HomeMy WebLinkAboutC12-023 Community Services Block Grant Application (3 yr grant) EAGLE COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISON OF CHILD, FAMILY AND ADULT SERVICES III COMMUNITY SERVICES BLOCK GRANT (CSBG) 2012 -2015 APPLICATION Page 1 of 17 09)-0315 2012 -2015 Community Services Block Grant (CSBG) Application COVER PAGE GRANTEE INFORMATION: Name of Eligible Entity: Eagle County HHS, Child, Family & Adult Services Full Mailing Address: P.O. Box 660, Eagle, CO 81631 Street Address: 500 Broadway, Eagle, CO 8163 (If different from mailing address) DUNS Number: PRIMARY CONTACT INFORMATION: PRIMARY Contact Person for Eligible Entity: Rosie Moreno Phone Number: 970/328 -2605 Provide direct line number and /or extension Fax Number: 855/848 -8826 Email Address: rosie.morenoaeaglecounty.us PROGRAM MANAGER CONTACT INFORMATION CSBG PROGRAM Manager Contact: Sherri Almond If different than above Phone Number: 970 - 328 -8852 Provide direct line number and /or extension Fax Number: 855/848 -8826 Email Address: sherri.almondAeaglecounty.us CHAIRPERSON CONTACT INFORMATION Chairperson for the Board of County Commissioners if the eligible entity is a public agency Chairperson /President if the eligible entity is a private community action agency: NAME: Jon Stavney Title: Chairperson, Board of County Commissioners Mailing Address: P.O. Box 660 Email Address: jon.stavneyaeaglecounty.us Page 2 of 17 2011 -2012 Community Services Block Grant (CSBG) Application APPLICATION CHECKLIST This Checklist includes requirements for completing the grant application for the Community Services Block Grant (CSBG). The Application Checklist must accompany your submission. Applicant should identify those items that have been included in the submission by placing an "X" in the appropriate box. Submitted Document Comments by Grantee ❑ Completed Application Cover Page Signed CSBG Certifications Tripartite Board Membership Roster Grantee and (if applicable) the Sub - Grantee Budget Information Page Tripartite Board Bylaws Newspaper Notice of Public Hearing Public Hearing Minutes CSBG Program Policy and Procedures ❑ Grantee's 501(C)(3) Certification (applicable to NA private eligible entities) Needs Assessment Report ❑ Copy of the Needs Assessment tool(s) used to Information on process and conduct the survey data collected in the report ROMA Summary for each activity funded with CSBG Tripartite Board Meeting Minutes when the CSBG Application and Plan was approved ❑ Copy of most current Financial Audit ❑ Copy of the Contract/MOU /Sub- Grantee NA Agreement Boiler Plate (if applicable) Community Action Plan that includes: • Results of the Needs Assessment • Description of community resources available and what is needed • Identification of service to be provided • Description of expected outcome ® • Projected number of clients and % of success expected • Description of measurement tool that will be used to determine success ❑ • Linkages Plan (if requesting funds for Linkages) • Description of how coordination will occur • Description of how CSBG funds will be coordinated with other resources • Description of innovative initiatives being undertaken Page 3 of 17 2012 -2015 Community Services Block Grant (CSBG) Application CSBG CERTIFICATIONS By signing and submitting this application and plan, the Grantee assures that activities implemented with CSBG funds will be: o used to accomplish the State CSBG Goal and Objective stated in the State Plan; and o within the requirements set forth in the Community Services Block Grant Act, Title IV of the Civil Rights Act, the Age Discrimination Act of 1975, the Rehabilitation Act of 1973, Public Law 103- 227, Part C, Environmental Tobacco Smoke, also known as the Pro - Children Act of 1994 (Act), Certification Regarding Drug -Free Workplace Requirements, Certification Regarding Lobbying, Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions, Office of Management and Budget (OMB Circular A110 and Al22), and the current State of Colorado CSBG Plan. The Grantee also assures that it will: o specifically consider, in a public meeting the designation of any local public or private entity to carry out the county community service activities under contract with the county, any local community action agency (CAA) which received federal fiscal 1981 -82 funding; and o consider, on the same basis as other non - governmental organizations, religious organizations to provide the CSBG services, so long as the program is implemented in a manner consistent with the Establishment Clause of the first amendment to the Constitution. Grantees shall not discriminate against an organization that provides assistance under, or applies to provide assistance, on the basis that the organization has a religious character. (Please review Sec.679 Operational Rule in the CSBG Act); and o provide for coordination between community anti - poverty programs and ensure, where appropriate, that emergency energy crisis intervention programs under Title XXVI (relating to low - income home energy assistance) are conducted in such community; and o provide, on an emergency basis, for the provision of such supplies and services, nutritious foods, and related services, as may be necessary to counteract conditions of starvation and malnutrition among low- income individuals; and o coordinate, to the extent possible, programs with and form partnerships with other organizations serving low- income residents of the community and members of groups served, including religious organizations, charitable groups, and community organizations; and o establish procedures under which a low- income individual, community organization, or religious organization, or representative of low- income individuals that considers its organization, or low - income individuals, to be inadequately represented on the CSBG board (or other mechanism) to petition for adequate representation; and Page 4 of 17 2012 -2015 Community Services Block Grant (CSBG) Application CSBG CERTIFICATIONS o ensure that in order for a public organization to be considered an eligible entity, the entity shall administer the CSBG program through a tri- partite board, which shall have members selected by the organization, and shall be composed so as to assure that not fewer than 1/3 of the members are persons chosen in accordance with democratic selection procedures adequate to assure that these members are: • Representative of low- income individuals and families in the community served; and • Reside in the community served; and • Able to participate actively in the development, planning, implementation and evaluation of the program o ensure that In order for a private, non - profit agency to be considered an eligible entity, the entity shall administer the CSBG program through a tri- partite board that fully participates in the development, planning, implementation, and evaluation of the program. The members of the board shall be selected by the entity and the board shall be composed so as to assure that: • 1/3 of the members of the board are elected public officials holding office or their representatives; and • Not fewer than 1/3 of the members are persons chosen in accordance with democratic selection procedures adequate to assure that these members are representative of low - income individuals and families in the neighborhood served and resides in the neighborhood represented; and • The remainder of the members are officials or members of business, industry, labor, religious, law enforcement, education or other major groups and interests in the community served. o prohibit the purchase or improvement of land, or the purchase, construction, or permanent improvement (other than low -cost residential weatherization or other energy - related home repairs) of any building or facility with CSBG funds; and o prohibit, including subcontractors, (a) any partisan or nonpartisan political activity or any political activity associated with a candidate, or contending faction or group, in an election for public or party office, (b) any activity to provide voters or prospective voters with transportation to the polls or similar assistance in connection with any such election, or (c) any voter registration activity; and o prohibit that persons shall, on the basis of race, color, national origin or sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any program or activity funded in whole or in part with CSBG. Any prohibition against discrimination on the basis of age under the Age Discrimination Act or 1975 (42 U.S.0 6101 et seq.) or with respect to an otherwise qualified individual with a disability as provided in Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 12131 et seq.) shall also apply to any such program or activity; and Page 5 of 17 2012 -2015 Community Services Block Grant (CSBG) Application CSBG CERTIFICATIONS o participate in the Results- Oriented Management and Accountability (ROMA) System, and describe outcome measure to be used to measure performance in promoting self- sufficiency, family stability, and /or community revitalization; and o make available for public inspection each plan prepared as part of the program planning process. The Grantee may, at its initiative, revise any plan prepared for CSBG funding and shall furnish the revised plan to the Director of the Community Services Block Grant under the Department of Local Affairs. Each plan prepared for submission shall be made available for public inspection within the county and /or service area in such a manner as will facilitate review of, and comments on, the plan; and o cooperate with the State, to determine whether grantee performance goals, administrative standards, financial management requirements, and other requirements of the State, in conducting monitoring reviews including (1) a full on -site review for each grantee at least once during each 3 -year period, (2) on -site review for each newly designated grantee immediately after the completion of the first year in which funds were received, (3) follow -up reviews with grantees that fail to meet the goals, standards, and requirement established by the State, and (4) other reviews as appropriate, including reviews of grantees with other programs that have had other federal, State, or local grants terminated for cause; and o make available appropriate books, documents, papers, and records for inspection, examination, copying, or mechanical reproduction on or off the premises upon reasonable request by the U.S. Controller General, the State, or their authorized representatives should an investigation of the uses of CSBG funds be undertaken; and o in the case of county governments or Subgrantees which receive a CSBG award in excess of $100,000, comply with the following three certifications related to the "Limitation on use of appropriated funds to influence certain Federal Contracting and financial transactions (P.L. 101- 121, Section 319 and USC Title 31 Section 1352) ": 1. No Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. 2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or any employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form LLL, "Disclosure Form to Report Lobbying," in accordance with its instruction. 3. The undersigned shall require that the language of this certification be included in the award document for subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. Page 6 of 17 2012 -2015 Community Services Block Grant (CSBG) Application CSBG CERTIFICATIONS The Grantee certifies to the best of its knowledge and belief, that it and its principals: a) are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; b) have not within a three -year period preceding this proposal been convicted or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public transaction; violation of Federal or State antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; c) are not presently indicted for otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (b) of this certification; and e) have not within a three -year period preceding this application had one or more public transactions (Federal, State or local) terminated for cause or default. The Grantee further certifies that it: a) requires that smoking not be permitted in any portion of any indoor routinely owned or leased or contracted for by an entity and used routinely or regularly for provisions of health, day care, education, or library services to children under the age of 18, if the services are funded by Federal programs either directly or through State or local governments, by Federal grant, contract, loan, or loan guarantee. b) that it will require the language of this certification be included in any sub awards which contain provisions for the children's services and that all Subgrantees shall certify accordingly. If you are unable to certify to any of the statements in this certification, please attach an explanation to this application. SIGNATURE: Authorized to Sign: If Public Eligible Entity: Chairperson of the Board of County Commissioners If Private Community Action Agency: Tri- Partite Board Chairperson /President If Multi- County Service Agency: Chairperson of the Board of County Commissioners of Lead Agency PRINT NAME: den - tavner PC i f .11-- POSITION TITLE: BoCC, Chairperson DATE: 10I 12— Page 7 of 17 o ° 5 k k CO ■> ■ 3 2 o a ■ 4 'E ca a >1 4- k E r E c q § c c cc . 1- � $ 72 1- 72 CO to Lu / 2 k, . / 2 CO 0 0 . w. § 3 w § � w r. § Q U 0 a c a) 0 0 0 I. 0 - & a rn ■ 2 r 2 _ 2 2 o o W § 0 k b 0 k 2§ k 2 r •-• m ■ m >. \ c k 2 2 § § . / d .0 S - . c.) k k k 0 ! E \ t \ �� $ — ■ U a k a 0 0 to Q / § 0 O 0 / 0 / § < R _1 Q 64 § o C. / g g � �_ � �� 2£� o w < � K � / cam \ � ��03 u U ■ Pi ■ o 2 o 2■ - - © © § Er ' § ° U U 0 00 r. � # c .' L.o■ M Lo , F ■IF ■ o Ce 2 o § E�o2o2 Ea4 v. O c k�k k� (5 0 > C 0 IR . C .= mo C a I— o " 2 0) . / 5 >, c > k • ■ 41) F, . ■ ■ ■ = ■ o. m o � � g c.) 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