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					                           American Recovery Reinvestment Act of 2009
                             Application for Sub-Contracting Services
                         from Gulf Coast Community Services Association

Dear Colleague,

Thank you for taking time to complete Gulf Coast Community Services Association’s (GCCSA) American Recovery and
Reinvestment Act Application for Sub-Contracting Services. As you are aware, on February 17, 2009, President Barack
Obama signed into law the American Recovery and Reinvestment Act (“Recovery Act”) of 2009. The Recovery Act
provides for $1billion in additional funds to the Community Services Block Grant (CSBG) program for the Fiscal Year 2009
and 2010. The state of Texas CSBG program received $48,148,071. GCCSA’s portion is $7,209,002.00. The funds have
just been released to GCCSA from the Texas Department of Housing and Community Affairs and must be obligated by
September 30, 2010. Unspent funds MUST be returned.

As a Community Action Agency, GCCSA is encouraged to partner with entities for the joint purpose of focusing assistance
on activities geared toward the preservation and creation of jobs to promote economic recovery and the provision of
assistance to those most impacted by the recession. Per the official poverty income guidelines as set by the U.S. Department
of Health and Human Services, eligible clients must meet the federal income poverty guidelines.

We are under a very strict timeframe (75% of these funds must be expended by May 31, 2010) to get this “stimulus” money
into the community, get results and jolt local economies (for instance. To receive Recovery Act funds from GCCSA,
prospective partners must complete the application process. This is the first step in applying for funds through GCCSA. WE
STRONGLY ENCOURAGE YOU TO VISIT OUR WEBSITE TO REVIEW THE GCCSA-ARRA POWERPOINT
PRESENTATION: www.gccsa.org.

Below you will find a brief explanation regarding the main components of the GCCSA ARRA Application for Sub-
Contracting Services.

Checklist for ARRA Application Packet

     Completed ARRA Application
     Most Recent Financial Audit (If an independent audit does not exist, please include the following: a
      statement from an authorized agent from your organization stating why an independent audit was not
      conducted, and three (3) years of your most recent tax returns.)
     Budget (Per proposed program/activity). Please note, entities may apply for more than one (1) program
     Statement of Work

                                                   Checklist Descriptors

       The application entails important information that will identify the status of a prospective sub-contractor
        in terms of capacity, location, history and programmatic information that is applicable to the decision-
        making process regarding funding. Inaccurate information on the application will automatically
        disqualify a prospective sub-contractor.

       The most recent financial audit pertains to last independent audit facilitated with an organization or
        agency. The audit will be used as a determining factor in the approval or disapproval of funding
        opportunities.


                                                                                                                           1
       A completed budget (using the budget templates provided) must be submitted for every program in which
        funding is being requested.

       A work plan consisting of the details of a specific program must be submitted. This plan would entail the
        number of people to be served and the number of projected outcomes associated with a program.

       All Sub-contractors will need to provide a DUNS (Data Universal Numbering System) identification
        number. To register with Dun and Bradstreet for DUNS, go to http://fedgov.dnb.com/webform.


To optimize the chances for a successful application the applying agencies/organizations should have the capacity
to deliver on their projected outcomes (both programmatic and fiscal outcomes). Due to the fiduciary
responsibility that GCCSA is charged with regarding the execution of these funds, GCCSA will be particularly
sensitive to the programmatic history of all applicants.



            Application Due Date: Tuesday, September 22, 2009 at 12pm.
    Please e-mail completed application packets to ARRAPartnership@gccsa.org.

                  Please note that applications received after 12pm will not be accepted




                                                                                                                2
                           ALL FIELDS ARE REQUIRED UNLESS LISTED AS “OPTIONAL”

Organization/Name:____________________________________________


Business Structure:
    Company
    Partnership
    Corporation
    Limited Partnership
    Limited Liability Partnership
    Limited Liability Corporation
    Government
    Individual
    Tax Exempt Organization

Physical Address: _________________________________________ City: __________________ ST: ______ Zip: ____________
                      (Street Address/PO Box,)

Remit To Address: ________________________________________ City: __________________ ST: ______ Zip: ____________
                      (If different from above address)

Contact Person: ___________________________ Email: _____________________________
Phone: ______________________ Fax: ____ Website (optional): ____________

DUNS Number: * If entity is in the process of applying for a DUNS number please indicate by stating “Application in Process”

Number of Employees: _________________

Annual Operating Budget $_______________

Please provide a brief summary of your organization (include history and mission statement):
_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________




Program Details (Regarding programs for which funds are being sought)

All programs must fall in at least one of the following programmatic areas: EDUCATION, COMMUNITY
REINVESTMENT, JOB PLACEMENT, BUSINESS DEVELOPMENT, AND EMPLOYMENT SUPPORTS. Please
note, the purpose of the funds is to provide a wide-range of innovative employment-related services and activities
tailored to the specific needs of the community; use funds in a manner that meets the short-term and long-term
economic and employment needs of individuals, families and communities; and make meaningful and measurable
progress toward the reform goals of the Recovery Act with special attention to creating and sustaining economic
growth and employment opportunities.


                                                                                                                        3
Name of Program #1: ______________________________________________________________________________________

Description of Program #1: __________________________________________________________________________________

__________________________________ ______________________________________________________________________

_________________________________________________________________________________________________________


Anticipated Outcomes of Program #1: __________________________________________________________________________

__________________________________________________________________________________________________________

_________________________________________________________________________________________________________


Desired funding amount $__________________




Name of Program #2: _______________________________________________________________________________________

Description of Program #2: ___________________________________________________________________________________

_____________________ __________________________________ __________________________________________________

__________________________________________________________________________________________________________

Anticipated Outcomes of Program #2: __________________________________________________________________________

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

Desired Funding Amount: $_______________


Name of Program #3: ______________________________________________________________________________________

Description of Program #3: __________________________________________________________________________________

_________________________________________________________ ________________________________________________

_________________________________________________________________________________________________________


Anticipated Outcomes of Program #3: __________________________________________________________________________

_________________________________________________________________________________________________________

__________________________________________________________________________________________________________

Desired Funding Amount: $____________________




                                                                                                          4
Name of Program #4: ______________________________________________________________________________________

Description of Program #4: __________________________________________________________________________________

_________________________________________________________ ________________________________________________

______________________ ___________________________________________________________________________________


Anticipated Outcomes of Program #4: __________________________________________________________________________

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

Desired Funding Amount: $_________________


Name of Program #5: ______________________________________________________________________________________

Description of Program #5: __________________________________________________________________________________

_________________________________________________________ ________________________________________________

__________________________________________________________________________________________________________


Anticipated Outcomes of Program #5: __________________________________________________________________________

_________________________________________________________________________________________________________

Desired Funding Amount: $________________


Additional Comments: _________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________



                                                                                                                  5
____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

I understand that filling out this application doesn’t guarantee that my organization will receive funding for a specified
program or any program for that matter. I agree to meet all of the requirements set forth. Furthermore, I attest to the fact
the all of the information included in this application is factual.

   ____________________________________                     ______________________                 _____________________
                 Signature***                                       Title                                  Date

**************************************************INTERNAL USE*******************************************************



Application Score _________


Programs to be funded (if applicable):
    1.   ________________________________ _________________________________________________________________________________

    2.   _________________________________________________________________________________________________________________

    3.   _________________________________________________________________________________________________________________

    4.   _________________________________________________________________________________________________________________

    5.   _________________________________________________________________________________________________________________




                                                                                                                              6
                                   STATEMENT OF WORK
    (This statement needs to be completed for every program in which funding is sought…)

Program Contact Person: ___________________________ Email: ____________________________
(Person managing the project on a daily basis)



Phone: ______________________ Fax: ___________________________



Finance Contact Person: ____________________________________________

(Person able to provide budget information)



Phone: ______________________ Fax: ___________________________



Authorized Contact: ______________________________________________

(Person authorized to sign on behalf of the organization)



Phone: ______________________ Fax: ________________________________




   1. What is the primary goal associated with this program?


   2. What are the objectives associated with this program?


   3. What are the performance measures that you will use to measure the effectiveness of the
      program (include any and all evaluation methods)?


   4. What are the eligibility standards for this program (outside of eligibility standards applied by
      GCCSA regarding these funds)?




                                                                                                         7
    5. Define the processes pertaining to the following:


               Outreach/Referral

               Intake

               Follow-up

    6. What are the output measures pertaining to this program? Demographic information should be
         included. (THE FOLLOWING IS AN EXAMPLE ONLY)

               Number of Clients enrolled in program.(Goal: 200)
               Number of Clients terminated.
               Number of Clients returning to the program.
               Number of Extremely Low Income Clients served.
               Number of Very Low Income Clients served.
               Number of Low Income Clients served.
               Number of Disabled served.
               Number of Female Head of Households.
               Number of American Indians served.
               Number of Asian or Pacific Islanders served.
               Number of Blacks served.
               Number of Hispanics served.
               Number of Whites/Non-Hispanics served.
                  o Number of families receiving direct assistance. (goal: 200)
                  o Number of families receiving one-time rent assistance.
                  o Number of families receiving one-time utility assistance.
                  o Number of families receiving security deposits.
                  o Number of families receiving short-term subsidy.
                  o Number of families receiving child care assistance.

    7.   What is the implementation schedule for this program (i.e. benchmarks, start date, etc.)?


                                             CERTIFICATION

I attest, to the best of my ability, the information submitted in this statement of work is accurate and
stems from realistic projection based on sound reasoning and track record.

___________________________________________                                  __________________
Executive Director/Chief Executive Officer                                    Date

(PLEASE COMPLETE, IF APPLICABLE)

Additionally I attest, to the best of my ability, our organization is not required to conduct an independent
financial audit, therefore we are submitting three years of our most recent IRS tax returns.

___________________________________________                                  _______________
Executive Director/Chief Executive Officer                                   Date



                                                                                                           8
 Budget Document for American Recovery Reinvestment Act (ARRA) Application
                       for Sub-Contracting Services

Sub-Contractor: ____________________________________________________________

     COMMUNITY SERVICES BLOCK GRANT RECOVERY ACT FUNDS BUDGET
                  August 1, 2009 through September 30, 2010


             BUDGET CATEGORIES                                 AMOUNT

              1. Personnel                                       $
                 (Detailed on Budget Support Sheet B.1)

              2. Fringe Benefits                                 $
                 (Detailed on Budget Support Sheet B.2)


              3. Supplies                                        $
                 (Detailed on Budget Support Sheet B.2)


              4. Other                                           $
                 (Direct Services; Budget Support Sheet B.3)




                 TOTAL                                           $




                                                                               9
              ARRA INCOME GUIDELINE MANDATE – IMPORTANT!
Please note that the American Recovery Reinvestment Act (ARRA) will adhere to a strict 200% Income
guideline through September 30th, 2010. The new income eligibility guidelines are listed in the table
below:



                      Family Size (Household)                     200%
                                 1                               $21,660
                                 2                               $29,140
                                 3                               $36,620
                                 4                               $44,100
                                 5                               $51,580
                                 6                                59,060
                                 7                               $66,540
                                 8                               $74,020


These income guidelines should be applied without exception in the servicing of all clients. If you have
any questions please e-mail them to ARRAPartnership@gccsa.org.




                                                                                                      10
         AMERICAN REINVESTMENT RECOVERY ACT FUNDS BUDGET
                   August 1, 2009 through September 30, 2010

                      BUDGET SUPPORT SHEET B.1

NAME OF SUB-CONTRACTOR:



                            PERSONNEL
  BUDGET CATEGORIES       NO. MOS.     % OF ARRA       AMOUNT OF
                                     PARTICIPATION   ARRA RECOVERY
                                                         FUNDS

                                              %

                                              %

                                              %

                                              %

                                              %

                                              %

                                              %

                                              %

                                              %

                                              %

                                              %

                                              %

                                              %

                                              %

PAGE TOTAL                                %




                                                                     11
            AMERICAN REINVESTMENT RECOVERY ACT FUNDS BUDGET
                      August 1, 2009 through September 30, 2010
                         BUDGET SUPPORT SHEET B.2

NAME OF SUB-CONTRACTOR:



                           FRINGE BENEFITS
 F.I.C.A.

 OTHER
    ARRA BUDGETED AMOUNT                                     $




                                SUPPLIES
 OFFICE SUPPLIES                                             $
 MAINTENANCE SUPPLIES
 PROGRAM SUPPLIES                                            $
 OTHER
 OTHER
      ARRA BUDGETED AMOUNT                                   $




                                                                  12
             AMERICAN REINVESTMENT RECOVERY ACT BUDGET
                                    FUNDS
                   August 1, 2009 through September 30, 2010

                       BUDGET SUPPORT SHEET B.3

NAME OF SUB-CONTRACTOR:



                       OTHER (Direct Services)
                BUDGET CATEGORIES                          AMOUNT




PAGE TOTAL                                                     $




                                                                    13

				
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