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HomeMy WebLinkAbout2006-158lM Zoo (0 Version 7/03 tkrruvn r rv,v . v,. FEDERAL ASSISTANCE 2. DATE SUBMITTED —...._.. Applicant Identifier 1. TYPE OF SUBMISSION: 3. DATE RECEIVED BY STATE State Application Identifier Application Pre -application 4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier F Construction C Construction Non -Construction 0 Non -Construction 5. APPLICANT INFORMATION Legal Name: Organizational Unit: Department: Indian River CountyBoard of County Commissioners ty Board of County Commissioners Organizational DUNS: Division: 079.208-989 Address: Name and telephone number of person to be contacted on matters involving this application (give area code) Street County Administration Bldg, 1840 25th Street Prefix: First Name: Mr. Jason City: Middle Name Vero Beach County: Last Name Indian River Brown State: Zip C�Ode suffix: 92 USA rY: Email: Jmil: IRCGOV.COM 6. EMPLOYER IDENTIFICATION NUMBER (EIN): Phone Number (give area code) Fax Number (give area code) 5❑�9 6 0� 0 0�©7 ® 772-567-8000x1257 772-77D-5331 8. TYPE OF APPLICATION: 7. TYPE OF APPLICANT: (See back of form for Application Types) I0 New Fil Continuation Revision B f Revision, enter appropriate letter(s) in box(es) See back of form for description of letters.) ❑ her (specify) S. NAME OF FEDERAL AGENCY: Other (specify) RENEWAL US DEPT. OF HOUSING AND URBAN DEVELOPMENT 10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 11. DESCRIPTIVE TITLE OF APPLICANTS PROJECT: AL OF TRANSITIONAL HOUSING PROJECT ONFAMILY OPTIONS TITLE (Name of Program): Continnuum of Care Homeless Assistance 12. AREAS AFFECTED BY PROJECT (Cities, Counties, States, etc.): FL 509 -FL Pierce/St. Lucie, Indian River, Martin 13. PROPOSED PROJECT 14. CONGRESSIONAL DISTRICTS OF: Start Date: Ending Date: a. Applicant 05!01/2007 0413012008 15AB S -i6Project 5 1S. ESTIMATED FUNDING: 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PI OC SSI a. Federal THIS PREAPPLICATION/APPLICATION WAS MADE 70,063.67 70,064 a. Yes. AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON DATE: b. Applicant c State (,)T} PROGRAM IS NOT COVERED BY E. O. 12372 d. Local b. No. C( OR PROGRAM HAS NOT BEEN SELECTED BY STATE a. Other17 515. FOR REVIEW I. Program Income 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? Wes" attach an planation. � No 0 Yes If Wex — U. TOTAL 87,579 87,578.67 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 Prefix ���q� FFiirrsst.Naq)a iddle Name Last Name _ uffix NEUBERGER " b. TWO . Telephone Number (give area code) CHAIRMAN 772.667-8000 . Sign M&A=MMA Date Signed May 16, 2006 Previous Edition Usable / Authorised for LocaiReoroduction U Standard Form 424 (Rev.5.4w.a) Prescribed by OMB Circular A-102 Applicant/Recipient U.S. Department of Housing Disclosure/Update Report and Urban Development OMB Approval No. 2510.0011 (exp. 12/31/2006) Indicate whether this is an Initial Report U or an nu INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS Employer ID Number: 1840 25' Street 59-6000674 (772)567-8000 Continuum of Care Homeless Assistance — SHPI Requested/Received 70,063 z_nameandiocanon(street-st-iress,cityand9. 1 2e Street, Vero Beach, FI 32960 Part I Threshold Determinations 1. Are you applying for assistance for a specific project or 'see 2. Han you received or do you expect to receive assistance within the terms do not include formula grants, such as public houm in jurisdiction of the Department (HUD) , involving the project or activity in this subsidy or CDBG block grants. (For further information see 4 Mae. application, in excess of $200,000 during this fiscal year (Oct. 1 - Sep. 30)? 4.3). For further information, see 24 CFR Sec. 4.9 If you answered "No" to either question 1 or 2, Stop! You do not need to complete the remainder of this form. However, you must sign the certification at the end of the report. or and Use of Funds. Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance, payment, credit, or tax benefit. Department/State/l-ocal Agency Name and Address Type of Assistance Amount RequestedlProvided Expected Uses of the Funds Part III Interested Parties. You must disclose: 1. All developers, contractors, or consultants Involved in the application for the assistance or in the planning, development, or implementation of the project or activity and ZT Alphabetical list of all the project or activity persons with a reportable financial interest in (For individualgive the last name fust Social Security No. or Employee ID No. Type of Participation in Project/Activity Project/Activity Financial ProlectlActivity Interest in ($ and % (Note: Use Additional pages if necessary.) Certification Warning: If you kroMrrgly make a false statement on this form, you may be subject to civil or criminal penalties under Section 1001 of Ttile 18 of the United States Code. in addition, any person who knowingly and materially violates any required disclosures of information, including intentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for each violation. 1 certify that this Information is true and complete. May 167 2006 TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE Part A* General Prqiect Information Projects) 1. Project PriorityNumber 2. El New Project 3. If renewal, lis[ previous Precious Gram Number: (From Project Priority ®Renewal BOJ grant number & project FL29B509002 Chart in Exhibitl): 2_ identifier number (PIN) PIN Number: FL13199 4. HUD -Defined CoC Name: 5. CoC Number: Ft. Pierce/St. Lucie, Indian Ricer. D9artin Counties CoC FL -509 6. Applicant's Organization Name (Legal Name from SF -424) 8. Applicant's DUNS Number Indian Ricer Coumh Board of County commissioners (From SF -424): 079-208-989 7. rl Check box if Applicant is a Faith -Based Organization ® Check box if Applicant has ever received a federal grant. either directly from a federal agency or through a state/local agency 9. Project Applicaut's Address (From SF -424) 10. Applicant's Employer Street: 1&10 25m Street Identification Nmnber (EIN) (From City: Vero Beach State: Fl Zi :32960 SF -424): 59-6000674 11. Contact person of Project Applicant: (From SF -424) li Check boy Name: Jason Brown Phone number:772-567-8000 mProject A Applicant is the same as Project Title: Budget Director Fax number: 772-567-5991 Sponsor Email Address: jbrmyriiircu o.cont 13. Project Name: 14. Project's location 6 -digit Family Options Transitional Housing Geographic Code: 129061 15. Project Address (S+C SRAs, if multiple sites list all addresses including): 18. ® Check box if Energy Star is Street: 720 4`s Street used in this project City: Vero Beach State: Fl Zip: 32962 19. Project Congressional Districts 16. ❑ Check box if project is located in a Rural Area 15-16- 5-16:17. 17.If project contains housing units, are these units: ❑ Leased? ® Owned? 20. Project Sponsor's Organization Name (If different from Applicant) 22. Sponsor's DUNS Number: 21. 0 Check box if Project Sponsor is a Faith -Based Organization ❑ Check box if Project Sponsor has ever received a federal grant, either directly from a federal agency or through a state/local a eiucc 23. Project Sponsor's Address (if different from Applicant) 24. Sponsors Employer Street: Identification Number (EIN): City: State: Zip: 25. Contact person of Project Sponsor (if different from Applicant) N/A Name: Phone number: Title: Fax number: Email Address: TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE Part Be Project Summary Budget Bl. Sunnortive Housing Program (SHP) (All SBP Projects) a. 0 SHP Program c. Grant Term (New Projects must be 2 or 3 years; Renewals or HMIS projects can be 1, 2 or 3 years) b. Component Types (Check only one box) ❑ ❑ ® ❑ • ❑ Safe Haven/TH (Check only one box) PH SSO HMIS F1 Safe Haven/PH ® El 1 Year 2 Years 3 Years d. Proposed e. SHP Dollars f. Cash Match g. Totals SHP Activities Request Col. e + Col. 1. Acquisition 2. Rehabilitation 3. New Construction 4. Subtotal Lines 1 through 3 5. Real Property Leasing From Leasing Budget Chart 6. Supportive Services 70,063.67 17,515.91 87,579.58 From Supportive Services Budget Chart 7. Operations From Operating Budget Chart 8, HMIS From fMS Budget Chart 9. SHP Request Total Budget (Subtotal lines 4 through 8) Total Cash Match (Total SHP Request + Total 10. Administrative Costs (Up to 5% of line 9 Cash Match) 11, Total SHP Request 707063.6 171515.91 87,579.58 Total lines 9 and 10 P TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM Or CARE Part Co Point in Time Dousing and Participants Chart All Projects Except Dedicated f MIS Projects 1. Housing Type* la. ❑ Multi -family 16. F] Scattered Site (Check all that apply) ❑ Single-family Protect Based Chronic Substance Abusers ® Con ate Facility❑ Veterans a. Current b. New Effort or c. Projected 2. Units, Bedrooms, Beds Level Change in Effort Level (Point -in -Time (If Applicable) (column a+ col. b) Number of Units 1 Number of Bedrooms 12 Number of Beds 28 3. Participants 16 a. Number of Families with Children (Family Households i. Number of adults in families 16 u. Number of children in families 12 iii. Number of disabled in families 4 b. Number of Single Individuals and Other Households w/o children i. Number of disabled individuals ii. Number of chronically homeless *Housing Types: Multi -family (apartments, duplexes, SROs, other buildings with 2 or more units); Single-family; Co ate Facility (dormito , barracks, shared -living). Part D: 'Targeted Subpopulations (All Projects Except Dedicated HMIS Projects) List the approximate percentages for each homeless subpopulation you expect to serve. If you expect to serve Subpopulations that fit more then one category (i.e. Severely Mentally Ill Persons with Chronic Substance Abuse), you may place overlapping approximate percentages on the appropriate lines. If this is a #I priority project it must serve 100% chronicald homeless persons to receive the PH bonus. 1. Homeless Sub o ulations 2. Approximate Percentages Chronically Homeless as defined by HUD Severely Mental) ID 30% Chronic Substance Abusers Veterans Persons with HIV/AIDS Victims of Domestic Violence Unaccompanied Youth Under 18 years of age) MENEM Part E: Diseharge Policy (Only State & Local Government Applicants) Are there policies and protocols developed or implemented for the discharge of persons from publicly funded institutions or systems of care (e.g., health care 1. ® Yes ❑ No facilities, foster care or other youth facilities, or corrections programs and institutions) in order to prevent such discharge from immediately resulting in homelessness or requiring homeless assistance for such persons in your TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE Part F. Project Leveraging Chart (Ail Projects) HUD homeless program, funding is limited and can provide only a portion of the resources needed to successfully address the needs of homeless families and individuals. HUD encourages applicants to use supplemental resources, including state and local appropriated funds, to address homeless needs. Please be aware that undocumented leveraging claims may result in a re -scoring of your application and possible withdrawal of your conditional award(s). For further instructions for filling out this section, see the Instructions section. Type of Contribution Source of Contribution Identify Source as: G 's ( ) Government or P) Private Date of Written Commitment Value of Written Commitment Example: Child Care CDBG G 2/15/06 $10,000 Housing and Services Homeless Family P 4/24/06 $728,000 "Government sources are appropriated dollars TOTAL: $728,000 Part G: Project Participation In homeless Management Information Systems S (All Projects Exc t Dedicated BNUS Projects) ® Yes ❑ No Is this project participating in the MRS? 06 / 2003 If "Yes," what date did this project begin participating in the HMIS? ear If "No," enter the date the project anticipates beginning participation. ® Yes ❑ No Will client -level data be included in the HWS for all persons served by this project? Part h: Renewal Performance (All Renewal 1. ❑ Yes ® No Are there any unresolved HUD monitoring findings, or outstanding audit findings related to this project? If "Yes," briefly describe. TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE Are there any significant changes that you propose in the project since the last funding approval? Check all that apply: ❑ Number of persons served: from to ❑ Number of units: from to ❑ Location of project sites. 2. ❑ Yes ® No ❑ Line item or cost category budget changes more than 10%. ❑ Change in target population. ❑ Change in project sponsor. ❑ Change in component type. ❑ Other: Please explain changes: H: Renewal Performance (Continued) or all S+C, SBP -PB, SBP -TB, SHP-Safe Haven, and SSO Renewals): Use information from the most recently submitted Annual Progress Report (APR) to answer questions 3, 4, and 5. Han APR has not yet been submitted for this renewal project, please check the N/A box and skip these questions. ❑ N/A 3. Permanent Housing (PH) Performance (To be idled out by all SHP and S+C renewal permanent housing projects, including both SHP-PH and SHP-Safe Haven permanent housing). Complete the following chart using data based on the preceding operating year from APR Questions 12(a) and 12(b): a. Number of participants who exited PH ro'ect(s�—APR Question 12(a) b. Number of participants who did not leave the pmject(s}—APR Question 12 (b) c. Of those who exited, how many stayed 7 months or longer in PH—APR Question 12(a) d. Of those who did not leave, how many stayed 7 months or longer in PH—APR question 12(b) e. Percentage of all participants in PH projects staying 7 months or longer [(c + d) divided by (a + b)] x 100 = e. Example: [(16 + 15) divided by (20 + 20)] x 100 = 77.5% 4. Transitional Housing (TH) Performance (To be filled out by all SHP renewal transitional housing projects, including both SHP-TH and SHP-Safe Haven transitional housing). Complete the following chart using data based on therp eceding oneratingvear from APR Question 14: a. Number of participants who exited TH project(s)-_-mcluding unknown destination 25 b. Number of participants who moved to PH—from any destination identified as pennanent housing 15 c. Of the number of participants who left TH, what percentage moved to PH? (b divided by a) x 100 = c Example: (14 / 18) x 100 = 77.7%. 60 TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE 5. Supportive Services - Mainstream Programs and Employment Chart (To be filled out by all S+C and SHP renewals, except dedicated HMIS projects) HUD will be assessing the percentage of clients in your renewal project who gained access to mainstream services and, especially, who gained employment. Based on responses to APR Question 11 complete the following: 1 Number of Adults Who Lek (Use the same number in each row) 2 Income Source 3 Number of Exiting Adults with Each Source of Income 4 % with Income at Exit (Col. 3 + Col. 1 a 100) Example: 105 a. Social Security Insurance 40 38.1% 105 b. Social Security Disability Insurance SSD 35 33.3% 105 c. Socia! Security 25 23.8% 25 a. SSI 2 8% 25 b. SSDI 2 80/0 c. Social Security 25 d. General Public Assistance 6 24% e. TANF f SCHM g. Veterans Benefits 25 b. Employment Income 16 64% i. Unemployment Benefits i. Veterans Health Care 25 k. Medicaid 9 36% 25 1. Food Stamps 9 36% 25 m. Other -Child Support -FEMA 2 8% n. No Financial Resources 1 4% TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE I2. SHP Supportive Services Budget i All SBP Pro'ects asApplicable) f.YS'1- 1i0ilIIi3a SHP Dollars Requested Supportive Services Costs Year 1 Year 2 Year 3 Total 1. Outreach Quantity: 2. Case Management Qui 3. Life Skills (outside of case management) 4. Alcohol and Drug Abuse Services Quantity: 5. Mental Health and Counseling Services Quantity: 6. HIV/AIDS Services 7. Health Related & Home Health Services Quantity: 8. Education and Instruction Quantity: 9. Employment Services 30,000.28 Quantity: One FTE 10. Child Care 11. Transportation Quantity: 12. Transitional Living Services Quantity: 13. Other (must specify *)HOUSING PLACEMENT SPECIALISTS 57,597.30 an ' :2 FTE 14. Total SHP supportive services dollars 70,063.67 requested in lines 1 to 13: ** 11 *If not specified, the costs will be removed from the budget. ** Total of Line 14 must match line 6 column c. on the Project S Bud et. 15. Total cash match to be spent on SHP 17,515.91 eligible su ortive service activities. *:: *** Cash Match can be spent on any SHP eligible activity (see the chart in Section M.A.3. of the NOFA for these activities). The amount of the SHP request (entered in line 14) must be no more than 80 percent of the total supportive services budget (i.e., 80 percent of line 14 plus line 15). The total of Line 15 must match line 6, column f. on the Project Summary Budget. f.YS'1- 1i0ilIIi3a TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE ;J111111 iiiii�illilI �illillilll!ll 111111 111111111111111111111 11111111111111111111111 111 I� These certified statements are required by law. Previous versions obsolete form HUD -400904 A. For the Supportive Housing (SHP), Shelter Plus Care (S+C), and Single Room Occupancy (SRO) programs: Fair Housing and Equal Opportunity. It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulations pursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, on the ground of race, color or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the applicant receives Federal financial assistance, and will immediately take any measures necessary to effectuate this agreement. With reference to the real property and structure(s) thereon which are provided or improved with the aid of Federal financial assistance extended to the applicant, this assurance shall obligate the applicant, or in the case of any transfer, transferee, for the period during which the real property and structure(s) are used for a purpose for which the Federal financial assistance is extended or for another purpose involving the provision of similar services or benefits. It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and with implementing regulations at 24 CFR part 100, which prohibit discrimination in housing on the basis of race, color, religion, sex, disability, familial status or national origin. It will comply with Executive Order 11063 on Equal Opportunity in Housing and with implementing regulations at 24 CFR Part 107 which prohibit discrimination because of race, color, creed, sex or national origin in housing and related facilities provided with Federal financial assistance. It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter 60- 1), which state that no person shall be discriminated against on the basis of race, color, religion, sex or national origin in all phases of employment during the performance of Federal contracts and shall take affirmative action to ensure equal employment opportunity. The applicant will incorporate, or cause to be incorporated, into any contract for construction work as defined in Section 130.5 of HUD regulations the equal opportunity clause required by Section 130.15(b) of the HUD regulations. It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended (12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that to the greatest extent feasible opportunities for training and employment be given to lower-income residents of the project and contracts for work in connection with the project be awarded in substantial part to persons residing in the area of the project. It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended, and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based on disability in Federally -assisted and conducted programs and activities. It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, and implementing regulations at 24 CFR Part 146, which prohibit discrimination because of age in projects and activities receiving Federal financial assistance. TREASURE COAST HCMMLESS SERVICES COUNCIL INC. CONTINUUM OF CARE It will comply with Executive Orders 11625, 12432, and 12138, which state that program participants shall take affirmative action to encourage participation by businesses owned and operated by members of minority groups and women. If persons of any particular race, color, religion, sex, age, national origin, familial status, or disability who may qualify for assistance are unlikely to be reached, it will establish additional procedures to ensure that interested persons can obtain information concerning the assistance. It will comply with the reasonable modification and accommodation requirements and, as appropriate, the accessibility requirements of the Fair Housing Act and section 504 of the Rehabilitation Act of 1973, as amended. Additional for S+C: If applicant has established a preference for targeted populations of disabled persons pursuant to 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within the designated population. B. For SHP Only, 20 -Year Operation Rule. For applicants receiving assistance for acquisition, rehabilitation or new construction: The project will be operated for no less than 20 years from the date of initial occupancy or the date of initial service provision for the purpose specified in the application. 1 -Year Operation Rule. For applicants receiving assistance for supportive services, leasing, or operating costs but not receiving assistance for acquisition, rehabilitation, or new construction: The project will be operated for the purpose specified in the application for any year for which such assistance is provided. C. For S+C Only. Supportive Services. It will make available supportive services appropriate to the needs of the population served and equal in value to the aggregate amount of rental assistance funded by HUD for the full term of the rental assistance. D. 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. Signature of Date: May 16, 2006 Chairman, Indian River County Board of County Commissioners Applicant: For PHA Applicants Only: (PHA Number) M n ODI IPATlnhl FnR Version 7/03 FEDERAL ASSISTANCE 2. DATE SUBMITTED Applicant Identifier 1. TYPE OF SUBMISSION: 3. DATE RECEIVED BY STATE State Application Identifier Application Pre -application 4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier 1_I Construction '.tel Construction Non -Construction rl Non -Construction 5. APPLICANT INFORMATION Legal Name: Organizational Unit: Department Indian River Count Board of Count Commissioners Y Y Board of County Commissioners Organizational DUNS: Division: 079-208.989 Address: Name and telephone number of person to be contacted on matters involving this application (give area code) Street: Prefix: First Name: County Administration Bldg, 1840 25th Street Mr. Jason City: Middle Name Vero Beach County Last Name Indian River Brown State: p 32960 a Suffix: Country. USA - J R�OWNQIRCGOV.COM G. EMPLOYER IDENTIFICATION NUMBER (EIN): Phone Number (give area code) Fax Number (give area code) 5❑❑9 —©MK�]©ff® 772-567.8000x1257 772-770-5331 8. TYPE OF APPLICATION: T. TYPE OF APPLICANT: (See back of form for Application Types) J New l"] Continuation Revision g If Revision, enter appropriate letter(s) in box(es) See back of form for description of letters.) ❑Other (specify) 9. NAME OF FEDERAL AGENCY: Other (specify) RENEWAL US DEPT. OF HOUSING AND URBAN DEVELOPMENT 10, CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 11. DESCRIPTIVE TITLE OF APPLICANTS PROJECT: LL==JJ ONE YEAR RENEWAL OF COC -WIDE HMIS EXPANSION TITLE (Name of Program): Continnuum of Care Homeless Assistance 12. AREAS AFFECTED BY PROJECT (Cities, Counties, States, etc.): FL 509 -Ft. Pierce/St. Lucie, Indian River, Martin 13. PROPOSED PROJECT 14. CONGRESSIONAL DISTRICTS OF: Start Date: Ending Date: a. Applicantb. Project 05/01/2007 04/30/2008 15-16 5-16 15. ESTIMATED FUNDING: 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS? a. Federal THIS PREAPPLICATION/APPLICATION WAS MADE Yes. 25,856 25,856 a. AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON DATE: Yl PROGRAM IS NOT COVERED BY E. 0.12372 b, Applicant c. State d. Local UV b. No. OR PROGRAM HAS NOT BEEN SELECTED BY STATE e. Other VU( 6,464 6.464 — FOR REVIEW f. Program Income 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? F � Yes If "Yes" attach an explanation. 1(J No g. TOTA32,320 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. Authorl d R resents We Prefix ARTN Middle Name Filt LIM R Last Name Suffix NEUBERGER . Title c. Telephone Number (give area code) CHAIR% N 772-567-8000 . Signure prized R ental LAA, . Date SignedI May 16s-/2006 Previous Edition Usable e `(\ Standard Form 424 (Rsv.9-2003) Authorized for Local Reproduction QJ Prescribed by OMB Circular A-102 Applicant/Recipient U.S. Department of Housing OMB Approval No. 2510-W11 (exp. 12/31/2006) and Urban Development Disclosure/Update Report 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: 1840 25" Street 59-6000674 (772) 567-8000 3. HUD Program Name 4. Amount of HUD Assistance Continuum of Care Homeless Assistance — SHP Requested/Received 25,856 5. State the name and location (street address, City and State) of the project or activity: 1840 25"' Street, Vero Beach, F132960 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 See. 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 Such II Other assistance Government Assistance Provided or Requested / Expected Sources and includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance, payment, credit, Use of Funds. or tax benefit. Department/State/Local Agency Name and Address Financial jecVA TVpe of Assistance Amount R uested/Provided Expected Uses of the Funds (Note: Use Addftional 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 lovrer). Alphabetical list of all the project or activity persons with a reportable financial interest in For individuals, give the last name first Social orEmploveelDNo. Security No. Type of Participation in ProjectlActivityPr Financial jecVA Interest in $ 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. Signature: May 16, 2006 TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE Section I: Project Summary Information Part A: General Project Information (All Projects) 1. Project Priority Number 2. ❑ New Project 3. If renewal, list previous Previous Grant Number: Project Priority ®Renewal Project 171,29B309003(From grant number & project in Chart Exhibitl): _4_ identifier number (PIN) PIN Number: FL 1311 4. HUD -Defined CoC Name: 5. CoC Number: Ft. Pierce/St. Lucie. hidian Ricer, Martin Counties CoC FL509 6. Applicant's Organization Name (Legal Name from SF424) 8. Applicant's DUNS Number Indian Ricer Counts Board of Count Commissioners (From SF424): 079-208-989 7. El Check box if Applicant is a Faith -Based Organization ® Check box if Applicant his ever received a federal grant. either directly from a federal agency or through a state/local a enc% 9. Project Applicant's Address (From SF424) 10. Applicant's Employer Street: 1840 21t" Street Identification Number (EIN) (From Cit%: Vero Beach State: FL Zi :329(,0 SF -424): 59-6000074 11. Contact person of Project Applicant: (From SF -424) ❑Check box if Name: JasonBroxvn Phone number: 772-567-8000 A Applicant is die same as Project Title: Budget Director Fax number: 772-567-5991 Sponsor Email Address: w jbron m 7flrcgoc.co 13. Project Name: 14. Project's location 6 -digit FMS Geographic Code: 15, Project Address (S+C SRAs. if multiple sites list all addresses including): 18. ❑ Check box if Energ} Star is Street: 2525 St. Lucie Avenue used in this project City: Vero Beach State: FL Zip: 32960 19. Project Congressional District 16. ❑ Check box if project is located in a Rural Area 15-16 17. If project contains housing units. are these units: ❑ Leased? ❑ Owned? 20. Project Sponsor's Organization Name (If different from Applicant) 22. Sponsor's DUNS Number: Treasure Coast Homeless Sen ices Council, hic. 21. Check box if Project Sponsor is a Faith -Based Organization ® Check box if Project Sponsor has ever received a federal gruit. either directly from a federal agency or through a state/local agency 23. Project Sponsor's Address (if different from Applicant) 24. Sponsor's Emplo}er Street: 2525 St. Lucie Avenue Identification Nuiniber (EIN): City: Vero Beach State: FL Zip: 32960 25. Contact person of Project Sponsor (if different from Applicant) Name: Louise Hubbard Phone number: 772-567-7790 Title: Executive Director Fax number: 772-567-5991 Email Address: irhsclhtiaofcom TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE Part B: Project Summary Budget I'll. Sunnortive Housing ProEram (SHP) (All SHP Proiects) a. SHP Program c. Grant Term (New Projects must be 2 or 3 years; Renewals or HMIS projects can be 11 2 or 3 years) ®(Check only one box) El 1 Year 2 Years 3 Years Z (Renewals b. Component Types (Check only one box) ❑ ❑ ❑ ® E]Safe Haven/TH PH SSO HMIS ❑ Safe Haven/PH d. Proposed e. SHP Dollars f. Cash Match g. Totals SHP Activities Request (Check only one (Col. e + Col. fj 1. Acquisition b. Component Types (Check only one box) El El El ❑/SRO 2, Rehabilitation El New New TRA S� 3. New Construction (PRAR,S+C/SRO) 4. Subtotal 1 Year 5 Years (Lines 1 through 3) 1. Total S+C Rental Assistance Amount $ from S+C and SRO Budget Chart 5. Real Property Leasing From Leasing Budget Chart 6. Supportive Services From Supportive Services Budget Chart 7. Operations From Operating Budget Chart 8. HMIS From HNUS Budget Chart 251856.00 6,464.00 32,320 9. SHP Request 25,856.00 Total Budget (Subtotal lines 4 through 8) Total Cash Match (Total SHP Request + Total 10, Administrative Costs (Up to 5% of line 9 Cash Match) 11. Total SHP Request 25,856.00 6464 32,320 (Total lines 9 and 10) R2. Shelter Plus Care (S+CI (All S+C Proiects) a• S+C Program c. Grant Term ❑ 10 Years c. Grant Term (Renewals are 1 year only) El $ (Check only one box) b. Component Types (Check only one box) El El El ❑/SRO ❑Renewal El New New TRA S� PRA PRAR S+C (PRAR,S+C/SRO) 1 Year 5 Years 10 Years 1. Total S+C Rental Assistance Amount $ from S+C and SRO Budget Chart B3. Section 8 Sin le Room Occu anc SRO All Section 8 SRO Pro'ects a SRO Pro ram c. Grant Term ❑ 10 Years b. Component T eSRO 1. Total SRO Rental Assistance Amount from SRO Budget Chart $ TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE Part Co. Point in Time )`lousing and Participants Chart (All Projects Except Dedicated HIVIIS Projects) N/A 1. Housing Type" la. ❑ Multi -family lb. El Scattered Site (Check all that apply) El Single-family ❑ Project Based Chronic Substance Abusers F]Congregate Facili Veterans a. Current b. New Effort or c. Projected 2. Units, Bedrooms, Beds Level Change in Effort Level (Point -in -Time) (If Applicable) column a+coL b) Number of Units Number of Bedrooms Number of Beds 3. Participants a. Number of Families with Children (Family Households i. Number of adults in families ii. Number of children in families iii. Number of disabled in families b. Number of Single Individuals and Other Households w/o children i. Number of disabled individuals ii. Number of chronical) homeless *Housing Types: Multi -family (apartments, duplexes, SROs, other buildings with 2 or more units); Single-family; Congregate Facility (dormitory, barracks, shared -living). Part D: Targeted Subpopulations N/A (All Projects Except Dedicated IMS Projects) List the approximate percentages for each homeless subpopulation you expect to serve. If you expect to serve subpopulations that fit more then one category (i.e. Severely Mentally Ill Persons with Chronic Substance Abuse), you may place overlapping approximate percentages on the appropriate lines. If this is a # I priority project, it must serve 100% chronically homeless persons to receive the PH bonus. 1. Homeless Sub o ulations 2. Approximate Percentages Chronical) Homeless as defined by HUD Severely Mentally BI Chronic Substance Abusers Veterans Persons with HIV/AIDS Victims of Domestic Violence Unaccompanied Youth Under 18 years of age) Part E. State & Local Government Are there policies and protocols developed or implemented for the discharge of persons from publicly funded institutions or systems of care (e.g., health care 1. ® Yes ❑ No facilities, foster care or other youth facilities, or corrections programs and institutions) in order to prevent such discharge from immediately resulting in homelessness or requiring homeless assistance for such persons in your TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE Part F: Project Leveraging Chart (All Projects) HUD homeless program funding is limited and can provide only a portion of the resources needed to successfully address the needs of homeless families and individuals. MUD encourages applicants to use supplemental resources, including state and local appropriated funds, to address homeless needs. Please be aware that undocumented leveraging claims may result in a re -scoring of your application and possible withdrawal of your conditional award(s). For further instructions for filling out this section, see the Instructions section. Type of Contribution Source of Contribution Identify Source as: (G) Government*Written or (P) Private Date of Commitment Value of Written Commitment Example. Child Care CDBG G 2/15/06 $109000 Will client -level data be included in the fMS for all persons served by this project? "Government sources are appropriated dollars. TOTAL: $ Part G: Project Participation In Homeless Management Information Svstems (HMIS) (All Proiects Except Dedicated BMS Projects) N/A Are there any unresolved HUD monitoring findings, or outstanding audit findings related to this project? If "Yes," briefly describe. 1. ❑ Yes ® No ❑ Yes ❑ No Is this project participating in the HMS? If "Yes," what date did this project begin participating in the BMS? If "No," enter the date the project anticipates beginning participation. mm/ ear ❑ Yes ❑ No Will client -level data be included in the fMS for all persons served by this project? Are there any unresolved HUD monitoring findings, or outstanding audit findings related to this project? If "Yes," briefly describe. 1. ❑ Yes ® No TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE Are there any significant changes that you propose in the project since the last funding approval? Check all that apply: ❑ Number of persons served: from to ❑ Number of units: from to ❑ Location of project sites. 2. ❑ Yes ® No ❑ Line item or cost category budget changes more than 10%. ❑ Change in target population. ❑ Change in project sponsor. ❑ Change in component type. ❑ Other: Please explain changes: H: Renewal Performance (Continued) N/A For all S+C, SUP -PH, SBP-TH, SHP-Safe Haven, and SSO Renewals): Use information from the most recently submitted Annual Progress Report (APR) to answer questions 3, 4, and 5. If an APR has not yet been submitted for this renewal project, please check the N/A boa and skip these questions. ❑ N/A 3. Permanent Housing (PH) Performance (To be filled out by all SHP and S+C renewal permanent housing projects, including both SHP-PH and SHP-Safe Haven permanent housing). Complete the following chart using data based on the preceding operating ye from APR Questions 12(a) and 12(b): a. Number of partici ants who exited PH project(s)—APR Question 12(a) b. Number of participants who did not leave the project(s)—APR Question 12 (b) c. Of those who exited, how many stayed 7 months or longer in PH—APR Question 12(a) d. Of those who did not leave, how many stayed 7 months or longer in PH—APR question 12(b) c. Percentage of all participants in PH projects staying 7 months or longer a �0 [(c + d) divided by (a + b)] x 100 = e. Example: [(16 + 15) divided by (20 + 20)] x 100 = 77.5% 4. Transitional Housing (TH) Performance (To be filled out by all SHP renewal transitional housing projects, including both SHP-TH and SHP-Safe Haven transitional housing). Complete the following chart using data based on the preceding operating year from APR Question 14: a. Number of participants who exited THproject(s)—including unknown destination b. Number of participants who moved to PH—from any destination identified as permanent housing c. Of the number of participants who left TH, what percentage moved to PH? % (b divided by a) x 100 = c Example: (14 / 18) x 100 = 77.7%. 5. Supportive Services - Mainstream Programs and Employment Chart (To be filled out by all S+C and SHP renewals, except dedicated HMIS projects) HUD will be assessing the percentage of clients in your renewal project who gained access to mainstream services and, especially, who gained employment. Based on responses to APR Question 11 complete the following: 1 2 3 4 Number of Adults Who Left Income Source Number of Exiting % with Income (Use the same number Adults with Each Source at Exit in each row) of Income (Col. 3 = Col. 1 x 100 Exam le: 105 a. Social Security Insurance SS 40 38.1% 105 b. Social Security Disability 35 33.3% Insurance SSD 105 ecuri a Social Security 25 23.8% TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE I5. SHP HMIS Budeet (All SBP Projects with FMS Costs) HMIS Costs SHP Dollars Requested Year 1 Year 2 Year 3 Total Equipment J 1. Central Server(s) 2. Personal Computers and Printers 3,100.00 3. Networking 4. Security Subtotal: Software 5. Software/User Licensing 21702.00 6. Software Installation 7. Support and Maintenance 8. Supporting Software Tools Subtotal, Services 9. Training by Third Parties 10. Hosting/Technical Services 11. Programming: Customization 12. Programming: System Interface 13. Programming: Data Conversion 14. Security Assessment and Setup 15. On-line Connectivity (Internet Access) 16. Facilitation 17. Disaster and Recovery Subtotal: Personnel 18. Project Management/Coordination 19. Data Analysis 20. Programming IF Technical Assistance and Training 20,054.00 22. Administrative Support Staff Subtotal: HMIS Space and Operations 23. Space Costs 24. Operational Costs Subtotal: 25. Total SHP HMIS dollars requested in lines I to 24 above: 25,856.00 * Total of Line 25 must match line 8 column e. on the Pro'ect Summag Budget. 26. Total cash match to be spent on SHP eligible HMIS activities: * 6,464.00 3# Cash Match can be spent on any SHP eligible activity (see the chart in Section M.A.3. of the NOFA for these activities). The amount of the SHP HMIS request (entered in line 25) must be no more than 80 percent of the total HMIS budget (i.e., 80 percent of line 25 plus line 26). TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE These certified statements are required by law. Previous versions obsolete form HUD -40090-4 A. For the Supportive Housing (SHP), Shelter Plus Care (S+C), and Single Room Occupancy (SRO) programs: Fair Housing and Equal Opportunity. It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulations pursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, on the ground of race, color or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the applicant receives Federal financial assistance, and will immediately take any measures necessary to effectuate this agreement. With reference to the real property and structure(s) thereon which are provided or improved with the aid of Federal financial assistance extended to the applicant, this assurance shall obligate the applicant, or in the case of any transfer, transferee, for the period during which the real property and structure(s) are used for a purpose for which the Federal financial assistance is extended or for another purpose involving the provision of similar services or benefits. It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and with implementing regulations at 24 CFR part 100, which prohibit discrimination in housing on the basis of race, color, religion, sex, disability, familial status or national origin. It will comply with Executive Order 11063 on Equal Opportunity in Housing and with implementing regulations at 24 CFR Part 107 which prohibit discrimination because of race, color, creed, sex or national origin in housing and related facilities provided with Federal financial assistance. It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter 60- 1), which state that no person shall be discriminated against on the basis of race, color, religion, sex or national origin in all phases of employment during the performance of Federal contracts and shall take affirmative action to ensure equal employment opportunity. The applicant will incorporate, or cause to be incorporated, into any contract for construction work as defined in Section 130.5 of HUD regulations the equal opportunity clause required by Section 130.15(b) of the HUD regulations. It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended (12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that to the greatest extent feasible opportunities for training and employment be given to lower-income residents of the project and contracts for work in connection with the project be awarded in substantial part to persons residing in the area of the project. It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended, and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based on disability in Federally -assisted and conducted programs and activities. It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, and implementing regulations at 24 CFR Part 146, which prohibit discrimination because of age in projects and activities receiving Federal financial assistance. TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE It will comply with Executive Orders 11625, 12432, and 12138, which state that program participants shall take affirmative action to encourage participation by businesses owned and operated by members of minority groups and women. If persons of any particular race, color, religion, sex, age, national origin, familial status, or disability who may qualify for assistance are unlikely to be reached, it will establish additional procedures to ensure that interested persons can obtain information concerning the assistance. It will comply with the reasonable modification and accommodation requirements and, as appropriate, the accessibility requirements of the Fair Housing Act and section 504 of the Rehabilitation Act of 1973, as amended. Additional for S+C: If applicant has established a preference for targeted populations of disabled persons pursuant to 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within the designated population. B. For SHP Only. 20 -Year Operation Rule. For applicants receiving assistance for acquisition, rehabilitation or new construction: The project will be operated for no less than 20 years from the date of initial occupancy or the date of initial service provision for the purpose specified in the application. 1 -Year Operation Rule. For applicants receiving assistance for supportive services, leasing, or operating costs but not receiving assistance for acquisition, rehabilitation, or new construction: The project will be operated for the purpose specified in the application for any year for which such assistance is provided. C. For S+C Only. Supportive Services. It will make available supportive services appropriate to the needs of the population served and equal in value to the aggregate amount of rental assistance funded by HUD for the full term of the rental assistance. D. 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.. Signature of Title: Date: May 16, 2006 Chairman, Indian River County Board of County Commissioners Applicant: For PHA Applicants Only: (PHA Number) APPI [CATION FOR Version 7103 FEDERAL ASSISTANCE 2. DATE SUBMITTED Applicant Identifier 1. TYPE OF SUBMISSION: - 3. DATE RECEIVED BY STATE State Application Identifier Application Pre -application 4, DATE RECEIVED BY FEDERAL AGENCY Federal Identifier U C Construction Construction Non -Construe" n FJ Non -Construction 5. APPLICANT INFORMATION Legal Name: Organizational Unit: m Department: Indian River CountyBoard of County Commissioners ty Board County Commissioners Organizational DUNS: Division: 079-208-989 Address: Name and telephone number of person to be contacted on matters involving this application (give area code) Street County Administration Bldg, 1840 25th Street Prefix: First Name: Mr. Jason City: Middle Name Vero Beach County Last Name Indian Riverpp Brown ZI Coe - Suffix: State: Country: Email: USA JBROWN IRCGOV.COM S. EMPLOYER IDENTIFICATION NUMBER (E1N): Phone Number (give area code) Fax Number (give area code) 772-567-8000x1257 772-7705331 8. TYPE OF APPLICATION: 7. TYPE OF APPLICANT: (See back of form for Application Types) UJ New (rI Continuation Revision B If Revision, enter appropriate letter(s) in box(es) See back of form for description of letters.) ❑Other (specify) 8. NAME OF FEDERAL AGENCY: Other (specify) RENEWAL -TWO YEARS US DEPT. OF HOUSING AND URBAN DEVELOPMENT 10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 11. DESCRIPTIVE TITLE OF APPLICANTS PROJECT: T®�EQF5] TWO YEAR RENEWAL OF COC -WIDE HMIS TITLE (Name of Program): Continnuum of Cara Homeless Assistance 12. AREAS AFFECTED BY PROJECT (Cities, CounHws, States, etc.): FL 509 -Ft. Pierce/St. Lucie, Indian River, Martin 13. PROPOSED PROJECT 14. CONGRESSIONAL DISTRICTS OF: Start Date: Ending Date: a. Applicant b. Project 05/01/2007 04/3012009 15-16 5-16 16. ESTIMATED FUNDING: 46. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12S72 PROCESS7 a. Federal ' THIS PREAPPLICATION/APPLICATION WAS MADE Yes. 72354 72,354 a. AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON DATE: b. No. V1 PROGRAM IS NOT COVERED BY E. O. 12372 OR PROGRAM HAS NOT BEEN SELECTED BY STATE b. Applicant a State d. Local e. Other 180088.50 160,089 FOR REVIEW I. Program Income 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? 0 Yes If "Yes' attach an explanation. No 9 TOTAL0 9044Z18. 80,443 TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATIONIPREAPPLICATION 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 s resentative Prefix ryarns AIRT Middle Name ryl)I( uFNc NEUBERGER . Title o. Telephone Number (give area code) CHAIRMAN 772-567-8000 . Signature"t dRepresogtetiye . Data Signed May 16 200 Previous Edition Usable 1 7 N V Standard rorm 424 (K9V.y-zurre) Authorized for Local Reproduction Prescribed by OMB Circular A-102 w 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.) Information Indicate whether this is an Initial Applicant/Recipient Name, Address, and Phone (include area code): INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS 1840 25TH Street (7721567-8000 Continuum of Care Homeless Assistance — SHP Employer ID Number: 59-6000674 WT -7 �Klii 1840 2EP Street, Vero Besch, FI 32960 Part I Threshold Determinations Department1. Are you applyng for assistance for a specific project or 2. Have you received the terms do not include formula grants, such as public hou jurisdiction of the , expect. ) , involving the project or activity ` subsidy or .: $200 ,000 during 4.3). For turther information, am 24 CFR Sec. 4.9 M Yes ■ No ■ Yes /. 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 11 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. 01 PartIII 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 fres 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 the project or persons with a For individuals reportable financial interest in the last name first Social Security No. or Emplovee ID No. Type of Participation in P Act- ' P Financial ' A ' Interest in ' $ and % PartIII 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 fres 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 the project or persons with a For individuals reportable financial interest in the last name first Social Security No. or Emplovee ID No. Type of Participation in P Act- ' P Financial ' A ' Interest in ' $ 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 1 D01 of Title 18 of the United States Code. In addition, any person who knowingly and materially violates any required disclosures of information, including intentional nondisclosure, is subject to civil money penalty not to exceed $10,000 for each violation. I certify that this information is true and complete. May 16, 2006 TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE Section Is. ProjectSummary r.' l 1 1 .l Part J'ral Pr9ject Information (AR Projects) 1. Project Priority Number 2. ❑ New Project 3. If renewal, list previous Precious Gmat Number: b (From Project Priority ® Renewal Project giant number project F12913509003 Chart in Exhibitl): _3_ identifier number (PIN) PIN Number: F113167 4. HUD -Defined CoC Name: 5. CoC Number: Ft. Pierce/St. Lucie. Indian Ricer. Martin Counties CoC FL509 6. Applicants Organization Name (Legal Name from SF -424) 8. Applicant's DUNS Number Indian Ricer Counts Board of Counts Commissioners (From SF -424): 079-208-989 7. F1 Check box if Applicant is a Faith -Based Organization ® Check box if Applicant has ever received a federal grant, either directly from a federal agency or through a state/local agency 9. Project Applicants Address (From SF -424) 10. Applicant's Employer Street 1840 25' Street Identification Number (EIN) (From City: Vero Beach State: FL Zip: 32960 SF -124): 59-6000674 11. Contact person of Project Applicant: (From SF424) El Check Name: Jason Brown Phone umber: 772-567-8000 mProject ame as Project Applicant is thee same Title: Budget Director Fax number: 772-567-5991 Sponsor Email Address: jbromvirirc ov.com 13. Project Name: 14. Project's location 6 -digit Geographic Code: 129061 15. Project Address (S+C SRAs. if multiple sites list all addresses including): 18. 0 Check box if Energy Star is Street: 2525 St. Lucie Avenue used in this project City: Vero Beach State: FL Zip:32960 19. Project Congressional District 16. ❑ Check box if project is located in a Rural Area 15-16: 17. If project contains housing units. are these units: ❑ Leased? ❑ Owned? 20. Project Sponsor's Organization Name (If different from Applicant) 22. Sponsor's DUNS Number: Treasure Coast Homeless Services Council. Inc. 21. Check box if Project Sponsor is a Faith -Based Organization ® Check box if Project Sponsor has ever received a federal grant. either directly from a federal agency or through a state/local agency 23. Project Sponsor's Address (if different from Applicant) 24. Sponsor's Employer Street: 2525 St. Lucie Avenue Identification Number (EIN): City: Vero Beach State: FL Zip: 32960 25. Contact person of Project Sponsor (if different from Applicant) Name: Louise Hubbard Phone member: 772-567-7790 Title: Executive Director Fax number: 772-567-5991 Email Address: idtsclh iraol.com TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE Part B: Project Summary Budget Bl. Supportive Housing Program (SHP) (All SBP Projects) a SHP Program c. Grant Term (New Projects must be 2 or 3 years; c. Grant Term (Check only one Renewals or HXHS projects can be 1, 2 or 3 years) I b. Component Types (Check only one boa) ❑ ❑ ❑ ® ❑ Safe Haven/TH❑ (Check only onbox) PH SSO HMIS ❑ Safe Haven/PH F1TH ❑ New 1 Year 2 Years 3 Years d. Proposed e. SHP Dollars f. Cash Match g. Totals SHP Activities Request (Col. e + Col. 1. Acquisition 10 Years I. Total S+C Rental Assistance Amount 2, Rehabilitation from S+C 3. New Construction 4. Subtotal Lines 1 through 3 5. Real Property Leasing From Leasing Budget Chart a K 6. Supportive Services From Supportive Services Budget Chart 7. Operations From Operating Budget Chart 8, EMS 72,354 18,088.50 From IMS Budget Chart 9. SHP Request 72,354 Total Budget (Subtotal lines 4 through 8) Total Cash Match (Total SHP Request + Total 10, Administrative Costs to 5% of line 9 Cash Match) 11. Total SHP Request 72,354 181088.50 90,442.50 Total lines 9 and 10 B2. Shelter Plus Care (S+C) (All S+C Projects)N/A a• S+C Program c. Grant Term 10 Years c. Grant Term (Check only one (Renewals box) are 1 year only) b. Component Types (Check only one boa) El D PR El Renewal ❑ New New TRA SRA PRAR S+C❑/SRO (PRA�S+C/SRO) 1 Year 5 Years 10 Years I. Total S+C Rental Assistance Amount $ from S+C and SRO Budget Chart B3. Section 8 Single Room Occupancy (SRO) (All Section 8 SRO Projects) a• LJ SRO Program c. Grant Term 10 Years b. Component e ❑(SRO)❑ 1. Total SRO Rental Assistance Amount $ from SRO Budget Chart r Part Co Point in Time Housing and Participants Chart (All Projects Except Dedicated BAGS Projects) N/A 1. Housing Type" la Multi -family lb. F1 Scattered Site (Check all that apply) ❑ Single-family ❑ Project Based Chronic Substance Abusers ❑ Con ate Facility Veterans a. Current b. New Effort or c. Projected 2, Units, Bedrooms, Beds Level Change in Effort Level (Point -in -Time) (If Applicable) (column a+ coL b) Number of Units Number of Bedrooms Number of Beds 3. Participants a. Number of Families with Children(Family Households i. Number of adults in families ii. Number of children in families iii. Number of disabled in families b. Number of Single Individuals and Other Households w/o children i. Number of disabled individuals ii. Number of chronically homeless *Housing Types: Multi -family (apartments, duplexes, SROs, other buit(hngs with 2 or more units); Single-family, Congregate Facihty Oonoito , banacks, shared -hvin ). Part D: Targeted Subpopulations N/A (All Projects Except Dedicated FMS Projects) List the approximate percentages for each homeless subpopulation you expect to serve. If you expect to serve subpopulations that fit more then one category (i.e. Severely Mentally Ill Persons with Chronic Substance Abuse), you may place overlapping approximate percentages on the appropriate lines. If this is a #1 priority project, it must serve 100% chronically homeless persons to receive the PH bonus. 1. Homeless Subpopulations 2. Approximate Percenta es Chronically Homeless as defined by HUD Severely Mentally nl Chronic Substance Abusers Veterans Persons with HIV/AIDS Victims of Domestic Violence Unaccompanied Youth (Under 18 years of age) Part E. Discharge Policy (Only State & Local Government A licants Are there policies and protocols developed or implemented for the discharge of persons from publicly funded institutions or systems of care (e.g., health care 1. ® Yes ❑ No facilities, foster care or other youth facilities, or corrections programs and institutions) in order to prevent such discharge from immediately resulting in homelessness or requiring homeless assistance for such persons in your TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE Part F: Project Leveraging Chart (All Projects) HUD homeless program funding is limited and can provide only a portion of the resources needed to successfully address the needs of homeless families and individuals. HUD encourages applicants to use supplemental resources, including state and local appropriated funds, to address homeless needs, Please be aware that undocumented leveraging claims may result in a re -scoring of your application and possible withdrawal of your conditional award(s). For further instructions for filling out this section, see the Instructions section. Type of Contribution Source of Contribution Identify Source as: (G) Government* or P Private Date of Written Commitment Value of Written Commitment Example: Child Care CDBG G 2/15/06 $10,000 Space and Staff Communi Church P 4/24/06 $109,151.00 *Government sources area ro riated dollars. TOTAL: $109,151.00 Part G: Project Participation In Homeless Management Information Systems (HMIS) (Ail Projects Except Dedicated FMS Projects)N/A ❑ Yes ❑ No Is this project participating in the HMS? If "Yes," what date did this project begin participating in the BMS? If `No," enter the date the project anticipates beginning participation. rain/ ear ❑ Yes ❑ No Will client -level data be included in the BNHS for all persons served by this project? NOWN Part H: Renewal Performance (All Renewal Projects) Are there any unresolved HUD monitoring findings, or outstanding audit findings related to this project? If "Yes," briefly describe. 1. ❑ Yes ® No TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE Are there any significant changes that you propose in the project since the last funding approval? Check all that apply: ❑ Number of persons served: from to ❑ Number of units: from to ❑ Location of project sites. 2. ❑ Yes ® No ❑ Line item or cost category budget changes more than 10%. ❑ Change in target population. ❑ Change in project sponsor. ❑ Change in component type. ❑ Other: Please explain changes: H: Renewal Performance (Continued) N/A or all S+C, SBP -PH, SBP-TH, SBP -Safe Haven, and SSO Renewals): Use information from the most recently submitted Annual Progress Report (APR) to answer questions 3, 4, and 5. If an APR has not yet been submitted for this renewal project, please check the N/A box and sldp these questions. ❑ N/A 3. Permanent Housing (PH) Performance (To be filled out by all SHP and S+C renewal permanent housing projects, including both SHP-PH and SHP-Safe Haven permanent housing). Complete the following chart using data based on the preceding operating year from APR Questions 12(a) and 12(b): a. Number of participants who exited PH project(s}--APR Question 12(a) b. Number of participants who did not leave the project(s)—APR Question 12 (b) c. Of those who exited, how many stayed 7 months or longer in PH—APR Question 12(a) d. Of those who did not leave, how many stayed 7 months or longer in PH—APR question 12(b) e. Percentage of all participants in PH projects staying 7 months or longer [(c + d) divided by (a + b)] x 100 = e. Example: [(16 + 15) divided by (20 + 20)] x 100 = 77.5% 4. Transitional Housing (TH) Performance (To be idled out by all SHP renewal transitional housing projects, including both SHP-TH and SHP-Safe Haven transitional housing). Complete the following chart using data based on the preceding operating year from APR Question 14: a. Number of participants who exited THro ect(s)—inclu own destination b. Number of participants who moved to PH—from any destination identified as permanent housing c. Of the number of participants who left TH, what percentage moved to PH? o % (b divided by a) x 100 = c Example: (14 / 18) x 100 = 77.7%. 5. Supportive Services - Mainstream Programs and Employment Chart (To be filled out by all S+C and SHP renewals, except dedicated HMLS projects) HUD will be assessing the percentage of clients in your renewal project who gained access to mainstream services and, especially, who gained employment. Based on responses to APR Question 11 complete the following: 1 2 3 4 Number of Adults Who Left Income Source Number of Exiting % with Income (Use the same number Adults with Each Source at Exit in each row) of Income (Col. 3 _ Col. 1 x 100 Example. 105 a Social Security insurance S 40 38.1% 185 b. Social Security Disability 35 33.3% Insurance SSD 105 e. Social Seco 25 23.8"/6 I5. SHP HMIS Budget (All SHP Projects with HNUS Costs) HMIS Costs SUP Dollars Requested Year 1 Year 2 Year 3 Total Equipment 1. Central Server(s) 2. Personal Computers and Printers 2100 2100 3. Networking 4. Security Subtotal: Software 11502.25 11502.25 5, SoftwarelUser Licensing 6. Software Installation 7. Support and Maintenance 8. Supporting Software Tools Subtotal: Services 9. Training by Third Parties 3000 10. Hosting/Technical Services 6933.00 6933.00 11. Programming: Customization 3000 12, Programming: System Interface 13. Programming: Data Conversion 14. Security Assessment and Setup 15. On-line Connectivity (Internet Access) 16. Facilitation 17. Disaster and Recovery Subtotal: Personnel 18. Project Management/Coordination 19. Data Analysis 20. Programming 21. Technical Assistance and Training 21676 21676 22. Administrative Support Staff Subtotal: MMS Space and Operations 23. Space Costs 24. Operational Costs Subtotal: 25, Total SHP MUS dollars requested in lines 1 to 24 above: 36177 36177 * Total of Line 25 must match line 8 column e. on the Project Summag Budget. 26. Total cash match to be spent on SBP eligible IMS activities: * 9044.25 9044.25 ** Cash Match can be spent on any SHP eligible activity (see the chart in Section III.A.3. of the NOFA for these activities). The amount of the SBP EMS request (entered in line 25) must be no more than 80 percent of the total HMIS budget (i.e., 80 percent of line 25 plus line 26). TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE Section We. Applicant Certification These certified statements are required by law. Previous versions obsolete form HUD -400904 A. For the Supportive Housing (SHP), Shelter Plus Care (S+C), and Single Room Occupancy (SRO) programs: Fair Housing and Equal Opportunity. It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulations pursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, on the ground of race, color or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the applicant receives Federal financial assistance, and will immediately take any measures necessary to effectuate this agreement. With reference to the real property and structure(s) thereon which are provided or improved with the aid of Federal financial assistance extended to the applicant, this assurance shall obligate the applicant, or in the case of any transfer, transferee, for the period during which the real property and structure(s) are used for a purpose for which the Federal financial assistance is extended or for another purpose involving the provision of similar services or benefits. It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and with implementing regulations at 24 CFR part 100, which prohibit discrimination in housing on the basis of race, color, religion, sex, disability, familial status or national origin. It will comply with Executive Order 11063 on Equal Opportunity in Housing and with implementing regulations at 24 CFR Part 107 which prohibit discrimination because of race, color, creed, sex or national origin in housing and related facilities provided with Federal financial assistance. It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter 60- 1), which state that no person shall be discriminated against on the basis of race, color, religion, sex or national origin in all phases of employment during the performance of Federal contracts and shall take affirmative action to ensure equal employment opportunity. The applicant will incorporate, or cause to be incorporated, into any contract for construction work as defined in Section 130.5 of HUD regulations the equal opportunity clause required by Section 130.15(b) of the HUD regulations. , It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended (12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that to the greatest extent feasible opportunities for training and employment be given to lower-income residents of the project and contracts for work in connection with the project be awarded in substantial part to persons residing in the area of the project. It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended, and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based on disability in Federally -assisted and conducted programs and activities. It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, and implementing regulations at 24 CFR Part 146, which prohibit discrimination because of age in projects and activities receiving Federal financial assistance. TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE It will comply with Executive Orders 11625, 12432, and 12138, which state that program participants shall take affirmative action to encourage participation by businesses owned and operated by members of minority groups and women. If persons of any particular race, color, religion, sex, age, national origin, familial status, or disability who may qualify for assistance are unlikely to be reached, it will establish additional procedures to ensure that interested persons can obtain information concerning the assistance. It will comply with the reasonable modification and accommodation requirements and, as appropriate, the accessibility requirements of the Fair Housing Act and section 504 of the Rehabilitation Act of 1913, as amended. Additional for S+C: If applicant has established a preference for targeted populations of disabled persons pursuant to 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within the designated population. B. For SEEP Only, 20 -Year Operation Rule. For applicants receiving assistance for acquisition, rehabilitation or new construction: The project will be operated for no less than 20 years from the date of initial occupancy or the date of initial service provision for the purpose specified in the application. 1 -Year Operation Rule. For applicants receiving assistance for supportive services, leasing, or operating costs but not receiving assistance for acquisition, rehabilitation, or new construction: The project will be operated for the purpose specified in the application for any year for which such assistance is provided. C. For S+C Only. Supportive Services. It will make available supportive services appropriate to the needs of the population served and equal in value to the aggregate amount of rental assistance funded by HUD for the full term of the rental assistance. D. 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. Signature of Authorized Cgrtifying Official: I Date: May 16, 2006 . Chairman, Indian River County Board of County Commissioners Applicant: For PHA Applicants Only: (PHA Number) MMI ATS/ hl QAn Version 7103 mrrul �I#Wpm. V.. FEDERAL ASSISTANCE 2. DATE SUBMITTED Applicant Identifier 1. TYPE OF SUBMISSION: 3. DATE RECEIVED BY STATE State Application Identifier Application Pre -application 4• DATE RECEIVED BY FEDERAL AGENCY Federal Identifier U Construction Construction P,,Non-Construction Non -const uction 5. APPLICANT INFORMATION Legal Name: Organizational Unit; Department IDNIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS BOARD OF COUNTY COMMISSIONERS Organizational DUNS: Division: 078-208-989 Address: Name and telephone number of person to be contacted on matters Street involving this application give area node) COUNTY ADMINISTRATION BUILDING, Prefix: First Name: 1640 25TH STREET I Jason VF170 BEACH Middle Nam County: at Name Brc wn INDIAN RIVER COUNTY State: p 232960 a Suffix: FL Country: USAJBROWN Email: IRCGOV.COM 6. EMPLOYER IDENTIFICATION NUMBER (EIN): Phone Number (give area code) Fax Number (give area code) 0 gp® 772-567-8000x1257 772-770-5331 8. TYPE OF APPLICATION: 7. TYPE OF APPLICANT: (See back of form for Application Types) QJ New Fj Continuation 151 Revision g If Revision, enter appropriate letters) in box(es) See back of form for description of letters) ❑ her (specify) Other (specify) 9. NAME OF FEDERAL AGENCY: US DEPT. OF HOUSING AND URBAN DEVELOPMENT RENEWAL 10, CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 11. OESCRIPTNE TITLE OF APPLICANTS PROJEOT: �i®ALJnn© SHELTER PLUS CARE TRA -ONE YEAR RENEWAL TITLE (Name of Program): Continnuum of Care Homeless Assistance 12. AREAS AFFECTED BY PROJECT fCi(fes, Com f!106, States, etc.): INDIAN RIVER COUNTY 13. PROPOSED PROJECT 114. CONGRESSIONAL DISTRICTS OF: Start Data: Ending Date: a. Applicant Project 06/01/2006 61313/2007 15-16 5-16 16. ESTIMATED FUNDING: 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE DRDER 12372 P CMSS? a. Federal [[f THIS PREAPPLICATION/APPLICATION WAS MADE 110806 110.808 a. Yes. AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON DATE: b. Applicant c. State PROGRAM IS NOT COVERED BY E.O. 12372 , d. Local b. No.1 OR PROGRAM HAS NOT BEEN SELECTED BY STATE e. Other .. FOR REVIEW f. Program Income 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? g, TOTAL 110808 110,808' [I Yes If "Yes" attach an explanation. VI No 18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATIONIPREAPPLICATION 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. Authorized Representative a, Prefix First Na Rte HUN fiddle Name Last Name uffuk NEUBERGER Title Telephone Number (give area code) . COMMISSIONER 772-567-8000 . Sign u of horized 1 e"enta a .Date Signed May 16- 2006 VC Previous Edition Usable V ( \ Authorized for Local Reoroddction v `. umcara term 4L4 kK0V.a-CUV0J Prescribed by OMB Circular A-102 Applicant/Recipient. U.S. Department of Housing Disclosure/Update Report and Urban Development OMB Approval No. 2510-0011 (exp. 12/31/2006) ... - ... - licant/Reci lent Information Indicate whether this is an Initial Report ❑ or an Update Report 19 Applieant/Reciplart Name, Address, and Phone (include area code): 2. Social Security Number or INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS Employer ID Number: 1840 25' Street 59-6000674 (772)567-8000 Continuum of Care Homeless Assistance — S+CI Requested/Received 110,808 5. SGte me name R'F, SF. -) of me project7t r 2EP Street, Vero Beach, FI 32960 Part I Threshold Determinations 1. Are you p applyingterms do not include formula grants, such as public housing in jurisdiction of the Deparknent (H UID) . involving the project or act" in this subsidy or D : _ - -$200,000, , (O- A 4-3)- For furthier information, see 24 CIFR Sec. 4.9 /1 F]►/�, If you answered "No" to either question 1 or 2, Stop! You do not need to complete the remainder of this form. However, you must sign the certification at the end of the report. Part II Other Government Assistance Provided or Requested / Expected Sources and Use of Fun Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance, payment, credit, or tax benefit. Part III Interested Parties. You must disclose: 1. All developers, contractors, or consultants involved in the application for the assistance or In the planning, development, or Implementation of the project or activity and Alphabetical list of all the project or activity persona with a reportable financial interest in For individuals give the lost name first Social or Employee Security No. ID No. Type of Participation in ProjectiActivily Financial Interest in ProtectlActivity$ and % (Note: Use Additional pages If necessary.) Certification Warning: If you knowingly make a false statement on this form, you rrwy be subject to civil or criminal penalties under Section 1001 of Title 18 of the Untied 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. Date: (mm/dd/yyyy) May 16, 2006 TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM Or CARE Section I: Project Summary Information Part A: General Project Information All Projects) 1. Project Priority Number 2. El New Project 3. If renewal, list previous Precious Gram Number: Priority Project Pri (From Proj ® Renewal Project grant number project FL29C 109001 Chart in Extubitl): N/A identifier number (PIN) PIN Number: 4. HUD -Defined CoC Name: 5. CoC Number: Ft. Pierce/St. Lucie. Indian Ricer. Martin Counties CoC FL -509 6. Applicant's Organization Name (Legal Name from SF -124) 8. Applicant's DUNS Number Indian Ricer County Board of Counh Commissioners (From SF -424): 079-208-989 7. Check box if Applicant is a Faith -Based Organization ® Check box if Applicant has ever received a federal grant, either directly- from a federal agency or through a state/local agency 9. Project Applicant's Address (From SF -124) 10. Applicant's Employer Street: 1840 25h Street Identification Number (EIN) (From Cit: Vero Beach State: FL Zip: 32960 SF -424):59-6000674 11- Contact person of Project Applicant: (From SF -424) 12. ❑Check box if Project Name: Jason Brown Phone number: 772-567-8000 Applicant is the same as Project Title: Budget Director Fac number: 722-567-5991 Sponsor Email Address: jbrowmiirc. oc 13. Project Name: Indian Ricer County Shelter Plus Care TRA 14. Project's location 6 -,digit Geographic Code: 129061 15. Project Address (S+C SRAs. if multiple sites list all addresses including): 18. ❑ Check box if Energy Star is Street: used in this project City: State: Zip: 19. Project Congressional District: 16. ❑ Check box if project is located in a Rural Area 15-16 17. If project contains housing units. are these units: ❑ Leased:' ❑ Owned? 20. Project Sponsor's Organization Name (If different from Applicant) 22. Sponsor's DUNS Number: 21. Check box if Project Sponsor is a Faith -Based Organization ❑ Check box if Project Sponsor has ever received a federal grant, either directly from a federal agency or through a statellocal agency 23. Project Sponsor's Address (if different from Applicant) 24. Sponsor's Employer Street: Identification Niniber (FIN): Citv: State: Zip: 25. Contact person of Project Sponsor (if different from Applicant) n/a Name: Phone number: Title: Fax number: Email Address: 4V.1ni: 40' nWGiO):F9at(0)31:4 A AA4 iy*iOTili �Loi� •.M .l 11� � . _ . Part Co Point in Time Dousing and Participants Chart (All Projects Except Dedicated IMS Projects) 1. Housing Type` Ia. ® Multi -family ® Scattered Site (Check all that apply) ElSingle-familylb. Based Chronic Substance Abusers [EDCon a ate FacilityProject Veterans a. Current b. New Effort or c. Projected 2, Units, Bedrooms, Beds Level Change in Effort Level (Point -in -Time) Applicable) (column a+col. b Number of Units 19 Number of Bedrooms 19 Number of Beds 19 3. Participants a. Number of Families with Children (Family Households i. Number of adults in families ii. Number of children in families iii. Number of disabled in families b. Number of Single Individuals and 19 Other Households w/o children i. Number of disabled individuals 1 19 Number of chronically homeless 117 .ii. *Housing Types: Multi -family (apartments, duplexes, SROs other buildings with 2 or more units); Single-family; Congregate Facility (dormitory, barracks, shared -living). Part D: Targeted Subpopulations (All Projects Except Dedicated FMS Projects) List the approximate percentages for each homeless subpopulation you expect to serve. If you expect to serve subpopulations that fit more then one category (i.e. Severely Mentally Ill Persons with Chronic Substance Abuse), you may place overlapping approximate percentages on the appropriate lines. If this is a # 1 priority project, it must serve 100% chronically homeless persons to receive the PH bonus. 1. Homeless Subpopulations 2. Approximate Percentages Chronical) Homeless as defined by HUD 80 Severely Mentally 111 100 Chronic Substance Abusers Veterans Persons with HIV/AIDS Victims of Domestic Violence Unaccompanied Youth oder 18 years of !Le Part E: State & Local Government Are there policies and protocols developed or implemented for the discharge persons from publicly funded institutions or systems of care (e.g., health care 1. ® Yes ❑ No facilities, foster care or other youth facilities, or corrections programs and institutions) in order to prevent such discharge from immediately resulting in homelessness or requiring homeless assistance for such persons in your FL -509 Ft. Pierce/St. Lucie. Indian River. Martin Counties CoC APPLICANT DUNS 079-208-989 TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE Part F: Project Leveraging Chart (All Projects) HUD homeless program funding is limited and can provide only a portion of the resources needed to successfully address the needs of homeless families and individuals. HUD encourages applicants to use supplemental resources, including state and local appropriated funds, to address homeless needs. Please be aware that undocumented leveraging claims may result in a re -scoring of your application and possible withdrawal of your conditional award(s). For further instructions for filling out this section, see the Instructions section. Type of Contribution Source of Contribution Identify Source as: (G) Government" or ) Private Date of Written Commitment Value of Written Commitment Child Cam CDBG G 2/15/06 $109000 n/a "Government sources are appropriated dollars TOTAL: 1 $ Part G: Project Participation In homeless Management Information Systems S (All Projects Except Dedicated BNHS Projects) ® Yes ❑ No Is this project participating in the HMIS? 06/2003 If "Yes," what date did this project begin participating in the HMIS? mm/ ear If "No," enter the date the project anticipates beginning participation. ® Yes ❑ No Will client -level data be included in the HMIS for all persons served by this ro'ect? Part II: Renewal Performance (All Renewal Proiects) Are there any unresolved HUD monitoring findings, or outstanding audit findings related to this project? If "Yes," briefly describe. 1. ❑ Yes ® No FL -509 Ft. Pierce/St. Lucie. Indian River, Martin Counties CoC APPLICANT DUNS 079-208-989 TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE ti FL -509 Ft. Pierce/St. Lucie, Indian River, Martin Counties CoC APPLICANT DUNS 079-208-989 Are there any significant changes that you propose in the project since the last funding approval? Check all that apply: ® Number of persons served: from to 19_. �12_ ❑ Number of units: from to ❑ Location of project sites. ❑ Line item or cost category budget changes more than 10%. 2. ® Yes ❑ No ❑ Change in target population. ❑ Change in project sponsor. ❑ Change in component type. ❑ Other: Please explain changes: Efficient use of grant funds , client co -pays and entitlements has allowed us to have 19 units leased up at renewal time. H. Renewal Performance (Continued) For all S+C, SHP-PH, SBP-TH, SHP-Safe Haven, and SSO Renewals): Use information from the most recently submitted Annual Progress Report (APR) to answer questions 3, 4, and 5. If an APR has not yet been submitted for this renewal project, please check the N/A box and skip these questions. ❑ N/A 3. Permanent Housing (PH) Performance (To be filled out by all SHP and S+C renewal permanent housing projects, including both SHP-PH and SHP-Safe Haven permanent housing). Complete the following chart using data based on the preceding operating ye from APR Questions 12a)and l2b: a. Number of participants who exited PHproject(s)—APR Question 12(a) 6 b. Number of participants who did not leave the project(s)—APR Question 12 (b) 11 c. Of those who exited, how many stayed 7 months or longer in PH—APR Question 12(a) 5 d. Of those who did not leave, how many stayed 7 months or longer in PH—APR question 12(b) 10 e. Percentage of all participants in PH projects staying 7 months or longer 88% (c + d) divided by (a + b)] x 100 = e. Example: [(16 + 15) divided by (20 + 20)] x 100 = 77.5% 4, Transitional Housing (TE) Performance (To be filled out by all SHP renewal transitional housing projects, including both SHP-TH and SHP-Safe Haven transitional housing). Complete the following chart using data based on the preceding operating year from APR Question 14: a. Number of participants who exited THpwject(s)—incIudLnZ unknown destination b. Number of participants who moved to PH—from any destination identified as permanent housing c. Of the number of participants who left TH, what percentage moved to PH? % b divided by a) x 100 = c Example: 14 / 18) x 100 = 77.7%. FL -509 Ft. Pierce/St. Lucie, Indian River, Martin Counties CoC APPLICANT DUNS 079-208-989 TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARE 5. Supportive Services - Mainstream Programs and Employment Chart (To be filled out by all S+C and SHP renewals, except dedicated HMIS projects) HUD will be assessing the percentage of clients in your renewal project who gained access to mainstream services and, especially, who gained employment. Based on responses to APR Question 11 complete the followin 1 2 3 4 Number of Adults Who Left Income Source Number of Eating %with income (Use the same number Adults with Each Source at Exit in each row) of Income (Col. 3 = Col. i x 100) Example: 105 a. Social Security Insurance 5 40 38.l% 105 b. Social Security Disability 35 33.3% Insurance SSD 105 c. Social Security 25 23.80/6 6 3 50% 6 3 50% Securi EGeneml Public Assistance f. SCHIP g. Veterans Benefits b. Employment income i. Unemto ent Benefits j. Veterans Health Care 6 k. Medicaid 4 66% 6 1. Food Stamps 4 66% m. Other lease ec' n. No Financial Resources FL -509 Ft. Pierce/St. Lucie, Indian River, Martin Counties CoC APPLICANT DUNS 079-208-989 TREASURE COAST HOMELESS SERVICES COUNCIL INC. CONTINUUM OF CARS Part J: Shelter Plus Care and Section 8 SRO Project Budgets (All S+C and SRO Projects as Applicable) Jl. Shelter Plus Care and Section 8 SRO Rental Assistance Budget a. Check the boa to indicate the type of program: 0 S+C El Section 8 SRO b. Name of metropolitan or non -metropolitan Fair Market Rent (FMR) area: Indian River County, Vero Beach, FL c. Check the appropriate box that relates your rent to the published FMR*: ❑ 1% to 99% of FMR ® 100% of FMR ❑ 101 % to 110% of FMR (PHA approval letter must be attached). ❑ Greater than 110% (HUD approval letter must be attached . d. Size of Units e. Number Of Units f. FMR or Actual Rent g. Number of Months h. Total SRO x x = $ 0 Bedroom x x = $ 1 Bedroom 19 x 486 x 12 = $1103808.00 2 Bedrooms x x = $ 3 Bedrooms x x = $ 4 Bedrooms x x = $ 5 Bedrooms x x = $ 6 Bedrooms x x = $ Other: x x = $ i. Totals: 19 x 486 x 12 = $110,808.00 *Please be advised that the actual FMRs used in calculating your S+C or SRO grant will be those in effect at the time the grants are approvers, which may be higher or lower than the FMRs listed above FL -509 Ft. Pierce/St. Lucie. Indian River. Martin Counties CoC APPLICANT DUNS 079-208-989 TREASURE COAST HOWLESS SERVICES COUNCIL INC. Section IV: Applicant Certification These certified statements are required by law. Previous versions obsolete A. For the Supportive Housing (SHP), Shelter Plus Care (S+C), and Single Room Occupancy (SRO) programs: Fair Housing and Equal Opportunity. It will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d)) and regulations pursuant thereto (Title 24 CFR part I), which state that no person in the United States shall, on the ground of race, color or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the applicant receives Federal financial assistance, and will immediately take any measures necessary to effectuate this agreement. With reference to the real property and structure(s) thereon which are provided or improved with the aid of Federal financial assistance extended to the applicant, this assurance shall obligate the applicant, or in the case of any transfer, transferee, for the period during which the real property and structure(s) are used for a purpose for which the Federal financial assistance is extended or for another purpose involving the provision of similar services or benefits. It will comply with the Fair Housing Act (42 U.S.C. 3601-19), as amended, and with implementing regulations at 24 CFR part 100, which prohibit discrimination in housing on the basis of race, color, religion, sex, disability, familial status or national origin. It will comply with Executive Order 11063 on Equal Opportunity in Housing and with implementing regulations at 24 CFR Part 107 which prohibit discrimination because of race, color, creed, sex or national origin in housing and related facilities provided with Federal financial assistance. It will comply with Executive Order 11246 and all regulations pursuant thereto (41 CFR Chapter 60- 1), which state that no person shall be discriminated against on the basis of race, color, religion, sex or national origin in all phases of employment during the performance of Federal contracts and shall take affirmative action to ensure equal employment opportunity. The applicant will incorporate, or cause to be incorporated, into any contract for construction work as defined in Section 130.5 of HUD regulations the equal opportunity clause required by Section 130.15(b) of the HUD regulations. It will comply with Section 3 of the Housing and Urban Development Act of 1968, as amended (12 U.S.C. 1701(u)), and regulations pursuant thereto (24 CFR Part 135), which require that to the greatest extent feasible opportunities for training and employment be given to lower-income residents of the project and contracts for work in connection with the project be awarded in substantial part to persons residing in the area of the project. It will comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), as amended, and with implementing regulations at 24 CFR Part 8, which prohibit discrimination based on disability in Federally -assisted and conducted programs and activities. It will comply with the Age Discrimination Act of 1975 (42 U.S.C. 6101-07), as amended, and implementing regulations at 24 CFR Part 146, which prohibit discrimination because of age in projects and activities receiving Federal financial assistance. TREASURE COAST HOMELESS SERVICES COUNCIL INC. It will comply with Executive Orders 11625, 12432, and 12138, which state that program participants shall take affirmative action to encourage participation by businesses owned and operated by members of minority groups and women. If persons of any particular race, color, religion, sex, age, national origin, familial status, or disability who may qualify for assistance are unlikely to be reached, it will establish additional procedures to ensure that interested persons can obtain information concerning the assistance. It will comply with the reasonable modification and accommodation requirements and, as appropriate, the accessibility requirements of the Fair Housing Act and section 504 of the Rehabilitation Act of 1973, as amended. Additional for S+C: If applicant has established a preference for targeted populations of disabled persons pursuant to 24 CFR 582.330(a), it will comply with this section's nondiscrimination requirements within the designated population. B. For SHP Only. 20 -Year Operation Rule. For applicants receiving assistance for acquisition, rehabilitation or new construction: The project will be operated for no less than 20 years from the date of initial occupancy or the date of initial service provision for the purpose specified in the application. 1 -Year Operation Rule. For applicants receiving assistance for supportive services, leasing, or operating costs but not receiving assistance for acquisition, rehabilitation, or new construction: The project will be operated for the purpose specified in the application for any year for which such assistance is provided. C. For S+C Only. Supportive Services. It will make available supportive services appropriate to the needs of the population served and equal in value to the aggregate amount of rental assistance funded by HUD for the full term of the rental assistance. D. Explanation. Where the applicant is unable to certify to any of the statements in this certification, such applicant shall attach an explanation be*d this page. Title: Of Date: May 169 2006 Chairman, Indian River County Board of County Commissioners Applicant: For PHA Applicants Only: (PHA Number)