HomeMy WebLinkAboutResolution - 2005-R0295 - Approve Proposal - Women's Protective Services - ESG, Essential Services Program - 06_23_2005Resolution No. 2005-R0295
June 23, 2005
Item 76
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the City Council of the City of Lubbock does hereby approve of the
proposal for the Women's Protective Services Essential Services program from the
Emergency Shelter Grant (ESG) Program and all related documents. Said proposal is
attached hereto and incorporated in this resolution as if fully set forth herein and shall be
included in the minutes of the City Council.
Passed by the City Council this 23rd day of June , 2005.
GAL, MAYOR
ATTEST:
Rebeeca Garza, City Secretary
APPROVED AS TO CONTENT:
Community
APPROVED A�5 TO FORM:
Amy Sims, Assistant Attorney
ccdocs/WPS Essential Services-ESG.res
June 15, 2005
r
FY 2005-2006 Funding Request
FY 2005-2006 Finding Request
Page 2
To submit an application, complete Part A — J, Attachments 14 (if applicable) and any other items requested. Do
not bind the application or include any items that are not requested. Submit one proposal per project Submit one
original and one copy of each application (SINGLE SIDE ONLY) to Community Development, 1625 13th Street,
PO Box 2000, Lubbock, Texas 79457 by April 1, 2005 5:00 PM. Please review the "Citizen's Guide" for the
Community Development programs, goals, requirements and timelines. For assistance, please call the Community
Development Department at 775-2301.
A. GENERAL INFORMATION
1.
2.
Name of Applicant: Women's Protective Services of Lubbock, Inc.
® Not -For -Profit ❑ For -Profit ❑ CHDO []City Dept ❑ Other
(Please include a copy of your IRS ruling providing tax exempt status under
Section 501(e)(3) of the 1986 IRS Code if you are a non-profit)
Nance of Project: Essential Services Program
Area or Location of Project: 8910 S . University (CONFIDENTIAL)
4. ContactPerson/Title: Fritzi Cates, 'Executive Direct6r--
Mailing AddressZip. PO Box 54089 Lubbock, T% 79453
Telephone/Fax Number(s): (806) 748--5292/ (806) 745-8739
Grant Request: ❑ CDBG
® ESG
❑ HOME
6. Amount of Funds Requested for Project: 16 , 500.00
7. Amount of Matching Funds for Project:
Match Type: ❑ Cash [] Sweat Equity ® Other Grants ❑ Donations
Identify Source of Match: Texas Department of Health and Human Services
Match Status: KIConfirmed ❑ Requested
8. Unduplicated Units Served (agency's definition) '1,194
(a) Total CD Funds Requested # 16 ,900.00 d) Total Project. #114080.00
(b) Total Unduplicated Units Served 3,194 le) Total Unduplicated Units Served 3,194
(c) Average CD Cost Per Unit (a(b):
_ 20 :^or r-1 i pnt'ppr service
Is this project? []Year 1 0 Year 2
f) Average Cost Per Unit (d/e):
$35_77 npr_Pliant, per service
❑ Year 3 ® Year 4
Women's Protective Services PO Boa 54089 Lubbock, Texas 79453
Office (806) 748-5292 Fax (806) 745-8739
PROJECT SUMMARY
Proposed Program
The Essential Services Program strives to meet immediate needs of victims of domestic
violence by obtaining and coordinating essential services and social referral services for
residents and non-residents, and assisting these clients in developing and implementing a
specific, individualized plan of service. Specifically, we provide clients with information and
referrals for housing, employment, education, childcare, medical care, TANF, mental health,
and other individualized, specific needs. In addition to these services, WPS is beginning the
fifth year of our on -site job readiness and job placement program.
Job Assistance for Moms (JAM)
While we continue to help our clients build emotional strength through individual and group
counseling sessions and social services referral, in February 2000 we began the new
program, Job Assistance for Moms (JAM), designed to assist women in gaining job readiness
skills and to assist with job placement. Clients participating in the JAM Program receive a one
month of job -readiness training at the WPS Resource Center, then work as paid employees
at local businesses participating in the JAM Program for a minimum period of six months.
Clients participate in weekly follow-up sessions at the Resource Center throughout the six-
month assistance program. The program finished its fourth year in February 2004 and has
graduated 379 women.
The JAM Program provides many opportunities for our clients. By receiving consistent
feedback and support during their employment period, as well as the daycare and
transportation assistance they need, the agency assists these women in developing the
emotional resilience and job skills necessary to become permanent full-time, independent
members in the workforce. With the promise of work and new employment opportunities,
many of our clients have acquired the internal and external resources to redefine their
abusive family relationships.
Program Correlation with WPS Mission
As the Essential Services Program name suggests, it is absolutely essential to provide the
services described above to our clients to fulfill our mission, "...to create an environment of
empowerment for women, children and families and to eliminate family violence.
JAM is just one example of the kinds of programs possible through the expanded living
environment of the shelter. WPS is in a position to make a profound and long-term difference
in the lives of battered women and their children in our 12-county area. That difference
includes plans to accommodate our burgeoning shelter population with expanded outreach to
the rural population of our service area.
Impact on Current Operation
Continued support from the ESG-City to pay 36% of our Coordinator of Essential Services
salary makes a huge impact on our operation, because it allows us to continually update our
services and programming. An additional 40% of our direct assistance to clients is funded by
the ESG-City grant. These funds are used to purchase local bus passes for travel to and from
Women's Protective Services PO Box SW89 Lubbock, Texas 79453
Office (SM) 74&S292 Fax (906) 745-9739
appointments to social services agencies, educational facilities and local businesses for
employment opportunities and to purchase emergency prescription medication. Without the
assistance of the Essential Services program, our clients' most basic needs would go unmet.
Until their basic needs are met, they are incapable of achieving their individual goals. WPS
has a far-reaching and lasting impact on homeless women, children and families who
need food, shelter, transportation, and other essential services as they become self-
sufficient within the larger community.
Essential Services within Consolidated Plan Priority
As it has for the past several years, the WPS Essential Services Program fits into the
guidelines of the Consolidated Plan. By providing shelter, food, health services, employment
training to otherwise homeless women, we fit the criteria exactly for several objectives listed
under the City of Lubbock Summary of Specific Objectives. (e.g. Objective CD-6 Public
Service, and HS-2. By upgrading our facility, we also fit the criteria for Number CD-5 Public
Service, and Number HS-2. Based on the High Needs By Category sheets from the
Consolidated Plan, this program fits under Homeless Facilities, Employment Training, Health
Services, Youth Services and Capacity Building.
Targeted Area
WPS serves 12 West Texas counties including Bailey, Cochran, Crosby, Dickens, Garza,
Hockley, King, Lamb, Lubbock, Lynn, Terry, and Yoakum. Population: 325,000, Area: 10,500
square miles.
Predominant Lubbock Client Zip Codes that Coordinate with Defined ESGICDBG High
Impact Areas, with Number of Unduplicated Clients for 2003:
79411
117
79405
229
79414 113
79412
60
79404
117
79415 176
79401
124
79403
151
All others 2,105
Program Location
All residential and non-residential services are performed at the WPS shelter in Lubbock,
which is a confidential location. Outreach services to non-resident clients are offered on -site
and in the twelve -county service area at specified locations in each county.
Benefits to Low -Moderate Income Community
The vast majority of clients who stay at the shelter are otherwise homeless. There is currently
an 18-month waiting list for federally subsidized housing in Lubbock. Resident clients of
WPS automatically qualify for federal preference, allowing them to move into housing at least
9 months sooner than otherwise.
Since our move to the new location in May 1999, the shelter facility has given us new
opportunities for serving the hard -to -employ population that is characteristic of shelter
clientele. As of February 1, 2000, WPS received a grant for $106,000 to implement a job
readiness and job placement program called JAM. It has helped us extend our elemental
WomeWs Protective Scnices PO Boa 54089 Lubbock, Texas 79453
Office (806) 748-3292 Fax (806) 745-8739
mission of reducing and preventing incidents of family violence by nurturing self-sufficiency in
our clients. Through this job training and employment program we have been able to expand
our support programs to include the trained staff and environmental structure for job skills
assessment, resume and job application assistance, interview training, time management
training, and support group assistance. We are also able to offer our clients job placement
services and the guidance necessary for consistent and successful employment. Long-term
economic self-sufficiency is an elemental ingredient in the mission of WPS. The assurance
of employment is the basic key to helping victims of domestic abuse leave their violent
situation and pursue healthier, happier lives. JAM is an indication of the programs now
possible for serving the homeless through .WPS resources.
WPS Cooperative Efforts and Participation with Other Organizations/Service Providers
WPS participates in numerous coalitions and councils. Among these are the Homeless
Consortium, the Housing Consortium, the Interagency Work Group, Resources United, and
Rural South Plains Coalition Task Force. We participate in numerous workshops during the
year pertaining to the Consolidated Plan for any of our 12 counties.
WPS relies upon the support of many local, state, and federal resources to meet the needs of
its clients. WPS currently coordinates its resources with a wide range of service organizations
across our 12-county region that includes the criminal justice system, law enforcement
agencies, medical facilities, educational institutions, health and human service organizations,
and religious organizations.
Specifically, WPS coordinates with the following local resources to meet the specific needs of
individual clients: Lubbock Regional Mental Health Mental Retardation, Texas Department of
Protective and Regulatory Services - Children's Protective Services, Salvation Army, Texas
Department of Human Services, South Plains Food Bank, Community Health Center of
Lubbock, Texas Department of Health, Lubbock Rape Crisis Center, Court Appointed Special
Advocates, Children's Advocacy Center, South Plains Regional Workforce Development
Board, Texas Workforce Commission, Texas Workforce Center, Childcare Management
Services, South Plains Community Action, Adult Protective Services, Boys and Girls Club,
Catholic Family Services, Covenant Healthcare System, University Medical Center,
Community Housing Resource Board, Family Counseling Services of Lubbock, Family
Outreach Center of Lubbock, Goodwill Industries, Guadalupe Economic Service Corporation,
City of Lubbock Housing Authority, Lubbock Interfaith Hospitality Network, Social Security
Administration, United Way of Lubbock, Volunteer Center of Lubbock, Women Infant and
Children's Program, Managed Care Center for Addictive Disorders, Lubbock Independent
School District, Lubbock County Victims Assistance Program, FEMA, and the YWCA. In
2003, over 17,000 community referrals were made to women and children seeking services
from our agency.
Goals and Objectives
Goal: To provide supportive services and referrals for the purpose of assisting women,
children and families to become and remain self-sufficient and free from violence.
Women's Protective Services PO Box SM89 Lubbock, Texas 79453
Office (806) 748-5292 Fax (806) 745-8739
Obiective: To provide an Essential Services program focused on meeting basic client needs
for independent living by providing healthcare, job readiness and job placement, mentodng,
education, transportation and referral to community resources/services.
Strategy: Make referrals for 95% of client goals checked on Client Goal Attainment sheets.
Output Measurements for Essential Services Program
Adults $ Children Service Categories Adults & Children
Current Statistics Projected Output
October 2003 — September 2004 October 2004 — September 2005
3,194 3,200
Activity Measures To Reach Goals and Objectives
Social Referral Groups: Community resources and the Essential Services Coordinator
discuss services and resources available in the community.
Frequency: One meeting each week.
Unit of Service: One group
Women of Excellence Group: Female community leaders share their experiences and
provide mentoring to residents.
Frequency: One meeting each week.
Unit of Service: One group
Individual Meetings with Essential Services Coordinator: Provides information about
housing, employment, education, childcare, medical care, TANF, mental health, etc,
Frequency: Weeklyfindividual sessions for residents.
Unit of Service: One meeting.
lmRact Measured: Weekly progress of residents toward stated goals and plan of service.
JAM Program
Provides Job Readiness Activities: Job interview skills, resume writing, dress -for -success
skills, job coping skills, support groups to discuss job experiences.
Provides Job Placement Activities: recruiting employers to hire WPS JAM participants and
performing follow-up and providing supportive services for employers and participants for a
minimum of six months.
Six Month Timeline
Residents & Non -Residents:
Initial meeting with every client: Complete Client Goal Attainment sheet and develop
service plan.
Weekly: meetings thereafter to evaluate progress toward achievement of goals.
Evaluation
When Essential Services staff meets with a client for the first time, they will complete a, Client
Goal Attainment Sheet to determine goals, and track referrals and achievements. Clients
review their sheets weekly with staff to evaluate progress. In addition, clients will be asked to
complete an evaluation of their entire stay at WPS and discuss how helpful the Essential
Services Program was to them. Based on these evaluations, WPS staff will regularly adjust
the program to effectively meet the needs of victims of domestic violence.
Women's Protective Services PO Box SM89 Lubbock, Texas 79453
Office (846) 748-5292 Fax (806) 745-8739
Upon exiting the shelter, women are encouraged to continue their WPS individual and group
counseling, essential services program, and parenting classes as non-resident clients to
receive ongoing support, referrals, and education. Non-resident services are free and
confidential for as long as the client desires our assistance.
Women's Protective Services PO Box 54089 Lubbock, Texas 79453
Office (806) 748-5292 Fax (806) 745-8739
ESSENTIAL SERVICES PROGRAM - CURRENT FUNDING SOURCES
TEXAS DEPARTMENT OF HUMAN
SERVICES
AMOUNT FUNDED
Direct Services to Clients
$4,500
Telephone
$2,000
Salary, Coordinator of Essential
Services
$18,000
Employment Advocate
$24 000
-Salary,
Payroll Taxes
$14,580
Benefits
$18,000
-Employee
Office Supplies
$500
Supplies
$500
-Copy
Postage
$1,000
Vehicle/Milea a
$500
Rental Equipment
$14,000
Total - TDHS Funds
$97,580
ESG - CITY
AMOUNT REQUESTED
Direct Services to Clients
$4,500
Utilities
$0
Salary, Coordinator of Essential
Services
$12,000
Total ESG Funds
$16,500
TOTAL PROGRAM EXPENSE
$114,080
PROGRAM INCOME
The Essential Services Program at WPS is free to all Resident and Non -Resident
clients. Income will not be generated from the services provided.
Women's Protective Services PO Box 54089 Lubbock, Texas 79433
Office (806) 748-5292 Fax (906) 745-8739
APPLICANT INFORMATION
CAPACITY OF ORGANIZATION
Founded in 1978, WPS was established as a 501(c)(3) shelter program for victims of
domestic violence and has grown in strength and services over the past 26 years to become
one of the three largest residential shelters in the State of Texas. In 2004, WPS served
3,194 unduplicated clients, answered 4,192 hotline calls, and provided 50,188 shelter days
for women, children, and families. WPS is the only agency that provides crisis intervention,
emergency shelter, and support services to battered women and their children in a 10,500
square -mile region with a population of 325,000 comprising the 12 West Texas counties of
Bailey, Cochran, Crosby, Dickens, Garza, Hockley, King, Lamb, Lubbock, Lynn, Terry and
Yoakum.
In the past 10 years, our budget has grown from.$265,000 in 1993 to $1,600,000 in 2005
through support from: the Texas Department of Human Services, VOCA, VAWA, United Way,
individuals, private foundations, the South Plains Food Bank, and USDA commodities. The
agency receives donations of household items; clothing; personal hygiene items; furnishings;
and child care products from generous individuals and institutions throughout the region.
WPS provides a wide range of crisis intervention services and support services including:
emergency shelter, food, clothing, medical assistance and a 24-hour, toll -free hotline, as well
as individual and group counseling for adults and children; parenting classes; an infant
stimulation program; a food and nutrition program; legal advocacy; social services referral for
housing, education and child care; an onsite job readiness and job placement program;
outreach services; community education; volunteer training programs; and rehabilitation of
violent family members through its Battering Intervention and Prevention Program (BIPP).
Mission Statement
The mission of Women's Protective Services of Lubbock, Inc. is to create an environment of
empowerment for women, children and families and to eliminate family violence.
Purpose/Objectives:
1) Provide a safe environment;
2) Offer community education/prevention;
3) Encourage transition to self-sufficiency; and
4) Advocate for the prevention and elimination of family violence.
Mission Description
It is the mission of WPS to reduce and prevent family violence by providing emergency
shelter to women and their dependent children as residents of WPS. It is also the mission of
WPS to nurture self-sufficiency in our clients by providing them with the emotional support
and life skills to overcome the pattern of violence that has dominated their domestic
relationships and build strong, healthy, and promising lives. Our network of support services
extends far beyond the walls of WPS to include former shelter residents and vulnerable
women and children throughout the region for as long as they need our help.
Women's Protective Services PO Box 54089 Lubbock, Taus 79453
Office (806) 749-5292 Fax (806) 745-8739
WPS Shelter Living Space
The WPS shelter is an innovative concept. Designed to de -institutionalize shelter living, our
shelter provides traumatized families with their own individual living space and a
neighborhood atmosphere to help them build independence and trust. The facility is
arranged as a series of quadruplex cottages, comprising 24 independent living units with'
each cottage containing 2-3 bedrooms, 2 bathrooms, a living room, dining room, and kitchen.
Two to three families share a cottage. The families have individual bedrooms and bath and
share a common cooking and living area.
The WPS shelter is an open campus. We encourage independence and responsibility in
every aspect of shelter life. Clients prepare their own meals in their cottage kitchens and do
their own laundry in a shared laundry area in the Resource Center. They are free to come
and go for job interviews, to accept employment, to meet with their children's teachers, attend
school programs and other. essential activities.
We balance this freedom with responsibility. Shelter residents are responsible for specific
shelter duties each week that include childcare, clean-up tasks, and food inventory. We also
promote self-sufficiency and responsibility by selecting a residential client from each
quadruplex of cottages to serve as the liaison between the residents and the WPS staff.
WPS Shelter Population
Women and children who must utilize the residential and non-residential services at WPS
have suffered sexual, emotional and/or physical abuse from a family or other household
member or spouse/spousal equivalent. WPS is the only agency that provides crisis
intervention, emergency shelter and support services to battered women and children
residing in the 12 South Plains counties of Bailey, Cochran, Crosby, Dickens, Garza,
Hockley, King, Lamb, Lubbock, Lynn, Terry and Yoakum. This twelve county area served by
Women's Protective Services has a population of approximately 325,000 and covers over
10,500 square miles. WPS provides services to all victims of family violence from these
counties as either a resident or a non-resident client.
WPS is one of only six Texas shelter programs that provides transportation services to
women in domestic crisis, services that require WPS staff to travel as much as 100 miles -
often in the middle of the night - to meet victims and their children at the local law
enforcement office, a friend's home, or other safe place, process the necessary paperwork,
then travel the distance back to Lubbock to bring the family to safety at the WPS shelter.
Our clients come to us frantic, battered and destitute with an average of three children.
Approximately 68% of our residential clients are living in poverty and almost all would be
homeless without WPS resources. Because of the abusive nature of their domestic lives, a
majority of these women do not have a significant employment history or even an elemental
livelihood outside of their abusive environments.
With the opening of the shelter, we anticipated a residency increase of 15% within the first
year with a gradual residency increase to 30% within a three-year period. However, the
Women's Protective Services PO Box 54089 Lubbock, Texas 79453
Office (806) 748-5292 Fax (806) 745-8739
agency experienced a 42% increase in clients within its first 6 months of operation. That new
percentage of clients has since remained constant. The appeal of the shelter environment is
demonstrable through these numbers, and the additional space we now have available has
also led WPS to develop new therapeutic programs to help our clients rebuild their lives.
2004 Resident Client Ethnic Breakdown 2004 Resident Age Breakdown
Adult
Children
59%
0-17
Hispanic
34%
40%
21 %
18-29
Anglo
30%
37%
10%
30-39
African American
24%
21 %
8%
40-49
Am. Indian or bi-racial
12%
2%
2%
50+
It is our mission to reduce and prevent incidents of family violence by providing emergency
shelter to these women and their dependent children in residence and support services for as
long as necessary to nonresident WPS families. It is also our mission to nurture self-
sufficiency in our clients by providing them with the emotionaP support and the life skills to
overcome the pattern of violence that has dominated their domestic relationships and help
them build strong, healthy and promising lives.
Financial Management
The current operating budget of WPS is $1,600,000. WPS is audited on an annual basis and
monitors and reports financial and program information to several federal, state, and local
funding sources as a matter of course, including providing monthly, quarterly, and annual
reports to DHS, FEMA, VOCA, VAWA, United Way and CJAD.
Women's Protective Services PO Box 54089 Lubbock, Texas 79453
Office (806) 748-5292 Fax (806) 745-8739
Staf n g
In the 2004 calendar year, 43 staff members and 86 trained volunteers served 3,194
unduplicated clients, assisted 4,192 callers, and provided over 17,000 referrals to community
resources. The staff member relevant to this request is the Essential Services Coordinator.
The Essential Services Coordinator is a licensed Social Worker who has 4 years experience
in providing information and referral services to all clients. She oversees the JAM program
and the Employment Advocate. Overall, the WPS Essential Services Program provides the
following services:
♦ Assistance in obtaining housing goals:
• Temporary housing;
• Permanent housing.
♦ Assistance in obtaining employment goals, through the JAM program including:
• Assessment for job skills;
• Job readiness activities;
• Job placement activities.
♦ Assistance in obtaining education goals:
• GED;
• College;
• Specific coursework/training.
♦ Assistance in obtaining federal, state and local assistance, for example:
• Disability income/benefits for emotional physical disabilities;
• Medicaid;
• Veteran's benefits;
• TANF;
• Food Stamps.
♦ Assistance in obtaining basic needs
• Clothing;
• Childcare;
• Transportation;
• Food.
♦ Referral to and coordination with other agencies/resources, as needed for:
• Medical and prescription assistance;
• Dental assistance;
♦ Assistance in developing a family budget.
Women's Protective Services Po Box 54089 Lubbock, Texas 79453
Office (906) 748-5292 Fax (806) 745-8739
Reporting Capabilities
Since many of our grant sources rely heavily on statistical information, WPS has many
systems in place for data collection. WPS utilizes a client intake packet that requires
demographic information as well as goal attainment sheets. At the initial intake, WPS staff
collects the information required from various funding sources, and compiles the information
at the end of each month for reporting. Texas Department of Human Services provided a
computer system including a database for client data collection. Shelter staff enters data
relevant to client numbers and demographics, activities, meals, shelter days and other
essential information. WPS developed a manual system to provide backup for the computer
information to ensure accuracy and accountability. Shelter staff and administrative staff
combine infonmation from monthly reports and send required documentation to each grant
source on a monthly, quarterly, semi-annual or annual basis as requested. We regularly
report to VOCA, VAWA, TDHS, FEMA, United Way and other local, state and federal grant
sources.
Woment's Protective Services Pa Box 54089 Lubbock, Texas 79453
Office (806) 748-3292 Fax (806) 745.8739
Governing Body Profile
Selection of officers and board meeting logistics
A 17-member Board of Directors, that includes a 4-member Executive Committee, governs
the agency. The Executive Committee is comprised of the President, Vice President,
Secretary and Treasurer, who meet on the third Tuesday of each Month. General Board
meetings are held on the 4t" Wednesday of every month.
Any WPS board or staff member can recommend someone as a Board member, but a voting
board member must make a motion to nominate that person at a general board meeting.
Another voting board member must second the motion, followed by a general vote. If the
majority of the votes are favorable, the person can begin their term at the following general
board meeting.
Article ll. Board of Directors
Section 2. Eligibility, Election and Tenure
A. Terms of the Board of Directors shall be for three years and shall begin at the regular
meeting following the annual meeting.
B. The nominating committee shall present a slate of one or more nominees for each
expiring term two meetings prior to the expiration of a term.
C. A board member who is absent from three meetings in a 12 month period (April 1.
through March 31) may, (with the exception of excused absences which are approved
at the discretion of the President of the Board and the Executive Director) thereupon
be removed from the Board. He/She shall be notified.
lift
FY 2005-2006 Funding Request
G. PROJECT BUDGET
Page 6
1. Please list applicant's anticipated expenditures, detailing requested funds and applicant's matching
funds. Please place Cush, S—Sweat Equity, 0--Other Grants, D=Donations beside each amount
under "Applicant's Match" to denote the type of match being used.
ADMINISTRATION:
Personnel #
12 ,000.00
12,000.00
30 ,000.00
54,000.00
Payroll Taxes
14,580.00
14 580.00
f.,ETloyee Benefits
18 000.00
18,000.00
Office lies
500.00
500.00
Copy Supplies
500.00
500.00
Postage
1,000.00
1900m 00
Tel hone
2,000.00
2,000.00
Promotional
—0--
-a-
Professional Service
—0-43
—0—
Vehicle Fuel/Mileage
500.00
500.00
Other.
PROGRAM:
Acquisition
Reconstruction
Rehabilitation
Installation
Demolition
T ech. Asst.
Direct Assistance
4,500.00
4,500.00
—0:'-
9,000.00
Rental of Space
Rental of Equipment
14,000.00
14,000.00
Professional Services
for Clients
Other:
Professional services
Construction
TOTALS
16,500.00
16,500.00
81,080.00
114,080.00
Page 8
I Conflict Of Interest
Federal law (24CFR574.611) prohibits persons who exercise or who have exercised any functions or responsibilities
with respect to the above grants... or who are in a position to participate in a decision making process or to gain
inside information with regard to such activities, may obtain a financial interest or benefit from an assisted activity...
either for themselves or those with whom they have family or business ties, dv ring their tenure or for one year
thereafter.
1. Is there any member of the applicant's staff, member of the applicant's Board of Directors, or Officer who
currently is or has/have been within one year of the date of this application a City employee, a member of the
Community Development & Services Board, or a member of the City Council?
❑ Yes [K] No
If yes, please list names:
2. Will the fiords requested by the applicant be used to pay the salaries of any of the applicant's staff or award a
subcontract to any individual who is or has been within: one year of the date of this application a City employee,
a member of the Com amity Development & Services Board, or a member of the City Council?
❑ Yes ® No
If yes, please list names:
3. Is there any member of the applicant's staff: member(s) of the Board of Directors, or officer(s) who are business
partners or immediate family of a City employee, a member of the Community Development & Services Board,
or a member of the City Council?
❑ Yes ® No
If yes, please list names:
If any member of the Community Development Services Board has a conflict, they may not participate in the
subcommittee interview or discussions, nor vote during the recommendation.
The applicant certifies to the best of his/her knowledge and belief that the data in axis application is true and correct
and that the governing body of the applicant has duly authorized the filing of the application and that the applicant
will comply with all the requirements of each grant respectively if the application is approved.
Please include: 1) the minutes of the board meeting at which this item was authorized, and 2) who is authorized to
sign the application and/or contracts.
Name. GayLynn Stone Signature:
Title: Board Chairperson Date:
Name: Fritzi Cates
Title: Director
Signature:
_ 22��4a " (a OCL�-
Date: 3-1 5