Four Mounds Grant Grey HousefC)tll F OUftD l:OIJflDflflOfl
4900 Peru Road · Dubuque, Iowa 52001 · 563-557-7292
January t2, 201M
Mr. Michael Van Milligen, City Manager
CITY OF DUBUQUE
50 W. 13th Street
Dubuque, IA 52001
Dear Mr. Van Milligen,
Thank you for your continued support of our work as we preserve the Four Mounds
Estate and carry out our mission.
We are requesting that you sign an owner consent form for a grant application to the State
Historical Society oflowatothekHistoric Resources Development Program. Funding
from this grant (requesting $26,856, project totaling $40,284) will allow Four Mounds to
restore the structurally damaged Porte Cochere at the historic Grey House at Four
Mounds. During an investigation this fall, we found insect damage had undermined the
structure. The grant funding will help us to repair and mitigate the damage and restore
the structure entirely. As well, it will allow us to add extra protections to prevent similar
damage and deterioration in the future.
Please be aware that because this is a local landmark and listed on the National Register,
we will be going through the proper channels to ensure that we follow- all guidelines and
regulations regarding this historic structure.
Thanks once again and if there are any questions, please give me a call at 563/557-7292.
Sincerely,
tson
Executive Director
A Non Profit Foundation ~ Preservation · Education
.State ]Historical Society of Iowa Page 1 0£4
State Historical Society of Iowa's
REAP/HRDP Application Form
C. Match Requirements Section
Wi[[ you be using federal monies to carry out this project? Yes [] ilo []
For Non-Profits Only:
Does your total match equal at least 50% of the total grant request? Yes I~' No
(Total Cash Match + Total In-kind Match) + Grant Request x 100 = g~ %
Note: Cash Match must be at least 25% or greater in relation to the total grant request, in-kind
match may by replaced by Cash Match.
For Individuals Only:
Does your total match equal at least 75% of the total grant request? Yes lC I No CL~
(Total Cash Match + Total In-kind Match) + Grant Request x 100 = [~ %
Note: Cash Match must be at least 50% or greater in relation to the total grant request. In-kind
match may by replaced by Cash Match.
For For-Profits Only:
Does your total match equal at least 100% of the total grant request? Yes Ic` No f~'i
(Total Cash Match + Total In-kind Match) + Grant Request x 100 = [~ %
Note: Cash Match must be at least 75% or greater in relation to the total grant request. In-kind
match may by replaced by Cash Match.
D. Income
List aLI cash income to be used to defray the expenses of the project and List sources of that income.
Do not incLude In-kind contributions. Funds from other state grants are not aLLowable matches.
Earned Income: IncLude revenue from the sale of admissions, tickets, memberships, etc., for events
attributable or prorated to this project.
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Contributions: Include contributions from businesses, corporations, foundations, and other private
sources.
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Other Revenue: IncLude revenue from sources other than those listed above.
la= ~=o=~oua Dono= and annuaZ c~/npaign rev. j $ [2614
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Total Cash Income: This tota[ must equal the total Cash Match in the Budget Section.
$ [~639
E. Ownership
Does the appLicant own the historic resource?
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· State Historical Society of Iowa Page 2 of 4
Yes[-~-] Noir]
If the applicant does not own the historic resource the fol.[owing information is required:
Name of Owner:
ICity of Dubuque
Address:
50 W. 13th Street
City:
IDubuque
County:
I Dubuque
State:[IA
E-mai[ Address:
Zip code: L52OOl
Lcs t einha@ cit yo fdubuque, or9
Telephone (daytime):
L563/589-4110 j
I give my permission for the applicant to carry out the project described in this REAP/HRDP grant
application. /~
Sisnature/°x~/C~wner~: / ~'?~-'L /
Date: 11-12-03 I ~
F. Co-Applicant
If one or more co-applicants are involved in the project, provide the fo[lowing information is
required (include separate page if necessary):
Name of Co-applicant:
[
Address:
i
City:
County:
[
State: l j Zip code: L
E-mai[ Address:
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state kustoncal ~octety os Iowa Page 3 o~'4
Telephone (daytime):
J
Contact Person:
Contact's Telephone (daytime):
L
Contact's E-mail. Address:
L
I/My organization wii. l work with the applicant to carry out the project described in this REAP/HRDP
grant appUcation.
Signature of Co-applicant:
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G. Statement of Assurances
The applicant hereby agrees and acknowledges:
a) that, if funds are awarded, they wi[[ conduct their operations in accordance with title VI and VII
of the Civil Rights Act of 1964, as amended, and the Rehabilitation Act of 1973, as amended, which
bar discrimination against any employee, appUcant for employment or any person participating in
any sponsored program on the basis of race, creed, color, national origin, religion, sex, age, or
physical or mental disabitity, and require compensation for employment at no [ess than minimum
wage requirements, and provide safe and sanitary working conditions;
b) they wi[[ expend funds received as a result of this apptication solely on the described project;
c) that, if the proposed project impacts a property listed on or having qualities making it eligible for
listing on the National Register of Historic Pi. aces, the appUcant will consult with the Bureau of
Historic Preservation, State Historical Society of Iowa, and wi[[ act in accordance with the Secretary
of interior's Standards for Archeology ~t Historic Preservation;
d) that the facts, figures, and representations made in this application, including a~[ attachments,
are true and correct to the best of their knowledge;
e) that the filing of this application has been authorized by the governing board of the applicant;
f) that failure to comply with the REAP/HRDP Grant program administrative rules will disquatify the
application.
Signature~t/'./e2;'sor]/with/~tgal authority to obligate the Applicant:
Date: -
Typed name and title of the above person:
lchr±$~:J_ne O~L$on, ~;×eou~:±ve D±rec~:or
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### This is the end of the apptication form ###
http://www.i~wahist~ry.~rg/grants/shsi-grants/hrdp/app~icati~n/mat~h-secti~n.h~m 1/12/2004