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2011 CDBG Application Fillable Form

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2011 CDBG Application Fillable Form Powered By Docstoc
					           COOK COUNTY
  COMMUNITY DEVELOPMENT BLOCK
        GRANT PROGRAM
             (CDBG)




              2011 PROGRAM YEAR

APPLICATION FORMS AND INSTRUCTIONS

                         Applicant’s Name
               (Municipality, Township, Non-Profit Agency)


        Typed Name                  , and Title:
   (Mayor, President, Executive Director, Chief Executive Officer, etc.)


             Toni Preckwinkle, President
        Cook County Board of Commissioners
          Prepared by the Cook County Bureau Community Development
                                December, 2010
     APPLICATION EVALUATION                                    APPLICATION REVIEW
            CRITERIA                                                TIMELINE
                                                        Informational CDBG Public Hearings:
Applications are reviewed by county staff to                January 13, 2011 – Markham Court
determine completeness and eligibility.                       House
Grants are reviewed, and then recommended,                    January 20, 2011 - Rolling Meadows
through a competitive application evaluation process.          Court House
                                                              January 27, 2011 – Maywood Court
                                                               House
While a well-written application is no guarantee of
funding, you should make every effort to make the
application complete and concise. In addition to                February - April 2011
completeness and eligibility, the criteria below are      APPLICATION REVIEWS BY COUNTY STAFF
used to evaluate applications:

     Demonstration of unmet need,                                 March 24, 2011
     Demonstration of community support,                 COMMUNIITY DEVELOPMENT ADVISORY
     Percentage of low/mod persons to be served            COUNCIL (CDAC) PUBLIC HEARING
     Leveraged or other resources                        (Mandatory for Non-Municipal Applicants)
     Capacity and experience of organization

                                                                     May 19, 2011
                                                          COMMUNIITY DEVELOPMENT ADVISORY
                                                             COUNCIL (CDAC) PUBLIC HEARING
                                                         (Proposed CDBG Project Recommendations
     PLAN TO ATTEND OUR CDBG                                      and Approval by CDAC)
      APPLICATION TRAINING ON
         JANUARY 11, 2011                                            June - 2011
                                                          COUNTY BOARD CDBG BUDGET HEARING
                                                               Exact date to be determined.

INCOMPLETE APPLICATIONS
                                                               June 15th - July 15th 2011
WILL NOT BE RECOMMENDED                                           PUBLIC COMMENT PERIOD
      FOR FUNDING.
                                                        APPLICATION DEADLINE
  FOR HELP or ASSISTANCE                                           THURSDAY,
WITH THE APPLICATION CALL
       (312) 603-1000
                                                         FEBRUARY 17, 2011
or YOUR ASSIGNED PLANNER.                                   by 4:00 p.m.
                                                         Applications received after
                                                        this date will not be ccepted.
         CHANGES TO CDBG ACTIVITIES FOR
              2011 PROGRAM YEAR


 ACQUISITIONS:         If applying for CDBG funds for the acquisition of a
  building, please note that the project will not be funded unless a specific
  parcel is identified. The County will no longer provide grant funds to a
  municipality or not-for-profit agency for acquisition of a site to be identified
  at a later time.

 REHABILITATION: Cook County will not fund the rehabilitation of a
  building if the building is not owned by the agency. If applying for grant
  funds to rehabilitate a building, a copy of the Deed or Title showing
  ownership must accompany the application.

 START OF PROJECT: If a project will not start within 3 months of
  receiving the “Notice to Proceed” due to architectural or engineering issues,
  do NOT apply for funding until these issues have been resolved. Projects
  that require months of preparation will not be funded.

 VEHICLE PURCHASE: Cook County will no longer provide grant funds
  for the purchase any type of vehicle.




NEW FOR 2011:

               CDBG DEMOLITION APPLICATION
                   (SEE PAGES 26 AND 27)

             NEW STAFF SALARIES DETAIL FORM
                     (SEE PAGES 12)
                       ELIGIBLE ACTIVITIES and REQUIREMENTS

            ELIGIBLE ACTIVITIES                                COUNTY REQUIREMENTS

 A broad range of programs and activities are        Projects must fall within the program guidelines
   eligible for funding:                               below in order to be considered for funding:

   Acquisition: of real property, including vacant             MUNICIPALITY or TOWNSHIP
    land and commercial structures;
                                                          Low/Moderate Income > 49.2%
                                                          Maximum number of Projects = 2
    Demolition: where total costs are at least
                                                          Dollar Limitation* = $200,000
    $20,000 per parcel. (Demolition costs under
                                                                         -OR-
    $20,000 per parcel may still be applied for on a
                                                          Low/Moderate Income > 51.0%
    year-round basis);
                                                          Minimum population of 10,000
                                                         Maximum number of Projects = 2
   Economic Development: activities including            Dollar Limitation* = $300,000
    job training, rehabilitation of commercial
    structures;
                                                                NON-PROFIT ORGANIZATIONS

   Housing Services: for elderly, special needs           Clientele=Presumed benefit
    housing for persons with mental or physical                           -OR-
    disabilities or homeless persons;                      Low/Moderate income > 51.0 %
                                                          Maximum number of Projects = 2
   Housing-related Services:             such as          Dollar Limitation* = $200,000
    counseling and fair housing activities;
                                                       *The Dollar Limitation is for the total number of
    Plans and Studies: related to the above             projects allowed. It is not the amount allowed per
    activities.                                         project.

 Public Facilities: such as parks, street
   improvements and neighborhood centers;
 
   Public Services: Services directly related to
   housing and community development activities;          
                                 2011
     COMMUNITY DEVELOPMENT BLOCK GRANT
                           PROGRAM (CDBG)


                     APPLICATION COVER SHEET




Applicant Name




Chief Executive Officer Name            E-mail address




Contact Person Name & Title             E-mail address




Telephone                  Fax          Applicant website address




Total Number of Projects




                                 1
Total Amount Requested


Total Matching Funds




Chief Executive
Officer signature:           Date:




                         2
              COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
                              APPLICATION
             2011 PROGRAM YEAR - October 1, 2011 through September 30, 2012
                          Please complete pages 4 through 17 for each project, as applicable.
APPLICANT:
ADDRESS:
CITY:                 , IL ZIP CODE:
PROJECT MANAGER:                                                      E-MAIL:
TELEPHONE:                                                            FAX:
PRIORITY #:    (from 2010-2014 ConPlan)                               COUNTY COMMISSIONER DISTRICT #
PROJECT TITLE:

IS THIS A CONTINUATION OF A PRIOR YEAR PROJECT:                                           YES          NO
TYPE OF APPLICANT:                         Municipal                                      Non Profit   Other
Is your organization a faith-based entity? YES                                            NO
NATIONAL OBJECTIVE: (check one)
     Area Benefit Activities benefit all residents in a particular area, where at least 49.2% of the people are
     low- and moderate-income. The service area of the project must be specifically identified and the area must be
     primarily residential.
     Limited Clientele Activities benefit low- and moderate-income persons without regard to the area being
     served. At least 51% of the persons participating in the activity must be low- and moderate-income and the
     activity must meet one of the following criteria:
      Presumption of low- and moderate-income: the activity serves persons who are presumed to be low- and
          moderate-income: abused children; battered spouses; elderly persons; severely-disabled adults; homeless
          persons; illiterate adults; persons living with AIDS and migrant workers; or
      Income Guidelines: the activity must have eligibility requirements which limit the activity exclusively to low- and
          moderate-income persons.
    Housing Activities are carried out for the purpose of providing or improving permanent residential structures
     which, upon completion, will be occupied by low-and moderate-income persons.
     Job Creation or Retention is designed to create or retain permanent jobs where at least 51% of which,
     computed on a full-time equivalent basis, involve the employment of low- and moderate-income persons.
     Slum or Blight Activities aid in the prevention or elimination of slums or blight.
  Does Not Apply
ACTIVITY CATEGORY: (please refer to the CDBG Handbook for project eligibility before proceeding)
          (CHECK ONE)
   Capital Improvements                                    Single-Family Rehabilitation     Fair Housing
   Acquisition                                             Multi-Family Rehabilitation      Housing Counseling
   Commercial Rehabilitation                               ADA Compliance                   Public Service*
   Clearance/Demolition                                    Economic Development             Administration/Planning
*Please see Handbook for an explanation of a public service continuing project.

                                                                        2
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
     PROGRAM YEAR 2011 APPLICATION




                 3
                  COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
                       PROGRAM YEAR 2011 APPLICATION


                                        SUMMARY PROJECT DESCRIPTION


DUNS NUMBER (Required for funding)                                        FEIN NUMBER:

CDBG Dollars Requested: $

MATCHING FUNDS:                     $                 SOURCE(S):

MATCHING FUNDS:                     $                 SOURCE(S):

IS ACQUISITION REQUIRED?                          YES                NO

DESIGNATED PROJECT AREA:
(Provide a DETAILED map that shows the project site and defines service area. For Capital Improvement Projects, please include
PHOTOS.)




SUMMARY OF PROJECT:
(Provide a brief synopsis of the proposed project - 50 words or less)




SPECIFIC ANTICIPATED ACCOMPLISHMENTS:




                                                                 4
           COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
                 PROGRAM YEAR 2011 APPLICATION
A.   AREA BENEFIT: (if applicable)

     Total Number of low and moderate-income persons served in area:


        Census                                 Total            Low/Mod Income             % Low/Mod
         Tract          Block Group          Population           Population                Income




B.   LIMITED CLIENTELE BENEFIT: (if applicable)
     1. Presumed Benefit:

                   Qualifying group

                    Number of persons served

                                                             -OR-

     2. Low- and Moderate-Income Persons* Served:


                   Moderate-income (61-80% of AMI)

                   Low-income             (51-60% of AMI)

                   Very Low                (31-50% of AMI)

                   Extremely Low          (<30% of AMI)

                   Total Served (add above lines)


                   Number of Female-Headed Households:

     *How will income be verified? Check below:

        Income Verification Request Forms (Attach sample)
        Eligibility Status for other Governmental Assistance program
        Self Certification (Must request source documentation of 20% of certifications and must inform beneficiary that all
        sources of income and assets must be included when calculating annual income)
        Presumed benefit (HUD presumes the following to be low and moderate-income: abused children, battered
        spouses, elderly persons, severely disabled persons, homeless persons, persons living with AIDS, migrant farm
        workers)



                                                         5
    COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
          PROGRAM YEAR 2011 APPLICATION
                 ETHNICITY and RACE

Estimate of Population to be served:

                    RACE AND ETHNICITY DATA FOR PY 2011
                              RACE                                       TOTAL

                                                                   All
                           Single Race
                                                                 Persons    Hispanic

(11) White

(12) Black/African American

(13) Asian

(14) American Indian/Alaskan Native

(15) Native Hawaiian/Other Pacific Islander

                           Multiple Race

(16) American Indian/Alaskan Native & White

(17) Asian and White

(18) Black/African American and White

(19) American Indian/Alaskan Native and Black/African American

(20) Other Multi-racial

                          TOTAL NUMBER

NUMBER OF FEMALE-HEADED HOUSEHOLDS




                                              6
               COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
                    PROGRAM YEAR 2011 APPLICATION
                HUD PERFORMANCE MEASUREMENT SYSTEM

HUD instituted a mandatory Performance Measurement System to be used for reporting on each
project. One objective and one outcome must be identified for each project. The outcome indicators are
specified for each type of activity.

Please check a box for one objective and one outcome that best fits your project. The outcome
indicators are listed on the following page. Write in the proposed numbers for each applicable outcome
indicator.


     OBJECTIVE                    EXPLANATION OF OBJECTIVE

     Suitable Living              In general, this objective relates to activities that are designed to benefit communities,
     Environment                  families, or individuals by addressing issues in their living environment.
     Decent, Affordable           Activities would cover the wide range of housing possible under the CDBG program. It
     Housing                      focuses on housing programs 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 under Suitable Living Environment).

     Creating Economic            This objective applies to the types of activities related to economic development,
     Opportunity                  commercial revitalization, or job creation.


     OUTCOME                      EXPLANATION OF OUTCOME

     Availability/Accessibility   Applies to activities that make services, infrastructure, housing, or shelter available or
                                  accessible to low- and moderate-income people, including persons with disabilities.
                                  Accessibility does not refer only to physical barriers, but also to making the affordable
                                  basics of daily living available and accessible to low- and moderate-income people.

     Affordability                Applies to activities that provide affordability in a variety of ways in the lives of low- and
                                  moderate-income people. It can include the creation or rehabilitation of affordable
                                  housing, basic infrastructure hook-ups, or services, such as transportation or day care.

     Sustainability:              Applies to projects where the activities are aimed at improving communities or
     Promoting Livable or         neighborhoods, helping to make them livable or viable by providing benefit to persons of
     Viable Communities           low- and moderate-income or by removing or eliminating slums or blighted areas,
                                  through multiple activities or services that sustain communities or neighborhoods.


                                  Outcome #1                           Outcome #2                        Outcome #3
                            Availability/Accessibility                 Affordability                    Sustainability
      OBJECTIVE #1            Accessibility for the purpose          Affordability for the            Sustainability for the
      Suitable Living     of creating a suitable living          purpose of creating a            purpose of creating a
       Environment        environment.                           suitable living environment      suitable living environment.
      OBJECTIVE #2            Accessibility for the purpose          Affordability for the            Sustainability for the
      Decent Housing      of providing decent housing.           purpose of providing             purpose of providing
                                                                 decent housing.                  decent housing.
      OBJECTIVE #3            Accessibility for the purpose          Affordability for the            Sustainability for the
        Economic          of providing economic                  purpose of providing             purpose of providing
       Opportunity        opportunities.                         economic opportunities.          economic opportunities.




                                                          7
              COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
                  PROGRAM YEAR 2011 APPLICATION

OUTCOME INDICATOR:

       SPECIFIC OUTCOME INDICATORS

     1. PUBLIC FACILITY OR INFRASTRUCTURE ACTIVITIES
                      ANTICIPATED NUMBER OF PERSONS TO BE ASSISTED
        With NEW access to service or benefit
        With IMPROVED access to service or benefit

        Where activity was used to meet a quality standard (code) or measurably improved
        quality, report number of households that no longer have access to substandard
        service.


     2. PUBLIC SERVICE ACTIVITIES
                     ANTICIPATED NUMBER OF PERSONS TO BE ASSISTED
        With NEW access to service
        With IMPROVED access to service

        Where activity was used to meet a quality standard (code) or measurably improved
        quality, report number of households that no longer have access to substandard
        service.

3.
       Number of Commercial Facade Treatment/business Building Rehab (Site based)

4.
       Number of Acres of Brownfields Remediated (Site Not Target Area Based)

5.     New Rental Units Constructed per Project or Activity

       Total number of units constructed:
       OF TOTAL:
       Number affordable
       Number Section 504 accessible
       Number qualified as Energy Star
       OF THE AFFORDABLE UNITS:
       Number occupied by elderly
       Number subsidized with project-based rental assistance (federal, state, or local program)
       Number of years of affordability
       Number of housing units designated for persons with HIV/AIDS, including those units received
       assistance for operations. Of those, number of units for the chronically homeless
       Number of units of permanent housing designated for homeless persons and families,
                                                    8
       COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
           PROGRAM YEAR 2011 APPLICATION
including those units receiving assistance for operations. Of those, number of units for the
chronically homeless.




                                             9
             COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
                 PROGRAM YEAR 2011 APPLICATION
 6.   Rental Units Rehabilitated

      Total number of units rehabilitated:

      OF TOTAL:
      Number affordable
      Number Section 504 accessible
      Number qualified as Energy Star
      Number brought into compliance with lead safe housing rule (24 CFR part 35)
      OF THE AFFORDABLE UNITS:
      Number occupied by elderly
      Number subsidized with project-based rental assistance (federal, state, or local program)
      Number of years of affordability
      Number of housing units designated for persons with HIV/AIDS, including those units
      received assistance for operations. Of those, number of units for the chronically homeless
      Number of units of permanent housing designated for homeless persons and families,
      including those units receiving assistance for operations. Of those, number of units for the
      chronically homeless.


7.     Homeownership Units Constructed, Acquired, and/or Acquired with Rehabilitation
      (Per Project or Activity)

      Total number of units:
      OF TOTAL:
      Number of affordable units
      Number of years of affordability
      Number qualified as Energy Star
      Number Section 504 accessible
      Number of households previously living in subsidized housing.
      Number brought into compliance with lead safe housing rule (24 CFR part 35)
      OF THE AFFORDABLE UNITS:
      Number occupied by elderly
      Number subsidized with project-based rental assistance (federal, state, or local program)
      Number of years of affordability
      Number of housing units designated for persons with HIV/AIDS, including those units
      received assistance for operations. Of those, number of units for the chronically homeless
      Number of units of permanent housing designated for homeless persons and families,
      including those units receiving assistance for operations. Of those, number of units for the
      chronically homeless.




                                                   10
                 COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
                     PROGRAM YEAR 2011 APPLICATION
  8.      Owner Occupied Units Rehabilitated or Improved

          Total number of units:
          OF TOTAL:
          Number occupied by elderly
          Number of units brought from substandard to standard condition (HQS or local code)
          Number qualified as Energy Star
          Number of units brought into compliance with lead safe housing rule (24 CFR part 35)
          Number of made accessible for persons with disabilities

  9.      Direct Financial Assistance to Homebuyers
          Number of first-time homebuyers.
          Of those, number receiving housing counseling
          Number receiving down-payment assistance/closing costs.

  10.     Tenant-Based Rental Assistance
          Total number of households:
          OF THOSE:
          Number with short-term rental assistance (less than 12 months)
          Number of homeless households.
          Of those, number of chronically homeless households

11.     Homeless Persons Given Overnight Shelter
          Number of Homeless Persons Given Overnight Shelter

12.     Beds Created in Overnight Shelter
          Number of Beds Created in Overnight Shelter or Other Emergency Housing

13.     Homeless Prevention
          Number of households that received emergency financial assistance to prevent
                                                                                                 
          homelessness.
          Number of households that received emergency legal assistance to prevent
          homelessness.

14.     Jobs Created
          Total number of jobs created
          Employer-sponsored health care (Y/N)

          Type of jobs created (use existing Economic Development Administration (EDA)
          classification)

          Employment status before taking job created
          Number of unemployed




                                                     11
            COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
                  PROGRAM YEAR 2011 APPLICATION
15.   Jobs Retained
        Total number of jobs retained
        Employer-sponsored health care benefits

16.   Businesses Assisted
        Total business assisted
        New businesses assisted
        Existing businesses assisted. Of those, business expansion and business
        relocations.
        DUNS number(s) of businesses assisted.
             (HUD will use the DUNS numbers to track number of new businesses that remain
                                 operational for 3 years after assistance).




                                                   12
            COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
                  PROGRAM YEAR 2011 APPLICATION

PROJECT COMPLETION SCHEDULE
MONTH 1




MONTH 2




MONTH 3




MONTH 4




MONTH 5




MONTH 6




MONTH 7




MONTH 8




MONTH 9




MONTH 10




MONTH 11




MONTH 12
PROJECT COMPLETE




                               13
              COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
                    PROGRAM YEAR 2011 APPLICATION
                             STAFF SALARIES (5 Person Limit)
                                                                 (B)          (A) multiplied by B)
                                           (A)              % of time             Salary                  Salary          Project
                                       Annual               spent on          allocated for               CDBG             Match
                Position               Salary                project             project                  Portion        (In-Kind)




               TOTAL SALARIES


                                    FRINGE BENEFITS DETAILS
                                                    Payroll Taxes
                                     (A)         (A) multiplied by 6.2%   (A) multiplied by          (A) multiplied by
                                  Salary         Social Security              1.45%)                   Agency Rate
                                  CDBG              F.I.C.A.               Medicare             Unemployment               Total
           Position               Portion             6.2%                  1.45%               Compensation              Fringe




   TOTAL PAYROLL TAX


In columns (1), (2), or (3) list additional fringe benefit per name and Position (ie. health benefits, etc.)

                                                                                                  Multiply
                                                                                              Column 4 by %
                                                                                               of time spent
Name and Position      (1)           (2)                   (3)            (4) Subtotal          on project               Total




Total Other Fringe



                           TOTAL SALARY                                       $
                           TOTAL FRINGE                                       $
                           TOTAL SALARY AND FRINGE                            $

                                                         14
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
                       APPLICATION
                                                      (Continued)


                                                 LINE ITEM BUDGET

  Project Activity                                         CDBG       Matching Funds   Total
  Capital Improvement                                  Funds
  Single-family Rehabilitation
  Economic Development
  Demolition/Clearance
  Acquisition
  Relocation
                    TOTAL PROJECT ACTIVITY

  Project Delivery                                       CDBG Funds   Matching Funds   Total
  Staff Salaries
  Fringe Benefits
  Office Rent and Utilities
  Postage
  Printing
  Publication/Notices
  Project Travel @ $0.50 per mile
  Professional Services*
  Architectural
  Engineering
  Legal
  Accounting (except Single Audit)


  Other
                   TOTAL PROJECT DELIVERY
  Grand Total (Project Activity + Project Delivery)

*Professional Services need to be procured if using CDBG funds.




                                                         15
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
                APPLICATION


 (Please use this sheet for any additional comments you may have)




                               16
    COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
               APPLICATION CHECKLIST


You must provide the following attachments with the application:


MUNICIPALITIES (see attached forms):

      Citizen Participation Record - Form A
      Certified Copy of Resolution - Forms B-1, B-2, or B-3
      Estimated Matching Funds Certification - Form C
      Maintenance of Effort - Form D
      Audited Financial Statements (most current)
      Fair Housing Action Plan – Form E (See Handbook Page 41 for plan
      requirements);

      If a municipality has previously submitted an acceptable plan, attach an
      assessment of the activities carried out in the past year to implement the Plan.




NOT-FOR PROFITS (see attached forms):

      Matching Funds Certification - Form C
      List of Board of Directors
      Copy of 501(c)3
      Current Certificate of Good Standing (dated within the last 45 days)
      Certified Copy of Articles of Incorporation and Certified Copy of Amended Articles
      of Incorporation, if amended, from the Illinois Secretary of State. The
      certification must be dated within 45 days of the date of submission of the
      Application. This must be ordered every year.

      Current Audit

      Forms B-2 Resolution and B-3 Certification of Resolution

.




                                        17
FAIR HOUSING ACTION PLAN - 2011 PROGRAM YEAR


The Secretary of the United States Department of Housing and Urban Development requires
that Community Development Block Grant recipients certify that they will comply with Title
VIII of the Civil Rights Act of 1968.


To fulfill this certification, Cook County requires each municipal Subrecipient to take action
each year to affirmatively further fair housing. The actions that your community defined are
in the 2005 Fair Housing Action Plan that you submitted with the 2005 grant application as
required in order to be eligible for funds.


As part of the application, the Subrecipient may want to develop and implement an
Affirmative Action Plan. If you already have a plan, you should review it periodically to
ensure it is still relevant and up-to-date. Please provide County staff with a narrative to
explain what your agency plans to accomplish during this program year to further fair
housing.


Some actions your agency can take are:


     Copies of fair housing brochures published and distributed among realtors and other
    businesses in your community;
     Copies of newspaper articles published locally about fair housing issues in your
    community;
     A summary of activities conducted by the Human Relations Committee to promote an
    open community;
     Update/Amend Fair Housing Ordinance if necessary.


These points are merely suggestions for the types of actions that are acceptable to
demonstrate your community=s active commitment to fair housing. Additional or different
action may be acceptable as well, and your submissions are not limited to those types listed
above.


The County is required to provide documentation supporting its activities in compliance with

                                              18
Title VIII of the Civil Rights Acts of 1968. The activities of Cook County=s Subrecipients,
therefore, require this documentation. Failure by a community to provide this information to
the County in a timely manner may jeopardize future funding for that community.


Please use Form E in the Application package.




                                          19
                                    FORM A
                        Schedule of Local Public Hearing
                          Citizen Participation Record

Each municipality applying for Community Development Block Grant funds must develop
its application through a series of community and neighborhood meetings. At least one
(1) formal public hearing is required on a community-wide basis seeking input from
residents on community needs. At least one (1) other public hearing is then required to
present the municipality=s Community Development Plan and its proposed CDBG
application to local residents. Therefore, it is required that municipalities conduct at least
two (2) public hearings in compliance with the Citizen Participation Process as outlined.

Attach to the form the following items:

      Affidavits of Publication
      Minutes of the public hearings including lists of signatures from attendees
      Copy of response(s) to comments and/or complaints

                           NEEDS ASSESSMENT HEARING
 Municipality

 Location

 Date                              Time

 Describe the methods used to solicit participation of low- and moderate-income persons,
 including outreach to non-English speaking residents, if applicable.




 Describe any adverse comments/complaints received and describe resolution.




                                           20
APPLICATION REVIEW HEARING
Municipality

Location

Date                   Time

Describe the methods used to solicit participation of low- and moderate-income persons.



Describe any adverse comments/complaints received and describe resolution, including
outreach to non-English speaking residents, if applicable.




                                      21
                              Application Resolution
                                   Instructions


Cook County has prepared two versions of the authorizing resolution: one for
municipalities and one for all other applicants. Please choose the appropriate resolution.
Samples of the versions are included in this application.

The person signing the cover of the application must be the same person signing the
following Forms:

Please note that the Ratifying Resolution form is only to be used in limited circumstances.
The resolution must be adopted by your governing body and a certified copy submitted
with the application. Sample forms for certifications by non-municipal agencies are
included.




                                          22
                                   FORM B-1
                               SAMPLE RESOLUTION
                                  MUNICIPALITY



NOW, THEREFORE BE IT RESOLVED by the Mayor/President and Council/Board of
Trustees of Municipality, Illinois as follows:

Section 1. That a Request is hereby made to the County of Cook, Illinois for Community
Development Block Grant ("CDBG") funds for Program Year 2011 in the amount of
$        for the following project(s):

                                                                              Amount $
 Project:

 Project:                                                                     Amount $

As identified in the City's/Village's CDBG 2011 Program Year application.


Section 2. That the (insert position title of person signing the application) and
Clerk are hereby authorized to sign the application and various forms contained therein,
make all required submissions and do all things necessary to make application for the
funds requested in Section 1 of this Resolution, a copy of which application is on file with
the Secretary.


Section 3. That the (insert position title of person signing the matching funds
certification) is hereby authorized to certify that matching funds which have been
identified as supporting its projects as set out within its application will be made available
upon the approval of the projects by the County of Cook, Illinois or the prorated share
thereof.



Dated this _____ day of                             , 2011.


By:      __________________________________________
                        Mayor/President


Attest: __________________________________________
                       Clerk


(SEAL)



                                           23
                                           FORM B-2
                                       Sample Resolution
                       Not-for-Profit Organization/Non-Municipal Agency



NOW, THEREFORE BE IT RESOLVED by the Board of Directors of             (insert full name) as follows:

Section 1. That a Request is hereby made to the County of Cook, Illinois for Community
Development Block Grant ("CDBG") funds for Program Year 2011 in the amount of
$ _____________ for the following project(s):

 Project:                                                      $

 Project:                                                      $

 Project:                                                      $


as identified in the       CDBG 2011 Program Year application.


Section 2. That the (insert position title of person signing the application) are hereby
authorized to sign the application and various forms contained therein, make all required submissions
and do all things necessary to make application for the funds requested in Section 1 of this
Resolution, a copy of which application is on file with the Secretary.


 -B Optional -B
Section 3. That the (insert position title of person signing the matching funds certification) is
hereby authorized to certify that matching funds which have been identified as supporting its projects
as set out within its application will be made available upon the approval of the projects by the
County of Cook, Illinois or the prorated share thereof.

Dated this _____ day of                         , 2011.


By:     __________________________________________
                       Chairman/President


Attest: __________________________________________
                       Board Secretary

                                               (SEAL)


                                                24
                                         FORM B-3
                                    Sample Certification
                    Not-for-Profit Organization/Non-Municipal Agency




The undersigned Duly Qualified and Acting Secretary of the Board of Directors of (insert full name)
hereby certifies that the attached Resolution authorizing execution of the Application for the County of
Cook, Illinois' 2011 Community Development Block Grant ("CDBG") Program Year is a true and correct
copy of said Resolution as passed by the Board of Directors of (insert full name) on (insert Board
meeting date) which Resolution is still in full force and effect.




Dated this _____ day of _________________, 2011



Attest: __________________________________________
                       Board Secretary


(SEAL)




                                                 25
                                     FORM C
                       Estimated Matching Funds Certification


Matching funds are defined as any local, county, state, federal (other than CDBG) or private funds
used in conjunction with CDBG funds to implement or construct a proposed project. This form
must be filled out to document matching funds entered on each Project Summary. Please note
that the use of special assessments against property owned and occupied by low- and moderate-
income persons is prohibited.

In the event that the proposed project is funded at a lesser amount than requested, the matching
funds will be reduced in the same proportion. For example, if you request $100,000 with a
$30,000 (30%) match, and actually receive $50,000 in block grant funds, your required match will
be $15,000 (30% x $50,000).


  Subrecipients are urged to use additional matching funds whenever possible
1. Project Type
 2. Project Priority
 3. Amount of Matching Funds to Assist Project
 4. Source(s) of Matching Funds to Assist Project
 5. Timetable of Availability of Matching Funds
 6. Designated Use of Matching Funds

The Chief Executive Officer of the application certifies the availability of the above matching funds
by signing in the designated area below. Municipal/Agency seal is also required.

Dated this         day of          , 2011

By: ________________________________________

Title: _______________________________________

Attest: ______________________________________

Organization: __________________________________


(SEAL)




                                            26
                                          FORM D
                                       Public Service
                                             and
                        Maintenance of Effort after Project Completion


PUBLIC SERVICE:
How will one year of funding address the need? Will future funding from the County be critical for project
success? When will the project be self-sufficient?




CAPITAL IMPROVEMENTS:
CDBG funds cannot be used for on-going maintenance, building operations and staffing requirements for
projects constructed or rehabilitated with CDBG funds. Please provide the following information concerning
these costs:

Amount of Annual Funds Required for Maintenance of Effort:          $

Source of Funds:

Designated Use of Funds: (i.e. utilities, staff, equipment, maintenance):




                                                     27
                 FAIR HOUSING ACTION PLAN
                       (Municipalities)
                          FORM E
ACTIONS TO BE UNDERTAKEN FOR THIS PROGRAM YEAR:




                                  28
                                                     Cook County Bureau of Community Development
                                                          Community Development Block Grant
                                                                Demolition Application

69 West Washington - Suite 2900                                                                        Phone #: (312) 603-1000
Chicago, Illinois 60602                                                                                  FAX #: (312) 603-9770

COMMUNITY INFORMATION

Name of Municipality:


Municipal Contact Person:


Municipal Contact Person Title:


Address:


City:                                                                      State:       Illinois              Zip:


Phone:                                                                Fax:


E-mail:

PROPERTY OWNER INFORMATION (If different from municipality)

Owner/Business:


Owner/Business Contact Person:


Owner/Business Contact Person Title:


Address:


City:                                                                      State:       Illinois              Zip:


Phone:                                                                Fax:


E-mail:

NATIONAL OBJECTIVE (Please check one)

          Benefit to Low and Moderate                         Elimination or Prevention of
          Income (LMI) Persons                                Slums and Blight                                    Urgent Health and Welfare Threat

If selecting this National Objective, choose one   If selecting this National Objective, all of the      If selecting this National Objective, all of the
of the following and provide the necessary         following must be included with this application:     following criteria must be met:
supporting information:
                                                   A.   Slum/Blight Criteria selected                    A.   Determination of immediate threat – when
       City/County0wide LMI                                                                                  and by whom; include documentation
       Limited Clientele LMI                      B.   Additional Documentation (Photos, Letters        B.   Applicant’s inability to finance
       Site Specific LMI (survey required)             from Officials etc.)                             C.   Confirmation that no other financial sources
       Economic Development LMI                                                                              are available
       LMI Housing                                C.   Slum/Blight Declaration/Resolution
                                                                                                         D.   Confirmation that threat did not exist for
                                                                                                              more than 18 months prior to application


                                                                        29
DEMOLITION RATIONALE

Provide the rationale behind the municipality's desire to demolish this structure and why the municipality does not consider
rehabilitation a viable option. Include a letter from the municipal solicitor describing the municipality’s condemnation process,
acknowledging that condemnation proceedings ensued in accordance with all municipal ordinances and that the municipality has the
authority to remove the subject structure.

Include copies of the following documents in support of your rationale for demolition:
        On-site inspection reports identifying the nature of the unsafe condition(s) (e.g. engineer, building inspector/code enforcement
        officer, fire/police officials, etc.).
        Municipal notification of an unsafe condition to the property owner, agent or person in control of the structure. The
        correspondence must describe the unsafe condition(s), specifying the required repairs or improvements necessary to abate the
        existing conditions, or require the owner, agent or person in control to demolish the structure. Supply evidence that sufficient
        time was permitted to address the situation. Provide proof that notice was properly served (i.e. copy of certified or registered
        mail return receipt).
        Any correspondence from the owner, agent or person in control of the structure in response to municipal notification of unsafe
        conditions.
        Order of Condemnation (as posted at the site of the proposed demolition site).

PROPERTY INFORMATION

Property Identification Number:
Street Address:
Legal Description:

Please Describe Property:
- i.e. building size, type, condition




Is the property vacant?                                  YES                                       NO
Intended Use of Property After Demolition:




NOTE: If parcel is to remain vacant, describe how the municipality will assure that the resulting lot will be maintained and kept clear of health and safety
hazards (e.g. trash, debris).

CERTIFICATIONS

A.   There are no pending legal actions underway or being contemplated that would significantly impact the demolition of this facility.
B.   There are no unpaid property taxes filed against the property.
C.   There are no liens/assessments on the property, or proof of any are attached
D.   The property owner signing has full legal authority to sign



_______________________________                                                                _______________________________
Print Name                                                                                               Signature

_______________________________
Date




                                                                          30

				
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