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REQUEST FOR PROPOSALS
EMERGENCY SHELTER GRANT PROGRAM
YEAR 2008-2009
APPLICATION PACKET
Mark Lazzaretto, Interim Director
Planning and Housing Department
505 South Garey Avenue
Box 660, Pomona, Ca 91769
City of Pomona
FY 2008-2009 ESG RFP
Table of Contents
SECTION 1 – APPLICATION INTRODUCTION ........................................................................3
ESTIMATED FUNDING AVAILABLE .....................................................................................3
ELIGIBILITY FOR APPLICATION ..........................................................................................3
TECHNICAL ASSISTANCE: ..................................................................................................5
RFP SUBMISSIONS ...........................................................................................................5
SECTION 2 - ESG PROGRAM OVERVIEW ..............................................................................6
AUTHORITY ...........................................................................................................6
DEFINITION OF HOMELESS.................................................................................................6
ELIGIBLE ACTIVITIES ...........................................................................................................7
MAXIMUM AVAILABLE PER ACTIVITY ................................................................................7
SECTION 3 - RFP APPLICATION AND SELECTION CRITERIA ..............................................9
RFP APPLICATION REQUIREMENTS ..................................................................................9
General Program Requirements ........................................................................................10
RFP EVALUATION - SELECTION CRITERIA .....................................................................11
RFP REVIEW AND APPEALS PROCESS ...........................................................................11
BASIC INSTRUCTIONS FOR SUBMITTING .......................................................................12
APPLICATION WORKSHOP ...............................................................................................13
SECTION IV - RFP APPLICATION PACKAGE ........................................................................14
APPLICATION CHECKLIST .....................................................................................................15
APPLICATION COVER SHEET ...............................................................................................17
APPLICATION ..........................................................................................................................18
PROGRAM QUALIFICATIONS AND EXPERIENCE ...........................................................18
PROGRAM DESIGN .........................................................................................................18
PERFORMANCE MEASUREMENT .....................................................................................18
COLLABORATIVE EFFORT ................................................................................................18
FISCAL ADMINISTRATION .................................................................................................19
PROPOSED BUDGET .........................................................................................................20
MATCHING SHARE .........................................................................................................24
BOARD OF DIRECTORS AFFIDAVIT .....................................................................................29
STATEMENT OF CERTIFICATIONS .......................................................................................30
STATEMENT OF CONFIDENTIALITY .....................................................................................36
CERTIFICATION OF RELIGIOUS COMPLIANCE ...................................................................37
APPEALS PROCESS FOR TERMINATIONS ..........................................................................38
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City of Pomona
FY 2008-2009 ESG RFP
SECTION 1 – APPLICATION INTRODUCTION
INVITATION TO APPLY
10:00 A.M., MONDAY, JANUARY 7, 2008
NOTICE OF FUNDING AVAILABILITY FOR THE EMERGENCY SHELTER GRANT (ESG)
PROGRAM YEAR 2008-2009
The City of Pomona is seeking proposals from organizations with specific skills in providing
emergency shelter, homeless prevention and essential support services to implement the
emergency shelter components of the City's Continuum of Care System. Only homeless
provider organizations that meet the "Minimum Requirements" and "General Program
Requirements" (see Section 3 of application) will be considered at this time.
The Request for Proposal (RFP) Application Packet will be available at 10:00 a.m., at the
following locations:
POMONA PUBLIC LIBRARY – REFERENCE SECTION
625 SOUTH GAREY AVENUE
POMONA, CA 91769
PURCHASING DIVISION (basement)
505 SOUTH GAREY AVENUE
POMONA, CA 91769
The Purchasing Division must receive all completed submissions no later than:
4:00 p.m., Thursday February 7, 2008
POMONA CITY HALL HOURS:
City Hall is open Monday – Thursday, 8:00 AM – 6:00 PM and Fridays 8:00 – 5:00 PM.
POMONA PUBLIC LIBRARY HOURS:
The Pomona Public Library is open Monday - Thursday 9:00 AM - 8:00 PM, Friday - Saturday
12:00 PM - 5:00 PM and is closed on Sunday. The library will be closed on Monday, January
14th in observance of Martin Luther King Day.
AVAILABLE FUNDING
The total amount of ESG funds anticipated to be awarded to the City for program year 2008-
2009 is $126,099. Eligible activities that have established funding limits or caps will be adjusted
in accordance with final awarded amount.
ELIGIBILITY FOR APPLICATION:
The following eligibility criteria will be used in considering ESG applications for funding in
Program Year 2008 - 2009:
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FY 2008-2009 ESG RFP
1. Projects that meet the City of Pomona's Strategic Goals to Address Homelessness as
outlined in the Consolidated Plan will be considered. The Strategic Goals for this purpose
are:
a) Strengthening the City's Continuum of Care by addressing gaps in residential and
non-residential services and/or
b) Developing and implementing a plan of homeless prevention that emphasizes
“housing stabilization”.
2. Projects that show collaborative effort with at least one other agency to provide stated
services.
3. Projects from service providers that have at least two years experience in successfully
providing at least one of the following eligible ESG activities:
a) Emergency Shelter and Transitional Housing Operations: Emergency shelter or
transitional housing projects that promote homeless individuals and families moving from
homelessness into a self-sufficient status. Residential supervision of such projects should
include case management, support services and property security. A 10% Funding Cap
applies to total funded staff costs, with the exception of facilities maintenance and
security staff.
b) Homeless Prevention [30% Funding Cap.] - Homeless prevention activities that include
short-term subsidies to defray rent and utility arrearages for persons who have received
eviction or utility termination notices and deposit assistance that allows for moving into a
permanent housing situation.
c) Essential Support Services [30% Funding Cap.] - Essential Support Services include
services concerned with employment, transportation, health, mental health, substance
abuse and domestic violence. The goal of such services must be to help homeless
persons obtain permanent housing and access mainstream funding sources to increase
self-sufficiency.
4. ESG is a matching grant and match must be addressed within the application to be
qualified for funding.
Matching Funds: Identify an amount equal to or greater than the requested amount of
ESG funds. The amount of these supplemental funds may include the value of any
donated material or building; the value of any lease on a building; any salary paid to staff
in carrying out the emergency shelter program; and the time and services contributed by
volunteers to carry out the program based upon a $5 per hour rate.
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FY 2008-2009 ESG RFP
TECHNICAL ASSISTANCE:
Interested organizations are encouraged to request technical assistance from the City of
Pomona's Homeless Services Department. For technical assistance please contact Jan Cicco at
(909) 620-2571.
RFP SUBMISSIONS:
Three (3) copies (one with original signature and corporate seal) must be submitted in a sealed
envelope with the words “ESG PROJECT 2008-2009” written on the envelope.
THE CITY RESERVES THE RIGHT TO THE FOLLOWING:
Waive defects or irregularities in the presentation of an application.
Incomplete applications will not be processed unless the City grants a waiver, in writing.
Proposals that are disqualified will not be reviewed or evaluated by the RFP review team.
OTHER:
Questions regarding this notice may be directed to Jan Cicco at (909) 620-2571.
Questions regarding the City’s purchasing procedures should be referred to the Purchasing
Division, Kennie Nicomedie at (909) 620-2039.
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FY 2008-2009 ESG RFP
SECTION 2 - ESG PROGRAM OVERVIEW
AUTHORITY
The ESG Program was established by the McKinney – Vento Homeless Assistance
Amendments Act of 1988 (Public Law 100-628) and Section 832 of the 1990 Affordable Housing
Act (Public Law 101-625). This Program is governed by Title 24, Code of Federal Regulations
(CFR), Part 576. The Pomona City Council, in its capacity as a metropolitan city eligible for a
formula grant under the ESG regulations, has authorized participation as described in the City's
Comprehensive Housing Affordability Strategy.
Statutory changes made by the Housing and Community Development Act of 1992 included:
Up to 10% of ESG may be spent on staff operation costs related to emergency shelter.
Homeless persons/families must be involved in the construction, renovation, maintenance
and operation of facilities assisted under the ESG Program and in providing services for
occupants.
If an individual or family who receives assistance under the ESG Program violates program
requirements set by the recipient (awarded agency), the recipient may only terminate
assistance according to a formalized process established and made known by the recipient.
Such a process must recognize the rights of the assisted person and may include a hearing.
DEFINITION OF HOMELESS
Only programs serving homeless persons or families as defined under HUD's Federal regulation
will be considered. A homeless person is defined under Federal regulations as:
1) An individual who lacks a fixed, regular, and adequate night-time residence; or
2) An individual who has a primary nighttime residency that is:
A supervised publicly or privately operated shelter designed to provide temporary
living accommodations
An institution that provides a temporary residence for individuals intended to be
institutionalized; or
A public or private place not designed for, or ordinarily used as, a regular sleeping
accommodation for human beings.
3) A household at significant risk of becoming homeless within the next 60 days, and whose
income is below the poverty line.
4) This term does not include any individual while in jail or prison.
CONTINUATION OF FUNDING
Pursuant to the terms of the grant agreement between the Department of Housing and Urban
Development (HUD) and the City of Pomona, implementation of the City's Continuum of Care
Plan will take place over a five-year period, with regular performance evaluations by HUD.
Continuation of funding for each year is contingent upon the satisfactory fulfillment of the stated
goals of the grant agreement with HUD and between the City and the sub recipients.
Organizations must expect to make a significant difference in breaking the cycle of
homelessness and hold to high standards of effort and accomplishment. Failure to achieve
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FY 2008-2009 ESG RFP
contracted goals and comply with contract provisions will lead to potential de-obligation and
termination of funds to homeless providers unable to meet goals.
ELIGIBLE ACTIVITIES
Homeless Prevention (Section 576.21 (a) (4)) [Maximum Amount: $37,830]
Homeless prevention activities include, but are not limited to, short-term subsidies to defray rent
and utility arrearages for persons who have received eviction or utility termination notices, short-
term rental assistance (security deposit or first month's rent) to allow for moving into a
permanent housing situation, mediation assistance for landlord-tenants in eviction proceedings,
payment to prevent foreclosure on a home and other innovative activities to prevent the
incidence of homelessness.
Essential Services (Section 576.21 (a) (2)) [Maximum Amount: $37,830]
Essential services include, but are not limited to, medical and psychological counseling with
follow-up and supervision, employment/job development counseling, nutrition counseling,
substances abuse treatment with counseling, child care, transportation, assistance in obtaining
permanent housing, and staff costs necessary to provide these services. In addition, assistance
in obtaining other Federal, State, and local assistance is included.
Emergency Shelter and Transitional Housing Operations (Section 576.21 (a) (3))
Payment of maintenance, insurance, utilities, security, fuels, equipment, furnishing costs of
shelters, and up to 10% may be spent on staff costs of operations related to emergency shelter.
FUNDING CAPS FOR EMERGENCY SHELTER GRANT
MAXIMUM
ACTIVITY CAP AVAILABLE PER
ACTIVITY
Homeless Prevention 30% $37,830
Essential Services 30% 37,830
Operations Not applicable 44,134
City Administration 5% of Grant 6,305
TOTAL ESG
FUNDING 100% 125,099
Funding amounts are dependent on the award amount granted by HUD
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FY 2008-2009 ESG RFP
INELIGIBLE ACTIVITIES
The following activities are prohibited:
Acquisition of a facility for use as an emergency shelter for the homeless.
Rehabilitation services such as preparation of work specifications, loan processing, or
inspections.
Renovation or conversion of buildings owned by primarily religious organizations or
entities. All services must be free from religious influences.
CONTINUED SHELTER USE REQUIREMENTS
A shelter assisted with ESG funds must be maintained as a shelter for the homeless for a
specific minimum time period. The time period begins on the date of initial use as an emergency
shelter for the homeless or the date that grant amounts are first obligated by the grantee for the
shelter, whichever is later. The specific time frames, according to the specific activity assisted,
are as follows:
A. Conversion or Major Rehabilitation: 10 Years
B. Renovation: 3 Years
C. Homeless Prevention: No continued use requirement
D. All Other Activities: The period during which ESG assistance is provided, up to 2 years.
PROGRAM FEE POLICY
The Federal regulations do not address the issues of fee payment by Shelter clients.
A. Requirements regarding payment of fees by clients may be established by subrecipients
subject to the grantee's concurrence, so long as any fees charged do not exceed 30% of
the client's documented monthly income from all sources. If the family unit consists of
more than one (1) person, income of all family members 18 years of age and older can be
considered in making the 30% calculation.
B. Assisted clients must provide an appropriate budget management/savings plan to enable
an independent living transition.
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FY 2008-2009 ESG RFP
SECTION 3 - RFP APPLICATION AND SELECTION CRITERIA
RFP APPLICATION REQUIREMENTS
The following criteria must be included in the RFP application to be considered a qualified
application:
1. The scope of Program Services must be City-based.
2. Proposed program and activities must be of direct benefit to homeless persons as
defined by HUD in Federal regulations. Homeless prevention programs must benefit
those at risk of becoming homeless.
3. All applications must include a performance measurement system to track
productivity and program impact (the extent to which the activities produce the
desired outcomes in the community or in the lives of persons assisted). Link goals
with outcomes.
4. Evidence of a 100% cash match must be submitted.
5. All submitted projects must be considered an eligible activity under ESG as required
by HUD regulations.
6. Agency must be a legally incorporated non-profit organization or government entity
and operational before submission.
7. Must provide 501 (c) (3) tax-exempt IRS status.
8. Must provide current IRS Determination Letter.
9. Must provide Articles of Incorporation.
Must provide current Dun and Bradstreet Number
10. Applicant must provide current documentation that it possesses adequate fiscal,
Management Systems and legal certifications to implement the proposed project:
Must provide current 990’s
Must provide copy of Annual Report with Financial Data.
Must provide copy of last Independent Audit, results and copy of management
letter.
Must provide copy of current business license, local and/or State permits.
Must provide copy of Affirmative Action Plan.
11. Applicant must submit verification of Insurance Coverage. Minimum certifications
are:
Commercial General Liability, minimum limit $1,000,000 per occurrence,
$2,000,000 aggregate.
Automobile Liability (hired and non-owned vehicles), minimum limit $1,000,000 per
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FY 2008-2009 ESG RFP
occurrence.
Additional Insured Endorsements, regardless of form, must be signed by an
authorized representative of the insurance carrier or its broker.
Fidelity Bond (Employee Dishonesty Coverage)
Employee Benefits Liability – Worker’s Compensation (statutory) Insurance
The City (Grantee) must be named as an additional insured.
12. Must demonstrate a minimum of twenty-four (24) months previous experience as of
the application deadline of FEBRUARY 7, 2008.
13. A qualified Fiscal Officer/Bookkeeper (preferably certified by AICPA) must be listed in
the proposed budget and a resume included as part of the application.
14. Agencies that have not submitted performance reports and those with past
compliance and performance problems may not be considered for funding.
15. Program activities must be available to serve all religious, race and ethnic groups, in
accordance with Title VI of the Civil Rights Act of 1964, and Section 109 of Title I, of
the Housing and Community Development Act of 1974.
16. Program activities must comply with Section 504 of the Rehabilitation Act of 1973,
which states: “No qualified individual with handicaps can be excluded from
participation in or denied the benefits of any activity receiving Federal financial
assistance.
17. Board and/or advising board should be representative of the community, your
organization's service population, and homeless or formerly homeless persons.
Homeless persons must be involved in planning and/or operation of project.
18. Awarded agencies must be represented at the Pomona Continuum of Care Coalition
(PCOCC) monthly meetings on a regular and consistent basis.
19. Agency must be able to demonstrate bilingual capacity through paid or volunteer staff
on-site or on-call.
General Program Requirements:
Providers funded with ESG program funds will be expected to adhere to the following to be
considered in good program standing:
Make themselves familiar with and adhere to all program requirements of the
Emergency Shelter Grant, as stated in Title 24 of the Code of Federal Regulations,
Part 576;
Work with City staff in developing and implementing the City's Continuum of Care
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FY 2008-2009 ESG RFP
Plan;
Collaborate with other homeless providers in the operation of the project;
Adhere to Pomona's reporting and monitoring requirements;
Use common reporting software as specified by the City of Pomona;
Participate in training and coordination meetings;
Cooperate with related research and evaluation activities;
Prioritize referrals from homeless service providers within the City's Continuum of
Care System;
Meet high standards of professionalism in implementing the project;
Conform to all fiscal accountability standards required by the City of Pomona and
by the Federal government (see attached 24 CFR, Part 84);
RFP EVALUATION - SELECTION CRITERIA
The following scoring system will be applied in evaluating the proposals:
Program design ...................................................... 20
Program experience and qualifications .. ................ 20
Performance Measurement Tool ........... ................ 10
Collaborative Effort ................................ ................ 10
Fiscal capacity ....................................... ................ 20
Budget and source of matching funds ... ................ 20
Total Points Available: 100
RFP REVIEW AND APPEALS PROCESS
The City’s review process entails four levels of review prior to final authorization of a federally
assisted project:
1) Staff Evaluation Team reviews applications for responsiveness to RFP requirements
2) Determine ESG Eligibility of proposed activities
3) Eligible activities are reviewed and evaluated by the City’s Budget Ad Hoc Committee
and Staff Evaluation Team.
4) Funding is approved by the City Council
An organization that has sought funding may appeal to the City Council at any of the Public
Hearings held to obtain citizen comments. Written appeals may also be submitted to the
Community Development Department prior to adoption of the final budget in May 2008.
Public hearings will be noticed in local newspapers in the Legal Notice section.
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FY 2008-2009 ESG RFP
BASIC INSTRUCTIONS FOR SUBMITTING A REQUEST FOR FUNDING PROPOSAL
(RFP)
The following tips provide basic technical guidance for preparation and final submittal of an
ESG RFP application to the City for funding a proposed project:
1) The RFP application forms should be typewritten or printed for clarity of information
and numbered to ensure RFP evaluators and reviewers do not misread information.
2) Only one RFP application is submitted for each proposed project or program proposed
in an application (1 project for 1 application). This will ensure compliance with federal
requirements and also ensures that the project budget and staffing is adequate to
carryout a project.
3) The RFP Application Checklist of requested documents is provided to help the
applicants organize the application properly and to place it in the order requested by
the funding source.
4) Completion of the RFP Application in the order requested would make the proposal
more competitive for the funding grant you are seeking.
5) Proposed program activities should have a clearly written scope of services that links
goals with program outcomes: “Need” + “Design” + “Performance Measures” =
Proposed Outcomes.
6) If you are not sure about any section of the RFP Application, contact Jan Cicco at
(909) 620-2571 early in the application process to obtain a clear understanding of
what is required to properly complete the contents of the application.
7) Verify if all items listed with the application checklist have been answered to ensure
that the proposal can be properly evaluated and understood by its readers.
INCOMPLETE APPLICATIONS OR NON-RESPONSIVENESS
Incomplete applications will not be evaluated and will be returned to applicant. In order to be
considered complete and responsive to RFP requirements, your application must include all
items listed in the “Application Checklist”, regardless of whether or not any of these items
have been submitted in prior years.
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City of Pomona
FY 2008-2009 ESG RFP
APPLICATION WORKSHOP
A Request for Proposal Application Workshop is offered to guide the approach to and
answer questions regarding the ESG application. REGISTER NOW! SPACE IS LIMITED
DATE: WEDNESDAY JANUARY 16, 2008
LOCATION: LIBRARY, 1ST FLOOR COMMUNITY ROOM
625 S. GAREY AVENUE
POMONA, CA 91769
To register, contact Nancy Garcia at (909) 620-3772 or by e-mail at nancy_garcia@
ci.Pomona.ca.us. Please indicate that you are interested in the ESG Application.
WORKSHOP SESSION WILL BE HELD:
TIME WORKSHOP TOPICS
11:30 a.m. – 12:30 p.m. ESG Applications
THE WORKSHOP WILL COVER:
REVIEW OF APPLICATION
MINIMUM ELIGIBILITY REQUIREMENTS
HUD’s ELIGIBILITY REQUIREMENTS
TECHNICAL ASSISTANCE
Information and ESG application is available on the City’s Website at www.ci.pomona.ca.us,
the E-version has fill-in fields for most of the application questions.
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FY 2008-2009 ESG RFP
SECTION IV - RFP APPLICATION PACKAGE
The City of Pomona ESG program fiscal year 2006-2008 request for proposals consists of
the following elements:
DESCRIPTION
APPLICATION CHECKLIST
APPLICATION with cover sheet
ATTACHMENTS
REQUIRED DOCUMENTATION
INSURANCE COVERAGE
OTHER
APPLICATION PACKAGES ARE DUE
BY:
4:00 P.M., THURSDAY FEBRUARY 7, 2008
APPLICATIONS MUST BE SUBMITTED TO:
CITY OF POMONA
ATTENTION: PURCHASING
505 SOUTH GAREY AVENUE
P.O. BOX 660
POMONA, CA 91706
AN ORIGINAL AND THREE (3) COPIES MUST BE SUBMITTED
LATE, FAXED, E-MAILED OR HANDWRITTEN APPLICATIONS
WILL NOT BE ACCEPTED
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FY 2008-2009 ESG RFP
APPLICATION CHECKLIST
(SUBMIT WITH YOUR APPLICATION)
The Application Checklist must be completed to verify that all required documents are
completed for submission. Incomplete applications will be rejected with a written
justification of items missing. No opportunity will be given to provide additional information
after the Submittal Deadline. If further assistance is needed, contact Jan Cicco, Homeless
Services at (909) 620-2571.
CHECK WHEN COMPLETED
Program Experience and Qualification
Program Design
Performance Measurement – Program Goals with Outcomes
Collaborative Effort
Fiscal Administration
Proposed Budget Summary
Personnel Budget Form
Detailed Breakdown of Costs Form(s) (use applicable form(s))
Match Requirements
Shelter Facility Information (if applicable)
ATTACHMENTS
Board of Directors Affidavit
Attachment A - Statement of Certification
Attachment B - ESG Compliance Requirements
Attachment C – Statement of Confidentiality (if applicable)
Attachment D - Certification of Religious Compliance (if applicable)
Attachment E - Appeals Process for Termination
REQUIRED DOCUMENTATION
501 (c) (3) Tax-exempt status
Current 990’s
Copy of Annual Report with Financial Data
Copy of Audited Financial Data with Statement of Opinion
Business License, local and or State permits to legally operate
Dun and Bradstreet (DUNS) Number
INSURANCE COVERAGE – City must be named as co-insured
Current General Liability
Automobile Liability
Fidelity Bond
Employee Benefit Liability (Worker’s Compensation)
Additional Insured Endorsement (signed)
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FY 2008-2009 ESG RFP
CHECK WHEN COMPLETED
Other
Affirmative Action Plan
Attach resume of fiscal officer
Organization By-Laws
Articles of Incorporation
Memorandum(s) of Understanding (if applicable)
for collaborative services
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FY 2008-2009 ESG RFP
CITY OF POMONA
EMERGENCY SHELTER GRANT APPLICATION COVER SHEET
FY 2008 - 2009
Proposal Number_________
SUBMIT TO: CITY OF POMONA (909) 620-2361
Purchasing Division
P.O. Box 660
Pomona, California 91769
DEADLINE: SUBMIT ONE (1) ORIGINAL, SIGNED WITH CORPORATE
SEAL and THREE COPIES (3) BEFORE 4:00 P.M.
Thursday, February 7, 2008.
______________________________________________
Legal Name of Agency Submitting Proposal
______________________________________________
Project Name
______________________________________________
Federal Identification Number (Nine Digit Number)
_________________________________________________________________________
Address City Zip Code
Total Amount of ESG Funds Requested $____________________
Purpose of ESG Funds:
TYPE OF ACTIVITIES AMOUNT
HOMELESS PREVENTION (Limit 30% of Total Grant Amount) $_____________
ESSENTIAL SERVICES (Limit 30% of Total Grant Amount) $_____________
EMERGENCY SHELTER / TRANS. HOUSING OPERATIONS $_____________
________________________________________ ______________________________
Contact Person Title
________________________________________ ______________________________
Phone Number Date
_________________________________ ______________________________
Legally Authorized Signatory Typed or Printed Name
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FY 2008-2009 ESG RFP
APPLICATION
I. PROGRAM QUALIFICATIONS AND EXPERIENCE
A. Provide a summary of the qualifications of your organization to carry out the
proposed project.
B. Provide a summary of the experience of your organization. Include any program
that your agency has administered that is most similar to the proposed activity.
C. Describe your agency’s bi-lingual capacity. List all languages in which your agency
has capability.
II. PROGRAM DESIGN
A. Purpose of the proposed project.
B. Need for the project and how was the need for the proposed activity identified?
C. Target Population: Identify any unique characteristics of the population that you
propose to serve. Be specific (e.g. families with children, males with substance
abuse problems, chronic mentally ill).
D. Provide information on the types of supportive services that will be offered and
how they will be provided, such as permanent housing and job services, financial
management, medical/mental health services, substance abuse, education, food
and other appropriate services to be provided. List any supportive services that
will be provided through a local, state or other partnership
III. PERFORMANCE MEASUREMENT
A. List the measurable goals of the proposed project.
B. List the proposed outcomes for each goal.
C. Evaluation Plan: The evaluation process is designed as a planning and
measurement tool. Evaluation is the analysis of data for the purpose of determining
if and how the planned activities were carried out, if objectives/goals were achieved.
1. What data will be collected to identify the events that take place, when, with
whom? Include who will be responsible for collecting the information and at
what intervals it will be collected.
2. Outcome Evaluation: Describe your process for evaluating outcomes? How
will outcomes be measured? How will you build objective analysis into your
outcome evaluation process?
IV. COLLABORATIVE EFFORT
A. Collaborative Effort: Please list any coalitions, consortiums, or any other community
meetings that your agency participates in on a regular and consistent basis.
How, if at all, is your project considered a collaborative effort?
If this is a collaborative project, submit a copy of any documentation that
substantiates this
(i.e. Memorandum of Understanding, Letter of Support etc.)
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FY 2008-2009 ESG RFP
B. Community Involvement:
1. All organizations funded by this RFP must ensure the maximum feasible
participation of the homeless persons in project planning, implementation
and evaluation processes. Specify the methods used (or planned) for
recruitment (and hiring, if appropriate). Indicate whether those involved are
paid staff or volunteers.
2. If your organization does not currently have a Board of Directors or Advisory
Board whose membership includes a reasonable percentage of service
recipients and/or homeless individuals, what steps will be taken to ensure
representation of the poor and very low income persons on the Board of
Directors or Advisory Board?
C. Outreach Plan: Describe the methods to be used to ensure that the target
population and community residents will find out about the services provided by the
project. What are the possible referral sources for this project? How will they be used?
V. FISCAL ADMINISTRATION
A. Fiscal Management: Briefly describe your organization's accounting and
financial reporting system. Discuss the internal controls used to ensure the
safeguarding of funds and proper classification of expenditures to ensure that a
thorough record of expenditures can be provided for purposes of an audit.
The accounting system described must be appropriate for the proposed activity.
If the proposed budget will generate income, then the accounting system must
provide for the control of revenues as well as expenditures.
B. Fiscal Administration:
a) Does your agency have any past due obligations with any other funding
source?
b) Does your agency have an unearned grant from a previous contract which
has not been returned to the funding source?
If you answered yes to any of the above please submit the following
information:
1) Name of funding source and program title:
2) Reason for past due obligations, and the amount of such
obligation:
C. In the past three years, has your agency had an Internal Revenue Service (IRS) or
State levy? If so, are you on a repayment schedule? How was the matter
resolved?
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VI. PROPOSED BUDGET
Type of activity Total Funds Requested
Shelter Operation $__________________
Homeless Prevention $__________________
Essential Services $__________________
TOTAL AMOUNT REQUESTED $__________________
(For each budgeted activity listed above, complete the appropriate "Detailed
Breakdown of Individual Costs." Applications that do not demonstrate how the total
costs for each budgeted activity amount were derived may not be funded. For staff
proposed under any category, the Budget Detail form must be completed.
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PERSONNEL BUDGET FORM
Cost Category: Personnel Costs
NOTE: Job Descriptions Must Be Attached To Budget Detail Form
Agency Name:____________________________________________ Project Name:__________________________________________
A B C D E F G H
# OF POSITION TITLE CURRENT % TIME #OF TOTAL SOURCE AMOUNT
POSITIONS MONTHLY ALLOCATED MONTHS SALARY OF ALLOCATED
SALARY TO PROJECT ON . (C x D x E) MATCHING TO MATCH
PROJECT SHARE (IF ANY)
TOTAL WAGES
*NOTE: Indicate how a Fiscal Officer will be funded for this Grant.
Use additional sheets as needed.
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City of Pomona
FY 2008-2009 ESG RFP
DETAILED BREAKDOWN OF OPERATIONAL COSTS
SHELTER /TRANSITIONAL HOUSING OPERATION
Rent/Lease Costs $_________________________
Equipment Costs: Include a description, quantity and cost per unit.
1) Equipment Item: _________________________________ $_________________
2) Equipment Item: _________________________________ $_________________
3) Equipment Item: _________________________________ $_________________
SUBTOTAL $_________________________
Repair & Maintenance $_________________________
Security $_________________________
Insurance $_________________________
Utility Costs $_________________________
1) Electricity $_________________________
2) Gas $_________________________
3) Garbage $_________________________
4) Other $_________________________
Food $_________________________
Program Supplies $_________________________
Shelter Supplies $_________________________
Other Costs (Specify)
1) ________________________ $_________________________
2) ________________________ $_________________________
3) ________________________ $_________________________
4) ________________________ $_________________________
TOTAL OPERATIONAL COSTS REQUESTED $_________________________
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City of Pomona
FY 2008-2009 ESG RFP
DETAILED BREAKDOWN OF INDIVIDUAL COSTS
HOMELESS PREVENTION
Homeless Prevention Budget Calculation
Assistance is per household. Assistance provided to households on a one-time basis only.
A. No. of B. Type of Assistance C. Anticipated D. Equals Total payment
Households to Proposed Average Payment per type of assistance (A x
be Assisted Amount C = D)
Rent
Utilities
Security Deposit
Subtotal rent, utility and security deposit assistance: $ (E)
Other Homeless Prevention Costs
1. ________________________________________ $______________________
2. ________________________________________ $_____________________________
3. ________________________________________ $____________________________
Subtotal of other Homeless Prevention Costs $____________________ (F)
Period Covered (No. Of Months): ________
TOTAL HOMELESS PREVENTION COSTS:
Subtotals (E) + (F) = $________________________________
23
City of Pomona
FY 2008-2009 ESG RFP
DETAILED BREAKDOWN OF INDIVIDUAL COSTS
ESSENTIAL SUPPORTIVE SERVICES and/or TRANSITIONAL HOUSING
SERVICES
1. Staff Title: ______________________________ $_________________________
2. Staff Title: ______________________________ $_________________________
3. Staff Title: ______________________________ $_________________________
4. Staff Title: ______________________________ $_________________________
SUBTOTAL $_________________________ (A)
Food Costs: Include food for Food Baskets and Food Closets, NOT for shelter use.
1. Food Type: _____________________________ $_________________________
2. Food Type: _____________________________ $_________________________
SUBTOTAL $________________________ (B)
Transportation Costs
1. Type of Transportation: ______________________ $_______________________
2. Type of Transportation: ______________________ $_______________________
3. Type of Transportation: ______________________ $_______________________
SUBTOTAL $_______________________ (C)
Other Essential Services Costs
1. _______________________________________ $_________________________
2. _______________________________________ $_________________________
3. _______________________________________ $_________________________
4. _______________________________________ $_________________________
5. _______________________________________ $_________________________
SUBTOTAL $_________________________ (D)
TOTAL ESSENTIAL SERVICES FUNDS REQUESTED:
Subtotals (A) + (B) +(C) + (D) = $_________________________
VII. LOCAL MATCHING SHARE: THE TOTAL MATCH MUST BE EQUAL TO THE
AMOUNT OF FUNDS REQUESTED.
Identify any non-McKinney-Vento Act funds for matching share to be contributed in
support of the proposed project.
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City of Pomona
FY 2008-2009 ESG RFP
Matching Funds: Identify an amount equal to or greater than the requested amount of
ESG funds. The amount of these supplemental funds may include the value of any
donated material or building; the value of any lease on a building; any salary paid to staff
in carrying out the emergency shelter program; and the time and services contributed by
volunteers to carry out the program based upon a $5 per hour rate.
Source Match Amount Period Available
Cash or In-Kind From To
25
City of Pomona
FY 2008-2009 ESG RFP
E. Site Control
(1) Site currently occupied by Applicant? ___Yes ___ No
(2) Does the applicant/shelter: Own, Rent, Lease, Lease with option?
$____________Per month
If Lease, Term of Lease: From _______ To _________
If Lease, are any of the items below included in the Lease?
Electricity ___Yes __No $_______________________
Gas ___Yes __No $_______________________
Water ___Yes __No $_______________________
Garbage ___Yes __No $_______________________
Total Rent/Lease/Utility $_______________________
(3) Project Zoning:
Zoning Designation:
General Plan Designation:
Designation Permit Shelter Use: __Yes __No
If not, Entitlement Requirement:
__ Zoning Variance
__ Conditional Use Permit Waiver, granted
by:______________________
__ Standard "R" Zoning
___________Number of persons
Certificate of Occupancy
26
City of Pomona
FY 2008-2009 ESG RFP
OBJECTIVES, OUTCOMES AND OUTPUTS
HUD has prescribed a specific menu of objectives and outcomes to be used for all funded projects to
standardize achievements reporting on a local, state and national level. Please evaluate your proposed
projects according to the following definitions. Identify which objectives your project will address; then
identify the proposed outcome your project will achieve. Please choose 1 objective and 1 outcome per
project. Place a check mark indicating your choice. Keep in mind, if your project is funded, this
information will be utilized in preparation the FY 2007-2008 Annual Plan and in reporting your
accomplishments in the year-end Consolidated Annual Performance and Evaluation Report (CAPER).
Objectives:
Suitable Living Environment. Includes activities that benefit communities, families, or individuals by
addressing issues in their living environment such as public services, emergency essential services,
capital improvements, neighborhood revitalization, etc.
Decent Affordable Housing. Includes the wide range of housing programs possible under HOME, CDBG
or ESG where the purpose of the program is to meet individual family or community needs and not
programs where housing is an element of a larger effort (such as would be captured above in Suitable
Living Environment).
Creating Economic Opportunities: Includes activities related to economic development, commercial
revitalization, or job creation.
Outcomes:
Availability/Accessibility. Activities that make services, infrastructure, housing or shelter availability or
accessible to low-income people, including persons with disabilities. Accessibility includes making the
affordable basics of daily living available and accessible to low-income people.
Affordability. Activities that provide affordability in a variety of ways in the lives of low-income people.
Includes the creation or maintenance of affordable housing, basic infrastructure, or services such as
transportation or day care.
Sustainability: Promoting Livable or Viable Communities. Projects where the activity or activities are
aimed at improving communities or neighborhoods, helping to make them livable or viable by providing
benefit to low-income people or by removing or eliminating slums or blighted areas, through multiple
activities or services that sustain communities or neighborhoods
Objective and Outcomes: Check one box in each table below that best reflects your projects and
outcomes. If your agency was funded for more than one project, please submit a separate form for each
project that indicates the objectives and outcomes for that project. See sections above for projects
applicable to each objective and outcome.
Objective Check One Outcome Check One
Suitable Living Environment Availability/Accessibility
Decent Affordable Housing Affordability
Creative Economic Sustainability: Promoting
Opportunities Livable or Viable
Communities
27
City of Pomona
FY 2008-2009 ESG RFP
A. PERFORMANCE MEASUREMENT SYSTEM AND OUTCOMES STATEMENT
Agency Name: Program Name:
Benchmarks Outcomes
Eligible Service or Activity to Output Goal (units of Achievement Outcome Measurement Reporting Evaluation Process
Category fill Need service) goal (difference to the Tools
community)
Short Term
Intermediate
Long Term
Priority Need – show which need will be addressed by the Program/Project
Service or Activity- name the service that will be delivered (e.g. life skills workshops, employment placement assistance, utility bill
payment)
Output Goal – Set quantifiable goals, including time frames. This should allow the City to monitor progress
Achievement Outcome – State the proposed outcome for the actual impact you hope to achieve (i.e. 30% are able to renew and
maintain positive family relationships, 10% achieve employment, 50% achieve housing stability)
Measurement Reporting Tools- list the tools you will use to track output and/or outcome information (e.g. case reports, pre- and
post-tests, etc.)
Evaluation Process- identify the methodology you will use to assess success in meeting outputs goals and outcomes.
28
City of Pomona
FY 2008-2009 ESG RFP
BOARD OF DIRECTORS AFFIDAVIT
All applicant agencies must complete this affidavit listing the members of the Board of Directors. If there are
changes in the Board Membership after the proposal is submitted, Grants Administration Division of the City of
Pomona must be notified in writing of the changes. Note with an asterisk (*) any members who are considered
service recipients, homeless or low/moderate income.
I, ___________________________________________________________ (please print), depose and say that
I am_______________________________________________, (President, Vice President, etc.) of
_____________________________________________________________, (Name and address of organization),
which submits this proposal. The only other members of the Board of Directors and other officers of this
organization are:
Board Member Name Address
Signature of Deposer
29
City of Pomona
FY 2008-2009 ESG RFP
Attachment A
Page 1 of 3
STATEMENT OF CERTIFICATIONS
(a) It possesses the legal authority to apply for the grant, and to execute the proposed
program;
(b) Its governing body has duly adopted or passes as an official act or resolution, motion, or
similar action authorizing the fining of the application, including all understandings and
assurances contained therein, and authorizing the applicant's chief executive officer or
other designee to act in connection with the application and to provide such additional
information as may be required;
(c) It will comply with the policies, guidelines and requirements of OMB Circular A-87 and A-
102 as they relate to the acceptance and use of emergency shelter grant amounts by
local governments, and A-110 and A-122 as they relate to the acceptance and use of
emergency shelter grant amounts by private non-profit organizations.
(d) It will comply with the following regarding non-discrimination:
(1) Title VIII of the Civil Rights Act of 1968 and implementing regulations;
(2) Executive Order 11063 and implementing regulations;
(3) Title VI of the Civil Rights Act of 1964 and implementing regulations;
(4) The Age Discrimination Act of 1975 and Section 5043 of the Rehabilitation Act of
1973;
(5) Executive Order 11246 and implementing regulations;
(6) Section 3 of the Housing and Urban Development Act of 1968;
(7) Executive Orders 11625, 12432, and 12138 regarding encouragement of minority
and women's business participation;
(8) The prospective contractor's signature affixed hereon and dated shall constitute a
certification under penalty of perjury under the laws of the State of California that
the bidder has, unless exempted , complied with the non-discrimination program
requirements of Government Code Section 12990 and Title 2, California
Administrative Code, Section 8103;
(e) For major rehabilitation or conversion, it will comply with the Uniform Federal Accessibility
Standards (24 CFR Part 40, Appendix A);
(f) No person who is an employee, agent, consultant, officer, or elected or appointed official
of the non-profit recipient that receives emergency shelter grant amounts and who
exercises or has exercised any functions or responsibilities with respect to assisted
activities or who is in a position to participate in a decision-making process or gain inside
information with regard to such activities, may obtain a personal or financial interest or
benefit from the activity, or have an interest in
30
City of Pomona
FY 2008-2009 ESG RFP
Attachment A
Page 2 of 3
(g) any contract, subcontract, or agreement with respect hereto, or the proceeds there under,
either for him or herself or those with whom he or she has family or business ties, during
his or her tenure or for one (1) year thereafter;
(h) It will comply with the applicable requirements of the Lead Based Paint Poisoning
Prevention Act and implementing regulations;
(i) It will not comply, award contracts to, or otherwise engage the services of any contractor
while that contractor is in a period of debarment, suspension, or placement in ineligibility
status under the provision of 24 CFR Part 24;
(j) It will maintain records necessary to document compliance with applicable requirements
and will give HUD, the City of Pomona, or any of their authorized representatives access
to and the right to examine all records related to the grant;
(k) It will supplement its grant amount with an equal amount of funds from sources other that
this grant after the date of grant award;
(l) Reports required by the City or HUD shall be submitted in a timely manner and contain all
required information as can reasonably be made available;
(m) The requirements of 24 CFR 576.21(a)(4)(ii) providing that the funding of homeless
prevention activities for families that have received eviction notices or notices of
termination of utility services will not supplant funding for pre-existing homeless
prevention activities from any other source;
(n) The requirements of 24 CFR 576.51(b)(2)(iii) concerning the submission by non-profit
organizations applying for funding of a certification of approval of the proposed project(s)
from the unit of local government in which the proposed project is located;
(o) The requirements of 24 CFR 576.51(b)(2)(v) concerning the funding of emergency shelter
in hotels or motels or commercial facilities providing transient housing;
(p) The requirements of 24 CFR 576.73 concerning the continued use of buildings for which
emergency shelter grants or used for rehabilitation or conversion of buildings for use as
emergency shelters for the homeless; or when funds are used solely for operating costs
or essential services, concerning the population to be served;
(q) The building standard requirements of 24 CFR 576.75;
Attachment A
Page 3 of 3
31
City of Pomona
FY 2008-2009 ESG RFP
(r) The requirements of 24 CFR 576.77, concerning assistance to the homeless;
(s) The requirements of 24 CFR 576.79, other appropriate provision of 24 CFR Part 576, and
other applicable Federal laws concerning non-discrimination and equal opportunity;
(t) The requirements of 24 CFR 576.80 concerning the Uniform Relocation Assistance and
Real Property Acquisition Policies Act of 1970; and,
(u) The requirement of 24 CFR 576.80 concerning minimizing the displacement of persons
as a result of a project assisted with these funds.
This certification is made under penalty of perjury.
CERTIFYING OFFICIAL:
____________________________________
(Print Name)
____________________________________
(Signature)
____________________________________
(Date)
Attachment B
Page 1 of 3
32
City of Pomona
FY 2008-2009 ESG RFP
Use of the Emergency Shelter Grant Program requires compliance with the following additional
requirements:
(a) Non-discrimination and Equal Opportunity.
(1) The requirements of Title VIII of the Civil Rights Act of 1968, 42 U.S.C. 3601-19
and implementing regulations; Executive Order 11063 and implementing
regulations at 24 CFR Part 107; and Title VI of the Civil Rights Act of 1964 (42
U.S.C. 2002d-1) and implementing regulations issued at 24 CFR Part 1.
(2) The prohibitions against discrimination on the basis of age under the Age
Discrimination Act of 1975 (42 U.S.C. 6101-7) and the prohibitions against
discrimination against handicapped individuals under Section 504 of the
Rehabilitation Act of 1973 (29 U.S.C. 794);
(3) The requirements of Executive Order 11246 and the regulations issued under
the Order at 41 CFR Chapter 60; and,
(4) The requirements of Section 3 of the Housing and Urban Development Act of
1968, 12 U.S.C. 1801u (see 570.607 (b) of this Chapter); and,
(5) The requirements of Executive Orders 11625, 12432, and 12138. Consistent
with HUD's responsibilities under these Orders, the grantee must make efforts
to encourage the use of minority and women's business enterprises in
connection with activities funded under this part.
(b) Applicability of OMB Circulars. The policies, guidelines, and requirements of OMB
Circulars Nos. A-87 and A-102, as they relate to the acceptance and use of
emergency shelter grant amounts by States and units of general local government,
and nos. A-110 and A-122 as they relate to the acceptance and use of emergency
shelter grant amounts by private non-profit organizations.
(c) Uniform Federal Accessibility Standards. For major rehabilitation or conversion, the
Uniform Federal Accessibility Standards at 24 CFR Part 40, Appendix A.
(d) Lead-Based Paint. The requirements, as applicable, of the Lead-Based Paint
Poisoning Prevention Act (42 U.S.C. 570.611(d) and (e) of this chapter).
33
City of Pomona
FY 2008-2009 ESG RFP
Attachment B
Page 2 of 3
(e) Conflicts of Interest. In addition to conflict of interest requirements in OMB Circulars A-
102 and A-110, no person who is an employee, agent, recipient, officer, or elected or
appointed official of the grantee, State recipient, or non-profit recipient (or of any
designated public agency) that receives emergency shelter grant amounts and who
exercises or has exercised any functions or responsibilities with respect to assisted
activities or who is in a position to participate in a decision making process or gain inside
information with regard to such activities, may obtain a personal or financial interest or
benefit from the activity, or have an interest in any contract, subcontract or agreement
with respect thereto, those with who he or she has family or business ties, during his or
her tenure or for one year thereafter. HUD may grant an exception to this exclusion as
provided in 570.611(d) and (e) of this chapter.
(f) Use of debarred, suspended, or ineligible contractors. The provisions of 24 CFR Part 24
relating to the employment, engagement of services, awarding of contract, or funding of
any contractors or subcontractors funding any period of debarment, suspension, or
placement in ineligibility status.
(g) Flood Insurance. No site proposed on which renovation, major rehabilitation, or
conversion of a building is to be assisted under this part, other than by grant amounts
allocated to State, may be located in an area that has been identified by the Federal
Emergency Management Agency (FEMA) as having special flood hazards, unless the
community in which the area is situated is participating in the National Flood Insurance
Program and the regulations there under (44 CFR Parts 59-79 or less than a year has
passed since FEMA notification regarding such hazards), and the grantee will ensure that
flood insurance on the structure is obtained in compliance with section 102(a) of the
Flood Disaster Protection Act of 1973 (42 U.S.C. 4001 et seq.
(h) Audit. The financial management system used by a State or unit of local government that
is a grantee or State recipient shall provide for audits in accordance with 24 CFR Part 44.
A private non-profit organization is subject to the audit requirements of OMB Circular A-
110.
In addition to, and not in substitution for, other provisions of this agreement, the Recipient:
1. Represents that if it is, or may be deemed to be a religious or denominational
institution or organization or an organization operated for religious purposes which
is supervised or controlled by or in connection with a religious or denominational
institutional or organization; and,
Attachment B
34
City of Pomona
FY 2008-2009 ESG RFP
Page 3 of 3
2. Agrees that, in connection with such essential services and operational costs
a. it will not discriminate against any employee or applicant for employment on
the basis of religion and will not limit employment or give preference in
employment to persons on the basis of religion;
b. it will not discriminate against any persons seeking emergency shelter and
related services on the basis of religion and will not limit such services or
give preference to persons on the basis of religion;
c. it will provide no religious instruction or counseling, conduct no religious
worship or services, engage in no religious proselytizing, and exert no other
religious influence in the provision of housing or emergency services; and,
d. the portion of the facility used as an emergency shelter assisted in whole or
part under this agreement shall contain no sectarian or religious symbols or
decorations.
(i). Building Standards (subpart 576.75) Any building for which emergency shelter grant
amounts are used for renovation, conversion, or major rehabilitation must meet local
government safety and sanitation standards.
(j). Relocation and Acquisition (subpart 576.80) Minimizing displacement - Consistent with
other goals and objectives of this Part, grantees and recipients must assure that they
have taken all reasonable steps to minimize the displacement of persons (families,
individuals, businesses, non-profit organizations, and farms) as a result of a project
assisted under this part.
(k). Drug-Free Workplace Act of 1988. The sub-recipient will comply with maintaining a drug-
free work site by enforcing the requirements of 24 CFR Part 24, subpart F.
CERTIFYING OFFICIAL:
____________________________________
(Print Name)
____________________________________
(Signature)
____________________________________
(Date)
35
City of Pomona
FY 2008-2009 ESG RFP
Attachment C
STATEMENT OF CONFIDENTIALITY
FOR
VICTIMS OF FAMILY VIOLENCE
____________________________________________(Agency Name)
Assures that it will adopt policies which meet at least the minimal standards for protecting the
confidentiality of information as set forth in the State Information Practices Act (Civil Code 1798,
et. seq.).
__________________________________________
(President, Board of Directors
__________________________________________
(Date)
__________________________________________
(Executive Director)
__________________________________________
(Date)
36
City of Pomona
FY 2008-2009 ESG RFP
Attachment D
CERTIFICATION OF RELIGIOUS COMPLIANCE
________________________________________, agrees to provide all eligible activities under
this program in a manner that is free from religious influences and in accordance with the
following principles:
A. It will not discriminate against any employee or applicant for employment on the
basis of religion and will not limit employment or give preference in employment to
person on the basis of religion.
B. It will not discriminate against any person applying for shelter or any of the eligible
activities under this program on the basis of religion and will not limit such housing
or other eligible activities or give preference to person on the basis of religion; and
C. It will provide no religious instruction or counseling, conduct no religious worship or
services, engage in no religious proselytizing, and exert no other religious
influence in the provision of shelter and other eligible activities under this program.
_________________________________________
(Signature of Executive Director)
____________________________
(Date)
37
City of Pomona
FY 2008-2009 ESG RFP
Attachment E
APPEALS PROCESS FOR TERMINATIONS
An organization requesting funds under the Emergency Shelter Grant Program must state its
formal appeal process for the termination of any homeless families or individuals assisted, who
may violate established program requirements of the project. This process must recognize the
rights of the affected individuals and may include a hearing. The formal process must be stated
below or attached.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
38
