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Home My WebLink About2022 Fund 149 HOMELESS ASSISTANCE FUND APPLICATION1 Jan 1, 2022 – Dec 31, 2022 Homeless Housing and Assistance Funds Application Proposals must be RECEIVED: August 6, 2021 by 4pm Jefferson County & City of Port Townsend Joint Oversight Board and Affordable Housing & Homeless Housing Task Force 2 Jan 1, 2022 – Dec 31, 2022 Application Homeless Housing and Assistance Funds GENERAL INFORMATION – Funding is limited: Please prioritize multiple applications in order of importance. It is understood that if awarded funding for this period, there is no guarantee of future funding beyond this award. Application addresses: ____ Coordinated Entry ____ Housing ____ Shelters _____ Support Services 3 Name of Project: Requested total amount for this application: $ Area of the County to be served: Name of Applicant/Agency: Federal Tax ID #: Contact Person: Title: Address: City: State: Zip: Phone Number: Fax Number: E-mail: CERTIFICATION by Authorized Agency Representative (Board President, CEO, or another person authorized to bind the agency in a contract). Name of Authorized Agency Representative (print): _____________________________ Title: _________________________________________________________________ • Applicant certifies that these funds will be used as described in this application unless a change has been mutually agreed upon between Contractor and Jefferson County Board of County Commissioners. Substantive amendment requests will also require the approval of the Homeless and Affordable Housing Joint Oversight Board. • Applicant certifies that the information in this application is true and correct. • Applicant certifies that it has no outstanding obligations to the County with respect to housing funds. ____________________________________________________ _________________ Signature of Authorized Agency Representative Date 4 SPECIFIC INFORMATION Please separately tab each section of the application submission as to Project Description, Capacity, Alignment, Approach, Impact of Funds, Budget. PROJECT DESCRIPTION • Name of Project: ______________________________ • Amount requested: 149 FUNDS $ ________________ • Provide a brief description of the project: • Specify the Project or Program goals and expected outcomes. Specify the methods by which the Project or Program will be measured and assessed. • Specify the number of individuals who will be impacted by the project. • Note: Verify that units provided by your project will be affordable for households with incomes at or below fifty percent of the area median income. A. CAPACITY - Experience Providing Similar Program Services or Developing Similar Projects (20 Points) • Provide a brief description of the recent (within the last 5 years), relevant (same or similar Project or Program), and successful (goals and objectives met) experience of the organization.: • Describe your agency’s ability (infrastructure, staff, etc.) to carry out this project and any experience providing the services in your proposal. Provide a biographical sketch (one paragraph) of the organization’s Executive Director, Finance Manager and proposed Project or Program Manager: • If this is a collaborative project, identify the other partners involved, their role, and your role. If you are partnering with another agency/agencies, attach their letter of commitment and any MOUs. • Financial Capacity Please provide the following if applicable: ✓ Current operating budget for the organization requesting the funding ✓ Annual report for the previous year ✓ Most recent year audited financials OR 5 If applicant has not been audited within the last two (2) years, a certified “Current Financial Statement” must be submitted in lieu of an audit report B. ALIGNMENT- Meets Five Year Plan Priorities (20 Points) • Identify which specific goal(s) and priorities of the Five Year Plan your project addresses. Describe how specific minimum service units, deliverables, and outcomes to be achieved with this project relate to the Plan priorities of housing, shelter (a place to sleep) and support services. Specify the timeline or schedule for these minimum service units and deliverables. • Indicate if the Project addresses: housing, shelter, or support services with no shelter component. C. APPROACH - Completeness of Proposal and Readiness (20 Points) • Is the project ready to use the funding now or are there actions to be taken before the project can begin? If so, what are those actions? • Will the requested funds fully fund the Project or Program? If not, how does the organization intend to fill the gap? • Could the Project or Program be scaled (include the per unit cost of the Program or Project)? • Have additional funds have been requested or will be requested. Identify the sources for those requests and the status of the requests? D. IMPACT OF FUNDS - Leverage of Other Funds and Number of Persons Assisted (20 Points) • Are you using any matching funds? If yes, what is the source? • Are the requested funds to be used as a match for this project? If yes, provide a description of the project to be matched and how it relates to the goals and priorities of the Five-Year Plan. Also, provide a budget for the entire project including funding from all sources and identify what portion of the project these funds will support. • Specify the number of individuals who will be assisted with this project. • Discuss how this project will be sustained after these funds are exhausted. • If you received funding in 2020 from either 148 or 149 funds for this same project, briefly describe the outcomes obtained using those funds. E. PROGRAM OR PROJECT BUDGET – A Feasible Financial Plan (20 Points) 6 BUDGET FORMS Funding period begins Jan. 1, 2022 and ends Dec. 31, 2022. Please use the attached budget templates. If you need additional space, you may insert rows. “Program” refers to the total budget including all funding sources for the specific program discussed in this proposal. In most cases, this will not be the total agency budget, but only that of one program relevant to this proposal within that agency. “Proposal” refers to the funds requested from these funds that will be applied to this specific project. Blank spaces are provided for additional categories. Justification for budget items must be specific, and that same specificity should be reflected in subsequent billings. Budget items should be numerically prioritized with 1 being the most essential. A maximum 10% Administration fee is allowed for projects if needed, however, Administration fees are not allowed for Capital Projects. SERVICE/ OPERATING BUDGET 2022 Budget Categories Program Proposal Justification Priority Salaries $ $ Benefits $ $ Rental Subsidies $ $ Utilities $ $ Insurance $ $ Food/Supplies $ $ Furnishings/Equipment $ $ Repair/Maintenance $ $ Transportation (explain) $ $ $ Subtotal $ $ Administration (10% max.) $ $ TOTAL $ $ If your project includes salaries and benefits, please list position(s) and FTE to be paid by these funds (FTE should be that percentage of time the employee is dedicated to this project): 7 FUNDING SOURCES FOR THE PROGRAM in 2021 & 2022 Funding Sources Awards 2021 Awards 2022 Indicate if Committed or Application has been made. Public Sources (State or Federal Funds) $ $ Private Donations $ $ Foundation Grants $ $ United Campaigns $ $ Other $ $ Other $ $ TOTAL $ $ Please include any budget narrative that is descriptive or helpful, to explain any part of your proposed expenditures. For instance, if you are requesting furnishings or appliances specifically for housing included in your project, what are the items you are requesting? 8 CAPITAL BUDGET FOR REAL ESTATE DEVELOPMENT USES (Rehabilitation or New Development) Financing Categories Estimate Basis of Estimate Total Acquisition Costs $ Construction $ Construction Fees $ Financing Fees and Charges $ Guarantees and Reserves $ Developers’ Fee $ $ $ Subtotal $ TOTAL $ SOURCES Financing Categories Estimator Indicate if Committed or Application has been made. If not made indicate date application is to be submitted Private Loan $ Jefferson County Funds Public Sources (State or Federal Funds) $ Foundations $ Low Income Housing Tax Credits (indicate 9% or 4%) $ Historic Tax Credits $ New Market Tax Credits $ Gap (if any) $ TOTAL $ 9 Please include any budget narrative that is descriptive or helpful to explain any part of your proposed expenditures in your capital budget(s).