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Home My WebLink About2016-02-16 e-packetMeeting will be held at: CITT !TiA:11AGE&`S-CeAFEREACE ROOI 400 GRAND AVENUE SOUTH SAN FRANCISCO, CA TUESDAY, FEBRUARY 16, 201.6 1:00 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 Tuesday, the 16"' day of February, at 1:00 P.M., at City Hall, City Manager's Conference Room, 400 Grand Avenue, South San Francisco, California 940W 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. 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-In Minimum Grant Amount- N/A Received 1 application 6. Upcoming subcommittee meeting schedule. EMM]WIM! ----- --- - ----- - Needs Assessment Piublic Hearing March 11, 2016 i �i CI;BG Subcommittee to fina4ze funding recommendations Apr!127,2016 Final Publ'ic Hearing, Funding Allocations, & Adoption of City's 2016-2017 Action Plan C�ity's 2016-2017 Annual Action Plan is submitted to HUD F.."s relfr0auvMM I-- Gabriel Rodriguez Deputy City Clerk CDBG MEETING FEBRUARY 16, 2016 AGENDA PAGE 2 MINUTES SPECIAL MEETING OF THE COMMUNITY DEVELOPMENT 1QF0 BLOCK GRANT (CDBG) SUBCOMMITTEE OF THE CITY OF SOUTH SAN FRANCISCO P.O. Box 711 (City Hall, 400 Grand Avenue) South San Francisco, California 940�83 Meeting will be held at: ECD CONFERENCE ROOM 400 GRAND AVENUE SOUTH SAN FRANCISCO, CA THURSDAY, MARCH 12, 2.01.5 11:00 A.M. 1, Call to Order. 11:015 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. 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 Fagade 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: AVxandra Tup el Deputy CDBGlij City of South San Approved by: CDBG Subcommittee Member mittee Clerk City of South San Francisco CDBG SUBCOMMITTEE MEETING MARCH 12, 2015 MINUTES PAGE 2 AGENDA February 16, 2016 ':UNDING AVAILABLE -Funding Overview WW.'rfWe -7 _Two Year Grant Cycle -One Year Check-in -Received 11 applications _One Year Grant Cycle I I i I I, W D1 OW93 1101 [$1 OUT 1000141 WAL191 NO, 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. 1 M> 11 Wel I • 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 fimds, 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. 61% WON "It IM * PUBLIC SERVICES * ADMINISTRATION m MINOR HOME REPAIR PROGRiKJS CITY SPONSORED ACTIVITIES Im 0% In addition to CDBG funding, the City also receives HOME funds from the County of San Mateo 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. Film I kyj I I I 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 eligibty 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 final adopted FY 2016-2017 Annual Action Plan must be submitted to HUD for approval by May 13,2 . I Im us =1 If you have any further questions, please feel free to contact me at (650) 829-6620 or email me alex.greenwoodA)ssf.net. 30 day public comment period April 27, 2016 City Council Meetin-9: Final funding, allocations and vublic hearin,,w adoption of the City's 2016-17 Annual Action Plan I End of 30 day public comment period L May 13,2016 City's 2016-17 Annual Action Plan is submitted to HUD FY 2016-17 commences I Funding Overview fff Widw FY 16-17 COMMUNITY DEVELOPMENT BLOCK GRANT -in-titlement FY 15-16 (Estimate) Amount 415,864 415,864 Prior Years Uncommitted Funds 226,000 94,500 Estimated Program Income 35,000 35,000 TOTAL CDBG FUNDS 676,864 545,364 FY 16-17 HOME FUNDS FY 15-16 (Estimate) HOME Administrative Funds 8,762 9,000 ESTIMATED FUNDS FROM ALL SOURCES 685,626 No= 554,364 IN= FY 16-17 BUDGET FY 15-16 (Estimate) CDBG- PUBLIC SERVICES (15% of Entitlement & Prior Year's Program Income) Non-profits TBD Subtotal 1 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 I 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 *15% of Estimated Entitlement Amount (FY 16 -17) = $62,379; 15% of Estimated Prior Year Program Income (FY 15 -16) _ $5` "'! io ** 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 FY 2016-2017 k Ell .11*01 11 Biotech Partners Biotech Academy at South San Francisco Fjff,- 101 Al 1:1 IIIIJ ill 03:9 EM;1014A 10 reWNTMIff �;-§ Organization Program # CDBG- Category 1: PUBLIC SERVICE GRANTS I CORA CORA Emergency Shelter Program 2 HIP Housing Home Sharing Program 3 John Papan Memorial John's Closet 4 Legal Aid Society Homes avers 5 Pa rca Family Support Services 6 Rape Trauma Services Center Sexual Assault Services 7 Samaritan House of Harbor 8 tar is 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 Fjff,- 101 Al 1:1 IIIIJ ill 03:9 EM;1014A 10 reWNTMIff �;-§ Q' M Z 2 LLI F-Q 0 -1 9L 0 LL 0 0 42 9 s E; 2, 22 2 E mpg O a 2 F .2 72 -2 '.2 2 m. E 2 E t g g E Z' 91! 2 15 t, 3 a - -E 0 Y1 22 e 3 E .5 E L6 14 p Vi San 7E to 12 'm o 2: E 6i z Q 2 -j IL CL LL 0 R, U '6 2 2 E -6 a. O 6A E S A2 rC ZO 0 0 0 w. 1/2d2016 CRY Data Services - South San FrancisUo� Consolidated Community Funding Application Xedw♦ ♦d City, San Mateo County, and S. San Francisco Application for New Funding for FY 2016-17 90 UIFIN14-10TEWX 1. Organization Name, Cornmunfty Overcorrflng IReiationship Abuse (CORA) 2. Project Tide: CORA Safe i "IOUse (Ernerqency Shetter) Program re ire ying for funng from. r ;p pipl funding Redwood City 11 San it 10� Suth San Franso e Count of Sa __ of Mateo o cic v n Pir—ogiarn 16wj-�;Alwll 1-ou Budget E Qranj Fundgd Prggrarns: man 'M Income Verification: PYAA' AAROUX Third party documentation or client signatures on the cercation forms must be available on file for review at all times. Ail Of OUr chents are surOvors of domesfic vioience and, as such, have a presumed beinefit status. 3. Project Suppressed City: Zip: 94403-1814 Address: 4. Provide a onesentence project summary: Fhls pr9ject provldes operating aWstance for CORA's safe houses (emergency shelters) Iprovuding AcUrns and survivors of domestic violence and thdr children with a confidential and safe Iliiviirq envlronmentifor up to s'x rnonths. Organization 2211 Palm Avenue City: San Mateo Zip: 94403-1814 Address: Organization 650-652-0800 Website: Phone: http://www.,corasupporf,,,org/ DITMT11 M. http:/AwA,v.c7itydataservices.r*Vcities/Smatcatapp2Ol6arc.pl?rpt--C4561 &prop= 11 W 7. Fiscal Officer: Name: 11 yinn Sciluette-I Cheryle Ma-tteo Fiscal Officer 2211 Pakn Ave, Address: • k'stj 6 1 Email: lynnS@corasul)port.org; cheroeT-ri@corasupport..org City: San Mateo Telephone: 650-652 0800 MINIMURNM 8. Authorized Name: Meflissa L,ukin Email: Telephone: 650 652-0800 Signatory: Mel'ussal.... @corasupport.org i Autho ato rized : r 2211 i::'Mm Ave. City: San Mateo Zip: 94403-1814 Sgnry Addess 9. Please provide days and hours of regularly scheduled operation: I he see house is open 2.4 hours a day, seven days a week, year-round. Federal EINITIN Number: 94-2,48-1188 I - IRMPT77"t"U"M. 05G - Battered and Abused Slrmuses 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 CO RA's safe houses serving survivors of domestic violence and their chfldren. COI::Ws safe houses are part, of the agency's overall effort to progressively engage c1lients at risk of homellessness.. F-rorn hoW vouchers to3- year Ihousing vouchers, CORA prevents homeNessness, providing custorinized levAs of assistance that preserve the most expensive interventions for households with the most severe barriers to housing. http:/Mww.citydataservices.retfcites/Smatcalapp2Ol6arc.pl?rpt--C4561&prop= 11 W 1/252016 City Data Services - South Son Francisco considerations are fisted in our answer to question '18.. 14. Yi lin : Provide a brief timetable for project implementation and achievement of projected goals and how you plan to n your funds in a timely manne, by the end of the fiscal year. CORA without irut�;rn..perat s we requested l Imi continuously since 1978, therefore the program will continue llrito the new CI)BG Iprograrn year a� operated a'ts Safe U °lou..use oonti ificantly less funding than what lit costs to serve each jurisdiction, we anticipate 'invoicing for funds within the first two to three quarters for each ,pu.urlsdiction. CORA recently completed a third party evaluation prgz ect that examined tU -m iirnpact and effectiverness of its programs. TINS protect developed outcome tools that were aligned with the Domestic Violence Evidence Project's theory of change, impWnentable in CO R "s program structures, and compatible with the agency's database; while also iincreasin C IRA's ongoing capacity to conduct evaluation of its progrars. Two new tools were knpllemented to collect quaratitafiive data on safe house clients, the Self - Sufficiency Matrix arid the PTD Checklist. (hollowing implementation, 77% of safe house cliients showed an overall lncrease in self-sufficiency,, with the average clients iimpiroviing in 5 areas. 16. Collaboration: Describe partnerships with other organizations/ agencies, the nature of the hip, and how it relates to the proposed project. CORA's collaborative work spans three categories: Adjunct Services:: IFo ensure clients have the best opportunity to heal and rebuild a violence-free, II'lfe, CORA works closely with indMduals, other non- profiits„ governirrrnent entities„ and the private sector to increase the effectiveness and impact of its work with cHent.s in the safe houses to provide food, clothing, medical services, access to r•nainstireairn benefits, legal services, (life skills, transportation, and amore. CORA has also created partnerships with local landlords by cultivating relationships with those amenable to renting their properties to CORA cliients.. /Advocacy and Systems Change: CORA is part of a (larger network of domestic violence agencies named the California Partnership to End Domestic Viiolerice (CPEDV). lrn fact, our Director of Programs, Cori Manthome, serves on the board of directors for C ;PILDV CORA staff also represent us on various County committees including: the Domestic Violence Council, the IDeath Review learn, the I_egiisiative Committee, the Legal lilimcess Comrrnitt.ee, Coordinated (Response Committee„ and the Continuum of Care Steering Committee, Community EEducatiion. CORA partners with (local schools through presentations and activities to engage students avid teachers in how to ldentify and prevent dorestic (and dati!rng) violence. CORA coordinates its outreach through a number of other agericles, including come °nuriUt:y centers, doctors" offices, and legal aid agencies. http:/Avww.citydataservices.neUcities/Smatcalapp2Ol6arc.pl?rpt--C4561 &prop= 11 317 1/25/2016 City Data Services - South San Francisco Without receiving these CDBG funds, consequences could include reducing safe house staff houirs for services such as on -site tJIC a "s services continues Liven the in-pact of the continuing tinanoiall challeinges in the I {puublic and private sectors, the demand for u� GRA Ilne ere oouura,.ne u � Y capacity � g has Ibecor ne mare iunu.ues to exceed the agency's "s oa aa„ii to u °oviaie beds tarn sill who request ii hiille tu.uiridiin dliffding to ells for safety net. services as they ea ed. IIn additiion„ we have heard trornn certain fo undaboirns of tllneir intention to reduce iasu�lt to secure grad lin .�anwrne cases in funding � e given at a irate higher than they can sustain and imust, snow retu irra to a lower level of giving. 18. Project BeneficlariesiQuartifiable 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 sown 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. age A I 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 thnicity 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 Domest.io i/ideunoe 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 applicant please provide your best estimation. Race & Ethnicity Redwood City Po ulation p Redwood City % b Ethnicity y y Low Income by thnicity served b our P ram Your Program % by Ethnicity Total 74,40 100% 17 1000/0 White and not Hispanic 40,16561 54.64% C 0, °/ White and His anic 23,5571 31.66% 161 94.12% Asian 6,7151 9.03% A 0.00% African American 1,91 2.58% 01 0.00% Pacific Islander 6631 0.89% 0.00% Native American 0.52% 0 ®/ Other 1,511 2.03% 1 5.88 E South San I South San I Low income by I Your P� Race & Ethnicity Francisco Francisco % by Ethnicity served by Ethn citmy /° Pnnulatinn Fthnini4u hu umir Pre~ 11 http:Uwww.citydataservices.neV cities/ smatca/ app2016arc.pi?rpt= C4561&prop =11 417 1/2512016 City Data i i, b. Based on the r)ercentaecmlhatW,-Listr.K--ynuLp�oAox-s-aFizt that may be underserved by your program and the result cyf your efforts: CORA uses a range of outreach strategies to reach the diverse population of Sain Mateo County includfing distdbiAtng and/or displaying pamphlets/posters in public places such as bus stops, community centers, doctors," offices, courthouses, and legal aid agenc�es. COFRA's community education team conducts presentafions, workshops, and tables events fin a variety of community settings around the County. CORA's bilingual webske provides resources and contact. informaflon to its bilingual support groups and other programs. Concerning O;CDRA's fundraising efforts, the agency has added 1.5 FTE in the past year to now include a Director dn'ff Development and Communications, ns, Gr ruts & Contracts Officer, Grants & Contracts Writer, Development Officer, and Marketing Officer, and Database and Events Coordinator. Accordingly, teal dcnnn boi n income increased 07% 'fflrcurn $410,984.02 ,for F=°Y2014 to $688,278.54 for F'Y15. Seeds of Hope, ORA's annual taundraisurng event, netted $100,101 last ffiscall year compared to $89,670 in 2014, an increase of 88..2 %. We anficipate 'tthese trends to continue.. Position i IT Responsibilities Qualifications f i M 0 years of experience in doll"6net8 &a Director of Cod Ma nthorrne Support and oversite of management staff iio e nc y trai ned therapist, cdsis Prograrrs . rterverUon, staff tr i nirng and �rlNnsgCD rn Manager off 14 years of experience in socc M crisis iunteirverntidarn rnish Hughes uupport and oversite of sate house staff services; residential tre tern rnt, uupportive housing, supervisory Services / - - - - -- -- -- xrn rie nce rqt f i M / Y sun f rations ` .. ,. .. • „' Ai I Num f of f R Beneficiaries i. Cost per Individual rqt For the CL*! of Redwood Ci „ ..: 1. Funding Criteria: 2. (Homeless Assistance ct{vitfes, I= Irovisiion of fair housing counsel"rng services, provlision of legal intervention to prevent homelessness, Ilnrovlis'ion of operation funds for shared housing, emergency shelter and transitional housing and ire {sled service, for horn'neless and those at dsk of horrnelessiness, 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: . Flyers /brochures .e Website "•r Phone book listing CIP (Handbook/Database) Outreach presentations to service providers m ` 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 / brochurres and outreach presentations to service providers and the public are provided in both SpaNsh avid IEnngliish. "'IFhe presentations are provided iirn English or Spanish, depending on the needs of the group irequesting our presentation. c. How and where are the materials distributed? . 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 /1: In 03, Jasmine~' was referred to CORA by the rational Domestic Violence Hotline. She reported she left her abusive relationship with her g month old daughter, Rene *. This was the first tiime she attempted to leave and was very tearful of her partner locafing tier. 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 duce to orngoiing verbal and emotional abuse. the night she decided to (leave, her partner became physical and had kicked and slapped her multiple times. Law enforcern°nent had been 'involved inn the past, but Jasmine never pressed any charges out of fear. Her partner http.,/Mww.citydataservices.neVcities/Smatcatapp2Ol6arc.pl?rpt--C4561&prop=il I 0�4 would oftein threaten heir by saykig, "you lbetter not cdIi/yeU or you're dead". Her partner also had access to weapons and was affiliated with a gang which Fnade the threats very real arid paralyzed linear in a way. CORA's Cirsis Counselor understood the Ilevei of lethality invoNed in the case and conducted an assessment and cornpkted an intake for CORA's emergency safe house, Jasrrik-ie was provided support and connected to resources by the safe house staff for safe airrival iin Sain Mateo County. Jasmine was admMed Into the 8--week safe house prograirn where she and her daughter received addifioinM support and guidaince. * Names have been changed to rwiaiifftain coinfidenflafity, Attachments ;mf 1. Resolution authorizing application and designation of signatory, by the Board of Directors '� 2. Proof of 501(c)3 / tax-exempt status : 71; 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 501 c3letter. Naws, as, PLO-, N - RA 9-0-5—=O, A �Qin 02J Articles_of inco_%oration.pdf 5. Board �. BQQ_Mggba_&h�� 5. BOD Ter Lpt Offic -m of _gffig� 6. Organizational chart for entire organization 65- A Or g _- . COR_-, Chart 1-12-16-pdf 4� 7. Certified financial audit no more that I fiscal 7.-F-"-(-1-3---1-4-A-U-D-I-T-P-d-f 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. 4* 8. The following are required: • Current (FY15-16) Agency Operating Budget • Proposed (FY16-17) Agency Operating Budget B. Agency Budget 15-_16.pdf 8. _PrdLected_FY16-17 Agency Budget 12-15. Rdf 9. Mission Statement Mission atatementdocx 10. Non-discrimination policy for Staff and Clients Ngadiscnmination oofic .doc� 11. Reasonable Accommodations Policy for Staff Reasonable AccOmOdatiOn - Client, dOc and Clients Reasonable Accommodations - STAFF.docx -N'' 12. Conflict of Interest Policy. (if not available, Code of Conduct ®Conflict of Interest F9iq -hli ht doc please indicate when you will submit) 13. Other - DDwo dokd AljlAttach.ments Program Manager Signature Kate Wairath Date Signed 01/19/2016 Initially submitted: Jan 19, 2016 - 17:24:28 http:/Avww .city dataservices.neVcifies/Smatcalapp2Ol6arc.pl?rpt--C4561&prop=l 1 7/7 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 Training/Education $700 Staff Training $11,900 Registration Fees $8,300 Airfare $600 Lodging/Meals $2,650 Mileage $1,050 Parking/Transportation $300 Other Staff Training $0 Total Staff Training T1-2,800 Volunteer Training $700 Other Training $11,900 Materials $4,700 Train ing/Education $30,100 Meals and Entertainment Client Meals $800 Other L9,200 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 $0- 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 $5,90-0 Program Supplies Basic Needs $11,200 Children's Supplies $1,300 Other Program Supplies -.$3,300 $15,800 Bank Charges $4,000 Insurance $22,000 Taxes Sewer Assessment $4,000 Taxes $4,60-0 Interest Expense Mortgage Interest $62,400 Credit Line Interest $10,000 Other Interest 12,000 Interest Expense $74,400 Dues and Subscriptions $1111000 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) w Agency Operating • • R 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 Redvmod 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 N,. �- Agency i « -g Budget-Detai Fiscal Year 2r 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 $181800 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 $5,000 Program Supplies Basic Needs $16,200 Children's Supplies $1,300 Other $3,300 Agency 4 erating Budget-De Fiscal Year 1.' 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 574,400 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 FrancisT 4 •i f ! • •,: f 4 !: Application for New Funding for FY 2016-V CE14ERAL INFORMATION 1. Organization Name: Hurnan Investment Project (HII:� Housing) 2. Project Title: Horne Sharing Program are applying for fu.undu"ng Redwood Citv e City b `;t M7 ! m . `! 4 Amilimm, M .4l.. ! '^ f ' 4 `4 f w °' South San Francisco e County of San Mateo -. . udget, .- n of Served Total II f Per CDBG 'l_ i 'v li i ill - How are you serving low income populations? Service to low income clients verified through income documentation. 3. Project : 364 South railroad Avenue City: San Mateo Zip: 94401.4024 4. Provide a one sentence project The Home Sharing program interviews and screens ns clients for housing, provides housemate, altemative housing, and community resources to clients with the potential of matching persons in affordable home sharing arrangements. Organization 364 South Railroad Aven Address: Organization Ph Type of f + • 5. Contact Per Project Administrator: Contact Email: 1fanucchi@hiphousing, org 6. Name of Director: . Fiscal r: : Norma Cuiroz Fiscal Officer 364 South Railroad Avenue Address: Signatory: 8. Authorized ame: Kate Coir�rofod: Harr Authorized 364 South Il::Wlroad Avenue City: San Mateo Zip: 94401 -4024 Website: http://www.,hiphousing.,or,g/ Title: Associate Director Telephone: 650- 343 -6660 Fax. City: San Mateo Zip: 94401 -4024 httpJAwAq.citydataservices.nL,Vdties/smatcalapp2Oi6arc.pl?rpt=C4573&prop=12 1/ rr 470 Ti.0 T.71 , , - City Data Services - South San Francisco 9. Ease provide days and hours of regularly scheduled operation: M. -F 8:30 AIM •- 5:00 PIM Federal % DUNS Number: 120811997 Number: ♦ r 05 - Public Services 12. Project Specific Nlarmtive: 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. Idy utilizing existing housing, the Home sharing Program finds affordable housing for low- income residents, and provides a realliistic 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 cllient'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 ague 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 i : Briefly describe how you determined the need for your program kLftAgft1RMft jurisdiction at you are aoolyin for rids. Identify target population(s) and area(s) served. Please state the sou (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 451Xn at residents spend more than 30% of their income toward housing. Bearing the brunt of this situation are some of the most vulnerabie members of our communities: seniors living on a fixed income, persons with disabilities, single parent families, and those with special needs.. 13B. Assessment of Need - City of San Mateo: Briefly describe how you determined the need for your program _ r each oci c jurisdiction t you oil trig for rids 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 401X, of uresidents spend more than 30% of their income toward housing. Bearing the brunt of this situation are scrrne: of the most vulnerable members of our communities: seniors living on a fixed income, (persons with disabilities, singlle 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 frorn their place of employment, as well as family, friends and critical support networks. (Rental rates in Silicon Valley have increased by 8.7 %. Louring the same time period, median incomes have increased by 3,6 %. The rate of rent in r ase is not being offset by U e, rate of income increase. 40% of Silicon Valley residents are burdened by their rent, This hftplANww.citydataservices.neVcifies/smatcalapp2Ol6arc.pl?rpt--C4573&prop=12 218 1/25W16 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 Wcon Valley young adults (ages 18-34) five 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. 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 Snarling Program is evaluated based on the following criteria; 16. Collaboration: 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: I. Community centers: refer clients for rental assistance, shelter referral and basic human needs. interview c1fients at the Dally City Community Center, SSF Senior Center and at the IFair Oaks Community Center, http:/Avww.citydataservices.neUcities/Smatcalapp2Ol6arc.pl?rpt--C4573&prop= 12 3/8 2. innVision /Shelter Network: conduct presentations to shelter residents about IHome sharing as requested 3. safe (Harbor shelter: conduct Ipresentafiions to shelter residents about Home sharing as requested 4. Rebuilding 'Together Peninsula (RTIP): refers horneowners to the Home ?haring program and often relhoabillitates property in order to make it more feas'ibie to rent out to a home sharer. 5. .smchousingseairch.org: i-llP Housing posts acf'ive rooms for rent on this site weeMy 6. star Vista: work closely with staff to help piace emancipated foster youth in home sharing arrangements. 7.. San Mateo County (Housing Authority: refers Moving To Work recipients to the Home sharing prograrn to locate a room to rent with their housing voucher.. 3. Other organizations we refer clients to include: Aging and Adult Services; County Mental iHeaith; Dental iHeaith Access Team; Oasis; COR& Peninsula Works; Center for the independence of the Disabled; Legal Aid; Peninsulla Family Service; PCRC; senior Centers; Can Mateo County (Housing Authority; United Way's 211; JobTrain; Veterans programs 1111�111 11111111111111111111 1111111 111111111111111111111111 1111111piIII111 'III iiiiiiiiiiij III III .... Populations program. ,. are not considered "presumed benefit" by HUD, and require income vedfication. Persons exiting incarceration Low-income youth Other homeless persons 20. Affirmative Outreach: . 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 eoplicant please orovide vour best estimation. Redwood City Redwood City Income by Your P ram % Race Ethnicity Population % by Ethnicity Ethnicity served by Ethnicity 1hu V^'ar 13 nmm :/ .cityd ervi .net/cities /smatcala 16arc.pl?rpR =C 12 httP 4/$ 1/2512016 City Data • t that may be underserved by your program and the result of your efforts: Four of the staff who work on the 1--lome Sharing Program are bifinguaI in Spanish, Other staff at HIP Housing are a�so bilinguai in TagMog, Cantonese, Mandarin, and German. Outreach materialls are transiated into Spanish, Tagaiog, and Cantonese., I °IIIP Housing also conducts a variety of outreach activities to reach out to different ethnic groups. Staff partiicipates in committees such as the African American Health Ilnitiative; CoasWde Collaborative; Daly City Peninsula Partnership, Redwood City interagency Forum; blousing Operations and Pollicy Committee. Networking events are also attended throughout the year including resource events through AI..I..IICF (Alliance for Community Empowerment), department of Rehabilitation Spanish resource fail ; Sane Sana Cofita de IRana resource fair; Commission on Disabilities resource fair; Forth 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, 4. 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 Horne Sharing Program is the only home sharing program offered in San Mateo County, is one of the iargest programs in the US, and one of the few sources of read'uly 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. •l1,7 •, ,f u ^ •.- Person Job Job Responsibilities Coordinates forth County home baring activities as weill as wonting hidey Fob with other county residents, provides counseling for r. heats and inducts outreach for North San I I IMatei County. :/ .cityd ervi citi /s ca/ 01 c. ?r -05 12 has twelve years of experience g home sharing matches, has a degree ology with an emphasis in li..aw and V from UC Davis and a Masters in Work from San Francisco State M 1/2&2016 City Data Services - South San Francisco �IOSED PROGRAM BUDGET FOR FY 201647 For the City of Redwood City ONLY, answer the following: For the City of Redwood City ONLY, answer the following: 1. Funding Criteria: I. Affordable Housing: Acquisition of sites for affordablle housing, new construction of affordable housing, conversion of existing housing to affordable, acquisition and rehabilitation of rental housing (includes special needs housing), 2. MarketinglAdvert 'sin g a. Check all of the following methods your agency utilizes to promote and advertise your programs and services: Flyers/brochures Website Phone book listing CIP (Handbook/Database) 10' 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:/hvww.citydataservices.neUcites/Smatcalapp2Ol6arc.pl?rpt--C4573&prop= 12 618 TV appearances. . Program Outcomes: a. Please describe the accomplishments of program goals for F/1. IDuring the grant period, (Horne Sharing staff continued to prevent homelessness, processing 3,560 calls from individuals inquiring about IHiIP Housing's programs. IFach caller received vital housing information and resources that matched their specific needs. Of these individuals, 2,036 were interviewed and screened by program staff, receiving referrals to potential hoirne sharing placements as they became available.. Program staff placed 240 individuals in new affordable home shading arrangements, while maintaining 45'7 clients Sir Horne Sharing matches made in previous years, Housing costs for home providers before home shading 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 16 presentations, attended 11 Resource / (-Health Fairs, while continuing to grow our social media presence. With your heap, these individuais 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. 6. Organizational 2016 -1' IHIPYHousin Or Chartdf chart for entire organization 11� 7. Certified financial PIIP Inc. Fnna0cial Statem nts and Inge en nt Auditor lie rt I None 30 2014.. df audit no more that 1 fiscal year old, prepared by a CPA, and: httpJ/www.citydataservic .ret/citi /smatca/ 2016arc.pi?rpt -C45 op=12 7/ Mflwifl# U. 8. The following are required: Inkidy submitted: Jan 20, 2016 - 17:04:53 tittp:/Avww.citydataservices.reVcifies/Smatcalapp2Ol6arc,pi?rpt-- C4573&prop= 12 8/8 Projected Program u et Projected Budget HIP HOUSING APPROVED BUDGET FOR 20154016 APPROVED BY THE BOD ON JUNE 16.2015 H12014- 613012015 HS Approved ° Budget; 201512016+ SSP Approved Budget 2015/2016 4General Approved Budget Z01b1Y016, Fundraising Approved budget 201512016 Total Prog►ams t BG� "et In e: San Mateo County CDBG Cities within the County vial events Fundraising, Grants Contribution Indivivals Management Fess & developer fees Support from Affiliates Other Misc Income Total Income $ 57 083 373,250 76,500 15,395 328,315 850 523 47.081 20,595 94,000 234,169 $395 845 135 000 14,500 20,000 113,257 15,831 5,162 303 750 89,905 126 000 120,000 22,080 $357 985 $ 57,063 555,331 125,000 296,500 140,000 128,652 250,000 355 557 $1.908.1031 x sea Direct cost Salaries - Direct Payroll Taxes & Benefits - Direct Total Direct Salary & Benefits $418,170. $117,508 535 678 $ 161,528 37,210 $198 788 33.670 6,610 $40 280 $ 179,049 19,265 $198314 $792,417 $180593 973 010 Salaries - Indirect Payroll Taxes & Benefits - Indirect Total Administration $ 71,673 $ 30,259 101 932 $ 99,280 26,064 $125 344 $ 80,694 26,126 $106 820 $ 19,447 5,537 24 984 $ 271,094 $ 87.986 ADMINISTRATION q Program Service Ex enses: Bonus Office Supplies Rent - Office Calendar expenses Audit Expense Accounting & Bookkeeping Automobile Expense Telephone Office Equipment Bank Service Charges Training professional Fees Printing/Copying/Reproduction Dues and Subscriptions Postage and Delivery Computer Expense Office Expenses Adv./Promo/Mktg. Communications Office Maintenance/Janitor /Garb Gas & Electric Property & Uability Insurance Hop Workshop expenses Miscellaneous S al 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 2,676 8,174 2,483 1.674 2,8361 3,870 1,565 2,014 113,568 $212913 1350 1 707 22,790 2,919 991 1,286 1,415 2,906 1,872 1,950 1,652 4,172 964 1 695 5,177 1,572 1,060 1,796 2,451 991 9,773 1,275 $71753 2250 359 6,890 514 209 270 298 612 397 4,500 348 878 202 357 11090, 331 223 7,260 378 515 209 4,769 98,517 $131476: 1350 1,438 31,810 9,000 2,458 1.680 1,083 1,192 2,448 1,574 1,660 1,391 3,513 812 1,427 4 359 1,324 893 1,512 2,064 835 1,074 60,000 134 687 6,200 95,740 9,000 10.600 3.6-0-0- 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 27 ,576 357,9 5 ,882,929 OI 0 25,174 0 5,174 Projected Program Budget Projected Budget HIP MOUSING PROJECTED BUDGET FOR 2016.2017 1112016- 613012017 HS Approved Budget 201612017 SSP 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 Cafes 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 Fess & 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 1 365,205 Total Income 881,949.15 410,251.18 321 136.00 389 718.94 1 983,051.67 Ex nses: Direct Cost Salaries - Direct $ 430,715 $ 166,374, $ 34.680 $ 184,420, $ 816,190 Payroll Taxes & Benefits - Direct 125,734 39,815 7,073 20,614 193 235 Total Direct Salary & Benefits $ 556 206189 $ 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 592S 94,145 Total Adminlstratlon 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 8361 3,605 Postage and Delivery 2,756 1,746 368 1,4701 6,340 Computer Expense 8,419 5 332 1,123 4,4901 19,364 Office Expenses 2,567 1,619 341 1,364 5,881 AdvJPromo/Mkt . 1,724 1,092 230 920 3,966 Communications 7,478 7,478- Office 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 Fremont & Measure"A" 116,975 116 875 Mana ementfees 101473 E728 101,473 Total Program Services 219,300 73,916 135,4 0 1 7,364 Total Expenses $81,949 410,21111 T 286,243 3 1,950, 60 I 0 ,8 2 0 32, 1/2&2016 City Data Services - SotAh San Francisin GENERAL INFORMATION 1. Organizaton Name: John Papan Memorial 2. Project Title: Johns C�Ospt are applylrig for fundingfrom., Redwood City L City of San Mateo �e South San Francisco IWAIMAIM-11MMI Propose e # i ;�e rvd o � �W L0 E Grant Funded Pro rams: We are applying for a Public Services Program 3. Project Address: 444 F. IMarket St., Rm. 2 City: Dally City Zip: 94014-2101 Type of Applicant Non-Profit Our agency serves: S. Contact Person I Project Name: Diane and Gina Papaw Title: director Telephone: 650-871...7440 Administrator: Contact Email: dianepapan@grnNLcom Fax: 6. Name of Agency Diane and Gna Papan Director: 8. Authorized Email: Signatory: Name: [Nane Palpan diianepapan@grruail,comTelephone: 650-871-7440 http://www.citydataservices.roYcities/smatca/aM2Ol6arc.pl?rpt--C4598&prop=77 1/4 Gtr' =I. Authorized Signatory 440 Green KIII]s I 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. =.. 05D - Youth Services proposed project. John's Closet receives referrals from the schools, San Mateo County Health and Hurnan Services Agency, Headstart, Shelter Network, Edgewood, Kinship Program, and various family resource centers., % W, , - .. - I 1 141 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. t_t Persons exiting incarceration Low-income youth Other 20. Mr7native Outmch: a. Use the demooraDhics from vourgMX'QULQMqMny v vAlm b. Based on the Wrcentages that you indicate your that may be underserved by your program and the result of your efforts: The vast maiont"the dfients we serve are Hisnanic.. A iiii Willi WIWIiWWA6""iW 21. Levemging: 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 Mset aEpfies for CDBG -funds -from Daly City and South San Franc�sco. We also alonl1v fm' P, 2; • 16 A#M1,110 Ci http:/Mww.citydataservices.reVcifies/Smatcalapp2Ol6arc.pl?rpt--C4&qB&prop=77 9M, 1/25/2016 City Data Services - South San Francisco Administration 0% TOTA $5522A100 100 /® $55, 00 9®/� $5, 0 9% $5, Number of Individual Beneficiaries __ 1 10 .A- Cost r Individual :r $50e0 0 Attachments `g" 1. Resolution authorizing application and designation of signatory, by the Board of Directors U 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 CDBC Attachment 1 odf Johns Closet Articles of lnc.pdf Johns Closet ,. Attachment 5-6.pdf ✓I 6. Organizational chart for entire organization Johns Closet CDBC Attachment df 7. Certified financial audit no more that 1 fiscal Johns CI et NSF CDBC A At #achrnent 7 -8 2016 df 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 'O! 9. Mission Statement ,f. 10. Non - discrimination policy for Staff and Clients 11. Reasonable Accommodations Policy for Staff and Clients d, 12. Conflict of Interest Policy. Of not availabie, 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 � � f Johns Closet Conflict of Interest Policy odf p:/ .cityd ervi cities /Smatcal 01 e.pl?r -C4 77 414 JOHN'S CLOSET STATENWAIC, * P ,F 1-01-2015 TO 12-31-2015 Cash balance: 12/31/2014 Donations in Kind: 171 Presyterian Women 50 Handmade Seaters 100 pairs of new socks Total Donations in Kind: EXPENDITURES: Clothing Loan to John Papan Memorial Fund Cash Balance: 12/31/2015 $5,000.00 $5,000.00 $200.00 $980.00 $1,109.00 $4,750.00 $200.00 $500.00 Total: $38,739.00 $ 38,739.00 $ 97,954.94 $6.83 $ 6.83 $10,000.00 $300.00 10-0-00 Total: $10,400.00 EMEM ($ a 500.00 ($19,791.78) 9IM91-78J j$ 7 8,169.99 . Poon,fvonne z �111111 Diane Papan <dianepapan@gmail.com> aent: Monday, February 01, 2016 1:15 FM To: n, 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 coming year. i . ums� 0 �� iFz�l Fax: 650-875-7743 Email: ! ( # �ail.cq �m 440 Green Hills Drive, Millbrae, CA 94031t, lismy 7s irnmeTiamy Dy relepnone, ret this transmission, and delete or destroy any copies (digital or paper). Thank you. I Feb 1, 2016 at 1:04 PM, Poon, Yvonne <Yvonne.Poon@,ssf et> wrot- ___..,n S 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 low how I can be of assistance. 1/25/2016 City Data Services - South San Francisco Jig- I Irol Application for New Funding for FY 2016-17 29HER&LIUMMAIM 1. Organization Name: Legal Aid Society of San Mateo County 2. Project Tide: 11--iomeSavers: Preserving AffoirdaWe Housing iin our Community are allippillyfingfi-W fuindfing from: t' Redwood City ** Citv of San ffi I * IT 11.1 IIIIIIINUMITIM ELI= nqm- Grant Funded Progirgmy We are applying for a Pubilc Services Program ",* South San Francisco v'� fl 1i « f-R*S CDBG Na'al DW2gfixLEfigIhill - How are you serving low income populations? Service to low income clients verified through income documentation, 3. Project Address: 330 I'win Dolphin Drive, City: Redwood City Zip: 94065-1455 Suite 123 4. Provide a one sentence project summary: Legall assistance to people threatened with losing their homes or living in substandard conditions with the goals of keeping peopie in their hrxnes; preventing homelessness through the enforcement of iegai rights, in and out of court; and remedying substandard living conditions through advocacy, Organization Address- 330 I'win Dolphin Drive, City: Redwood City Zip: 94065-1455 Suite 123 Organization Phone: 650-558-0915 Website: hftp://www.legalaidsmc.org/ Type of Applicant Non-Profit Our agency serves: S. Contact Person I Name: Shirley G ;�hson Title: Directing Attorney Telephone: 650-517 8911 Project Administrator: Contact Email: SGibsor)@Iegalaidsrnc.orqFax: 650-517-8973 6. Name of Agency M. Stacey Hawver Director: 7. Fiscal Officer: Name: Susan Stortini Email: Telephone: 650-517-8913 SStortini@WgWaidsmc.org Fiscal Officer Address: 330 Twin Dolphin Drive, City: Redwood City Zip: 94065 Suite 123 idp:lAwAv.c'itydataservices.neVc'iteslsmatcalapp2Ol6arc.pl?rpt--C4768&prop=542 11F O« 8. Authorized Signatory:Name: M. Stacey I- iauwverEmail: Telephone: 650 - •517-8917 mshawver@Wgalaildsmc.org Authorized i n tory 330 Twin Dolphin Drive, City: Redwood City Zip: 94065 Address: Suite 123 9. Please provide and of ul rl scheduled o ton: The Legal Aid Society office is open from 9:00 a.m. to 12:00 noon, and ffrorn 1:00 p.m.. to 5:00 p.m., Monday through f"riday (except Ilegall holidays). Client intakes at off-site legall clinics occur on the following days and tiirnes: Mondays, 8:30 a.m. to 11:30 a.m.; Tuesdays, 1 :00 p.m. to 4:00 p.irn.; and l:`ridays, 9:00 a.m. to 12:00 noon. 10. DUNS Number: 0342377270000 Federal EINiTIN Number: 94•.1451694 05C - Lega� Services The evolution of legal protections for mobile home residents with recent amendments to the county mobile home rent ordinance vrill 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. httpJMww.citydataservices.rL,Vcites/smatcalapp2Ol6arc.pl?rpt--C4768&prop=542 2(7 4 t It is important to note that not all tenants who are evicted have fallen behind in rent payments or viollated their rental agreements.. (Forced moves can be caused by a nurnber of factors including landllord forecllosure, tenant4andlord disputes, and other external factors unrelated to tenant behavior. In San IMateo County, it is not uncommon for a change in ownership or property upgrades to result in no -fault evictions of tenants, sometimes d'uspllacing entire buildings. 14. Ti lin : Provide a brief timetable for pmject implementation and achievement of pmjected goals and how you plan to expend your funds in a timely manner by the end of the fiscal year. Legal Aid allready hosts three weekly housing clinics which are a well - (known point of service for Ilow income tenants in the county. Legal Aid can begin utilizing CDBG and HSFA funds iimmediatelly 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 IF1f1 -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. b. Indicate the total number of beneficiaries you expect to serve with this program in each jurisdiction - regardless of income. httPJhvww.c7itydataservices.neUc'ifies/smatcalapp2Ol6arc.pl?rpt--C4768&prop=542 M Staff List List below k2y staff me bars who work on is r1roaram Position Title Name of Staff n Perso Job Responsibilities Oversee project; provide Directing Attorney Shirley Gibson direct legal services to —1)2ou= 4 clients. Director of Litigation David Carducc'l Provide direct legal servic to housin clients Screen clients, complete Wake Coordinator Aleli Caballero intakes, provide bilingual support to Shirley and PROPOSED PROGRAM BUDGET FOR FY 2016-17 3er or me Uahrorma bitate Bar (15 ); Directing Attorney at Legal Aid (4 r of the California State Bar 20 vears' civil fitiaafian Pxm ilegal Certificate; bilingual in Spanish English; 5 years' experience at Legal as Housing Wake Coordinator 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. MarketinglAdvertising a. Check all of the followina methods our Ilia a .e Flyers/brochures .,e Website http://www.dtydataservices.noYcites/smatcalapp2Ol6arc.pl?rpt=C4768&prop=542 5f7 1/2512016 City Data Services - S San Francisco .e Phone book listing CIP (Handbook/Database) .je Outreach presentations to service providers le- Outreach presentations to public 5-1111 11 g-ffiatenafs ate avaiffib-Fe-fff— rm they available in? muffI--Fa—ng-u-aI-f0 and which languages are Flyers/brochures (Spanish); website (Spanish); outreach presentations (Spanish) M51.114=1 6171717-7777-y Name, Company, Years on Board Meeting dates for previous 12 months Number of years allowed for each board term ,e 6. Organizational chart for entire organization 4 7. Certified financial audit no more that 1 fiscal year old, prepared by a CPA, and: Legal Aid -9219� Letter. df Le al Aid Byl_ars.� Le al Arid Articles ofi Incorporation. df �e al Aid Board f httpJANww.c7itydataservices.neUcifieslsmatcalapp2Ol6arc.pl?rpt--C4768&prop=542 W VYkW1K#1 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) 13. Other - Download All Attachments Program Manager Signature M. Stacey Hawver Date Signed 01/22/2016 Inkialy submitted: Jan 22, 2016 - 15:19:35 http:lhvww.citydatoservices.nL-Vcifieslsmatcalapp2Ol6arc.pl?rpt--C4768&prop=542 77 4/1/2015 LEGAL AID SOCIETY OF SAN MATEO COUNTY $2,357,067 EXPENSES Salaries Budget REVENUES FY 2015 Private Foundations $533,067 Government Contracts & Grants $604,484 Corporate & Law Firm $135,300 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 FY 2017 (April 1, 2016 - March 31,2017" Salaries Budget REVENUES FY 2017 Private Foundations $627,765 Government Contracts & Grants $692,366 Corporate & Law Firm $101,0 Foundations $193,000 Events $585,000 Annual Campaign $230,000 Investment Income & Other $164,000 $2,492,131 Salaries $1,576,96 Benefits $477,00 Occupancy $69,1 Operating Expenses $181,0 Contract Services $101,0 Fundraising Expenses $87,01, $2,492,1 1j] U25/2016 City Data Services - SmM San Francisin Application for New Funding for FY 2016-17 1. Organization iUme: Peninsula Associaflon for Retarded ChMiren and Adullts (Parca) 2. Prolect Title: Famfly Support Services g Prom: are applying r Redwood City City of San Mateo 10� South San Francisco t ' Countv of San Mfivrr.91r-"�.w I aIed -h-Orn Bud et, belowl _g WME-7- =M I i { 1191 IF 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 BIL, Suite 320 City: Burlingame Zip: 94010-1919 4L Provide a one sentence project summary: Parca's I amily Support Services program provides support groups, information and refs I, comirnunrty outreach, advocacy, a professional speaker series, and inclusive recreation opportunities to low-4ncome 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. firganization Address: 800 Airport BL, Suite 3 #rganization Phone: 650-312-0730 5. Contact Person / Project Name: Beth Brown AdmiTilstrator: 3HHME=1 Name: Brad Pence 800 Airport BL, Suite 320 ,kq 800 Airport BL, Suite 320 City: Burlingame Zip: 94010-1919 Website: www.pairca.org Title: Development Telephone: 650-312-0730 Officer Fax: 650-312., 0737 Email: Telephone: 650-3120-730 bradp@1parca,org City: Burlingame Zip: 94010-1919 Email: �relephone- 650-312-0730 dianac@parca.org City: Burlingame Zip: 94010 1919 hftp:/hvww,citydataservices.roUcites/Smatca/app2Ol6arc.pl?rpt--C4754&prop=535 1/5 Monday through Friday, 9 arn to 5 pirn City Data Services - South San Francisco 10. DUNS Number: 020009510 Federal EINMN Number: 94-165083 11. HUD Activity: Choose the HUD activity that most closely matches your service: 05 - Public Services i:larca 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 inumber of people affected is 14% of any population; therefore 9,381 South San Franciscans are affected by one or moire developmental disaUhties. This number is rapidly growing as autisirn cases are as high as 1 in 68 (CDC)., These families need continuous, ongoing, comprehensive supports., Parca provides vftW services and supports free of charge, which are critical to the low-income SSF clients we serve., Family Support serves San Mateo County. One sirnilar 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. FaM 4 u rt SerAces is an oing0mg ear-round iprouram.. Goals stated above wii I be achieved in fl-nnn Nil nrnin IM, I the client and his or her family does inot express sabs-faction with the services they have received, changes are made to ensure the attainment of desired results. • . • . . . • I Kz -troposed project. Community Gatepath, Hope Services, Kainos, The ARC, Life Steps, Jainet Pomeroy Center, Square Peg, Skyline College, Figs Five, Legal Aid, CCS, SMCOIE, 11 ucile Packard CNldren's Hospital, County Office of Housing, County Behav�orall 1--lealth, Count] Office of Transportation, School Districts, Resource Centers, Samaritan House, Kaiser-Permanente E 337W =01 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 wodd enable us to confinue to meet the needs or families coming to Pairca for assistance in dealing with the challenges posed by developmental disabilities. http:lhvww.citydataservices.neVcifieslsmatealapp2Ol6arc.pl?rpt--C4754&prop=535 215 ilt According to a CDC study, develop mental diisabiliities (DDs) are common about 1 in 6 chRdr n in the U.S. had a DD in 2063„ These data also showed that prevalence of parent- repaorted DDs has increased 17.1% from 1997 to 2008. This study underscores the increasing rueed for health, education and social services, and irnore specialized health services for people with lwDDs. The prevalence of any DD in 19972008 was 13.67% alPirevalenc:e of learning diisahilities was 7.66 %; - Prevalence of attention deficit hyperactivity disorder (ADIHD) was 6.69%; - Prevalence of otheir develop mental delay was 3.65%; and, - Prevalence of autism was 0.47%. Over the last 12 years:: - Prevaier'ce of DDs has increased 17..1% that's about 1.,8 million moire children with DIDs in 20 06-2008 compared to a decade earlier; -Prevalence of autism increased 269.5 %; -Prevalence of ADHIICD increased 310 %; and, -Prevalence of hearing loss decreased 30.9%. To getter understand why the prevalence has increased, future research shouuld focus on understanding the influence of increases in the prevalence of known risk factors, changes in acceptance and awareness of coradiitions, and benefits of early intervention services. Persons A 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. • incarceration Low-income Other peop�e with developmental disabilities and their family members 1 Affirmative Outreach: Ayr. gkicrogm 711, 7 a .cityd ervi citi /satca/ 1 c.pl ?r —C47 KU 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 ethiruic groups at our parent support group. parents and some 11 =�arca staff have volunteered to act as translators for other pairents in Span sh, 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. t"arca derives revenue for, this pro irairn and for the agency through grants, iindiividival donations, special events (proceeds and sallvage resale„ Grant funds received to date for the If arnHy Support Services program for i:::Y201 5 -2016 total $10,000. Staff List List below kev staff members who work on this urooran Position Title Name of Staff Job Qualifications South San Francisco Person Responsibilities Agen Pgm P Togtalm Oversees all 19 years in position at Parcad BA Notre Dame de Director Sue Digre aspects of Namur; professional educator; well-known and • Meeting dates for previous 12 months Family Support highly- respected authority on developmental 6. Organizational chart for entire organization Personnel 1 Services ro ram isabiRies; tireless advocate PROPOSED PROGRAM 'BUDGET FOR FY 2016 -17 Attachments ?, 1. Resolution authorizing application and designation of signatory, by the city of ss r 1 -16 f South San Francisco Total Jurisdictions Budget Line Item Agen Pgm P Togtalm % Requested Pgm% Requested Labor • 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 Personnel 1 $1,330,32 40/6 $61,19 8%1 $4,7001 8%1 $4,70C Taxes/Benefits 1 $236,07 22%1 $4,21 J 100%1 that agency does not receive more than $500,000 in federal funds and is 0% http : /hnrww.citydataservices.neV cities/ smatca /app2Ol6arc.pi ?rpt= C4754&prop =535 Supplies Office u lies /Room Rental 9,14 $1,90 $1,90 $1,90 Operations/Maintenance $856,981 $ $ Administration $125,17 7% $9,32 0% 0% TOTAL $2,607,19-741 % $75, 52 9% $6,50 9%1 $6,50 Number of Individual Beneficiaries 124 12 Cost per Individual 1 $50.781 $50. Attachments ?, 1. Resolution authorizing application and designation of signatory, by the city of ss r 1 -16 f Board of Directors 2. Proof of 501(c)3 / tax - exempt status 501Q. f rf: 3. By-laws _ vlaws AZALc W 4. Articles of Incorporation art of inc_1-12.pdf 5. Board roster, including: boar ilst f 15-1 • 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 or chart 2016,0 7. Certified financial audit no more that 1 fiscal year old, prepared by a CPA, 13 -14 audited inl stmt f 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 : /hnrww.citydataservices.neV cities/ smatca /app2Ol6arc.pi ?rpt= C4754&prop =535 M Inkially submitted: Jan 21, 2016 - 11:37:16 hftp:IA%m.citydataservices.rL-Vcitieslsmatcalapp2Ol6arc.pi?rpt--C4754&prop=535 5/5 '*ARCA BUDGET >s � 9. Counselor wage& raic from 0 to $15.00 per . ' 2015. Manager salaries remain unchanged from last year. Executive Assistant salary removed. Auxiliary $ 160,000 Family Support $ 10,000 s I Memorials ® i Clues & Counties $ 6,500 Foundations , Cedar SL m Page Mill GRANTS FOR OPERATING ILb GRANTS ALLOCATED TO PROGRAMS o and an Increase of $25,000 expected Foundation donations. S. Cedar Street Is budgeted for ar clients for 12 months. Manager no ., In staff o atio to reduce Staff 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 am Included In budget. 7. Respits tervice revenues are projected based on actuals. Foundation grants are budgeted 500 which Is $2,500 more then last year. Fleninsula AssoclaWnfor Retarded C11hildren & Adults !Profit & Loss Budget Overview Alameda. HOUS8 July 2015 through June 2016 0.00 5401 . Grants Jul '15 -June 16 Income O.DO MO . Earned Income 0.00 5100 - Solicitations Revous 0.00 5200 - Regional Centers 0.00 5201 GGRC 26,700.00 5202 East Bay regional 0.00 5203 San Andrew 0.00 6204 Sacramento 0.00 5205 Kom 0.00 5300 - Special Events 0.00 5311 - Annual Dinner 0.00 5300. Special Events - her 0.00 Total IUMD . Special 0.00 5400 • Contibuted Income 6317 • Festa Revenue 0.00 5401 . Grants 0.00 5405 - Foundations O.DO 5406 - Corporate 0.00 5401 . Grants - her OMO Total 6401 - Grants 0.00 5402 - Indivdual Donations 0.00 5403 • Trust/Endowment 0.00 5404 - Auto Donations O.W 5408 ClubafOrganizations 0.00 5606 Government 5610 . State Government 5611 . RHCP Subsidies 0.00 5612 - CDE 0.00 Total 56110 - State Government 0.00 5616 - Local Government 0.00 Total 56►6 - Government 0.00 5740 - Memorials 0.00 Total 5400 - Contibuted Income 0.00 Total Income 98,547.20 Profit & Loss Budget Overview Alameda House July 2015 through June 2016 9E3K07M=_ 7121 . Payroll Expenses-FICA 4,190.90 7122 - Unemployment Insurance 600.00 7120 - Payroll Taxes - Other 0.00 Total 7120 - Payroll Taxes 4,690.90 7160 ° Depreciation w�_-AMEFNN Jul Is -June is 7111 - Sallaries-AdIrnin 0.00 7112 - Salades-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 126 Reimb 0.00 7117 - Aillocated Admin Salaries 8,202.88 7132 - Benefits 0.00 Total 71io -Salaries 62,985.88 9E3K07M=_ 7121 . Payroll Expenses-FICA 4,190.90 7122 - Unemployment Insurance 600.00 7120 - Payroll Taxes - Other 0.00 Total 7120 - Payroll Taxes 4,690.90 7160 ° Depreciation 37,650.88 7250 - Equipment Rental I Loan 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 2,056.00 7268 - Directors & Ofters 165.00 Tota17260. 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 7306 - 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 • Total 7300 - Maintenance & Repairs 9,360.00 7315 • Miscellaneous Expenses 0.00 7340 - Office SuPPII98 120.00 7300 - Postage 0.00 7380 - Printing Peninsula Association -for Retarded Children & Adulti- Profit & Loss Budget Overview Alameda, IHouse July 2015 through June 2016 7400 . Professional Contractual Jul 15 -June 16 7381 - Newsletter 0.00 7382 - Business Cards 0.00 7383 - or Hangers 0.00 7384 - Stationary 0.00 7385 ® Other Printing 0.00 Total 7360 - Printing 0.00 7400 . Professional Contractual 480.00 7401 • Accounting 5,300.00 7402 - Audit 7,500.00 7403 - Behavioral 0.00 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 - Professiona10 1 12,800.00 7422 - Program Food 480.00 7423 - Client Recreation 120.00 7424, Program Supplies 1,200.00 7426 - 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 7481 - Management Pan 0.00 7462 - Bank Service Fees 0.00 7465 - Physical Fees 0.00 7466 - Real Estate Taxes 0.00 7467 - Dues 0.00 74118 • License Fan 0.00 7470 - Frin g Few 0.00 Total 7460 - Taxes, Licenses IL Fen 0.00 7480 . Telephone 6W.00 7500 - Tmvel & 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 Comb (Company) 0.00 7600 - Bridge Tolls 0.00 7600 - Utille" 7601 • Electric 2,160.00 7 602 - Gas 780.00 Peninsula l stl for Retarded Children & Aduft Profit & Loss Budget Overview Alameda House July 2015 through June 2016 7603 Trash Removal 7604 7605 - Sewer 7610 Operating Expense Total 1,880.00 2,760.00 360.00 0.00 170,241.11 - 71,693,91 Peninsula Assoclaflon for Retarded ChIlldren & Adults Profit & Loss Budget Overview Cedar St July 2015 through June 2016 0.00 65`12 - Client Revenue-Cartilled Jul '14 -June 1Am 15514 - Client Revenue-Full Foe 0.00 Income 0.00 5000 . Earned Income 0.00 6100 - Solicitations Revaus 0.00 6200 . Regional Conters 158.280.00 6201 GGRC 0.00 5202 East Bay regional 0.00 6203 Son Andress; 0.00 5204 Sacramento 0.00 5206 Keni 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 9,3,288.00 5503 - HUD Tenant Assistance Payments 0.00 65`12 - Client Revenue-Cartilled 0100 15514 - Client Revenue-Full Foe 0.00 Sal 6 - Self Pay 0.00 6770 - Management Fee 0.00 Total 5000 - Earned Income 254,568.00 5400 - ConUbutBd Income 0.00 5317 • Fests Revenue 0.00 1° Grants 0.00 5405 • Foundations 20,000.00 5406 Corporate 0.00 5401 - Grants - her 93,725.00 Total 5401 • Grants 113,725.00 5402 • lndiwdual Donations 0.00 5403 - TrustlEndowment 0.00 5404 - Auto Donations 0.00 5408 - Clubs/Organizations 0.00 5606 - Govemment 5610 - State Government 5611 - RHCP Subsidies 27,720.00 5612 - COE 0.00 Total 5610 - State Government 27,72&00 5615 - Local Government 0.00 iotal 5606 - Government 27,720.00 5740 - Memorials 0.00 Total 5400 - Condbuted Income 141,445.00 Total 1 ncome 39GA13.00 Profit & Loss Budget Overview Cedar St July 2015 through June 2016 U�,l 7121 - Payroll Expenses-FICA Jul '04 -June 15 7111 - Salaries-Admin 0.00 7112 Salaries-Program Director 9,046.00 7113 Salaries-Site Supervisor 26,679.67 7114 - Salaries-Counselor 162,394.75 7115 - Salaries-Driver 0.00 7116 - Mod 125 ReImb 16,800.00 7117, Allocated Admin Salaries 8,202.86 7132 - Benefits 0.00 Total 7110 - Salaries 223,125.29 U�,l 7121 - Payroll Expenses-FICA 16,156.36 7122 - Unemployment Insurance 2,940.00 7120 - Payroll Taxes - Other 0.00 T 0 s otal 712 - Payroll Taxes 18,098.36 7160 Depreciation 20,890.75 7230 Equipment Rental I Lease 0.00 7260 • Insurance 0.00 7130 ° Workers Compensation 26,9W.91 72611 - General Liability 579.96 7262 - Property Insurance 1,932.00 7263 - Vehicle Insurance 2,058.00 7268 - Directors & 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 & Repairs 7301 - Vehicle Maintenance 240.00 7302 - Vehicle Repair 480.00 7303 - Grounds Maintenance 2.400.00 7304 - Maintenance Supplies 240.00 7305 - Houce Repair 240.00 7306 - House Maintenance 300.00 7307 - Exterminator 600.00 7308 - Equipment Machine Repair 0.00 7309 - Equipment Maintenance Contract OLOO 7310 - General Maintenance & Repair 360.00 Totad 7300 - Maintenance & Repairs 4,860.00 7316 • Miscellaneous Expenses 0.00 7340 - Office Supplies 360.00 7360 - Postage 0.00 7360 . Printing Peninsuh Association for Retarded ChUdren & Aduft Profit & Loss Budget Overview Cedar St July 2015 through June 2016 ry'rATIF2171-777r , �_7 � 7401 - Accounting Jul 14 -June 15 7381 - Newsletter 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 ry'rATIF2171-777r , �_7 � 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 O.DO 7407 - Computer 0.00 7406 • Temp worksm 0.00 7463 - Legal 0.00 7464 ° Payroll services 0,00 Total 7400 - Professional Contractual 4,850.00 RMN21=2,70 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 & Few 0.00 7461 - Management Fen 0.00 7462 - Bank Service Fees 0.00 7465 - Physical Fen 0.00 7486 - Real Estata Taxes 0.00 7467 - Dun 0.00 7468 - License Fees 0.00 7470 - FrIngerprinting Fees 0.00 Total 7460 -Taxes. Licenses& Few 0.00 7480 - Telephone 1,440.00 7600 •1 I & Fuel Costs (Employee) 650.00 7510 - Board Expense 0.00 7520 - Staff Appreciation 240.00 7530 - Staff Recruitment 0.00 7540 • Training 480.00 7550 - Fuel Costs (Company) 2,400.00 7560 - Bridge Tolls 0.00 7600 - Utilities 7601 • Electric 1,920.00 7602 - Gas 1,200.00 PeninsuN Assoclaftn for Retarded Children & Adufte Profit & Loss Budget Overview Cedar St July 2015 through June 2016 M3 +. 1606 Yotal 7600. U-7771 Jul 1 ® June 1 1,9 3,080.00 0.00 8,160.00 0.00 335,929.31 60,083.69 5402 • lndivdual Donations 0.00 5403 - Trust/Endowment 0.00 5404 - Auto Donations 0100 5408 - Clubs/Organizations 040 5606 - Government 5610 - State Govemment 5611 - RHCP Subsidies 0.00 5612 - CO E 0,00 Total 5610 - to Government 0.00 5655 • Local Government 0,00 Total 5606 - Govemn-eurt 0.00 5740 - Memorials 0.00 Total 5400 - Contibuted Income 7,500.00 Total Income 37,500.00 U 7 -" Jul 14 -June 16 Income 5000 - Earned Income 5100 - Solicitations Rovaue 0 0.00 5200 - Regional Centers 0 0.00 5201 GGRC 3 30,0 .0 5202 East Bay regional 0 0.00 5203 San Andreas 0 0.00 5204 Sacramento 0 0.00 6206 Kom 0 0.00 5300 - Special Events 0 0.00 6311 - Annual Dinner 0 0.00 5300 - Special Events - her 0 0.00 Total 6300 - Special Events 0 0.00 5W2 Client Revenue-Rent 0 0.00 5503 - HUD Tenant Assistance Payments 0 0.00 5512 - Client Rovenue-Ceriffied 0 0A0 5514 ® Client Revenue-Full Fee 0 0.00 6516 . Self Pay 0 0.00 ST70 - Management Fee 0 0.00 Total 5000 - Earned Income 3 30,000.00 5400 ® Cc outed Income 6317 - Feats Revenue 0 0.00 5401 - Grants 5405 - Foundations 7 7,500ZO 5406 - Corporate 0 0.00 5401 - Grants - Other O O.OD Total 6401 - Grants 7 7,500.00 • lndivdual Donations 0.00 5403 - Trust/Endowment 0.00 5404 - Auto Donations 0100 5408 - Clubs/Organizations 040 5606 - Government 5610 - State Govemment 5611 - RHCP Subsidies 0.00 5612 - CO E 0,00 Total 5610 - to Government 0.00 5655 • Local Government 0,00 Total 5606 - Govemn-eurt 0.00 5740 - Memorials 0.00 Total 5400 - Contibuted Income 7,500.00 Total Income 37,500.00 U 7 -" Total Income 37,500.00 U 7 -" r Profirt & Loss Budget Overview Raj! 11,1o, use July 2016 through June 2016 a -; 7121 - Payroll Expenses-FICA 4,673.08 7122 - Unemployment Insurance 1,000.00 7120 - Payroll Taxes - Other 0.00 Total 7120 - Payroll Taxes 5,673.08 7160 • Depreciation 2 Jul 14 June 15 71111 - Salaries-Admln O.DO 7112 - Salarles-Program Director 1B,960.D0 7113 ® Salaries-Site Supervisor 19,320.00 7114 - Salaries-Counselor 34.806.00 7115, Salanes-DrIver 0.00 7116 - Mod 125 Reimb 1,200.00 7117 - Allocated Admin Salaries 8.202.68 7132 - Benefits 0.00 Total 7110 - Salaries 70.488.80 a -; 7121 - Payroll Expenses-FICA 4,673.08 7122 - Unemployment Insurance 1,000.00 7120 - Payroll Taxes - Other 0.00 Total 7120 - Payroll Taxes 5,673.08 7160 • Depreciation 2 23,227.00 7230 - Equipment Rental I Lame 0 0.00 7260 - Insurance 7130 - Workers Compensation 5 5,288.68 7261 - General Liability 6 628.20 7262 . Property Insurance 2 2J54.00 7263 • Vehicle Insurance 2 2,424.00 7268 . Directors& Officers 1 183.96 Total 7260 • Insurance 1 10,670.84 • 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 Tota17 0 - Interest Expenses 0.00 7300 • Maintenance & Repalra 7301 . Vehicle.;;alntenence 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 600.00 7307 - Exterminator 600.DD 7308 - Equlprnervt 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 Supplies 0.00 7360 - Postage 0.00 7 360 - Printing 7300 • Maintenance & Repalra 7301 . Vehicle.;;alntenence 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 600.00 7307 - Exterminator 600.DD 7308 - Equlprnervt 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 Supplies 0.00 7360 - Postage 0.00 7 360 - Printing 7315 - Miscellaneous Expenses 0.00 7340 - Office Supplies 0.00 7360 - Postage 0.00 7 360 - Printing Peninsula Association for Retarded Children & Adulls Profit & Loss Budget Overview, Raj! House .July 2015 through June 2016 74110 • Professional Contractual NAMMOLION92mm"mmmmmol Jul 14 -June 16 7381 • Ne"1 0.00 7392 - Business. Cards 0.00 7383 - Door Hangers 0.00 7384 - Stationary 0.00 7385 - Other Printing 0.00 Tol:211380 - Printing 0 74110 • Professional Contractual 9W.00 7401 Accounting 2,650.00 7402 Audft 0100 7403 - Behinric 0.00 7404 - Management 0.00 7406 ® Fundralaing 0.00 7406 - Other Professional Contractual 0.00 7407 - Computer O.W 7406 •T workers 0.00 7463 - Legal 0.00 7464 • Payroll services 0.00 Total 7400 - Professional Contractual 2,650.00 7422 - Program Food 9W.00 7423 - Client Recreation 1,860.00 7424 - Program Supplies 480.00 7425 - Maint Supplies 120.00 Total 7420 - Program Operating Expenses 3,360.00 7430 - Advertising 0.00 7440 - Rent 0.00 7450 •T , Licenses& Fees 0.00 7461 - Management Fen 0.00 7462 - Bank Service Fees 0.00 7465. Physical Fees 0.00 7466 - Real Estate Taxes 0.00 7467 - Dues 0100 7468 • License Fen 1,000.00 7470 - FrIngerprinting Fees 0.00 Total 7460 • Taxes, Licenses IL Fees 1,080.00 7480 - Telephone and Cable 1,500.00 7500 • Travel & Fuel Costs (Employee) 240.00 7510 , Board Expense 0.00 7620 - Staff Appreciation 0.00 7NO - Staff Recruitment 0.00 7640 • Training 120.00 7550 - Fuel Costs (Company) 120.00 7660 - Bridge Tolls 0.00 7600 - Utilities 7601 - Electric 240.00 7 602 - Gas 300.00 Peninsula Asso0stion for Retaircled Children & Adults Profit& Loss Budget Overview RaP IHouse. July 2011 through June 2016 7603 - Trash Remova,% 7604 - Water 7605 - Saway TaW 7600 - UtIflUes `if iA -86,763.79 Peninsula Assoclatlon for Retarded Childmn & Adults Profit & Loss Budget Overview ILS 0.00 My 2015 through June 2016 0.00 Jul 15 - June 16 Income 5406 • Corporate 6000 Earned Income 5401 - Grants - her 5100 - Solicitations Revoue 0.00 5200 • Regional Centers 0.00 5201 GGRC 120,000.00 5202 East Bay regional 0.00 5203 San Andrew 0.00 5204 Sacramento 0.00 3205 Kern 0.00 5300 - Special Events 0.00 5311 • Annual Dinner 0.00 5300 • Special Events - her 0.00 Total 5300 - Special Events 0.00 5502 - Client Rovenuo4tent 0.00 5503 - HUD Tenant Assistance Payments 0.00 5512 - Client Revenue-Cortified 0.00 5614 - Client Revenue-Full Fee 0.00 5516 • Self Pay 5,208.00 5770 - Management Fee ---�725 0.00 Total 6000 - Earned Income 2708.00 7-7 411?MPT7,77jr =1 5317 • Feats Revenue 0.00 5401 - Grants 0.00 5405- Foundations 1,000.00 5406 • Corporate 0.00 5401 - Grants - her 0.00 Total 5401 • Grants 1000.00 5402 - Indlvdual 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 - MeMOTISIS 0.00 Total 5400 - Contibuted Income 1,000.00 1= II-3KI] MI I 1711"Mr * W OM 717 % --7uli.rj:m;viwrlrt,74T,7wlliT-T-m Profit & Loss Budget Overv, low ILS July 2015 thmugh June 2016 ulzl�M_ 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 MWEP'n E ma a SM NN Womm"Mm a Jul IS -June 16 7111• Salaries-Admin 0.00 7112 • Salaries-Prograrn Director 12,528.00 7113 - Salaries-Site Supervisor 21,6W.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 101374.38 ulzl�M_ 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 0.00 Tota1 7260 • Insurance 1,m 27.10 7281 • Credit Card Interest 0.00 7282 - Mortgage Interest 0.00 7283 - Lease Interest 0.00 7284 - Interest-Unes 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 0:- 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 0.00 7380 . Printing Profit & Loss Budget Overview ILIS" July 2015 through June 2016 7400 • Professional Contractual Jul 15 -June 16 7381 Newsletter 0.00 7362 Business Cards 0.00 7383 - Door Hangers 0.00 7384 - Stationary 0.00 7385 - Olher Printing 0.00 Total 7360 . Printing 0.00 7400 • Professional Contractual 240.00 7401 - Accounting 2,650.00 7402 • Audft 0.00 7403 - Behavioral 0.00 7404 - Management 0.00 7405 - Fundmising 0.00 7406 - Other Professional Contractual 0.00 7® Computer 0.00 7408 • Temp workers 0.00 7463 Legal 0.00 7464 Payroll services 0.00 Total 7400. Professional Contractual 2,650.00 7422 . Program Food 240.00 7423 - Client Recreaflon 115.00 7424 Program Supplies 120.00 7425 Maint Supplies 0.00 Total 7420 . Program Operating Expenses 475.00 7430 • Advertising 0.00 7440 - Rant 0.00 7460 - Taxes, Licenses & Fees 0.00 7461 • Management Few 0.00 7462 - Bank Service Fees 0.00 7465 - Physical Few 275.00 7466 - Real Estate Taxes 0.00 7467 - Dues 0.00 7468 - License Peso 0.00 7470 - Fringerprinting Fan ......... 200.00 Total 7460 - Tam, Licenses & Fees 475.00 7480 - Telephone 2,400.00 7500 - Travel & Fuel Costs (Employee) 6,840.00 7510 . Board Expense 0.00 MO - Staff Appreciation 200.00 MO - Staff Recruiltment 300.00 7540 • Training 480.00 7550 - Pool Costs (Company) 0.00 7560 - Bridge Tolls 0.00 7600 - Utilities 7601 - Electric 0.00 7 502 - Gas 00 Peninsula Association for Retarded Children & Adults Profit & Loss Budget Overview ILS July 2015 through June 20'16 - Trash Removal 7604 Water 7005 Total Utilities -1,79hicle Operating Total Expense Jul 15- June 96 0.00 0. 0. 126,660.09 - 462.09 Profit & Loss Budget Overview IReach July 2015 t1wiroughjum-m-&- 5402 • Indlvdual Donations 0.00 5403 • Trust/Endowment 0.00 5404 - Auto Donations 0.00 5408 - ClubsiOrgenizations 0.00 5606 - Government 6610 • State Government 5611 CP Subsidies 0.00 6612 • CDE 0.00 Total 5610 - State Govemment 0.00 5615 - Local Government 0.00 Total 5606 - Government 0.00 5740 • Memorials 0.00 Total 5400 - Contibuted Income 20,000.00 Total Income 147,101.00 Page I of 4 Jul IS - June 16 Income 6000 . Earned Income 0 0.00 5100 - Solicitations Reveue 0 0.00 5200 - Regional Centers 0 0.00 5201 GGRC 0 0.00 5202 East Bay regional 0 0.00 5203 Son Andreas 0 0.00 5204 Sacramento 0 0.00 5205 Kern 0 0.00 5300 - Special Events 0 0,00 5311 • Annual Dinner 0 0.00 5300 - Special Events - her 0 0.00 Total 5300 - Special Events 0 0.00 5502 • Client Revenue-Rent 0 0,00 5503 - HUD Tenant Assistance Payments 0 0.00 5512 - Client Rmnue-Ce fied 0 0.00 5514 • Client Revenue-Full Fee 1 127,101.00 6515 . Self Pay 0 0.00 5770 - Management Fee 0 0.00 Total 5000 - Earned I g 127,101.00 6400 - Contibuted Income 5317 - Fasts Revenue 0 0.00 5401 - Grants 5405 - Foundations 2 20,000.00 5406 - Corporate 0 0.00 5401 - Grants - Other 0 0.00 Total 6401 - Grants 2 20,000.00 • Indlvdual Donations 0.00 5403 • Trust/Endowment 0.00 5404 - Auto Donations 0.00 5408 - ClubsiOrgenizations 0.00 5606 - Government 6610 • State Government 5611 CP Subsidies 0.00 6612 • CDE 0.00 Total 5610 - State Govemment 0.00 5615 - Local Government 0.00 Total 5606 - Government 0.00 5740 • Memorials 0.00 Total 5400 - Contibuted Income 20,000.00 Total Income 147,101.00 Page I of 4 5615 - Local Government 0.00 Total 5606 - Government 0.00 5740 • Memorials 0.00 Total 5400 - Contibuted Income 20,000.00 Total Income 147,101.00 Page I of 4 Profit & Loss Budget Overview Reach July 2015 through June 2016 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 71111 • Salaries drain 8,352.00 7112 - Sularles-Prograrn Director 50,544.00 7114 Salaries-Counselor 85,003.50 7115 Salaries-Driver 0.00 7116 Mod 125 Rel 6,600.00 7117 Allocated Ai n Salaries 8,202.88 7132 - Benefits 0.00 Total 7110 - Salaries 158,702.38 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 Lem 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 & Ofrwrs 584.04 Total 7260 • Insurance 17,473.62 70•I nses 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 fK�14]RT_iMrI7, T-77=7 7301 -Vehicle Maintenance 60.00 7302 - Vehicle Repair 0.00 7303 - Grounds Mainlenance 0.00 7304 - Maintenance Supplies 0.00 7305 - House Repair 0.00 7306 - House Maintenance 20D.00 7307 - Exterminator 0.00 7308 - Equipment Machine Repair 0.00 7309 - Equipment Maintenance Contract 0.00 7310 - General Maintenance & Repair 1,060.00 Total 7300 - Maintenance & Repairs 1.310.00 7315 • Miscellaneous Expenses 0.00 7340 - Office Supplies 240.00 7360 - Postooe 3040 7380 - Printing 7361 - Neviialetter 0.00 Peninsula Association r Retarded d' «:; Profit & Loss Budget July 2015 through June 2016 74 00 - Professional Contractual Jul 15- Ju 1s 7 382 - Business Cards 0.00 73 o` Hangers 0. 7 Stationary 0.00 7 r Printing 50.00 Total 7380 - Printing 5.00 74 00 - Professional Contractual 2,700.00 7401 - Accounting 2,650.00 7402 it 0. 7 403 - Behavioral 01 7 ° Management 0.00 7405 ° Fundralsing 0.00 7 r Professional Contractual 0.00 7407 ° Computer 300. 7 ° Tomp workers 0100 7463 al 0.00 7464 ° Payroll services 0.00 Total 74 ° Professional n 1 2,950.00 h , Program 2,700.00 Y' ia;n 1,655.00 7424 - Program + ,, lies 1,900.00 7426 - Maint Supplies 720.00 Total 7420. Program Operating Expenses 6,975.00 7430 ° Advertising 0.00 7 ant 0.00 - Taxes, L' n 0, 7461 ° Management Fees 0.00 74 Bank Service Fans 0.00 7 Physical Fees 240.00 7466. Real Estate Taxes .0 7407.Ones 225.00 7468. License Few 4 7 0 - FrIngerprinfing Few 120.00 Total °'I 1,065.00 7 2,1 - Travel & Fuel Costs (Employee) 1,080.00 7510 Board Expense 0, 7520 Stalf Appreciation 150.00 7539 - Staff Recruitment OWN 7 - Training 0.00 7 Fuel Costs (Company) .0 Tolls 7560 - Bridge . 7 7001 ° Electric 0.00 7 ° Gas and Garbage 480.00 7603 ® Trash Removal 0.00 Peninsula Assocladmn for Retarded Children & Adults Profit & Loss Budget Overview Reach My 2015 through June 2016 7610 Operating Total Exp f �f - G8,406.89 Peninsula Association for Retarded Children & Adults Profit & Lass Budget Overview Horizons July 2015 through June 2016 W2 - Client Revenue-Certified Jui 16 -June iS Income 0.00 Earned Income 0.00 51 DO - Solicitations Revous, 0.00 5200 - Regional Centers 0.00 5201 GGRC 148,532.00 5202 East Say regional 0.00 6203 San Andreas 0.00 6204 Sacramento 0A0 6205 Kern 0.00 5300 - Special Events 0.00 5311 . Annual Dinner 0.00 5300 - Special Events - her 0.00 Total SWO - Special Events 0.00 5502 - Client Revenue-Rent 0.00 5603 - HUD Tenant Assistance Payments 0.00 W2 - 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 0.00 53V - Feats Revenue 0.00 5401 - Grants 0.00 5405 • Foundations 2,500k0 5406 - Corporate 0.00 5401 . Grants - Other 0.00 Total 6401 . Grants 2AOO.00 5402 . lndivdual Donations 0.00 5403, TrustlEndowment 0.00 5404 Auto Donations 0.00 5408 Club sIOrganizations 0.00 5608 - 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 6740 - Memorials 0.00 Total 6400 . Contibuted Income 2,500.00 Total income 160.736.04 Page 1 of 4 Peninsula Association for Retarded Children & Adults Profit & Loss Budget Overview Horizons July 2016 through June 2016 7121 . Payroll Expenses-FICA 8,925.48 7122 - Unemployment Insurance 1,3D0.0D 7120 - Payroll Taxes - Other 0.00 Total 7120 - Payroll Taxes 10,225.48 7160 • Depreciation 2,519.45 723D - Equipment Rental I Lease Jul 15 -June 16 7111 Sal arles-Admin 0.00 7112 Solarles-Program Direct ®r 8,352.00 7113 Salaries-Site Supervluor 27,0 .00 7114, Salaries-Counselor 81,321.00 7115 - Salaries-Driver 0.00 7116 Med 125 Reims 6,000.00 7117 Allocated Adrein Salaries 8,202.88 7132 - Benefits 0.00 otol 7110 - Salaries 130,875.88 7121 . Payroll Expenses-FICA 8,925.48 7122 - Unemployment Insurance 1,3D0.0D 7120 - Payroll Taxes - Other 0.00 Total 7120 - Payroll Taxes 10,225.48 7160 • Depreciation 2,519.45 723D - Equipment Rental I Lease 0.00 7260 • Insurance 0.00 7130 - Wbrkers 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 7281 Credit Card Interest 0.00 7282 Mortgage Interest 0.00 7283 Lease Interest 0.00 7284 In of Credit 0.00 Total 7280 . Interest Expenses • 0.00 7300 - Maintenance & Repairs 7301 -Tehicle Maintenance 100.00 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 - Equipmerwit Machine Repair 0.00 7309 - Equipment Maintenance Contract 0.00 7310 - General Maintenance & Repair 0.00 Total 7300 - Maintenance & Repairs 100.00 7315 • Miscellaneous Expenses 0.00 7340 - Office Supplies 0.00 7360 - Postage 60.00 7380 - Prinfing Peninsula Association for Relarded Childrvn & Adults Profit & Loss Budget Ovendew Horizons July 2015 through June 2016 7400 - Professional Contractual VASMOMMM -z Jul 15- June ie 7381 - Newsletter 0.00 7382 - BusIness Cards 0.00 7383 - Door Hangers 0.00 7304 Stationary 0.00 7355 Other Printing 0.00 Total 7380 - Printing 0.00 7400 - Professional Contractual 1,440.00 701 - Accounting 2,650.00 7402 • Audit 0.00 7 ioral 0.00 7404. - Management 0.00 T405 • Fundralsing 0.00 7406 - Other Professional Contractual 0.00 7407 ' Computer 0.00 7408 - Tom p workers 0.00 7463 - Legal 0.00 7464 - Payroll services 0.00 Total 7400 - Professional Contractual 2,650.00 7422 - Program Food 1,440.00 7423 - Client Recreation 540.00 7424 - Program Supplies 900.00 7426 - Naint Supplies 0.00 Total 7420 - Program Operating Expenses 2,880.00 7430 - Advertising 0.00 7440 - Rent 0.00 7460 m Taxes, Licenses & Fees 0.00 7461 ® Management Fees 0.00 7462 nk Service Fees 0.00 7465 - Physical Few 0.00 7466 - Real Estate Taxes 0.00 7467 - Dues 0.00 7468 - License Few 0.00 7470 - FringerprWng Foss 0.00 Total 7"0 - Taxes, Licenses & Fm 0.00 7480 , Telephone 2,220.00 7600 • Travel & Fuel Costs (Emplayee) 2,400.00 75i0 - Board Expense 0.00 MO - Staff Appreciation 120.00 7530 - Staff Recruitment 240.130 7640 Training 420.00 7550 Fuel Costs (Company) 960.00 7560 - Bridge Tel 0.00 Utilities 7601 - Electric MOO 7602- Gas MOO Peninsula Association for Retarded Children & Adufte Proffit & Loss Budget Overvieve Horizons. July 2015 through June 2016 7610 - Vehicle Operating Expense 0.00 Tote] Expense 165,711.18 -4,975.14 Jul 15 - June is 7603 •T Removal 0.00 4^ Water 0.00 7605 - Smwer 0.00 Total 7600 - Utilities 0.0 7610 - Vehicle Operating Expense 0.00 Tote] Expense 165,711.18 -4,975.14 Profit & Loss Budget Overview, Page Mill o July 2015 through June 2016 Jul 14 - June 16 5615 - Local Government Total 5600 - Government 5740 • Memorials Total 5400 - Contibuted Income =1 0.11 O.W 0.00 0111 0.00 8,101.08 AlLf oil I 0.00 OZO 0.00 0.00 5,OW.00 72,816.44 Profit & Loss Budget Overview Paget, Mill July 2016 through June 2016 7121 - Payroll Expenses-FICA 4,291.19 7122 - Unemployment Insurance 1,200.00 7120 - Payroll Taxes - her 0.00 Total 7120 • Payroll Taxes 5,491.19 7160 tion Jul 14 - June 15 7111 - Salaries-Admin 0.00 7112 - Salaries-Program Director 7,656.00 7113 - Sala te Supervisor 18,000.00 7114 - al for 30,438.00 7115 - Salaries-Driver 0.00 7116 - Mod 125 RaImb 1,20 . 7117 - Allocated Admin Salaries 8,202.68 7132 • Benefits 0.00 Total 7110 , Salaries 65,496.88 7121 - Payroll Expenses-FICA 4,291.19 7122 - Unemployment Insurance 1,200.00 7120 - Payroll Taxes - her 0.00 Total 7120 • Payroll Taxes 5,491.19 7160 tion 2,405.01 7230 - Equipment Rental I Lane 0,00 7260, Insurance 0.00 7130 - Wbrkers Compensation 1,457.22 7261 - General Liability 4,431.00 7262 - Property Insurance 48,96 7263 - Vehicle Insurance 1,117.66 7268 - Directors & Officers 1,296.96 Total 7260 • Insurance 8,351.70 720.1 t Expenses 7281 - Credit Card Interest 0.00 7262 - Mortgage Interest 0.00 7283 Lease Interest 0.00 7284 Interest-Lines of Credit 0100 Total 7280 - Interest Expenses 0.00 7V,kl - 46hicle Maintenance O.GT 7212 - 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 O.W 7306 - 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 0.00 7360 • Postage 0100 7360 Printing 6�� Pen1insWo Association for Retarded Children & Adults Profit & Loss Budget Overview Page Mill July 2016 through June 2016 7400 - Professional Contractual Jul 14 - June IS 3 Newsletter 0.00 7362 Businezu Cmrds 0.00 7383 - Door Hangers 0.00 73 84 Stationary 0.00 nab Other Printing 0.00 Total 7380 - Printing 0.00 7400 - Professional Contractual 3,600.00 7401 - Accounting 2,650.00 7402 - Audit MOD 7403 - Behavioral 0.00 7404 • Management 0.00 7405 • Fundralsing 0.00 7406 - Other Professional Contractual 0.00 7407 • Computer 0.00 7408 • Ternp workers 0.00 7463 - Legal 0.00 7464 - Payroll services 0.00 Total 7400 - Professional Contractual 765ra rLY1111111;MT=• 7422 - Program Food 3,600.00 7423 - Client Recreation 540.1 D 7424 - Program Supplies 540.00 7425 - Maint Supplies 70,►0 Total 7420 - Program Operating Expenses 4,750.01) 7430 • Advertising 0.00 7440 - Rent 0,00 7480 • Taxes, Ucenen & Few 0.00 7461 • Management Feet 0.00 7462 Bank Service Fees 0.00 7465 - Physical Few 0.00 7468 - Real Estate Taxes 0.00 7467. Dues 0.00 7468 •U Fan 0.00 7470 - Fringerprinting Few 0.00 Total 7460 • Texas, Licenses & Few 0.00 74BO - Telephone 4,080. 00 7500 • Travel & Fuel Costs (Employee) 1,800.00 710° Board Expense 0.00 7520 - Staff Appreciation 60.00 7530 - Staff Recruitment 240.00 7540 •T I f 580.00 7550 - Fuel Costs (Company) 640.00 7560 - Bridge Tolls 0.00 7600 - Utilities 7601 - Electric 0.00 7602 - Gas 0.00 Peninsula Association for Retarded Children &, Adulte Profit & Loss Budget Overview Page Mill July 2016 through June 2016 '1003 - Trash Removal 7004 - Water 7605 - Sovmr Total 7600 - Utilities 7610 - Vehicle Operating Expcn'i Total Expense TTUI= Jul 14 - June IS 0.00 0.00 0.00 0. 0.00 96,544.77 Peninsula Association for Retarded Children & Adults Profit & Loss Budget Overview Family Support Services July 2015 thiough June 2016 5402 • lndivdual Donations Jul 14 -June IS 5403 • TrustlEndowment 0.00 Income 0.00 6000 . Earned Income 0.00 5100 - Solicitations Reveue 0.00 6200 - Regional Centers 0.00 5201 GORC 0.00 5202 East Bay regional 0.00 5203 San Andreas 0.00 5204 Sacramento 0.00 5205 Kom 0.00 5300 . Special Events 0.00 5311 • Annual Dinner 0.00 5300 - Special Events - her 0.00 Total 6300 - Special Events 0.00 5502 • Client Revenue-Rent 0-00 5503 HUD Tenant Assistance Payments 0.00 5512 • Client Revenue-Cortifled 0.00 6614 • Client Revenue-Full Fee 0.00 6515 Seff Pay O.W 5770 - Management Fee 0.00 Total 5000 - Earned Income =00' 5400 - Contlbuted Income 5317 • Festa Revenue 0.00 5401 - Grants 5406 - Foundations 10,000.00 5406 . Corporate 0.00 5401 • Grants - Other O.W Total 5401 • Grants 10,000.00 5402 • lndivdual Donations 0.00 5403 • TrustlEndowment 0.00 Auto Donations 0.00 5406 - Clubs/Organizations 0.00 5606 - Governmard 5610 - State Govemrnsnt 5611 - RHCP Subsidies O.W 5612 - CDE 0.00 Total 5610 - State Government 0.00 5615 • Local Government 0.00 Total 560 - Government 0.00 5740 - Memorials 0.00 Total 5400 - Contibuted income 10.000.00 Total Income 10.000.00 Peninsula Association for Retarded Children & Adults Profit & Loss Budget Overview Family Support Services July 2015 through June 2016 rIfflo R =lk 7121 - Payroll Expenses-FICA 4,007.07 7122 • Unemployment Insurance 211.09 7120 - Payroll Taxes - Other 0.00 Total 7120 • Payroll Taxes 4,211816 7160 epredation Jul 14 - June 15 7111 - Salerles-Admin 0.00 7112 - Sallaries-Program Director 4,176.00 7113 - Salarles-Site Supervisor 48.204.00 71114 - Salarles-Counselor 0.00 7116 - Salarles-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 rIfflo R =lk 7121 - Payroll Expenses-FICA 4,007.07 7122 • Unemployment Insurance 211.09 7120 - Payroll Taxes - Other 0.00 Total 7120 • Payroll Taxes 4,211816 7160 epredation 0100 7230 - Equipment Rental I Lease 0.00 7260 • Insurance 0.00 7130 - Workers Compensation 674.13 7261 - General Liabilky, 0A0 7262 - Property Insurance 0.00 7263 • Vehicle Insurance 0.00 7268 - Directors & Officers 0.00 Total 7260 • Insurance 67413 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 -Tehicle.;ialintenance 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 A Repair 0.00 Total 7300 - Maintenance & Repairs 0.00 7315 - Miscellaneous Expenses 0.00 7340 - Office Supplies 0.00 7300 - Postage 0.00 7 380 - Printing Peninsula Association for Retarded CMild & Adufts Pro-fit & Loss Budget Overview Faraill uppart Services Julio y 2015 through June 2016 7400 - Professional Contractual 7401 - Accounting Jul 14- June 15 7381 - Newsletter 0.00 7382- Business Cards 0.00 7363 • Door Hangars 0.00 7384 - Stationary 0.00 7395 - 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 - Fundralsing 0.00 7406 - Other Professional Contractual 4,000.00 7407 - Computer 0.00 7408 - Temp worLers 0.00 7463 - Legal 0.00 7464 • Payroll se 0.00 Total 7400 - Professional Contractual 6,650.00 au=o n!�4= 7422 • Program Food 0.00 7423 - Client Recreation 0.00 7424 - Program Supplies 0.00 7425 - Maint Supplies O.DO Total 7420 - Program Operating Expenses 0.00 7430 - Advertising D.00 7440 - Rent 1,000.00 7460 •T 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 0.00 7470 - Fringerprinting Fees 0.00 Total 7400 • Taxes, Licenses & Fees 0.00 7480 - 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 7590 - Fuel Costs (Company) 0.00 7560 - Bridge Tolls 0.00 7600 - Utilities 7601 - Electric 0.00 7 602 - Gas 0.00 Peninsula Association for Retarded ChUdren & Aduka Profit & Loss Budget Ovendew Famill y Suppoit Seirvices My 2015 through June 2016 Jul 14 -June IS 7603 - Trash Removal 0.00 7604 - Mter 0.00 7605 - Sewer 0.00 Total 7600 - Witles 0.00 7610 - Vehicle Operating Expense 0.00 Total Expense 75,525,17 -GS,525.17 T 7 Administration Budget Overview July 2015 through June 2016 Depreciation ---- =U, -,'Tuns 1-6 REVENUE Equip. RentallLesse 6 Donations $ $ Memberships $ $ Investment Income $ $ Management fees D & 0 Insurance $ TOTAL REVENUE Interest Expense $ PERSONNEL EXPENSES Maintenance/Repairs $ Salaries $ 131,246 FICA $ 20,081 WIC $ 3,003 Unemployment $ 11000 Benefits $ 7,200 TOTAL PERSONNEL EXPENSES Printing 162,630 Depreciation $ 10.291 Equip. RentallLesse 6 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 $ 600 Audit $ 33,600 Software Support $ - rd ional contractual $ 49,600 Advertising $ Soo Client Recreation $ Program Food $ Program Supplies $ Management Few $ - Rent $ 81,761 Bank Charges $ 4,000 Taxest Licensee/Dues & Mgmt F $ 3,0D0 Telephone $ 25,000 Board Expense $ 1,000 Staff Appreciation $ 1,000 Staff recruitment $ 500 Training $ 3.0D0 Travel $ 500 Meeting Expense $ 500 Vehicle Operating $ - Calpital Asset A— - 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 20`15 through June 2016 E 150,000 25,000 $ 35,000 $ 5,000 $ 1,500 $ 6,500 $ 5,000 $ 2,400 $ 45,000 $ 283,000 51,636 FICA $ 3,950 W/C $ 691 Unemployment $ 250 Benefits $ 2,400 Admin Salaries $ 39,374 TOTAL PERSONNEL EXPENSES $ 98,201 OPERATION EXPENSES Depreciation $ Dues & Subscription $ Equip. Rentaill-ease Maintenance/Repairs Grounds maintenance Maintenance supplies $ - Miscellaneous $ 1,000 Office Supplies $ 1,000 Postage $ 3,000 Printing $ 5,000 Audit $ - u rt $ - P sinl contractual $ 39,700 Advertising Program Supplies (Giro) $ 25,000 Management Fees $ - Rent Bank Charges $ Taxes & Licenses $ Payroll Fees $ Telephone $ Board Expense $ Staff Appreciation $ Staff recruitment $ Training $ - T l $ 600 Fuel $ - I ri til $ Gas $ Trash removal $ Water $ Vehide Operating $ - T L PROGRAM EXPENSES $ 75,200 TOTAL OPERATING EXPENSES $ 173,401 EXCESS REVENUE OVER (UNDER) EXPENSES $ 109,599 July 2016 through . «; Draft e 20O le Salavage Revenues 1,194,300 Auto Donations 38,875 Waste , 0 Management fees - 7 °l L 1,275,175 PERSONNEL EXPENSES Salaries 321® FICA 24,828 VVIC $ 15,215 Unemployment 1, 7 Benefits 19,200 Arvin Salaries $ 26,2 TOTAL PERSONHEL EXPENSES $ 406,6 OPERATION Depreciation - Dues & Subscription - q l/ se 60,7 Equip° improvements - Vehicle Insurance $ 14,010 Liability Insurance lei Property Insurance Officers Directors Umbrella 1 MaintenanoefRepairs 6, Truck CPS system 1, Grounds maintenance $ 1, Maintenance supplies - Miscellaneous 5 Office u lies 11 Postage $ 255, Printing 2, Audit Software Support Professional contractual 17,474 Advertising ,5 Client Recreation Program Food Program Supplies Management Rent 3, Taxes & Licenses 2,7 Payroll Fees Telephone $ 7,824 Board nse Staff Appreciation 300 Staff recruitment 500 Training 1, Travel 1,0 Fuel 05, Bridge Tolls 3, Direct loth Purchase $ 14,0 Trash oval ,5 Utilities 3,0 Vehicle Operating $ 8,640 Total Program Operating Expenses 529, TOTAL °C ,4 EXPENSES $ 336,725 y r O 0 0 0 0 O r N O 0 ON) 0 Oro Cl) N N co ti T M a0 O O U U) CO O O M r C CA 0) lC) JO T N M O M . .0 O M r i* O IL r d 2 M Ln 0 0 0 W W N 1 1- n n n W O d w L Ln r- r C CA O O O M M 00 CO O O O Pm W d n n C� M M 0 0 N C CO M A O O O O W CA 00 O C CO M M M r 0 0 CO It N N d' p W P- I�t 00 O O h h Ln O 0 00 �t N I Bn M 000 O O M M n� N 0 0 b CO r N LO Ln O O H OD N CA O � N-t N M v v 0 r0 +° v r M r O CL w W 69 vi tt? to FA ti9 CA E!i E9 to em 619, N N CO M M N r- 0 O CO v O to n O CO 1-t i[) CO d 0 000 M OMD 0 v n LOO co ano NP+ h C tm N CD b G = N N k m W 69 EA 63 Efl 69 CA H9 Ni fA 60 en to O LA n I CO O O O O LO m O 00 0 Go 0 00 O 0 0 U) LO co M O Go CO co d OO N a lA Id7 CO O N M ui C4 r 7 d 0 N M CN Lo cn 0 r M r CD N r. C O) co M O r N N S r N Efl 69 f!� (A Cfl fA to E+9 M h LU O N O M M c � C 7 h 7 a >- LLJ ti P Z Z LL LU v O J w ® — Lu J — J J •� m - a J 0 h 0 C O w W M lb Y m C_ Q Q y N O J d Z h LU O N O M M c � C 7 h 7 a >- LLJ ti P Z Z LL LU v O J w ® — Lu J — J J •� m - a J 0 h 0 C O w W M lb Y m C_ Q Q y N O J d Z C O w W M lb Y m C_ Q Q y N O J d Z \} \ «: 2 \} \} 2M - k _ � k 2 CL k N- A cm /2 ~ {¥» / 3 \ \ \ \ \ } \ } \ \ \ \ \ , . % \ . . \ CL ; . ® w 0 r w v » z ? » 4 < _ \} \ «: 2 \} \} 2M - k _ � k 2 CL k N- A 1/2512016 City Data r r `V i♦♦ * T s p i for Fun-ding for FY 2016-17 INFORMATION 1. Organization Project 2. Tide: I' IMT.M. �r E� r 5 ♦ r I - v r CDBG National Ob jective ♦ r How are you it low income raw Service to "presumed beinefit" groups fisted bellow (income verification not required, but verificaflon of piresurn benefit status is req&ed)� Abused children Homeless persons Victims of domestic violence adults Elderly persons/seniors r` ♦ 2+) Persons living with AIDS Severely disabled adults Migrant 3. Project 1860 El Camino Real, Suite 406 City: Buftgame a, r 1; 4. Provide a one sentence project summary: The Sexual Abuse Services Program for Children and Youth (provides mental health services to address the imultiple healing needs of child survivors of sexual violence including: crisis intervention, iirndvidauall and group counseling, advocacy, mediicalflegal and forensic accomparnlment, and information and referrals„ Organization Address: httP:/Awww.citydataserVices.r*Vcifies/Smatcalapp2Ol6arc.pl?rpt--C463OWopr-359 11/9 1/2512016 City Data Services - South San Francisco Organization 650-652.-0598 Website: rapetraumaservices.org Phone: OEM=, :jjk'k� Signatory 1860 El Camino Red, Suite 406 City: Burlingame Zip: 94010 Address: 0 B. Please provide days and houm of regularly scheduled opemfion: RTS' crisis intervention services (crisis counseling, advocacy, accompaniment, information and referrals) are available 24-hours a day, Counselling is scheduled to meet the needs of clients and families. In addiflon to IMonday - Firiday 9:00arn - &W pm hours, sessions are available in the early Ynornings, evenings and on weekends.. 10. DUNS Number: 876425245 Federal EIN/TIN Number: 94-3215045 11. H U D Acdvity: C hoose the H U D activity that most closely matches your service: 05N - Abused and Neglected Children IT M-9 continued or future abuse. 3revent RTS' program clearly matches many HUD activities by providing Basic Human Needs to Abused Children., IRTS provides child abuse survivors with Advocacy & Accompaniment, Crisis Intervention, Counsefing, 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, Counselor's are trained to provide services to youth of all ages. RTiS works with police to ensure victims receive verball and written information about ongoing RTS services, RTS provides children with individual counseling as well as group counselling to o continue the healing process with others who have had sarri'gllar experiences & help break the isolation that is common among survrvors — 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 Sly„ RWC, & SSIF. 13A. Assessment of Need - Redwood City: Briefly describe how you determined then for your program fKjjch ARMIllig juriadiglon tha t you AfflAaRRIhd0g_ for funs 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." 14n-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 18-1 22% before age 12. For men, 75% of rapes occur before age 18, 48% be-fore age 12 (rjaden & 'rhoennes) Many sexually abused children also experience other traumas .- physical & emotional abuse, exposure to violence & parental substance abuse. (Child Abuse & Neglect, 2000. Intervention is especially important for child & adolescent victims to prevent re- victimization over their Iffetimes. http:/AwAY.c7itydataservices.neVcifies/Smatcalapp2Ol6arc.pl?rpt--C4638Wop=359 2J9 )Last year, PTS (the only Pape Crisis Center serving SM County) provided crisis intervention to 485 victims of child sexual abuse, '75 of these children live In PW/W/C.. Childrenn range iin age from infancy to 17 yrs. Funding allows us to provide a larger percentage of children with comprehensive ongoiing services. Children who are sexually abused often exhibit emotional, cognitive, and behavioral Iproblerrs, such as depression, suicidal) behavior, difficulty in school, use of alcohol & drugs, & early sexual activity. PTS is a place where survivors can find the support they deserve. The ability to heal from (past trauma its fundamental to a child "s safety and well- being. The target group is child victims of sexuall abuse. At Pisk .rmeen Counseling & workshops are (provided in nt of Need - City of San Mateo: Briefly describe you determined the need P for your f r i I ur i n u o population(s) O. Please state the sou (s) and date(s) of information. Identify any similar programs in the community. The Bain Mateo County Grand .fury 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 (Natlonal Crime Survey). Loire thain half of rapes of women occur before 18; 22% before age 12. For rnen, 75% of rapes occur before age 18, 48% before age 12 (rjaden & Th nnes) Many sexually abused children also experience other traumas ... physical & en-iotional 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 Ilifetimes. Last year, PT (the only Pape Crisis Center serving CM County) provided crisis intervention to 485 victims of child sexual abuse, '71 of these children (live in SM. Children range in age frorn infancy to 17 yrs. (Funding allows us to provide a larger percentage of children wiitlh comprehensive ongoing services. Children who are sexually abused often exhibit emo't'ional, cognitive, and behaviiorai problems, such as depression, suicidal behavior, difficulty in school, use of alcolholl & drugs, & early sexual activity. RTS is a place where survivors can find the support they deserve. The ability to heal from past traurna 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 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 ire•. victirnizat'ion over their lifetimes. Last year, PTS (the only Pape Crisis Center serving CM County) provided crisis intervention to 485 victims of child sexual abuse, 47 of these children (live iun SSF. Children range In age frorn 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. RT a is a place where survivors can fund 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 rvictirns of sexual abuse. At Risk Teen Counseling & workshops are provided In 14. Timeline: Provide a brief timetable for project implementation and achievement cif 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 carnpus 70 Child Abuse survivors in the City of Sain Mateo with - Advocacy and Accompaniment services - In person counseling (individual or group) - Crisis Intervention, counselling and /or support services on their school campus http:/Mww.citydataservices.neVcifies/smatca/app2ol6arc.pl?rW-C4&3U.prop=359 319 50 CNN Abuse survivors in the City of South San Francisco wfth Advocacy and Accompaniment services in person counseling (individual or group) Crisis Ilrntcrven fion, counseling and/or support services on their school campus As a current recipient of the San Mateo County Hurrian Service Agency CHU Abuse Prevention Grant, RI"S has become an active member of the Chilldren's Collaborative Action Team and attends monNy meetings to 6scuss different issues of CHid Abuse arid Child Abuse Prevention throughout San Mateo County, Without funds, RTS wouid initiate a wafting list for counseling, fevver schW communities wouid receive on campus services maHng it necessary for youth to travel to RTS' office, some child victims may not receive accompaNment support during forensic examshrr 'Lerviews, & fewer residents would receive infonTlation needed to make important & informed decisions. htip:/Awdw.citydataservices.reVcibes/Smatcalapp2Ol6arc.pl?rpt--C463BWop=359 419 r throughout San Mateo County and beyond, ffor example Dative American Health Center, LG. B'r Community Center, Bayshore Prevention Project, Pyramid Alternatives, kaiser Permanente (Redwood City, Souuth San IF::randsco and San Mateo Meftall Office) Sam Mateo County Human Services Agencies, and Asian American Recovery Services. for Unrilaren ania 0 Wo Icerve 1111 1-Y zulbl /Trorn � neFsain iMateo County Human Service Agency for Child Abug-e- Prevention and intervention, RTS has received current funding from Kaiser Perm°aanente ($15,000), Palo Alto Medical Foundation ($10,000), Trills Peninsula Foundation ($7,500) , Atkinson Foundation ($5,000) and the Bella Vista Foundation ($15, 000). VVe will re-apply to these sources for the upcoming fiscal year and apply to additional Corporations and Foundations, including: The intero Foundation and The lBothin Foundation. A financial commitment from Sam Mateo, Redwood City, and South Sara Francisco lends additional credibility to our requests from all types of fenders. When approaching business owners and city residents it Ihas been helpful to discuss ongoing city support. RTS has continued its Non-profit membership of the R C /SM Chamber of Commerce and speaks to and receives support from several service organizations (Rotary„ Kiwaniis, Lions, Soroptirmist) throughout the county. V . F. Position Titie Name of Staff Person Job Responsibilities Qualifications Provides training and mentoning to staff and volunteers, provides crisis intervention, individual couurnseiing, Founding member of R TS. 20+ years experience Executive Director Emily Abrarns 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. IPirovides 8:)Breot Services (cournsel`ing, advocacy, acooirmpanirmemt, Has worked in the field of sexual assault and i nforrmation and omrnestic violence for °83 years. Advocate and Program Director rn and a Freeman referrals) and Educator specially trained to work with youth and coordinates and families. CA State Certified Sexual Assault implements services Couarnselor, and programs to At Risk Youth. Provides crisis Bi.••cuultuurd immigrant who has both personal and intervention, iradiviiduual rofessional experiences .navigating and accessing and group counsel"orng„ ervices as weVB as issunes of dormeatio and sexuuaV l: Program pare and facilitates direct iolenoe in the Latino /a cormruuunities. She Latinos Cindy U�arro uirn services tr Spanish nderstands the cultural dynamics and needs that oordirntorCTraurm speaking residents. Latino/as have in accessing services and is Sensitive Counselor Trains staff and o these challenges. 10+ years experience providing on issues workshops, case management, advocacy, and of trauma of trauurma and culture. support to Latino /a families. CA State Certified Sexual Assault Counselor. herapist provides crisis intervention, individual and group therapy, and facilitates t I FTI who has worked for ITS -ffor 3 years. As a ounselimg direct services to counseling intern she has provided group and Program St~perer� v�csiornsk °� children and youth, irndividual therapy to children in San Mateo Courtly fo ana er/Thera ist g • p rains staff and years. CA State Certified Sexual Assault oluunteers on issues Counselor. Counselor. of trauma and couunselin . .. ' s . A r . :K ::... U25=16 City Data Services - SWh San Francis PROPOSED PROGRAM BUDGET FOR FY 2016-17 1 Ffiz�� Wl CAME= El '-South San-, Fr neisco Program rr Ffiz�� Wl CAME= El EE �6 �E is EMAW� For the City of Redwood City ONLY, answer the following: For the City of Redwood City ONLY, answer the following: 1. Funding Criteria: IMOTEWINJ 1 of a volunteer program is an improvement to the quality of life. 2. Markabing/AdverUsing a. Check all of the following methods your agency utilizes to promote and advertise your programs and services: htip:/AwAv.citydataservices.rL-Vcibes/Smatcalapp2Ol6arc.pl?rpt--C4638&prop=359 EM Mal I '-South San-, Fr neisco EE �6 �E is EMAW� For the City of Redwood City ONLY, answer the following: For the City of Redwood City ONLY, answer the following: 1. Funding Criteria: IMOTEWINJ 1 of a volunteer program is an improvement to the quality of life. 2. Markabing/AdverUsing a. Check all of the following methods your agency utilizes to promote and advertise your programs and services: htip:/AwAv.citydataservices.rL-Vcibes/Smatcalapp2Ol6arc.pl?rpt--C4638&prop=359 EM Mal I City Data Services San Francisco b. Which the above marketingladvartising matedals are available in multi4angual form and which languages they available in? Ali RTS mateda'Is are (printed two sided in English and Spanish. Outreach presentations are provided in either English or Spanish. Radio and TV announcements are provided can English and Spanish stations.. Materdals are sent to over 75 agencies that target underserved populatiions, for example Native American Health Center, L.GBT Community Center, Bayshore Prevention Project, (Pyramid Alternatives, Kaiser Pe anente (Redwood City, South ran Francisco and Sari Mateo Medical Office) San Mateo County Human Services Agencies, and Asian American recovery Services. r"f'S continues to supports children seeking services who are victims of CSEC. RTS provided services to 7 children who identified being victimized by commercial sexual expioitation while residing in Redwood City. RTS (provided on carnpus "At Disk. " 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 victlm 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 serial abuse. http:/Mww.Citydataservices.reVdfies/Smatcalapp2Ol6arc.pl?rpt--C4638&prop=359 1/25/2016 City Data Services - South San Francisco 1 1. Resolution authorizing application and designation of RTS Board Resolution 16.doc signatory, by the Board of Directors 'i 2. Proof of 501(c)3 / tax - exempt status `i 3. By-laws N� 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 term Rar)e Trauma Services IRS Tax E-xemQt Letter. pdf RLS articles of incoao p" RTa Board ' ` ♦ oc RTS Board MeetJng,_QMtes.doc " 6. Organizational chart for entire organization Org Chart 1 1.docx i!e'' 7. Certified financial audit no more that 1 fiscal year old, —RTS Audit 6 30 1 .odf prepared by a CPA, and: TS Financial Audit tJ ate - 2015 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 9. Mission Statement R "TS ission Statement 16,doc 10. Non - discrimination policy for Staff and Clients RI Non Discrimination Policy 16 doc i� 11. Reasonable Accommodations Policy for Staff and RTS Reasonable Ac—co—mmodations Policy 16 doc Clients d; 12. Conflict of Interest Policy. (If not available, please indicate when you will submit) 13. Other - Download All Attachments Program Manager Signature Fm'iiy Abirams Date Signed 01/2212016 Initially submitted: Jan 22, 2016 - 12:20:25 http:l .citydataservi cities /smatcaJ 016arc.pl ?rpt =C 9/9 FY 6 JuIX 1, n . 4000 - Gram Clubs and Svrvies Orpnizations 1,500.00 School Contracts 30,440.00 Foundeltion Grants 75,000.00 Tom 4000 106.940.00 4100 4,131.00 allim 38,750.00 CCAT 51,500.00 Federat &Countlr YSC GIRLS 39,000.00 Dept of Healtin Services: Prev. Educ. 85,000.00 Cal-OES; Rap Crisis Grant 267,217.00 714100 1,4677 4200 - Individual Contributions 2,550.00 Total 4200 ions 60,000,00 4300 - Service Prideled Contributions Donations 10,000.00 Equipment & Furnishings Purchase 1,000.00 Tinge 2,250.00 Total Contrib. 13,250.00 Interest 48W Other Income: RTS Workshops 0.00 4700 Contributions (match) 2,500.00 Total Inam W.A 197 m 6000 • Wages & Salaries Total 6000 • Wages & Salaries 401 ,00 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 2,550.00 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 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 r� , 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 Rape Trauma Services FY .- 30, 2017 4000 Clubs and Service Organizations 1,500.00 school cordrects 35,000.00 Foundation reesffi 85,000.00 Total 4000. Graft 121,500.00 4100 7,237.00 fie: 40,000.00 CCAT 51,500.00 Federal & Countf.. YSC GIRLS 39,000.00 Dept of Health Servlces: Prov. Educ. 85,000.00 COMM CHAT 225,000.00 CsIS: Rape Cdels Grant 384,615.00 Total 4100 rent Conareft 8251115.00 4200 - Individual Contributions 1,500.00 Total 4200 I Contirbutions 801Q00.O0 4300 • SerNa Related Contribuilliona 2,500.00 Donations 12,500.00 Honorarium 1,000.00 Training Fees 2,250.00 Total 4300 • Service Related 15,750.00 4400 • Interest Income 3,200.00 4600 Other Income: RTS Workshops 0.00 4700 Coribi s (match) 2,500.00 Tall 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 141,605.00 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 2,550.00 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 7.000.00 Rape Trauma Services " + `+ FY 20116-2017 July 1, 2016 - June 30, 2017 7300 • Professional Services Audit Amounting & 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 1/2512016 City Data Services - SoLAh San Francisco I I I I* Application for New Funding for FY 2016-17 GENEEAL INEMMATION 1. Organization Name: Samaritan House 2. Project Tide: Safe Haibor ffAm, ft AM I receiving this application 12-r7t7*=o, UT ym- so ff.= Em 1/8 RP74t =4-� Contact Email: lauira@samadtanhousesanmateO.Org;ahsieh@samahtanhousesanmateo.oirgFax: 650-294-4338/650..523-0839 S. Name of Agency lBart Chadow Director: 7. Fiscal Name: Johe Bou n1licer: Fiscal Officer 4031 Pacific Blvd. Address: 8. Authorized Name: Bart Chadow Signatory: Email: Telephone: jbouP—samadtanhousesarimateo.org 650-523 - 0610 City: San Mateo Zip: 94403 Email: T elephone: bartP_sama(itanhousesanimateo.org 650-523- 0812 ATAKINFO, W, • Federal EINITIN Number: 237416272 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 I located in South 6AWSW 162.1 iroyigp, VM1 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, ADD 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 ADD s of information. Identify any similar programs in the community. As the average rent for an apartment �n Redwood Citv reaches record W41i permanent housing. fing 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 Carninar, 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 - CounN of San c: 0 fill] OvIly, httP:lMfww.Citydataservices.neUcitieslsmatcalapp2Ol6arc.pl?rpt--C4747&prop=52 218 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 Laminar; 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 clangert 13C. Assessment of Need - South San Firancisco: Briefly describe how you determined the need for your program for each sReciflg iurisdiction thatim-are apiplAna for funds, Identify target population(s) and area(s) served. Please state the source(s) and date(s) • 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.1, 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 infl ux of new clients is due in part to new client referrals and more eff ective 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 Nodh County there are no other homeless shelters. There are motel voucher programs through IVSN; transitional housing through Laminar; 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, 2-4 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. Briefly describe how vou will determine a-rd neasur- ftP. WIMM11 Safe 1--larbor 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 ner proposed project. It_ re _s 0 To effectively work with the most chailenging homeless population in the County, Samaritan House leverages its resources and ensures timely and relevant services for its clients throukh close collaborations with local non 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 1••larvest Food Bank. http:/Avww.citydataservices.nettcifies/Smatcalapp2Oi6arc.pl?rpt--C4747&prop= 62 318 .. F=ormal collaborative work with County SIi:AL tearrn to expedite application process for SS DI and SSl benefits. - -On site dental services provided every other week Iby the County IMobile Dental Van. Employment resources at Peninsula Works. Basic healthcare provided twice a week ornsite through the County Public Health Clinic, —Basic mental healthcare provided weekly onsite through County Behavioral IHealth Services. Project Sentinel provides advocacy around housing discdmination for hornelless and loom - income tenants that are facing discrimination and rental issues such as repairs, privacy, deposits and rental disputes.. — l-leallthRight 360, a new integrated care organization, provides mental health and substance use otisorder treatment in an outpatient setting in San Mateo to offer free individual and group counseling for the l - Ancorne. .f"hese are only a fever of the many collaboration and partnerships in place to support the ongoing needs of the homeless residents o 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 Mouse 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 Jurisdiction 111IF =.# A • • °. •..- ♦ • " ♦ •: R Fri are not considered "presumed benefit" by HUD, and require income veirification. Persons exiting incarceration Lowmincome Other grant jurisdiction application regardless of Income 20. Affirmative Outreach: • ♦. R . ♦ - '.. • # r1iffiR., is : @000 f ♦. ♦ 1 ► " • •• 11111111111Z&TUM . #5 WAMUMTR TQ 1191111119101WAill M, :/ .cityd ervi cities /smatcal 1 c.pl?rpt =C4747 52 4/8 'GRAM BUDGET FOR FY 2016-17 For the CItv of Redwood Citv ONLY. answer Ye j1ol[w-jLTq- 1. Funding Criteria: 2. Homeless Assistance Activities: Provision of fair housin , c unseling, sery prevent homelessness, Drovision Of ODeration funds for share" '-OJMww.Citydataservices.neVcifies/smatcal .es 2Oi6arc.pi?rpt-- C4747&prop= 52 612 m ,Rene-'Marino �erves as Assistant Intake Coordinator. Assists in ev K in Beel —M'day to day intake and orientation process and front desk Dperations. —11 — --------- 'Serves as Program Aide. Coordinates the orderly I operation of Safe Harbor Shelter and facilitates the Winston delivery of shelter services to clients. This position also �,morks with vendors and community support services to ,Gerald support client needs. I year experience at "rogram amad i an House. 9 kide Kenya Malveaux w y rs experience in hener services. H.S. )WOMM 'GRAM BUDGET FOR FY 2016-17 For the CItv of Redwood Citv ONLY. answer Ye j1ol[w-jLTq- 1. Funding Criteria: 2. Homeless Assistance Activities: Provision of fair housin , c unseling, sery prevent homelessness, Drovision Of ODeration funds for share" '-OJMww.Citydataservices.neVcifies/smatcal .es 2Oi6arc.pi?rpt-- C4747&prop= 52 612 9 ... A and related services for horrielless and those at fisk of Ihomelessiness, youth and single persons. N — they available in? Samadtan House makes every attempt to market its program, services in multi4ingual 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. MI 0 =1 - 11711 1777777Z 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 xear-round shelter that Drovides erneruenc and tran needs. Our outcomes for FY'14/15 were as follows: OUTCOME 1: The shelter was at full capacity 98% of the time. OUTCOME 2: 63°x® 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. EAM; hftp:/Awm.c7itydataservices.noUcities /sat calapp2Ol6arc.pl?rpt--C4747&prop=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` 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 Citf Data Services - South San Francisc-t aamaritan House IRS -501c3 .,, t g.__ticles of IngWor4tion revised 2, 71.dgc 91, 6. Organizational chart for entire organization ro Orq Chars ?015 5 14 15 f 7. Certified financial audit no more that 1 Samaritan House 6 30 2015 AUDITED Financials odf fisca? 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: ua et Summa ®FY16 cdf Pro f3u e# Sam house FY17 df • Current (FY15 -16) Agency Operating Budget • Proposed (FY16 -17) Agency Operating Budget i. 13. Other - Download All Attachments Program Manager Signature Date Signed Initially submitted: Jan 22, 2016 - 16:02:35 httplM ww.citydataseMces.net/ cities/ SmatcWapp20l6arc .pl ?rpt= C4747&prop =52 818 Samaritan House Total Operating Budget - Approved 6 -25 -2015 Fiscal Year FY16 (711 - 6130) i : :yJx Proposed Budget F-YE S f2.g16 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 Business/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 Is (4,967) 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: StarV�sta 2. Project Title: TransftionM Housing �:"lacernent �-'Illus City of San Mateo 0' South San Francisco 1C = - 1kqf M- P, NYX7V =7 f isTiFnial 07 11 an Income Vercation: 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. Verificabon of income wifl be verified by pay stubs, W-2 tax forms, income tax returns, report of benefits, 1pens�ons or other avaflaWe verification of incorne. ff no documentation i�s avaflablle, StarVis' a s�gned statement of income. 3. Project 701 Grand Ave City: South San Francisco Zip: 94080-2553 Address: 4. Provide a one sentence project summary: SWbildized jjiJW Organization 610 Elm Street Suite City: San Carlos Address: 212 Organization 65C�591-9623 Website: www.star-vista.org Phone: 5. Contact Person Name: Peter Ehrhorn & I Pro ' lect Robin Rudkoff Title: Department Director Administrator: roHn.rudiikoff@ star Osta.org; Contact Email: peter. ehrhorn@ star.. Fax: visfaorq Telephone: 650-591-9623 http.,/Mww.citydataservices.roUcites/smatcalapp2Ol6arc.pl?rpt=C4538&prop= 121 1/5 8. Authorized —11ame: Sara Laflos Email: srnRcheH@star.Msta.o Signatory: Mftchefl, 1::Ilh.D. Authorized 610 Brn Street Sufte City: San Cailos Signatory Address: 212 1 MMKIR QU)"UMA Monday, Tuesday 12am-4am and 10am-6pirn and 81pm-?y 2am Wednesday 12 r 4em and 4prn-midNght "rhursday 12arn4arn and 12pm-6pim and 10prn...12arn Fdday 12arn-6arn and 10am-2lpm and 41pm-6pirn and 10pirn-12 airn Saturday/Sunday 1prn-6am Federal El N Number: i1wall 'I 0_015 IAWUTTP a • - 05D - Youth Ser0ces Zip: 94070-3070 "---:valuation: 13HO describe how gW 4"jig Ig tft.,/Mww.citydataservices.rt&Vcites/smatcalapMl6arc.pl?rpt--C4538Wop= 121 2/5 iVrWf,zjI City Data Services - South San Francisco Jurisdiction b. All beneficiaries to be served per grant jurisdiction application regardless of income 141 , .11 - 1 11 . r.77e 777=bones 9-re not considered "presumed benefit" by HUD, and require income verification. r"I Persons exiting incarceration Y. Low-income youth "q' . Other homeless youth; emancipated fosteir youth http:/Mww.citydataservices.roUcites/smatcalapp2Ol6arc.pl?rpt--C453BWop= 121 3/5 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. ti 8. The following are required: • Current (FY15 -16) Agency Operating Budget • Proposed (FY16 -17) Agency Operating Budget 9. Mission Statement d. 10. Rion- discrimination policy for Staff and Clients _d 11. Reasonable Accommodations Policy for Staff and Clients LT]ission Values..pdf StarVista M iscrimination 111�" M 71"M Y� 12. Conflict of Interest Policy. (If not available, please indicate whenC— nflict of Interest P®Gcy 2016 apdf you will submit) L' 13. Other - Download All Attachments Program Manager Signature Rob'iru Rr.udiikoff Date Signed 01/22/2016 Initially submitted: Jan 22, 2016 - 14:24:21 http: /ANww.citydaWervic:es. net / cities/ Smatcalapp20l6arc .pl?rpt= C4538&prop =121 515 sta, [41114f REVENUE ;Cities' 58,662 'First Mateo County 1,551,542 .County of San Mateo: Human Services Agency, Probation, Police Depts., Health System, Measure A 8,036,574 ,Federal Grant- Dept. of Health and Human Services 200,000 Fees for Services 755,160 ;Fundraising- Individuals and Events 630_ ,000 :Foundations /Corporate Grants 665,300 '!School Contracts 578,500 .Board approved investment from reserve i $ 60,000 Other Income/Miscellaneous 24,262 . ..... TOTALREVENUE� 12;560, 0 00 EXPENSES Personnel 'Salaries, benefits, payroll taxes, workers comp. $ 10,298,340 Operating Supplies/Telephone /Internet /Printing/Postage 248,450 Employee Costs & Mileage Reimbursement 347,810 Facilities & Equipment: Office Rent/Maintenance/Utilities/Security 812,138 Americorps Workers/interns/Volunteer Costs 18,600 Professional Services & Fees 302,470 Client Costs: Rent / Utilities /Food /Transportation /Drug testing/Other 482,692 -Other/Misc. 49,500 TOTAL EXPENSES $ 12,560,000 9 PROPOSED OPERATING BUDGET July 1, 2016 to June 30, 2 01.7 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 $ 206,000 11 Fees for Services $ 777,815 ;Fundraising Individuals and Events _.._ a _.._ _ $ 648,900 9 ir Foundations /Corporate Grants 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 r ............ ...._ ._.. 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 $ 19,158 Professional Services & Fees $ 311,544 Client Costs: Rent/Utilities/Food/Transportation/Drug ' testing /Other $ 497,173 _ Other /Misc. _. _ n ... _ 50,985 a r 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 EEMIM -,- , I W.r.11ERVIII41E.141•1 11 Main ryll income an presurn 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 long4erm 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. • f. - - 711 Nevada Street Type of Applicant: Non Profit Our agency serves: 5. Contact Person / Name- Tippy lnMn Project Administrator: Contact Email: ossmc@ossmc.org 6. Name of Agency Tippy Irwin Director: City: Redwood Zip: 94061-1555 Uty Website: www.ossmc.orq Title: Executive Telephone: 650 780 5702 Director Fax: 650..364-5,399 http:/Mww.citydataservices.neUcites/sm atca'app20I6arc.pl?rpt-C 1 &prop= 21 1/8 1/2&2016 City Data Services - South San Francisco . Fiscal Officer: : Bob Mordevaido ail: Telephone: 650 760 5707 ossrnc @ossrnc.org Fiscal Officer Address: '711 Nevada Street City: Redwood Zip: 94061 City S. Authorized Signatory: Name: Tippy irwin Authorized .. . r r. HM 10 , ,.., 05A ... Senior Services Email: Telephone: 650 -760 -5702 ossrncossrnc..org City: Redwood Zip: 94061 -1555 City / scheduled operation: 12. Project Specific Narrative: Provide a nanative description of the specific activities to be carried out with the requested funds. This should also include program objectives and key priorities fore each ific jurisdiction. OSSMC peifon -r:s advocacy work with the 6,663 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 II_TC industry by using highly - trained, skilled volunteers to irnonitor facilities and investigate coirnplaiints.. 3.. Community education includes the following: - 12 inservice education sessions for facility staff on issues related to resident care - 150 consultations with facility staff ire resident care - 350 consultations to individuals on issues re issues related to aging & choosing a facility for a loved one. _3 J .cityd ervi citi /smat 1 c.pl?rpt-- C4521 &prop= 21 218 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. OSSI C's field ornlbaudsirnern are the front hi ne of defense, providing vital, ongoing feedback to the Hcernsiing bodies so that they can make tiirne8y responses to meet the residents" needs.. 1. Case Records -- Onnhudsirmenn turn in detailed, written reports on every case that is opened which is then entered into the database, incluuding whether or not a case was resolved to the resident's satisfaction. The Office of the State Long-Term Care Ornlbaudsrnann has determined that the (bar for success is to resolve 80% of all counnplaiiirits. if we achieve that goal, it its deterrninned that we have achieved success.. We anticipate that we will continue to meet that goall.. .. Or nlbuudsmrnan Activities — Ombudsmen record on a tIn°oorntlhnly (basis all activities detaiH ng, among other things, visits that are made, to facilities, in.--service training to facility staff, consultations with staff and farn'ily members, etc.. Our facility coverage plan is updated and evaluated every three irrnornths to determine the we are on track to meet our goals. We evaluate statistics on a monthly basis to idenfify trends regarding cases and types of complaints. lrn this way we have been able to (pick up on a facility vvith an increased number of resident to resident abuse inncHennts. Once this was identified we were able to work with the facility to reduce these types of incidents. http:/Alvww.citydataservices.noUcifies/Smates/app2Ol6arc.pl?rpt--C4521 &prop= 21 3/$ 112512016 City Data Services - South San Framisco 1b. 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 ciiients are A 8,863 residents in 527 long-term care facillities iin San Mateo County, regardless of ethnicity, age oir any other demographilc. We do not select our cHents., We have created new Mformational cards in the following languages for our clients and -their families: Spanish, Chinese, Tagalog. it is our goal to translate other organizational mateflais into those languages as well, including our program brochure,, 21. Lev ng: Describe your fundralsing efforts and additional sources of revenue for this project and your organization. Please state her any of these fund sources are already committed and in what amount. Funding for FY 2016/17, including fun61ng from Aging & Adult Services, will not be confiffned unfill at least June 2016. Our fuindraising efforts include grant writing to foundafions, heaffl'i care districts, and corporations, as well as to otheir cMes. We allso secure funding from individuals through twice a year mail appeals, board, volunteer and staff campaigns, and an aninuai fundraising event, Healithcare (Districts: Sequoia Health Care (District $40,000 Peninsula Heallthcare Dist., $50,000 htlp:/Avww.citydataservices.naUcifies/smatcalapp2Ol6arc.pl?rpt--C4521&prop=21 51 112 016 City Data Services - South San Francisco For of f ., : City ONLY, the For the of d s r City ONLY, answer the following: 1. Funding Criteria: 1 available urn n i W6 1611 TF-MIMMMU0, SUIT they informational tent cards are avaflable fin English, Spanish, Tagalog, and Chinese, Core Services brochure available in English and Spanish i,ne concrete example from the people served in FY/15: a .citydat ervi citi /smat 1 rc.pi7r -C 1 21 718 ill. 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 i` 4. Articles of Incorporation ld: 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 -11 pdf 13 Vaws.d AirticVes of lanco ration. df Board Members 1 „a.15.doo V�oard Members witVu aftoln "atie,n ears ofi service 1.5.15.doc 6. Organizational chart for entire organization C; �,rganiationaV Chaim 2.docx 7. Certified financial audit no more that 1 fiscal Audited Financial Statements2012.PIDF year old, prepared by a CPA, and: Not Sub "ect to the Sin Ile Aradit Re uiuremernt I ekter,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 n' 11. Reasonable Accommodations Policy for Staff and Clients 12. Conflict of Interest Policy. (If not available, please indicate when you will submit) ! _ 13. Other - Download All Attachments Program Manager Signature Hippy iWirn Date Signed 0112212016 Initially submitted: Jan 22, 2016 - 13:04:11 C�SSMC Airy roved Budget FinaV FY 1b-16 rsdf Draft Budget Summary fiuirrdedrs deta'iV IF i' 2.016 1,7 012016.xlsx Mission Staterrient docx OSSMC Non Discrkninabon Policy docx MUC Reasonable Accommodations Poky .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 Total Revenue 672613 956,896 Development/Marketing 11 Hi r iness Funding 12000 15,000 Mills Peninsula Health Services 8,000 Other 7,000 Direct Public Support 18815 j 115,000 Appeal letters spring and fall 20,000 Individual donations 20,000 Fundraising event income 75,000IF7� Foundation Funding 90000 197,693 Atkinson 7,500 Callison 10,000 Palo Alto Medical Foundation 10,000 May & Stanley Smith 50,00() Woodlawn 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 State General Fund 27,76'3 Measure A 111,632 CDBG San Mateo i 14,501) CDBG Redwood City 51 000 Other City Grants 3,180 Health Care District Funding 85000 90,000 Peninsula Health Care District 50,000 Sequoia Healthcare District 40,000 L Interest Income 80000 80,000 Other 99796 Total Revenue 672613 956,896 Development/Marketing WEEM= now rf oil 16,00Q OMBUDSMAN SERVICES OF SAN MATEO COUNTY, INC DRAFT BUDGET FY 16/17 Total Revenue Development/Marketing 953,716 969,622 / ,,, � / iii i , , � i/ , i riding Mills Peninsula Health Services Direct Public Support ��;Appeal letters spring and lei 071111*10.1111111111111111 Fundraising event income foundation • . �� - -- •.• -� New Foundations • • Government 4 .. •• MC Title 11113 I - - SIVIC Title - LVA - Special Dep• -��- -I SNF Quality Assurance State General Fund �!- CDBG San Mateo CDBG Redwood City Health Care District Fund ing Peninsula Health Care District Sequoia Healthcare District Interest Total Revenue Development/Marketing 953,716 969,622 ME= Grant Writing Special Event - Fundraiser Appeal spring and fall Marketing Supplies Printing & Reproduction Employee Expenses Employee Expense Direct Payroll & Bonus Benefits ER Taxes Workers Compensation Educatiox, A # Bookkeeper Bank Charges Directors and Officers General Liability I'Le-N-VA M- Office Supplies Postage and Delivery Telephone and Internet Program Expense 11 Corporate Registration Special Projects Alzheimer's Association Random Act of Flowers Music and Memory Consolidated Community Funding Application Redwood City, San Mateo County, and S. San Franc!sco Application for New Funding for FY 2016-17 GENERAL iNFORMATION 1. Organization Name: Health Mobile 2. Project Title: Dental Care for Children are appillyfing foirfund�hngfroirn:: E]RedwoodCi _ FlqtyofSanMateo 0 South San Francisco El 0 12 Wo =o- # F J no 0 • I Grant FundeSLr_ra�ms.- We are applying for a Public Services Program I t 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 onsde comprehensive dental care to low-incorne children at participating schoolsites. We provide care to children efigUe for free lunch. Participating schools screen children for free lunch. '0. 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 Address: 1659 Scott Blvd # 4 City: Santa Clara Zip: 95050--4172 Organization Phone: 408-879-0110 Website: www.healthmobile.org Type of Applicant: Our agency serves: 5. Contact Person I Project Name: Mike Reza Title: COO Telephone: 408-879-0110 Administrator: Contact Email: mike@healthmobille.org Fax: 6. Name of Agency A Parhizkari Director: 7. Fiscal OFicer: Name: Mlike Reza Fiscal Officer 1659 Scott Blvd # 4 Address: Email: Telephone: 4083905893 irnike@healthmolbille.org ' City: Santa Clara Zip: 95050 4172 Email: Telephone: 408 390-5893 irnike@heaithirnobile.or-g City: Santa Clara Zip: 95050-4172 W-M • �. 9. Please provide days and hours of regularly scheduled operation- Mondays through Fridays from 8:30 am to 2:30 prn 05M - Health Services U�=, 14. Timeline: Provide a brief timetable for nic��l your funds in a timely manner by the end of the fiscal year. September 2016: Dental assessment of students November -December 201 up dental check-up proposed project. South San Francisco School District is schools. immulei UY inul,;�&J, -[s. rxerer o ne an a ateo ounty -a Income Limits. 19. Pro ect Beneficiaries uantiflable Measgrerrij _Ji ligIgN JJW Ain V"U ntmDel Vi 11151,1,luuals. KeTer to the ban mateo-County Inco-irt,e Lirtits. Ingiiate the total num er 9 iwtf-iao�, be Qw"v fal ni $J*J1 14t� 14 LIP] IN Lei Ell 11 N I I &O]w K*V,'Z5T9OTffr;11;249YAns A- C"ity Data Services - South San Francisco Page 3 of 4 M. Jurisdiction I 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: 2. Use the demographics fromyour previOUS Droaiw, Mear to grovivP-9 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 sltes. We select schools with higher number of minority students. We go where the patients are, oil TM=IMdWIU fuHfla E5 um I Major Mainricia su Nfischments W 1. Resolution authorizing application and designation Board authorizqt�ion 2015.pdf of signatory, by the Board of Directors 5. Board roster, including: Healt�, Mobile agard Member 2ol5.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 7. Certified financial audit no more that 1 fiscal year No need for A-133 gqditpdf L _ old, prepared by a CPA, and: 2014 UM_ * Current (FY15-16) Agency Operating Budget * Proposed (FY16-17) Agency Operating Budget • Mission Statement MISSION STATEMENT.doc 10. Non-discrimination policy for Staff and Clients nondiscrimination__p2�� 11. Reasonable Accommodations Policy for Staff and Reasonable Accommodation Clients I - TY-MY9F0rF' please indicate when you will submit) El 13. Other Download All Attachments Program Manager Signature Mike Reza Date Signed 01/26/2.016 Initially submitted: Jan 26, 2016 - 15:09:45 r^s. « � !I!++- • 4a- 4 — n+/ -4 - 11 -+ /-, .. '1 'l 1 15---1 ..In , . I Ap?n'n P =s __ Health Mobile 2015 Budget Revenues 4,200.00 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 Revenues 4,200.00 Fedral Grant Mobiles 785.00 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 .., Application GENERAL iNFORMATION 1. Organization Name: By ofech Partners 2. Project Title: Bioteoh Partners" (Biotech Academy at South San Francisco ye airs applying for funding troiuiv ❑ Redwood City ❑ City of San Mateo ® South San Francisco ❑County of San Iu. get/Client Su�nsrnary (Auto - populated from Budget, below) R Jurisdictions Amount % of Program Proposed # of receiving this application Requested Budget Served f % of Served oath San Francisco°Q,t1Q0 39 0 / 7_ Inn ®/ Grant Funded Programs: We are applying for a Public Services Program COBG National Objective Eligibility - How are you serving low income populations? Service to low income clients verified through income documentation. Per 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 tip to 75 11 th -12th grade low - income youth of codor Mh intensive academe c bioscience training, along with reall- world, paid science-based internships in science settings as ri,Ung seruiors and extensive wrap - around support. Organization P.O. Box 2186 City: Berkeley Zip: 94702.0965 Address: Organization 510-705-5192 sit: Phone: www.Uotechpartners,org Type of Applicant: Our agency serves: S. Contact Person / Name: Lynda Gayden Title: Executive Director Telephone: 510 - 705 5192 Project Administrator: Contact Email: Ig eyel e i-i@tr,iote�rhpaml::rers,ort't Fax: 510- 705 -5237 6. Name of Agency Lynda Gayden Director: 7. O Fiscal Officer: Name: t:![rPna Atlrins Hadad Email: edna@rnosscpa.com Telephone: (925) 48482-26,,0 11101 Uyrnp k;13o,i evard City: Walnut creek Zip: 9459ta,507F http: / /www.citydataservices. net /citieslsmatcalapp20l 6arc.pl ?rpt =C4801 &prop =553 Page 1 of 6 2/1/2016 City Data Services - South San Francisco Page 2 of Fiscal Officer Address: 40. DUMB Number: 0303 953 Federal EINITIM Number: 94- 3171100 I L HUD Activity: Choose the HUD activity that most closely matches your service: 05H - ErnptloymeW Traiin Jng Beyond giving BP students unparalleled access to professional Ibioscience environments & career development opportunities, the Academy also teaches saft skMs (romrr^er,unr nfia n, time management, proper attire, etc.) that will mare students successful wi SSFF1 students struq?Ile with STEM content and cdtege preparedness. Among 11th graders iin 20113-14, ornd 11/6 proficiency or better in Biology au rd aWrnnragly, only % ar fn eyed proficiency in Integrated Science 1. IMore broa0y, Less than half of seniors (13 %) tootle the SAT in pre I,parabo n for post sr, condary enrollment (CA Dept of Pd, via greatschootls.com) BP has hound a high derrnand for our pmrrograrnrnong at SSF high school among our target population of Iloweir- income students of color. BP had 100 applocants for the 1st 'I 1tti[ Grade Biotech Academy class. Among the 100 students who applied, 65 are Latina and all come from draw- incor ne famMs, in 2016 -2017 BP expects to be at Ml enrollment at S SFH with two 1 1'th grade and one 12th grade class for a toW of 50 students. SP knows of no other local programming providing the same ser 14. Timeiine: 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" pro jrarrn is underway at Goufh San Francisco High School. At the beer nning of the grant penod, students wM be immersed in theiir irnterrnsNpG w tln nr judged poster presentation and cetlebration at the end Of Ihr, snuirnmer. During the f.uur°orrner, Biotech Partners wM provudr SSIF tcacpoers with training in IdP's curriculum and industry practices, hi f0 2016, BP's Biotech Academy at SSF wnll frautwe two juurur,'a year Bl otw„ ch 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 & EvW uahon ® 90% of students wM& o successfultly connpiete the Ai nior year &ote.ch 1 & 2 courses o elect to participate in surn mer PnternsNp s _ rw 1 ' ��1 �s ' t. r 1 City Data Services - South San Francisco Page 3 of 6 80% of participating students will) successfully ce,'umpllete their, internships and 70% of students wind continue Unto senior yew lNotech 3 & 4. I "o evaluate prograumnrahc success, tip°: t °racks student enrollment, gr ade!s transcedpts„ internship /co -op job placement and completion, and graduation; and farrnully dernographics: racy;, eatlrnidty, f arnlly kicome and t «am0y1guardiian (level of education m Lases student, tear he and rnentor suape visor evaluations to measure levels of academic and yob performance and satisfaction - (Evaluates job peuferrraruaruce lhroughi ,ute visit observation and mentor /intern interviews * Conducts surveys pre- ju.urw w year„ pre and Post intemship and post senior year Conducts perfomrr„ance reviews and e.valuaatians of internship and co....op.Vob performance Regular cuir6culla.urro rev ew conducted by aMacade;rnics and industry professionals to ensure that the high school classes meet industry skill and knowledge reeuteulrernents. 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 cl' pro..Farrnrll aft rsraCCEr SS impacting thousands of young people in l3erkeley and Oakland, (Biotech Partners is now in the midst or a significant rxpar�r;oon lei 2018 -2010 we launched our Motech Academy prograrn at South San Francisco and Antioch I °Iigh Scho6s and in 20E6 1 f were wi &B be i'aaunching at San IMarin Ilsigh School in Novato and Making Waves Acaderny in Richmond, along with piloting an expansion at Oakland Technical High School to incorporate t 0th grade Chemistry into the Biotech Academy. Local funding and pnvate pwtrar.re (rip are essential to our program's success. CDIBC support wceli help sustain our crtficaHy our ortant Pro n at(S ordin ato rose tion which works onsiite at SSF I °Sigh School, and will support l31P in expanftg our program to � d. Include the senior year (Biotech 3 & d prcag� a�arrvning, and finally, will help us add a second junior class, based on the high demand for p g . g 18. Project Beneficiaries /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. 19. Prcrect 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. a. Number of low - income beneficiaries b All beneficiaries to be served per .i.�risaiction to be served per grant jurisdiction P application. —Low- income"* is 80% of E grant jurisdiction application Area Median Income or below. regardless of income Persons Persons - Daly City http:// www. citydataservices. neticities lsmatcalapp20l6arc.pl ?rpt =44801 &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..4frirrs12tive Outreach: a. Use the demographics from your previous program year to provide an analysis of the population you serve relative to the demoaraphics in the tahip Race & EthnlcigZ 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% 1 0.00% ite and His anic 21,6451 34.02% 2 20.00/ sian _23293[_ 36.61% 5 50,00®/ frican American 1,6251 2.55% 0.00®/ acific Islander 1,1111 1.75% 3 30.00® ative American 39 0.62% 0.001, ther 9,5981 15.08%1 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 imentioned above, for our inauu guuraC year, we had over 100 applicants, Al...11... from our target dernogmphic of lower- i�t"ud��2 me yon f�, of color, including 60 t rani -, a yu�uurag worrwaM! friar target audience is well understood by our part�nefirig South Sari V raancisco Higd Bchooi administration and they w'ory, wqh us to idwitify 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. IBS otech V:Iartners has received expans; on grarft from TK II:' :oundation and Toyota USA t~ oundataurn„ both of $100,000 per year for three and two years respective ctive y, BP rb in the first year o'fthe 1X funding and in the second year of the Toyota USA funding. y ho' „ei; funds are ailocated ac: oss the* four schools to which we are expanding, with a portion allocated to our work lri South San G'�°r'arrodsco BP has received 7.55 f'rorn ftue Atkinson Foundation and 10k 'frorn Genentech for our SSI::: tfigh School work and we have proposals pending wu h the KirnbaH Fou.undafian ($10k for BBV) and the Berigier Fouridal:ion ($2040. BP also has an active, tfoard of V. :girrctors and individui aN avd major donor prograrn which will contribute some amount of unrestricted fundiing to the program. i lowever, public supfpmt is a Wary eVe irr ent of our program's success at existing sites in Berk0ey and Oakland, wherw:,n w 've received origoing public support for both prograrns, inctuuding Cl:)BO fundBng from the City of Berkeley for many years. Staft Ust List helow kev staff mPmhars whn wnrk nn this nr^nr- Position Title Name of Staff Person - Job Responsibilities p Qualifications ions organizational aaer f i Executive Director Lynda Gayde n oversight, rr'�Wf oriish p development decades experience inno ru- profflrt and isuin nd ublic sector management ernent, internship ��ormer teacher and scficoW Prograrn hector Kenneth Purser teacther` ti "aining, overall dlrr8ini �ti'�tor wrti,b experieP'ace it, . ram, eirsi fit �on'�'' iiro'fit rriia`Ana ernent Program r9 ariager` f491a he G R'4" r4 pport, dm! °ea'k students SSW �nr0i many year"; xp�' P@¢; ince 4PVC9YV n,cj Mth BIf 's �yl Cbk1 and Vnfi�,r�erPfrGkill target p,1puiaf ion tons 1::. ro °aril Coordinator fe ruunr t' earnuc.a g i i �fn... " VabMas�nlistanoc graduate of G )C Be:rkeiey M0 anc d srnali rou tutorin BA in inte�arative 1133 logy h4: / /www.citydataservices. net / cities lsmatcalapp20l6arc.pl ?rpt =C4801 &prop =553 2/1/2016 City Data Services - South San Francisco PROPOSED PROGIZAM BUDGET FOR FY 2016 -17 Att ,chiments 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. PJ 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 IM t s Biotech Partners - 2016 - 2017 R iected Orc� Budcets - SSF QDBC.odf BP Kssion Statement. df 13101@a fr Partners - Non - Discrimination Polic . df BP - Reasonable Accommodatignq Poligy for Staff and Clients. df ® 12. Conflict of Interest Policy. (If not � � ui;9::i. San Francisco 32015.odf available, please indicate when you will submit) © 13. Other - SSf° .-BP MOU x z Page 5 of 6 http: / /www.citydataservices. net / cities lsmatcalapp20l6arc.pl ?rpt =04801 &prop =553 2/1/2016 South San Francisco Total Jurisdic'dons Budged Line Item Agency g=PFTogram _ % Req uested Pgm% Requested abor Executive Director $137,02 5% $6,851 0 °/ 1 0°/ Program Director $86,27 20% $17,2- $5,00 29®/ $5,00 Program ana er. $67,95 25% $16,98 29®! $5,00 290 $5,00 Pro ram Coordinator $44,8001 97% $43,25 46°/ $20 00 46®/ $20 00 Taxes/Benefits $127,45 18% $18,550 36 °! $9,50 00/ $ u lies Student a es J $77,85 5` %F r1 $13,72 58 ®! $5,00 145 ® / 5$00 Student Support and $65,00 $3,45 $2,00 $ ervices dministration $202,604 3 %e $6,91 51®/ $3,5 510% 350 TOTA $808,96 16% $126,98 39% $50,00 39 °/ $50,00 umber of Individual Beneficiaries 7f, 7 ost per Individual $666.6 $666.6 Att ,chiments 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. PJ 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 IM t s Biotech Partners - 2016 - 2017 R iected Orc� Budcets - SSF QDBC.odf BP Kssion Statement. df 13101@a fr Partners - Non - Discrimination Polic . df BP - Reasonable Accommodatignq Poligy for Staff and Clients. df ® 12. Conflict of Interest Policy. (If not � � ui;9::i. San Francisco 32015.odf available, please indicate when you will submit) © 13. Other - SSf° .-BP MOU x z Page 5 of 6 http: / /www.citydataservices. net / cities lsmatcalapp20l6arc.pl ?rpt =04801 &prop =553 2/1/2016 BOtect Parblers CLonffict oLlUtgr st EgiJipL.pcit Biotech Partners - 2015 Determination Lefteir. f IBP AjLr,!es of inc.24f _Ley, 1 -27-QI._pAf Download All Attachments Program Manager Signature Lynda Gayden Date Signed 02/0112016 Initially submitted: Feb 1, 2016 - 15:22:15 Page 6 of 6 http://www.citydataservices.net/cities/sm,atca/app20l6arc.pl?rpt=C4801 &prop=553 2/1/2016 Year 2016 Org 20170-9 11 Budget Budget • •1• 1r1l - 0 INN ---Meetings Mileage & Transportation Bank Charges General & Administrative Expenses Contract Services Supplies & Equipment Accounting, Audit, & Tax Dues & Subscriptions Other Contract Services Postage & Delivery M-0 M, UMEM 3:1W Marketine Occupancy ITITO I F.Mffl111 • •1• 1r1l - 0 Insurance Bank Charges Contract Services Accounting, Audit, & Tax Grantwrit;,ng Other Contract Services M-0 M, UMEM 3:1W Occupancy 00 OWE �_ f . , I M Tetai Projecied Surpius (Deficit) 1/26/2016 City Data Services - South San Francisco !%tq#U" NEER M, ima GENERAL INFORMATION 1. Organization -Name: Center foir lndependence of Individuals with 1'. )isabififies 2. Project Title: Housing Accessibility Modifications (1-1AM) are applyingfor funding from: -1 Redwood City -' City of San Mateo e South San MIM1.1i =1 lwm�l Qr1nJ Funded ProglELm& We are applying for a Minor IHome Repair Program �iy WAQ= CDBG National Ob*ecfive Eligibilily - How are you serving low income populations? Service to "presurned benefit" groups listed bellow (income verification not required, but verification of presum 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 AdUk Migrant farm workers I 3. Project Address: 2001 /inward Way, Suite 103 City: San Mateo Zip: 94404-2499 4. Provide a one sentence project summary: 1'he Housing Accessibility Modification (IHAM) 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 Websill http:itwww.cidsanmateo.org/ Type of Applicant Our agency serves: S. Contact Person I Project Name: Donne Reed Title: Telephone: 650-645- Administrator: 1780, Ext. 113 Contact Email: doinnar@,cidsanmateo.org; Fax- fisah@cidsainmateo.org 6. Name of Agency Director: David DeNola http:/twww.citydataservices.neVcifies/Smatcalapp2Ol6arc.pl?rpt--C4742&prop=26 M. httpJ/www.citydataservices.rL-Vcifies/Smatcatapp2Ol6arc.pl?rpt--C4742&prop=26 216 &wNd Areas: A01 residentiall households within the South San Francisco city hirnits that are Ilow, very Ilow, and extremely low income level. 'South San Francisco (city) QuickFacts from the US Census lBuireau.' San IMateo (city) QuiclkFacts from the LYS Census Bureau. IN.P., n.d. Web. 21 Jan. 2016 Income Limits. ekerer V tne San F I ateo Coul 19. Proiect Beneficiaries/Quantflable Measurement: I ;gWale W WW" —1WAIrA ine ban aiateo Cou Income L!MitSL I a. Indicate the total number of low4ncome beneficiaries you expect to serve with this program for each jurisdiction application for funding. *Low4ncome is 80% of Area Median Income or below. aggAMLtgtk b. Indicate the total number of beneficiaries vou vmnct to i -q, n . . i--i - - are not considered "presumed benefit" by HUD, and require income verification. Persons exiting incarceration OEM== http:/Mww.citydaWservices.nettclties/Smatcalapp2Ol6arc.pl?rpt--C4742&prop=25 No IWKIIN L mm r previous proqram year • DrOVide a-F alralvsis of fta nvnidot47 vv,, M 1 " 0 ♦ 07-=rm ll . 0 I T"Vo' 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: lBased on the statisticall analysis of people served by CIII) and race and ethnicity avprage of each city (Redwood City, SSF, and City of San Mateo, additional outreach needs to be conducted in the I-fispanic (non white) and Asian communities in W11 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 lRehabiliitatiion (DOIR) revenue. As of date, we have already allocated funding from DOR to help fund support staff to hellp coordinate the modification of jobs, contractors, biffing, and additionall administrative duties associated with the HAM program. below key staff members who work on this Prourarn Position Tile Name of Staff Job Responsibilities bff Person las Qualifications n R Order Lisa I M pro iM�strator Lisa IHeath oorddination of all HAM projects Background in Administration ,M Manager ITsgereda Andarge JiFiscall Management entire organization 1113a - ckg - ro . und - in Fiscai PROPOSED PROGRAM BUDGET FOR FY 2016-17 http:/Aqww.citydateservices.reVcifiesismatcalapp2Ol6arc.pl?rpt--C4742&prop=26 416 G n. =. For the Citv of Redwood Citv ONLY a-T, Q;� City of San Mateal Mateo 0 Franc;sco I Total Jurisdictions 1. Funding Criteria: 1. Affordable Housing: Acquisition of sites for affordable housing, new construction of affordable housing, conversion of existing housing to affordaNe, acquisition and rehabditatilon of rental housing (iincludes special needs housing). PI . Markefing/Adverdsing ;�7,- C'mck all n�-GA fal 4we hIN Flyers/brochures Website Outreach presentations to public W PSA's b. Which of the above marketing/advertising materials are available in multi-langual forrn 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, l ifipino, Spanish, & Arabic c. How and where are the materials distributed? http:/Awiw .cod ataservices.neUcites/smatcalapp2Ol6arc.pl?rpt--C4742&prop=26 516 ,W 8. The following are required: Current (FY15-16) Agency Operating Budget Proposed (FY16-17) Agency OperatinS Budget 9. Mission Statement 10. Non-discrimination policy for Staff and Clients 11. 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OFganization Name: EI Concilliio of San Mateo County 2. Project Title: Peninsula IMilnor i lome Repair lye are alipplyingfor funding fron ,' Redw d, City Sa (Auto- Jurisdictions Amount receiving this application J Requested roWrl Mateo $ South San «71 , =0 Grant Fupdgd Prograrres: We are applying fora Minor Home Repair Program It'll OIAoi-1 COU How are you serving low income populations? Minor home repairs for low income households whose incomes are verified, 3. Project Address: 1419 Burlingame City: Burlingame Zip: 94010••123 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 Iprograrn 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.ei- concifio.com Type of Applicant: Our agency serves: S. Contact Person I 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: •.L. Minahan Email: Telephone: 650-373-1099 http:/Avww.citydataservices.neVcifoes/Smatcalapp2Ol6are.pl?rpt-- C4746&prop= 117 1/9 Fiscal Officer Address City Data Services - South San Francisco ft i nahan@ yahoo, corn 1419 Burlingame City: Budingame Zip: 94010-4123 Avenue, Suite N Name: Ortensia Lopez Email: oirlOsia@aol.com Authorized Signatory Address: 1419 Burlingame City: Burlingame Avenue, Suite N 9. Please provide days and hours of vegularly scheduled operaflon: Monday through Friday 9AM.-•5PM axj Telephone: 650-373-1080 R-INNA92w, Ii. HUD Acedvity: Choose the HUD activity that most closely matches your service: 05 - Publir. Services :/ .cityd ervi .r citi /sm ca/ 01 rc. ?r -C 7 117 219 utility bift, which in turn hellp to provide economic opportunities by provi6rig discretionary funds for farnifies who are econornicW y disadvantaged.. Of City househoWs, 44.2% speak a non-Engfish Hanguage, making PIKHR's mullflfinguW (English, Spanish, Chinese, "ragabg, Tongan, Russian) and cufturaHy-sensitive staff a great asset, j�-Axr f 1. � describe how If-M "RIAr l[QWMIW - - 6 -1 A All UNA IN 61111A 46AWW"- 11 L;jAll Fm L:�iy�j k'A I i� lahlaWmal" http:/Mww.citydataservices.rL-Ycifies/Smatcalapp2Ol6arc.pi?rpt--C4746Wop=117 3/9 IFY15-16 IPMHR program goalls are, provide cost-effective home repairlimprovements focusing on home safety and energy conservation through weatherization increase awareness/participation of ELINWIL.1 minor home repair prograrns provide "Green Job" opportunities through job training, internships and phacement of residents in PMIH R r0ated trainhng/emp0oyment The success of PIMHIR wiH be measured by: • # of homes receiving repairs that wHI improve home safety and cornfort • # of ELII/VLUU homes with PMHIR complIeted enabfing IF quafification # of trainees who Warn skiff that make them job/certification ready Abdity to compWe repairs witNn budget and timefine IM MdMT MT7771 17 M11 7- b. All beneficiaries to be served per Jurisdiction L M.!:��jjjj L I V I grant jurisdiction application regardless of income �M ."Op:/Awm.citydataservices.reVcities/smatcalapp2Ol6arc.pl?rpt--C4746&prop= 117 419 LOM .. 19. Populations Semed: Check the boxes below if they describe a significant population served by your program. These cstyoiam Persons exiting incarceration L - income youth Other ELINLII /l..1 20. Attirmative Outreach: 4 , r�'T1':.iZT.1 4 KE _ R f • .f f r .f • W We continue our on -going collaborative work with (Rebuilding Together Peninsula, San Mateo Energy Watch, HEAP, collar 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 xallud y IRecursos in San Jose, 10/21115, 11/16/15, 12/6 &12116 Food Distribution in (Half loon (gay, 10/23/15 Housing Leadership Council and 10/31/15 (Homeless Connect. We will continue outreach efforts and partnering with CIBO "s and government entities to increase the visibility of the PMHIR program for ELI /VLI /LII residents.. 1. Leveraging: Describe your fund (sing 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 ED:aMC for the past 11 years, providing us with extensive experience in reaching EUNLII /ILi 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 ELIINILI /Li residents (including in their native 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. PROPOSED PROGRAM BUDGET FOR FY 2016-17 hftp:fhvww.citydOwervices.reVeities/smatea/app2Ol6arc.pl?rpt--C4746&prop=117 6/9 l City Data Services - South San Francisco 1. Funding Criteria: 1. Affordable Housing: Acquisition of sites for affordabie housing, new construction of affordable housing, conversion of existing housing to affordable, acquisition and rehabilitation of rentall housing (iurokua es speciiai needs housing). . Which of the above marketing/advertising materials are available in multi -1 n u l form and which languages are they available in? FCSII C currently has flyers available in English, Spanish, Chinese, and'Tagallog. c. How and where are the materials distributed? FCSMC staff informs local agencies of our services including the P HR 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 Ihow to access program services. hftp:IANww.citydataservices.neVcitieslsmatcalapp2Ol6arc.pi?rpt--C4746&prop=117 7f9 9 =� ® Name, Company, Years on Board * Meeting dates for previous 12 months * Number of years allowed for each board term Attach I El q 0�6 6. Organizational chart for entire organization ��' 7. Certified financial ECSMC AUDIT REPORT FYE_&�30�-Udf audit no more that 1 fiscal year old, prepared by a CPA, and: ,A-,' , 8. The following are ECSMC OPERATING BUDGET FY 15-16 FY 16-17.xlsx ,equired: • Current (FY15-16) Agency Operating Budget • Proposed (FY16-17) Agency Operating Budget ��? 9. Mission Statement 10. Non-discrimination po!icy for Staff and Clients , 11. Reasonable Attach 11 Accommodations Policy for Staff and Clients 4' 12. Conflict of Interest Attach 12 El —COWHO COnfliet Of lnter!aLP--0liQY-Q—df Policy. (if not available, please indicate when you will submit) 13. Other - Download All Attachments Program Manager Signature Kristy Camacho http:lAwAv.citydataservices.i,eVciOeslsmatcalapp2Oi6arc.pl?rpt--C4746&prop=117 8/9 1/25/2016 City Data Services - South San Francisco Date Signed 01/2212016 Inkialy submitted: Jon 22, 2016 - 13:05:08 http:/ANww.Citydataservices.net/cities/Smatcalapp2Ol6arc.pl?rpt--C4746&prop= 117 9/9 .A, z D 0 U Ov Lo Q N Q N U H , W 00 0� J CO U z O U J W mm 5t, 41-pudIA.V FA' z n 0 U 0 Ha Q N � M Q N U H LL W 00 Oj J CD U z O U J W 1/2512016 City Data Services - South San Francisco Application for Now Funding for FY 2016-17 G E W LE �,2,A L IW F O �T➢I�h! 1. Organizavort'Hame: rebuilding Together Peninsuis 2. Project Tilde: National Rebuilding Day - Hornie Rehabilitation Program are applying for fun ✓ Redwood City i4 Budoet/Client Su receiving this application San Mateo 10 South San Granif nded Programs: We are applying for a Minor Home Repair Program et, below) R "ME1111p W i I TIRAN 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, r ace/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 orrace/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. WRITIMTW �7711 Project Administrator: Contact Email: INA I V wig 0�� Name: Cad Pang Chen Cari@RTPeninsula.org Fiscal Officer 841 IKaynyne Street Address: 8. Authorized Name: David Cattivera Signatory: City: Redwood City Zip: 94063-3000 Website: www.RTPeninsula.org Title: Associate Director Telephone: 650-366-6597 x226 Rml�� Email: Telephone: 650• 366-6597 David@ RTPeninsuh. org City: Redwood City Zip: 94063-3000 Email: Telephone: 650.366-6597 David@ RTPenms ula, org http:lhvww.citydataservices.rL-Vc'ifieslsmatcalapp2Ol6arc.pl?rpt--C4758&prop=36 IR 10. DUNS Number: 11-399-5612 Federal EINITIN Number: 94-3106209 T,LNW"t* � � . . I 'V& 14A - IRehab: Single-Unit Residential 12. Project Specific NauTative. Provide a narrative description of the specific activities to be carded 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, IRTP requests funding -froirn each of the Consolidated Community Funding juilsdictions. This funding will be used specifically for eligible building materials and supplies for National Rebuflding Day (NRD), which is scheduled for Aprill 30, 2016 and any additional projects completed prior to the end of fiscal year 2015-16. nb 9;PT =I. Lem 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. AdditionaRy, because we conduct site visits for alll income-digiNe applicants, we have a strong sense of the housing stock in city hrnfts, and are able to cross refer clients to other agencies based on the specific needs of each individual. IS. 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 irrionitor projects as each unfolds, scopes of work are created for each project, lEach home and homeowner has a different set of needs, but certain safety repairs and home modifications are prioritized by elect. For example, RIFF 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. R"I"P requests post-project surveys from homeowners, volunteer 6aders and general volunteers. Combined, this information can be powerful both in terms of impact, but also in terms of enhancing our programs. I geodun Income Limits. 19. PrAct BeneficiarleslQuanfiflabie MeasureTreS I-irdigge t1ri PTI Income Limits. TFY4-6—�53. HIM-FOr UY 1no1TWJ-85—.&Mer to ine ban diated Coul =fcate the total numf' r • ; I 5rOT-diTTJT*WftK*=[K*T��. *Arm, to be served per grant jurisdiction b. All beneficiaries to be served per application. "Lowmincome" is 80% of grant ju6s1 iction application Area Median Income or regardless of income below. '*P:/Mww.c7itydataservices.neUcifies/Smatcatapp2Ol6arc.pi?rpt--C4758&prop=36 Y7 M O FTi 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 her �MJw-rFj7j,TI oMRTTI IMMIRI [oil fli.1 0 IN _h�ediwood R F-I I. ". Race & Ethnicity Pog)ulat ion lk, 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 R'T1FI serve to attract any and all iincomL-quaiified homeowners in need of our free repair services. RTP: targets outreach opportunities at food distribution events, senior health and welliness faiirs, and senior and community centeirs, 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 foffnall outreach plan and use the data above to ensure, we are reaching all populations throughout the county, RTFs biennial Dreams Happen Gala & Playhouse Auction is one our most important fundraising activities. With support from the hftp:/Mww.citydataserVices.reVcifies/Smatea/app2Ol6arc.pl?rpt--C4758&prop=36 417 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. USt below Key start members who work on this arourar.,l Position Tide Name Of Staff Person i Job Responsibilities Qualifications Redwood City City WSan Mateo County of San Mateo 7+ years with RTP, Master's Degree, Associate Director Cad Pang Chen Oversight of all programs program evaluation at foundations, Program % nonprofit leader Program Manager, NRD Lydia Beltran Implementation and project Masters Degree, prior work with HUD, management of N RD affordable housi . Program Coordinator Billy Hoover Project file management, operational support, Bachelor's Degree, database expert, .—.— application review decade of nonprofit experience Construction/Warehouse Supply management and Bachelor's Degree, 7+ years of warehouse Coordinator Frank Hebscher technical support work, two terms with AmedCorps 02l0 $( Rebuilding Together $178,3961 41%1 Fundraising and sponsor 7+ years with RTP, Bachelor's Degree, Development Director nnef Aguayo relations extensive writing experience and $C1 011/4 sDonsorshio manaaement PROPOSED PROGRAM BUDGET FOR FY 2016A7 For the City of Redwood City ONLY, answer the following: For the City of Redwood City ONLY, answer the folloviring: 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 �' Website 4, Phone book listing 4: CIP (Handbook/Database) Outreach presentations to service providers id Outreach presentations to public PSA's http://www.ditydataservices.neVeitieslsmatcalapp2Oi6arc.pl?rpt--C4758&prop=36 &7 Redwood City City WSan Mateo County of San Mateo South San Francisco i0tal Jurisdictions Budget Line RE CY P gm% 1 I Program % Requested] % Requested Pgm% Requested Labor Staff $714,3001 362/® $257J4810%1 $102! 4 $01 01,1 0% 02l0 $( a e s 1 $178,3961 41%1 $73,13910%1 $01021 $01 00/01 $C1 011/4 0%1 $( a 'e n ials Rx Re air ir & Renovation Costs 1 $631,0001 40%1 $25E4�O $20,00 0% $25,00011000/4 $3 )0014,450%1 $89.0 vi Environmental Reviews 1 $5,0001 1 $2,0001 1 $2,0001 1 $OL 1 $2,00( erations/Maintenance p r a 0 0 r perations/outreach/volunteersi $142,45 $82,621 $01 1 $01 1 $01 1 $01 1 $1 I m n dministration I $125,174 0%1 $0 $1 1 $01 1 $01 1 $01 0%1 d TOTA[4$1,796,316i 37%1 73083%1 $20, 2V $25,0001 50/4 $34,0001221 $12,00 14%1 $91,00 Number Number of Individual Beneficiaries 51 21 1 ostj ost per Individual $4,000.001 $5,00aciol $4,250.0+ $4.000.001 $4,333.3 For the City of Redwood City ONLY, answer the following: For the City of Redwood City ONLY, answer the folloviring: 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 �' Website 4, Phone book listing 4: CIP (Handbook/Database) Outreach presentations to service providers id Outreach presentations to public PSA's http://www.ditydataservices.neVeitieslsmatcalapp2Oi6arc.pl?rpt--C4758&prop=36 &7 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 /T'agolog /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 14/16, the NRD program staff are pleased to report that all contracted goals were met. 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 ' 1. Resolution authorizing application and designation of signatory, by the Board of Directors i 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 d 7. Certified financiai 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 C3 laws and Procedres. f 4. RTP Articles of Inco oration„pdf 2015 - 2016 hoard Roster.doc i Kam-0111 0!,M iU" r ` 9. Mission Statement RTP ission Statement.doc 10. Non -discrimination policy for Staff and Clients 10. RTP on- discriminate -EO PolicX.doc d' 11. Reasonable Accommodations Policy for Staff and Clients 11. RTP Reasonable Accomodations Polic doc V� 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 1125(2016 City Data Services - South San Francisco LDownioad AR Attaphrrients Program Manager Signature David Cattivera Date Signed 01/2212016 Inkially submitted: Jan 22, 2016 - 14:11:16 http:IANww .city dataservices.roYc'itieslsmatcatapp2Ol6arc.pl?rpt--C4758&prop=36 7 'ricome 000 Foundations - Unrestricted �4005 Foundations - Restricted .4100 Fall Appeal & Nwsltr Donations �4150 Board Donations 4200 - Spring Appeal & Newsletter 4400 - Sponsorship/Renovation Income Government Funding A415 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 .4815 - Rental Income .4•00 Interest Income 4905 Dividend Income Inkind donations !Total Income Expense 'Program Ex.- t t - RT National membership 5025 - HO Outreach Expenses Materials, Labor, Svcs. ;110 - Roofing 5115 - Energy Efficiency Programs 5120 Site Renovation Site Related Volunteer 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 Warehouse stock :5160 - Special Programs 5100 - Materials, Labor, Svcs - Other Total 5100 - Materials, Labor, Svcs. 'Vollunteer Costs - AmeriCs 5305 f 531t f s& Appreciation ,5320 Youth Board Costs, Meetings ,5330 - Volunteer Insurance Volunteer Communication 'Total 5300 - Volunteer Costs rtl • r 110 I 11tig. 1=4 ,422,837 fill * 114 ftif E V, 1% N� MWA Llftr� ML-114 U#�� fill 52,5 11,985 149,2 Itl 16,2 27,8 75,375� 50,9 11 Ili 0111 411A 370,2 10 7 • L-W 0, i ia� • • IRMO, 79,1 11,985 41,3 Itl 16,2 75,375� 3,3 11 Ili 0111 1 334,7 •; 1,2 111 7,6 7,353 00 10r 11,4 5,197- 16,7 10 7 • L-W 0, i ia� • • IRMO, 11,985 111 Itl 5,024 75,375� 11 Ir! 11 Ili 0111 •; 111 111 7,353 00 10r 5,197- 1. 21,44G 26,616l 5,064 oil 53,126 1,204, 232 1,32411 101869i" 6,399 100 rrr off Page I of 9 5-46 | FY16-1/ vomm vW lee 40 VA 369 1 1 7,268 5-46 | FY16-1/ vomm vW 1. 1. 1� a am-Of ti 2,1 Page emo 40 VA 369 1 1 7,268 1. 1. 1� a am-Of ti 2,1 Page emo 1611711 - WTI. E 71,149- 62,258 MOM: 65,000 J;1 Il Actuals 11,0— 15 167�, 18,86d, 2,514 2:095C 2,4149, ol 1,413- WTI. E 71,149- 62,258 MOM: 65,000 J;1 Il Page 3 of 9 GENERAL INFORMATION 1. Organization Name: Rebuiiding Together Peninsula 2. Project Title: Safe at Home are applying for funding from: -0 Redwood City City of San to e out San Z= -Z Grant Eundqd-Erglgram - IL We are applying for a Minor Home Repair Program A p *' County of San Mateo 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 Address: Zip: 94063-3000 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 Address: Zip: 94063-3000 Organization 650-366-6597 Website: Phone: www,rebuii dingtogetherperiinsula,oirg Type of Applicant Non-Profit Our agency serves: S. Contact Person I Name: Chris Wahi Title: Program Manager Proect ] Telephone: 650 -366- Administrator: 6597 Contact Email: chriis@rebuilld'ngtogetherpeninsula.org; Fax, 650-366-9053 cad@rebuiidingtogetherpeninsula.org 6. Name of Agency David Catfivera Director: 7. Fiscal Name: David Cattivera Email: Telephone: 650-366 - r: davild@rebuildingtogetherpeninsula..org6597 http:ihwjw.citydataservices.neVCites/smatcalapp2Ol6arc.pl?rpt=C4717&prop=37 117 1/25=16 City Data Services - South San Francisco Fiscal Officer 841 Kaynyne St. City: Redwood h,Jty Zip: 94063-3000 Address: 9 to 51prn Available by appointment on evenings and weekends.. 10. DUNS Number: 11-399...5612 Federal EIN17IN Number: 94-3106209 14A - Rehab: Single-Unit Residential 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. Rebuilding "i'ogether Peninsula (RTP) preserves the supply of affordable housing for low income individuals and farriffies so that they can live more independently in safer, cleaner, and healthier environments. To accomplish this goal, R"TP requests funding from each of the Consolidated Community Funding jurisdictions.. This funding will be used specifically for eligible costs for our Safe at Flome program. In the City of San Mateo, RTP is the only organization offering free expert home repairs and safety modifications performed IlDrimarily 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 tile individual homeowners. http:lAkrww.citydataserVices.roYcifieslsmatcalapp2Ol6arc.pl?rpt--C4717&prop=37 217 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. 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 I"rancisco, 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. 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 worts 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 fail prevention in mind. We have developed an impact summary that quantifies the number of health and safety goals we address throughout our programs. RTIP 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. http:IANww.citydataservices.rieVclbesismatcalapp2Ol6arc.pl?rpt--C4717&prop=37 WIM, a. Number of lov.Mncorne beneficiaries Jurisdiction to be served per grant jurisdiction application. "Low-income" is 80% of Area Median 1-tco7Te or %a_kwv--- a grant jurisdiction application regardless of income 911 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 her 20. Affirmative Outreach: s. Use the dern raohics from %our grevi us n-wria-a vaor to nrovidp 9-t, !P T 1 0; 4MA " « 9 Race & Ethnicity �dc 11, f q n W b. as on the percentages that you indicate your organization served describe your efforts to improve affirmative outreach t o g roups 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-quallified homeowners 'in need of our free repair services. iR,rp targets outreach opportunities at food distribution events, senior Iheaith and wellness fairs, and senior and community centers, as well as partner with other nonprofit agencies to distribute information to c1lients, volunteers, and members, In the coming year, R,rp will also develop a formal outreach plan and use the data above to ensure we are reaching all populations throughout the county. http:/ANww.citydataserVices.noVelfies/Smatcalapp2Ol6arc.pl?rpt--C4717&prop=37 _41i Staff it List below key staff members who work on We Proamm PROPOSED PROGRANI BUDGET FOR FY 2016-17 1time RTP volunteer, 30+ years in ;truction, City of San Mateo CDBG ELI nsed contractor with 307 -years of arience I k 11 f 1 k 1. Funding Criteria: 1, Affordable Housing: Acquisition of sites for affordable housing, new construction of affordable housing, crAwersion of existing housing to affordable, acquisition and rehabilitation of rental housing (includes special needs bowsi nq), hdp*/ANww.citydataservices.roUcifies/Smatcalapp2Ol6arc.pl?rpt--C4717&prop=37 W, Job RespainsEbWfies Program Manager, Safe hris at Home Completion of projects Frank Tijerina projects mily Hoover PROPOSED PROGRANI BUDGET FOR FY 2016-17 1time RTP volunteer, 30+ years in ;truction, City of San Mateo CDBG ELI nsed contractor with 307 -years of arience I k 11 f 1 k 1. Funding Criteria: 1, Affordable Housing: Acquisition of sites for affordable housing, new construction of affordable housing, crAwersion of existing housing to affordable, acquisition and rehabilitation of rental housing (includes special needs bowsi nq), hdp*/ANww.citydataservices.roUcifies/Smatcalapp2Ol6arc.pl?rpt--C4717&prop=37 W, 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) Outreach presentations to service providers Outreach presentations to public ;d PSA's b. Which of the above marketing /advertising materials are available in multi - langual form and which languages are they available in? Rebuilding Together Peninrs0a (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 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, Laverne 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 i�. 2. Proof of 501(c)3 / tax -exempt status d 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 d 6. Organizational chart for entire organization 7. Certified financial audit no more that 1 fiscal year old, prepared by a CPA, and: CQBG Auth n ation df 2. RTP 501c3 letter- f 3. RTP_Bylaws and F?rocedres,odf 4. _RTP Articles of Inc° oration odf 2®15 2016 E3oard Rosterrdf RTPO Chart1.14.16, df RTP Audited FS FYE R.30.2014.rsdf http: /Mrww.citydataservices. net / cities/ smatca lapp2016arc.pi?rpt= C47178prop =37 1/25/2016 City Data Services - South San Francisc-,r 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.cloc 10. Non-discrimination policy for Staff and Clients 10. RTP Non-discrimination_PoILgy&df Reasonable Accommodations Policy for Staff and Clients 11. RIP Reasonable Accomodations Policy.cloc , 12. Conflict of Interest Policy. (if not available, please indicato when you will submit) I 13. (kker - Download All Attachments Program Manager Signature David Cattivera Date Signed 01/2212016 ---------- ----- . . ...... ------- -- - Inkially submitted: Jan 22, 2016 - 16:16:35 http:/Avww.citydaWervices.neVcifies/Smatcalapp2Ol6arc.pl?rpt--C4717&prop=37 V s �-q4g off s. 04 499, NOW 21,440 26, M' I 1.• 11 ------------- so 53, li of 1,204 232 1,3 10,869 6,399, =I Page 1 of 9 K, KOLI FY1 6-17 1122116 1XI RM X11 !1 367 M INEEKINTO in 11 ... . ... ... I_ ., , . - _1 Page 2 of 9 5570 - Equipment, Repairs & Rental 6,61151 4,900 1 6,474 571 - Software/Database/ROOMS 1,384:: 1,045' 2,163�, Nages, Benefits, Taxes '5710 - Staff Wages, Taxes & Benefits 491,130, 533,3641 539,1127� Total 5700 - Wages, Benefits, Taxes 491,130': 533,3640 539,1 2-T'j �5•05 Program Supplies 4,107:: 3,848 4,43) Postage & Shipping 1, 8 04 2,471 2,416� 5911 -Annual Report (Allocated) 5,082:: 5912 - Program Printing & Reproduction 2,0981 3,245 2 476�, .5913 - Program Professional Svcs. 4,783: 5,572 13:4021, �5925 - Building Expenses, Allocated 12,054:: 8,8041 110,543� �5920 - Telephone & Telecommunications 4,115" 4,7931 6,991' ,Tota; 5000 - Program Expenses 1,199,8981 1152-7,933 - ---------------- - --- 1, 183,141 i Operating Expenses �6010 - Bank & Credit Card Charges 4,835": 1,678 112,7831� 6015 - Investment Acct. Fees & Charges 5•": 6100 - Ofc. Equip., SNV & Furniture 68: 153 86 6110 - Equipment Rental 418:: 4581 751. 6125 Telephone & Telecommunications 356! 445 401 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 3,4091' Professional Svcs. 5,625 29,060 6276 -Accounting 40,5091 43,315 43,634 1280 - Recruiting Expense 480:: 615 23,5311 .)285 Subscriptions/Memberships 700 407 1541 Travel, Meals & Entertainment 6,223:: 4,662 8,553! :6325 Board & Staff Development 6,809' 6,230 7,268 .6500 Office Supplies 846:1 1,427 1,3001 Misc Operating Expenses - Other 485': 301 -109, ,7300 - Postage & Shipping 405 480 417 �7310 - Printing & Reproduction 42111 0 346 �Operating Wages, Benefits & Taxes �7510 - Staff Wages, Taxes & Benefits 65,834 76�,631 74,900 Jotal 7500 - Wages, Benefits & Taxes 65,834: 76,6310 74,900 7600 - Payroll Processing Fees 1,1821 2,614 1,353 7•01 - 403(b) Admin Fees 1,412: 1,4881 1,393 �7925 - Building Expense, Allocated 1,067: 9284 1,84-. Total 6000 - Operating Expenses 144,194;: 182, 1,85,497 -8 fundraising Expenses Fundralsing Wages, Benefits & Taxes '8510 - Staff Wages & Bonuses 145,855 126 , 881 'Total 8505 - Wages, Benefits & Taxes 124,777 145,855 126,884 8574 Equipment 1,198: 3,252 11,421 ;8576 Postage & Delivery 7,338: 9,097 5,864 Printing & Reproduction 2,7421 6,646 2,43S :8580 - Annual Report (Allocated) 3,388: 3,275 2,49! ;8585 - Membership Dues/Subscriptions 29 1,041 1,30' �8590 - Professional Services 1,6931 15,986 9,0w. 3593 - Supplies 354: 902 4N. 3595 - Telephone & Telecommunications 835' : 1,049 8•00 - Travel, Meetings, Entertainment 1,336' 1,421 2,1184 .8610 - Bank Processing Fees 0: K, KOLI FY1 6-17 1122116 1XI RM X11 !1 367 M INEEKINTO in 11 ... . ... ... I_ ., , . - _1 Page 2 of 9 Net Income MA511MULAAM Q=. ULM Actuals 11,0951 15 111 18,8 • 9' 2,514- 2:0 • 2478 11 1:473 MMMUM Mom, A 126 -14 16 UAPVMI Page 3 of 9 Application for New Funding for FY 2016-17 GENERAL INFORMATION 1. Organizetion Maine: Project Sentinel Inc 2. Project Title: Fa�r I iousing are aipplying for funding froirn.- -I' Redwood City -e City of San Mateo e South San Francisco e County of 111M I Gm,L&J FundetEM%MM We are applying for a Fair Housing Program 'rom Budget, below) I. L. V LA � E �d A Viol 11JtvIA V1;44 HY How are you serving low income populations? Service to low income clients verified throuoi 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 compllainant 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 BWd 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,,Ihousing.org Type of Applicant: For Profit Our agency serves: Persons 5. Contact Person / Title: Fair 1-lousing Project Name: Moily Current Director Telephone: 650-321-6291 Administrator: Contact Email: mcurreirot@lhousing.org Fax: 650-321-4173 6. Name of Agency Ann Marquart Director: 7. Fiscal Officer: Name: Andrea Ellhott Fiscal Officer 3180 Newberry Dr Address: Email: Telephone: 408-479-4117 andreaE@IheaRhtrust.org City: San Jose Zip: 95118 8. Authorized Name: Ann Marquart Email: Telephone: 650-321-6291 x 8100 Signatory: amarquart@housing.org Authorized Signatory 1490 Il l Carnino Real City: Santa Clara Zip: 95050-4609 Address: 9. Please provide days and hours of regularly scheduled operation: 110onday4: Tiday 9:00 AiM - 430 PM http:/A~.citydataservices.r*Vcifies/Smatcalapp2Ol6arc.pl?rpt--C4658&prop=25 11 iff"WK6 10. DUNS Number: 781326608 Federal EINITIN Number: 77-0266612 I!. HUD Activity: Choose the HUD activity that most closely matches your service: 05J - Fair Housing ActivitiesRubj.to Pub.Serv.Cap 13D. Assessment of Need - South San Francisco: Briefly describe how you determined then for your program fgr each _Rpec iurisdIctlonjhMt3MMJA2EMR, a I jfIc -RRR1X1njjff!ms!& Identify to 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 fight of all people and is a FlUD requirement for the receipt o f f ederal 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 wholle, protected populations, and housing providers. Services are also needed to assist victims secure redress from the harm of housing discrimination, http:/Ayww.citydataservices.neVcifies/Smatcalapp2Ol6arc.pl?rpt--C4658&prop=25 W i FX& ao 14. 7-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 l&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 acutOyr aware of time management and the need to plan and track time expenditures and to achieve reasonable contract goals: 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 all your agency to do that you may not be able to don . For Continuing Applicants — describe how your program would be impacted without these funds. 'The increasing demand for affordable housing and systernic displacement of low income renters from many areas of San Mateo County has placed tremendous pressure on the rental irrharket and the tow income renters in the County.. Without this funding our ability to assist these renters and ensure that tihey are able to secure and maintain housing would be compromised. a. NumBer at iow-income beneficiaries to be served per grant jurisdiction b. All beneficiaries to be served per Jurisdiction to **Low4ncorne** is 0° /® of grant jurisdiction application Area Median Income or below. regardless of income Persons Persons Daly C!1_ Redwood Citv '153 153 it of San at 110 110 Vounty n at o ut San a at ?13 )f o uth San Francisco 77 77 httpJANww.c'itydataservices.neticibeslsmatealapp2Ol6arc.pi?rpt--C4658&prop=26 3/7 1/25=16 City Data Services - South San Francisco 553 777� 553 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 II..Ml (persons residing or seeking it) reside in Sara Mateo Co and cities 20. Affarrnative Outreach: a. Use the demographics from your previous program year to provide an analysis of the population you serve relative to the demoaraphics in the table. NOTE: If you are a new annlicant n/ease nrovida vnur hart pstimatinn Race & Ethnicrty Redwood City I Population Redwood City % by Ethnicity Low Income by Ethnicity served b our Program ram % icity Total 74,40 100% 46 100% FE White and not Hispanic 40,65 54.64% 7 2.86 ° / and His anic 23,55 31.66% 152.38 ° / sign 6,71 9.03% 1 0.00% V/hite n American 1,91 2.58% 1 4.76% c Islander 66 0.89% 0.00°/ e American 3 0.52% 0.00 ° / her 1, 511 2.03 °k 0.00°x° 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% 46 100% White and not Hispanic 45,24C 46.54% 7 15.56% hite and Hispanic 25,81 26.56% 82.22 °! sign 18,15 18.67% 1 0.00% frican American 2,09 2.16% 1 2.22% Pacific Islander 1,93 1.99% 0.00 ° / Native American 14 0.14% 0,.007 her 3,82 3.93%1 0.00°/ Race & Ethnicity South San Francisco Population South San Francisco % by Ethnicity Low Income by Ethnicity served b our P ram 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 ° / In addition, we placed ads in newspapers serving ethnic communities: in Mandarin papers, the EPA'fioday, and the Manila Dail, the largest Filipino paper in the region. We made presentations in Spanish to irr migimnt groups. We conducted several workshops at IninVision Network transitional housing properties for chronicaily 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! - lousing idtiatiive Program (FHIP) for FY 2016 -17 to augment local CDBG funding. A rninimurn of $18,500 from the FHIP award will be provided for fair Ihrousing services conducted throughout San Mateo County.. We also provide some fee generating training programs for housing providers beyond those supported by Ilocal government contracts. The agency maintains over 40 contracts in Northem C0fornia which aII cornbVmd keep our overhead costs to a rnif,4i um httplhvww.citydataservices.net/ cities/ smatca /app2016arc.pl ?rpt= C46588prop=25 4/7 1/2512016 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 wo on We prograrn -------- -- "ame af Staff Person Job Responsibilities emor Fair Housing Jaqueline Ramirez Coordinator T MIR supervise and provide direct servi Mll -�Iadministers overall agency operatons WRy]Z4!T �,40`-IOGRAM BUDGET FOR FY 2016-17 0 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 Hum qMa[A,y of life, regardless of income. For exam*—amew of a volunteer program is an improvement to the quality of life, b. Which of the above marketing/advertising materials are available in multi-langual form and which languages are they available in? hftp://www.citydataservices.net/cifies/Smatcalapp2Ol6arc,pl?rpt--C4658Wop=25 919 Flyers:: Spanish, Mandarin, Vietnamese, Tagalog, and several other Asian languages. Outreach: We have a bilinguall staff mern1ber 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 rnafl, at outreach events, by Ikeeping a supply at places such as City Hall, public hbrades, the offices of cooperating agencies such as Legal Aid of San Mateo County, by posting at public bulletin boards at places such as Wundrornats and coff ee shops, and by tabling at community fairs and eveints, 3. Program Outcorres: a. Please describe the accomplishments of program goals for FY/15. Cases --- Redwood City Goal: 20 •- Achieved: 24 (120%) San Mateo City Goall 11 •-Achieved: 50 (455%) San Mateo County Goal 18 -Achieved: 25 (139%) South San Francisco Goal 8 - Achieved 8 100% TOTAL GOALS.- 57 TOTAL ACH IIEVIEID 107 (188%) Audits - Redwood City Goall 10 .- Achieved 8 (80%) South San Francisco Goall 2 .- Achieved 2 (100%) Outreach Goals for aill jurisdictions were exceeded by 388% Consultations arid 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/1 5: Housing providers wdi understand and operate within the law and homes kers 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 The 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. Affachments ,e. 1. Resolution authorizing application and designation of signatory, by the Board of Directors Proof of 501(c)3 / tax-exempt status 3. By4aws 4. Articles of Incorporation 5. Board roster, including: ,e 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) • * A letter from your Executive Director or Chief Financial Officer certifying that agency does not receive more than $500,000 in federal funds and is not subject to the Single Audit. ,t', 8. The following are required: 4 9. Mission Statement 10. Non-discrimination policy for Staff and Clients Iz Federal and State Tax Exemn PROJECT SENTINEL _Amepd2d_Bv- Laws 2011.130C P iLs of Incorporation 11-26-1990.pdf Board Roster 2015-16Rev. 12-12:15.docx Pa_AU0gLXX!5:1Q. , a PMggLed FY 1617 bud et. df Mission_Statement.pdf !Affirmative Action Plan - Non- http:lAwAy,c7itydataservices.noUciteslsmatcalapp2Ol6arc.pl?rpt--C4658&prop=25 W 1/25/2016 City Data Services - South San Francisco of 11. Reasonable Accommodations Policy for Staff and Clients aasc�nabte accommodation statement doc e -:� 12. Conflict of Interest Policy. (if not available, please indicate -C-0-nif i-c-t-o-f--tn-t-er-e-st--P-o-li-cx.d—oc when you will submit) 13. Other - DowHoad Alt Attachments Program Manager Signature 19orecita 'T"urnusok, Adirnin Assistant Date Signed 01122/20,16 Inkialy submitted: Jan 22, 2016 - 15:09:13 http:IM,ww.citydataservices.reVeitieslsmatcalapp2Ol6arc.pl?rpt--C4658&prop=25 V I-- LL � 'O h 0) C C .N .= o 'o ai C O =U C y O Z = It CD �i ^ 0 CD III +F, • LU o CL n 000 000000 cooco 000000 MI Oc o0000DC It v VNMMNC Co co r 7!" C V Q Y I VI EEC `` Tm 4 «` w r s i v to I Ln rn r- N im 1 4 ad C CD co N 1 9101 / co ci tm CD CD a CD C C ON Ti o 1 1 1 1 M 1 1 1 m 04 1 1 f- 1 C V Q Y I VI EEC `` Tm 4 «` w r s i v to I C U- 1 4 ad C C V Q Y I VI EEC `` Tm 4 «` w r s i v to I 1 \ 1 1 9101 / ci tm 0 Ti 1 1 1 1 1 1 1 N 'Cf f- 1 ' 0 T- 000ar*- ca IL.D ca O c C C C v. .® cc LL O C — C ' O `.0 vi `. O C ` O ` O C3 O ` ` o h C O Ir O Z MIL s+ h l Net surplus (deficit) 1_$ 110,952.00 government grants, foundations, training income and 7rojected Revenue: fees, settlements Expenses FY 161.7 benefits 1,553,312.00 .0 10 22,666.00 • .10 . . . . . . . . . . . . axes & Licenses 462.00 Lytililies 5,467.00 • udit Fees I of$ It - -------- I1 • g services I III If • 00 Dues & Subscriptions ------ - ------- - - - - - ---------------- A* 41 Telephone & Internet Office Supplies ------ ---- – 7,935.00 Bank & Finance Charges I1 • uip Maint 6,2-64.00. • II Equip Rental 9,180.00 +VIII Equipment Purchases 7,509.00 • II Lodging & Meals fIl Alb I Printing/Publications 7,8-94RT Outreach 12,000.00 Wolf Conf e–r–e–nde–ITr—ain i ng ; to 49,632.00 pepreciation Expense Presidio Rent FMV 20,764.00 Net surplus (deficit) 1_$ 110,952.00