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HomeMy WebLinkAbout2005-166A APPLICATION FORVersion 7/03 Y FEDERAL ASSISTANCE 2. DATE SUBMITTED Applicant Identifier 1 . TYPE OF SUBMISSION : 3. DATE RECEIVED BY STATE State Application Identifier Application Pre-application ConstructionConstruction 4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier Non-Construction ❑ Non -Construction 5. APPLICANT INFORMATION Legal Name : Organizational Unit: INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS Department: COUNTY GOVERNMENT Organizational DUNS : Division : 079-208-989 Address : Name and telephone number of person to be contacted on matters Street: involving this application (give area code) 184025TH STREET Prefix . First Name : JASON Cityy: Middle Name VERO BEACH County: Last Name INDIAN RIVER BROWN State : Zip Code Suffix : FLORIDA 32960 BUDGET DIRECTOR Country: Email : UNITED STATES JBROWN@IRCGOV . COM 6. EMPLOYER IDENTIFICATION NUMBER (EIN) : Phone Number (give area code) Fax Number (give area code) MKKE 0❑ © E ® 772-567-8000 772-567-5991 B. TYPE OF APPLICATION : 7. TYPE OF APPLICANT : (See back of form for Application Types ) V New F1 Continuation [7 Revision B If Revision , enter appropriate letter(s ) in box( es ) (See back of form for description of letters . ) ❑ ❑ Other ( specify ) Other (specify) 9. NAME OF FEDERAL AGENCY : US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 10 . CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER : 11 . DESCRIPTIVE TITLE OF APPLICANT' S PROJECT : o ® - oao S +C TENANT RENTAL ASSISTANCE TITLE ( Name of Program ): CONTINUUM OF CARE HOMELESS ASSISTANCE - SHELTER PLUS CARE 12. AREAS AFFECTED BY PROJECT (Cities , Counties, States. etc.) : INDIAN RIVER COUNTY , FLORIDA 13 . PROPOSED PROJECT 14 . CONGRESSIONAL DISTRICTS OF : Start Date: Ending Date : a . Applicant b . Project 5/01 /2006 4/30/2011 fs 15. ESTIMATED FUNDING : 16 . IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS ? a . Federal THIS PREAPPLICATIONIAPPLICATION WAS MADE 355 , 080 . 00 a . Yes . AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 b . Applicant PROCESS FOR REVIEW ON c. State DATE : d . Local b . No . PROGRAM IS NOT COVERED BY E . O . 12372 e . Other n OR PROGRAM HAS NOT BEEN SELECTED BY STATE 355 , 080 . 00 FOR REVIEW f. Program Income 17 . IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? g . TOTAL 710 , 160 . 00 ❑ Yes If "Yes" attach an explanation . _ No 18 . TO THE BEST OF MY KNOWLEDGE AND BELIEF , ALL DATA IN THIS APPLICATION /PREAPPLICATION ARE TRUE AND CORRECT. THE DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED . a . Authorized Representative C�(AIRMAN THOMASe Middle Name Last Name Suffix LOWTHER b . Title c . Telephone Number (give area code) CHAIR , BOARD OF C UNTY COM SSIONERS 772 — Signatur Author ed I�� e t e . Daate Si n d 200 Previous Edition Usable Standard Form 424 ( Rev . 9-2003) Authorized for Local Reoroduction Prescribed by OMB Circular A- 102 SURVEY ON ENSURING U. S . DEPARTMENT OF HOUSING OMB No. 1890-0014 EQUAL OPPORTUNITY AND URBAN DEVELOPMENT (EXP. 1 /31 /2006) FOR APPLICANTS Purpose: The Federal government is committed to ensuring that all qualified applicants, small or large, non-religious or faith- based, have an equal opportunity to compete for Federal funding. In order for us to better understand the population of applicants for Federal funds, we are asking nonprofit private organizations (not including private universities) to fill out this survey. Upon receipt, the survey will be separated from the application. Information provided on the survey will not be considered in any way in making funding decisions and will not be included in the Federal grants database. While your help in this data collection process is greatly appreciated, completion of this survey is voluntary. Instructions for Submittine the Survey: If you are applying using a hard copy application, please place the completed survey in an envelope labeled "Applicant Survey." Seal the envelope and include it along with your application package. If you are applying electronically, please submit this survey along with your application. Applicant' s (Organization) Name : _INDIAN RIVER CO . BOARD OF COUNTY COMMISSIONERS Applicant' s DUNS Number : 079-208-989 Grant Name : COC HOMELESS ASSISTANCE PROGRAM CFDA Number : 14-235 4 . Is the applicant a faith-based/religious 1 . Does the applicant have 501 (c)(3 ) status? organization? 0 Yes a No [j Yes No 2 . How many full-time equivalent employees does 5 . Is the applicant a non-religious community-based the applicant have? (Check only one box). organization? 3 or Fewer 15 -50 Yes No 4 -5 51 - 100 6- 14 over 100 6 . Is the applicant an intermediary that will manage the grant on behalf of other organizations? 3 . What is the size of the applicant ' s annual budget? Yes IB No (Check only one box.) Less Than $ 150,000 7 . Has the applicant ever received a government grant or contract (Federal, State, or local ) ? $ 15000 - $ 299, 999 Yes El No $ 300 ,000 - $499,999 $ 500, 000 - $ 999 , 999 8 . Is the applicant a local affiliate of a national organization? $ 1 ,000, 000 - $4, 999, 999 Yes No $ 5 , 000, 000 or more SF 424- SUPP (4/2004) r Applicant Assurances U .S . Department of Housing OMB Approval No . 2501 -0017 and Certifications and Urban Development (expires 01 /31 /2008) Instructions for the HUD-424-B Assurances and Certifications As part of your application for HUD funding , you , as the official authorized to sign on behalf of your organization or as an Individual must provide the following assurances and certifications . By submitting this form , you are stating that to the best of your knowledge and belief, all assertions are true and correct. As the duly authorized representative of the applicant, I certify that the 5 . Will comply with the acquisition and relocation app a t [Insert b low the Name a d title of the Authorized Representative , requirements of the Uniform Relocation Assistance na a of O gan" I�rrand e d of signature) : and Real Property Acquisition Policies Act of 1970 , Name . J ` Title : CHAIR as amended (42 U .S . C . 4601 ) and implementing Or COUNTY COMMISSION Date : 05/19/ZOOS . regulations at 49 CFR Part 24 and 24 CFR 420 1 . Has the legal authority to apply for Federal assistance, has the Subpart A. institutional, managerial and financial capability (including funds to pay 6 . Will comply with the environmental the non-Federal share of program costs) to plan , manage and complete requirements of the National Environmental the program as described in the application and the governing body Policy Act (42 U .S .C .4321 et seq . ) and related has duly authorized the submission of the application , including these Federal authorities prior to the commitment or assurances and certifications , and authorized me as the official expenditure of funds for property acquisition and representative of the applicant to act in connection with the application physical development activities subject to and to provide any additional information as may be required . implementing regulations at 24 CFR parts 50 or 58 . 2. Will administer the grant in compliance with Title VI of the Civil Rights 7. That no Federal appropriated funds have been Act of 1964 (42 U .S .C . 2000 (d )) and implementing regulations (24 CFR paid , or will be paid , by or on behalf of the applicant, Part 1 ), which provide that no person in the United States shall , on the to any person for influencing or attempting to grounds of race , color or national origin, be excluded from participation influence an officer or employee of any agency, a in , be denied the benefits of, or otherwise be subjected to discrimination Member of Congress, and officer or employee of under any program or activity that receives Federal financial assistance Congress, or an employee of a Member of Congress, OR if the applicant is a Federally recognized Indian tribe or its tribally in connection with the awarding of this Federal grant designated housing entity, is subject to the Indian Civil Rights Act or its extension , renewal , amendment or modification . (25 U .S . C . 1301 -1303). if funds other than Federal appropriated funds have 3 . Will administer the grant in compliance with Section 504 of the or will be paid for influencing or attempting to Rehabilitation Act of 1973 (29 U .S . C . 794) , as amended , and implement- influence the persons listed above , I shall complete ing regulations at 24 CFR Part 8 , and the Age Discrimination Act of 1975 and submit Standard Form-LLL, Disclosure Forth to (42 U .S . C . 6101 -07 ), as amended , and implementing regulations at 24 Report Lobbying . I certify that I shall require all sub CFR Part 146 which together provide that no person in the United States awards at all tiers ( including sub-grants and contracts ) shall , on the grounds of disability or age, be excluded from participation to similarly certify and disclose accordingly . in , be denied the benefits of, or otherwise be subjected to discrimination Federally recognized Indian Tribes and tribally under any program or activity that receives Federal financial assistance ; designated housing entities (TDHEs) established by except if the grant program authorizes or limits participation to designat- Federally-recognized Indian tribes as a result of the ed populations , then the applicant will comply with the nondiscrimination exercise of the tribe's sovereign power are excluded requirements within the designated population . from coverage by the Byrd Amendment, but State- r . Will comply with the Fair Housing Act (42 U .S .C . 3601 -19 ), as recognized Indian tribes and TDHEs established amended , and the implementing regulations at 24 CFR Part 100 , which under State law are not excluded from the statute's prohibit discrimination in housing on the basis of race , color, religion, coverage . sex , disability, familial status , or national origin ; except an applicant These certifications and assurances are material which is an Indian tribe or its instrumentality which is excluded by representations of the fact upon which HUD can rely statute from coverage does not make this certification ; and further when awarding a grant. If it is later determined that, except If the grant program authorizes or limits participation I the applicant, knowingly made an erroneous to designated populations, then the applicant will comply with the certification or assurance, I may be subject to nondiscrimination requirements within the designated population . criminal prosecution. HUD may also terminate the grant and take other available remedies. form HUD-424-B (0212004) Y TREASURE COAST HOMELESS SERVICES COUNCIL, INC. CONTINUUM OF CARE Attachment 8 . Applicant Certifications (These certified statements are required by law. ) A. For the Supportive Housing (SHF), Shelter Plus project be awarded in substantial part to persons Care (S+C), and Single Room Occupancy (SRO) residing in the area of the project. programs : It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U. S . C . 794), as 1 . Fair Housing and Equal Opportunity. amended, and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based on It will comply with Title VI of the Civil Rights Act of disability in Federally-assisted and conducted 1964 (42 U. S. C . 2000(d)) and regulations pursuant programs and activities. thereto (Title 24 CFR part I), which state that no It will comply with the Age Discrimination Act of person in the United States shall, on the ground of 1975 (42 U. S. C. 6101 -07), as amended, and race, color or national origin, be excluded from implementing regulations at 24 CFR Part 146, which participation in, be denied the benefits of, or be prohibit discrimination because of age in projects and otherwise subjected to discrimination under any activities receiving Federal financial assistance. program or activity for which the applicant receives It will comply with Executive Orders 11625 , Federal financial assistance, and will immediately take 12432, and 12138, which state that program any measures necessary to effectuate this agreement participants shall take affirmative action to encourage With reference to the real property and structure(s) participation by businesses owned and operated by thereon which are provided or improved with the aid members of minority groups and women. of Federal financial assistance extended to the If persons of any particular race, color, religion, applicant, this assurance shall obligate the applicant, sex, age, national origin, familial status, or disability or in the case of any transfer, transferee, for the period who may qualify for assistance are unlikely to be during which the real property and structure(s) are reached, it will establish additional procedures to used for a purpose for which the Federal financial ensure that interested persons can obtain information assistance is extended or for another purpose concerning the assistance. involving the provision of similar services or benefits. It will comply with the reasonable modification and It will comply with the Fair Housing Act (42 accommodation requirements and, as appropriate, the U. S . C. 3601 - 19), as amended, and with implementing accessibility requirements of the Fair Housing Act and regulations at 24 CFR part 100, which prohibit section 504 of the Rehabilitation Act of 1973, as discrimination in housing on the basis of race, color, amended. religion, sex, disability, familial status or national origin. Additional for S+C: It will comply with Executive Order 11063 on If applicant has established a preference for targeted Equal Opportunity in Housing and with implementing populations of disabled persons pursuant to 24 CFR regulations at 24 CFR Part 107 which prohibit 582 .330(a), it will comply with this section' s discrimination because of race, color, creed, sex or nondiscrimination requirements within the designated national origin in housing and related facilities population. provided with Federal financial assistance. It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter 60- 1 ), B. For SHP Only. which state that no person shall be discriminated against on the basis of race, color, religion, sex or 1. Maintenance of Effort. national origin in all phases of employment during the It will comply with the maintenance of effort performance of Federal contracts and shall take requirements described at 24 CFR 583 . 150(a). affirmative action to ensure equal employment opportunity. The applicant will incorporate, or cause 2. 20-Year Operation Rule. to be incorporated, into any contract for construction work as defined in Section 130 . 5 of HUD regulations For applicants receiving assistance for acquisition, the equal opportunity clause required by Section rehabilitation or new construction: The project will be 130 . 15(b) of the HUD regulations . operated for no less than 20 years from the date of It will comply with Section 3 of-the Housing and initial occupancy or the date of initial service Urban Development Act of 1968, as amended ( 12 provision for the purpose specified in the application. U. S . C. 1701 (u)), and regulations pursuant thereto (24 CFR Part 135 ), which require that to the greatest 3. 1 -Year Operation Rule. extent feasible opportunities for training and employment be given to lower-income residents of the For applicants receiving assistance for supportive project and contracts for work in connection with the services, leasing, or operating costs but not receiving HUD-40076-CoC (2003) OMB Approval No. 2506-0112 (exp. 08/31/2006) TREASURE COAST HOMELESS SERVICES COUNCIL, INC. CONTINUUM OF CARE assistance for acquisition, rehabilitation, or new construction: The project will be operated for the A For SRO Only, purpose specified in the application for any year for which such assistance is provided. 1. Standards, Definitions, and $3, 000 Minimum. C. For S+C Only. The proposed site meets HUD' s site and neighborhood standards (24 CFR 882 . 803(bx4)), 1. Maintenance of Effort. meets the regulatory definition of single room occupancy housing (24.CFR 882. 802), and the It will comply with the maintenance of effort rehabilitation costs will met the per unit rehabilitation requirements described at 24 CFR 582. 115(d). minimum of $3 ,000. 2. Supportive Services. E. For SHP and SRO It will make available supportive services 1. Nonprofit Board of Directors . appropriate to the needs of the population served and For private nonprofit applicants, members of its equal in value to the aggregate amount of rental Board of Directors serve in a voluntary capacity and assistance funded by HUD for the full term of the receive no compensation, other than reimbursement rental assistance and that it will fund the supportive for expenses, for their services. services itself if the planned resources do not become available for any reason. F. For SBP and S+C. 3. Components : Standards, Definitions, and 1. Lead-Based Paint. $3,000 Minimum. It will comply with the requirements of the Lead- Based Paint Poisoning Prevention Act, 42 U. S.C. (a) For the SRO component only, the proposed site 48214846 , and implementing regulations at 24 CFR meets HUD 's site and neighborhood standards Part 35 . (24 CFR 882. 803 (b)(4), and meets the regulatory definition of single room occupancy housing (24 G. For S+C and SRO. CFR 882 . 802). (b) For the SRO and PRA with rehabilitation 1. PHA Qualification. components, the rehabilitation costs will meet the For PHA applicants, that it qualifies as a Public per unit rehabilitation minimum of $3 ,000 . Housing Agency as specified in 24 CFR 882. 102 and is legally qualified and authorized to carry out the proposed project(s). R Explanation. Where the applicant is unable to certify to any of the statements in this certification, such applicant shall attach an explanation behind this page. ature of Authorized Certi ' Official: Date: S, May 17 , 2005 Title: Chairman, Board of County Commissioners Applicant : For PHA Applicants Only: (PHA Number) Indian River County Board of County Commissioners HUD40076-CoC (2003) OMB Approval No . 2506-0112 (exp. 08/31 /2006) DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB Complete this form to disclose lobbying activities pursuant to 31 U . S . C . 1352 0348-0046 See reverse for public burden disclosure . 1 . Type of Federal Action : 2. Status of Federal Action : 3 . Report Type : [ b 1 a . contract f a ] a . bid/offer/application la 1 a . initial filing l 1 b . grant ` J b . initial award l J b . material change c . cooperative agreement c . post-award For Material Change Only ' . d . loan year quarter e . loan guarantee date of last report f. loan insurance 4 . Name and Address of Reporting Entity : 5 . If Reporting Entity in No. 4 is a Subawardee, Enter Name ❑ Prime ❑ Subawardee and Address of Prime : Tier if known : INDIAN RIVER CO. BOARD OF COUNTY COMMISSIONERS THIS ENTITY DOES NOT ENGAGE IN LOBBYING Congressional District, if known : Congressional District , if known : 15. 16 6 . Federal Department/Agency : 7 . Federal Program Name/Description : US DEPT. OF HUD CFDA Number, if applicable : 8 . Federal Action Number, if known : 9 . Award Amount, if known : 10 . a . Name and Address of Lobbying Registrant b . Individuals Performing Services ( including address if ( if individual, last name, first name, Ml ) : different from No. 10a ) ( last name, first name, IV/ ): NONE Information requested through this forth is authorized by title 31 11 . U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact Signature: upon which reliance was placed by the tier above when this transaction was made Print Name : THOMAS LOWTHER, CHAIRMAN or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for Chairman public inspection. Any person who fails to file the required disclosure shall be Title : subject to a civil penalty of not less that $10,000 and not more than $100,000 for each such failure. Telephone No . : 772 - 226 - 1490 Date : 5 / 17 / 2005 Authorized for Local Reproduction Federal Use Only : Standard Form LLL (Rev. 7-97) Applicant/ Recipient U .S . Department of Housing OMB Approval No. 2510-0011 (exp . 12/31 /2006) Disclosure/ Update Report and Urban Development Instructions . (See Public Reporting Statement and Privacy Act Statement and detailed instructions on page 2 .) Applicant/Recipient Information Indicate whether this is an Initial Report ❑ or an Update Report 1 . Applicant/Recipient Name, Address , and Phone (include area code) : 2. Social Security Number or Indian River County Board of County Commissioners Employer ID Number: 184025 th Street , Vero Beach , FL 32960 59-6000-674 - ( ) - 772-567-8000 x 1467 3 . HUD Program Name: Continuum of Care Homeless Assistance Program- S+C 4. Amount of HUD Assistance Requested/Received 355 , 080 . 00 5. State the name and location (street address , City and State) of the project or activity: Indian River County Part I Threshold Determinations 1 . Are you applying for assistance for a specific project or activity? These 2 . Have you received or do you expect to receive assistance within the terms do not include formula grants , such as public housing operating jurisdiction of the Department (HUD) , involving the project or activity in this subsidy or CDBG block grants. ( For further information see 24 CFR Sec. application , in excess of $200 ,000 during this fiscal year (Oct. 1 - Sep . 30)? 4.3) . For further information, see 24 CFR Sec . 4.9 ® Yes ❑ No ❑ Yes ® No . If you answered " No" to either question 1 or 2 , Stop ! You do not need to complete the remainder of this form . However, you must sign the certification at the end of the report . Part II Other Government Assistance Provided or Requested / Expected Sources and Use of Funds . Such assistance includes , but is not limited to , any grant, loan , subsidy, guarantee, insurance, payment, credit , or tax benefit. Department/State/Local Agency Name and Address Type of Assistance Amount Requested/Provided Expected Uses of the Funds (Note: Use Additional pages if necessary. ) Part III Interested Parties . You must disclose : 1 . All developers, contractors , or consultants involved in the application for the assistance or in the planning , development, or implementation of the project or activity and 2. any other person who has a financial interest in the project or activity for which the assistance is sought that exceeds $50 ,000 or 10 percent of the assistance (whichever is lower) . Alphabetical list of all persons with a reportable financial interest in Social Security No. Type of Participation in Financial Interest in the project or activity For individuals , give the last name first or Employee ID No. Project/Activit Project/Activity $ and % (Note: Use Additional pages if necessary. ) Certification Warning : If you knowingly make a false statement on this form , you may be subject to civil or criminal penalties under Section 1001 of Title 18 of the United States Code. In addition , any person who knowingly and materially violates any required disclosures of information , including intentional non-disclosure , is subject to civil money penalty not to exceed $10 , 000 for each violation . I certify that this information is true and complete . Signare: Date: (mmldd/yyyy) X May 17 , 2005 TREASURE COAST HOMELESS SERVICES COUNCIL, INC. CONTINUUM OF CARE Special Project Certification Coordination and Integration of Mainstream Programs All applicants must certify for their grant and submit this certification along with form SF-424 as part of their Continuum of Care application . (You may submit a single certification covering all of your projects . ) I hereby certify that if our organization ' s grant application is selected for funding as a result of this competition, we will coordinate and integrate our homeless program with other mainstream health, social services, and employment programs for which homeless populations may be eligible, including SSI, Temporary Assistance for Needy Families, Medicaid, Food Stamps, State Children ' s Health Insurance Program, Workforce Investment Act and Veterans Health Care programs . Chairman, Board of County Commissioners Authorized signature of applicant Position Title (required for all applicants) ,May 17 , 2005 Date HUD-40076-CoC (2003 ) OMB Approval No. 2506-0112 (exp. 08/31 /2006) TREASURE COAST HOMELESS SERVICES COUNCIL, INC. CONTINUUM OF CARE V Special Project Certification Discharge Policy Required of all State and local government applicants . Submit this certification along with form SF-424 . (You may submit a single certification covering all of your projects . ) I hereby certify that as a condition for any funding received as a result of this competition, our government agrees to develop and implement, to the maximum extent practicable and where appropriate, policies and protocols for the discharge of persons from publicly funded institutions or systems of care (such as health care facilities, foster care or other youth facilities, or correction programs and institutions) in order to prevent such discharge from immediately resulting in homelessness for such persons . I understand that this condition for award is intended to emphasize that States and units of general local government are primarily responsible for the care of these individuals, and that McKinney-Vento Act funds are not be to used to assist such persons in place of State and local resources . Chair, Board of County Commissioners_ Authorized signature of applicant Position Title (required only for applicants that are States or units of general local government) May 17 , 2Wn Date HUD-40076-CoC (2003) OMB Approval No. 2506-0112 (exp. 08/31/2006 ) Attachment 7 . OMB Approval No . 2506-0112 ( exp 9/30/2005) Continuum of Care Applicant Certifications (These certified statements are required by law . ) A. For the Supportive Housing (SUP) , Shelter Plus feasible opportunities for training and employment be Care (S+C), and Single Room Occupancy (SRO) given to lower-income residents of the project and programs : contracts for work in connection with the project be 1 . Fair Housing and Equal Opportunity . awarded in substantial part to persons residing in the It will comply with Title VI of the Civil Rights Act of area of the project. 1964 (42 U. S . C . 2000(d)) and regulations pursuant It will comply with Section 504 of the thereto (Title 24 CFR part I) , which state that no person Rehabilitation Act of 1973 (29 U. S . C . 794), as in the United States shall, on the ground of race, color amended, and with implementing regulations at 24 or national origin, be excluded from participation in, be CFR Part 8 , which prohibit discrimination based on denied the benefits of, or be otherwise subjected to disability in Federally-assisted and conducted programs discrimination under any program or activity and activities .for which It will comply with the Age Discrimination Act of the applicant receives Federal financial assistance, and 1975 (42 U. S . C . 6101 -07), as amended, and will immediately take any measures necessary to implementing regulations at 24 CFR Part 146, which effectuate this agreement. With reference to the real prohibit discrimination because of age in projects and property and structure(s) thereon which are provided or activities receiving Federal financial assistance . improved with the aid of Federal financial assistance It will comply with Executive Orders 11625 , extended to the applicant, this assurance shall obligate 12432 , and 12138 , which state that program the applicant, or in the case of any transfer, transferee, for the period during which the real property and participants shall take affirmative action to encourage participation by businesses owned and operated by structure(s) are used for a purpose for which the members of minority groups and women . Federal financial assistance is extended or for another If persons of any particular race, color, religion, purpose involving the provision of similar services or sex, age, national origin, familial status, or disability benefits . who may qualify for assistance are unlikely to be It will comply with the Fair Housing Act (42 U. S . C . 3601 - 19), as amended, and with implementing reached, it will establish additional procedures to regulations at 24 CFR part 100, which prohibit ensure that interested persons can obtain information discrimination in housing on the basis of race, color, concerning the assistance . religion, sex, disability, familial status or national It will comply with the reasonable modification origin and accommodation requirements and, as appropriate, It will comply with Executive Order 11063 on the accessibility requirements of the Fair Housing Act Equal Opportunity in Housing and with implementing and section 504 of the Rehabilitation Act of 1973 , as regulations at 24 CFR Part 107 which prohibit amended . discrimination because of race, color, creed, sex or Additional for S+C : national origin in housing and related facilities If applicant has established a preference for targeted provided with Federal financial assistance . populations of disabled persons pursuant to 24 CFR It will comply with Executive Order 11246 and all 582 . 330(a), it will comply with this section' s regulations pursuant thereto (41 CFR Chapter 60- 1 ), nondiscrimination requirements within the designated which state that no person shall be discriminated population . against on the basis of race, color, religion, sex or national origin in all phases of employment during the B . For SHP Only. performance of Federal contracts and shall take 1 . Maintenance of Effort . affirmative action to ensure equal employment opportunity . The applicant will incorporate, or cause to It will comply with the maintenance of effort be incorporated, into any contract for construction requirements described at 24 CFR 583 . 150 (a) . work as defined in Section 130 . 5 of HUD regulations 2 20-Year Operation Rule. the equal opportunity clause required by Section For applicants receiving assistance for acquisition, 130 . 15 (b) of the HUD regulations . rehabilitation or new construction: The project will be It will comply with Section 3 of the Housing and operated for no less than 20 years from the date of Urban Development Act of 1968 , as amended ( 12 U. S . C . 1701 (u)), and regulations pursuant thereto (24 initial occupancy or the date of initial service provision CFR Part 135 ), which require that to the greatest extent for the purpose specified in the application. HUD40076-CoC (2003 ) 3 . 1 -Year Operation Rule . D. For SRO Only. For applicants receiving assistance for supportive 1 . Standards , Definitions, and $3,000 Minimum . services, leasing, or operating costs but not receiving assistance for acquisition, rehabilitation, or new The proposed site meets HUD ' s site and neighborhood construction : The project will be operated for the standards (24 CFR 882 . 803 (b) (4)) , meets the regulatory purpose specified in the application for any year for definition of single room occupancy housing (24 CFR which such assistance is provided . 882 . 802) , and the rehabilitation costs will met the per unit rehabilitation minimum of $3 , 000 . C. For S+C Only. E. For SHP and 5R0 1 . Maintenance of Effort . 1 . Nonprofit Board of Directors . It will comply with the maintenance of effort For private nonprofit applicants , members of its Board requirements described at 24 CFR 582 . 115 (d) . of Directors serve in a voluntary capacity and receive 2. Supportive Services . no compensation, other than reimbursement for expenses , for their services . It will make available supportive services appropriate to the needs of the population served and equal in value F. For SHP and S+C. to the aggregate amount of rental assistance funded by HUD for the full term of the rental assistance and that it L Lead-Based Paint. will fund the supportive services itself if the planned It will comply with the requirements of the Lead-Based resources do not become available for any reason . Paint Poisoning Prevention Act, 42 U . S . C . 4821 -4846, and implementing regulations at 24 CFR Part 35 . 3 . Components : Standards, Definitions , and $3,000 Minimum. G. For S+C and SRO . (a) For the SRO component only, the proposed site meets HUD ' s site and neighborhood standards (24 CFR 1 . PHA Qualification . 882 . 803 (b)(4), and meets the regulatory definition of For PHA applicants, that it qualifies as a Public single room occupancy housing (24 CFR 882 . 802) . Housing Agency as specified in 24 CFR 882 . 102 and is (b) For the SRO and PRA with rehabilitation components, legally qualified and authorized to carry out the the rehabilitation costs will meet the per unit proposed project(s) . rehabilitation minimum of $3 , 000 . H. Explanation. Where the applicant is unable to certify to any of the statements in this certification, such applicant shall attach an expl tigwbeh ' nd i 5e,,. Signature of Authorized Certifying Official : Date : May 17 , 2005 Title: Chair, Indian River County Board of County Commissioners Applicant: For PHA Applicants Only: (PHA Number) Indian River County Board of County Commissioners Public reporting burden for this collection of information is estimated to average 0. 1 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The information collection requirements contained in this application have been submitted to the Office of Management and Budget (OMB) for review under the Paperwork Reduction Act of 1995 (44 U. S. C. 3501 -3520). This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. Information is submitted in accordance with the regulatory authority contained in each program rule . The information will be used to rate applications, determine eligibility, and establish grant amounts. Selection of applications for funding under the Continuum of Care Homeless Assistance are based on rating factors listed in the Notice of Fund Availability (NOFA), which is published each year to announce the Continuum of Care Homeless Assistance funding round. The information collected in the application form will only be collected for specific funding competitions. HUD40076-CoC (2003 ) Applicant Name : INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS DUNS #_079 - 208 - 989 Project Name : New Horizons S+C Tenant Rental Assistance - Project Priority# ONE Exhibit 3 : Project Narrative Section A is a description of your proposed project. Please respond to all of the items in this section. Submit a separate Exhibit 3 for each priority project. A project may include no more than one component (i . e . , TRA, SRA, PRA without rehab, PRA with rehab, SRO) and may be carried out by no more than one project sponsor. 1 . Project summary . Please provide the following : a. Applicant and sponsor (if appropriate) names : Indian River County Board of County Commissioners b . Program component- TRA c . Total S+C request: $355 ,080.00 d . The type of housing and number of units proposed- 11 units, variety of types e . The population to be served : Homeless disabled unaccompanied adults . f. If this is the Priority # 1 permanent housing bonus project, indicate that 100 % of the persons to be served will be chronically homeless : II Yes 0 No Exhibit 3 : Project Narrative PROJECT PRIORITY ONE , New Horizons S +C Tenant Rental Assistance 1 . Project Summary. The Indian River County Board of County Commissioners as the applicant is requesting $ 355 , 080 . 00 in Tenant Rental Assistance under the Shelter Plus Care component to provide permanent affordable housing for at least eleven homeless disabled, unaccompanied adults, at least 70% of whom are chronically homeless . New Horizons of the Treasure Coast and Family Preservation services will provide the match supportive services to the assisted tenants . Indian River County Human Services will administer the tenant based rental assistance . 2 . Homeless population to be served. a. Characteristic and need for housing and supportive services . The population to be served will include homeless single adults who homeless due to the nature of their disability . At least 70 % will be chronically homeless and have mental illness and or/ mental illness and substance abuse . They will come from the street, camps in the woods, from the county jails or from jail diversion programs in Indian River and St . Lucie County. It is likely that 100% of the population will come from these locations and 0% will come from transitional housing . The applicant, Indian River County is now well experienced in providing permanent supportive housing to this client population . The Treasure Coast Homeless Services Council, New Horizons of the Treasure Coast Inc . , Family Preservation, the Mental Health Association and the Homeless Shelter have formed a monthly Shelter Plus Care Committee to assist homeless individuals on a daily with Housing and Entitlement Assistance . These organizations will continue to outreach clients in their normal course of services and will be assisted by the Sheriff' s Departments, the Ft . Pierce Police Department, and the Court System in identifying homeless people who can benefit from this program. b . Where they will come from. New Horizons, case manages more than 600 individuals a year who are homeless and have chronic mental health and substance abuse problems . They are repeatedly evicted, living in abandoned buildings or under the bridges, sent to treatment by law enforcement directly to New Horizons Inpatient mental health or substance abuse units, or repeatedly jailed for misdemeanor offenses . Once released, since they reside in camps in the woods they do not have a home to return to . New Horizons has been a key provider of supportive services in the successful S+C programs including Indian River and Martin county and is assisting St . Lucie County in developing it ' s first Shelter Plus Care Program . Applicant Name : INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS DUNS # 079 - 208 - 989 Project Name : New Horizons S+C Tenant Rental Assistance - Project Priority# ONE_ c . The outreach proposed to bring them into the project . New Horizons of the Treasure Coast will use the Jail Diversion Project present in two counties, as well as the Community Aggressive Treatment Teams, present in two counties to outreach to this population . The Indian River County ' s Human Services Department and The Treasure Coast Homeless Services Council work together to identify street people who come in for assistance to be screened for eligibility . They have formed a working partnership which serves as clearing house for homeless assistance, mainstream entitlements and case management . They will use their combined financial resource to secure medical treatment, dental care and emergency medicine for this population while they are being assessed for disability . Shelter Plus Care funds will allow the County to develop and deliver a new tenant based rental assistance project to house and serve at least eleven disabled adults at one time . . 3 . Discharge planning changes. The CoC has a tri- county Pre-Release Discharge Planning Process in place . The larger effort also includes a Mental Health Jail Diversion Program targeted to mentally ill homeless people, usually those who are chronically homeless . 4 . Housing where participants will reside. a. What the type and scale of the proposed housing will be . The Case Management Team will review potential housing choices in both Indian River and St. Lucie County that will be near the fixed route bus line, One Stop Career Center, New Horizons ' Treatment Facilities, Mental Health drop-in centers and New Horizons Social Clubs, provided for this population in each county . Apartments will be inspected prior to rental, to ensure safety and compliance with all threshold requirements following the Fair Housing guidelines . , the proposed living units will be reviewed by the County Housing Manager to ensure that the apartment is suitable for persons with physical disabilities so when a client with those needs are identified, there is a proper unit available . In addition to the one year lease, clients will be asked to sign an agreement with the Community Services Department and New Horizons to ensure that they agree to participate in their service plan and will work to meet the long term goal of becoming self sufficient . The clients will have the opportunity to live anywhere in Indian River or St . Lucie County where suitable housing is available and will not be required to live in any particular structures or units . b . That the basic COMMUNITY AMENITIES (e .g . , grocery store, medical facilities , recreation) will be readily ACCESSIBLE (e . g . , walking distance, near bus line) to your clients . The Team will locate at least eleven ( 11 ) one bedroom apartments in safe neighborhoods and drug free zones and will work with landlords to alleviate their concerns regarding payment of rent and other concerns associated with renting to mentally or physically disabled clients . Various living arrangements, including single units, duplexes and small apartment complexes will be pre-identified, inspected and approved to ensure that tenants will have access to housing that suits their needs and is also accessible to other community amenities . New Horizons also has licensed capacity to transport clients to appointments, shopping, social clubs and other services if fixed route transportation or demand response public transportation is not available . Form HUD 40076 CoC -3B page 1 Applicant Name : INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS DUNS #_079 - 208 - 989 Project Name : New Horizons S+C Tenant Rental Assistance -- Project Priority# ONE c . For TRA projects , if participants are required to line in particular structures or units during the first year or live in a particular area for the entire period of participation. There are no particular structures in which clients will be required to live . They will be required to remain in Indian River County or St. Lucie County for the first year to assure that they can access ongoing case management and supportive services . 5 . Supportive services the participants will receive. The supportive services the participants will receive will be provided by Indian River County Community Services, St . Lucie County Community Services, New Horizons of the Treasure Coast, One Stop Career Center, Family Preservation Services, Community Aggressive Treatment Team and other community service organizations, as applicable . The Treasure Coast Homeless Services Council ' s Shelter Plus Care Team will open a case file on each client and determine the mainstream benefits that the individual should receive through federal, state and local programs . The Shelter Plus Care Case Management Team will assign a case manager to each client to personally assist the individual with accessing mainstream benefits and appropriate services in the community, including food, medical care and life skills services . All information on clients needs and services will be maintained on the HMIS system . The Treasure Coast Homeless Services Council ' s Entitlement Specialists will oversee progress in securing entitlements for all clients in the program and will intervene in ex-parte, representative payee and court hearings, whenever necessary to ensure that all entitlements and services for which the client is eligible are secured . Specialized services for the clients in this program will include : Mental Health Counseling and Socialization Skills Dependency and Addiction Management Support Group Participation Consumer Skills Nutritional Support and Food Subsidies Pre-Employment Training and Job Placement Tenant / landlord relations Representative Payee Services 6 . Self-sufficiency.Describe specifically how participants will be assisted both to increase their INCOMES and to maximize their ability to LIVE INDEPENDENTLY . With the assistance of the supportive services provided by qualified professionals, the participants will be assisted in managing their medications and financial affairs . Family Preservation Services will work with clients to provide in home life- skills retraining . Some clients will be referred to Gulfstream Goodwill for re-training, if they qualify by virtue of their disability. Participants will be assisted in overcoming obstacles to their independence through a personalized self- management case plan, developed as a contract between the participants and New Horizons Case Managers . This case plan includes increasing co-pays to the point of 30% of the participant ' s adjusted income to assure gradual, achievable steps to self- sufficiency . The case plan will contain measurable goals, objectives and milestones, for evaluation and re- evaluation to accomplish the maximum level of economic and social self- sufficiency possible . Rent co-pays are currently reviewed monthly to assure that clients can continue to make progress toward paying their portion of the rent to assist them in learning to manage finances . Applicant Name : INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS DUNS #_079 - 208 - 989 Project Name : New Horizons S+C Tenant Rental Assistance _- Project Priority# ONE Through efforts to maximize the available mainstream financial and mental health support, the Continuum anticipates that approximately at least 60% of the tenants will have a significant increase in income over the next five years and that at least 30% of the tenants will be able to establish permanent affordable housing outside of the project after five years . Applicant Name : INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS DUNS #_079 - 208 - 989 Project Name : New Horizons S+C Tenant Rental Assistance _- Project Priority# ONE 7 . Homeless Management Information System a. Date (mm/yyyy) this project will begin participating (entering data) in the FMS _06/01/2006 . b . Will all clients served by this project be entered in the HMIS ? Yes II No Form HUD 40076 CoC-3B page 2 Applicant Name : INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS DUNS #_079 - 208 - 989 Project Name : New Horizons S+C Tenant Rental Assistance - Project Priority# ONE 8 . Program Goals . In a separate narrative, which should be submitted as an attachment to this exhibit, please describe the performance measures that will be used for each of the homeless assistance goals, and how success in meeting each of the goals will be measured . Please include the three programmatic goals listed below, and address both housing and services in your discussion . You will be reporting on your success in meeting the performance measures in your Annual Progress Report . The programmatic goals for HUD ' s homeless assistance programs address the success of homeless persons in achieving residential stability, increasing skills and income, and achieving greater self-determination . These program goals directly complement HUD 's Government Performance and Results Act (GPRA) goals of ending chronic homelessness and moving homeless families and individuals to permanent housing . In order to meet these program goals, each project should develop specific performance measures . Performance measures have three major components . First, they must relate to the outcomes (e .g. , the program participant will successfully complete substance abuse treatment), rather than inputs (e . g . , the program participant will attend 25 substance abuse sessions) . Second, they must have a time frame for achievement and, third, they must have a percentage/number indicating a level of achievement. Goal : Obtain and Remain in Permanent Housing a) 60% of individuals entering the program will remain in permanent housing for more than one year. Goal : Increase Skills and Income b) 80% of the participants who are eligible for mainstream resources including SSDI, Medicaid, Food Stamps and Share of Cost Medicaid will receive benefits for which they are eligible within one year of entering the program . Goal : Achieve Greater Self-Determination c) 55 % of clients will participate regularly in Social Club or a Drop-In Center to improve their skills and will voluntarily seek out at least part time employment within 6 months of entering the program . 9 . Major Milestones Please complete the chart by entering the number of months planned from grant execution to the following milestones : First Unit Occupied Supportive Services Last Unit Occupied Begin Months 1 Months 1 Months 12 Form HUD 40076 CoC-313 page 3 Applicant Name : INDIAN RIVER COUNTY BOARD OF COUNTY COMISSIONERS DUNS #_079 -208 - 989 Project Name : New Horizons S+C Tenant Rental Assistance - Project Priority# ONE Exhibit 3 : Tenant-based Rental Assistance (TRA) Project Budget Budget Forms Fill out the information requested for the S+C component for which you are requesting funding. Make certain that only one component (TRA, SRA, PRA without rehab, PRA with rehab, and SRO) budget is completed in this section. Requested subsidy cannot exceed current FMR unless an Exception Reni approval letter is attached. Requests for rents above 100% but not more than 110% must be accompanied by a statement from the PHA that they have exercised their authority to set rents above the published amount. The PHA statement must cite at what level the rents are set, up to 110% of the FMR. TRA Project Budget Applicants requesting TRA must complete the chart below showing the number of units expected to be used in your program. Multiply the applicable existing fair market rents (FMRs) as revised and published in the Federal Register (FR) on February 28, 2005 , by the number of units of a given size by 60 months . [Please be advised that the actual FMRs used in calculating your grant will be those in effect at the time the grants are approved which may be higher or lower than those found in the revised February 28, 2005 , FR Notice . ] The SRO FMR should be rounded to the nearest whole number before multiplying by the number of units and the number of months . The FMR for each single room occupancy SRO unit is equal to 75 percent of the 0- bedroom FMR. Complete a separate chart for each jurisdiction that has a different FMR Name of metropolitan or non-metropolitan area for the FMR used: Number of FMR Number of Months Total Amount Requested Dwelhng Units Units X $ X = $ 60 SRO 60 0 Bedroom One Bedroom 11 538 . 00 60 355,080. 00 60 Two Bedroom 60 Three Bedroom 60 Four Bedroom 60 Other: (specify) Total TRA Assistance Is 355,080 .00 Applicant Name : INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS DUNS #_079 - 208 - 989 Project Name : New Horizons S+C Tenant Rental Assistance - Project Priority# ONE Exhibit 3 : Additional Key Information HUD needs the following information to respond to public and Congressional inquiries about program benefit . Responses from this section will also be used to measure compliance with the requirement that no less than 10 percent of the funds awarded are for projects predominantly serving individuals experiencing chronic homelessness, where at least 70 percent of the persons served meet HUD ' s definition of chronic homelessness . 1 . Which of the following subpopulations will your project assist? (Check the Predominantly Serve box if your project primarily targets the given subpopulation, i . e . , 70 percent or more of the persons you propose to serve, or the Serve box if less than 70 percent. ) Subpopulation Serve Predominantly Serve (Less than 70%) (70% or more) Chronically Homeless X Severely Mentally Ill X Chronic Substance Abuse X Veterans Persons with HIV/AIDS Victims of Domestic Violence Women with Children 2 . If you propose to serve persons experiencing chronic homelessness in your project , provide the number of chronically homeless persons to be served ( at a point in time ) : 8 3 . Will the proposed project be located in a rural area? (A project is considered to be in a rural area when the project will be primarily operated either ( 1 ) in an area outside of a Metropolitan Area, or (2) in an area outside of the urbanized areas within a Metropolitan Area . ) ❑ Yes No 4 . Is the sponsor or applicant of the project a religious organization, or a religiously affiliated or motivated organization? (Note : This characterization of religious is broader than the standards used for defining a religious organization as "primarily religious" for purposes of applying HUD ' s church/state limitations . For example, while the YMCA is often not considered "primarily religious " under applicable church/state rules , it would likely be classified as a religiously motivated entity. ) Sponsor: ❑ Yes Applicant: ❑ Yes ❑ No IQ No 5 . Is the Logic Model attached? Please see the General Section for instructions . 2 Yes ❑ No 6 . Have you ever received a Federal grant, either directly from a Federal Agency or through a state/local agency ? ❑ Yes E No 7 . Have you ever received SHP or S+C or SRO funds ? E Yes ❑ No Form HUD 40076 CoC —3H page 1 Applicant Name : INDIAN RIVER COUNTY BOARD OF COUNTY CommISSIONERS DUNS #_079 - 208 - 989 Project Name : New Horizons S+C Tenant Rental Assistance - Project Priority# ONE Component Selection Select the S+C component which describes your project (check only one box) F TRA ❑ SRA ❑ PRA without Rehab ❑ PRA with Rehab ❑ SRO Check here if the rent for this project exceeds the published Fair Market Rent : ❑ 100- 110%1 PHA Letter attached ; ❑ Greater than 110% , HUD Approval Letter attached . Project Information (please type or print) Project Name: Project Priority No. New Horizons S+C Tenant Rental Assistance (from project priority chart in Exhibit 1 ): Project Address (street, city, state, & zip): ONE 184025a` Street, Vero Beach, FL 32960 Project Sponsor' s Name (for SRA projects) : Proj. Congressional District(s): 15,16 Sponsor' s Address (street, city, state, & zip) (for SRA projects): Project 6-digit Geographic Code: 129061 Authorized Representative of Project Sponsor (name, title, phone number, & fax) (for SRA projects) :N/A Participant Count In each category shown in the chart below, estimate, when the program is fully operational, the number of proposed participants expected to receive rental assistance at a point in time. Include each participant only once, in either Part f or Part 2. Part 1 should only include persons with disabilities who will not have family members living with them The actual subpopulations to be served must be noted below on Form HUD 40076 CoC-3H, Targeted Subpopulations. Do not double count Number of Participants Part 1 : Individual Participants not in Families 11 Part 2 : Participants in Families (a) Total Targeted Participants : (in families) (b) Number of other Family Members Living with Participants Total Participants in Families Total Persons Served from Parts 1 and 2 11 Form HUD 40076 CoC -3C page 1