank Service Charge 250.00 Credit Card Fees 600.00 Payroll Processing Fees 1,500.00 7000 • Bank Service Charges - Other 200.00 Total 7000 - Bank Service Charges 2,550.00 7080 • Dues & Subscriptions Cal CASA membership 1,500.00 7120 • Equipment & Furnishings Equipment Leases 2,500.00 Equipment & Furnishings Purchase 2,000.00 7120 • Equipment & Furnishings - Maint 1,500.00 Total 7120 • Equipment & Furnishings 6,000.00 7140 • Insurance General Liability Insurance 3,200.00 Total 7140 • Insurance 3,200.00 7160 - Interest, Fingerprinting, filing fees 500.00 7180 - Miscellaneous Expense 300.00 7200.Occupancy 5mo x 5502 - 7mo x 5877 68,649.00 Total 7200.Occupancy: 68,64970 7220.Office Supplies 4,000.00 7240 • Postage & Delivery 6,500.00 7260 - Printing and Reproductions 8,500.00 7280 - Professional Development Conferences, Trainings, Inservices 6,000.00 Educational Materials & Books 500.00 Volunteer Training 500.00 Total 7280 • Professional Development 7.007(—)C Rape Trauma Services PROPOSED AGENCY BUDGET FY 2016 -2017 July 1, 2016 - June 30, 2017 7300 • Professional Services Audit Accounting & Finance Metis Clinical Supervision & Consultation Trauma Training - Mentoring Development: Contract Wk, Grants, marketing Organizational Development Other Support Services (SAC & other) Total 7300 • Professional Services 7320 Promotion /Outreach 7325 Development Software 7340 • Recruitment Staff & Vol Recruitment Total 7340 • Recruitment 7380 Supplies & Materials (food & water) 7400 Telephone & Communications Answering Service Business Telephone Internet and Website Other Communication Total 7400 • Telephone & Communications 7420 - Travel Local Travel - Mileage (.505 per mile) Total 7420 • Travel Total Enwme Not Income 1/2512016 City Data Services - South San Francisco Consolidated Community Funding Application Redwood City, San Mateo County, and S. San Francisco Application for Now Funding for FY 2016 -17 GENERAL INFORMATION 1. Organization Name: Samaritan House 2. Project Title: Safe Harbor are applying for funding from: Redwood City City of San Mateo 0 South San Budget/Client Summa;y (Auto - populated from Budget. below) County of San Mateo Jurisdictions receiving this application Amount Requested % of Program Budget , Proposed # of Served % of Served Total $ Per Redwood City $17,0 1% 401 9% $425. County of San Mateo $100,0 6% 35_8F_ 5 78% $279.3 South San Francisco $12,00 1% 6 14% $190.4 [Total $129,00 8% 461 100% $279.$ Grant Funded Programs: We are applying for a Public Services Program CDBG National Objective Eligibility - How are you serving low income populations? Service to "presumed benefit" groups listed below (income verification not required, but verification of presumed benefit status is required): Abused children d Homeless persons Victims of domestic violence illiterate adults Elderly persons /seniors (age 62 +) Persons living with AIDS Severely disabled adults Migrant farm workers Income Verification: Describe how you obtain, verify, and maintain proof of income and presumed benefit status. Third party documentation or client signatures on the certification forms must be available on file for review at all times. Homeless persons who are extremely low income are a presumed benefit population in San Mateo County. All homeless clients served by Safe Harbor are extremely low to very low income, and Samaritan House has a strict application and verification process to document eligibility based on household income. To verify income data, Safe Harbor staff obtains and reviews copies of pay stubs for employed clients and obtains and reviews checks stubs for Social Security, General Assistance and other forms of income. For client homeless certification, Intake Staff verifies presumed benefit status utilizing a County form that is also utilized by the Housing Authority. This third party documentation is available on file for review at all times. 3. Project 295 North Access Road Address: City: South San Francisco 4. Provide a one sentence project summary: Safe Harbor provides emergency and transitional shelter for homeless adults over age 18 in San Mateo County. Organization 4031 Pacific Blvd. Address: Organization 650-341 -4081 Phone: Type of Applicant: Non - Profit Our agency serves: 5. Contact Person / Project Name: Laura Bent/Amy Hsieh Administrator: City: San Mateo Website: www.samadtanhousesanmateo.org Title: Chief Operating Officer /Grants Manager Zip: 94080- 6907 Zip: 94403- 3666 Telephone: 650-523- 0824;650- 523-0816 httpllwww.citydataservices. net / cities/ Smatcalapp2Ol6arc .pi?rpt= C4747&prop =52 1/8 1/25/2016 City Data Services - South San Francisco Contact Email: laura@ samadtanhousesanmateo. org; ahsieh @samadtanhousesanmateo.orgFax: 650 - 294-4338/650- 523-0839 S. Name of Agency Bart Chadow Director: 7. Fiscal Name: Jolie Bou Officer: Fiscal Officer 4031 Pacific Blvd. Address: S. Authorized Name: Bart Chadow Signatory: Authorized Signatory 4031 Pacific Blvd. Address: 9. Please provide days and hours of regularly scheduled operation: Safe Harbor is open 7 days per week, 24 hours per day. 10. DUNS Number: 884486341 11. HUD Activity: Choose the HUD activity that most closely matches your service: 05 - Public Services Email: Telephone: jbou@samadtanhousesanmateo.org 650 -523- 0810 City: San Mateo Z94: Email: Telephone: bart@samadtanhousesanmateo.org 650 -523- 0812 City: San Mateo Zip: 94403 Federal EIN/TIN Number: 237415272 12. Project Specific Narrative: Provide a narrative description of the specific activities to be carried out with the requested funds. This should also include program objectives and key priorities for each specific jurisdiction. Safe Harbor is a 90 bed homeless shelter located in South San Francisco that provides both emergency and transitional housing for homeless women and men 18 years and older from San Mateo County. As the County's only shelter where people who are homeless and under the influence have access to the shelter without a sobriety requirement, Safe Harbor houses clients that are among the County's most vulnerable, many being dually diagnosed with both addiction and mental health disorder or addiction and physical health disorder. Each day, 90 people receive safe and warm shelter at Safe Harbor as well as nutritious meals, on -site case management, counseling, educational programming, daily transportation vouchers, access to benefits enrollment and other supportive services. The program utilizes a tiered case management model that is carried out by our dedicated case management and intake team. Case managers act as advocates, connecting residents with much needed community services, including referrals to housing, mental health, AOD and employment resources. Project outcomes include: OUTCOME 1: The shelter will be at full capacity 95% of the time. OUTCOME 2: 60% of Safe Harbor clients will move into permanent, transitional or supportive housing. OUTCOME 3: 75% of clients identified as having mental health needs will receive referrals to mental health services. OUTCOME 4: 75% of clients identified as having substance abuse issues will receive referrals to AOD s 13A. Assessment of Need - Redwood City: Briefly describe how you determined the need for your program for each specific jurisdiction that you are applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. As the average rent for an apartment ii i Redwood City reaches record highs ($2,662 in January 2016 according to zumper.com), high unemployment among our target population and rising rents continue to be a factor in the rate of homelessness. The lack of affordable housing in the County is a formidable obstacle that is increasingly preventing our homeless clients from locating permanent housing. The county's housing crisis is impacting a diverse set of populations, and many of our newly homeless are seniors and younger people. 50% of our clients are new clients who are staying at Safe Harbor for the first time. This influx of new clients is due in part to new client referrals and more effective collaboration between local Police Departments, HOT team outreach workers, and homeless services providers that have been effective in reaching the homeless who have been living on city streets. Safe Harbor serves homeless adults over 18 years of age from San Mateo County. The majority of homeless clients served by Safe Harbor are extremely low income. In the North County there are no other homeless shelters. There are motel voucher programs through IVSN; transitional housing through Caminar, and transitional housing for those with substance abuse issues through Catholic Charities and the Latino Commission. Safe Harbor is unique in the County because we accept homeless individuals under the influence unless they are a danger to themselves or others. 13B. Assessment of Need - County of San Mateo: Briefly describe how you determined the need for your program for each s eciflc 0urisdiction that you are appying for funds Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. As the average rent for an apartment in San Mateo County reaches record highs in the first quarter of 2015 - $2,680, an increase of httpJ/w ww. citydataservices. neUcities/ smatcalapp2016arc .pl?rpR= C4747&prop =52 218 1/25(2016 City Data Services - South San Francisco 13.6 % from the year before, high unemployment among our target population and rising rents continue to be a factor in the rate of homelessness. The lack of affordable housing in the County is a formidable obstacle that is increasingly preventing our homeless clients from locating permanent housing. The county's housing crisis is impacting a diverse set of populations, and many of our newly homeless are seniors and younger people. 50% of our clients are new clients who are staying at Safe Harbor for the first time. This influx of new clients is due in part to new client referrals and more effective collaboration between local Police Departments, HOT team outreach workers, and homeless services providers that have been effective in reaching the homeless who have been living on city streets. Safe Harbor serves homeless adults over 18 years of age from San Mateo County. The majority of homeless clients served by Safe Harbor are extremely low income. In the North County there are no other homeless shelters. There are motel voucher programs through IVSN; transitional housing through Caminar; and transitional housing for those with substance abuse issues through Catholic Charities and the Latino Commission. Safe Harbor is unique in the County because we accept homeless individuals under the influence unless they are a dangert 13C. Assessment of Need - South San Francisco: Briefly describe how you determined the need for your program for each s ecific jurisdiction that you are applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. As the average rent for an apartment in South San Francisco reaches record highs ($2,621 in January 2016 according to zumper.com), high unemployment among our target population and rising rents continue to be a factor in the rate of homelessness. The lack of affordable housing throughout the County is a formidable obstacle that is increasingly preventing our homeless clients from locating permanent housing. The county's housing crisis is impacting a diverse set of populations, and many of our newly homeless are seniors and younger people. 50% of our clients are new clients who are staying at Safe Harbor for the first time. This influx of new clients is due in part to new client referrals and more effective collaboration between local Police Departments, HOT team outreach workers, and homeless services providers that have been effective in reaching the homeless who have been living on city streets. Safe Harbor serves homeless adults over 18 years of age from San Mateo County. The majority of homeless clients served by Safe Harbor are extremely low income. In the North County there are no other homeless shelters. There are motel voucher programs through IVSN; transitional housing through Caminar, and transitional housing for those with substance abuse issues through Catholic Charities and the Latino Commission. Safe Harbor is unique in the County because we accept homeless individuals under the influence unless they are a danger to themselves or other 14. Timeline: Provide a brief timetable for project implementation and achievement of projected goals and how you plan to expend your funds in a timely manner by the end of the fiscal year. Safe Harbor is an ongoing, continuing program, open to San Mateo County's homeless population, 24 hours a day, 7 days per week. Therefore, we do not foresee any obstacles to implementing our project workplan as described, fully achieving our projected goals, and fully expending our contracted funds by the end of the fiscal year ending June 20, 2017. 15. Evaluation: Briefly describe how you will determine and measure the success of your program and whether or not program goals were met? if your program is currently receiving grant funds please describe accomplishments of goals to date. Samaritan House utilizes a mix of process and outcome evaluation strategies to capture meaningful objectives and outcomes for our various programs, including Safe Harbor. In addition to utilizing required external funder -driven databases, we currently maintain internal databases to track and provide information about all of our clients and services. Safe Harbor complies with all data collection and reporting requirements required by our funders. The Shelter uses Clarity Plus for capturing and managing client data, and keeps case management files. Safe Harbor serves homeless adults from across San Mateo County, annually providing services for about 397 unduplicated homeless adults (in fiscal year 2015). Evaluation results are used in ongoing review and revision of program delivery, and recommendations formulated as a result of evaluation efforts are incorporated into the program planning process. We continue to adapt and modify our services in order to more effectively meet our clients' needs and expectations. We share evaluation results, and lessons learned with our executive team, board, and funders as required through regular program reports. Accomplishments to date include: exceeded mid -year contract outcomes for the City of Redwood City, City of South San Francisco and County of San Mateo. 16. Collaboration: Describe partnerships with other organizations /agencies, the nature of the partnership, and how it relates to the proposed project. To effectively work with the most challenging homeless population in the County, Samaritan House leverages its resources and ensures timely and relevant services for its clients through close collaborations with local nonprofits and government agencies. Some of our many collaborations include: — Transportation for shelter clients provided by SamTrans. — Nutritious meals served at the shelter provided by the Samaritan House Food Program in partnership with Second Harvest Food Bank. httpJ/www.citydataservices.net/ cities/ smatca /app2016arc.pl?rpt= C47478pxop =52 318 1/25/2016 City Data Services - South San Francisco — Formal collaborative work with County SEAL team to expedite application process for SSDI and SSI benefits. —On site dental services provided every other week by the County Mobile Dental Van, — Employment resources at Peninsula Works. —Basic healthcare provided twice a week onsite through the County Public Health Clinic, —Basic mental healthcare provided weekly onsite through County Behavioral Health Services. — Project Sentinel provides advocacy around housing discrimination for homeless and low- income tenants that are facing discrimination and rental issues such as repairs, privacy, deposits and rental disputes. — HealthRight 360, a new integrated care organization, provides mental health and substance use disorder treatment in an outpatient setting in San Mateo to offer free individual and group counseling for the low- income. These are only a few of the many collaboration and partnerships in place to support the ongoing needs of the homeless residents o 17. Impact:: Discuss any general trends and conditions that have affected or impacted your service levels or service populations. For New Applicants — describe what these funds would allow your agency to do that you may not be able to do now. For Continuing Applicants — describe how your program would be impacted without these funds. Safe Harbor houses San Mateo County's most difficult to serve homeless population who have multiple barriers to self - sufficiency, including fixed income due to age or disability, poor general health and low education levels. The rising cost of area rents and the increasing lack of affordable housing have severely impacted the ability of our clients to achieve permanent housing placements, While we continue to identify and successfully place clients into non-traditional housing options, including HIP Housing's Homesharing Program, and successfully help clients attain housing vouchers, a contributing factor is that increasingly, fewer landlords countywide are accepting housing vouchers, which is impacting the availability of affordable housing for our clients. This dearth is due to base rates for rentals being so high and the huge gap between base rents and fair market rent. Given the economic trends that are adversely affecting our service population, our program would be tremendously affected by any loss or decrease in CDBG funds that are an integral part of Safe Harbor Shelter's budget. Without these funds we cannot assure the same level of service we have historically provided to all of the County's homeless adults seeking our help. In response to the ongoing housing crisis, Samaritan House participates in the County's Homeless Systems Redesign project and continues to advocate for our clients at various forums led by housing advocacy groups, agencies, and 18. Project Beneficiaries/Quantifiable Measurement,: indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. 19. Project Beneficiaries /Quantifiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. a. Indicate the total number of low-income beneficiaries you expect to serve with this program for each jurisdiction application for funding. *Low-income is 80% of Area Median Income or below. See AMI table b. Indicate the total number of beneficiaries you expect to serve with this program in each jurisdiction - regardless of income. Jurisdiction a. Number of low- income beneficiaries to be served per grant jurisdiction application. * *Low- income*" is 80% of Area Median Income or below. b. All beneficiaries to be served per grant jurisdiction application regardless of Income _ Persons Persons Daly City 100% 57 Redwood City _ 40 40 City of San Mateo 24 42.11% County of San Mateo 358 358 South San Francisco 63 63 otals 1 461 1 461 19. Populations Served: Check the boxes below if they describe a significant population served by your program. These categories are not considered "presumed benefit" by HUD, and require income verification. Persons exiting incarceration Low- income youth F Other 20. Affirmative Outreach: a. Use the demographics from your previous program year to provide an analysis of the population you serve relative to the demograohics in the table. NOTE: If you are a new applicant nlease nmvlrla vnrir heat nefimatinn Race & Etitnici Redwood City Population Redwood City % by Ethnicity Low Income b y Ethnicity served by our Program Your Program °h by Ethnicity Total 74,40 100% 57 100°/ White and not Hispanic 40,6 54.64% 24 42.11% http: //www.citydataservices.net/ cities/ smatca lapp2Ol6arc.pl?rpt= C4747Wop =52 4/8 1/25/2016 City Data Services - South San Francisco White and Hispanic 23,55 31.66% 16 28.07% Asian 6,71 9.03% 1 1.75% African American 1,91 2.58% White and not Hispanic 0.00% Pacific Islander _ 6631 0.89% 53.51% 0.00% Native American IRAI 0.52% 1 1.75% Other: 1,511 2.03 ° / 1 26.32% Race & Ethnicity South San Francisco Population Sour San Francisco % by Ethnicity Low Income by Ethnicity served by our P ram Program % Y by Ethnicity Total 63,63 100% 1851 100% White and not Hispanic 23,7 37.34% 991 53.51% White and Hispanic 21, 34.02% 3 17.84% Asian 23,29 36.61% 1 6,49/ African American 1,6251- ,62 2.550/6 2 15.14% Pacific Islander 1,111 1.75% Eric Brown 1.08% Native American 391 0.62% 1 0.54% Other 9,59 15.080% 1 5.41% b. Based on the percentages that you indicate your organization served describe your efforts to improve affirmative outreach to groups that may be underserved by your program and the result of your efforts: In existence since 1974, Samaritan House bolsters its accessibility by regularly: • Providing local agencies with information about its services in both English and Spanish; • Securing opportunities for stories in local English and Spanish language newspapers and other media; • Securing opportunities to speak to local service organizations (i.e., Rotary, Lion's) • Participating in local community celebrations /fairs; • Reaching out to agencies outside the mainstream of "Safety Net Services'; and • Reaching out to bilingual service providers to establish cross - referral relationships. 21. Leveraging: Describe your fundraising efforts and additional sources of revenue for this project and your organization. Please state whether any of these fund sources are already committed and in what amount. Samaritan House's Development Department raises grant funding from foundations, corporations, and government entities; forges partnerships with local businesses and community groups; holds fundraising events; cultivates donors in the community; and conducts large scale direct mail appeals to support the agency's operations. Besides CDBG funds from the City of Redwood City, City of South San Francisco and County of San Mateo, Samaritan House receives government funding from the HUD Continuum of Care Program ($107,000); FEMA Emergency Food and Shelter Program ($52,000); City of San Mateo ($15,000); City of Burlingame ($5,000); San Mateo Medical Center Healthcare for the Homeless Program ($55,000), County of San Mateo BHRS ($90,95), County of San Mateo Measure A Funds ($200,000),and County of San Mateo General Funds ($375,017). We also receive private support for Safe Harbor from foundations such as the Gellert Foundation, Union Bank Foundation, and other family foundations. Staff List List below kev staff members who work on this oroaram Position Titre Name of Staff Person .lob Responsibilities Qualifications Serves as Shelter Associate Director. Responsible for the years experience at Samaritan House. GED. Associate n e Rodriguez g anagement, administration and supervision of staff Some college, AOD Director associated with intake and assessment, client services, Studies. Prior experience rogramming, facility and data operations. with shelter programming and services. Serves as Shelter Associate Director, Operations. 10 years experience at Responsible for the management, administration and Samaritan House. GED. Associate Eric Brown upervision of case management services, programming, Some college, Human Services. Prior Director afety and compliance. Directly supervises all case anagement staff and ensures the overall operational experience with shelter ompliance related to case management. programming and services. Health Serves as Mental Health Case Manager. Provides 3 years experience at Case Julia Parmer assessment, case plan development, life skills Samaritan House. BA and MSW. 5 Manager programming and referral for homeless residents who have been identified with mental health issues. years experience in social work. Serves as the Intake Coordinator. Manages the day to 4 years experience at intake and orientation process. Supports shelter Samaritan House. HS Intake ocesses of entrance and exits and management of Py Diploma. Some college. ht tpJ/ www. citydataservices. nailcities/ smatcalapp2016arc .pl?rpt= C4747&prop =52 5/8 1/25/2016 City Data Services - South San Francisco Coordinatoi Rene Marino documents to support case management. Manages front Prior experience with Total Jurisdictions Budget Line Item desk operations, such as laundry, bed assignments, client shelter programming and Program Total % concerns/complaints, referral process. services. Assistant % Serves as Assistant Intake Coordinator. Assists in the 1 year experience at Intake Kevin Beel day to day intake and orientation process and front desk Samaritan House. B.S. Coordinator $55,81 operations. rom Notre Dame de 70% $38,81 0% Namur Universit 100 °l° $55,81 Serves as Program Aide. Coordinates the orderly 12 years experience at Program $30, Aeration of Safe Harbor Shelter and facilitates the Samaritan House. H.S. Diploma. Some college. Aide Gerald Winston delivery of shelter services to clients. This position also 100% $30,00 works with vendors and community support services to 18 years experience in 100 ° / $49,661 support client needs. counseling and AOD 31% $15,59 0% services. 31% $15,59 Serves as Program Aide. Coordinates the orderly 1 year experience at Program $33,65 operation of Safe Harbor Shelter and facilitates the Samaritan House. 9 Aide Kenya Malveaux Pelivery of shelter services to clients. This position also ears experience in 46% $15,60 orks with vendors and community support services to ter services. H.S. 100% $18,72 u ort client needs. ED lo ma. PROPOSED PROGRAM BUDGET FOR FY 2016 -17 -] Redwooa Mateo County of San ateo South San Francisco Total Jurisdictions Budget Line Item Agency Total Pgm °A Program Total % Requested % Requested % Requested =gm%uested Labor Case Manager EB $55,81 100% $55,81 30 °1° $17,00 70% $38,81 0% $ 100 °l° $55,81 Intake Coordinator CM $30,00 100% $30, 0°l 100% $30,00 0% 100% $30,00 Case Manager JP $49,661 100 ° / $49,661 0 °L° 31% $15,59 0% 31% $15,59 P ram Aide GW) $33,65 100 ° / $33,65 0% 46% $15,60 0°/ 46% $15,60 P ram Aide TG $18,72 100% $18,72 0% 0% 64% $12,00 64% $12,00 Other Salaries $3,497,991 16% $563,64 0% 0% 0% 0% $ axes /Benefits $921,61 14% $265,0 0 °i° 0% 0% 0% $ u lies Office Su lies $73,31 33% $10,5D 0% 0% 0 °/ 0% $ Program Supplies & Meals $442 I $144,69 $C O rations /Maintenance Occu anc $563,801 10% $2,14E: 0 °I 0% 0% 0% $ Utilities & Communications $222, 29% $21,20: 0% 0% 0°/ 0% $ Housekee in $62,29 36% $17,850: 0% 0% 0% 0% $ Outside Services & Prof Fees $420,73 13°/ $149,61 0% 0% 0% 0% $ Transportation & Conf $83,87 6% $10,9 0% 0 °/ 0 °/ 0% Fees and Taxes $70,54 5% $4,2 0% 0% 0% 0% $ Equipment Rental $41,96 0% $2,141 0°/ 0 °/ 0% 0% TZ Client Financial ssistance $831,76 $ D °i 0% 0% 0% $ 6% $ 0°/ 0% 0°/ 0% In -kind bus passes facilit $3,700,00 $231,0 $ dministration $146,11 16°/ $23,8 0% 0°/ 0% 0% TOTA $11,267,04 15°/ $1,634,76 1% $17,00 6% $100,00 1°/ $12,00 8% $129,00 umber of Individual Beneficiaries 4 35 6 461 Cost r Individual $425. $279.3 $190.4 $279.8 For the City of Redwood City ONLY, answer the following: For the City of Redwood City ONLY, answer the following: 1. Funding Criteria: 2. Homeless Assistance Activities: Provision of fair housing counseling services, provision of legal intervention to prevent homelessness, provision of operation funds for shared housing, emergency shelter and transitional housing httpJ/www.citydataservices. net / cities/ smatca/ app2016arc.pi ?rpt= C4747&prop =52 6l8 1/25✓2016 City Data Services - South San Francisco and related services for homeless and those at risk of homelessness, youth and single persons. 2. Marketing /Advertising a. Check all of the following methods your agency utilizes to promote and advertise your programs and services: i Flyers /brochures f-i Website ti : CIP (Handbook /Database) r e Outreach presentations to service providers :' Outreach presentations to public W PSA's b. Which of the above marketing/advertising materials are available in multi4angual form and which languages are they available in? Samaritan House makes every attempt to market its program services in multi-lingual formats by: — Providing local agencies with information about our services (program flyers are available in both English and Spanish); — Reaching out to bilingual service providers to establish cross - referral relationships. c. How and where are the materials distributed? Samaritan House makes every attempt to market its program services in multi-lingual formats by: — Providing local agencies with information about our services (program flyers are available in both English and Spanish); — Reaching out to bilingual service providers to establish cross - referral relationships. 3. Program Outcomes: a. Please describe the accomplishments of program goals for FY /15. Safe Harbor is Samaritan House's year -round shelter that provides emergency and transitional housing services for the homeless population of San Mateo County. Safe Harbor's primary purpose is to prcvide warmth, shelter, nutrition and access to supportive services to homeless individuals in a compassionate manner to meet their basic needs. Our outcomes for FY14/15 were as follows: OUTCOME 1: The shelter was at full capacity 98% of the time. OUTCOME 2: 63% of Safe Harbor clients moved into permanent, transitional or supportive housing. OUTCOME 3: 100% of clients identified as having mental health needs received referrals to mental health services OUTCOME 4: 100% of clients identified as having substance abuse issues received referrals to AOD services. b. In what ways has your program made a difference in the lives of the people you serve? Please provide at least one concrete example from the people served in FY /15: The following client story demonstrates the impact that Safe Harbor has made in the life of just one recent resident of the shelter. Christina grew up in Redwood City, and lived in and out of her parents' house for most of her teens and early twenties. She battled a severe drug addiction brought on by a traumatic incident with a former boyfriend. After her drug problem began to cause friction with her family, she decided to check herself into a program to get clean and sober and to be a more stable mother to her seven year old daughter. Christina enrolled in the Women's Recovery Association in February of 2015, and completed the 90 day program. She then went on to get a job, and she moved back in with her parents, while continuing to partake in WRA's outpatient aftercare program. in October, after she arrived at Safe Harbor, she was chosen for the Moving to Work Voucher that she had applied for while in treatment. Through diligent housing searches, Christina found a studio apartment that was willing to accept her voucher. While at Safe Harbor, Christina also spent every weekend visiting her daughter and her parents, and steadily worked to continue rebuilding those relationships. She also connected with San Mateo County's Behavioral Health Services and began to work on addressing her PTSD. After signing the lease on her new apartment, Christina obtained move -in funds, with the help of Samaritan House, through the SOS grant. Attachments hftp : //www.citydataservices.rret/ cities/ smatca lapp2016arc.pl ?rpt= C47478prop=52 7/8 1/25/2016 1. Resolution authorizing application and designation of signatory, by the Board of Directors 2. Proof of 501(c)3 / tax-exempt status 3. 3yiaws 4. Articles of Incorporation 5. Board roster, including: • Name, Company, Years on Board Meeting dates for previous 12 months • Number of years allowed for each board term Cihf Data Services - South San Francisco CDBG Resolution 121715pdf Samaritan House IRS 501c3 Determination Letter.odf Sarnadtan House Bylaws rev 061908 doc Samaritan House Articles of Incorooraticn revised 225971.doc Samaritan House Board List 2016 doc 6. Organizational chart for entire organization Proceed Orq_Chart 2015 5 14 15 pdf 7. Certified financial audit no more that 1 Samaritan House 6 30 2015 AUDITED Financials pdf fiscal year old, prepared by a CPA, and: • Management letters (if applicable) • A -122 and A -133 Single Audit (for entities that receive more than $500,000 in federal funding) OR © A letter from your Executive Director or Chief Financial Officer certifying that agency does not receive more than $500,000 in federal funds and is not subject to the Single Audit. (?-' 8. The following are required: • Current (FY15 -16) Agency Operating Budget • Proposed (FY16 -17) Agency Operating Budget i` 9. Mission Statement is 10. Non - discrimination policy for Staff and Clients Iii 11. Reasonable Accommodations Policy for Staff and Clients Samaritan House General Acoroved Budget Summary FY16 Ddf Pr000sed Budget Sam House FY1712df Samaritan House Mission Statement.doc Samaritan House Non - Discrimination Policy doc Samaritan House Reasonable Accommodations Policy doc �- 12. Conflict of Interest Policy. (If not Conflict of Interest Policy.docx 06e-1 Conflict of Interest Policy — available, please indicate when you will submit) Approved by the SH Board 022714.odf �.. 13. Other - Download All Attachments Program Manager Signature Amy Hsieh Date Signed 01/22/2016 Initially submitted: Jan 22, 2016 - 16:02:35 httplM ww.citydataseMces.nat/ cities/ SmatcWapp2016arc .pl ?rpt= C4747&prop =52 8/8 Samaritan House Total Operating Budget - Approved 6 -25 -2015 Fiscal Year FY16 (711 - 6130) FYI Proposed Budget FYE 6/30/2016 Income Individual Contributions 900,000 Business/Corp contributions 195,000 Government fees & grants 2,500,430 Government - Healthcare Districts 917,696 Foundation Contributions 1,500,000 Family Foundations 74,000 Community Org Contributions 50,000 Religious Org Contributions 35,000 Main Event (Net) 150,000 Earned Income 335,173 Interest Income 52,000 In - Kind Contributions 3,792,480 Net funds release from restrictions 150,000 Other funding 147,408 Samaritan House General Fund 198,083 Total Income 10,997,270 Expense Personnel Expenses Personnel 3,578,484 Benefits 402,702 Workers Compensation 193,214 Payroll taxes 298,853 Personnel Expenses 4,473,253 Operating Expenses Office Supplies 71,175 Program Supplies 355,740 Postage 19,670 Printing / design 54,050 Telephone 65,756 Utilities 114,597 Rent 117,152 Repairs and Maintenance 80,583 Housekeeping 60,483 Client Assistance (Gov't funded) 807,541 Advertising and Marketing 31,400 Recruitment 4,600 Travel, Meetings, & Conferences 30,130 License, Dues & Subscriptions 13,926 Mileage Reimbursement 13,764 Training and Education 22,063 Equipment Rental 40,743 Insurance 84,052 Fees / Taxes 10,266 Interest Expense 21,199 Professional Fees 54,450 Outside Services 354,034 Educ/Ref Materials 1,050 GasNehicle Expense 14,425 Temporary Staffing - Depreciation Expense 244,394 Other Fees and Charges 44,293 In -Kind Expenses 3,792,480 Sub Total Operating Expenses 6,524,017 Total Operating & Shared Expenses - Total Personnel and Operating 10,997,270 Net Income with Depreciation $ 0 Samaritan Mouse Preiiminary Proposed Operating Budget Fiscal Year FY17 (7/1 - 6130) Income Individual Contributions Buslness/Corp contributions Government fees & grants Government - Healthcare Districts Foundation Contributions Family Foundations Community Org Contributions Religious Org Contributions Main Event (Net) Earned Income Interest Income In - Kind Contributions Net funds release from restrictions Other funding Total Income Expense Personnel Expenses Personnel Benefits Workers Compensation Payroll taxes FY 17 Proposed Budget FYE 6/3012017 950,000 200,850 2,575,443 945,227 1,545,000 76,220 75,000 36,050 154,500 345,228 53,560 3,700,000 275,000 330,000 11,262,078 3,685,839 414,783 199,010 307,819 Personnel Expenses 4,607,451 Operating Expenses Office Supplies Program Supplies Postage Printing / design Telephone Utilities Rent Repairs and Maintenance Housekeeping Client Assistance (Gov't funded) Advertising and Marketing Recruitment Travel, Meetings, & Conferences License, Dues & Subscriptions Mileage Reimbursement Training and Education Equipment Rental Insurance Fees /Taxes Interest Expense Professional Fees Outside Services Educ/Ref Materials Gas/Vehicle Expense Depreciation Expense Other Fees and Charges In -Kind Expenses Shared Operating Expense Sub Total Operating Expenses Total Personnel and Operating 73,310 366,412 20,260 55,672 67,728 118,035 120,667 83,001 62,298 831,767 32,342 4,738 31,034 14,344 14,177 22,725 41,966 86,574 10,574 21,835 56,084 364,655 1,082 14,858 251,726 45,622 3,700,000 146,112 6,659,594 11,267,045 Net Income $ (4,967) 1/25/2016 City Data Services - South San Francisco Consolidated Community Funding Application Redwood City, San !Mateo County, and S. San Francisco Application for New Funding for FY 2016 -17 GENERAL INFORMATION 1. Organization Name: StarVista 2. Project Tillie: Transitional Housing Placement Plus e are applying for funding from: ; Redwood City City of San Mateo a South San Francisco z County of San Mateo Budget/Client Summa (Auto-populated from Bud et, below Jurisdictions receiving this application Amount Requested % of Program Budget Proposed # of % Of Served Served Total $ Per South San Francisco $10,0 3% 1 100°/ $666.6 Total $10,00 3% 1 100°/ $666.67 Grant Funded Programs: We are applying for a Public Services Program CDBG Nationai Objective Eligibility - How are you serving low income populations? Service to "presumed benefit' groups listed below (income verification not required, but verification of presumed benefit status is required): Abused children If Homeless persons Victims of domestic violence Illiterate adults Elderly persons /seniors (age 62 +) Persons living with AIDS Severely disabled adults Mi rant farm workers Income Verification: Describe how you obtain, verify, and maintain prof of income and presumed benefit status. Third party documentation or client signatures on the certification forms must be available on file for review at all times. Verification of income will be verified by pay stubs, W -2 tax forms, income tax returns, report of benefits, pensions or other available verification of income. If no documentation is available, StarVista will accept self- certification with a signed statement of income. 3. Project 701 Grand Ave City: South San Francisco Zip: 94080 -2553 Address: 4. Provide a one sentence project summary: Subsidized apartments in South San Francisco and case management services for emancipated foster youth aged 18-25, in addition to essential life skills training and assistance finding employment or attending school. Organization 610 Elm Street Suite City: San Carlos Address: 212 Organization 650 -591 -9623 Website: www.star- vista.org Phone: Type of Applicant Our agency serves: 5. Contact Person Name: Peter Ehrhom & i Project Robin Rudikoff Title: Department Director Administrator: robin. rudikoff @star- vista.org; Contact Email: peter. ehrhorn@ star- Fax: vista.org Zip: 94070 -3070 Telephone: 650 - 591 -9623 http: //www.citydataservices.neN cities/ smatca /app2016arc.pl ?rpt= C4538&prop =121 1/5 1/25/2016 City Data Services - South San Francisco S. Name of Sara Larios Mitchell, Ph.D. Agency Director: Name: Dianette Email: dwasher @star - vista.org; 7. Fiscal Officer: Washer, CFO & Jill jill.kingery@star - vista.org; Telephone: 650 - 591 -9623 Kingery, AR Director robin.rudikoff @star - vista.org Fiscal Officer 610 Elm Street Suite City: San Carlos Zip: 94070-3070 Address: 212 8. Authorized Name: Sara Larios Email: smitchell @star - vista.org Signatory: Mitchell, Ph.D. Authorized 610 Elm Street Suite City: San Carlos Signatory Address: 212 9. Please provide days and yours of regularly scheduled operation: Apartments are available to residents 24/7. Staffing is available on -site: Monday, Tuesday 12am- 4am and 10am -6pm and 8pm -12am Wednesday 12am -4am and 4pm- midnight Thursday 12am-4am and 12pm -6pm and 10pm -12am Friday 12am -6am and 10am -2pm and 4pm -6pm and 10pm -12am Saturday /Sunday fpm -ham 10. DUNS Number: Federal EIN/TIN Number: Telephone: 650- 591 -9623 Zip: 94070 -3070 11. HUD Activity: Choose the HUD activity that most closely matches your service: 05D - Youth Services 12. Project Specific Narrative: Provide a narrative description of the specific activities to be carried out with the requested funds. This should also include program objectives and key priorities for each specific jurisdiction. We are seeking funds for our Transitional Housing Placement Plus (THP +) program that serves emancipated foster youth aged 18- 24. The program serves approximately 18 youth each year (including parenting youth) with safe and stable living accommodations for up to two years (cumulative) with, among other options, a three -unit apartment complex in South San Francisco. Our counselors provide basic life skill building, consumer education and instruction in budgeting, the use of credit, housekeeping, menu planning, food preparation and parenting skills; educational opportunities such as GED preparation, post - secondary training and vocational education; assistance in job preparation and attainment, career counseling and job placement; interpersonal skill building, to enhance young peoples abilities to establish positive relationships with peers and adults, make decisions and manage stress, and mental health and physical health care. Youth are provided with a matched savings account that they receive upon completion; a stipend for groceries and transportation. Our program is strength- based, holistic, and individualized, and starts with an assessment and Transitional Independent Living Plan, developed at intake, based on each youth's needs and goals. We use a positive youth development approach which has been proven to prevent risky behavior and give young people the chance to exercise leadership, build skills and become involved in their communities. 13. Assessment of Need - South San Francisco: Briefly describe how you determined the need for your program for each specific jurisdiction that you are applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. THP+ is the only program of its kind, specifically tailored to emancipated foster youth, serving South San Francisco and the community. Homeless and former foster youth have an elevated risk for a variety of mental health problems, and a history of foster care correlates with becoming homeless at an earlier age and remaining homeless for a longer period of time. As victims of abuse or neglect, these youth can't return to their families but they are not equipped to live on their own. They have to work to support themselves, often without having a high school degree. They have to seek their own role models rather than leaning on parents. Many use drugs or participate in survival sex for food or shelter. Our THP offers safe and stable housing, independent living skills training, and supportive services to help them stay in and complete high school, access health care, obtain job training, and receive mental health support. The programs break the cycle of homelessness among these youth, connects youth to community resources and promotes personal economic stability. Research has shown that 82% of youth who enter transitional living programs like ours make the transition to positive independent living rather than to homelessness. The Corp for Supportive Housing and the John Burton Foundation have established that supportive housing and independent living skills training are effective and necessary in assisting these youth in making successful transitions to independence. 14. Timeline: Provide a brief timetable for project implementation and achievement of projected goals and how you plan to expend your funds in a timely manner by the end of the fiscal year. THP+ is an ongoing program operating year -round and will not require any start-up time for implementation. StarVista has a lengthy track- record of efficient spend -down of CDBG and other funding. If awarded, StarVista will draw down CDBG funding each month, for 10 months, consistent with actual expenses incurred. THP+ has a strong history of meeting projected goals and anticipates a continued level of service excellence in 2016 -17. 15. Evaluation: Briefly describe how you will determine and measure the success of your program and whether or not program goals were met? If your program is currently receiving grant funds please describe accomplishments of goals to date. http: //www.citydataservices. net/ citeslsmatcalapp2016arc .pl?rpt= C4538&prop =121 215 U25/2016 City Data Services - South San Francisco Evaluation methods to measure success include pre and post youth development asset gains surreys; Ansel -Casey Life Skills assessments; client self - evaluations and clinicians' assessments of client progress. Most of our direct service measures are tracked through the national Runaway and Homeless Youth Management Information System(RHYMIS). We also evaluate success through our internal data monitoring and evaluation. Data on participants' progress towards education and work goals are noted in individual case files and in our database for tracking against annual goals. Client data is collected and stored in Efforts to Outcomes (ETO) software. ETO is a secure, web -based performance management data base that is accessed for tracking and reporting purposes. In 14/15, the following outcomes were achieved. 100% of participants maintained /stabilized housing (goal: 85 %), 100% of youth were attending /school or utilizing staff /resources toward academic achievement (goal: 88 %), 100% of participants were connected to community resources around food, legal services, financial aid, IDA banking, and more (goal: 95 %). 16. Collaboration: Describe partnerships with other organizations /agencies, the nature of the partnership, and how it relates to the proposed project. Our transitional housing placement plus program is the only one of its kind in our County. Youth served by THP+ face many challenges and their need for support extends beyond services provided by StarVista. We are fortunate to collaborate with a number of partners to provide services for our clients. In addition to educational agencies (community colleges, Guardian Scholar's Programs) and vocational programs like JobTrain, these include Project Outlet in Mountain View, which support LGBTQ youth; Freedom House (for survivors of human trafficking), Asian American Recovery Services, the Youth Bereavement Program, Sequoia Counseling Services, the Rape Trauma Center, CORA (Community Overcoming Relationship Abuse), Standing Against Global Exploitation (SAGE), which works with youth traumatized by sexual exploitation and prostitution; El Centro Substance Abuse Services, Al Anon family groups, Friends for Youth Mentoring Services, and the Youth Services Bureau. We connect you to health providers such as San Mateo Medical Center, Keller Center Family Violence Intervention Center and Daly City Youth Health Center, and food and shelter services such as Second Harvest Food Bank and Samaritan House. 17. Impact:: Discuss any general trends and conditions that have affected or impacted your service levels or service populations. For New Applicants — describe what these funds would allow your agency to do that you may not be able to do now. For Continuing Applicants — describe how your program would be impacted without these funds. In Califomia, 65% of youth leaving foster care do so without a place to live. Fourier foster youth face disproportionately higher rates of dependence on public assistance, incarceration, unemployment, substance abuse and mental health disorders. Over 70% of all State Penitentiary inmates have spent time in foster care. These youth make the transition to adulthood alone and un- served. They remain largely unclaimed, falling through the cracks. Poverty is pervasive and families struggle to meet their basic needs. Because the cost of housing is so high, families respond by doubling and tripling up in studio apartments or they seek shelter in substandard dwellings such as garages and storage sheds. Youth stay away from home to avoid overcrowded conditions and many describe lining up on whatever floor space is available to sleep at night. Funds would allow us to serve more needy youth, avoid placing youth on a waitlist and run our program at full capacity. 18. Project Beneficlaries/Quantifiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. 19. Project Beneficlares/Quantifrable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. a. Indicate the total number of low-income beneficiaries you expect to serve with this program for each jurisdiction application for funding. '"Low-income is 80% of Area Median Income or below. See AMI table b. Indicate the total number of beneficiaries you expect to serve with this program in each jurisdiction - regardless of income. Jurisdiction a. Number of low-income beneficiaries to be served per grant jurisdiction application. "Low-income* is 80% of Area Median Income or below. b. All beneficiaries to be served per grant jurisdiction application regardless of income Persons Persons Daly City 5 g Redwood City 0 0 City of San Mateo 5 5 County of San Mateo 15 15 South San Francisco 15 15 otals 40 40 19. Populations Served: Check the boxes below if they describe a significant population served by your program. These categories are not considered "presumed benefit" by HUD, and require income verification. .? Persons exiting incarceration d Low- income youth ',e Other homeless youth; emancipated foster youth 20. Affirmative Outreach: http: //www.citydaWervices.neV cities/ smatca lapp2016arc.pi?rpt= C4538&prop =121 3/5 V25J2016 City Data Services - South San Francisco a. Use the demographics from your previous program year to provide an analysis of the population you serve relative to the demographics in the table. NOTE: ff ou area new apo icant Please provide your best estimation Race & Ethnlcity South San South San Francisco Francisco % by P ulatlon Ethnicit LurPM Income by city served am Your P ° by Ethnicity /o otal 63,6 10 0% 1 100% White and not Hispanic 23,7 37.34% equeste 25.00% White and Hispanic 21, 34.02% 18.750/0 Asian 23,2931 36.61% 01 0.00°/ African American 1,6251 2.55% 81 50.000 Pacific Islander 1,1111 1.75% Operations/Maintenance 0.000 Native American 39 0.62% $54,83 % 0,000 her _ 9,59 15.08% i 11 6.250 b. Based on the percentages that you indicate your organization served describe your efforts to improve affirmative outreach to groups that may be underserved by your program and the result of your efforts: We use various strategies to ensure that we reach all ethnic backgrounds. This includes recruiting a diverse group of student and adult volunteers; actively recruiting for bilingual and Spanish- speaking volunteers; maintaining strong relationships with community - based workers; having materials available in Spanish as well as English; and maintaining an up-to -date list of Spanish - speaking referral resources so that clients can receive services in their own language. Many staff and volunteers are bilingual. We work with the Lifeline Spanish language network to meet their requirements for sharing Bay Area calls and having a dedicated Spanish line. We have served the community for the past 36 years by addressing issues that disproportionately affect the health and well -being of children, youth and families in the lower socio-economic strata, those without insurance and those from communities of color, which may be the reason we serve a lower percentage of Caucasian and Asian clients. In addition, according to kidsdata.org, a majority of children in foster care in San Mateo County are African American, Latino /a and Caucasian. 21. Leveraging: Describe your fundraising efforts and additional sources of revenue for this project and your organization. Please state whether any of these fund sources are already committed and in what amount. Our Youth Supportive Housing programs have been in existence for over 30 years and we would continue to sustain the program after funding from CDBG ends. StarVista is a large multi - service agency with a diversified funding base and we have over 37 years of experience in maintaining programs as grant sources change. We have had the opportunity to implement numerous grants over the years, allowing an array of creative and effective services, including receiving consecutive years of federal grants from the Family and Youth Services bureau, Staff List List below key staff members who work on is program Position Tide Name of Staff Job Responsibilities Qualifications Person Department Director Peter Erhom Supervise Program Mgr; Ensure high quality ILMFT Manager ITina LaPede ISupervise staff and counselors PROPOSED PROGRAM BUDGET FOR FY 2016 -17 httpJ/ www. citydataservices. neVeittes/ smatcalapp2016arc .pl ?rpt= C4538&prop =121 4/5 South San Francisco I Total Jurisdictions Budget Line Item Agency P,,% P Togtalm % Requeste Pgm% equeste Labor Total Staff $7,381,76 2%1$168,57515%1 $7,93 524 $7,93 axes /Benefits 1 $1,919,26 100/6 $43,83010%1 $2,06 00/6 $ u lies P ram Supplies $35,27 $3,60 $ Materials Office Supplies $70,34 $1,03 $ Operations/Maintenance Client Costs $497,1731 1% $54,83 % 0% $ Employee Related Expenses $358,2 2% $5,05 % 0% $ Facilities & Equipment: Office Rent /M ai ntenance/U tilities /Secudt $816,67 14% $17,61 % 0% $ Tele hone /Posta elPrintin $120,274 6% $16,39 % 0% $ httpJ/ www. citydataservices. neVeittes/ smatcalapp2016arc .pl ?rpt= C4538&prop =121 4/5 1/25✓2016 City Data Services - South San Francisco Professional Services & Fees $281, 0% $16,99 %1 000/4 $ Americo s /r� IntemsNolunteers $19,1 3% $ % 0% $ Other /Misc. $50,98 $1,3 $ Administration $1,386,0861 3% $44,89710% 0% TOTA $12,936,8001 3 %. $374,14 % $10,00 3% $10,00 Number of Individual Beneficiaries 151 1 ost per Individual -$6W.6-1-- 666.6 $666.6 Attachments i 1. Resolution authorizing application and designation of signatory, SSF CDBG Board Resolution Ddf by the Board of Directors +s' 5. Board roster, including: 2016 CDBG Board Documentation pdf • Name, Company, Years on Board • Meeting dates for previous 12 months • Number of years allowed for each board term < . 6. Organizational chart for entire organization o chart 12- 14-15. df Fe, 7. Certified financial audit no more that 1 fiscal year old, prepared byAudit 13- 14.1?df a CPA, and: • Management letters (if applicable) • A -122 and A -133 Single Audit (for entities that receive more than $500,000 in federal funding) OR • A letter from your Executive Director or Chief Financial Officer certifying that agency does not receive more than $500,000 in federal funds and is not subject to the Single Audit. w) 8. The following are required: • Current (FY15 -16) Agency Operating Budget • Proposed (FY16 -17) Agency Operating Budget 9. Mission Statement d. 10. Non - discrimination policy for Staff and Clients 11. Reasonable Accommodations Policy for Staff and Clients StarVista Proposed Operating Budgets 15- 16 16- 17.odf Mission Values.pdf StarVista Non - Discrimination Policy doc Reasonable Accomodations Policy pdf 12. Conflict of Interest Policy. (If not available, please indicate whenConflict of Interest Policy 2016 pdf you will submit) -' 13. Other - Download All Attachments Program Manager Signature Robin Rudikoff Date Signed 01/22/2016 Initially submitted: Jan 22, 2016 - 14:24:21 http: /Mrww.citydataservic:es. net / cities/ smatcalapp2016arc .pl?rpt= C4538&prop =121 515 St a r 1,list OPERATING BUDGET July 1, 2015 to June 30, 2016 REVENUE ;Cities'' ---'-----------~--'--- --- -------------------------'-- �-------�----�--'--�'--- -----`���� , � 'First S San K4�teoCounty _- � $ 10,298,340 | 1,5��1,S4% � ![muntyofSanK8a1eo:Human3erv�esAgenq�Pnubo�on,Po|�eDe�s, ---' --� ',Health K4ea�ureA -------- - ' ---- --------- --------'---'---_— | � --,�' Federal Grant- Dept. of Health and Human Services _��c 2 0 0, 066 Fees for Services 812,138 ;Fundraising- Individuals and Events '6 -3 0, 6-0, 0- .Foundations/Corporate Grants $ 665,300 'School Contracts $ 482,692 .Board approved investment from reserve �Other Income/Miscellaneous $ 12,560,000 TOTAL REVENUE� 12;560,000 EXPENSES Personnel 'Salaries, benefits, payroll taxes, workers comp. $ 10,298,340 bperating Employee Costs & Mileage Reimbursement 1 $ 347,810 Facilities & Equipment: Office Rent/Maintenance/Utilities/Security $ 812,138 ,;Americorps Workers/interns/Volunteer Costs Professional Services & Fees 302,470 Client Costs: Rent/Uti lities/Food/Tra ns portatio n/D rug testing/Other $ 482,692 TOTAL EXPENSES $ 12,560,000 StarIvIlista PROPOSED OPERATING BUDGET July 1, 2016 t0 June 30, 201.7 REVENUE Cities $ 60,422 First 5 San Mateo County _ 1,598,088 County of San Mateo: Human Services Agency, Probation, Police Depts., °Health System, Measure A . -._... _.. $ 8,277,671 ;Federal Grant - Dept. of Health and Human Services -: . . j p ; $ �- 206,000 Fees for Services $ ' 77.7__-8- Fundraisin g Individuals and Events $ _1...5 648,900 9 ;Foundations /Corporate Grants J ;$ �p 685,259 a School Contracts 595,855 Board approved investment from reserve . .- ._ . . $ 61,800 Other Income /Miscellaneous $ 24,990 TOTAL REVENUE $ 12,936,800 EXPENSES Personnel Salaries, benefits, payroll taxes, workers comp. $ 10,607,290 Operating Supplies / Telephone /Internet /Printing /Postage $ 255,904 Employee Costs & Mileage Reimbursement $ 358,244 '. Facilities & Equipment Office Rent /Maintenance /Utilities /Security $ 836,502 ;Americorps Workers /Interns /Volunteer Costs $ 58 19,1 ,1 `Professional Services & Fees $ 311,544 Client Costs: Rent/ Utilities /Food/Transportation /Drug testing /Other $ 497 173 Other /Misc.. _..� 50,985 , TOTAL EXPENSES $ 12,936,800 U2512016 City Data Services - South San Francisco Consolidated Community Funding Application Redwood City, San Mateo County, and S. San Francisco Application for New Funding for FY 2016 -17 GENERAL INFQRK4ATION 1. Organization Name: Ombudsman Services of San Mateo County, Inc 2. Project Title: Ombudsman Services of San Mateo County, Inc We are applying for funding from: ,e Redwood City O' City of San Mateo 0 South San Francisco County of San Mateo Budoet/Client Surnmary (Auto- nonulated frnm Rudnaf hainw) Jurisdictions receiving this application Amount Requested % of Program Budget Proposed # of Served % of Served Total $ Per Redwood City $15, 2% 851 33°J $176.4 City of San Mateo $15, 2% loci 39% $150.0 South San Francisco $15,00 1 2% 7 29% $202.7 [Total $45,00 -5-/.l 2591 100o/ $173.7 Grant Funded Programs: We are applying for a Public Services Program CDBG National Objective Eligibility - How are you serving low income populations? Service to "presumed benefit' groups listed below (income verification not required, but verification of presumed benefit status is required): Abused children Homeless persons Victims of domestic violence Illiterate adults Elderly persons /seniors (age 62 +) Persons living with AIDS d Severely disabled adults Migrant farm workers Income Verification: Describe how you obtain, verify, and maintain proof of income and presumed benefit status. Third party documentation or client signatures on the certification forms must be available on file for review at all times. Our clients are presumed benefit under CDBG rules. 3. Project Address: 711 Nevada Street City: Redwood Zip: 94061 -1555 City 4. Provide a one sentence project summary: Ombudsman Services provides advocacy to 8,863 residents in 526 long-term care facilities in San Mateo County and receives complaints made by or on behalf of residents, investigates and brings resolution to those complaints which may range from something as simple as cold coffee through egregious abuse. Organization Address: Organization Phone: 711 Nevada Street 650 780 5707 Type of Applicant: Non - Profit Our agency serves: 5. Contact Person / Project Administrator: Contact Email: 6. Name of Agency Director: Name: Tippy Irwin ossmc @ossmc.org Tippy Irwin City: Redwood Zip: 94061 -1555 City Website: www.ossmc.org Title: Executive Telephone: 6.50 780 5702 Director Fax: 650 - 3645399 http: /Mww.citydataservices.neti cities/ smatca/ app2016arc.pl ?rpt= C4521&prop =21 1/8 1/25/2016 City Data Services - South San Francisco 7. Fiscal dicer: Name: Bob Montevaldo Email: Telephone: 650 780 5707 ossmc @ossmc.org Fiscal Officer Address: 711 Nevada Street City: Redwood Zip: 94061 City 8. Authorized Signatory: Name: Tippy Irwin Authorized Signatory 711 Nevada Street Address: 9. Please provide days and hours of regularil Monday through Friday 8:30 am to 4:00 pm 10. DUNS Number: 178766965 Email: Telephone: 650 - 780 -5702 ossmc @ossmc.org City: Redwood Zip: 94061 -1555 City f scheduled operation: Federal EIN/TIN Number: 943397402 11. HUD Activity: Choose the HUD activity that most closely matches your service: 05A - Senior Services 12. Project Specific Narrative: Provide a narrative description of the specific activities to be carried out with the requested funds. This should also include program objectives and key priorities for each specific jurisdiction. OSSMC performs advocacy work with the 8,863 frail elderly and developmentally disabled individuals that reside in the county's 527 long term care facilities. We advocate for the health, safety and dignity of these residents and for broader changes in the system. We work to combat negligence and abuse, fraud, violations of residents' rights, and other serious issues plaguing the LTC industry by using highly - trained, skilled volunteers to monitor facilities and investigate complaints.. OSSMC has set four primary goals for FY 2016 -17. They are: 1. Achieve 82% of the agency's facility coverage plan, which calls for a minimum of 4,750 unscheduled visits overall in the County; 853 visits to 136 facilities in SM, 413 visits to 61 facilities in RWC. and 364 visits to 75 facilities in SSF. We also strive to visit each of the adult residential and intermediate care facilities that serve DD clients at least once per year. 2. Investigate 1,500 complaints and resolve 90% of all cases to the satisfaction of the residents. In this manner we will serve the following unduplicated individuals in each of the cities -100 inSM - 85 in RWC - 74 in SSF 3. Community education includes the following: - 12 inservice education sessions for facility staff on issues related to resident care - 150 consultations with facility staff re resident care - 350 consultations to individuals on issues re issues related to aging & choosing a facility for a loved one. -3 13A. Assessment of Need - Redwood City: Briefly describe how you determined the need for your program for each specific jurisdiction that you are applving for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. The need for OSSMC services is increasing as our population ages and our economy fluctuates. Ombudsmen often come across facilities so eager to fill empty beds that they are willing to take any and all applicants, regardless of the level of care required or whether the facility has the resources to meet the resident's needs. This results in many residents not receiving the full range of medical and social services they need to maximize their functionality and well- being. The ombudsmen's continual presence in the facilities, the trust they build with residents, and their familiarity with the relevant issues are key to connecting residents with critical needed services. In addition, dealing with the inadequacies of the state -wide oversight system presents an overwhelming challenge. The licensing bodies of the facilities are unable to keep up with the demand for services as the general population ages, but rather than change the system, they changed the laws for their expedience. For example, Community Care Licensing, which licenses residential care facilities in California, was unable to comply with a law requiring annual inspections, so they changed the requirement to one inspection every five years. Much can happen to threaten residents' health, safety and quality of life over such a long period. OSSMC's field ombudsmen are the front line of defense, providing vital, ongoing feedback to the licensing bodies so that they can make timely responses to meet the residents' needs. 13B. Assessment of Need - City of San Mateo: Briefly describe how you determined the need for your program for each specific lurisdiction that you aw applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. The need for OSSMC services is increasing as our population ages and our economy fluctuates. Ombudsmen often come across facilities so eager to fill empty beds that they are willing to take any and all applicants, regardless of the level of care required or whether the facility has the resources to meet the resident's needs. This results in many residents not receiving the full range of medical and social services they need to maximize their functionality and well - being. The ombudsmen's continual presence in the facilities, the trust they build with residents, and their familiarity with the relevant issues are key to connecting residents with critical needed services. In addition, dealing with the inadequacies of the state -wide oversight system presents an overwhelming challenge. The licensing bodies of the facilities are unable to keep up with the demand for services as the general population ages, but rather than change the system, they changed the laws for their expedience. For example, Community Care Licensing, which licenses residential care facilities in California, was unable to comply with a law requiring annual inspections, so they changed the requirement httpl www.citydataservices.net/ cities/ smatcalapp2016arc .pl ?rpt= C4521&prop =21 218 1/25/2016 City Data Services - South San Francisco to one inspection every five years. Much can happen to threaten residents' health, safety and quality of life over such a long period. OSSMC's field ombudsmen are the front line of defense, providing vital, ongoing feedback to the licensing bodies so that they can make timely responses to meet the residents' needs. 13C. Assessment of Needs - South San Francisco: Briefly describe how you determined the need for your program for each specific Wrisdiction that vcu are anplyrng for funds Identify target population(s) and area(s) served. Piease state the source(s) and date(s) of information. Identify any similar programs in the community. The need for OSSMC services is increasing as our population ages and our economy fluctuates. Ombudsmen often come across facilities so eager to fill empty beds that they are willing to take any and all applicants, regardless of the level of care required or whether the facility has the resources to meet the resident's needs. This results in many residents not receiving the full range of medical and social services they need to maximize their functionality and well - being. The ombudsmen's continual presence in the facilities, the trust they build with residents, and their familiarity with the relevant issues are key to connecting residents with critical needed services. In addition, dealing with the inadequacies of the state-wide oversight system presents an overwhelming challenge. The licensing bodies of the facilities are unable to keep up with the demand for services as the general population ages, but rather than change the system, they changed the laws for their expedience. For example, Community Care Licensing, which licenses residential care facilities in California, was unable to comply with a law requiring annual inspections, so they changed the requirement to one inspection every five years. Much can happen to threaten residents' health, safety and quality of life over such a long period. OSSMC's field ombudsmen are the front line of defense, providing vital, ongoing feedback to the licensing bodies so that they can make timely responses to meet the residents' needs. 14. Timeline: Provide a brief timetable for project implementation and achievement of projected goals and how you plan to expend your funds in a timely manner by the end of the fiscal year. The services we provide are ongoing with no specific timeline. Complaints are received when they come into the office, are entered into the database and tracked through closure. Visits to facilities are made on a monthly basis, based on our facility coverage plan and are entered into the state's ODIN database so that we can track facility coverage and close gaps as they arise. Other services such as community and facility presentations, consultations with individuals and facilities, etc. are provided on an ongoing basis. OSSMC annually co-sponsors two conferences with the Alzheimers Association in the Fall and Spring, which are each attended by 300 attendees. We also plan to hold two trainings for new ombudsmen during the year, one in the fall and one in the spring. 15. Evaluation: Briefly describe how you will determine and measure the success of your program and whether or not program goals were met? If your program is currently receiving grant funds please describe accomplishments of goals to date. As our services are mandated by the state of California, we must adhere to public reporting guidelines. Information on cases and activities is recorded into the state - provided database. OSSMC tracks data on its staff, volunteers and constituency members on two levels: 1. Case Records — Ombudsmen turn in detailed, written reports on every case that is opened which is then entered into the database, including whether or not a case was resolved to the resident's satisfaction. The Office of the State Long -Term Care Ombudsman has determined that the bar for success is to resolve 80% of all complaints. if we achieve that goal, it is determined that we have achieved success. We anticipate that we will continue to meet that goal. 2. Ombudsman Activities — Ombudsmen record on a monthly basis all activities detailing, among other things, visits that are made to facilities, in- service training to facility staff, consultations with staff and family members, etc. Our facility coverage plan is updated and evaluated every three months to determine the we are on track to meet our goals. We evaluate statistics on a monthly basis to identify trends regarding cases and types of complaints. In this way we have been able to pick up on a facility with an increased number of resident to resident abuse incidents. Once this was identified we were able to work with the facility to reduce these types of incidents. 16. Collaboration: Describe partnerships with other organizations /agencies, the nature of the partnership, and how it relates to the proposed project. Our regular collaborative partners include the following: Aging & Adult Services Office of Public guardian — working on cases involving mutual clients Adult Abuse Prevention Collaborative Golden Gate Regional Center — working on cases involving mutual clients Legal Aid Society — make regular referral to them for clients needing their services Local Law Enforcement — working together on cases involving allegations of abuse Licensing Bodies — make regular referrals to these agencies as necessary Alzheimers Association — co-sponsor their two education events, reaching out to caregivers for those with dementia Other special collaborative projects include the following: Transitioning — working with Health Plan San Mateo and Institute of Aging to move residents who qualify out of nursing homes to the community Reducing Hospital Readmits — working with the Hospital Consortium and others to reduce readmits to hospitals — from the ombudsman perspective this looks closely at the discharges from hospitals to facilities and whether they have been properly implemented Music & Memory — still working on getting this program up and running in a small number of facilities in our county, impacting clients with dementia, enabling them to connect to the back to family, friends and community, thus impacting their quality of life Reducing Use of Antipsychotic Drugs — working with CMS and a large state -wide collaborative to bring down the use of http: //www.citydataservices.neU cities/ smateat app2016arc.pl ?rpt= C4521&prop =21 3/$ 1/25/2016 City Data Services - South San Francisco 17. Impact:: Discuss any general trends and conditions that have affected or impacted your service levels or service populations. For New Applicants — describe what these funds would allow your agency to do that you may not be able to do now. For Continuing Applicants — describe how your program would be impacted without these funds. At its inception, the ombudsman program was a volunteer -based program. Depending on volunteers does present challenges. A reduction in funding from the state left us severely under resourced. Recruitment fell to an all time low and staff found themselves trying to fill the gap visiting facilities, detracting from their ability to provide technical support to volunteers in the field, thus further compounding the problem. As a result our ability to meet our facility coverage plan diminished. With the receipt of Measure A funding together with some other leveraged funds, we hired a full time Volunteer Coordinator in July 2015. Sherine organized three highly successful volunteer recruitment information nights in the Fall 2015 with more than 30 people attending. We have held two training sessions, and have added 11 new certified volunteers to our ranks. A third training will be held beginning February 2016. CDBG funding supports the Regional Coordinators in the respective areas. These individuals assist with the training of new volunteers and provide supervision and ongoing technical support in the field, critical aspects of maintaining a healthy functional volunteer base. These volunteers are the frontline in the facilities, meeting with the clients and resolving the problems that arise. 18. Project Beneiiciaries/Quantifiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. 19. Project Benefrciaries/Quandflable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. a. Indicate the total number of low - income beneficiaries you expect to serve with this program for each jurisdiction application for funding. 'Low- income is 80% of Area Median Income or below. See AMI table b. Indicate the total number of beneficiaries you expect to serve with this program in each jurisdiction - regardless of income. Jurisdiction a. Number of low-income beneficiaries to be served per grant jurisdiction *„ . ° application. Low-income is 80% of Area Median Income or below. b. All beneficiaries to be served per grant jurisdiction application regardless of income Your Program % by Ethnicity Persons Persons DaIv Cit 1000/0 ite and not Hispanic Redwood City 85 $5 City of San Mateo 100 100 County of San Mateo sian 6,7151 9.03% South San Francisco 74 74 [Totals 259 1 259 19. Populations Served: Check the boxes below if they describe a significant population served by your program. These categories are not considered "presumed benefit" by HUD, and require income verification. Persons exiting incarceration Low- income youth L = Other 20. Affirmative Outreach: a. Use the demographics from your previous program year to provide an analysis of the population you serve relative to the demoaranhics in the table. NOTE If you are a new anntiranf nlaacp nmvirfa vruir hoef cefimAK^n Race & Ethnicity Redwood City Redwood City Low population % by Ethnicity Income by Ethnicity served b our P ram Your Program % by Ethnicity Total 74,402 100 ° / 162 1000/0 ite and not Hispanic 40,6561 54.64°/ 13E 85.80°/ ite and Hispanic 23,5571 31.66% 51 3.09% sian 6,7151 9.03% 81 4.94% frican American 2.58% 5,56°/ Pacific Islander A66 0.89% 1 0.62°/ Native American 0.52% 0.00°/ her 2.03;/or 01 0.00 ° / City of San City of San Low Inc( Race & Ethnicity Mateo I Mateo % by I Ethnicity by (Your Program % by Ethnicity httpJ/www.citydataservices.net/ cities/ smatcalapp2016arc .pl ?rpt= C45218prop=21 418 1/25/2016 City Data Services - South San Francisco JL Po ulation I Ethnicity by our Prq9rad Total _ Total 97,20 100% 1021 100% White and not Hispanic _ 45,24C 46.54% 761 74.51 % White and His anic_ — 25,81 26.56°/ 1101 9.80 % Asian— frican American 18,153, 2,09 18.67% 2.16% 81 1 7.84% 0.98°/ Pacific Islander _ _ 1,93 1.99% Native American 0.62% Native American 14CI 0.14% a39 EEE 15.08% 000 ° / Other 3,82 ' 3.93% 0.00°/ Race & Ethnicity South San South San Francisco Francisco % by Po ulation Ethnicit Low Income by Ethnicity served by our Nograrn Your P ° by Ethnicity Total _ 63,63 100% 10C 100% White and not Hispanic 23,7 37.34% 6E 56.00% White and His nic. 21,64 34.02%1 141 14.00% Sian 23,991 36.610 201 20.00% African American 1,62,51 2.55% 101 10.000 Pacific Islander 1,1111 1.75% 01 0.00% Native American 0.62% 0.00 ° / Other a39 EEE 15.08% 0.00 b. Based on the percentages that you indicate your organization served describe your efforts to improve affirmative outreach to groups that may be underserved by your program and the result of your efforts: Our clients are all 8,863 residents in 527 long -term care facilities in San Mateo County, regardless of ethnicity, age or any other demographic. We do not select our clients. We have created new informational cards in the following languages for our clients and their families: Spanish, Chinese, Tagalog. It is our goal to translate other organizational materials into those languages as well, including our program brochure. 21. Leveraging: Describe your fundraising efforts and additional sources of revenue for this project and your organization. Please state whether any of these fund sources are already committed and in what amount. Funding for FY 2016/17, including funding from Aging & Adult Services, will not be confirmed until at least June 2016. Our fundraising efforts include grant writing to foundations, health care districts, and corporations, as well as to other cities. We also secure funding from individuals through twice a year mail appeals, board, volunteer and staff campaigns, and an annual fundraising event. Other regular funding previously received is as follows: Government: San Mateo County AAA/Fed $187,534 Special Deposit & SNF Quality ASsurance $68,568 CDBG San Mateo $14,500 CDBG Redwood City $15,000 City of Burlingame $1,500 City of Foster City $2,500 City of Menlo Park $500 SM County Measure A $111,632 Healthcare Districts: Sequoia Health Care District $40,000 Peninsula Healthcare Dist. $50,000 Foundations: Bernard A. Newcomb Foundation $55,000 Atkinson Foundation $7,500 Woodlawn Foundation $35,000 May & Stanley Smith Foundation $50,000 Sidney Stem Charitable Trust $2,500 Palo Alto Medical Foundation $10,000 Callison Foundation $10,000 Touchpoint Foundation $3,000 Boston Bank & Trust $1,500 Safeway $1,500 Mills- Peninsula Health Services $5,000 http: //www.citydataservices.naU cities/ smatcalapp2016arc .pl ?rpt= C4521&prop =21 58 1/25/2016 City Data Services - South San Francisco Staff List List below kev staff members who work on this nrnnram Position 'Titre Flame of Staff Person .lob Responsibilities Quallfcations Executive Budget Line Item _ Day Day to day management responsibilities for BS Business Management and 23 Director ippy Irwin running the program and ensuring we meet years experience working in the aging Requested % target Uoals industry and nonprofit world Regional Labor Supervises a group of field ombudsmen BS Human Relations and has worked Coordinator- Nicki Manske (volunteers) who provide facility visits and in the commercial sector as a Sales South respond to complaints in the facilities on Director, Regional Manager, and VP of County $ behalf of residents. Operations. Regional $83,63 Supervises a group of field ombudsmen Coordinator- Sheri Ross (volunteers) who provide facility visits and BA in Finance Central $ respond to complaints in the facilities on $66,95 County $66,95 behalf of residents. Regional Supervises a group of field ombudsmen _ Coordinator- Kirsten Irgens -Molle (volunteers) who provide facility visits and MSW North respond to complaints in the facilities on ount behalf of residents. PROPOSED PROGRAM BUDGET FOR FY 2016 -17 http: //www.citydataservices.net/ cities/ smatcalapp2016arc .pl ?rpt= C4521&prop =21 618 Redwood City City of San Mateo South San Francisco Total Jurisdictions Budget Line Item Agency Total Pgm% Program Total % Requested % Requested % Requested Pgm% Requested Labor Executive Director $76,51 100% $76,51 0% 0%1 0% 0% $ Director of Development $83,63 100% $83,63 0% 0% 0% 0% $ Operations $66,95 100% $66,95 0% 0% 0% 0% $ ana er Proaram Mana er $70,65 100% $70,65 0% 00/0 0%1 0°/ $ Regional Coordinator-North $61,80 100% $61,80 0% 0% 24% $15,00 24°/ $15,00 Regional Coordinator- $60,131 100% $60,131 0% 25% $15,000 0 °/ 25 °/ $15,OOC Central Regional Coordinator-South $63,43 95% $60,43 25% $15,0 0% 0% 25% $15,00 Abuse Specialist $38,10 100% $38,10 0% 0% 0°/ 0% $ Volunteer $54,5 100% $54,59 0% 0% 0% 0% $ New Executive hector -3 month $43,5 100% $43,50 0% 0% 0% 0% $ versa Taxes/Benefits $51,22 100°/ $51,22 0% 0% 1 00/0 0% $ Supplies Office Supplies $6,50 100 % $6,50 0% 0% 0% 0% $ Posta e/Delive $1,50 100% $1,50 0% 0°/ 0% 0% $ Staff Education $2,0 100% $2,00 0% 0% 0% 07. $ Staff Mileage $16,0 $16,00 $ Reimbursement aterials Marketina $2.8001 100°/ $2,80 00/6 0%1 1 0% 0°/ $ Newsletter & $7,20 $7,20 $ nnual Report rations /Maintenance Writer $20,0 100% $20,0 0% 0% 0°/ 00 $ cial ffinan $45,5 100 % $45,50 0% 0% 0% 0°/ $ ses Board evelo ment $ 2,00 100% $2,0 0% 0% 0% 0 °/ $ Facilities & http: //www.citydataservices.net/ cities/ smatcalapp2016arc .pl ?rpt= C4521&prop =21 618 1/2512016 City Data Services - South San Francisco Equipment $22,70 100%1 $22,70 0°/ 0% 0 °/ 0% $ Insurance $10,50 100% $10,50 0% 0% 0% 0% $ Membership/Dues $2,1001 1007. $2,101 0% 0% 0% 0% $ Tel e hone/Inteme $14,58 100% $14,58 076 0% 0% 0% $ Special Projects $5,5 100 % $5,5 0% 0% 0% 0°/ $ Volunteer Expense $16,OOC $16,00 0% 0% 0% 0% $ Miscellaneous $ $ $ dministration i 0% TOTA $845,411 100°/ $842,411 2% $15,00 2% $15,00 2% $15,00 5°/ $45,00 Number of Individual Beneficiaries 851 124 25 Cost per Individual $176.4A.. $150.001 $202.71 $173.7 For the City of Redwood City ONLY, answer the following: For the City of Redwood City ONLY, answer the following: 1. Funding Criteria: 3. Human Services: Basic Human Needs are activities that are vital for survival and not just an improvement to the quality of life, regardless of income. For example, emergency food programs are essential to survival. Coordination of a volunteer program is an improvement to the quality of life. 2. f4larketing /Advertising a. Check all of the following methods your agency utilizes to promote and advertise your programs and services: Flyers /brochures ('e Website Outreach presentations to service providers Outreach presentations to public v* PSA's b. Which of the above marketing/advertising materials are available in multi - langual form and which languages are they available in? Informational tent cards are available in English, Spanish, Tagalog, and Chinese. Core Services brochure available in English and Spanish c. How and where are the materials distributed? Collateral material is distributed to residents' rooms in facilities, to family members during case meetings, at tabling events and at presentations. 3. Program Outcomes: a. Please describe the accomplishments of program goals for FY /15. Below are the outcomes achieved for our general operations during the FY 2014 -15 grant period: 1. Maintaining a presence in the facilities: OSSMC made 4,462 visits to facilities during the fiscal year and succeeded in meeting 78% of our facility coverage plan during the grant period. We consider our presence in the facilities to be our single most important tool. By maintaining a constant and vigilant presence, we are able to build relationships of trust with residents, and a good, solid professional relationship with staff —a very important consideration if we are to succeed in meeting our goal to resolve complaints in the most efficient way possible. 2. Investigating/Resolving Complaints: OSSMC investigated and closed 1,506 complaints during the grant period. Of these, 133 complaints involved serious allegations of abuse. 94% of the complaints were resolved to the satisfaction of the residents. Every case resolved is indicative of an improvement in the quality of care and /or the quality of life for the residents served. 3. Promoting Community Awareness: During the grant period, OSSMC conducted 40 in- service and provided 168 consultations to facility staff; provided 331 consultations with individuals on issues directly related to long -term care; and hosted 55 community education events on a variety of topics related to elder care and the role of the ombudsman. b. In what ways has your program made a difference in the lives of the people you serve? Please provide at least one concrete example from the people served in FY /15: hdp:/A ww.citydataservices.net/ cities/ smatca lapp2016arc.pl?rpt= C4521&prop=21 7/8 1/25!2016 City Data Services - South San Francisco The case example below is a good illustration of the positive impact our program has had on residents in long -term care: A family member called, incensed because her husband's facility had informed her that they did not provide care after 8 pm. Her husband, a resident in this small six -bed facility, was unable to get out of bed without assistance. When he needed to go to the bathroom in the middle of the night, they failed to provide assistance and ignored his calls. The man had managed to get himself out of bed and, on his way to the bathroom, had fallen to the floor. Unable to pick himself up, he called and called for help, but got no response. He lay on the floor for six hours until the staff came into his room the next morning and found him, bruised, soiled and very agitated. We turned this complaint over to the licensing body and the facility was cited for physical abuse and neglect. Staff has been retrained on the need to provide 24 hour care to their residents. We are carefully and diligently monitoring this facility which has been the subject of numerous complaints over the past several months. Attachments 1. Resolution authorizing application and designation of signatory, by the Board of Directors 2. Proof of 501(c)3 /tax-exempt status !- 3. By-laws 4. Articles of Incorporation Ed 5. Board roster, including: • Name, Company, Years on Board • Meeting dates for previous 12 months • Number of years allowed for each board term Board Resolution 2016- 17.odf 501c3 Jpg.ipg Bylaws. doc Articles of Irlcorporation;pdf Board Members 1.5.15.doc Board Members with affiliation years of service 1 5 15 doc 6. Organizational chart for entire organization Organizational Chart 2.docx 7. Certified financial audit no more that 1 fiscal Audited Financial Statements2012.PDF year old, prepared by a CPA, and: Not Subject to the Single Audit Requirement Letter docx • Management letters (if applicable) • A -122 and A -133 Single Audit (for entities that receive more than $500,000 in federal funding) OR • A letter from your Executive Director or Chief Financial Officer certifying that agency does not receive more than $500,000 in federal funds and is not subject to the Single Audit. 8. The following are required: • Current (FY15 -16) Agency Operating Budget • Proposed (FY16 -17) Agency Operating Budget 9. Mission Statement !` 10. Non - discrimination policy for Staff and Clients ' 11. Reasonable Accommodations Policy for Staff and Clients 12. Conflict of Interest Policy. (If not available, please indicate when you will submit) ' -J 13. Other - Download All Attachments Program Manager Signature Tippy Irwin Date Signed 01/22/2016 Initially submitted: Jan 22, 2016 - 13:04:11 OSSMC Approved Budget Final FY 15-16 odf Draft Budget Summary funders detail FY 2016- 17 012016.xisx Mission Statement.docx OSSMC Non Discrimination Policy.docx OSSMC Reasonable Accommodations Policy docx http: //www.citydataservices.neV cities/ smatcalapp2016arc .pi?rpt= C4521&prop =21 818 OMBUDSMAN SERVICES OF SAN MATEO COUNTY, INC DRAFT BUDGET FY 15/16 Operating Income FY 14-15 Business Funding 12000 FY 15-16 15,000 Mills Peninsula Health Services Other 8,000 7,000 Direct Public Support 18815 j 115,000 Appeal letters spring and fall 20,000 Individual donations 20,000 Fundraising event income 75,000 Foundation Funding 90000 197,693 Atkinson 7,500 Callison 10,00() Palo Alto Medical Foundation 10,00() May & Stanley Smith 50,00() Woodlawn p 35,000 New Foundations 85,193 Government Funding 287002 459,203 SMC Title IIIB 33,438 SMC Title VITA 42,107 SMC General Funds 117,536 Special Deposit Funds 30,192 SNF Quality Assurance 63,855'1 State General Fund 27,76 3 Measure A 111,63.2 CDBG San Mateo I 14,504) CDBG Redwood City 51 004) Other City Grants 3,180 Health Care District Funding 85000 90,000 Peninsula Health Care District 50,000 Sequoia Healthcare District = 40,000 Interest Income 80000 Other 99796 nj Total Revenue 672613 956,896 Development/Marketing Fundraising Grant Writing Special Event - Fundraiser Appeal spring and fall Marketing Marketing Supplies Printing & Reproduction Newsletter /Annual Report Employee Expenses Employee Expense Direct Payroll & Bonus Benefits ER Taxes Workers Compensation Employee Indirect Expenses Education Travel Reimbursement Payroll Service Fee Operating Expenses Board Expenses Facilities & Equipment Computer Maintenance Maintenance Agreements Office Equipment Office Furnishings Rent Financial Expenses Accounting /Audit Bookkeeper Bank Charges Insurance Directors and Officers General Liability Membership Dues & Subscriptions Office Supplies Postage and Delivery Telephone and Internet Program Expense M isc Corporate Registration Special Projects Alzheimer's Association Random Acts of Flowers Music and Memory Volunteer Expenses Total Expenses 20000 20,000 50,000 3,000 3000 1,800 2500 2,870 7,235 483625 593,793 42,749 48,944 5,000 1500 2,000 120001 15,600 1700 2,500 2750 3,500 1000 1,500 1200 1,800 2500 6,000 500 1,000 12000 12,000 4500 13,500 10000 40,000 9000 11,000 4300 5,000 4900 5,500 1825 2,100 6000 6,750 2500 2,500 11840 16,000 750 750 85 85 5000 5,000 500 10,920 20000 624975 16,000 956,896 OMBUDSMAN SERVICES OF SAN MATEO COUNTY, INC DRAFT BUDGET FY 16/17 Pperating Income Business Funding I FY 15-3-6 15,000 FY 16-17 17,0001 Mills Peninsula Health Services 8,000 10,000 Other 7,000 7,000 Direct Public Support 115,000 1 115,000' Appeal letters spring and fall 20,000 20,000 Individual donations 20,000 20,000 Fundraising event income 1 75,000 75,000 Foundation Funding 197,693 181,224 Atkinson 7,500 Callison _ 10,000 X0,000 50,000 5,000 20,000 Palo Alto Medical Foundation j _ _ 10,000 May & Stanley Smith 50,000 Woodlawn 35,000 New Foundations Funding _ SMC Title 1116 85,193 66,224 Government 456,023. 466,398 33,438 42,107 33,438 42,107 SMC Title VIIA SMC General Funds 117,536 117,536 Special Deposit Funds 30,192 30,192 SNF Quality Assurance 63,855 63,855 State General Fund 27,763 27,763 Measure A 111,632 111,507 CDBG San Mateo 14,500 15,000 CDBG Redwood City 15,000 15,000 CDBG SSF 10,000 Other City Grants 3,180 4,000 Health Care District Funding 90,000 110,000 Peninsula Health Care District 50,000 60,000 Sequoia Healthcare District 40,000 50,000 Interest Income 80,000 80,000 Other Total Revenue Develop.ment/Marketing 953,716 969,622 Fundraising Marketing Grant Writing Special Event - Fundraiser Appeal spring and fall Marketing Supplies Printing & Reproduction Newsletter /Annual Report Ernpleyee Expenses Employee Expense Direct Payroll & Bonus Benefits ER Taxes Workers Compensation Employee Indirect Expenses Education Travel Reimbursement Payroll Service Fee Operating Expenses Board Expenses Facilities & Equipment Computer Maintenance Maintenance Agreements Office Equipment Office Furnishings Rent Financial Expenses Accounting /Audit Bookkeeper Bank Charges Insurance Directors and Officers General Liability Membership Dues & Subscriptions Office Supplies Postage and Delivery Telephone and Internet Program Expense Misc Corporate Registration. Special Projects Alzheimer's Association Random Act of Flowers Music and Memory Volunteer Expenses Total Expenses 20,000 20,000 50,000 50,000 3,000 4,000 1,800 2,800 2,870 7,235 7,200 593,793 629,305 42,749 51,227 48,944 52,613 5,000 4,262 2,000 2,000 15,600 16,000 2,500 2,500 A3,500 ,500 _ ,800 ' 0 2,000 1,500 2,200 6,000 1,000 1,000 12,000 12,000 13,500 4,500 40,000 30,000 11,000 11,000 5,000 5,000 5,500 5,500 2,100 2,100 6,750 6,500 2,500 1,500 16,000 14,580 750 750 85 85 5,000 5,000 500 10,920 16,000 956,396 16,000 969,622 City Data Services - South San Francisco Consolidated Community Funding Application Redwood City, San Mateo County, and S. San Franc'ssco Application for New Funding for FY 2016 -17 GENERAL iNFOR ATION 1. Organization Name: Health Mobile 2. Project Title: Dental Care for Children Ve are applying for funding from: ❑ Redwood City ❑ City of San Mateo ® South San Francisco ❑ County of San Mateo Budae`t/Clier'at �[d!@YOR74 J+r'!� (AI ItA- t1r1n1IlafPri from Ri irincf holn��il Jurisdictions receiving this application Amount Requested % of Program Budget PIyro- p ; s ; 7 # of I Served % of Served Total $ Per outh San Francisco $10,00 1000/ 14 1000! $71.4 otal $10 00 1000% 14 10001 $71.4 Grant Funded Programs: We are applying for a Public Services Program CDBG National Obiactive Eligibility - How are you serving low income populations? Service to low income clients verified through income documentation. Income Verification: Describe how you obtain, verify, and maintain proof of income and presumed benefit status. Third party documentation or client signatures on the certification forms must be available on file for review at all times. We provide onsite comprehensive dental care to low- income children at participating school sites. We provide care to children eligible for free lunch. Participating schools screen children for free lunch. 3. Project Address: 1659 Scott Blvd # 4 City: Santa Clara Zip: 95050 -4172 4. Provide a one sentence project summary: We provide free, onsite, comprehensive dental care to low- income children at school sites in South San Francisco. Organization 1659 Scott Blvd # 4 Address: Organization Phone: 408- 879 -0110 Type of Applicant: Our agency serves: 5. Contact Person / Project Name: Mike Reza Administrator: Contact Email: mike @healthmobile.org 6. Name of Agency A Parhizkari Director: 7. Fiscal Officer: Name: Mike Reza Fiscal Officer 1659 Scott Blvd # 4 Address: 8. Authorized Name: Mike Reza Signatory: Authorized Signatory 1659 Scott Blvd #4 Address: I_— _.!I. -. -- - I . . I. a.. -..._ - -- - , I I City: Santa Clara Website: www.healthmobile.org Title: COO Fax: Zip: 95050 -4172 Telephone: 408 - 879 -0110 Email: Telephone: 4083905893 mike@healthmobile.org City: Santa Clara Zip: 95050 -4172 Email: Telephone: 408 - 390 -5893 mike @healthmobile.org City: Santa Clara Zip: 95050 -4172 Page 1 of 4 City Data Services - South San Francisco Page 2 of 4 9. Please provide days and hours of regaiarly scheduled operation: Mondays through Fridays from 8:30 am to 2:30 pm 10. DUNS Number: 938737827 Federal EIN/TIN (dumber: 31- 1658149 11. HUD Activity: Choose the HUD activity that most closely matches your service: 05M - Health Services 12. Project Specific Narrative: Provide a narrative description of the specific activities to be carried out with the requested funds. This should also include program objectives and key priorities for each specific jurisdiction. Health Mobile provides dental services at school sites through a self - contained, state -of -the art, full - service dental clinic in a specially made 40 -foot motor home. Health Mobile pre - screened students to determine their dental needs. In September 2011, Health Mobile will begin providing follow -up services on the students who were screened. Patients will receive dental cleaning, preventive dental procedures, x -rays, and oral hygiene instructions. Dental procedures will include, as necessary, fillings, root canal treatments, extractions, crowns, sealants, bridges, partials, oral surgery, space maintainers, and sports guards. Health Mobile staff will emphasize prevention techniques and schedule patients for preventive treatment every six months until they graduate from the school. Parents will sign a consent form and complete a medical history form on their children prior to treatment. Services will be available to uninsured South San Francisco Unified School District's students and their family members. 13. Assessment of Need - South San Francisco: Briefly describe how you determined the need for your program for each specific jurisdiction that You are aoplvina for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. The need for dental services among low- income children in South San Francisco parallels the need across the State. According to a 1999 U.S. Surgeon General's Report, California has the highest percentage of children without dental insurance in the country. A report of the Dental Health Foundation highlights what happens to children without access to dental care: "Among school -age children in the U.S., 25% experience 75% of the tooth decay. That 25% typically represents children who are from economically or socially disadvantaged families, children who have some type of disabling condition, or children who experience other barriers to preventive and treatment services." Lack of preventive dental care can lead to more serious oral health problems in the future, cause severe pain that leads to school absences, and contribute to poor self - esteem. A preliminary assessment of students at South San Francisco Unified School District indicated that most of the young people had never seen a dentist. Of the 164 students pre- screened, 100% require follow -up dental care. For example, 89% need four or more fillings, 16% need root canals (because cavities have not been filled), and 12% need at least one extraction. According to information released by the Coalition for Oral Health, based on a Center for Disease Control report, every dollar invested in preventive dental care saves between $8 and $50 in more costly care. Therefore, the dollar impact of a $10,000 CDBG grant will range fr 14. Timeline: Provide a brief timetable for project implementation and achievement of projected goals and how you plan to expend your funds in a timely manner by the end of the fiscal year. September 2016:Dental assessment of students November - December 2016:Dental Treatment Feb. -June 2017 Six month follow - up dental check -up 15. Evaluation: Briefly describe how you will determine and measure the success of your program and whether or not program goals were met? If your program is currently receiving grant funds please describe accomplishments of goals to date. Following Health Mobile services, students will experience no tooth decay.2.Each student will establish a healthy oral hygiene routine. 3.Although not measurable, each student's visit to the Health Mobile will produce increased self -worth, a bright smile, and an increased sense of self- esteem. Evaluation measures include:-Analysis of patient's progress: This will show how many patients follow oral hygiene instructions and are free of tooth decay. Health Mobile will evaluate oral hygiene every six months.-Follow up surveys: Staff conducts six -month follow up surveys of patients who have received dental treatment. -There will be presentations of the "analysis of patient's progress" and "follow up surveys" at staff meetings. 16. Collaboration: Describe partnerships with other organizations /agencies, the nature of the partnership, and how it relates to the proposed project. South San Francisco School District is our partner in this project. They collect parental consents and schedule our visits at various schools. 17. Impact:: Discuss any general trends and conditions that have affected or impacted your service levels or service populations. For New Applicants — describe what these funds would allow your agency to do that you may not be able to do now. For Continuing Applicants — describe how your program would be impacted without these funds. We will provide dental care to low- income children of South San Francisco without which we are not able to provide for them. 18. Project Beneficiaries /Quantifiable (Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. 19. Project Beneficiaries /Quantifiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. a. Indicate the total number of low- income beneficiaries you expect to serve with this program for each jurisdiction application for funding. *Low- income is 80% of Area Median Income or below. See AMI table b. Indicate the total number of beneficiaries you expect to serve with this program in each jurisdiction - regardless of income. amity Data Services - South San Francisco Page 3 of 4 Jurisdiction a. Number of low-income beneficiaries to be served per grant jurisdiction application. " *Low - income "" is 80% of Area Median Income or below. b. All beneficiaries to be served per grant jurisdiction application regardless of income Low Income byV Ethnicity serve1 by your Pro ram Persons Persons 63,63 100% 14 Mod ite and not Hispanic 23,76 37.34% teo 0.00% ite and Hispanic co 140 140 otals 140 140 19. Populations Served: Check the boxes below if they describe a significant population served by your program. These categories are not considered "presumed benefit' by HUD, and require income verification. ❑ Persons exiting incarceration ® Low - income youth ❑ Other 20. Affirmative Outreach: a. Use the demographics from your previous program year to provide an analysis of the population you serve relative to the demographics in the table. NOTE. If you are a new annticant ntPacP nrnvirtp vnoir hoof pofimpffn., Race & Ethnicity South San Francisco Population South San Francisco % by Ethnicity Low Income byV Ethnicity serve1 by your Pro ram VV y v oYour Program /o by Ethnicity Total 63,63 100% 14 100% ite and not Hispanic 23,76 37.34% 0.00% ite and Hispanic 21,64 34.02% ME 60.71% sian 23,29 36.61% 4E 34.2906 frican American 1,62 2.55% 2 2.140 / acific Islander 1,111 1.75% 0.000 'Native American 39 0.62%1 0.000/ ther 9,5981 15.08% 41 2.86 0 b. Based on the percentages that you indicate your organization served describe your efforts to improve affirmative outreach to groups that may be underserved by your program and the result of your efforts: Health Mobile provides accessible dental care at school sites. We select schools with higher number of minority students. We go where the patients are. 21. Leveraging: Describe your fundraising efforts and additional sources of revenue for this project and your organization. Please state whether any of these fund sources are already committed and in what amount. Health Mobile is very well received by individuals, community, public and private organizations. As such we receive financial support from local and national foundations and government agencies. State of California is our major financial supporter. Staff List List below key staff members who work on this program Position i itie Name of Staff Person Job Responsibilities P Qualifications Dentist Pgm% Progra Totalm % ssistant Pgm% Requested Labor PROPOSED PROGRAM BUDGET FOR FY 2015 -17 South San Francisco Total Jurisdictions Budget Line Item Agency Pgm% Progra Totalm % Requested Pgm% Requested Labor Dentist $ assistant Taxes/Benefits - 100%1 0°/ $ City Data Services - South San Francisco upplies _ Dental Exam $4 75 100% $475 100 ° / $4 75 138 ° / $4,75( Preventative $3,45 100(/ $3,45 100°/ $3745 192°/ $3,45 Restorative $1,80 $1 80 $1,80cl, $ dministration TOTAL $1000 100`/° $10,00 1 p °/ 1000/ $10 0011000 $10,00131 umber of Individual Beneficiaries ost per Individual 14 14 $71.431 $71.4 Aftechmants ® 1. Resolution authorizing application and designation Board authorization 2015.pdf of signatory, by the Board of Directors © 5. Board roster, including: Health Mobile Board Member 2015.docx • Name, Company, Years on Board • Meeting dates for previous 12 months • Number of years allowed for each board term ® 6. Organizational chart for entire organization Organization Chart.xls © 7. Certified financial audit no more that 1 fiscal year No need for A -133 audit.pdf old, prepared by a CPA, and: 2014 Audit Report.odf • Management letters (if applicable) • A -122 and A -133 Single Audit (for entities that receive more than $500,000 in federal funding) OR • A letter from your Executive Director or Chief Financial Officer certifying that agency does not receive more than $500,000 in federal funds and is not subject to the Single Audit. © 8. The following are required: Health Mobile 2015 Budget CDBG Final.xlsx Health Mobile 2016 Budget CDBG Final xlsx Current (FY15 -16) Agency Operating Budget • Proposed (FY16 -17) Agency Operating Budget ® 9. Mission Statement MISSION STATEMENT.doc ® 10. Non - discrimination policy for Staff and Clients nondiscrimination policy 2.doc 11. Reasonable Accommodations Policy for Staff and Reasonable Accommodation Policy CDBG Aft 11 doc Clients © 12. Conflict of Interest Policy. (If not available, please indicate when you will submit) ❑ 13. Other - xyz Download All Attachments Program Manager Signature Mike Reza Date Signed 01/26/2016 Initially submitted: Jan 26, 2016 - 15:09:45 Page 4 of 4 Health Mobile 2015 Budget Revenues Fedral Grant Mobiles 500,000.00 City of South SanFrancisco 10,000.00 Fedral Grant Oral Health 200,000.00 Foundations 100,000.00 Fee for service 190,000.00 Total Revenues 1,000,000.00 Expenses Audit 4,200.00 DMV 785.00 Bank Charges 311.73 Dental Supplies 10,295.49 Dues and Subscriptions Exp 3,316.79 Gas 6,246.26 Insurance Expense 28,587.32 Lab Services Expense 5,055.30 Licenses Expense 1,659.19 Office Expense 11,803.76 Medical Supplies Expense 4,745.52 Office Supplies 9,204.06 Mobile Expenses 56,696.45 Payroll Tax Expense 81,720.61 County Tax 606.60 Print 1,809.87 Outside Service 4,075.72 Rent or Lease Expense 33,776.00 Repairs Expense 5,295.20 Payroll 703,605.59 Payroll Services 1,693.64 Storage 4,279.00 Telephone Expense 10,552.88 Utilities Expense 6,559.67 Waste Disposal 3,118.35 Total Expenses 1,000,000.00 Change In Net Assets (0.00) Page: 1 Health Mobile 2016 Budget Revenues Fedral Grant Mobiles City of South SanFrancisco 10,000.00 Fedral Grant Oral Health 200,000.00 Foundations 100,000.00 Fee for service 290,000.00 Total Revenues 600,000.00 Expenses Audit 4,200.00 DMV 785.00 Bank Charges 311.73 Dental Supplies 10 295.49 Dues and Subscriptions Exp 3,316.79 Gas 6,246.26 Insurance Expense 28,587.32 Lab Services Expense 5,055.30 Licenses Expense 1,659.19 Office Expense 11,803.76 Medical Supplies Expense 4,745.52 Office Supplies 9,204.06 Mobile Expenses 56 696.45 Payroll Tax Expense 81,720.61 County Tax 606.60 Print 1,809.87 Outside Service 4,075.72 Rent or Lease Expense 33,776.00 Repairs Expense 5,295.20 Payroll 303,605.59 Payroll Services Storage 4,279.00 Telephone Expense 10 552.88 Utilities Expense 6,559.67 Waste Disposal 3,118.35 Total Expenses 598,306.36 Change In Net Assets 1,693.64 Page: 1 City Data Services - South San Francisco Consolidated Community Funding Application Redwood City, San Mateo County, and S. San Francisco Application for New Funding for FY 2016 -17 GENERAL 1f4FORMATION 1. Organization Name: Biotech Partners 2. Project Title: Biotech Partners' Biotech Academy at South San Francisco are applying for funding from: ❑ Redwood City ❑ City of San Mateo ® South San Francisco ❑County of San Si:;eBgelt/Client Sumrnar y (Auto - populated from Budget, below) _ Jurisdictions Amount % of Program Proposed posed # of ° Total ,$ receiving this application Requested Budget I Served /o of Served ��Per [South San Francisco 1 $50.000 39% 74 1 n n o_/3 c&M11 Grant Funded Programs: We are applying for a Public Services Program CDBG National ObiiecVve Eligibility - How are you serving low income populations? Service to low income clients verified through income documentation. Income Verification: Describe how you obtain, verify, and maintain proof of income and presumed benefit status. Third party documentation or client signatures on the certification forms must be available on file for review at all times. Biotech Partners accepts students into our program recommended to us from our partner school, South San Francisco High School. Based on Biotech Partners focus on serving low- income youth, High School staff only refer students to our program who qualify for free and reduced priced lunch, for which families must provide income documentation. When enrolling in Biotech Partners programs, families self- certify that they meet low- income requirements and commit to making financial documents available if requested. 3. Project 400 B Street Address: City: South San Francisco Zip: 94080 -4425 4. Provide a one sentence project summary: Biotech Partners will partner with South San Francisco High School to provide up to 75 11 th -12th grade low - income youth of color with intensive academic bioscierce training, along with real - world, paid science-based internships in science settings as rising seniors and extensive wrap - around support. Organization P.O. Box 2186 Address: City: Berkeley Zip: 94702 -0186 Organization 510 -705 -5192 Website: Phone: www.biotechpartners.org Type of Applicant: Our agency serves: S. Contact Person / Name: Lynda Gayden Title: Executive Director Telephone: 510-705-5192 Project Administrator: Contact Email: igayden @biotechpartners.org Fax: 510- 705 -5237 6. Name of Agency Lynda Gayden Director: 7. Fiscal Name: Erina Atkins -Hadad Email: erina @mosscpa.com Telephone: (925) 482 -26.11 Officer: 1901 Olympic Boulevard City: Walnut creek Zip: 94596 -5076 http: / /www.citydataservices. net / cities /smatca/app2016arc.pl ?rpt =C4801 &prop =553 Page 1 of 6 2/1/2016 City Data Services - South San Francisco Page 2 of 6 Fiscal Officer Address: 8. Authorized Name: Lynda mail: Signatory: a Gaylen Igayden @biotechpartners.org Telephone: 510- 705 -5192 Authorized Signatory P.O. Box 2186 City: Berkeley Zip: 94702 -0186 Address: 9. Please provide days and hours of regularly scheduled operation: Monday- Friday - 8:30 -5 10. DUNS Plumber: 036366953 Federal EIN/TIN Number: 94- 3171180 L HUD Activity: Choose the HUD activity that most closely matches your service: 05H - Employment Training 12. Project Specific Narrative: Provide a narrative description of the specific activities to be carried out with the requested funds. This should also include program objectives and key priorities for each specific jurisdiction. BP's Biotech Academy features hands -on lab -based biotech classes & paid 8 -week summer internships in science settings, matching students with professionals serving as mentor - supervisors. Academy elements include: 1) Experienced instructors with science industry backgrounds who teach BP's industry- informed & regularly updated 11th & 12th grade curriculum featuring three labs per week. 2) A BP Program Coordinator in classrooms to support teachers & provide biotech, chemistry & algebra tutoring. 3) Guest presentations by academic & industry scientists, financial managers, motivational speakers & health specialists. 4) Academic & personal advising, service referrals, one -on -one guidance & basic needs stipends (e.g. food, transportation, & work attire). 5) Individual college planning & application support (enrollment requirement review, GPA, California A -G college entry requirements, standardized testing, essays & personal statements), & career guidance. BP trains students to perform biotech tasks, preparing at- promise youth for fulfilling industry careers. Students earn at least $12.25 per hour, totaling $1,960 across 160 hours of job training during the summer between 11th -12th grade. Beyond giving BP students unparalleled access to professional bioscience environments & career development opportunities, the Academy also teaches soft skills (communication, time management, proper attire, etc.) that will make students successful wi 13. Assessment of Need - South San Francisco: Briefly describe how you determined the need for your program for each specific jurisdiction that You are applying for funds Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. BP selected South San Francisco School Unified School District (SSFUSD) because of both the challenges faced by its student population and its proximity to the burgeoning local biotech industry. As a district, SSF has much less resource than neighboring districts in San Mateo County. SSFUSD has 14% more students per class and benefits from $0 community-based fundraising, compared to $2.2 million in nearby San Carlos. One -third of students are English Language Learners and 40% from low- income families. At SSFHS, 94% students are youth of of- color, more than half are Hispanic and approximately one third (31 %) qualify for free and reduced price lunch. SSFH students struggle with STEM content and college preparedness. Among 11th graders in 2013 -14, only 61 % proficiency or better in Biology and alarmingly, only 3% achieved proficiency in Integrated Science 1. More broadly, less than half of seniors (13 %) took the SAT in preparation for post - secondary enrollment (CA Dept of Ed, via greatschools.com) BP has found a high demand for our programming at SSF high school among our target population of lower- income students of color. BP had 100 applicants for the 1st 11th Grade Biotech Academy class. Among the 100 students who applied, 65 are Latina and all come from low- income families. In 2016 -2017 BP expects to be at full enrollment at SSFH with two 11th grade and one 12th grade class for a total of 50 students. BP knows of no other local programming providing the same ser 14. Timeline: Provide a brief timetable for project implementation and achievement of projected goals and how you plan to expend your funds in a timely manner by the end of the fiscal year. Biotech Partners' program is underway at South San Francisco High School. At the beginning of the grant period, students will be immersed in their internships, with a judged poster presentation and celebration at the end of the summer. During the summer, Biotech Partners will provide SSF teachers with training in BP's curriculum and industry practices. In fall 2016, BP's Biotech Academy at SSF will feature two junior year Biotech 1 & 2 classes and a new Biotech 3 & 4 class. 15. Evaluation: Briefly describe how you will determine and measure the success of your program and whether or not program goals were met? If your program is currently receiving grant funds please describe accomplishments of goals to date. Objectives & Evaluation • 90% of students will: o successfully complete the Junior year Biotech 1 & 2 courses o elect to participate in summer internships http: / /www.citydataservices. net / cities /smatca/app20l 6arc.pl ?rpt =04801 &prop =553 2/1/2016 City Data Services - South San Francisco Page 3 of 6 80% of participating students will successfully complete their internships and • 70% of students will continue into senior year Biotech 3 & 4. To evaluate programmatic success, BP: • Tracks student enrollment, grades, transcripts, internship /co -op job placement and completion, and graduation; and family demographics: race, ethnicity, family income and family /guardian level of education • Uses student, teacher and mentor - supervisor evaluations to measure levels of academic and job performance and satisfaction • Evaluates job performance through site visit observation and mentor /intern interviews • Conducts surveys pre - junior year, pre and post internship and post senior year • Conducts performance reviews and evaluations of internship and co -op job performance • Regular curriculum review conducted by academics and industry professionals to ensure that the high school classes meet industry skill and knowledge requirements. 16. Collaboration: Describe partnerships with other organizations /agencies, the nature of the partnership, and how it relates to the proposed project. Based on a memorandum of understanding (MOU) signed by both parties and in alignment with BP's model with partner schools throughout the Bay Area: BP provides: • An industry- informed, regularly updated bioscience curriculum for Bioscience 1 & 2 (11th grade) and Bioscience 3 &4 (12th grade) • Teacher training • In -class teaching assistance and lab support • Support with consumable lab supplies • Intensive student oversight, guidance and counseling • Workforce preparedness training (resume and cover letter development, interviewing skills) • Paid internships in bioscience settings for qualifying rising seniors (receiving a C or better in Bioscience 1 &2 and meeting behavioral expectations Schools provide: • Classroom and lab space • Full -time teachers • Collaboration with BP staff • Student referrals For the internship portion of our program, bioscience organizations provide: • Meaningful skill -based internship opportunities • Professionals who serve as Supervisor Mentors (all of whom receive background checks and training) • Wages (while most organizations pay students, BP subsidizes some internships if the host cannot afford to pay) 17. Impact:: Discuss any general trends and conditions that have affected or impacted your service levels or service populations. For New Applicants — describe what these funds would allow your agency to do that you may not be able to do now. For Continuing Applicants — describe how your program would be impacted without these funds. After over two decades of programmatic success impacting thousands of young people in Berkeley and Oakland, Biotech Partners is now in the midst of a significant expansion. In 2015 -2016 we launched our Biotech Academy program at South San Francisco and Antioch High Schools and in 2016 -17 we will be launching at San Marin High School in Novato and Making Waves Academy in Richmond, along with piloting an expansion at Oakland Technical High School to incorporate 10th grade Chemistry into the Biotech Academy. Local funding and public- private partnership are essential to our program's success. CDBG support will help sustain our critically important Program Coordinator position which works onsite at SSF High School, and will support BP in expanding our program to include the senior year Biotech 3 & 4 programming, and finally, will help us add a second junior class, based on the high demand for our programming at SSF 18. Project Beneficianes/Ouantifable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. 19. PrcYect Beneficiaries /Quantif able Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. a. Indicate the total number of low-income beneficiaries you expect to serve with this program for each jurisdiction application for funding. *Low- income is 80% of Area Median Income or below. See AMI table b. Indicate the total number of beneficiaries you expect to serve with this program in each jurisdiction - regardless of income. a. Number of low - income beneficiaries j to be served per grant jurisdiction b. All beneficiaries to be served per Jurisdiction application. —Low- income"* is 80% of grant jurisdiction application Area Median Income or below. regardless of income Persons Persons Daly City http:// www. citydataservices. neticities lsmatcalapp20l6arc.pl? pt= 0801 &prop =553 2/1/2016 City Data Services - South San Francisco Page 4 of 6 19. Populations Served: Check the boxes below if they describe a significant population served by your program. These categories are not considered "presumed benefit" by HUD, and require income verification. ❑ Persons exiting incarceration ® Low - income youth ❑ Other 2C. A iM12tive Outreach: a. Use the demographics from your previous program year to provide an analysis of the population you serve relative to the demogranhics in Pip tnhla Nr)TF' If vnn aro n nnm. —.1;# 'A 'A ... .- �__. _-. Race & EthnEcit o South San Francisco Population South San Francisco % by Ethnicity Low Income by Ethnicity served Your Program by your /o by Ethnicity Program Total 63,63 100% 10C 100% hite and not His anic 23,76 37.34% 0.00% ite and His anic 21,6451 34.02% 2 20.00°/ sian 23 29 36.61% 5 50.00°/ frican American 1,62 2.55% 0.00°/ acific Islander 1,1111 1.75% 3 30.00° ative American 39 0.62% 0.000 ther 9,5981 15.08%1.. 0,00°/ b. Based on the percentages that you indicate your organization served describe your efforts to improve affirmative outreach to groups that may be underserved by your program and the result of your efforts: As mentioned above, for our inaugural year, we had over 100 applicants, ALL from our target demographic of lower- income youth of color, including 60 Latina young women! Our target audience is well understood by our partnering South San Francisco High School administration and they work with us to identify and recruit appropriate students. 21. Leveraging: Describe your fundraising efforts and additional sources of revenue for this project and your organization. Please state whether any of these fund sources are already committed and in what amount. Biotech Partners has received expansion grants from TK Foundation and Toyota USA Foundation, both of $100,000 per year for three and two years respectively. BP is in the first year of the TK funding and in the second year of the Toyota USA funding, These funds are allocated across the four schools to which we are expanding, with a portion allocated to our work in South San Francisco, BP has received $7.5k from the Atkinson Foundation and $10k from Genentech for our SSF High School work and we have proposals pending with the Kimball Foundation ($10k for SSF) and the Bengier Foundation ($20k). BP also has an active Board of Directors and individual and major donor program which will contribute some amount of unrestricted funding to the program. However, public support is a key element of our program's success at existing sites in Berkeley and Oakland, where we've received ongoing public support for both programs, including CDBG funding from the City of Berkeley for many years. Staff' Uat List below kev staff members who work nn this nrn"nm Position Tilde Name of Staff Person Job Responsibilities Qualifications rogram and organizational Former teacher, over three Executive Director Lynda Gayden versight, relationship development decades experience in non -profit nd fundraising and Public sector management Staff management, internship Former teacher and school Program Director Kenneth Purser ultivation, teacher training, overall dministrator with experience in ro ram oversight on-profit mana ement Program Manager Mabel Brown n -site support, direct students SW with many years xperience working with BP's upport and intervention arget population n -class and individual student Program Coordinator Jeanine Porzio upport, lab assistance, one -on- graduate of UC Berkeley with a �BA ne and small group tutorin in Integrative Biology http: / /www.citydataservices. net / cities lsmatcalapp20l6arc.pl ?rpt =C4801 &prop =553 2/1/2016 City Data Services - South San Francisco PROMISED PROGRRAI M BUDGET FOR FY 2076_17 Att ,chl' eats 0 1. Resolution authorizing application and designation of signatory, by the Board of Directors 0 5. Board roster, including: Name, Company, Years on Board • Meeting dates for previous 12 months • Number of years allowed for each board term ® 6. Organizational chart for entire organization ® 7. Certified financial audit no more that 1 fiscal year old, prepared by a CPA, and: • Management letters (if applicable) • A -122 and A -133 Single Audit (for entities that receive more than $500,000 in federal funding) OR • A letter from your Executive Director or Chief Financial Officer certifying that agency does not receive more than $500,000 in federal funds and is not subject to the Single Audit. 8. The following are required: Current (FY15 -16) Agency Operating Budget • Proposed (FY16 -17) Agency Operating Budget L 9. Mission Statement ® 10. Non - discrimination policy for Staff and Clients ® 11. Reasonable Accommodations Policy for Staff and Clients Biotech Partners CDBG Grant Resolution pdf BP Board of Directors w Meeting Dates.pdf BP Oro Chart 2015 Update 10142015 pdf BiotechPartners - 2014 - Reviewed Financial Statements pdf LG certification of no single audit needed -1 pdf Biotech Partners - 2016- 2017 Proiected Ong Budgets - SSF CDBG pdf BP Mission Statement.odf Biotech Partners - Non - Discrimination Policv pdf BP -_ Reasonable Accommodations Policy for Staff and Clients pdf ® 12. Conflict of Interest Policy. (If not South San Francisco 32015 pdf available, please indicate when you will submit) © 13. Other - SSF -BP MOU xyz Page 5 of 6 http: / /www.citydataservices. net / cities lsmatcalapp20l6arc.pl ?rpt =04801 &prop =553 2/1/2016 South San Total Jurisdic'Ions Budget ! Ine Item CCAgency _ _ R Total _ gm% Program Total _Francisco % Requested Pgm% Requested abor Executive Director $137,02q 5% $6,851 00 1 0°/ $ Program Director $86,27 20% $17,25 290 $5,00 290 $5,00 Program Manager $67,95 25% $16,98 290 $5,00 290 $5,00 Program Coordinator $44,80 97% $43,25 460 $20,00 460 $20,00 Taxes/Benefits $127,454- 127,45 u lies Student Wages $77,85 18% 5% $18,55 r $13,72 36 °/ 58 °/ $9,50 00 / $ $5,00 145 °1 $5,00 Student Support and $65,00 ervices $3,45 $2,00 $ dministration $202,604 30% $6,91 519% 510K 350 TOTAL $808,96 16% $126,98 39% —$3,50CI $50,00 39°/ $50,00 umber of Individual Beneficiaries 7 7 ost per Individual $666.61 $666.6 Att ,chl' eats 0 1. Resolution authorizing application and designation of signatory, by the Board of Directors 0 5. Board roster, including: Name, Company, Years on Board • Meeting dates for previous 12 months • Number of years allowed for each board term ® 6. Organizational chart for entire organization ® 7. Certified financial audit no more that 1 fiscal year old, prepared by a CPA, and: • Management letters (if applicable) • A -122 and A -133 Single Audit (for entities that receive more than $500,000 in federal funding) OR • A letter from your Executive Director or Chief Financial Officer certifying that agency does not receive more than $500,000 in federal funds and is not subject to the Single Audit. 8. The following are required: Current (FY15 -16) Agency Operating Budget • Proposed (FY16 -17) Agency Operating Budget L 9. Mission Statement ® 10. Non - discrimination policy for Staff and Clients ® 11. Reasonable Accommodations Policy for Staff and Clients Biotech Partners CDBG Grant Resolution pdf BP Board of Directors w Meeting Dates.pdf BP Oro Chart 2015 Update 10142015 pdf BiotechPartners - 2014 - Reviewed Financial Statements pdf LG certification of no single audit needed -1 pdf Biotech Partners - 2016- 2017 Proiected Ong Budgets - SSF CDBG pdf BP Mission Statement.odf Biotech Partners - Non - Discrimination Policv pdf BP -_ Reasonable Accommodations Policy for Staff and Clients pdf ® 12. Conflict of Interest Policy. (If not South San Francisco 32015 pdf available, please indicate when you will submit) © 13. Other - SSF -BP MOU xyz Page 5 of 6 http: / /www.citydataservices. net / cities lsmatcalapp20l6arc.pl ?rpt =04801 &prop =553 2/1/2016 City Data Services - South San Francisco Biotech Partners Conflict of Interest Policv pdf Biotech Partners - 2015 Determination Letter pdf BP Articles of Inc pdf By-Laws rev.1 -27 -04 pdf Download All Attachments Program Manager Signature Lynda Gayden Date Signed 02101/2016 Initially submitted: Feb 1, 2016 - 15:22:15 Page 6 of 6 http: / /www.citydataservices. net / cities /smatca/app20l6arc.pl ?rpt =C4801 &prop =553 2/1/2016 Biotech Partners Projected Organizational Budgets Nscal Year Projected Revenues II 2016 Org ! 2017 Crg Budget � Budget Individual Donations & Fundraisers 125,000 150,000 Foundation Grants 450,000 Corporate Grants 250,000 Government Grants 225,000 I 450,000 250,000 450,000 In -Kind Contributions 74,00011 74,000 Total Projected Revenues 1,124,00011 1,374,000 L� Projected Expenses Personnel Executive Director (1 FTE) 135,000 139,050 Program Director (1 FTE) 85,000 Program Manager - (1 FTE) 66,950 87,550 68,959 Program Coordinator (1 FTE) - 13HS /0TH 1 50,000 J1 51,500 Program Coordintor (1 FTE) - Antioch F 43,250 46,350 Program Coordinator (1 FTE) — SSF Program Coordinator (1 FTE) — San Marin F 43,250 46,350 9,500 43,250 Biotech Partners Projected Organizational Budgets ryscaE Year b 2016 Crg 2017 Crg Budget � Budget Meetings 3,605 3,713 Mileage & Transportation 7,725 7,957 Total Direct Prcgrarr. Expenses 160,200 J 230,000 General & Administrative Expenses I - Supplies & Equipment ' �� 3,150 3,308 Dues & Subscriptions 2,57511 2,652 Postage & Delivery 1,030 1,061 a Marketing 15,000 16,500 Corpo ate Expense a Insurance Bank Charges -� 200 , 5,285 600111 250 5,444 600 Staff Recruitment & Development 4,300 4,300 Total General & Administrative Expenses 32,140 34,114 Contract Services Accounting, Audit, & Tax 42,000 45,000 Grantwriting 40,000 42,000 Other Contract Services 7,725 7,957 Totai Contract Services 89,7251, 94,957 Occupancy 77,090 77,183 Other /Indirect Expenses 1 Total Operating Expenses 1,008,7444 1,200,289 �Tetai Projeciee- Surprus (Deficit) 135,256 173,711 �OrganazatEOnaE Budget Note:Projected organizational budgets are included for calendar year 2016 and 2017 since the proposed project period spans the two fiscal years. BP is in advanced discussions and under consideration by BayerUSA Foundation regarding a large expansion grant, but this is not yet a certainty. Should BP have a surplus, funding will support expansion efforts in 2017 and will also be committed to establishing an operational reserve. l U25/2016 City Data Services - South San Francisco Consolidated Community Funding Application Redwood City, San Mateo County, and S. San Francisco Application for New Funding for FY 206 -17 GENERAL INFORMATION 1. Organization Name: Center for Independence of Individuals with Disabilities 2. Project Title: Housing Accessibility Modifications (HAM) We are applying for funding from: Redwood City City of San Mateo a South San Francisco f County of San Mateo Budget/Client Summary (Auto - populated from Budoet. below) Jurisdictions receiving this application R Amount Requested % of Program Budget Proposed # of Served % of Served Total $ Per Redwood City $18,50 14% 1 20% $1,088.2 it o f San Mateo $1 5,00 11% 14-- 18% $1,000.0 ount of San Mateo $60,00 45% 4 52% $1,395.3 outh San Francisco $10,00 8%1 4 1024 $1,250.0 [Total $103,50 78% 8 100% $1,246.9 Grant Funded Programs: We are applying for a Minor Home Repair Program CDBG National Objective Eligibility - How are you serving low income populations? Service to "presumed benefit' groups listed below (income verification not required, but verification of presumed benefit status is required): Abused children Homeless persons Victims of domestic violence Illiterate adults Elderly persons /seniors (age 62 +) Persons living with AIDS Severely disabled Adults Migrant farm workers Income Verification: Describe how you obtain, verify, and maintain proof of income and presumed benefit status. Third party documentation or client signatures on the certification forms must be available on file for review at all times. All Home Accessibility Modification (HAM) consumers /applicants must qualify under the low income requirements limiting benefits exclusively to extremely low, very low, and low income status. Services are only available to individuals and families with special needs; thus CID requires all applicants to do a complete intake to verify that they qualify under the terms stated under each grant agreement, as well as the policies necessary for consumers of an Independent Living Center (e.g. Disabilities, income requirements, and needs) in accordance to becoming more independent. When more than self verification is required under a specific grant and policy and stipulation, we gather all pertinent income information prior to starting modification to any households. Examples of acceptable forms of income verification are as follows: W -2 from prior years, recent payroll stubs ( 3 months), copies of SSI award letters, AFDC award letters etc. 3. Project Address: 2001 Winward Way, Suite 103 City: San Mateo Zip: 94404 -2499 4. Provide a one sentence project summary: The Housing Accessibility Modification (HAM) program will provide modifications to homes of persons with disabilities to improve accessibility and increase safety. Organization Address: 2001 Winward Way, Suite 103 City: San Mateo Zip: 94404 -2499 Organization Phone: 650 -645 -1780 Website: http:ilwww.cidsanmateo.org/ Type of Applicant: Our agency serves: S. Contact Person / Project Name: Donna Reed Title: Telephone: 650-645 - Administrator: 1780, Ext. 113 Contact Email: donnar @cidsanmateo.org; Fax- lisah@cidsanmateo.org 6. Name of Agency Director: David DeNola ht tp: //www.citydataservices.neVcif es/ smatcalapp2Ol6arc .pl ?rpt= C4742&prop =26 1/6 1/25/2016 City Data Services - South San Francisco 7. Fiscal Officer: Name: Tsegereda Andarge Email: Telephone: 650-645 - tsegeredat @cidsanmateo.org1780 Ext. 111 Fiscal Officer Address: 2001 Winward Way City: San Mateo Zip: 944042499 6. Authorized Signatory: Name: David DeNola Email: David Denola Telephone: 650 -645 - 1780 Ext 111 Authorized Signatory Address: 2001 Winward Way City: San Mateo Zip: 94404 -2499 9. Please provide days and hours of regularly scheduled operation: Office Hours are from 9 am - 5 pm. The Home Accessibility Modification Administrator is only a 20 hours position. Work hours are approximately 8:30 - 3:30 pm, hours may vary. All other employees are full time and operate within normal business hours. 10. BUNS Number: 049014111 Federal EIN/TIN Number: 94- 2581080 11. HUD Activity: Choose the HUD activity that most closely matches your service: 05B - Handicapped Services 12. Project Specific I'larrative: Provide a narrative description of the specific activities to be carried out with the requested funds. This should also include program objectives and key priorities for each specific jurisdiction. Accessible, affordable housing is a major concern for people with disabilities in San Mateo County. A recent government report showed that San Mateo County ranks the least affordable housing market in the state with 12% of its residents able to purchase a home (SF is at 14 %). The major emphasis in CID's housing efforts is our Housing Accesssibility Program (HAM), the program puts ramps, rails, grab bars, vertical lifts, and other modification to make homes accessible. These modifications assist people with disabilities to remain at home or move back into their homes with greater independence, and are not forced into a skilled nursing or other institutional care facility. CID cooperates with cities and the County housing agencies in San Mateo County to increase then number of accessible and affordable housing. 13A. Assessment of Need - Redwood City: Briefly describe how you determined the need for your program for each specific jurisdiction that you are applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. Determination of need for each specific jurisdiction that we are applying for funds is based on past performances of the agency, demands identified by request, and similar programs within a specific jurisdictional area. Additionally, we audit our organization on key demographic of nationality and diverse population of services provided and outreach to different communities. Population: Disabled individuals, according to 2010 data, 18.9% of the Redwood City population have disabilities. Additional increase projection in the future occurring with the growing elderly community. Areas: All residential households within the Redwood city limits that are low. very low, and extremely low income level. 136. Assessment of Need - City of San Mateo: Briefly describe how you determined the need for your program for each specific jurisdiction that you are aRp_lying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. Determination of need for each specific jurisdiction that we are applying for funds is based on past performances of the agency, demands identified by request, and similar programs within a specific jurisdictional area. Additionally, we audit our organization on key demographic of nationality and diverse population of services provided and outreach to different communities. Population: Disabled individuals, according to 2010 data 15% of the City of San Mateo population have disabilities. Additional increase projection in the future occurring with the growing elderly community. Areas: All residential households within the San Mateo city limits that are low, very low, and extremely low income level. 13C. Assessment of Need - County of San Mateo: Briefly describe how you determined the need for your program for each s ecific jurisdiction that you are applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. Determination of need for each specific jurisdiction that we are applying for funds is based on past performances of the agency, demands identified by request, and similar programs within a specific jurisdictional area. Additionally, we audit our organization on key demographic of nationality and diverse population of services provided and outreach to different communities. Population: Disabled individuals, according to 2010 data 19.8 %the County of San Mateo population have disabilities. Additional increase projection in the future occurring with the growing elderly community. Areas: All residential households within the San Mateo County limits that are low, very low, and extremely low income level. 'County of San Mateo QuickFacts from the US Census Bureau.' San Mateo (city) QuickFacts from the US Census Bureau. N.p., n.d. Web. 21 Jan. 2016 13D. Assessment of Need - South San Francisco: Briefly describe how you determined the need for your program for each specific jurisdiction that you are applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. Determination of need for each specific jurisdiction that we are applying for funds is based on past performances of the agency, demands identified by request, and similar programs within a specific jurisdictional area. Additionally, we audit our organization on key demographic of nationality and diverse population of services provided and outreach to different communities. Population: Disabled individuals, according to data from 2010, 17.75 % of the South San Francisco population have disabilities. Additional increase projection in the future occurring with the growing elderly community. httpJ/www.citydataservices.rret/ cities/ smatcalapp2016arc .pl?rpt= C4742&prop =26 216 V2&20116 City Data Services - South San Francisco Areas: All residential households within the South San Francisco city limits that are low, very low, and extremely low income level. 'South San Francisco (city) QuickFacts from the US Census Bureau.' San Mateo (city) QuickFacts from the US Census Bureau. N.p., n.d. Web. 21 Jan. 2016 14. Timmins: Provide a brief timetable for project implementation and achievement of projected goals and how you plan to expend your funds in a timely manner by the end of the fiscal year. Our Home Accessibility Modification (HAM) Program is monitored to make sure that protective time lines and milestones are met through out the fiscal year. In the beginning of each fiscal year we evaluate the amount of funding that is allotted for each individual city and /or county to determine what goals were proposed in each grant. We then determine monthly and quarterly milestones to be met in order to hit each specific target set forth. After each monthly review we evaluate which cities counties may be lacking in consumers request and schedule outreaches in the target areas to enhance awareness to our program and organization. Structurally we intend to achieve protected goals in the timelines allotted by having a list task in logical order to demonstrate feasible work plans. We identify and evaluate all resources need to preform proposed actives. All our HAM project goals are set, achievable, measurable, time limited, and clearly stated on our work plans for each project. 15. Evaluation: Briefly describe how you will determine and measure the success of your program and whether or not program goals were met? If your program is currently receiving grant funds please describe accomplishments of goals to date. CID provides quality satisfaction survey's for all Home Accessibility clients served in order to monitor the services provided by the clients. We gauge our program success by our consumer's satisfactions, as well as reaching milestones set in the grant stipulations; those include, the number of households and people served, modifications provided, and diversification of consumers. Internally, one of our greatest accomplishments to date is cutting our waiting list down by 50% from prior years. On a consumer stand point we are happy to report that we are getting great feedback from our consumers and changing individuals lives by giving them more independence. We provide that independence in simple ways by installing grab bars in their bathrooms so that they can shower without care attendants, and providing the installation of ramps in their homes so that they can move in and out freely without assistance. This essentially prevents them from having to be institutionalized and allows them to live more independently. 16. Coliaborafiion: Describe partnerships with other organizations /agencies, the nature of the partnership, and how it relates to the proposed project. We are working closely with Rebuilding Together, another local non profit that also provides home modifications to the community. The nature of our partnership /collaboration is working closely on projects, outside contracts, and proper referrals. We have collaborated on a share of cost to consumers on specific funding sources, we make referrals to one another if the other agency is better equipped to provide services. 17. Impact:: Discuss any general trends and conditions that have affected or impacted your service levels or service populations. For New Applicants — describe what these funds would allow your agency to do that you may not be able to do now. For Continuing Applicants — describe how your program would be impacted without these funds. Trends show that the elderly and disabled population in San Mateo County could increase by 30-40% by 2020 (Lisa et all). As an Independent Living Center for Individuals of all ages and Disabilities we are seeing an increase in the needs for our Home Accessibility Program as well as our AT Department (e.g Staidifts). Without these funds there could be an increase of individuals will no longer be able to live independently in their homes, and consequently stripped of their independence. It could also potentially put a financial strain on the individuals family, county, and state due to high cost of institutionalization. As a Center, our HAM program is the most vital to the San Mateo County community and without these funds we would inevitably lose staff and lose one of our most valued and long standing programs in the community. 18. Project Beneficilaries/Quantifiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. 19. Project Beneficiaries /Quantifiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. a. Indicate the total number of low-income beneficiaries you expect to serve with this program for each jurisdiction application for funding. *Low-income is 80% of Area Median Income or below. See AMI table b. Indicate the total number of beneficiaries you expect to serve with this program in each jurisdiction - regardless of income. Jurisdiction a. Number of low-income beneficiaries to be served per grant jurisdiction application. *"Lowincome ** is 80% of Area Median Income or below. b. All beneficiaries to be served per grant jurisdiction application regardless of income Persons Persons Daly City 8 8 Redwood City 17 17 ity of San Mateo 15 15 ounty of San Mateo 43 43 outh San Francisco 8 8 otals 91 91 19. Populations Served: Check the boxes below if they describe a significant population served by your program. These categories are not considered "presumed benefit" by HUD, and require income verification. Persons exiting incarceration Low- income youth d Other Disabled http: /1www.citydataservices.neV cities/ smatca /app20l6arc.pl?rpt= C4742&prop =26 3/6 1/25/2016 City Data Services - South San Francisco 20. AffirmaVve Cutreach: a. Use the demographics from your previous program year to provide an analysis of the population you serve relative to the demographics in the table. NOTE If vnu arw a naw annfiranr niaaco .,.,,,,;ae ,,,,... ties , .1'.'- 4.1-- Race & Ethnicity w y Redwood City Population Redwood City % by Ethnicity Low Income by Ethnicity served b our P ram ° .Your Program /o . by Ethnicity l 74,40 100% 10 100% and not His nic 40,6 54.64% 5 53.00 ° / [Aite e and His anic 23,55 31.66% 23 23.00 ° / n 6,71 9.03% 1 5.00% an American 1,91 2.58% 11 8.00% Pacific Islander 6 0.89° 1 1.00% Native American 141 0.52% 1 2.00% her 3,8231 2.03 % 01 8.00% Race & 'Ethnicity I City of San r Mateo Population City of San Mateo /o by Ethnicity Low Income by Ethnicity served by our Program Your Program % by Ethnicity l 97,20 100% 10 10p% e and not Hispanic 45,24 46.54% 5 58.00% e and Hispanic Vh 25,81 26.56% 1 13.00% n 18,15 18.6 7% 1 14.00% an American 2,09 2.16% 11 11.00% Pacific Islander 1,9371 1.99% 21 3.00% Native American 141 0.140/6 1 1.00% Other 3,8231 3.93%1 01 0.00 Race & Ethnicity FrFrancisco Po So%21,64 South San /o by Ethnicity Low Income by Ethnicity served b our P ram Your Program % by Ethnicity Total Coordination of all HAM projects 100% 10 100 %' White and not Hispanic Background in Fiscal 37.34% 44.00% hite and Hispanic 34.02% 24 27.00% sian 23,2931 36.61% 1 16.00% frican American 1,6251 2.55% 7.00% Pacific Islander 1,1111 1.75% 21 2.00% Native American 394 0.62% 11 1.00°/ ther 9,5981 15.08% 3.00% b. Based on the percentages that you indicate your organization served describe your efforts to improve affirmative outreach to groups that may be underserved by your program and the result of your efforts: Based on the statistical analysis of people served by CID and race and ethnicity average of each city (Redwood City, SSF, and City of San Mateo, additional outreach needs to be conducted in the Hispanic (non white) and Asian communities in all 3 demographic areas. 21. Leveraging: Describe your fundraising efforts and additional sources of revenue for this project and your organization. Please state whether any of these fund sources are already committed and in what amount. Majority of our administrative costs are funded by the Department of Rehabilitation (DOR) revenue. As of date, we have already allocated funding from DOR to help fund support staff to help coordinate the modification of jobs, contractors, billing, and additional administrative duties associated with the HAM program. Staff List List below kev staff members who work on this uroararm Position Title Name of Staff Job Responsibilities Qualifications Work Order Administrator Lisa Heath Coordination of all HAM projects Background in Administration Fiscal Manager Tsgereda Andarge Fiscal Management entire organization Background in Fiscal Management PROPOSED PROGRAM BUDGET FOR FY 2016 -17 3 County of San South San http. /Mrww.citydataservices.rieu cities/ smatcalapp2016arc.pl ?rpt= C47428 prop = 416 1/25/2016 City Data Services - South San Francisco For the City of Redwood City CUY, answer the following: For the City of Redwood City ONLY, answer the following: 1. Funding Criteria: 1. Affordable Housing: Acquisition of sites for affordable housing, new construction of affordable housing, conversion of existing housing to affordable, acquisition and rehabilitation of rental housing (includes special needs housing). 2. 'Marketing /Advertising a. Check all of the following methods your agency utilizes to promote and advertise your programs and services: Flyers/brochures id, Website W Outreach presentations to public Ife PSA's b. Which of the above marketing /advertising materials are available in multi- langual form and which languages are they available in? Brouchers are in Spanish, English, Tagalog, and Chinese. Large print or braille are available upon request. Languages Spoke in the office: Hebrew, Filipino, Spanish, & Arabic c. How and where are the materials distributed? Material of our Home Accessibility Modification (HAM), is prominently displayed in the lobby of our Main Office (San Mateo ) and our Branch Office (San Bruno). Additionally, when any of our programs do an intake on individuals, materials for the HAM program are distributed to the client. IN all outreaches to different community partners in San Mateo County, we distribute pamphlets describing the services at our center. Some of our common outreaches for the HAM program are: Hospitals, Social Workers, Teachers, Organizations that are specially geared towards diverse groups. 3. Program Outcomes: a. Please describe the accomplishments of program goals for FY /15. Our program helps the lives in the community by modifying homes or using Assitive technology (e.g stair lifts). These are just two of several related efforts that may assist us to maintain peoples independence, safety, while fostering community integration. With our program,going to the grocery story, getting to work or to a doctor's appointment becomes possible. One of the biggest impact we have through this program is helping individuals remain in their homes as well as return home form institutional settings by providing structural improvements that give power and independence back to the consumer. b. In what ways has your program made a difference in the lives of the people you serve? Please provide at least one concrete example from the people served in FY /15: We have a 77 year old male consumer who resides in San Mateo County. His primary disability is blindness, but he also has suffered from a stroke and a broken hip fracture. By installing a ramp and grab bars, James is able to be mobile and maintain the ability to participate in community activities. One of his favorite pastimes is to go to parties with his biker friends. He also attends daycare 4 times a week where he walks regularly and learns to exercise with his hands. When spoke with Katie, the caregiver, she told me that he absolutely enjoys his ramp and the "social" freedom it has given him. Attachments. http: //www.citydataservices. net / cities/ smatcalapp2016arc .pl ?rpt= C4742&prop =26 516 Redwood City City of San Mateo Mateo Franc:sco Total Jurisdictions Budget Line item Agency P,,, %, Program % Requested % Requested % Requested % Requested Pgrn Requested axes en i s $ $ erati ms /Maintenance Contractor 1,115,32 $1,115,323-- _ $96,949 $15,54 $12,60 $50,40 $8,40 dministration $51,00q 70%1 $35,56 ' B°/ $2,96 7% $2,40 ° 27/0 $9,60 o 4/ $1,60 47 °/ 1656 TOTA $1,166,32 11% $132,500614°/ $18,50 11% $15,00 45 °/ $60,0 8 °/ $10,00 78% $103,50 Number of Individual Beneficiaries 1 1 ost per Individual $1,088.2 $1,000.0 $1.395.351 $1,250.00I 8 $1,246.9 For the City of Redwood City CUY, answer the following: For the City of Redwood City ONLY, answer the following: 1. Funding Criteria: 1. Affordable Housing: Acquisition of sites for affordable housing, new construction of affordable housing, conversion of existing housing to affordable, acquisition and rehabilitation of rental housing (includes special needs housing). 2. 'Marketing /Advertising a. Check all of the following methods your agency utilizes to promote and advertise your programs and services: Flyers/brochures id, Website W Outreach presentations to public Ife PSA's b. Which of the above marketing /advertising materials are available in multi- langual form and which languages are they available in? Brouchers are in Spanish, English, Tagalog, and Chinese. Large print or braille are available upon request. Languages Spoke in the office: Hebrew, Filipino, Spanish, & Arabic c. How and where are the materials distributed? Material of our Home Accessibility Modification (HAM), is prominently displayed in the lobby of our Main Office (San Mateo ) and our Branch Office (San Bruno). Additionally, when any of our programs do an intake on individuals, materials for the HAM program are distributed to the client. IN all outreaches to different community partners in San Mateo County, we distribute pamphlets describing the services at our center. Some of our common outreaches for the HAM program are: Hospitals, Social Workers, Teachers, Organizations that are specially geared towards diverse groups. 3. Program Outcomes: a. Please describe the accomplishments of program goals for FY /15. Our program helps the lives in the community by modifying homes or using Assitive technology (e.g stair lifts). These are just two of several related efforts that may assist us to maintain peoples independence, safety, while fostering community integration. With our program,going to the grocery story, getting to work or to a doctor's appointment becomes possible. One of the biggest impact we have through this program is helping individuals remain in their homes as well as return home form institutional settings by providing structural improvements that give power and independence back to the consumer. b. In what ways has your program made a difference in the lives of the people you serve? Please provide at least one concrete example from the people served in FY /15: We have a 77 year old male consumer who resides in San Mateo County. His primary disability is blindness, but he also has suffered from a stroke and a broken hip fracture. By installing a ramp and grab bars, James is able to be mobile and maintain the ability to participate in community activities. One of his favorite pastimes is to go to parties with his biker friends. He also attends daycare 4 times a week where he walks regularly and learns to exercise with his hands. When spoke with Katie, the caregiver, she told me that he absolutely enjoys his ramp and the "social" freedom it has given him. Attachments. http: //www.citydataservices. net / cities/ smatcalapp2016arc .pl ?rpt= C4742&prop =26 516 1/2512016 City Data Services - South San Francisco e 1. Resolution authorizing application and CID - Board Resolutions .of designation of signatory, by the Board of Directors 5. Board roster, including: CID - Board of Directors Roster odf Name, Company, Years on Board • Meeting dates for previous 12 months • Number of years allowed for each board term d. 6. Organizational chart for entire organization CID - Organizational Chart 2016 pdf !°- 7. Certified financial audit no more that 1 fiscal CID - Audit Report.Ddf year old, prepared by a CPA, and: Management letters (if applicable) • A -122 and A -133 Single Audit (for entities that receive more than $500,000 in federal funding) OR • A letter from your Executive Director or Chief Financial Officer certifying that agency does not receive more than $500,000 in federal funds and is not subject to the Single Audit. 8. The following are required: • Current (FY15 -16) Agency Operating Budget • Proposed (FY16 -17) Agency Operating Budget 4 9. Mission Statement 10. Non - discrimination policy for Staff and Clients 11. Reasonable Accommodations Policy for Staff and Clients CID - Agency Budget 2015 -2016 odf CID - Agency Budget 2016- 2017.pdf CID - Mission Statement.odf CID - Non-discrimination Policy for Staff and Clients. df CID - Reasonable Accommodations Policy for Staff and Clients pdf d. 12. Conflict of Interest Policy. (If not available, CID - Conflict of Interest Policv pdf please indicate when you will submit) L.? 13. Other - Download All Attachments Program Manager Signature Donna Reed Date Signed 01/21/2016 Initialy submitted: Jan 21, 2016 - 16:08:26 http:// www. citydataservices. reUcities/ smatca/ app2016arc.pl ?rpt= C4742&prop =26 6/6 Agency Budget 2015 -16 Center for Independence of Individuals with Disabilities FY 10.1.2015- 9.30.2016 Agency A8204 A8204AT VII - C VII - C Contract WIPA General ILS BRANCH HAM Fund Agency Income 1,161,322 325,444 70,000 199,574 132,804 113,600 300,000 20,000 $1,161,322 EXPENSES PERSONNEL TOTAL 798,649 246,927 44,100 148,820 116,756 8,364 233,682 $798,649 PERSONNEL TOTAL Personnel Personnel P -1 Executive Director -1 fte 92000 46000 27600 18400.00 $92,000 vExecutive Director -1 fte - DeNala P -2 Program Manager -1 fte 60000 24000 12000 5400.00 18600 $60,000 Program Manager -1 fte - Reed P -3 Office Manager -1 fte 37193 29754 7439 $37,193 Office Manager -1 fte -Luna P -4 Fiscal Manager -1 fte 48000 22560 10560 4800.00 7680 2400 $48,000 Fiscal Manager -1 fte - Andarge P -5 Systems Change Advocate -1 fte 38054 19027 15222 3805.40 $38,054 Systems Change Advocate -1 fte - Merola P -6 Independent Living Generalist -1 fte 37193 26035 11158 $37,193 ILS Generalist -1 fte - Hanson P -7 HAM Coordinator - .50 fte 19760 19760 $19,760 HAM Coordinator -.5 fte - Lisa P -8 Independent Living Generalist - .5 fte 19760 19760 $19,760 IL Generalist - .5 fte - TBD P -9 AT Coordinator -1 fte 37193 37193 $37,193 AT Coordinator -1 fte - Camargo Peer Support Coordinator -.26 fte 12150 12150 $12,150 Peer Support Coordinator - .26 fte - Sahouria Independent Living Generalist -1 fte 37193 3719 33473.70 $37,193 IL Generalist -1 fte - McMullen Independent Living Generalist -1 fte 37193 3719 33473.70 $37,193 IL Generalist -1 fte - TBD Independent Living Generalist - .5 fte 19760 19760 $19,760 IL Generalist -.5 fte - Williams WIPA Coordinator -1 fte 38543 38543 $38,543 WIPA Coordinator -1 FTE - Maheshwary WIPA Coordinator -1 fte 38543 38543 $38,543 WIPA Coordinator -1 FTE - Brune WIPA Coordinator -1 fte 38543 38543 $38,543 WIPA Coordinator -1 FTE - Stephanie WIPA Coordinator -1 fte 38543 38543 $38,543 WIPA Coordinator -1 FTE - TBD WIPA Data Coordinator -.5 fte 20478 20478 $20,478 WIPA Data Coordinator -.5 FTE- Lisa TOTAL WAGES: 670,099 206,896 37,193 123,327 99,353 7,680 195,650 $670,099 30% 6% 19% 13% 1% Health 42591 12,800 2,400 8200 5400 591 13200 State Tax 6522 2,768 300 1645 609 0 1200 Payroll tax 50665 15,828 2,845 9433 7592 0 14967 LTD, Visior: and Dental 19553 6,305 984 4767 2552 0 4945 W. Comp 9219 2,330 378 1448 1250 93 3720 P -10, P -11 Fringe Benefits: PR Tax /UST /WC /Ins 128,550 40,031 6,907 25,493 17,403 684 38,032 $128,550 Fringe Benefits: PR Tax /UST/WC /Ins PERSONNEL TOTAL 798,649 246,927 44,100 148,820 116,756 8,364 233,682 $798,649 PERSONNEL TOTAL Operating AB204 A8204AT VII - C VII - C Contract WIPA General ILS BRANCH HAM Fund Operating 0-1, 0 -17 Occupancy 117776 26192 8788 26173 10025.00 46598 $117,776 Occupancy 0-2, 0 -18 Insurance- Liability 22259 13078 3149 2532 0.00 0 3500 $22,259 Insurance - Liability 0-3, 0 -19 Telephone /Internet 16963 5317 2598 2830 1986.00 4232 $16,963 Telephone 0.4, 0 -20 Dues /Subscriptions 5300 3000 1000 1200 100.00 0 $5,300 Dues /Subscriptions 0-5, 0 -21 IT Contract Services 20160 7899 3504 3619 1298.00 3840 $20,160 IT Contract Services 0-6, 0 -22 Financial Contract Services 16200 6480 1620 6952 1148.00 0 $16,200 Financial Contract Services 0-7, 0-23 Equipment Maintenance 3600 2070 190 1340 0.00 0 $3,600 Equipment Maintenance 0-8, 0 -24 Equipment Lease 5748 2874 574 1437 863.00 0 $5,748 Equipment Lease 0-9, 0 -25 Postage 3844 1985 831 500 0.00 528 $3,844 Postage 0 -10 0 -26 Printing & Copying 2633 840 489 500 278.00 526 $2,633 Printing & copiying 0 -11, 0 -27 Resource Material 2660 773 532 200 0.00 1155 $2,660 Resource Material 0-12,0-28 Supplies -Office 7786 3875 876 935 350.00 1750 $7,786 Supplies -Office 0 -13 Utilities 1810 1030 0 780 0.00 0 $1,810 Utilities 0 -14, 0 -29 Travel 10785 1125 1425 896 0.00 7339 $10,785 Travel 0 -15, 0-30 Staff Training/Conferences /Recruitment 2559 1375 324 860 0 0 $2,559 Staff Training/Conferences 0 -16, 0-31 Workshop 954 604 0 0 0 350 $954 Workshop Independent Contractor -HAM 105136 105136 $105,136 Independent Contractor -HAM Bank Charge and Other General Admin. Cost 1500 1500 $1,500 Bank Charge WIPA Match 15_000 15000 $15,000 WIPA Klatch OPERATING TOTAL 362,673 78,517 25,900 50,754 16,048 105,136 66318 20,000 $362,673 OPERATING TOTAL TOTAL COST 1,161,322 325,444 70,000 199,574 132,804 113,500 300,000 20,000 $1,161,322 GRAND TOTAL Income 1,161,322 325,444 70,000 199,574 132,804 113,500 300,000 20,000 $1,161,322 Income difference 0 0 0 0 0 0 0 0 0 difference Color Key - Operations: Direct Costs Indirect Costs Independent Contractor Agency Budget 2016 -17 Center for Independence of Individuals with Disabilities FY 10.1.2016- 9.30.2017 Agency Income 1,166,322 EXPENSES A6204 AB204AT VII - C ILS 325,444 70,000 199,574 Agency VII - C Contract WIPA General BRANCH HAM Fund 132,804 113,500 300,000 25,000 $1,166,322 Personnel Personnel P -1 Executive Director -1 fte 92000 46000 27600 18400.00 $92,000 Executive Director -1 fte - DeNola P -2 Program Manager - 1 fte 60000 24000 12000 5400.00 18600 $60,000 Program Manager -1 fte - Reed P -3 Office Manager -1 fte 37193 29754 7439 $37,193 Office Manager -1 fte - Luna P-4 Fiscal Manager -1 fte 48000 22560 10560 4800.00 7680 2400 $48,000 Fiscal Manager -1 fte - Andarge P -5 Systems Change Advocate -1 fte 38054 19027 15222 3805.40 $38,054 Systems Change Advocate -1 fte - Merola P -6 Independent Living Generalist -1 fte 37193 26035 11158 $37,193 ILS Generalist -1 fte - Hanson P -7 HAM Coordinator - .50 fte 19760 19760 $19,760 HAM Coordinator - .5 fte - Lisa P -8 Independent Living Generalist -.5 fte 19760 19760 $19,760 IL Generalist - .5 fte - TBD P -9 AT Coordinator -1 fte 37193 37193 $37,193 AT Coordinator -1 fte - Camargo Peer Support Coordinator -.26 fte 12150 12150 $12,150 Peer Support Coordinator -.26 fte - SAhouria Independent Living Generalist -1 fte 37193 3719 33473.70 $37,193 IL Generalist -1 fte - McMullen Independent Living Generalist -1 fte 37193 3719 33473.70 $37,193 IL Generalist - i fte - TBD Independent Living Generalist -.5 fte 19760 19760 $19,760 IL Generalist -.5 fte - Williams WIPA Coordinator -1 fte 38543 38543 $38,543 WIPA Coordinator -1 FTE - Maheshwary WIPA Coordinator -1 fte 38543 38543 $38,543 WIPA Coordinator -1 FTE - Brune WIPA Coordinator -1 fte 38543 38543 $38,543 WIPA Coordinator -1 FTE - Stephanie WIPA Coordinator -1 fte 38543 38543 $38,543 WIPA Coordinator -1 FTE - TBD WIPA Data Coordinator -,5 fte 20478 20478 $20,478 WIPA Data Coordinator -.5 FTE - i l TOTAL WAGES: 670,099 206,896 37,193 123,327 99,353 7,680 195,650 $670,099 30% 6% 19% 13% 1% Health 42591 12,800 2,400 8200 5400 591 13200 State Tax 6522 2,768 300 1645 609 0 1200 Payroll tax 50665 15,828 2,845 9433 7592 0 14967 LTD, Vision and Dental 19553 6,305 984 4767 2552 0 4945 W. Comp 9219 2,330 378 1448 1250 93 3720 P -10, P -11 Fringe Benefits: PR Tax /UST/WC /Ins 128,S50 40,031 6,907 25,493 17,403 684 38,032 $128,550 Fringe Benefits: PR Tax /UST/WC /Ins PERSONNEL TOTAL 798,649 246,927 44,100 148,820 116,756 8,364 233,682 $798,649 PERSONNEL TOTAL AB204 AB204AT VII - C VII - C Contract WIPA General Operating^ ILS BRANCH HAM Fund Operating 0 -1, 0 -17 Occupancy 117776 26192 8788 26173 10025.00 46598 $117,776 Occupancy 0 -2, 0 -18 Insurance - Liability 23759 13078 3149 2532 0.00 0 5000 $23,759 Insurance - Liability 0-3, 0 -19 Telephone /Internet 16963 5317 2598 2830 1986.00 4232 $16,963 Telephone 0-4, 0 -20 Dues /Subscriptions 5300 3000 1000 1200 100.00 0 $5,300 Dues /Subscriptions 0-5, 0 -21 IT Contract Services 20160 7899 3504 3619 1298.00 3840 $20,160 IT Contract Services 0-6, 0 -22 Financial Contract Services 16200 6480 1620 6952 1148.00 0 $16,200 Financial Contract Services 0 -7, 0 -23 Equipment Maintenance 3600 2070 190 1340 000 0 $3,600 Equipment Maintenance 0-8, 0 -24 Equipment Lease 5748 2874 574 1437 863.00 0 $5,748 Equipment Lease 0-9, 0 -25 Postage 3844 1985 831 500 0.00 528 $3,844 Postage 0 -10 0 -26 Printing & Copying 2633 840 489 500 278.00 526 $2,633 Printing & copiying 0 -11, 0 -27 Resource Material 2660 773 532 200 0.00 1155 $2,660 Resource Material 0 -12, 0 -28 Supplies - Office 7786 3875 876 935 350.00 1750 $7,786 Supplies -Office 0.13 Utilities 1810 1030 0 780 0.00 0 $1,810 Utilities 0-14,0-29 Travel 10785 1125 1425 896 0.00 7339 $10,785 Travel 045, 0-30 Staff Training/Conferences /Recruitment 2559 1375 324 860 0 0 $2,559 Staff Training/Conferences 0 -16, 0-31 Workshop 954 604 0 0 0 350 $954 Workshop Independent Contractor -HAM 105136 105136 $105,136 Independent Contractor -HAM Bank Charge and Other General Admin. Costs 5000 5000 $5,000 Bank Charge WIPA Match 15000 15000 $15,000 WIPA Match OPERATING TOTAL 367,673 78,517 25,900 500754 16,048 105,136 66318 25,000 $367,673 OPERATING TOTAL TOTAL COST 1,166,322 325,444 70,000 199,574 13_2,804 113,500 300,000 25,000 $1,166,322 GRAND TOTAL Income 1,166,322 325,444 70,000 199,574 132,804 113,500 300,000 25,000 $1,166,322 income difference 0 0 0 0 0 0 0 0 0 difference Color Key -Operations: Direct Costs Indirect Costs Independent Contractor 1/25/2016 City Data Services - South San Francisco Consolidated Community Funding Application Redwood City, San Mateo County, and S. San Francisco Application for New l=unging for Fly 2016 -17 GENERAL INFORNIATION 1. Organization Name: El Concilio of San Mateo County 2. Project Title: Peninsula Minor Home Repair R.Awle are applying for funding from: Redwood City 4 Ci�of San Miateo $ South San Francisco $ County of San Mateo I ,udget/Cilent Sum aty (Auto- o Dulated from Budget, 1419 Burlingame City: Burlingame Zip: 94010 -4123 Avenue, Suite N below 650 - 373 -1080 Website: www.el- Jurisdictions receiving this application Amount %of Requested Program Budget Proposed # of I Served % of Served Total $ Per Redwood City $45,0 32% Name: T.L. Minahan Email: Telephone: 650 - 373 -1099 11 34% $409_ City of San Mateo $25,00 18% 551 17% $454. County of San Mateo $60001 43% 12 39% $481 South San Francisco $10 00 7% 3 9% $333.3 IFS 100% 32 100% $437.5 Grant Funded Programs: We are applying for a Minor Home Repair Program CDBG National Objective Eli igl bilitf - How are you serving low income populations? Minor home repairs for low income households whose incomes are verified. Income Verification: Describe how you obtain, verify, and maintain proof of income and presumed benefit status. Third party documentation or client signatures on the certification forms must be available on file for review at ali times. Income verification is a standard requirement for all ECCMC programs. The income thresholds for the PMHR program are consistent with San Mateo County and entitlement cities standards. We require documented proof of income for all programs, such as the Energy Savings Assistance program, which has strict qualification and income verification requirements. For the PMHR program, we require the two most current proofs of income (pay check stubs or proof of amount given to applicant by Social Security, Disability or unemployment). A proof of ownership waiver needs to be signed by owner. Ownership of the home is verified by checking with the County Assessor's office. If the name on this waiver is different than the name that the house is under, the application will not be approved. Renters can apply but must have the property owner waiver signed by the owner of the house or apartment. All documents collected go into customer files and are available for review at all times. Along with maintaining appropriate documentation for new customers, the PMHR program will leverage existing documents on file and in ESCMC's database to ensure appropriate income verification is documented and maintained for all PMHR customers. 3. Project Address: 1419 Burlingame City: Burlingame Zip: 94010 -4123 Avenue, Suite N 4. Provide a one sentence project summary: ECSMC proposes to continue providing minor home repair services to residents of San Mateo County enabling extremely low, very low, low and fixed income residents whose homes do not initially qualify for the Energy Savings Assistance program to become eligible to benefit from energy and water conservation solutions. Organization Address: 1419 Burlingame City: Burlingame Zip: 94010 -4123 Avenue, Suite N Organization Phone: 650 - 373 -1080 Website: www.el- concilio.com Type of Applicant: Our agency serves: 5. Contact Person / Project Administrator: Name: Joaquin Narvaez Title: PMHR Manager Telephone: 650 - 918 -9553 Contact Email: joaquinn75 @yahoo.com Fax: 6. Name of Agency Director: Ortensia Lopez 7. Fiscal Officer: Name: T.L. Minahan Email: Telephone: 650 - 373 -1099 http: /Avww.citydataservices. net / cities/ smatca (app2016arc.pl ?rpt= C4746&prop =117 1/9 1/25/2016 Fiscal Officer Address: 8. Authorized Signatory: City Data Services - South San Francisco tlminahan @yahoo.com 1419 Burlingame City: Burlingame Zip: 94010 -4123 Avenue, Suite N Name: Ortensia Lopez Email: or10sia @aol.com Authorized Signatory Address: 1419 Burlingame City: Burlingame Avenue, Suite N 9. Please provide days and hours of regularly scheduled operafion: Monday through Friday 9AM -5PM 10. DUNS Number: 94 -6525250 Telephone: 650 - 373 -1080 Zip: 94010 -4123 Federal EIN /TIN Number: 94- 2772110 14. HUD Activity: Choose the HUD activity that most closely matches your service: 05 - Public Services 12. Project Specific Narrative: Provide a narrative description of the specific activities to be carried out with the requested funds. This should also include program objectives and key priorities for each specific jurisdiction. The unique feature and benefit of the PMHR program is ECSMC's holistic approach and considerable experience in providing home repair services to Extremely Low Income (ELI), Very Low Income (VLI) and Low income (LI) residents including those on a fixed income. The PMHR program objectives are providing cost - effective minor home repair improvements /repairs focusing on: • health and safety, • housing quality standards, • increasing energy /water conservation, • making more homes eligible for energy /weatherization improvements that would otherwise not be completed, • and/or access modifications. The key priorities of the PMHR program are to focus on its target audience on households who: • need but are unaware of programs available to improve their homes through minor home repairs, • may be eligible for low -cost installation of energy /water conservation solutions, and • would benefit significantly from reducing monthly energy /household water expenses. Under the PMHR program, the services provided to eligible homes include (but are not limited to): • Attic insulation. • Water heater wrapping • Carbon monoxide /fire alarm inspections /installation • Repair /replace heating, ventilation, and air condition (HVAC) • Natural gas appliance testing • Refrigerator replacement • Water leak testing • Energy audits /concurrent energy education • Quality control inspections • Repair /replace doors, windows, fences • Weatherization • Accessibility for disabled and elderly • Electrical work 13A. Assessment of Need - Redwood City: Briefly describe how you determined the need for your program for each specific jurisdiction that you are 8112121yina for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. The PMHR program is in line with Redwood City's affordable housing priorities of preserving existing rental housing and improving the condition of existing housing. ECSMC determined the need for the PMHR program based on our experience as a contractor for PG &E's Energy Savings Assistance (ESA) program. Our specialists conduct minor home repairs such as broken or moldy windows, or a lack of accessibility modifications such as safety hand rails, which are unsuitable and unsafe, especially for children or the elderly. Our target population of ELI/VLI /LI and fixed income households cannot make these minor home repairs due to health conditions and /or financial reasons. Rebuilding Together Peninsula offers similar minor home repair services improving the condition of existing housing within the city. However, such programs are limited to specific jurisdictions and do not have the necessary resources to meet all of the needs within RWC. The city's population is 82,881 (2014 US Census est.) with 8.6% living below poverty level. In addition to improving safety, potential energy /water conservation measures yield savings in monthly utility bills, which in turn help to provide economic opportunities by providing discretionary funds for families who are economically disadvantaged. Of RWC households, 45.8% speak a non - English language, making PMHR's multilingual (English, Spanish, Chinese, Tagalog, Tongan, Russian) and culturally- sensitive staff a great asset.. 138. Assessment of Need - City of San Mateo: Briefly describe how you determined the need for your program for each specific jurisdiction that you are applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. The PMHR program is in line with City of San Mateo's affordable housing priorities of preserving existing rental housing and improving the condition of existing housing. ECSMC determined the need for the PMHR program based on our experience as a contractor for PG &E's Energy Savings Assistance (ESA) program. Our specialists conduct minor home repairs such as broken or moldy windows, or a lack of accessibility modifications such as safety hand rails, which are unsuitable and unsafe, especially for children or the elderly. Our target population of ELI /VLI /LI and fixed income households cannot make these minor home repairs due to health conditions and /or financial reasons. Rebuilding Together Peninsula offers similar minor home repair services improving the condition of existing housing within the city. However, such programs are limited to specific jurisdictions and do not have the necessary resources to meet all of the needs within San Mateo. The city's population is 102,893 (2014 US Census est.) with 7.4% living below poverty level. In addition to improving safety, potential energy /water conservation measures yield savings in monthly http: //www.citydataservices.net/ cities/ smatca /app2016arc.pl ?rpt= C4746&prop =117 219 1/25/2016 City Data Services - South San Francisco utility bills, which in turn help to provide economic opportunities by providing discretionary funds for families who are economically disadvantaged. Of City households, 44.2% speak a non - English language, making PMHR's multilingual (English, Spanish, Chinese, Tagalog, Tongan, Russian) and culturally- sensitive staff a great asset. 13C. Asses "i ent of Need - County of San Mateo: Briefly describe how you determined the need for your program fol each specific jurisdiction that you are applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and dates) of information. Identify any similar programs in the community. The PMHR program is in line with the County's Consolidated Plan, supporting decent, affordable housing, suitable living environments, and economic opportunities). ECSMC determined the need for the PMHR program based on our experience as a contractor for PG &E's Energy Savings Assistance (ESA) program. Our specialists conduct minor home repairs such as broken or moldy windows, or a lack of accessibility modifications such as safety hand rails, which are unsuitable and unsafe, especially for children or the elderly. Our target population of ELINLI /LI and fixed income households cannot make these minor home repairs due to health conditions and /or financial reasons. Rebuilding Together Peninsula offers similar minor home repair services improving the condition of existing housing within the County of San Mateo. However, such programs are limited to specific jurisdictions and do not have the necessary resources to meet all of the needs within San Mateo. The county's population is 758,581 (2014 US Census est.) with 7.5% living below poverty level. In addition to improving safety, potential energy /water conservation measures yield savings in monthly utility bills, which in turn help to provide economic opportunities by providing discretionary funds for families who are economically disadvantaged. Of County households, 46% speak a non - English language, making PMHR's multilingual (English, Spanish, Chinese, Tagalog, Tongan, Russian) and culturally- sensitive staff a great asset. 13D. Assessment of Need - South San Fraricisco: Briefly describe how you determined the need for your program for each specific jurisdiction that you are applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. The PMHR program is in line with South San Francisco's (SSF) affordable housing priorities of preserving existing rental housing and improving the condition of existing housing. ECSMC determined the need for the PMHR program based on our experience as a contractor for PG &E's Energy Savings Assistance (ESA) program. Our specialists conduct minor home repairs such as broken or moldy windows, or a lack of accessibility modifications such as safety hand rails, which are unsuitable and unsafe; especially for children or the elderly. Our target population of ELINLI /LI and fixed income households cannot make these minor home repairs due to health conditions and /or financial reasons. Rebuilding Together Peninsula offers similar minor home repair services improving the condition of existing housing within the city. However, such programs are limited to specific jurisdictions and do not have the necessary resources to meet all of the needs within SSF. The city's population is 67,009 (2014 US Census est.) with 7.2% living below poverty level. In addition to improving safety, potential energy /water conservation measures yield savings in monthly utility bills, which in turn help to provide economic opportunities by providing discretionary funds for families who are economically disadvantaged. Of SSF households, 57.9% speak a non - English language, making PMHR's multilingual (English, Spanish, Chinese, Tagalog, Tongan, Russian) and culturally- sensitive staff a great asset. 14. Timeline: Provide a brief timetable for project implementation and achievement of projected goals and how you plan to expend your funds in a timely manner by the end of the fiscal year. Quarter 1: • Preparation, negotiation and execution of contract. • Review administrative protocols /staff training update. • Generate PMHR customer leads. • Contacting residents who did not qualify for ESA due to minor home repair needs. • Implement Environmental review process. • Quarterly expense review and report. Quarter 2: • Submit Q1 report. • Validate monthly home repair completions /QA paperwork. • Assess materials and labor actuals. • Adjust service forecast and /or staffing assumptions. • Produce mid -tern production reports. • Quarterly expense review and report. Quarter 3: • Submit Q2 report. • Monitor progress and results /QA paperwork . • Identify any operational modification needs. • Quarterly expense review and report. Quarter 4: • Submit Q3 report. • Complete remaining contract commitments /QA paperwork. • Assess actual vs. forecasted expenses. • Reassess program and staffing needs. • Quarterly expense review and report. • Review outcomes /prepare and submit year -end report. We will review our numbers quarterly and adjust outreach efforts accordingly. Pending funding requests, the total number of units the FY16 -17 PMHR program targets (with quarterly reassessments) are: • San Mateo County: 45 households • San Mateo: 20 households • Redwood City: 30 households • So San Francisco: 10 households. 15. Evaluation: Briefly describe how you will determine and measure the success of your program and whether or not program goals were met? If your program is currently receiving grant funds please describe accomplishments of goals to date. hftp:Nwww.citydataservices.net/ cities /sm atcalapp20l6arc.pl ?rpt= C4746Wop =117 3/9 1/25/2016 City Data Services - South San Francisco FY15 -16 PMHR program goals are: • provide cost - effective home repair /improvements focusing on home safety and energy conservation through weatherization • increase awareness /participation of ELINLI /LI minor home repair programs • provide "Green Job" opportunities through job training, internships and placement of residents in PMHR related training /employment The success of PMHR will be measured by: • # of homes receiving repairs that will improve home safety and comfort • # of ELINLI /LI homes with PMHR completed enabling ESA qualification • # of trainees who learn skills that make them job /certification ready • Ability to complete repairs within budget and timeline During FY 2014 -15 the PMHR program completed minor home repair services for 54 households, with 74% elderly, 53% female head of household, and 15% disabled (San Mateo County 25, San Mateo 15, So San Francisco 10, Redwood City 3). In the first two quarters of FY15, we provided PMHR services to 16 households. We continue to face some challenges regarding income threshold documentation. Also, the high number of renters requesting assistance has impacted our service numbers. We continue to communicate with both city and county housing staff to overcome these obstacles. Pending funding requests, the total number of units the FY16 -17 PMHR program targets (with quarterly reassessments) are: • San Mateo County: 45 households • San Mateo: 20 households • Redwood City: 30 house U. Collaboration: Describe partnerships with other organizations /agencies, the nature of the partnership, and how it relates to the proposed project. PG &E has contracted ECSMC for the past 11 years, providing us with extensive experience in reaching ELUVLULI and fixed income residents, conducting energy usage assessments and arranging to install energy conservation and weatherization solutions as part of the Energy Savings Assistance Program. This partnership has helped ECSMC establish a positive reputation as an installation and repair service provider to ELINLI /LI households and has helped build a large customer base within the community. ECSMC also partners with governmental entities such as San Mateo County Energy Watch, performing outreach for the residential portion of the program and performing energy audits and handles quality - control inspections. We continue collaborating with Rebuilding Together, San Mateo Energy Watch, HEAP, Solar oversight and other providers that provide similar services to provide added services for our customers. ECSMC also partners with a number of community based organizations (CBO's) and government entities over the years, such as the Chicana Latina Foundation, San Mateo County Behavioral Health and Alcohol, Tobacco and Other Drugs program, One East Palo Alto, Free At Last, Nuestra Casa, Ecumenical Hunger Project, For Youth By Youth, San Mateo County Health Services Agency, JobTrain, Ravenswood Family Health Center, Voices of Recovery, and Second Harvest, that serve the area to increase the visibility of the PMH R program, along with our many other programs for ELINLI /LI residents. 17. Impact:: Discuss any general trends and conditions that have affected or impacted your service levels or service populations. For New Applicants — describe what these funds would allow your agency to do that you may not be able to do now. For Continuing Applicants — describe how your program would be impacted without these funds. Over the past four years, grant funding has helped underwrite the cost of PMHR program materials and labor, as well as a portion of the administrative costs related to program administration and management. These funds will allow ECSMC to continue providing minor home repairs to residents whose homes do not initially meet the eligibility requirements for energy conservation installments because of required minor home repairs. Minor home repairs such as broken or moldy windows and faulty electrical work make these living environments unsuitable, especially for children or the elderly. These ELINLI /LI households are unable to make these minor home repairs due to health conditions and/or financial reasons, and do not have the means to perform this work without assistance, resulting in a lost opportunity to receive energy conservation services. By helping homes to become qualified for energy and water efficiencies, conservation, ELINLI /LI residents can realize necessary expense savings to help improve their quality of life. Without these funds, ECSMC would not be able to justify leveraging other limited funding and program resources to supplement the PMHR program, and would be forced to discontinue the PMHR program, resulting in a lost opportunity for ELINLI/LI and fixed income San Mateo County, City of San Mateo, South San Francisco, and Redwood City residents who do not have the means to perform these minor home repairs without assistance. 18. Project Beneficiaries/Quantifiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County : ncome Limits. 59. Project Beneficiaries/Quantifiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. a. Indicate the total number of low4ncome beneficiaries you expect to serve with this program for each jurisdiction application for funding. *Low- income is 80% of Area Median Income or below. See AMI table b. Indicate the total number of beneficiaries you expect to serve with this program in each jurisdiction - regardless of income. Jurisdiction a. Number of low-income beneficiaries to be served per grant jurisdiction application. *"Low-income ** is 80% of Area Median Income or below, b. All beneficiaries to be served per grant jurisdiction application regardless of income Persons Persons Daly City 0 0 Redwood City 110 110 ity of San Mateo 55 55 ounty of San Mateo 125 125 South San Francisco 30 30 http: //www.citydataservices.net/ cities/ smatca /app2016arc.pl?rpt= C4746&prop =117 419 1/25/2016 City Data Services - South San Francisco ITatals 1 320 1 320 19. Populations :sewed: Check the boxes below if they describe a significant population served by your program. These categories are not considered "presumed benefit" by HUD, and require income verification. Persons exiting incarceration Low- income youth Other ELINLI/LI 20. Affirmative Outreach: a. Use the demographics from your previous program year to provide an analysis of the population you serve relative to the demoaraohics in the table. NOTE If vnu ara a new ann6cant mmovo n uwa -," h-f Race 8 Ethnicity+ , Redwood City Population ` Redwood City % by Ethnicity Low Income by Ethnicity served b our P ram Your Program % by Ethnicity Total 74,40 100% 10C 100 °k White and not Hispanic 40,65 54.64% C 0.00% White and Hispanic 23,55 31.66% 1001 100.00% Asian 6,71 9.03% 1 0.00% African American 1,91 2.58% Native American 0.00% Pacific Islander 66 0.89% 9, 59 15.08 °k 0.00% Native American 3 0.52% 0.00% Other 1,511 2.03%1 0.00% Race &Ethnicity City of San Mateo Population City of San Mateo /o by Ethnicity Low Income by Ethnicity served b our Program Your Program % by Ethnicity Total 97,20 100% 10 100% White and not Hispanic 45,24 46.54% 21,64 34.02% 54.00% hite and Hispanic 25,81 26.56% 2 27.00% ran 18,15 1$.67% 1 13.00% frican American 2,09 2.16% Native American 0.00% Pacific Islander 1,93 1.99% 9, 59 15.08 °k 6.00% Native American 14 0.14 °k 0.00% her 3,82 3.93%1 0.00% Race & Ethnicity South San South San Francisco Francisco % by Population Ethnicity Low Income by Ethnicity served by our Program Your Program °k by Ethnicity Total 63,632 100% 10C 100% White and not Hispanic 23,76C 37.34% 4C 40.00% hite and Hispanic 21,64 34.02% 4 40.00% sian 23,29 36.61% 2 20.00% frican American 1,62 2.55% 0.00% Pacific Islander 1,111 1.75% 0.007 Native American 39 0.62% 0.00% her 9, 59 15.08 °k 0.00% b. Based on the percentages that you indicate your organization served describe your efforts to improve affirmative outreach to groups that may be underserved by your program and the result of your efforts: A unique feature of the ECSMC program is the multicultural staff. The ECSMC staff is multilingual beyond English (Spanish, Chinese, Tagalog, Tongan and Russian) and many come from households with limited income levels as well, which helps build a rapport with households that are often hesitant to contact non community -based providers due to cultural and linguistic barriers, in addition to privacy concerns. In South San Francisco, the percentage of households where a language other than English is spoken is 57.9 %, in the County of San Mateo, 46 %, in Redwood City, 45.8 %, and in the City of San Mateo, 44.2 %, making PMHR's multilingual staff a great asset in reaching a broad customer base. ECSMC attributes its success to working with all ethnic groups within the community to our organization's use of a family centered, community based, and culturally focused model. We continue our on -going collaborative work with Rebuilding Together Peninsula, San Mateo Energy Watch, HEAP, Solar oversight and other providers that provide similar services. This leverages and/or provides added services for our customers. During the past quarter we attended 10/15/15 Feria de Salud y Recursos in San Jose, 10/21/15, 11/18/15, 12/6 &12/16 Food Distribution in Half Moon Bay, 10/23/15 Housing Leadership Council and 10/31/15 Homeless Connect. We will continue outreach efforts and partnering with CBO's and government entities to increase the visibility of the PMHR program for ELI /VLI /LI residents. 21. Leveraging: Describe your fundraising efforts and additional sources of revenue for this project and your organization. Please state whether any of these fund sources are already committed and in what amount. PG &E has contracted ECSMC for the past 11 years. providing us with extensive experience in reaching ELI/VLI /LI and fixed income residents, conducting energy usage assessments and arranging to install energy conservation and weatherization solutions as part of the Energy Savings Assistance Program. Our Specialists have direct contact with ELINLI /LI residents (including in their native http:// www. citydataservices. neVeities/ smatca lapp20l6arc.pl ?rpt= C4746&prop =117 519 1/25!2016 City Data Services - South San Francisco language) as they verify income eligibility, assess the conditions of income eligible housing units, and perform energy audits. With the PMHR program, our specialists are able to perform these minor home repairs, enabling households who otherwise wouldn't qualify, to become eligible for the ESA Program to realize energy savings. Fundraising efforts and additional sources of revenue for this project include: • $752,000 contract (already committed through June 2016 and will be revisited then for July through December) with PG &E /Richard Heath & Associates for 2016 to provide energy education, enrollment in 20% discount on energy bills and conservation solutions for 800 residents of San Mateo County, • $65,000 contract (already committed through April, 2016 and another contact will be awarded then) with PG &E /Richard Heath & Associates for 2016 to provide lighting and water measures for working households of San Mateo County. • $60,000 contract (already committed) with Self -Help for the Elderly /CPUC to provide Outreach, Consumer Education Workshops and Dispute Resolution with utilit Staff List List helow kev staff mernhers whn wnric nn thin mmnrnm Position Title Name of Staff Person Job Responsibilities Qualifications South San Francisco Total Jurisdictions ECSMC Executive Director. Executive Director of ECSMC for over 18 Executive Director Ortensia Lopez Overall management of PMHR years and 36 years of executive positions % Requested MOM-- in non-profit sector. Peninsula Minor Requester.! As supervisor, oversees the 6 years as lead crew member. Graduate Home Repair Accountant minor home repair program and of Fire Fighter academy and is a certified Program 1,500143% ensures coordination, quality Emergency Medical Technician. Supervisor /National $1,12 0%_ assurance and documentation Possesses the following certifications: - as Appliance Joaquin Narvaez activities. Performs minor home OSHA - Asbestos - Lead - Natural Gas Technician 6 °/ repairs, natural gas appliance Appliance Technician (NGAT) - Duct (NGAT) /Team $3 100°/ testing, duct testing, combustible Testing - Combustible Appliance Service Leader Lead 1000 appliance services, blower door - Blower Door - Weatherization. Currently eatherization $1,25 and weatherization services. traininq for electrical license. $1,15 100°/ $17,61 Performs minor home repairs, Possesses the following certifications: - Minor Home Repair Specialist eoli Tuipoluto duct testing, combustible appliance services, blower door OSHA - Lead - Duct Testing - Combustible Appliance Services - Blower $3,70 53% and weatherization services. Door - Weatherization. Currently training $44,97 Taxes/Benefits $28,81 for electrical license $28,81 24°/ $10,18 Environmental review process to $2,24 25% $15,07 12% San Mateo County and $ Administrative Jennifer McCray entitlement cities. Income verification review, data entry, Bachelor of Arts Degree. Over 4 years Assistant schedule appointments, quality with ECSMC. $15,52 ssurance checks, complete $4,68 aperwork Administration ccountant imothy Minahan fFiscal billing and financial ECSMC accountant for 7 years. Bachelor reporting. of Arts PROPOSED PROGRAM BUDGET FOR FY 2016 -17 For the City of Redwood City ONLY, answer the followSng: For the City of Redwood City ONLY, answer the following: http: /A~.citydataservices.neV cities/ smatcalapp2016arc .pl ?rpt= C4746&prop =117 6/9 Redwood City City of San Mateo County of San Mateo South San Francisco Total Jurisdictions Budget Line Item ATotaly Pgm "�6 program To % Requested % Requested % Requested % Requester.! Pgm% Requested Labor Accountant $4,60 100% $4,6081330 1,500143% $1,98124% $1,12 0%_ $ 100°/ $4,60 Case Manager $5,00 100% $5,00 50°/ $2,49 6 °/ $30112 $1,87 7% $3 100°/ $5,0 Weatherization Lead $17,61 1000 $17,61 38 °/ $6,76 7% $1,25 48% $8,45 7% $1,15 100°/ $17,61 Weatherization Crew $44,97 1000 $44,97 33°/ $14,87 8% $3,70 53% $23,87 6% $2,531 100°/ $44,97 Taxes/Benefits $28,81 100% $28,81 24°/ $10,18 40% $2,24 25% $15,07 12% $1,29 0 °/ $ Supplies Construction Materials $38,99 $38,99 $9,18 $15,52 $9,60 $4,68 $ Administration 0 TOTAL $140,00 100% $140,00 32°/' $45,0 18% $25,000143%1 $60,00 7%1 lit) norl 100°/ $140,00 Number of Individual Beneficiaries 111 54 12 31 32 ost r Individual $409.0 $454.5 $480.0 $333.3 $437.5 For the City of Redwood City ONLY, answer the followSng: For the City of Redwood City ONLY, answer the following: http: /A~.citydataservices.neV cities/ smatcalapp2016arc .pl ?rpt= C4746&prop =117 6/9 1/25!2016 City Data Services - South San Francisco 1. Funding Criteria: 1. Affordable Housing: Acquisition of sites for affordable housing, new construction of affordable housing, conversion of existing housing to affordable, acquisition and rehabilitation of rental housing (includes special needs housing). 2. f+_e?arketing /AdveEfising a. Check all of the following methods your agency utilizes to promote and advertise your programs and services: .? Flyers /brochures ,d, Website W1 CIP (Handbook /Database) W: Outreach presentations to service providers ?r; Outreach presentations to public J. PSA's b. Which of the above marketing /advertising materials are available in multi- langual form and which languages are they available in? ECSMC currently has flyers available in English, Spanish, Chinese, and Tagalog. c. How and where are the materials distributed? ECSMC staff informs local agencies of our services including the PMHR program through site visits, meetings, presentations and correspondence, as well as distributing the project brochure at outreach events. We conduct monthly outreach efforts to help ensure community residents in need of assistance are aware of and know how to access program services. ECSMC is a collaborative partner and lead on issues impacting the quality of life in the communities we serve, partnering with the SM County Behavioral Health and Alcohol, Tobacco and Other Drugs program, One East Palo Alto, Free At Last, Nuestra Casa, Ecumenical Hunger Project, For Youth By Youth, SM County Health Services Agency, JobTrain, Ravenswood Family Health Center, Voices of Recovery, and Second Harvest, to increase visibility and access to needed prevention and intervention resources. Through our work with CBO's, we promote awareness and maintain an extensive inter - agency referral system helping to promote the PMHR progr 3. Program Outcomes: a. Please describe the accomplishments of program goals for FY /15. ECSMC provided outreach at over 20 community events to increase awareness /promote the PMHR program for ELI/VLI /LI minor home repairs. As a result, during FY14 -15 PMHR specialists interviewed, enrolled and assessed (provided LEAD education and brochure): • 12 households in Redwood City and 3 units had work completed. 236 Redwood City families received energy /water education and installation of retrofit measures to conserve energy and water through other programs. • 46 households in San Mateo County and 26 units had work completed. 527 County families received energy /water education and installation of retrofit measures to conserve energy and water through other programs • 21 households in San Mateo City and 15 units had work completed. 23 City of San Mateo families received energy /water education and installation of retrofit measures to conserve energy and water through other programs. • 17 residents in South San Francisco City and 10 units had work completed. 131 families received energy /water education/installation of retrofit measures to conserve energy and water through other programs. In addition to making these households healthier and safer for residents, ECSMC's minor home repairs assisted these families in conserving energy and water, lowering utility /water bills and yielding savings for other critical needs. Of the units completed, 74% were elderly, 53% female head of household, and 15% disabled. Through PMHR, two additional jobs were created. b. in what ways has your program made a difference in the lives of the people you serve? Please provide at least one concrete example from the people served in FY /15: The PMHR program has made a significant difference in the lives of the people served. Juanita Infusino of San Mateo County was first enrolled in the ESA Program and received a new door, weather stripping, light fixtures, and shower heads. Her caregiver (she is very elderly and needs around the clock care) mentioned she has a leaky faucet so she was then informed about the PMHR program. Upon County approval in May of 2015, we were able replace all of her bathroom and kitchen sink water supply lines, shut off valves and faucet stems. She was given new window screens and another door was replaced. She was very happy that there are programs like these that can help those who cannot afford to fix their homes because of economic hardship. In February 2015, Belkis Pineda of San Mateo received new light fixtures, weatherstripping, and had her ducts checked for efficiency. Due to her single low income that covered only living expenses, she shared she could only afford one window replacement at a time, replacing one window each year for the past two years. We explained the PMHR program and in April 2015 we were able to replace her remaining five windows allowing for energy savings and a warmer home for this hard-working widow. In June 2.015, Jose Rodriguez was grateful to receive weatherization repairs, vent repairs, junction boxes for wiring, a new door and thermostat, and carbon monoxide alarms and smoke detectors, he now feels his home is bath safer and more energy efficient http: /Iwww.citydataservices. nett cities/ smatcalapp2016arc .pl ?rpt= C4746&prop= 117 7l9 U25016 Attach61 enis 1. Resolution authorizing application and designation of signatory, by the Board of Directors 5. Board roster, including: Name, Company, Years on Board Meeting dates for previous 12 months • Number of years allowed for each board term City Data Services - South San Francisco Attach 1 El Concilio Resolution pdf Attach 5 Bd of Dir Roster.pdf !y 6. Organizational chart Attach 6 El Concilio Org Chart pdf for entire organization N` 7. Certified financial ECSMC AUDIT REPORT FYE 6 -30-14 pdf audit no more that 1 fiscal year old, prepared by a CPA, and: • Management letters (if applicable) • A -122 and A -133 Single Audit (for entities that receive more than $500,000 in federal funding) OR • A letter from your Executive Director or Chief Financial Officer certifying that agency does not receive more than $500,000 in federal funds and is not subject to the Single Audit. ,V, 8. The following are ECSMC OPERATING BUDGET FY 15 -16 FY 16-17 xlsx required: • Current (FY15 -16) Agency Operating Budget • Proposed (FY16 -17) Agency Operating Budget ' 9. Mission Statement Attach 9 El Concilio Mission Statement pdf 10. Non-discrimination Attach 10 El Concilio Non - Discrimination Policy for Staff and Clients pdf po!icy for Staff and Clients �e 11. Reasonable Attach 11 El Concilio Reasonable Accommodations Policy for Staff and Clients pdf Accommodations Policy for Staff and Clients ,V' 12. Conflict of Interest Attach 12 El Concilio Conflict of interest Po!icy.Ddf Policy. (If not available, please indicate when you will submit) 13. Other - Download All Attachments Program Manager Signature Kristy Camacho httpJ/www.citydataservices. net / cites/ smatca lapp2016arc.pl ?rpt= C4746&prop =117 819 1/25/2016 cityootaaonxves - oovmoonpranvwxv Date Signed 01/22/2016 Inkialy submifted: Jan 22, 2016 - 13:05:08 1�h_______"--_e..~--_.~-.-~.a.a.,,....~.~.,-._.-..p+- am Run Date 21V2018 8:. HM EL CONCILIO OF SAN MATEO COUNTY BUDGET 2013 -2014 Page 1 EL CONCILIO OF SAN MATEO COUNTY BUDGET 2013 -2014 LINE ITEMS EL CONCILO OF SAN MATEO COUNTY TOTAL BUDGET 7/15 -6/16 Direct Program Costs 17 Rent 18 Office Supplies 19 Printing/Copying 20 Stipends 21 Communications 22 Local Travel - Mileage 23 Local Travel -gas 24 Non Local Travel 25 Prgm SuppliesMth Ed. Material 26 Weatherization & MHR 27 Training 28 Energy Partners Training 29 Utilities 30 Promotional /Campaign 31 Board Costs 32 Postage 1 33 Emergency Assistance Subtotal Direct Program Costs Equiliment/Furnishin s 34 Computer/ printer _ 35 Furniture 36 Software/Acessories Subtotal E ui ment/Fu nishl Indirect 37 Insurance - Liability 38 LegaUTaxes 39 Audit 40 Bank Charges 41 Vehicle Purchase 42 Repair and Maintenance 43 Repair and Maint- Vehicle 44 Other/EquipmentRental 45 Building- Interest 46 Claims 47 Miscellaneous Subtotal in"Mrecif Total Expenses Indirect Allowance Su lua Deficit 1 87,608 17,260 4,900 3,750 36,900 9,500 54,000 4,600 16,500 406,500 8,000 5,000 9,000 20,000 6,000 7,250 25,000 721,768 8,000 1,500 2,500 12,000 30,000 18,000 12,000 500 30,000 13,500 15,000 11,500 18,357 20,000 9,500 178,357 3,052,593 394,733 Run Date 2/2/2019 9:o AM Pape 2 N 1 9 � � 7 T 19 1].. EL CONCILIO OF SAN MATEO COUNTY BUDGET 2013 -2014 Run Date 2/2/2018 8:ao AM Page 1 Run Dab 21=016 8:30 AM EL CONCILIO OF SAN MATEO COUNTY BUDGET 2013 -2014 Page 2 1/25/2016 City Data Services - South San Francisco Consolidated Community Funding Application Redwood City, San Mateo County, and S. San Francisco Application for Now Funding for FY 2016 -17 GM- AMEAL INFORMATION d. Organization 'Name: Rebuilding Together Peninsula 2. Project Title: National Rebuilding Day - Horne Rehabilitation Program We are applying for funding from: ' Redwood City 4 City of San Mateo * South San Francisco ** County of San Mateo �uaaevullent e-um e Lary Auto- populated from Bud —� et, belobv) Jurisdictions receiving this application Amount Requested % of Program Budget i Proposed # of Served _ % of Served Total $ Per Redwood City $20,00. 3% 51 24°/' $4,000. CitX of San Mateo $25,00 4% 24°/ $5,000.00 County of San Mateo $34,00 5% 38 0/c $4,250.00 ouch San Francisco $12,004 2% 31 142 $4,000.0 Otal $91, 00 14% 21 100°/ _ $4,333.3 Grant Funded Programs: We are applying for a Minor Home Repair Program CDBCs Nationag Objective Eligibility - How are you serving low income populations? Service to low income clients verified through income documentation. Income Verificaldcn: Describe how you obtain, verify, and maintain proof of income and presumed benefit status. Third party documentation or client signatures on the certification forms must be available on file for review at all times. Rebuilding Together Peninsula (RTP) requires proof of income during the application process. This includes the most recent income tax return or a combination of bank statements, pay stubs, or social security award letters. All service recipients must meet low income standards (80% AMI) as provided by the United States Department of Housing and Urban Development. On application forms, race /ethnicity information is both requested and required. Because each applicant must have a completed file prior to any work being done on site, we have zero gaps in income or race /ethnicity data. 3. Project Address: 841 Kaynyne Street City: Redwood City Zip: 94063 -3000 4. Provide a one sentence project summary: National Rebuilding Day is a volunteer -driven home repair program that brings thousands of volunteers together on behalf of low- income homeowners each year. Organization Address: 841 Kaynyne Street Organization Phone: 650- 366 -6597 Type of Applicant Non - Profit Our agency serves: S. Contact Persor: / Project Administrator: Contact Email: 6. (Name of Agency Director: Name: Cad Pang Chen Cari@RTPeninsula.org David Cattivera 7. Fiscal Officer: Name: David Cattivera Fiscal Officer 841 Kaynyne Street Address: 6. Authorized Name: David Cattivera Signatory: City: Redwood City Zip: 94063 -3000 Website: www.RTPeninsula.org Title: Associate Director Telephone: 650 - 366 - 6597x226 Fax: 650 -366 -9053 Email: Telephone: 650 -366 -6597 David@RTPeninsula.org City: Redwood City Zip: 94063 -3000 Email: Telephone: 650 - 366 -6597 David@RTPeninsula.org h tp:// www. citydataservices. neVcibes/ smatcal app2Ol6arc.pl ?rpt= C4758&prop =36 1n 1/25(2016 City Data Services - South San Francisco Authorized Signatory 841 Kaynyne St. City: Redwood City Zip: 94063 -3000 Address: 9. Please provide days and hours of mgulariy scheduled operation: Monday to Friday 9 to 5pm Available by appointment on evenings and weekends. 10. DUNS Number: 11- 399 -5612 Federal BIN /TIN Number: 94 -3106209 11. HUD Activity: Choose the HUD activity that most closely matches your service: 14A - Rehab: Single -Unit Residential 12. Project Specific NauTative: Provide a narrative description of the specific activities to be carried out with the requested funds. This should also include program objectives and key priorities for each specific jurisdiction. Rebuilding Together Peninsula (RTP) preserves the supply of affordable housing for low- income individuals and families so that they can live more independently in safer, cleaner, and healthier environments. To accomplish this goal, RTP requests funding from each of the Consolidated Community Funding jurisdictions. This funding will be used specifically for eligible building materials and supplies for National Rebuilding Day (NRD), which is scheduled for April 30, 2016 and any additional projects completed prior to the end of fiscal year 2015 -16. NRD is different from other programs and agencies in part because of its ability to harness skilled volunteers to perform the majority of the work, allowing a different scale of the community to be reached. Each year on NRD, thousands of volunteers throughout the county —and across the country—come together to complete necessary repair work such as interior and exterior painting, accessibility modifications, debris removal, fencing, yard work, low- maintenance landscaping, weatherization and energy efficiency measures. This collaborative effort is combined with volunteer project management, private and public funding, donations of materials and partnerships with professionals in the construction trades who install furnaces, repair or replace roofs, complete plumbing and electrical repairs, repair or replace windows and doors, install flooring, and repair stucco. The results of this collective effort revitalizes communities a 13A. Assessment of Deed - Redwood City: Briefly describe how you determined the need for your program for each specific jurisdiction that you are aRpiying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. RTP supports the City of Redwood City's Consolidated Plan Affordable Housing Priority aim to improve the condition of existing housing, particularly aging housing owned by lower income households that i in need of repair in order to preserve the housing. RTP offers services throughout the City of Redwood City and received 51 applications last year. As the housing stock and population continue to age, the need for our services will only continue to increase. By providing repair work at zero cost to our service recipients, RTP helps Redwood City residents remain safe, warm, and independent in their own homes. For many of our senior clients, our work allows them to age in place. RTP serves those outlined as preferred service recipients in the Consolidated Plan, such as those in large households, those that are elderly, persons with disabilities as well as extremely low and very low income households. Additionally, because we conduct site visits for all income - eligible applicants, we have a strong sense of the housing stock in Redwood City, but are also able to cross refer clients to other agencies based on the specific needs of each individual. 13B. Assessment of Need - City of San Mateo: Briefly describe how you determined the need for your program for each specific jurisdiction that you are aRDIving for funds Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. RTP supports the City of San Mateo's Consolidated Plan Affordable Housing Priority to preserve affordable housing. Specifically, we received 17 applications for repairs last year. As the housing stock and population continue to age, the need for our services will only continue to increase. By providing repair work at zero cost to our service recipients, RTP helps San Mateo City residents remain safe, warm, and independent in their own homes. For many of our senior clients, our work allows them to age in place. Additionally, because we conduct site visits for all income - eligible applicants, we have a strong sense of the housing stock in city limits, but are also able to cross refer clients to other agencies based on specific needs of each individual. 13C. Assessment of teed - County of San Mateo: Briefly describe how you determined the need for your program for each specific jurisdiction that you are applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. RTP meets the the County of San Mateo funding priorities outlined in the application materials. Specifically, the services of RTP align with the Housing Development/Housing Repair and Modification Program priority.Our repair programs are available at zero cost to low- income homeowners within the County and we received 136 applications last year for the County service area. Additionally, because we conduct a site visit for all income -eligible applicants, we have a strong sense of the housing stock and conditions in every jurisdiction, and are able to cross refer clients to other agencies based on specific needs of each individual. 13D. Assessment of Need - South San Francisco: Briefly describe how you determined the need for your program for each s ecific jurisdiction that you are applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. RTP meets the City of South San Francisco NOFA priorities by serving low - income residents with free home repair services. Specifically, we received 21 applications with the city limits of South San Francisco last year. As the housing stock and population continue to age, the need for our services will only increase. By providing repair work at zero cost to our service recipients, RTP helps http: /Avww.citydataservices.neV cities/ Smatcalapp20l6arc .pi?rpt= C4758&prop =36 nb 1/25/2016 City Data Services - South San Francisco South San Francisco residents remain safe, wane, and independent in their own homes. For many of our senior clients, our work allows them to age in place. Additionally, because we conduct site visits for all income - eligible applicants, we have a strong sense of the housing stock in city limits, and are able to cross refer clients to other agencies based on the specific needs of each individual. 14. Timsllns: Provide a brief timetable for project implementation and achievement of projected goals and how you plan to expend your funds in a timely manner by the end of the fiscal year. This fiscal year, RTP invested in a new staff position dedicated to the outreach efforts of the organization. This will allow the organization to intensify outreach in general, but specifically in the footprint of the jurisdictions that fund the organization. For National Rebuilding Day, all site visits for qualified applicants are conducted in late fall and early winter. When RTP receives applications that do not align with the priorities of NRD, referrals are made to other services. Simultaneously, RTP focuses staff resources on recruiting volunteer project managers and sponsors, many of whom have become long -time supporters. Projects are selected early in the year and applicants are notified of acceptance or denial by mid - February. Selected volunteer project managers begin planning projects in February, which caries through to the end of April. Most projects are completed on NRD with the support of thousands of volunteers each year. Projects with larger scopes can carry over into May and June. 16. Evaluation: Briefly describe how you will determine and measure the success of your program and whether or not program goals were met? If your program is currently receiving grant funds please describe accomplishments of goals to date. The evaluation of our programs has become an increasingly important part of our approach, as it allows us to monitor the impact of our programs and make adaptations accordingly. In order to monitor projects as each unfolds, scopes of work are created for each project. Each home and homeowner has a different set of needs, but certain safety repairs and home modifications are prioritized by the organization. For example, RTP aims to install fire and CO detectors in every home. For our clients over the age of 65, grab bars and handrails are prioritized, with fall prevention in mind. We have developed an impact summary that quantifies the number of health and safety goals we address throughout our programs. RTP requests post - project surveys from homeowners, volunteer leaders and general volunteers. Combined, this information can be powerful both in terms of impact, but also in terms of enhancing our programs. 15. Collaboration: Describe partnerships with other organizations /agencies, the nature of the partnership, and how it relates to the proposed project. RTP is strong proponent of collaboration and has a strong record of working closely with other nonprofit and public agencies throughout the County of San Mateo. We make reciprocal referrals, coordinate service implerentation, as well as leverage funds to support the community. Specifically, RTP works closely with El Concilio, PG &E, Senior Ccastsiders, Center for Independence of Individuals with Disabilities, the Child Care Partnership Council, the Thrive Community Resiliency Task Force, the Fall Prevention Task Force, Central Coast Energy Services, and the Housing and Community Development Departments of individual jurisdictions. RTP continues to host a biannual Energy Workgroup that provides a forum for agencies providing energy upgrades to understand the programs offerings of each other, allowing for partnership opportunities and cross - referrals. These partnerships are integral to the outreach efforts of the organization. 17. Impact:: Discuss any general trends and conditions that have affected or impacted your service levels or service populations. For New Applicants — describe what these funds would allow your agency to do that you may not be able to do now. For Continuing Applicants — describe how your program would be impacted without these funds. This program is effective because volunteers, sponsors, and government entities come together to support home repairs performed at zero cost for low- income homeowners throughout our community. Sponsorship money is leveraged to make government funds go further, allowing us to perform critical repairs for those who need our help most - seniors, families with children, people with disabilities, and other nonprofit organizations and community centers. Funding from specific jurisdictions allows us to target a certain numbers of households in each service area, assuring our reach is thoughtfully distributed throughout the County of San Mateo. Without this funding stream, the breadth of our impact would be severely hampered. 18. Project Beneficlarles/Quantifiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. 19. Proyect Beneficiarles /Quantifrabie Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. a. Indicate the total number of low-income beneficiaries you expect to serve with this program for each jurisdiction application for funding. *Low - income is 80% of Area Median Income or below. See AMI table b. Indicate the total number of beneficiaries you expect to serve with this program in each jurisdiction - regardless of income. .jurisdiction a. Number of low-income beneficiaries to be served per grant jurisdiction application. **Low-income ** is 80% of ! Area Median Income or below. b. All beneficiaries to be served per p grant jurisdiction application regardless of income Hoouseholds Hoouseholds Dalv Citv 6 6 Redwood City 5 5 City of San Mateo 5 5 County of San Mateo 8 8 http: //www.citydataservices. net / cities/ smatearapp2016arc .pl ?rpt= C4758&prop =36 3/7 1/25/2016 City Data Services - South San Francisco outh San Francisco 3 3 Low Income by Ethnicity served b y our Program otals 27 _ 27 1000/0 E 19. Populatons Served: Check the boxes below if they describe a significant population served by your program. These categories are not considered "presumed benefit" by HUD, and require income verification. Persons exiting incarceration y Low- income youth Other 2C. Affirmative Ouftach: a. Use the demographics from your previous program year to provide an analysis of the population you serve relative to the demographics in the table. NOTE If you are a new applicant nlpamp nmvi.ia vnur hoof aofimafinn Race & Ethnie ty Redwood City Population Redwood City % by Ethnicity Low Income by Ethnicity served b y our Program Your Program % by Ethnicity Total 74,40 1000/0 E 100% White and not His anic 40,6 54.64% Z 1 100.00 % hite and Hispanic 23,55 - 31.66% 1 0.00°/ sian 6,71 9.03% 1 0.000 / frican American 1,91 2.58% 0.00°/' Pacific Islander 66 _ 0.89% 1 0.0001 Native American 3 0.52% 0.000/ her 1,511 2.03%1 C1 0.00 °I Race & Ethnicity City of San Mateo Population City of San Mateo % by Ethnicitv Low income by Ethnicity served b our Program Program /o ° Your by Ethnicity Total 97,20 100% 2 100% White and not Hispanic 45,24 46.54% 1 60.00% White and His anic 25,815, 26.56% 1 0.00% Asian 18,151 18.67% 1 20.00 % African American 2,0991 2.16 % 0.00 % Pacific Islander 1,93 1.99% 1 20.00% Native American 144 0.14% 0.00 % her 1 3,8231 3.93%1 01 0.00 Race &Ethnicity South San Francisco Population South San Francisco /o by Ethnicitv Low Income by Ethnicity served by our Program Your Program % by Ethnicity Total 63,63 100% 2 100% White and not Hispanic 23,76 37.34% 1 33.33% hite and Hispanic 21,64 34.02% 1 33.33% sian 23,29 36.61% t 33.33 % frican American 1,62 2.55% 0.00% Pacific Islander 1,111 1.75% 0.00 % Native American 39 0.62% 0.00% her 9,522 15.08%1 0.00 h. Based on the percentages that you indicate your organization served describe your efforts to improve affirmative outreach to groups that may be underserved by your program and the result of your efforts: The goal of the outreach efforts undertaken by RTP serve to attract any and all income- qualified homeowners in need of our free repair services. R'rP targets outreach opportunities at food distribution events, senior health and wellness fairs, and senior and community centers, as well as partner with other nonprofit agencies to distribute information to clients, volunteers, and members. In the coming year, RTP will also develop a formal outreach plan and use the data above to ensure we are reaching all populations throughout the county. 21. Leveraging: Describe your fundraising efforts and additional sources of revenue for this project and your organization. Please state whether any of these fund sources are already committed and in what amount. Over the past 26 years, Rebuilding Together Peninsula (RTP) has served nearly 2,000 low- income homeowners with the support of over 60,000 volunteers. With a track record of engaging volunteer opportunities and tangible impact, thousands of new volunteers join our effort to preserve affordable housing through National Rebuilding Day (NRD). A combination of private donations, foundation grants, sponsorships, and government grants continue to fund NRD. Additionally, commitment from both new and longtime volunteer support allows this program to flourish each year. RTP will continue to leverage this support, as well as our positive community recognition. RTP's biennial Dreams Happen Gala & Playhouse Auction is one our most important fundraising activities. With support from the http: //www.citydataservices.r eV cities/ smatca /app20l6arc.pl ?rpt= C475Uprop =36 4n 1/25/2016 City Data Services - South San Francisco Junior League of Mid - Peninsula *Palo Alto, local architects and builders, the Stanford Shopping Center, and generous underwriters, we consistently raise enough funds to support the operations of the organization for two years. Staff List I icf hainw Icav cuff mamhare whn wnrlr nn 4Ala m.....-- Position Tiede Name of Staff Person job Respo«sioilifies Qualifications Redwood City '; W. San Mateo County of San Mateo + years with RTP, Master's Degree, Associate Director Cad Pang Chen Oversight of all programs program evaluation at foundations, Program Total %Requested nonprofit leader Program Manager, NRD Lydia Beltran Implementation and project asters Degree, priorwork with HUD, Requested Labor management of NRD affordable housing ex edence Coordinator Billy Hoover Project file management, operational support, ach Bachelor's achelors Degree, database expert, application review ecade of nonprofit experience 7,onstruction/Warehouse 36% Supply management and Bachelor's Degree, 7+ years of warehouse oordinator Frank Hebscher technical support work, two terms with AmeriCorps Rebuilding Together nefits $178,3 Fundraising and sponsor 7+ years with RTP, Bachelor's Degree, Development Director AnnelAguayo relations extensive writing experience and 022 $010014 $ sponsorship management PROPOSED PRC ^R.AM RII nnFT FnR FY 9n1R_49 Fo r the City of Redwood City ONLY, answer the following: For the City of Redwood City ONLY, answer the following: 1. Funding Criteria: 1. Affordable Housing: Acquisition of sites for affordable housing, new construction of affordable housing, conversion of existing housing to affordable, acquisition and rehabilitation of rental housing (includes special needs housing). 2. Marketing /Advertising a. Check all of the following methods your agency utilizes to promote and advertise your programs and services: Flyers/brochures 4v. Website 4 Phone book listing 4 CIP (Handbook /Database) Outreach presentations to service providers Fd: Outreach presentations to public PSA's http:// www. citydataservices. neVeities/ smatcalapp20i6arc .pl?rpt= C47588prop =36 517 Redwood City '; W. San Mateo County of San Mateo South San Francisco otal Jurisdictions Budget Line Item Agency Total Pgm °� Program Total %Requested %Requested °� Requested %Requested Pgm% Requested Labor Staff $714,304 36% $257,14810%1 $10014 $ nefits $178,3 41% $73,13910%1 $0100/4 $ 022 $010014 $ 0% $ Renovation Costs $631,00 40% $252,40 0% $20,00 0% $25,00410021 $32,00 0°/ $12,00 ,450% $89,00 ental Reviews $5,00 $2,00 $ $ $2,00 $ $2,00 s /Maintenance Fumber ns /outreach /volunteers $142,45 $82,621 $ $ $ $ $ ration $125,17 0% $ $ $ $ $ 0%1 01 TOTA $1,796,31 37% $667,30 3% $20,0044%1 $25,00 5 °/ $34,00 22/ $12,00 14% $91,00 f Individual Beneficiaries 21 Individual $4,000.0 $ 5,000.0 $4,250.0 $4,000.0 $4,333.3 Fo r the City of Redwood City ONLY, answer the following: For the City of Redwood City ONLY, answer the following: 1. Funding Criteria: 1. Affordable Housing: Acquisition of sites for affordable housing, new construction of affordable housing, conversion of existing housing to affordable, acquisition and rehabilitation of rental housing (includes special needs housing). 2. Marketing /Advertising a. Check all of the following methods your agency utilizes to promote and advertise your programs and services: Flyers/brochures 4v. Website 4 Phone book listing 4 CIP (Handbook /Database) Outreach presentations to service providers Fd: Outreach presentations to public PSA's http:// www. citydataservices. neVeities/ smatcalapp20i6arc .pl?rpt= C47588prop =36 517 1/25/2016 City Data Services - South San Francisco b. Which of the above marketing/advertising materials are available in multi - langual form and which languages are they available in? Spanish /English - Flyers /brochures, outreach presentations to service providers and the public Spanish /English/Tagolog /Chinese - Flyers c. How and where are the materials distributed? Flyers are distribution at community fairs, during outreach presentations, senior centers and through through dissemination at partnering agencies. 3. Program Outcomes: a. Please describe the accomplishments of program goals for FY /15. In FY 14/15, the NRD program staff are pleased to report that all contracted goals were met. b. In what ways has your program made a difference in the lives of the people you serve? Please provide at least one concrete example from the peopie served in FY /15: With an organizational vision of leaving each client in a safe and healthy home, our approach is to problem solve and leave all those we serve in a better living situation. Our repair programs also give us personal access to our clients, which allows us to build meaningful relationships and mutual trust with isolated members of our community. Because of the volunteer -driven nature of our organization, our programs help build a great sense of community amongst our volunteers and communities we serve. Statistics show when one homeowner takes initiative in the upkeep of their home it inspires neighbors to follow, helping revitalize the entire neighborhood. An example of our tangible impact was a family who had plumbing corroded to the point they could not bathe or wash dishes in their home, resorting to the use of an RV outside. In addition, we learned that their sewer line was clogged, rendering their toilet useless. Replacing the plumbing lines and clearing the sewer line allowed the family to have access to proper running water, not to mention much safer conditions for the family, which included a senior with a physical disability and her developmentally disabled adult son. We were able to do additional repairs at the home with private funding later in the year. Attachments 'W 1. Resolution authorizing application and designation of signatory, by the Board of Directors " 2. Proof of 501(c)3 / tax -exempt status 3. By-laws { 4. Articles of Incorporation !! 5. Board roster, including: • Name, Company, Years on Board • Meeting dates for previous 12 months • Number of years allowed for each board tern 6. Organizational chart for entire organization i 7. Certified financial audit no more that 1 fiscal year old, prepared by a CPA, and: Management letters (if applicable) • A -122 and A -133 Single Audit (for entities that receive more than $500,000 in federal funding) OR • A letter from your Executive Director or Chief Financial Officer certifying that agency does not receive more than $500,000 in federal funds and is not subject to the Single Audit. 'di 8. The following are required: • Current (FY15 -16) Agency Operating Budget Proposed (FY16 -17) Agency Operating Budget CDBG Authorization, df 2. RTP 501c3 letter.odf 3. RTP Bylaws and Procedres odf 4. RTP Articles of Incorooration odf 2015 -2016 Board Roster.doc RTPOrgC hart 1.14.16. odf RTP Audited FS FYE 9.30.2014 odf 2015 -17 Budget CDBG Bud q t pdf 9. Mission Statement RTP Mission Statement.doc 10. Non -discrimination policy for Staff and Clients 10. RTP Non - discriminate -EO Policy doc d' 11. Reasonable Accommodations Policy for Staff and Clients 11. RTP Reasonable Accomodations Policy doc 12. Conflict of Interest Policy. (if not available, please indicate when you will submit) 13. Other - http:/Avww.citydataservices.neV cities/ smatca /app2016arc.pl ?rpt= C4758&prop =36 V 1/25(2016 Download All Attachments Program Manager Signature David Cattivera Date Signed 01/2212016 -- - — --------- Inkially submitted: Jan 22, 2016 - 14:11:16 City Data Services - South San Francisco http://www.citydataservices.rieVCitieslsmatcalapp2Ol6arc.pl?rpt--C4758&prop=36 W7 Rebuilding Together Peninsula Budget Oct 15 - Sep4 1 S FY12 -13 FY13 -14 FY14 -15 I FY15 -16 FY16 7 000 • Foundations - Unrestricted ,4005 • Foundations - Restricted 4100 Fall Appeal & Nwsltr Donations 4150 Board Donations ;4200 Spring Appeal & Newsletter 4400 • Sponsorship /Renovation Income 4410 Government Funding 4415 - Roof Donations Unrestricted 4420 Roof Donations - Restricted '4425 Team Build Sponsorship Income 4430 - Safe At Home 4435 - Sponsorship - RT Nat'l 4550 - Youth Funding 4560 - Prior Year renovation Income 4600 • Misc. Income /Transfers .4650 - Restricted Income General 4651 - Restricted Income Special Projects '4815 - Rental Income 4656 • Legacies & Bequests- Unrestricted ;4900 • Interest Income 4905 • Dividend Income Inkind donations !Total Income Expense Program Expenses .5010 - RT National membership 5025 HO Outreach Expenses Materials, Labor, Svcs. 110 • Roofing 5115 - Energy Efficiency Programs 5120 Site Renovation .5130 - Site Related Volunteer Expenses 5131 - Non -site Specific Project Expenses 5135 - Prior Year Project Expenses .5140 • Team Build Renovation Expenses 5140.1 - Team Build - Jones 5140.0 - Team Build - General 5145 • Kumin YASP Site Expenses 5150 - Safe At Home 5155 - Warehouse stock 5160 - Special Programs 5100 - Materials, Labor, Svcs - Other Total 5100 • Materials, Labor, Svcs. Volunteer Costs 5305 - AmeriCorps 5310 Meetings & Appreciation X5320 Youth Board Costs, Meetings ;5330 - Volunteer Insurance ;5335 - Volunteer Communication 'Total 5300 Volunteer Costs I ,5400 Miscellaneous :5405 - Contractor Licensing 5410 • Memberships /Subscriptions Truck 5541 • Repairs, Gas & Insurance Travel & Entertainment 5552 Meals, Travel, Mileage & Entertainment ;Total 5550 • Travel & Entertainment Actuals �ActuaSs I Actuals 85,835; 93,600 110,530 35,000; 53,000 52,500 111,017; 119,268 149,235 32,915: 30,200 27,839 44,025; 57,429 50,954 455,659: 461,017 411,477 289,469: 384,116 370,227 20,000; 0 0__ 7,000; 0 0 100,200; 109,900 79,127; 146,608: 65,708 41,300 64,000E 16,200 0: 0 0 5,000: 5,927 3,375 26,514; 31 127 0 25,000 334,737 268,433 1,204 22,800 22,800P, 7,600 20,000: 0 0 10,503: 12,119 11,472 10,291; 17,366 16,748 1,422,837 1,789,914 1,684,652 q 10,000: 10,000 11,985 13,521; 7,290' 5,024 102,489: 88,452 75,375 3,520: 0 0 247,790: 237,218 217,956 26,990; 26,271 24,148 11,103 4,877 3,841 - 1,044: 2,311 7,353 61,960: 247,772 5,197 90,153, 47,314 0: 0 0 107,548; 131,286 116,905 2,845; 7,342: 1,048 563,201: 835,682 499,137 36,734; 28,689 21,440 21,085: 45,584, 26,616 0: 5,274 5,588 5,064 1,343 1,429 0 64,4361 81,291 53,120 970: 50 1,204 : 691 232 1,278: 1,263 1,324 5,238: 7,556 10,869 8,081: 8,429 6,399 8,081 8,429 6,399 Budget Budge: 75,000 "_ 55000° 75,000 50,000' 125,000 125,000 25,000 25,000; 47,500 47,5001 460,000 560,000] 410,000 410,000; 0 0 0 0 100,000 100,000! 75,000 - --100,000 15,000 U1 a 01 15,000; 0 0 01 0 5,0001 5,000! 10,000 - 16,000 0 0; 0 0 10,000 10,000; 12,000 12,000 1,419,500 1,544,500 12,000 12,000' 9,000 10,000 -° 100,000 100,000 0 0 275,000 275,000; 27,000 27,000, 5,000 5,000; 5,000 5,000; 65,000 65,0001 0 . 0; 0 01 151,000 200,000 3,000 3,000; 0 0! 0: - 01 631,000 680,000; 1,500 30,000; 30,000 30,000' _ 0 0 5,500 5,600; 0 Oi 37,100 65,600! 250 250i 1,000 1,000; 1,300 1,300; . -; 6,500 6,500; - 7,000 7,000 7,000 7.000! 1/22/16 Page ' of 9 Actual3 Actual41 Actu 15 FY-15-16 - FY16 -17 Actuals Actuals Actuals _, Budget , Budget 5570 • Equipment, Repairs & Rental 6,615; 4,900 6,474 571 - Software /Database /ROOMS 1,384; 1,045 2,163 'Wages, Benefits, Taxes 5710 • Staff Wages, Taxes & Benefits 491,130: 533,364 539,127 Total 5700 • Wages, Benefits, Taxes 491,130 533,364 539,127 ;5905 Program Supplies 4,107: 3,848 4,433 5910 Postage & Shipping 1,804: 2,471. 2,416° 5911 • Annual Report (Allocated) 5,082 7,641 5,832; 5912 • Program Printing & Reproduction 2,098: 3,245 2,476 5913 • Program Professional Svcs. 4,783: 5,572 13,402 5925 - Building Expenses, Allocated 12,054: 8,804 10,543 5920 • Telephone & Telecommunications 4,115: 4,793 6,981 Total 5000 - Program (Expenses 1,199,858; 5,527,933 1,183,141 Operat €ng Expenses 6010 • Bank & Credit Card Charges 4,835: 1,678 12,783 6015 • Investment Acct. Fees & Charges •59: 6100 • Ofc. Equip., SMI & Furniture 68€ 1534' 8 6110 • Equipment Rental 418; 458 75 6125 • Telephone & Telecommunications 356: 445 401 6175 - Equipment Repairs & maintenance 0: 6 369 6200 • Insurance - Business 3,997: 4,400 3,813 6225 Taxes, Licensing, Filing Fees 420: 677 50 6226- Property Tax Kaynyne 2,042: 6,370 3,409 6275 • Professional Svcs. 5,625: 29,060 6276 - Accounting 40,509; 43,315 43,634 ,280 - Recruiting Expense 480: 615 23,531 .1285 • Subscriptions /Memberships 700: 407 154 6300 Travel, Meals & Entertainment 6,223 4,662 8,553 6325 • Board & Staff Development 6,809; 6,230 7,268 6500 • Office Supplies 846: 1,427 1,300 6900 • Misc Operating Expenses - Other 485: 301, -109 7300 • Postage & Shipping 405: 480. 417 7310 • Printing & Reproduction 421: 0 346 Operating Wages, Benefits & Taxes :7510 • Staff Wages, Taxes & Benefits 65,834: 76,631 " 74,900 'Total 7500 • Wages, Benefits & Taxes 65,834: 76,631 74,900 7600 Payroll Processing Fees 1,182: 2,614. 1,353 7601 - 403(b)Admin Fees 1,412; 1,488 1,393 7925 - Building Expense, Allocated 1,067: 928 1,849 Total 6000 - Operating Expenses 144,194: 182,345 185,497 Fur:draming Expenses Fundraisin Wages, Benefits & Taxes 9 9 � 8510 Staff Wages &Bonuses 124,777: 145,855` 126,880 Total 8505 • Wages, Benefits & Taxes 124,777; 145,855 126,880 8574 Equipment 1,198: 3,252 1,420 8576 Postage & Delivery 7,338: 9,097 5,860 8577 • Printing & Reproduction 2,742; 6,646 2,432 X8580 Annual Report (Allocated) 3,388: 3,275 2,499 8585 Membership Dues /Subscriptions 29: 1,041 ' 1,301 8590 • Professional Services 1,693: 15,986' 9,096 9593 - Supplies 354; 902 496 8595 • Telephone & Telecommunications 835: 1,049_ 1,173 8600 . Travel, Meetings, Entertainment 1,336: 1,421 2,188 8610 • Bank Processing Fees 0: I 1 1 00 1,200 , v1,04 ,7 of,azwl 87,329 __77 3-29 11 1 ,auu 5 83,753 154,1071 154,1 1,5001 1.5 1/22/16 - 1 - . - ___ Page 2 of 9 _ 13 FY13 -94 F%'114-115 FY15 -16 FY16 -17 � 8700 • Public /Donor Relations 8925 - Building Expense, Allocated 571 - Software /Database /ROOMS Total 8500 • Fundraising Expenses Total Expense Net Cash Flow Other Income (Investments) Dreams Happen Allocation Net Income Actu Act�tals 11,095; 2,514: 157,299' 1,501,391: 78,555: 71,149: 10,000: 2,59e �uals 15,167 2,095. 0, 205,785 1,916,063 126,149 62,258 65,000 ;, 09 Actuals 18,869 2,478 1,473 .'R Budget 12,000 Budget � y 12,000 3,000 3,000 1,700 1,700, 176,165 � 204,907 204,901; o i 1,544,803 1,796,316 1,874,8161 139,849 376,816 330,316 62,258 55,000 377,000 331,000 4 i 267,107 184 684 1/22/16 Page 3 of 9 1/25/2016 City Data Services - South San Francisco Consolidated Community Funding Application Redwood City, San Mateo County, and S. San Francisco Application for Now Funding for FY 2016 -17 GENERAL INFORMATION 1. Organization blame: Rebuilding Together Peninsula 2. Project Title: Safe at Home We are applying for funding from: Redwood City ✓ City of San Mateo a South San Francisco *' County of San Mateo Budget/Client Sum ma (Auto-populated from Bud et, below Jurisdictions receiving this application Amount Requested % of Program Budget Proposed # of Served _ o % f Served Total $ Per Redwood City $16,50 3% 18 15% $916.6 Eity of San Mateo $46,00 10% 21 18% $2,190.4 County of San Mateo $126,00 26% 62 53% $2,032.2 South San Francisco $25,00 5% 1 14 °/ $1,562.5 otal $213,50 44% 11 100°/ $1,824.7 Grant Funded Programs: We are applying for a Minor Home Repair Program CDBG National Objective Eligibility - How are you serving low income populations? Minor home repairs for low income households whose incomes are verified. Income Verification: Describe how you obtain, verify, and maintain proof of income and presumed benefit status. Third party documentation or client signatures on the certification forms must be available on file for review at all times. Rebuilding Together Peninsula (RTP) requires proof of income during the application process. This includes the most recent income tax return or a combination of bank statements, pay stubs, or social security award letters. All service recipients must meet low income standards (80% AMI) as provided by the United States Department of Housing and Urban Development. On application forms, race/ethnicity information is both requested and required. Because each applicant must have a completed file prior to any work being done on site, we have zero gaps in income or race /ethnicity data. 3. Project 841 Kaynyne Street City: Redwood City Zip: 94063 -3000 Address: 4. Provide a one sentence project summary: The Safe at Home minor home repair program addresses minor repair needs of low- income homeowners before the needs become serious deferred maintenance issues. Organization 841 Kaynyne Street City: Redwood City Zip: 94063 -3000 Address: Organization 650 - 366 -6597 Website: Phone. www.rebuildingtogetherpeninsula.org Type of Applicant: Non - Profit Our agency serves: S. Contact Person / Name: Chris Wahl Title: Program Manager Telephone: 650-366 - Project 6597 Administrator: Contact Email: chris@ rebuildingtogetherpen ins ula .org;Fax- 650-366 -9053 cad@rebuildingtogetherpeninsula.org 6. Name of Agency David Cattivera Director: 7. Fiscal Name: David Cattivera Email: Telephone: 650-366 - Officer: david@ rebuildingtogetherpeninsula .org6597 http : /Mrww.citydataservices.neV cities/ smatca /app20l6arc.pi?rpt= C4717&prop =37 17 1/25/2016 City Data Services - South San Francisco Fiscal Officer 841 Kaynyne St. City: Redwood City Zip: 94063 -3000 Address: 8. Authorized Name: David Cattivera Email: Telephone: 650-366 - Signatory: david@ rebuildingtogetherpeninsula .org6597 Authorized Signatory 841 Kaynyne St. City: Redwood City Zip: 94063 -3000 Address: 9. Please provide days and hours of regular'y scheduled operation: Monday to Friday 9 to 5pm Available by appointment on evenings and weekends. 10. DUNS Number: 11- 399 -5612 Federal EIN /YIN Number: 94- 3106209 R1. HUD Activity: Choose the HUD activity that most ciosely matches your service: 14A - Rehab: Single -Unit Residential 12. Project Specific Naerative: Provide a narrative description of the specific activities to be carried out with the requested funds. This should also include program objectives and key priorities for each speck jurisdiction. Rebuilding Together Peninsula (RTP) preserves the supply of affordable housing for low- income individuals and families so that they can live more independently in safer, cleaner, and healthier environments. To accomplish this goal, RTP requests funding from each of the Consolidated Community Funding jurisdictions. This funding will be used specifically for eligible costs for our Safe at Home program. Safe at Home is a minor home repair program addresses the repair needs of low- income homeowners before the needs become serious deferred maintenance issues. While the program serves all of our target populations - seniors, veterans, people with disabilities, and families with children - 80% of the homeowners served through Safe at Home are seniors aged 65 and older with very limited fixed incomes. Through this program, RTP concentrates on critical repairs and home safety modifications that allow seniors to age in place by eliminating the threat of being injured by an accident or fall. Specific repairs include installing grab bars /handrails and ramps; removing tripping hazards; replacing old carpeting with resilient flooring; installing adequate lighting around the interior and exterior of the house; and removing debris /clutter in and around the house. In addition, RTP completes repairs that remove moisture issues in the home that ca 13A. Assessment of Need - Redwood City: Briefly describe how you determined the need for your program for each s ecific jurisdiction that you are applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. RTP supports the City of Redwood City's Consolidated Plan Affordable Housing Priority to improve the condition of existing housing, particularly aging housing owned by lower income households that i in need of repair in order to preserve the housing. RTP offers services throughout the City of Redwood City and received 51 applications last year. As the housing stock and population continue to age, the need for our services will only continue to increase.By providing repair work at zero cost to our service recipients, RTP helps Redwood City residents remain safe, warm, and independent in their own homes. For many of our senior clients, our work allows them to age in place. RTP serves those outlined as preferred service recipients in the Consolidated Plan, such as those in large households, those that are elderly, persons with disabilities as well as extremely low and very low income households. In Redwood City, RTP is the only organization offering free expert home repairs and safety modifications performed primarily by a licensed contractor. Safe at Home looks at each home in its entirety, rather than one focus area, which allows us to be responsive to the specific needs and concerns of the individual homeowners. 13B. Assessment of Need - City of San Mateo: Briefly describe how you determined the need for your program for each specific jurisdiction that you are appiving for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. RTP supports the City of San Mateo's Consolidated Plan Affordable Housing Priority to preserve affordable housing. Specifically, we received 17 applications for repairs last year. As the housing stock and population continue to age, the need for our services will only continue to increase. By providing repair work at zero cost to our service recipients, RTP helps San Mateo City residents remain safe, warm, and independent in their own homes. For many of our senior clients, our work allows them to age in place. Because we conduct site visits for all income -eligible applicants, we have a strong sense of the housing stock in city limits, but are also able to cross refer clients to other agencies based on specific needs of each individual. In the City of San Mateo, RTP is the only organization offering free expert home repairs and safety modifications performed primarily by a licensed contractor. Safe at Home looks at each home in its entirety, rather than one focus area, which allows us to be responsive to the specific needs and concerns of the individual homeowners. 13C. Assessment of (feed - County of San Mateo: Briefly describe how you determined the need for your program for each specific jurisdiction that you are applying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. RTP meets the the County of San Mateo funding priorities outlined in the application materials. Specifically, the services of RTP align perfectly with the Housing Development /Housing Repair and Modification Program priority.Our repair programs are available at zero cost to low- income homeowners within the County and we received 136 applications last year for the County service area. Because we conduct a site visit for all income -eligible applicants, we have a strong sense of the housing stock and conditions in every jurisdiction, and are able to cross refer clients to other agencies based on specific needs of each individual. http : /Mrww.citydataservices.rret/ cities/ smatcalapp2016arc .pl ?rpt= C4717&prop =37 217 1/25/2016 City Data Services - South San Francisco Throughout the County of San Mateo, RTP is the only organization offering free expert home repairs and safety modifications performed primarily by a licensed contractor. Safe at Home looks at each home in its entirety, rather than one focus area, which allows us to be responsive to the specific needs and concerns of the individual homeowners. 13D. Assessment of Need - South San Francisco: Briefly describe how you determined the need for your program fe- each specific jurisdiction that you ere at►olving for funds. identify target population(s) and area(s) served. Please state the source(s) and dates) of information. Identify any similar programs in the community. RTP meets the City of South San Francisco NOFA priorities by serving low- income residents with free home repair services. Specifically, we received 21 applications with the city limits of South San Francisco last year. As the housing stock and population continue to age, the need for our services will only increase. By providing repair work at zero cost to our service recipients, RTP helps South San Francisco residents remain safe, warm, and independent in their own homes. For many of our senior clients, our work allows them to age in place. Because we conduct site visits for all income-eligible applicants, we have a strong sense of the housing stock in city limits, and are able to cross refer clients to other agencies based on the specific needs of each individual. In South San Francisco, RTP is the only organization offering free expert home repairs and safety modifications performed primarily by a licensed contractor. Safe at Home looks at each home in its entirety, rather than one focus area, which allows us to be responsive to the specific needs and concerns of the individual homeowners. 14. Timeline: Provide a brief timetable for project implementation and achievement of projected goals and how you plan to expend your funds in a timely manner by the end of the fiscal year. Safe at Home operates year round and has recently hired an outreach coordinator to help us find eligible homeowners throughout the County of San Mateo. Applications are accepted on a rolling basis and we encourage homeowners to submit applications according to grant cycles. Review of applications and site assessments will occur on a rolling basis. Once an application has been deemed an appropriate fit for the program, all required paperwork and environmental reviews will be filed with the jurisdiction. Once all paperwork is completed, the licensed contractor we have on staff performs the actual work, contracting with vendors according to the nature of the project. 16. Evaluation: Briefly describe how you will determine and measure the success of your program and whether or not program goals were met? If your program is currently receiving grant funds please describe accomplishments of goals to date. The evaluation of our programs has become an increasingly important part of our approach, as it allows us to monitor the impact of our programs and make adaptations accordingly. In order to monitor projects as each unfolds, scopes of work are created for each project. Each home and homeowner has a different set of needs, but certain safety repairs and home modifications are prioritized by the organization. For example, RTP aims to install fire and CO detectors in every home. For our clients over the age of 65, grab bars and handrails are prioritized, with fall prevention in mind. We have developed an impact summary that quantifies the number of health and safety goals we address throughout our programs. RTP requests post - project surreys from homeowners, volunteer leaders and general volunteers. Combined, this information can be powerful both in terms of impact, but also in terms of enhancing our programs. 16. Collaboration: Describe partnerships with other organizations /agencies, the nature of the partnership, and how it relates to the proposed project. RTP is strong proponent of collaboration and has a strong record of working closely with other nonprofit and public agencies throughout the County of San Mateo. We make reciprocal referrals, coordinate service implementation, as well as leverage funds to support the community. Specifically, RTP works closely with El Concilio, PG &E, Senior Coastsiders, Center for Independence of Individuals with Disabilities, the Child Care Partnership Council, the Thrive Community Resiliency Task Force, the Fall Prevention Task Force, Central Coast Energy Services, and the Housing and Community Development Departments of individual jurisdictions. RTP continues to host a biannual Energy Workgroup that provides a forum for agencies providing energy upgrades to understand the programs offerings of each other, allowing for partnership opportunities and cross - referrals. These partnerships are integral to the outreach efforts of the organization. 17. Impact:: Discuss any general trends and conditions that have affected or impacted your service levels or service populations. For New Applicants — describe what these funds would allow your agency to do that you may not be able to do now. For Continuing Applicants — describe how your program would be impacted without these funds. Government funding is critical to the Safe at Home program and it would be impossible for us to reach the homeowners served in this program without support from local jurisdictions. The ongoing need for this program is evident by the number of applications we receive each year. In fact, the program could quickly double if not for funding limitations. As local housing stock continues to age, along with its population, these services will only become more important. We thank our government partners, as this critical work could not be done without your support. 18. Project Beneficiaries /Quantifiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. 19. Project Beneficiaries /Quantifiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. a. Indicate the total number of low - income beneficiaries you expect to serve with this program for each jurisdiction application for funding. *Low - income is 80% of Area Median Income or below. See A I table b. Indicate the total number of beneficiaries you expect to serve with this program in each jurisdiction - regardless of income. http: /Mrww.citydataservices.neV cities/ smatea tapp20l6arc.pi ?rpt= C4717&prop =37 3/7 1/25/2016 City Data Services - South San Francisco 13. Populations Served: Check the boxes below if they describe a significant population served by your program. These categories are not considered "presumed benefit" by HUD, and require income verification. Persons exiting incarceration Low- income youth Other 20. Affirmative Outreach: a. Use the demographics from your previous program year to provide an analysis of the population you serve relative to the demographics in the table. NOTE: If you are a new annlicant nlaasP nmvirlp your haef aer;matiA., Race & Ethnicity a. Number of lor+- income beneficiaries � b. All beneficiaries to be sewed per Jurisdiction to be served per grant jurisdiction grant rant jurisdiction application 11 application. **Low-income** is 80% of of income 40,656 54.64% Area Median Income or below. 72.73% hite and Hispanic Hoouseholds Hoouseh+oids Dal City -� 10 10 Redwood City 18 18 City of San Mateo 21_ 21 Coun!X of San Mateo __ 62 62 South San Francisco 16 16 [Totals 127 127 13. Populations Served: Check the boxes below if they describe a significant population served by your program. These categories are not considered "presumed benefit" by HUD, and require income verification. Persons exiting incarceration Low- income youth Other 20. Affirmative Outreach: a. Use the demographics from your previous program year to provide an analysis of the population you serve relative to the demographics in the table. NOTE: If you are a new annlicant nlaasP nmvirlp your haef aer;matiA., Race & Ethnicity Redwood City Redwood City Population % by Ethnicity Low Income by Ethnicity served by our Program Your Program % by Ethnicity Total� 74,40 1000/0 11 100% White and not Hispanic 40,656 54.64% 8 72.73% hite and Hispanic 23,55 31.66% 1 9.09% Sian 6,71 9.03% 1 18.18% frican American 1,91 2.58% 0.00 °10 Pacffic Islander 66 0.89% 0.00% Native American 3 0.52% 0.007 ther 1,5111 2.03% 01 0.00ON Race & Ethnicity City of San City of San Mateo Mateo /o by Population Ethnicity Low Income by Ethnicity served b our Program Your Program by Ethnicity Total 97,20 100% 14 100% White and not Hispanic 45,240 46.54% 8 57.14% and His anic 25,81 26 .56% 14.29% Asian 18,15 18.67% 1 28.57% Vihite n American 2,09 2.16% 0.00% c Islander 1,93 1.99% 0.00% e American 14 0.14% 0.00% 3,8231 3.93%1 01 0.00% Race & Ethnicity South San South San Francisco Francisco % by Population I Ethnicity Low Income by Ethnicity served b y our Program, Your program ° by Ethnicity /° Total 63,63 100 %• 14 100% White and not Hispanic 23,76 37.34% 42.86% White and Hispanic _ 21,64 34.02% 21.43% Asian 23,29 36.61% 1 7.14% African American 1,62 2.55% 21.43 % Pacific Islander 1,111 1.75% 0.00% Native American 39 0.62% 0,00% her 9,59 15.08%1 7.14 °1 b. Based on the percentages that you indicate your organization served describe your efforts to improve affirmative outreach to groups that may be underserved by your program and the result of your efforts: The goal of the outreach efforts undertaken by RTP serve to attract any and all income - qualified homeowners in need of our free repair services. RTP targets outreach opportunities at food distribution events, senior health and wellness fairs, and senior and community centers, as well as partner with other nonprofit agencies to distribute information to clients, volunteers, and members. In the coming year, RTP will also develop a formal outreach plan and use the data above to ensure we are reaching all populations throughout the county. http: /lwww.citydataser ices.r*V cities/ smatca/ app2Ol6arc.pl?rpt= C4717&prop =37 4!i' 1/25/2016 City Data Services - South San Francisco 21. Leveraging: Describe your fundraising efforts and additional sources of revenue for this project and your organization. Please state whether any of these fund sources are already committed and in what amount. Over the past 26 years, Rebuilding Together Peninsula (RTP) has served nearly 2,000 low- income homeowners with the support of over 60,000 volunteers. While our government partners are critical in funding our Safe at Home program, we use a combination of private donations and foundation grants to support the operations of the organization. RTP's biennial Dreams Happen Gala & Playhouse Auction is one our most important fundraising activities. With support from the Junior League of Mid - Peninsula *Palo Alto, local architects and builders, the Stanford Shopping Center, and generous underwriters, we consistently raise enough funds to support the operations of the organization for two years. Staff Lost List below kev staff members who work on this Pos €tion Title R!ame of Staff Pemen Job Res orts!bUiLies P Qaaaiificatio es Program Total Jurisdictions Project management and Longtime RTP volunteer, 30+ years in Manager, Safe Chris Wahl reporting, staff supervision, project construction, City of San Mateo CDBG A Home Agency Total scopes analyst afe at Home echnician II Rick Lambers Completion of projects Licensed contractor with 30+ years of % Requested % Requested q experience afe . Home echnician I Frank Tijerina Completion of projects 5+ years of experience in construction Program Billy Hoover Project file management, g (operational support, application Bachelor's Degree, database expert, oordinator Program Supplies $3,5 42°/ $1,47 0% $ 0% $ 0% $ 0°/ $ 0°/ $ review decade of nonprofit experience PROPOSED PROGRAFI51 BUDGE' FOR FY 2016-17 For the City of Redwood City ONLY, answer the following: For the City of Redwood City ONLY, answer the following: 1. Funding Criteria: 1. Affordable Housing: Acquisition of sites for affordable housing, new construction of affordable housing, conversion of existing housing to affordable, acquisition and rehabilitation of rental housing (includes special needs housing), http: /A ww.citydataservices.noU cities/ Smatcalapp2Ol6arc .pl?rpt= C4717&prop =37 517 Redwood CKy CftyoFSanMateo County of San South San Total Jurisdictions Mateo Francisco Budget Line Item Agency Total Pgmo Pro t., Total I % Requested % Requested % Requested % Requested q P m% 9i Requested q Labor Chris Wahl $67,00 88% $58,96 89 / $4,716112% $7,07 24% 63 57°/ $33,57 Rick Lambers $70,00 80°/ $56,00 8% $4,54 12% $6,72 40% ,96 76°/ $42,62 Frank Tijerina $60,40 80 °/ $48,32 0% $ 6% $3,00 12% 33 19°/ $906 W130/4 Bill Hoover $47,00 42°/ $19,74 5°/ $98 11% $2,20 19% 59 38 °/ $7,53 Other Staff $469,90 10 °/ $46,99 0% $ 0% $ 0% $ po/ $ axes /Benefits $178,39 42°/ $74,92 0% $ 0% $ 0% $ 0°/ $ Supplies Program Supplies $3,5 42°/ $1,47 0% $ 0% $ 0% $ 0°/ $ 0°/ $ Postage $2,20 42 °/ $92 0D/ $ 0% $ 0% $ 0 °/ $ Oo $ Phone $1,68 25°/ $70 11 °/ $ 22% $ 44% $ 22% $ Q °/ $ Mileage $9,00 $2,25 $25 $50 $1,00 $50 $2,25 Materials Materials and Sub- ontractors $631,00 60°/ $151,44 0°/ $6,00 0% $26,504100%1 $75,50 0°/ $6,50 3,817 ° / $114,50 Environmental Reviews $5,00 $3,00 $ 1 $ $3,00 $ $3,00 Operations/Maintenance Outreach $9,03T-42% $1,89 0°/ $ 0% $ 0% $47 0°/ $47" 6°/ $94 Volunteer Costs $37,10 $15,58 $ $01 $C1 $ $ Administration $125,17 0% $ $ $ $ $ 0% TOTAL $1,716,34 28% $482,19 3°/ $16,50 10% $46,00 26% $126,00 5°/ $25,00 44°/ $213,50 Number of Individual Beneficiaries 1 21 6 1i 11 ost r Individual $916.6 $2,190.4 $2,032.2 $1,562.5 $1,824.7 For the City of Redwood City ONLY, answer the following: For the City of Redwood City ONLY, answer the following: 1. Funding Criteria: 1. Affordable Housing: Acquisition of sites for affordable housing, new construction of affordable housing, conversion of existing housing to affordable, acquisition and rehabilitation of rental housing (includes special needs housing), http: /A ww.citydataservices.noU cities/ Smatcalapp2Ol6arc .pl?rpt= C4717&prop =37 517 U25120116 City Data Services - South San Francisco 2. Markefing /Advertising a. Check all of the following methods your agency utilizes to promote and advertise your programs and services: Flyers /brochures f, Website Phone book listing 'ie, CIP (Handbook/Database) vf: Outreach presentations to service providers Outreach presentations to public ;d PSA's b. Which of the above marketing /advertising materials are available in multi4angual form and which languages are they available in? Rebuilding Together Peninsula (RTP) makes a concerted effort to reach residents with limited English proficiency. An indicator of this commitment is evident in the fact that four of our eleven staff members have a bilingual proficiency in English /Spanish. All application and outreach materials are bilingual English/Spanish and Spanish - only presentations are made available based on the needs of the community. For other languages, translation services are provided. Spanish /English - Flyersibrochures, outreach presentations to service providers and the public Spanish/English /Tagoiog /Chinese - Flyers c.. low and where are the materials distributed? Flyers are distribution at community fairs, during outreach presentations, senior centers and through through dissemination at partnering agencies. 3. Program Outcomes: a. Please describe the accomplishments of program goals for FY /15. In partnership with local jurisdictions, RTP was able to complete repairs for 93 households in FY 14/15. This is a major accomplishment, not only because of the nature of the work, but because of key staff transitions that left gaping holes in capacity and institutional knowledge. Now fully staffed, RTP plans to strengthen all aspects of the program with the goal of impacting more and more homeowners each year. b. In what ways has your program made a difference in the lives of the people you serve? Please provide at least one concrete example from the people served in FY /15: Over the last 26 years, RTP has worked to provide repairs and renovations for the Peninsula's most vulnerable neighbors. Our reputation as experts in home repairs and rehabilitation; preserving affordable housing; and senior services and aging in place, has made us the clear choice for the area's low- income homeowners to turn to when in need. Today, we complete approximately 200 repair projects each year. Safe at Nome addresses minor repair needs of low- income homeowners before the needs become serious deferred maintenance issues and all repairs are done at zero cost. Common repairs aim to prevent falls in seniors, remove moisture issues in the home, and other safety and health hazards. For the past three years, Laverne's daughter and granddaughter were living with her while her daughter worked and went to school. Laverne's daughter was able to assist with housing expenses along the way, although not to a great extent. A few months after Laverne's daughter moved out, Laveme started to undertake some of the deferred maintenance that had been building up. She quickly found out the things she needed to be safe in her home cost more than she had hopped. A neighbor who had received services from RTP a few years prior suggested she call RTP. RTP was able to address Laverne's most pressing needs and to allow her to feel safe at home. Attachments !!` 1. Resolution authorizing application and designation of signatory, by the Board of Directors 2. Proof of 501(c)3 / tax -exempt status d' 3. By-laws 4. Articles of Incorporation 5. Board roster, including: • blame, Company, Years on Board • Meeting dates for previous 12 months • Number of years allowed for each board term d 6. Organizational chart for entire organization 7. Certified financial audit no more that 1 fiscal year old, prepared by a CPA, and: CDBG Authorization.adf 2. RTP 501c3 letter odf 3. RTP Bylaws and Procedres pdf 4. RTP Articles of Incorporation pdf 2015 -2016 Board Roster pdf RTPOrgChart1.14.16_pdf RTP Audited FS FYE 9.30.2014 odf http: /Mrww.citydataservices. net / cities/ smatca lapp20l6arc.pi?rpt= C47178prop =37 617 1/25/2016 City Data Services - South San Francisco Management letters (if applicable) A -122 and A -133 Single Audit (for entities that receive more than $500,000 in federal funding) OR • A letter from your Executive Director or Chief Financial Officer certifying that agency does not receive more than $500,000 in federal funds and is not subject to the Single Audit. d 8. The following are required: 2015 -17 Budget CDBG.xlsx • Current (FY15 -16) Agency Operating Budget Proposed (FY16 -17) Agency Operating Budget 9. Mission Statement RTP Mission Statement.doc :d 10. Non - discrimination policy for Staff and Clients 10. RTP Non - discrimination Policy odf 11. Reasonable Accommodations Policy for Staff and Clients 11. _ RTP Reasonable Accomodations Policy doc =e.' 12. Conflict of Interest Policy. (If not available, please indicate when you will submit) 13. Other - Download All Attachments Program Manager Signature David Cattivera Date Signed 01/22/2016 Initially submiRed: Jan 22, 2016 - 16:16:35 http: //www.citydataservices.net/ cities/ smatca/ app2016arc.pl?rpt= C4717&prop =37 77 Ctebuiiding Together Peninsula Budget Oct 15 -Sept 15 ±=Y72 -13 FY13 -14 FY14 -15 FY15 -16 F7y56 -17 Income J00 - Foundations - Unrestricted 4005 • Foundations - Restricted :4100 • Fall Appeal & Nwsltr Donations 4150 • Board Donations 4200 • Spring Appeal & Newsletter 4400 • Sponsorship /Renovation Income .4410 • Government Funding ;4415 - Roof Donations Unrestricted 4420 • Roof Donations - Restricted 4425 • Team Build Sponsorship Income 4430 - Safe At Home 4435 - Sponsorship - RT Nat'l 4550 - Youth Funding 4560 - Prior Year renovation Income '4600 • Misc. Income/Transfers 4650 - Restricted Income General 4651 - Restricted Income Special Projects 4815 - Rental Income 4656 • Legacies & Bequests- Unrestricted .4900 Interest Income 4905 Dividend Income Inkind donations ;Total Income Expense Program Expenses 5010 - RT National membership 5025 • HO Outreach Expenses Materials, Labor, Svcs. 110 • Roofing 5115 - Energy Efficiency Programs 5120 Site Renovation 5130 - Site Related Volunteer Expenses 15131 - Non -site Specific Project Expenses 5135 - Prior Year Project Expenses 5140 • Team Build Renovation Expenses :5140.1 - Team Build - Jones 5140.0 - Team Build - General 5145 • Kumin YASP Site Expenses 5150 - Safe At Home '5155 - Warehouse stock 5160 - Special Programs :5100 - Materials, Labor, Svcs - Other :Total 5100 • Materials, Labor, Svcs. Volunteer Costs 5305 - AmeriCorps :5310 • Meetings & Appreciation 5320 • Youth Board Costs, Meetings ,5330 - Volunteer Insurance 15335 - Volunteer Communication Total 5300 • Volunteer Costs 15400 • Miscellaneous 5405 - Contractor Licensing 5410 - Memberships /Subscriptions 'ruck )541 • Repairs, Gas & Insurance travel & Entertainment 5552 Meals, Travel, Mileage & Entertainment Total 5550 • Travel & Entertainment 85,835: 93,60 35,000: 53,OC 111,017: 119,2E 32,915: 30,2C 44,025: 57,42 455,659: 461,01 289,469: 384,11 20,000: 17,36E 7,000: 691 100,200: 109,9C 146,608: 65,7C 0: 64,OC 5,000: 5,927 26,514: 31 0: 25,OOC 3,520: 268,433 22,800: 22,80C 20,000: C 10,503: 12,11 f 10,291: 17,36E 1,422,837 1 1,789,914 10,000: 10,000 13,521: 7,29C 102,489: 88,452 3,520: C 247,790: 237,218 26,990: 26,271 11,103: 4,877 - 1,044: 2,311 61,960: 691 1,278: 247,772 5,238: 90,153 0: C 107,548: 131,28E 2,845: 7,342 563,201: 835,682+ 36,734: i 28,6891 21,085: 45,5841 0: 53,120 1,204 232 1,324 10,869 6,399 5,274: 5,588 1,343: 1,429 64,436: 81,291 970: 50 7,000 691 1,278: 1,263 5,238: 7,556- 8,081: 8,4291 8,081 8,429 110,5 52,5 149,2 27,8 50,9 411,4 370.2 79,1 41,3 16.2 12 334,73 1,20A 7,60( 11,47, 16,74! 1,684,652 11, 217,956 24,148 3,841 7,353 5,197 47,314 0 116,905 1.048 499,1 1 41 1 U U Oi 0� 0 0 0 200,000 i 0 3,000', 01 0 631,0001 680.000 1122/16 21,440 26,616 5,064 0 1,500 30,000 30,000' 0 5,600; Oj 65,600 4i 250. 1,0001 1,300; 'i 6,500 7,000 7,000' - -- Page 1 of 9 30,000 0 5,600 0 53,120 1,204 232 1,324 10,869 6,399 37,100 250 1,000 1,300 6,500 7,000 6,399 7,000 - - - - -- FY12 -13 FY13 -14• I FY14 -15 FY9 5-16 FY16 -17 1122116 Actuals Actuilij Actuals Budget I Budget 5570 • Equipment, Repairs & Rental 6,615: 4,900' 6,474 10,000 10,000' 671 - Software /Database /ROOMS 1,384; 1,045, 2,163 2,000 _ 2,000' !Napes, Benefits, Taxes 5710 • Staff Wages, Taxes & Benefits 491,130: 533,364 539,127 651,260 651,260' Total 5700 • Wages, Benefits, Taxes 491,130: 533,364: 539,127 651,260 651,2601. :5905 Program Supplies 4,107': 3,848 4,433 3,500 3,500! 5910 Postage & Shipping 1,804: 2,471 2,416 2,200 2,200; 5911 • Annual Report (Allocated) 5,0821 7,641 5,832 7,000 7,0001 5912 Program Printing &Reproduction 2,098; 3,245 2,476 3,000 3,000! 5913 • Program Professional Svcs. 4,783; 5,572 13,402 5,500 5,500' .5925 - Building Expenses, Allocated 12,054 8,804 10,543 10,500 10,500 5920 Telephone & Telecommunications i 4,115: 4,793 6,981 7,500 7,500' Tota's 5000 - Program Expenses 1,499,8981 1,5?-7,933 1,193,141 1,407,610 1,486,110' Operating Expenses' 6010 Bank & Credit Card Charges 4,835. 1,678 12,783 2,000 2,000; 6015 • Investment Acct. Fees & Charges 59: 6100 • Ofc. Equip., S/W & Furniture 68: 153E 8� 100 1001' 6110 • Equipment Rental 418: 458 75 500 5001 6125 Telephone & Telecommunications 356: 445 401 480 480 j 6175 - Equipment Repairs & maintenance 0: 6 369 10,000 10,000, +6200 Insurance - Business 3,997: 4,400 3,813 4,800 4,800', 6225 • Taxes, Licensing, Filing Fees 420: 677 50 500 5001 6226- Property Tax Kaynyne 2,042: 6,370 3,409 3,500 3,500 ;6275 • Professional Svcs. 5,625: 29,060 6276 - Accounting 40,509: 43,315 43,634 48,000 48,000 1280 - Recruiting Expense 480: 615 23,531 1,200 1,2001 .)285 Subscriptions /Memberships 700: 407 154 500 500' 6300 Travel, Meals & Entertainment 6,223: 4,662 8,553 7,500 7,500' 6325 Board & Staff Development 6,809: 6,230'. 7,268 10,000 10,000, 6500 Office Supplies 846 1,427 1,300 1,200 1,200; 6900 • Misc Operating Expenses - Other 485 301 150 150' 7300 • Postage & Shipping 405: 480 417 500 500; 7310 • Printing & Reproduction 421: 0 346 500 500' Operating Wages, Benefits & Taxes 7510 • Staff Wages, Taxes & Benefits 65,834: I, 76,631. 74,900 87,329 87,329 ;Total 7500 • Wages, Benefits & Taxes 65,834: 76,631, 74,900 87,329 87,329 7600 • Payroll Processing Fees 1,182: 2,614$ 1,353' 1,700 1,700; '7601 - 403(b)Admin Fees 1,412: 1,488• 1,393 1,440 1,440; 7925 - Building Expense, Allocated 1,067: 928'' 1,849 1,900 1,900 Total 6000 - Operating Expenses 144,194: '482,345' 183,799 :83,799' `Fu.nd'raising Expenses Fundraising Wages, Benefits & Taxes :8510 • Staff Wages & Bonuses 124,777: 145,855' 126,880 154,107 154,107:. ;Total 8505 • Wages, Benefits & Taxes 124,777: 145,855` 126,880 154,107 154,107: i 8574 Equipment 1,198: 3,252 1,420 1,500 1,5001 8576 Postage & Delivery 7,338; 9,097 5,860 8,800 8,8001 8577 Printing & Reproduction 2,742: 6,646+ 2,432 6,500 6,500 8580 • Annual Report (Allocated) 3,388: 3,275` 2,499 3,000 3,000, 18585 • Membership Dues /Subscriptions 29: 1,041 1,301 1,000 1,000' 8590 • Professional Services 1,693 15,986 9,096 10,0001 10,000' 3593 - Supplies 354; 902 496 6001 600, 3595 • Telephone & Telecommunications 835: 1,049, 1,173 1,200' 1,200, 8600 • Travel, Meetings, Entertainment 1,336: 1,421r 2,1881 1,500 1,500; '8610 • Bank Processing Fees 0: Page 2 of 9 1/22116 Page 3 of 9 FY12 -13 I FY13 -14 FYI -15 FYI FY16 -17 i 8700 • Public /Donor Relations 8925 - Building Expense, Allocated 371 - Software /Database /ROOMS Total 8500 • Fundraising Expenses Total Expense Net Cash Flow Other Income (Investments) Dreams Happen Allocation Net income Actuais 11,095: 2,514: 157,2999 1,500 391-` (781555)' 71,149: 10,000: 2,59 Actuals 15,167 2,095 0 205,785' 1,916,063 126,149 62,258 85,000 !,109 Actuals 18,869 2,478 1,473 X76,:65 1,544,803 139,849 62,258 65,000 267,1071 Budget Y 12,000 Budget 12,000 3,000 3,000 1,700 1,700 204,9G7 204,907 1,796,316 1,874,816 376,816 330,316 377,000 331,000 184 684 1/22116 Page 3 of 9 1/25/2016 City Data Services - South San Francisco Consolidated Community Funding Application Redwood City, San Mateo County, and S. San Francisco Application for Now Funding for FY 2016 -17 GENERAL INFORMATION 1. Organization Warne: Project Sentinel Inc 2. Project TEtlo: Fair Housing Vlfe are applying for funding from: I k �. Redwood City �' City of San Mateo �' South San Francisco County of San Mateo 0uVg8VCI1efnt Summ Jurisdictions E receiving this application a (Auto -p Amount Requested ulated from Bud % of Program Budget et, below) Proposed # of a Persons Served % of Persons Served w _ Total $ Per Persons Redwood Cit $28,35 8% 15 280 1 $185.2 'Cif ty of San Mateo $154501 4% 11 20°/ $140.4 ount of San Mateo 9 °fo 21 39% $148. outh San Francisco q$84,2 2% 7 14% $113.7 opal 23% 55 1000/4 $152.4 Grant Funded Programs: We are applying for a Fair Housing Program CDEG National Objective Eligibility - How are you serving low income populations? Service to low income clients verified through income documentation. Income Verification: Describe how you obtain, verify, and maintain proof of income and presumed benefit status. Third party documentation or client signatures on the certification forms must be available on file for review at all times. Upon complaint in -take each bona fide complainant is asked to provide income verification by a signed statement or by pay stubs, income tax returns, report of benefits, pensions or other suitable verification of income. 3. Project Address: 626 Jefferson Blvd Ste 6 City: Redwood City Zip: 94063 -1726 4. Provide a one sentence project summary: Project Sentinel will provide comprehensive fair housing services including complaint investigation, community outreach and education to San Mateo County residents. Organization Address: 1490 El Camino Real City: Santa Clara Zip: 95050 -4609 Organization Phone: 650 - 321 -6291 Website: www.housing.org Type of Applicant: For Profit Our agency serves: Persons 5. Contact Person / Project Name: Molly Current Title: Fair Housing Administrator: Director Contact Email: mcurrent @housing.org Fax: 650 - 321 -4173 6. Name of Agency Ann Marquart Director: 7. Fiscal Officer: Name: Andrea Elliott Fiscal Officer 3180 Newberry Dr Address: Telephone: 650 -321 -6291 Email: Telephone: 408 - 879 -4117 andreaE@healthtrust.org City: San Jose Zip: 95118 8. Authorized Email: Signatory Name: Ann Marquart amarquart@housing.org Telephone: 650 - 321 -6291 x 8100 Authorized Signatory 1490 El Camino Real City: Santa Clara Zip: 95050-4609 Address: 9. Please provide days and hours of regularly scheduled operation: Monday -Friday 9:00 AM - 4:30 PM http:lh vww. citydataservices. neVcittes/ smatcal app2016arc.pl ?rpt= C4658&prop =25 1n 1/25/2016 City Data Services - South San Francisco 10. DUNS Number: 781326608 Federal EIN /TIN Number: 77- 0266612 1 ?. HUD Activity: Choose the HUD activity that most closely matches your service: 05J - Fair Housing Activities Subj.to Pub.Serv.Cap 12. Project SpeclFc leaarative: Provide a narrative description of the specific activities to be carried out with the requested funds. This should also include program objectives and key priorities for each specific jurisdiction. To combat illegal housing discrimination and ensure civil rights protection, Project Sentinel provides comprehensive fair housing services of complaint investigation, consultation, information and referral, and community outreach and education. Fair housing investigations that reveal evidence of illegal discrimination are addressed through education, conciliation, HUD or DFEH filings, or litigation. Consultations address fair housing questions that do not warrant an investigation. Information and referral services links a caller with a housing problem to the most appropriate service provider(s). Education and outreach activities increase the targeted population's and the public's awareness of the existence and benefits of fair housing. These services are available to home seekers, in -place residents, and housing providers. Provision of these services will help create and maintain healthy communities and will assist San Mateo County, Redwood City and South San Francisco in meeting its CDBG obligation to affirmatively further fair housing. 13A. Assessment of Need - Redwood City: Briefly describe how you determined the need for your program for each specific jurisdiction that you are applying for funds. Identify target popuiation(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. Fair and equal access to housing is a primary civil right of all people and is a HUD requirement for the receipt of federal funding. FH services need to serve those of protected status, producing integrated, healthy communities. To be effective, FH services must proactively outreach and educate the community as a whole, protected populations, and housing providers. Services must also be available to assist victims secure redress from the harm of housing discrimination. Target population: low income, minority, renter HHs with disabilities. Victims of housing discrimination are often among the poorest and most underserved residents of our communities. The linguistic, cultural, mental, and physical barriers that contribute to discrimination often prevent victims from perceiving, understanding, and addressing discriminatory treatment. Redwood City's demographics show 38.8% Hispanic many with limited English proficiency. Thirty eight percent of the City's population spends over 30% of their income for housing (ACS 2014). Discrimination against people with disabilities remains a real and chronic problem. ACS 2014 estimates show 32% of persons over 64 years have some form of disability. Harmful stereotypes have shut the doors of housing opportunity for many people with disabilities, and disability (7.7% of Redwood City's population) is the protected category we receive the most calls about- both for antidiscrimination and for help in getting reasonable accommodatio 13B. Assessment of geed - City of San Mateo: Briefly describe how you determined the need for your program for each specific jurisdiction that you are aRBlying for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information, identify any similar programs in the community. Fair and equal access to housing is a primary civil right of all people and is a HUD requirement for the receipt of federal funding. Fair Housing services need to serve those of protected status, producing integrated, healthy communities. To be effective, FH services must proactively outreach and educate the community as a whole, protected populations, and housing providers. Services are also needed to assist victims secure redress from the harm of housing discrimination. Target population: low income, minority, renter HHs with disabilities. Victims of housing discrimination are often among the poorest and most underserved residents of our communities. The linguistic, cultural, mental, and physical barriers that contribute to discrimination often prevent victims from perceiving, understanding, and addressing discriminatory treatment. San Mateo City's demographics are 20% Hispanic, 15% Asian (Census 2010), and many with limited English proficiency. Census 2014 estimates also show that 47.8% of the housing units in San Mateo City are renter occupied, and 30% pay 30% of their income on rent (ACS, 2014). Discrimination against people with disabilities remains a real and chronic problem, and 9.2% of San Mateo City is disabled. Harmful stereotypes have shut the doors of housing opportunity on many disabled, and disability is the protected category we receive the most calls about —both for antidiscri mination help and for help getting reasonable accommodations. 13C. Assessment of Heed - County of San Mateo: Briefly describe how you determined the need for your program for each specific jurisdiction that you are aBg_lyina for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. Identify any similar programs in the community. Fair and equal access to housing is a primary civil right of all people and is a HUD requirement for the receipt of federal funding. Fair Housing services will contribute to integrated, healthy communities. To be effective, FH services must proactively outreach and educate the community as a whole, protected populations, and housing providers. Services are also needed to assist victims secure redress from the harm of housing discrimination. Target population: low income, minority, renter HHs with disabilities. Victims of housing discrimination are often among the poorest and most underserved residents of our communities. The linguistic, cultural, mental, and physical barriers that contribute to discrimination often prevent victims from perceiving, understanding, and addressing discriminatory treatment. San Mateo Co. is 25.4% Hispanic, 24.8% Asian, and many have limited English proficiency. Data shows 40.6% of housing units are renter occupied, with 38% percent cost burdened (ACS 2014 estimate). High housing costs are projected to increase with little effective relief for low income HHS. Discrimination against people with disabilities remains a real and chronic problem, and 9.2% of the County's population is disabled. Harmful stereotypes have shut the doors of housing opportunity on many disabled, and disability is the protected category we receive the most calls about - both for antidiscrimination help and for getting reasonable accommodations. 13D. Assessment of Need - South San Francisco: Briefly describe how you determined the need for your program for each specific jurisdiction that you are 0013fina for funds. Identify target population(s) and area(s) served. Please state the source(s) and date(s) of information. identify any similar programs in the community. Fair and equal access to housing is a primary civil right of all people and is a HUD requirement for the receipt of federal funding. FH services need to serve those of protected status, producing integrated, healthy communities. To be effective, fair housing services must proactively outreach and educate the community as a whole, protected populations, and housing providers. Services are also needed to assist victims secure redress from the harm of housing discrimination. http: /ANww.citydataservices. net / cities/ Smatca/ app2016arc.pl ?rpt= C4658&prop =25 W 1/=016 City Data Services - South San Francisco Target population: low income, minority, renter HHs with disabilities. Victims of housing discrimination are often among the poorest and most underserved residents of our communities. The linguistic, cultural, mental, and physical barriers that contribute to discrimination often prevent victims from perceiving, understanding, and addressing discriminatory treatment. The City's demographics are 34% Hispanic, 36% Asian, and many with limited English proficiency; 39.1 % are foreign bom. Census 2014 estimates show 39.8% of the housing units are renter occupied, and 34% are paying more than 30% of their income on rent. Discrimination against people with disabilities remains a real and chronic problem for many of So. San Francisco's residents (10% are disabled). Harmful stereotypes have shut the doors of housing opportunity on many disabled, and disability is the protected category we receive the most calls about —both for antidiscrimination help and for help getting reasonable .accommodations. 14. imeline: Provide a brief timetable for project implementation and achievement of projected goals and how you plan to expend your funds in a timely manner by the end of the fiscal year. All program services of I &R, consultations, complaint counseling and investigation, community outreach and education are on -going. Reimbursement requests are based on direct service hours recorded on daily time sheets. Staff time spent on any one jurisdiction will vary based on case load demands but can be controlled by increasing or decreasing outreach to comply with budget requirements and timely draws. All Project Sentinel staff are acutely aware of time management and the need to plan and track time expenditures and tc achieve reasonable contract goals: 15. Evaluation: Briefly describe how you will determine and measure the success of your program and whether or not program goals were met? If your program is currently receiving grant funds please describe accomplishments of goals to date. Quantitative: 1.Case files will confirm fair housing investigation assistance as well as tangible outcomes. We follow complaints beyond the investigation stage to final resolution. 2.Phone logs will record information and referral services as well as how callers learned of the service to help shape future outreach efforts. 3.Participant sign -in sheets will confirm attendance at outreach presentations 4.Post- process surveys solicit feed back on educational presentations and evaluate the effectiveness of trainings and presentations by measuring whether the participants' knowledge was increased. Information on enforcement activity as well as outreach and education work efforts are submitted to the jurisdiction in quarted reports. J 16. Collaboration: Describe partnerships with other organizations /agencies, the nature of the partnership, and how it relates to the proposed project. Project Sentinel collaborates with a wide range of organizations to enlist their support to promote fair housing and to reach members of protected groups. We believe it is important to educate 'front line' providers on what fair housing is, how to recognize a complaint, and how to make an effective enforcement referral. The more the staff at other service agencies understand what fair housing is, the better they can serve their clientele with a referral to Project Sentinel. Collaborations increase service visibility, allow for making and receiving referrals and help ensure technical accuracy: InnVision Shelter Network (education, referrals), Caminar (referrals), Center for Independence of Individuals with Disabilities (education, referrals), Legal Aid of San Mateo County (referrals), Community Legal Services in East Palo Alto (referrals), Peninsula Interfaith Action (education and referrals), NAACP (education, referrals), AARP (education, referrals), StarVista (education, referrals), Sunset Project (education, referrals), Swords to Plowshares (education referrals) San Mateo County Child Care Coordinating Council (education, referrals), and SparkPoint (education, referrals), Legal Aid an CLESPA (referrals & technical accuracy), HUD -FHEO (referrals & technical accuracy). 17. Impact:: Discuss any general trends and conditions that have affected or impacted your service levels or service populations. For New Applicants — describe what these funds would allow your agency to do that you may not be able to do now. For Continuing Applicants — describe how your program would be impacted without these funds. The increasing demand for affordable housing and systemic displacement of low income renters from many areas of San Mateo County has placed tremendous pressure on the rental market and the low income renters in the County. Without this funding our ability to assist these renters and ensure that they are able to secure and maintain housing would be compromised. 18. Project BenefOades /Quantifiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individuals. Refer to the San Mateo County Income Limits. 19. Project Benefelarles/Quantifiable Measurement: Indicate the expected number of beneficiaries to be served by the program. For each response below please indicate both the number of households and number of individua ".s. Refer to the San Mateo County Income Limits. a. Indicate the total number of low-income beneficiaries you expect to serve with this program for each jurisdiction application for funding. "Low - income is 80% of Area Median Income or below. See AMI table b. Indicate the total number of beneficiaries you expect to serve with this program in each jurisdiction - regardless of income. Jurisdiction a. Number of low-income beneficiaries to be served per grant jurisdiction application. ""'Low4ncome"* is 80 °/a of Area Median Income or below. b. All beneficiaries to be served per grant jurisdiction application regardless of income Persons Persons Daly City Redwood City 153 153 ity of San Mateo 110 110 ounty of San Mateo 213 213 outh San Francisco 77 77 MtpJ/www.citydataservices.neticities/ smatea lapp2016arc.pl ?rpt= C4658&prcp=25 X7 1/25=16 City Data Services - South San Francisco __553— 19. 553 � � 19. Populations Seared: Check the boxes below if they describe a significant population served by your program. These categories are not considered "presumed benefit' by HUD, and require income verification. Persons exiting incarceration Low- income youth id Other LMI persons residing or seeking to reside in San Mateo Co and cities 20. Affarrsatiive Outreach: a. Use the demographics from your previous program year to provide an analysis of the population you serve relative to the demoaraohics in the table. NOTE: If you are a new ann/icant n/aasa rvnvida vnur hart asfimatinn s Rice Ethnicity Redwood City Population Redwood City % by Ethnicity Low Income by Ethnicity served by our Program Your Program °�/o by Ethnicity Total 74,40 100 °k 21 100% White and not Hispanic 40,6561 54.64% G 42.86% hite and Hispanic 23,55 31.66% 11 52.380 / sian 6,71 9.03% 1 0.00% frican American 1,91 2.58% 3 4.76% Pacific Islander �_�' 66 0.89% 0.00 ° / Native American 3 0.52% 0.00 ° / her 1, 511 2.03 °k G1 0.00% Race & Ethnicity City of San Mateo Population City of San Mateo /o by Ethnicity Low Income by Ethnicity served b our Program Your Program % by Ethnicity Total 97,20 100% 4 100% White and not Hispanic 45,24C 46.54% 7 15.56% hite and Hispanic 25,81 26.56% 37. 82.22 % sian 18,15 18.67% 1 0.00% frican American 2,09 2.16% 1 2.22 % Pacific Islander 1,93 1.99% D.00 °/ Native American 14 0.14% 0.00% her 3,82 3.93%1 01 0.00 ° / Race & Ethnicity South San Francisco Population South San Francisco % by Ethnicity Low Income by Ethnicity served b our Program Your Program % by Ethnicity Total 63,63 1000/0 E 1000/0 White and not Hispanic 23,760 37.34% 1 12.50 % and His anic 21,64 34.02% 75.00°/ 23,29 36.61% 1 12.50% n American V 1,62 2.55% 0.00% c Islander 1,111 1.75% 0.00°/ e American 39 0.62% 0.00 ° / 1 9,5981 15.080/0 0.00 ° / b. Based on the percentages that you indicate your organization served describe your efforts to improve affirmative outreach to groups that may be underserved by your program and the result of your efforts: Project Sentinel has increased its outreach efforts over the past two years to reach more ethnic and racial minorities. We believe our work in that area has been successful and we intend to continue targeting special populations. During the past yearwe developed and translated four different brochures on disability, familial status, and a generic FH brochure into Spanish, Mandarin, Vietnamese, Tagalog and Korean. We are working to complete a new brochure for Veterans and one for the LGBT community. We have also developed a 27 page instruction manual for small Mom and Pop housing providers which should be available for distribution in the next few months. In addition, we placed ads in newspapers serving ethnic communities: in Mandarin papers, the EPA Today, and the Manila Mail, the largest Filipino paper in the region. We made presentations in Spanish to immigrant groups. We conducted several workshops at InnVision Network transitional housing properties for chronically homeless families. 21. Leveraging: Describe your fundraising efforts and additional sources of revenue for this project and your organization. Please state whether any of these fund sources are already committed and in what amount. Project Sentinel has secured HUD funds through the Fair Housing Initiative Program (FHIP) for FY 2016 -17 to augment local CDBG funding. A minimum of $18,900 from the FHIP award will be provided for fair housing services conducted throughout San Mateo Ccunty. We also provide some fee generating training programs for housing providers beyond those supported by local government contracts. The agency maintains over 40 contracts in Northern California which all combined keep our overhead costs to a minitwirn. httplhvww.citydataservices.net/ cities/ smatca/ app2016arc.pl ?rpt= C46588prop =25 417 1/25/2016 City Data Services - South San Francisco We have also obtained a HUD approved indirect cost rate which also minimizes our overhead costs by reducing unnecessary backup paperwork. Staff List List below key staff members who work on this roroararn Maine of Staff Posltioe� Title Person i Job Resp¢nsibilities Quasificati¢ns Senior Fair 1, J.D. (candidate), community Housing Jaqueline Ramirez provide direct service service experience in Human Coordinator % Rights Fair Housing Molly Current _ supervise and provide direct service J.D.; community service Director_ Senior Fair Housing Coordinator experience in Human Ri hts Executive aAnn Marquart administers overall agency operations 30+ years experience in Fair Director 18 °f° Housin PROPOSED PRO(GfMl BUDGET FOR FY 2016 -17 For the City of Redwood City ONLY, answer the following: For the City of Redwood City ONLY, answer the following: S. Funding Criteria: 3. Human Services: Basic Human Needs are activities that are vital for survival and not just an improvement to the quality of life, regardless of income. For example, emergency food programs are essential to survival. Coordination of a volunteer program is an improvement to the quality of life. 2. !Marketing /Advertising a. Check all of the following methods your agency utilizes to promote and advertise your programs and services: ts� Flyers/brochures Website i v. Phone book listing ;' Outreach presentations to service providers e Outreach presentations to public v PSA's b. Which of the above marketing/advertising materials are available in multi- langual form and which languages are they available in? httpJ/ www. citydataservices. neUcities/ smatca/ app2016arc.pl ?rpt= C4658&prop =25 5(7 Redwood C' C of San Mateo ounty of Says South San Mateo Francisco Total Jurisdictions Budget Line I�Bn° Agency gm% P Togtaim % Requested % Requested L%16] Requested % Requested Pgrrt% Requested Labor Senior Fair Housing Coordinator $46,00 100% $16,00 18 °f° $8,38 o 37/0 $16,90 9/ ° $4,00 98/0 $45,28 Fair Housing Director $66 00 94% a2O% $90 1% $80 1 % $80 0 °/ $30 5% $2,80 Executive Director $104 58 32% $1,00 1% $42 7°/ $2 211 1°/ $50 12% $4,131 Taxes/Benefits $43,31 47% $3 58 0% $1 92 0% $3 98 0% $82 0% $ u lies Office Supplies 1 $16,001 $7,5001 $ rations /Maintenance Occueancy 82 49% $28,8321 0% $62 0% $55 0% $77 0% $1,2001 19% $3,15 Tele hone ,00 58% $16,32 0% $ 0% $ 1% $ 1 °/ $ 0% $ Mileage P$23 61 100% $13,79 2% $5 1% $6 2 °/ $9 2 °/ $8 1% $29 Testers ,00 400 $20 00 5% $40 3% $20 6% $50 1°/ $30 1% $1,40 Indirect costs ,61 $109 $5,80 $3,'1111 $-6-45 $1,55 $ Administration $ $ 0% TOTA $682,951 53% $364,05 8% $28,35 4% $15,45 9°/ $31,72 2°/ $8,76 23% $84 28 Number of Individual Beneficiaries 151 ill 21 74 55 Mist per Individual $185.291 $140.451 $148.9 $113.7 $152.4 For the City of Redwood City ONLY, answer the following: For the City of Redwood City ONLY, answer the following: S. Funding Criteria: 3. Human Services: Basic Human Needs are activities that are vital for survival and not just an improvement to the quality of life, regardless of income. For example, emergency food programs are essential to survival. Coordination of a volunteer program is an improvement to the quality of life. 2. !Marketing /Advertising a. Check all of the following methods your agency utilizes to promote and advertise your programs and services: ts� Flyers/brochures Website i v. Phone book listing ;' Outreach presentations to service providers e Outreach presentations to public v PSA's b. Which of the above marketing/advertising materials are available in multi- langual form and which languages are they available in? httpJ/ www. citydataservices. neUcities/ smatca/ app2016arc.pl ?rpt= C4658&prop =25 5(7 1/25/2016 City Data Services - South San Francisco Flyers: Spanish, Mandarin, Vietnamese, Tagalog, and several other Asian languages. Outreach: We have a bilingual staff member who gives outreach presentations in Spanish to both service providers anto the public PSAs: Spanish c. How and where are the materials distributed? The materials are distributed by mail, at outreach events, by keeping a supply at places such as City Hall, public libraries, the offices of cooperating agencies such as Legal Aid of San Mateo County, by posting at public bulletin boards at places such as laundromats and coffee shops, and by tabling at community fairs and events. 3. Program Outcornes: a. Please describe the accomplishments of program goals for FY /15. Cases — Redwood City Goal: 20 — Achieved: 24 (120 %) San Mateo City Goal 11 — Achieved: 50 (455 %) San Mateo County Goal 18 — Achieved: 25 (139°/x) South San Francisco Goal 8 —Achieved 8 100% TOTAL GOALS - 57 TOTAL ACHIEVED 107 (188 %) Audits — Redwood City Goal 10 — Achieved 8 (80 %) South San Francisco Goal 2 — Achieved 2 (100 %) Outreach Goals for all jurisdictions were exceeded by 388% Consultations and Referrals — 41 % b, In what ways has your program made a difference in the lives of the people you serve? Please provide at least one concrete example from the people served in FY /15: Housing providers will understand and operate within the law and home seekers will be able to secure and maintain housing of their choice. Those with disabilities will be granted reasonable accommodations and reasonable modifications. Families with children will be able to secure housing with reasonable occupancy standards and where their children can play under reasonable rules of conduct. Those of foreign national origin will live free from intimidation and threats of deportation. Attachments �• 1. Resolution authorizing application and designation of signatory, by the Board of Directors 'd` 2. Proof of 501(c)3 / tax-exempt status ;tf 3. By-laws d• 4. Articles of Incorporation 5. Board roster, including: • Name, Company, Years on Board • Meeting dates for previous 12 months Number of years allowed for each board term Board Resolution authorzina AM 12 14 15 pdf Federal and State Tax Exempt ndf PROJECT SENTINEL Amended By- Laws 2011.DOC PS Articles of Incorporation 11- 26- 1990 .odf Board Roster 2015- 16Rev. 12 -12 -15 docx e 6. Organizational chart for entire organization 1516 PS Organization Chagdf ' <'. 7. Certified financial audit no more that 1 fiscal year old, Final audit 2014-15 submitted 12- 18- 15.pdf prepared by a CPA, and: Management letters (if applicable) • A -122 and A -133 Single Audit (for entities that receive more than $500,000 in federal funding) OR • A letter from your Executive Director or Chief Financial Officer certifying that agency does not receive more than $500,000 in federal funds and is not subject to the Single Audit. ,', 8. The following are required: Current (FY15 -16) Agency Operating Budget • Proposed (FY16 -17) Agency Operating Budget 9. Mission Statement d 10. Nondiscrimination policy for Staff and Clients PS Budget FY 15 -16 .odf Proiected FY 1617 budoet.pdf Mission Statement.pdf [Affirmative Action Plan - Non - Discriminationpolicy.doc Mtp:Uwww.citydataservices. net / cities/ smatcalapp2016arc .pl ?rpt= C4658&prop =25 6r7 1/25/2016 City Data Services - South San Francisco 11. Reasonable Accommodations Policy for Staff and Clients reasonable accommodation statement doc ,{ 12. Conflict of Interest Policy. (If not available, please indicate Conflict of Interest Policy.doc when you will submit) 13. Other - Download All Attachments Program Manager Signature Florecita 'Tumusok, Admin Assistant Date Signed 01/22/2016 Initialy submitted: Jan 22, 2016 - 15:09:13 http: //www.citydataservices. net / cities/ smatcalapp2016arc .pl ?rpt= C4658&prop =25 V Pro, Sentinel DRAFT Budget for Statement of Activities - Total Organization For The Fiscal Year Ending 6/30/16 Revenue: Unrestricted Support Government Grants Contributions Total Support Revenue Training Fees Counseling Fees HECM Fees Settlement Revenue Presidio services FMV Donated use of facilities Interest & Dividends Total Revenue Released from Restriction Total Unrestricted Temporarily Restricted Support SF Foundation Other Total Support Released from Restriction Total Temporarily Restricted Total Revenue Expenses: Payroll Costs Non -Labor Costs Total Expenses 100 200 400 500 600 Fair Mediation HUD Housing Total DRAFT Account M &G Fundraising Housing Services Counseling Budget 42100 - - 904,076 761,984 174,300 1,840,360 4,500 4,500 904,076 761,984 178,800 1,844,860 600 - 44200 -02 -000 3,000 16,000 19,000 600 - 44400 - 02-000 2,000 2,000 600 - 44300 - 02-604 33,000 33,000 400 -47000- 02-418 30,000 30,000 500 - 47300 -02 -420/520/620 7,020 8,675 5,105 20,800 47600 7,920 20,880 25,920 17,280 72,000 inn -Asi nn -w -nnn Soo 500 600 -49100 -02 -000 200 - 41300 - 02-610 200 - 41300 -02 -000 200 - 49200 -02 -000 Net Surplus /(Deficit) For reference only, M &G Allocation: Surplus /deficit including M &G: 8,420 (5,000) 964,976 796,579 329,435 2,094,410 116,361 - 563,318 495,568 236,855 1,412,102 181,837 40 239,311 105,608 49,802 _576,598 298,198 40 802,629 601,177 286,657 1,988,699 PROJECTED BUDGET FOR 16 -17 government grants, foundations, training income and Projected Revenue: fees, settlements Expenses FY 161.7 $2,038,163 50000 Payroll, taxes, benefits Totai Labor Cost $ w� _1,553,312.00 $ 1,553,312.08 Ij 60100 Occupancy $ 22,566.00 63600 60200 _ 161100 ;Taxes & Licenses n Utilities _ 1 Payroll Service Fees f $ 462.00 $ _ 5,467.00 $ i_ 2,974.00 , 61300 Audit Fees i -: $ 10,000.00 61500 Professional Fees $ 6,739.00 ,p 61300 Accounting services $ 120,000.00 63500 Dues & Subscriptions $ 390.00 62100 Insurance -Prop & Liab _ $ 1,947.00 62600 Telephone & Internet $ 33,000.00 63100 Office Supplies _ $ 7,935.00 63700 Bank & Finance Charges $ 234.00 64200 Equip Maint $ 6,264.00 64300 Equip Rental $ 9,180.00 64400 65100 Equipment Purchases Travel $ 5,196.00 $ 4,000.00 11 65200 Mileage _ $ 7,509.00 65300 Lodging & Meals $ 1,332.00 66100 Postage /Shipping $ 2,754.00 67100 Printing /Publications $ 7,894.00 67200 Outreach $ 12,000.00 65500 Conference/Training $ 17,183.00 61900 Contract Services $ 49,632.00 j 68000 Depreciation Expense $ 4,089.00 69000 Presidio Rent FMV $ 14,285.00 62000 Testers $ 20,764.00 Totai Non -Labor Cost $ 373,896.00 Total !Labor and Non -Labor Costs $ ,1,927,208.00 ��� I Net surplus (deficit) $ 1i0,952,0�J�