HUD Continuum Care Program
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MEMORANDUM
March 31,2004
TO:
The Honorable Mayor and City Council Members
FROM:
Michael C. Van Milligen, City Manager
SUBJECT: HUD Continuum of Care Program Renewal Application
HUD's Continuum of Care Program provides funding for a variety of housing and
supportive services for homeless individuals and families.
Housing and Community Development Department Director David Harris is
recommending City Council approval of an application to HUD's Continuum of Care
Program for renewal grants for Maria House and Project Concem.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
j11d{~~
Michael C. Van Milligen '---
MCVM/jh
Attachment
cc: Barry Lindahl, Corporation Counsel
Cindy Steinhauser, Assistant City Manager
David Harris, Housing and Community Development Department
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MEMORANDUM
22 March 04
To: Mike Va\~igen, City Manager
From: David ~~s, Housing and Community Development Department
Re: HUD Continuum of Care Program Renewal Application
Introduction
The purpose of this memorandum is to request the City Council's approval of an
application to the US Department of Housing and Urban Development (HUD) for
renewal of funding under the Continuum of Care Program for homeless assistance.
Background
HUD's Continuum of Care Program provides funding for a variety of housing and
supportive services for homeless individuals and families. In 2001, the Housing
Department sponsored an application, in partnership with Hillcrest Family Services,
Project Concern and Maria House for $609 000 in federal assistance. A grant was
received for that amount, to be used as follows:
Hillcrest received $387 000 toward costs to purchase an apartment building adjacent to
their campus and convert it to a transitional housing facility for families. Additional
assistance was received from the City's Community Partnership (CP2) Program and
from the Iowa Finance Authority. This 5-unit facility opened in the summer of 2003. It is
the only transitional housing in Dubuque that offers residential and supportive services
for families with children and both female and male parents
Maria House received a grant of $126000 to employ two staffpersons to work with their
clients. Services provided include legal services advocacy and follow-up counseling for
women and families who have moved on from the facility.
Project Concern used a $94 000 award to establish a "single-point-of-entry" intake,
assessment and referral service for homeless persons and families. This initiative
provides coordinated delivery of services across agencies, data entry reporting and
follow-up tracking of families receiving services. This program has proved essential in
responding to the needs of the many families recently moving to Dubuque without
adequate housing or other basic resources.
Discussion
The grants received by Maria House and Project Concern were for three years each.
Renewal applications have now been prepared to fund continuation of these services.
The Housing Department has facilitated a process including meetings of more than 20
area agency providers to assess needs, rank priorities and monitor service delivery. As
well, staff have prepared the required narrative element to accompany the applications
from the two agencies requesting renewal funding.
Action Step
The action requested of the City Council is to authorize the Mayor's signature on the
attached application and related documents, for submission to HUD's Continuum of
Care Program funding, for renewal grants for Maria House and Project Concern.
2004 Statewide Continuum of Care Application
Summary Page
Project Name: Single-Point-Of-Entry Coordination; Counseling and Outreach Services
Project Connty or Counties to be served. Inclnde corresponding Geographic Area Code(s):
Dubuque 19146411\
Project Sponsor's Name: City ofDubuqne Housing Department
Project Sponsor's Address (street, city, state, zip):
1805 Central Avenue
Dubuque, IA 52001
Antborized Representative of Project Sponsor (name, title, pOOne, fax & email):
David Harris, Director
(563) 5894239 phone
(563) 5894244 fax
dbarris@cityofdubnque.org
Type of Project (ched< one)
Snpportive Housing (outreach, safe baven, transitional housing, suppOrtive services
only, and/or permanent housing for disabled homeless)
Shelter Plus Care (check tbat which is applicable):
- Tenant-based rental asst.
- Sponsor-based rental asst
- Project-based rental asst.
- SRO-based rental asst.
SRO Moderate Rehabilitation
..1L Renewal
--X- SHP
S+C
Amonnt reqnested for tbis project:
Population(s) served: City ofDubuqne Homeless Families and Individuals
State Representative, State Senator, and Congressional District (name & corresponding district
nomber):
Jochum, Connolly, 2'" Congress District
Project Sponsor is (ched< one):
_501(c)(3)
--1L- nnit of government
- other
Initial Submission
Page 5
1. Type of Federal Action:
~a. contract
b. grant
c. cooperative agreement
d.loan
e. loan guarantee
f. loan insurance
4. Name and Address of Reporting Entity:
lEI Prime 0 Subawardee
Tier -' ifknown:
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
(See reverse for public burden disclosure.)
2. Status of Federal Action: 3. Report Type:
~a. bid/offerlapplication ~ a. initial filing
b. initial award b. material change
c. post-award For Material Change Only:
year quarter
date of last report
Approved by OMS
0348-0046
5. If Reporting Entity in No.4 is a Subawardee, Enter Name
and Address of Prime:
City of Dubuque Housing Depar1ment
Congressional District, if known: 4c
6. Federal Department/Agency:
HUD
Con ressional District, ifknown:
7. Federal Program Name/Description:
Continuum of Care
CFDA Number, if applicable:
8. Federal Action Number, ifknown:
9. Award Amount, if known:
$
10. a. Name and Address of Lobbying Registrant
(if individual, last name, first name, MI):
b. Individuals Performing Services (including address if
different from No. 10a)
(last name, first name, MI):
11. ~:,,""':: =: ':'=. :;,:. ":".=, ~ ';:;
"""pwhiohrel.--_bythe""""""'whepthiS"""""""'-""'"
Œ"-" rote. 1Ns """"'"'" is requ""" pu~"" to 31 U.6.o. 1352. This
_P wiI'be~_""pub'._. Anyp"",mwhora'tofilethe
...,""" """""'" ""'be""'i""to. .."""","of""""!hap $10.000'00
oot__$100,000.""""""","'.",
Signature:
Print Name: Terrance M. Duggan
Title: Mayor
Telephone No.: 563-5894120
Date:
Authorized for Local Reproduction
Standard Form LLL (Rev. 7-97)
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosurelorm shall be completed by the reporting entity. whethersubawanJeeor prime Federal recipient, at the initiation or receipt of a covered Federal
action, or a material change to a previous fling, pul5Uant to title 31 U.S.C. section 1352. The flUng of a form is required for each payment or agreementto make
paymentto anylobbyingantityfor influencing or attempting to influence an ollicer oremployeeof anyaganey, a Member of Congress, an officer or employeeof
Congress, or an employeeola MemberofCongress in connection with a covered Federaiaclion. Completeail items thatappiyfor both the initialfiting and material
change report. Refer to the implementing guidance published by the Office 01 Management and Budget for additional information.
1. Idenlify the type of covered Federal action for which lobbying activity is andlor has been secured to influence the ou!come of a covered Federal action.
2. Identify the status 01 the covered Federal action.
3. Identify the appropriate classification of this report. If this is a foilowup report caused by a material change to the information previouslyreporied, enter
the yearand quarter in which the changeoccuned. Enter the date 01 the last previoustysubmitied report by this reporting entity for this covered Federal
action.
4. Enterthefuil name. address, city, Stale and zip code 01 the reporting entity. Include Congressional District. if known. Check the appropriateclassification
of the reporting entity that designates if it is, orexpeclsto be. a prime or subawanJ recipienl Identify the tier of the subawardee,e.g.. the first subawardee
of the prime is the 1st tier. Subawards include but are notlimiied to subcontracls, subgrantsand contractawalds under grants.
5. II the organization filing the report in item 4 checks "Subawardee,"then enter the foil name. address, city, State and zip code of the prime Fed-
recipient. Inctude Congressional District, if known.
6. Enterthe nameofthe Federalagencymakingthe award or loan comm.ment.lnclude at least one organizational level below ageneyname, if known. For
example, Department o!Transportation. United States Coast Guard.
7. Enterthe Federal program name or description for the covered Federal action (item 1). II known, enter the full Catalog of Federal DomesticAssisiance
(CFDA) numbel" for grants. coopemIive agreements, loans, and loan commitments.
8. Enter the most appropriate Federal identifying numbel" available for the Federal action idantilied in .em 1 (e.g., Request for Proposal (RFP) numbe"
Invitation for Bid (IFB) numbe" grant announcement numbe" the contract, grant, or loan award number; the applicalionlproposal control number
assigned by the Federal agency). Include prefixes. e.g., "RFP-DE-90-001."
g. For a covered Federal action where there has been an award or loan commitment by the Fed_agency, enter the Federel amount of the awardlloan
commitment for the prime entity identified in .em 4 or 5.
10. (a) Enterthefuil name. address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act 01 1995 engaged by the reporting
entity identified in .em 4 to influence the covered Federal action.
(b) Enterthefuil names of the individual(s) performing services, and include full address ildilferentfrom 10 (a). Enter Last Name, First Name, and
Middle Initial (MI).
11. The certifying official shall sign and date the fonn, print hislher name, title, and telephone number.
According to the PaperworkReduction Act, as amended, no persons are required to respond to a collection of information unless. displays a valid OMB Control
Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is
estimated to average 10 minutes per response. including time for reviewing instructions, searching existing data sources, gathering and maintainin9 the data
needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect 01 this collection of
information. inctuding suggestions for reducing this burden, to the Office of Managementand Budget, Paperwork Reduction Project (0348-0046), Washington.
DC 20503.
Application for
Federal Assistance
U.s. Department of Housing
and Urban Development
OMB Approval No.2501-OO17 (exp. 0313112005)
2. Date Submitted
1. Type of Submission
[]ApprK:ation
4. HUD AppJicalion Number
0 PreappIication
25-Ma<
3. Date and Tune Received by HUD
5. Existing Grant Number
. Appficant's Legal Name
GìIy of Dubuque, IA
. Address (give city, county, sæte, and zip code)
A. Address: 1805 Central Avenue
B. City: Dubuque
C. County: Dubuque
D. sæte: Iowa
E. Zip Code: 52001
11. Employer Identification Number (EIN) or SSN
42-6004-696
13. Type of Application
New 0 Continuation IE] Renewal
0 Revision
If Revision, enter appropriate letters in box(es) 0 0
. Increase Amount B. Decrease Amount C. Increase Duration
D. Decrease Duration E. Other (Specify)
15. Catalog of Federal Domestic Assistance (CFDA) Number
TdIe: Continuum of Care
Component TdIe: City of Dubuque
17. Areas affected by Program (boroughs, cities, counties, S1ates,
Indian Reservation, etc.)
18a. Proposed Program start date
18b. Proposed Program end dale
6. Applicanlldentification Number
8. Organizational Unit
City Government
10. Name,title,telephone number,fax number, and e-mail of the person to be
contacted on matters involving this apprrcation Qncluding area codes)
A. Name: David Harris
B. TdIe: Director, Housing Department
C. Phone: 563-589-4239
D. Fax: 563-589-4244
E. E-mail: dharristW.citvofdubuaue.ora
12 Type of Applicant (enter appropriate letter in box) C
A. S1ate I. University or CoUege
B. County J. Indian Tribe
C. Municipal K Tribally Designated Housing Entity (TDHE)
D. Township L Individual
E. Interstate M. Prof~ Organization
F. Intennunicipal N. Non-prof~
G. Special DisIJict O. Public Housing Authority
H. Independent School DisIJict P. Other (SpecIfy)
14. Name of Federal Agency
U.S. Department of Housing and Urban Development
16. Descriptive rrtle of Applicant's Program
Supportive Housing Renewal:
Coordinated intake & HMIS Management Services
Administered by Projeot Concern; Legal/Advocacy Staff Services
Administered by Maria House.
190. Congressional Districts of Applicant
2nd
19b. Congressional Districts of
Program 2nd
20. Estimated Funding: Applicant must complete the Funding Matrix on Page 2.
21. Is Application subject to review by State Executive Order 1 =2 Process?
A. Yes This preapplication/application was made available to the sæte Executive Order 12372 Process for review on: Date-
S. No Program is not covered byE.O. 12372
Program has not been selected by sæte for review.
22. Is the Applicant delinquent on any Federal debt? X No
0 Yes If "Yes," explain below or attach an explanation.
Previous ver-.s of HUD-424 and 424-M are obsolete
Page 1 of2
form HUO-424 (0112003)
ref. OMB Circular A-102
Funding Matrix
The applicant must provide the funding matrix shewn below, listing each program for which HUD funding is being
requested, and complete the certifications.
Grant Program' HUD Applicant Other HUD Other Federa State LocaVTribal Other Program Total
Share Match Funds Share Share Share Income
Grand Totals
, For FHIPs, show both initiative and component
Certifications
I certify, to the best of my knowledge and belief, that no Federal appropriated funds have been paid, or will be paid, by or on behalf
of the applicant, to any person for infiuencing or attempting to influence an officer or employee of an 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 this Federal grant or its extension, renewal, amendment or modification. If funds other than Federal appropriated funds have
or will be paid for influencing or attempting to infiuence the persons listed above, I shall complete and submti Standard Form-LLL,
Disclosure Form to Report Lobbying. I certify that I shall require all sub awards at all tiers (including sub-grants and contracts) to
similarly certify and disclose accordingly.
Federally recognized Indian Tribes and tnbally designated housing entities (TDHEs) established by Federally-recognized Indian tribes
as a result of the exercise of the tribe's sovereign power are excluded from coverage of the Byrd Amendment, but State-recognized Indian
tribes and TDHEs established under State law are not excluded from the statute's coverage.
This application incorporates the Assurances and Certifications (HUD-424B) attached to this application or renews and incorporates for
the funding you are seeking the Assurances and Certifications currently on flle with HUD. To the best of my knowledge and belief, all
information in this application is true and correct and constiMes material representation of fact upon which HUD may rely in awarding
the agreement.
23. Signature of Authorized Official Name (printed) Tenance M. Duggan
Title Mayor Date (mm/ddIyyyy)
Previous versions of HUD-424 and 424-M are obsolete.
Page 2 of2
form HUD-424 (01/2003)
ref.OMBCircularA-102
IFunding Matrix
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U. S. Department of Housing and Urban Development
Certification of Consistency with the Consolidated Plan
I certify that the proposed activities/projects in the application are consistent with the jnrisdiction's
cnrrent, approved Consolidated Plan. Additionally, if the applicant is a state or nnit of general local
government, that the jnrisdiction is following its cnrrent approved Consolidated Plan.
(Type or clearly print the following information)
Applicant Name:
City of Dubuque
Project Name: Single-Point-Of-Entrv Coordination: CoUIlBeling and Outreach Services
Location of the Project:
City of Dubuque
Name of the Federal
Program to which the
Applicant is appl)ing:
Continuum of Care Supported Housing
Name of
Certifying Jurisdiction:
City of Dubuque. IA
Certifying Official
Of the Jurisdiction
Name:
Terrance M. Duggan
Title:
Mavor
Signatnre:
Date:
Fonn HUD-40076-CoC (2003)
Consolidated Plan Certification
A. Completing
Certification
Consolidated
Plan
HUB is reqnired by law to obtain Consolidated Plan Certification for each proposed project.
the
Except as stated below, all projects must have a
Consolidated Plan (which is hereafter called the Plan)
certification from the applicable State or local
government official responsible for submitting the
appropriate Plan. States and uuits of general local
government are req1rired to certifY both that the project
is consistent with the Plan, but also that they are
following their cmrently approved Consolidated Plan.
The following instructions indicate the requirement for
certification by applicant type for each program.
For SUP, S+C and SRO: Units of general local
government that apply must have either an approved
Plan or Abbreviated Plan, and therefore must submit
a certification for projects located within its
jurisdiction. If the application contains projects
located outside of the jurisdiction, a Plan certification
must be submitted ftom a jurisdiction with an
approved Plan, or if no local Plan covers the project,
from the State. A uuit of general local government
applicant which does not have a Plan should seek the
assistance of the local HUD Field Office regarding
the development of an Abbreviated Plan.
fusntar Areas (America Samoa, Guam, Northern
Mariana Islands, U.S. Virgin Islands) are not required
to have a Plan or Abbreviated Plan, and therefore
applications submitted from these jurisdictions do not
require a certification of consistency with a Plan.
For SUP and SRO: State government applicants
must only snbmit a certification of consistency with
the State Plan.
An applicant that is a private nonprofit organization,
a community mental health organization that is a
public nonprofit organization, or other
governmental entity inch as a public homing
agency must provide a certification from each
jurisdiction in which a project will be located. If the
local jurisdiction in which the project will be located
does not have a Plan or an Abbreviated Plan, then a
certification ftom the State must be submitte<i For
example, if an application contained projects in
jurisdiction A have a Plan and jurisdiction B not
having a Plan, then the applicant would have to submit
a certification from jurisdiction A and a certification
ftom the State for jurisdiction B.
For SUP Only: Non-State applicants proposing
activities which will occur in more than one
jurisdiction, only need to obtain a certification from
the jurisdiction in which the program is administered
if they are proposing: (I) Services Only activities; or
(2) Scattered-Site Leasing where a participant selects
the specific rental uuit for which SHP rental
assistance will be used. For other forms of leasing,
submit a certification from each jurisdiction \\here
uuits are located.
For S+C Only: State government applicants must
snbmit a certification from both the State and the
applicable localjurisdiction(s) where the proposed
project will be located.
Public homing agencies must provide a certification
from each jurisdiction in which a project will be
located. If the local jurisdiction in which a project
will be located does not have a Plan or an
Abbreviated Plan, then a certification ftom the State
must be snbmitted. For example, if an application
contained projects injurisdiction A having a Plan and
jurisdiction B not having a Plan, then the applicant
would have to submit a certification from jurisdiction
A and a certification from the State for jurisdiction B.
B. Completing the Location Section
For SUP, S+C and SRO: Facility-Based. If the
project involves acquisition, rehabilitation, new
construction, or leasing (except scattered-site leasing
of rental housing uuits), enter the city and county in
which the site is located.
For SUP and S+C: Scattered-Site Leasing.
Follow (I) or (2) depending on \\he1herthe project
sponsor or the participant selects the uuits.
(I) If the project involves scattered-site leasing of
rental housing uuits where the project sponsor
will select and lease the uuits, identifY each city
and county in which the rental uuits will be
located.
(2) If the project involves scattered-site leasing
of reníal housing uuits \\here the participant will
select the rental uuits, enter the city and county in
which the orgaIrization that will be administeiing
the rental assistance is located.
For SUP Only: Services Only. If the project is a
Services Only project (not expansions of existing
projects with additional services h enter the city and
county in which the orgmrization that will be
administering the project is located.
FonnHUD-40076-CoC (2003)
Applicant/Recipient
DisclosurelUpdate Report
u.s. Department of Housing
and Urban Development
OMB Approval No. 2510-0011 (exp. 12/31/2006)
Instructions. (See Public Reporting Statement and Privacy Act Statement and detailed instructions on page 2.)
licantlReci ient Information Indicate whether this is an Initial ReporlX or an Update Report
1. ApplicantlRecipient Name, Address, and Phone (include area code): 2. Social Security Number or
City of Dubuque Housing Department Employer ID Number:
1805 Central Avenue Dubuque, IA 52001 42-6004596
(563) 589-4239
3. HUD Program Name
Continuum of Care
4. Amount of HUD Assistance
Requested/Received
5. State the name and location (street address, City and State) of the project or activity:
City of Dubuque
Part I Threshold Determinations
1. Are you applying for assistance for a specific project or activity? These
terms do not include fonnula grants, such as public housing operating
subsidy or CDBG block grants. (For further information see 24 CFR Sec.
4.3).
X Yes
No
2. Have you received or do you expect to receive assistance within the
jurisdiction of the Department (HUD) , involving the project or activity in this
application, in excess of $200.000 durtng this fiscal year (Oct. 1 - Sep. 30)?
For further infonnation, see 24 CFR Sec. 4.9
Yes X No.
If you answered "No" to either question 1 or 2, Stop! You do not need to complete the remainder of this form.
However, you must sign the certification at the end of the report.
Part II Other Government Assistance Provided or Requested I Expected Sources and Use of Funds.
Such assistance includes, but is not limited to, any grant, loan, subsidy, guarantee, insurance, payment, credit, or tax benefit
De rtmentlStatelLocal A en Name and Address T of Assistance Amount R uestedIProvided ed Uses of the Funds
Social Security No.
or Em I IDNo.
42-1298833
42-1490364
Type of Participation in
p' A.'
Grantee
Grantee
Financial Interest in
Pro'ectlActiv. $ and %
(Note: Use Additional pages if necessary.)
Certification
Warning: If you knowingly make a false_menton this fonn, you may be subject to civil or criminal penatties under Section 10010fTitle 18 of the United
Slates Code. In addition, any parson who knowingly and materially violates any required disclosures of information, includin9 intentional non-disclosure, is
subject to civil money penalty not to exceed $10,000 for each violation.
I certify that this information is true and complete.
Signature:
Terrance M. Duggan, Mayor
I Date: (mrnlddlyyyy)
Public reporting burden forthis collection of information is estimated to average 2.0 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may not
conduct or sponsor, and a person is not required to respond to, a collection information unless that collection displays a valid OMB control number.
Privacy Act Statement. Except for Social Security Numbers (SSNs) and Employer IdentifICation Numbers (EINs), the Department of Housing and Urban
Development (HUD) is autholÍzed to collect all the information required by this form under section 102 of the Department of Housing and Urban Development
Reform Act of 1989. 42 U.S.C. 3531. Disclosure of SSNs and EINs is optional. The SSN or EIN is used as a unique identifier. The information you provide
will enable HUD to carry out its responsibilities under Sections 102(b), (c), and (d) of the Department of Housing and Urban Development Reform Act of 1989,
Pub. L. 101-235, approved December 15, 1989. These provisions will help ensure greater accountability and integrity in the provision of certain types of
assistance administered by HUD. They will also help ensure that HUD assistance for a specific housing project under Section 102(d) is not more than is
necessaJ)l to make the project feasible after taking account of other government assistance. HUD will make available to the public ati applicant disclosure
reports for five years in the case of applications for competitive assistance, and for generally three years in the case of other applications. Update reports will be
m- available along with the disclosure reports, but in no case for a period generally less than three years. All reports, both initial reports and update reports,
will be made available in accordance with the Freedom of Information Act (5 U.S.C. §552) and HUD's implementing regulations at 24 CFR Part 15. HUD will
use the information in evaluating indMduai assistance applications and in performing Internal administrative analyses to assist in the management of specific
HUD programs. The information will also be used in making the determination under Section 102(d) whether HUD assistance for a specifiC housing project is
more than is necessary to make the project feasible after taking account of other government assistance. You must provide all the required information. Failure
to provide any required information may delay the processing of your application, and may resuit in sanctions and penalties, including imposition of the
administrative and CÍVll money penalties specified under 24 CFR §4.38.
Note: This form only covers assistance made available by the Department. States and units of general local government that carry out responsibilities under
Sections 102(b) and (c) of the Reform Act must develop their own procedures for complying with the Act.
Instructions
OVerview.
A. Coverage. You must complete this report if:
(1) You are applying for assistance from HUD fora specific projector
activity and you have received, or expect to receive, assistance from
HUD in excess of $200,000 dulÍng the during the fiscal year,
(2) You are updating a pñor report as discussed below; or
(3) You are submitting an application for assistance to an entity other than
HUD, a State or local government if the application is required by
statute or regulation to be submitted to HUD for approval or for any
other purpose.
S. Update reports (filed by "Recipients" of HUD Assìstam:e): General.
All recipients of covered assistance must submit update reports to the
Department to reflect substantial changes to the initial applicant
disclosure reports.
Une-by-Une Instructions.
ApplicantlRecipient Information.
All applicants for HUD competitive assistance, must complete the information
required in blocks 1-5 of form HUD-2880:
1. Enter the full name, address. city, S_, Zip code, and telephone number
(including area code) of the applicant/recipient. Where the
applicant/recipient is an individual, the last name, first name, and middle
initial must be entered.
2 Entry of the applicantlrecipienfs SSN or EIN, as appropriate, is optional.
3. Appiicants enter the HUD program name under which the assistance is
being requested.
4. Applicants enter the amount of HUD assistance that is being requested.
Recipients enter the amount of HUD assistance that has been provided
and to which the update report relates. The amounts are those stated in
the application or award documentation. NOTE: In the case of
assistance that is provided pursuant to contract over a period of time
(such as project-based assistance under section 8 of the United States
Housing Act of 1937), the amount of assistance to be reported includes
all amounts that are to be provided over the term of the contract,
irrespective of when they are to be received.
5. Applicants enter the name and full address of the project or activity for
which the HUD assistance is sought. Recipients enter the name and full
address of the HU~isted project or activity to which the update report
relates. The most appropñate government identifying number must be
used (e.g., RFP No.; iFB No.; grant announcement No.; or contract.
grant, or loan No.) include prefixes.
Part I. Threshold Determinations - Applïcants Only
Part I contains information to help the appticant determine whether the
remainder of the form must be completed. Recipients filing Update
Reports should not complete tills Pari.
If the answer to either questions 1 or 2 is No, the applicant need not
complete Parts II and III of the report, but must sign the certification at the
end of the form.
Part u. Other Goverrunent Assistance and Expected SOUrces and Uses
of Funds.
A. Other Government Assistance. This Part is to be compieted by both
applicants and recipients for assistance and recipients filing update
reports. Applicants and recipients must report any other government
assistance involved in the project or activity for which assistance is
sought. Applicants and recipients must report any other government
assistance involved in the project or activity. Other government
assistance is defined in note 4 on the last page. For purposes of this
definition, other government assistance is expected to be made available
if, based on an assessment of all the circumatances involved, there are
reasonable grounds to anticipate that the assistance will be forthcoming.
Both applicant and recipient disclosures must include all other
government assistance involved with the HUD assistance, as well as any
other government assistance that was made available before the request,
but that has continuing vitality at the time of the request. Examples of this
lalter category include tax credits that provide for a number of years of tax
benefos, and grant assistance that continues to benefit the project at the
time of the assistance request.
The following information must be provided:
1. Enter the name and address, city, State, and Zip code of the
government agency making the assistance available.
2. State the type of other government assistance (e.g.. loan, grant, loan
insurance).
3. Enter the dollar amount of the other government assistance that is, or
is expected to be, made available with respect to the project or
activities for which the HUD assistance is sought (applicants) or has
been provided (recipients).
4. Uses of funds. Each reportable use of funds must clearly identify the
purpose to which they are to be put. Reasonable aggragations may be
used, such as "etal structure" to include a number of structure! costs,
such as roof, elevators, _r masonry, etc.
B. Non-Government Assistance. Note that the applicant and recipient
disclosure report must specify all expected sources and uses Of funds -
both from HUD and anyothersource-thathave been or are to be.
made available for the project or activity. Non-government sources of
Form HUD-2880 (3199)
funds typically include (but are not limited to) lou_s and private
contribUtors.
Part III. Interested Parties.
This Part is to be completed by both applicants and recipients filing update
reports. Applicants must provide information on:
1. All developers, contractors, or consultants involved in the application lor
the '-nceor in the planning, development, or implementation 01 the
project or acövity and
2 any other person who has a fmancial interest in the project or acövity for
which the '-nce is sought that exceeds $50,000 or 10 percent of the
a_ce (whichever is lower).
Note: A financial interest means any financial involvement in the project
or activity, including (but not limited to) -ons in which an individual or
entity has an equity interest in the project or acövity, shares in any profit
on resale or any distribution of surplus cash or other asseIs of the project
or activity, or receives compensation lor any goods or services provided in
connection with the project or activity. Residency 01 an individual in
housing for which assistance is being sought is not, by itsell, considered
a covered financial interest.
The inlormation required below must be provided.
1. Enter the full names and addresses. II the person is an entity, the listing
must include the full name and eddress 01 the entity as well as the CEO.
Please list all names alphabetically.
2. Entry 01 the Social Security Number (SSN) or Employee Identification
Number (EIN), as appropriate, lor each person listed is optional.
3. Enter the type of participation in the project or activity for each person
listed: i.e., the person's specific role in the project (e.g., contractor,
consultant, planner, investor).
4. Enter the financial interest in the project or activity lor each person listed.
The interest must be expressed both as a dollar amount and as a
percentage 01 the amount of the HUD a_co involved.
Note that il any olthe source/use Inlormation required by this report has
been provided elsewhere in this application peckage, the applicant need
not repeat the information. but need only refer to the lorm and location to
incorporate II into this report. (It is likely that some 01 the information required
by this report has been provided on SF 424A, and on various budget lorms
accompanying the application.) II this report requires information beyond that
provided elsewhere in the application package, the applicant must include in
this report all the additional information required.
Recipients must submit an update report for any change in previously
disclosed sources and uses 01 funds as provided in Section I.D.5., above.
Notes:
1. All citations are to 24 CFR Par! 4, which was published in the Federal
Register. [Apri11, 1996, at 63 Fed. Reg. 14448.]
2. Assistance means any contract, grant, loan, cooperative agreement, or
other lorm 01 assistance, including the insurance or guarantee 01 a ican or
mortgage, that is provided with respect to a SpecifIC project or activity
under a program administered by the Department. The term does not
include contracts. such as procurements contracts, that are subject to the
Fed. Acquisition Regufation (FAR) (48 CFR Chapter 1).
3. See 24 CFR §4.9 lor detailed guidance on howthe threshold is
calculated.
4. "Other government '-nce" is defined to include any ican, grant,
guarantee, insurance, paymen~ rebate, subsidy. credit. tax benefd, or any
other lorm 01 direct or indirect assistance from the Federal government
(other than that requested lrom HUD in the application), a State, ora unit
of general local government, or any egency or instrumentality thereof, that
is, or is expected to be made, available with respect to the project or
activities for which the assistance is sought.
5. For the purpose 01 this form and 24CFR Par! 4, "person" means an
individual (including a consuitant, lobbyist, or lawyer); corporation;
company; association; authority; firm: partnership; society; State, unit of
general local government, or other government entity, or agency thereof
(including a public housing agency); indian bibe; and any other
organization or group 01 people.
Form HUD-28S0 (3199)
Special Project Certification
Coordination and Integration of Mainstream Programs
All applicants must certifY for their project(s) and submit this certification along with
fonn HUD-424 as part of their Continuum of Care application. (You may submit a single
certification covering all of your projects.)
I hereby certifY that if our organization's project(s) (are) selected for funding as a result
ofthis competition, we will coordinate and integrate our homeless program with other
mainstream health, social services, and employment programs for which homeless
populations may be eligible, including SSI, Temporary Assistance for Needy Families,
Medicaid, Food Stamps, State Children's Health Insurance Program, Workforce
Investment Act and Veterans Health Care programs.
Terrance M. Duggan
Mayor
Date
Fonn HUD-40076-CoC (2003)
Applicant Certification
(These certified statements are reqnired by Jaw.)
A. For the Supportive Housing (SlIP), Shelter
Plus Care (S+C), and Single Room Occupancy
(SRO) programs:
1. Fair Housing and Equal Opportunity.
It will comply with Title VI of the Civil Rights Act of
1964 (42 US.C. 2000(d» and regulations pursuaut
thereto (Title 24 CFR part I), which state that no
person in the United States shall., on the ground of
race, color or national origin, be excluded wm
participation in, be denied the benefits ot; or be
otherwise snbjected to discrimination under any
program or activity for which the applicant receives
Federal financial assistance, and will immediately
take any measures necessary to effectuate this
agreement. With reference to the real property and
structure(s) thereon which are provided or improved
with the aid of Federal financial assistance extended
to the applicant, this assurance shall obligate the
applicant, or in the case of any transfer, transfuree,
for the period during which the real property and
structure( s) are used for a pwpose for which the
Federal financial assistance is extended or for another
purpose involving the provision of similar services or
benefits.
It will comply with the Fair Housing Act (42
U.S.C. 3601-19), as amended, and with implementing
reguJations at 24 CFR part 100, which prohibit
discrimination in housing on the basis of race, color,
religion, sex, disability, familial -.,. or national
origin.
It will comply with Executive Order 11063 on
Equal Opportunity in Housing and with implementing
regnlations at 24 CFR Part 107 which prohibit
dìscrimination because of race, color, creed, sex or
national origin in housing and related facilities
provided with Federal financial assistance.
It will comply with Executive Order 11246 and
all regnlations pursuant thereto (41 CFR Chapter 60-
I), which state that no person shall be discriminated
against on the basis of race, color, religion, sex or
natioual origin in all phases of employment during
the performance of Federal con1racts and shall take
affirmative action to ensure equal employment
opportunity. The applicant will incorporate, or canse
to be incorporated, into any contract for cons1rnction
work as defined in Section 130.5 ofHUD regnlations
the equal opportunity clause reqtùred by Section
130.15(b) oftheHUD regn1ations.
It will comply with Section 3 of the Housing and
Urban Development Act ofl968, as amended (12
US.C. 1701(n», and regulations pnrsnaut thereto (24
CFR Part 135), which reqlrire that to the greatest
extent feasible opportunities for training and
employment be given to lower-income residents of
the project and contracts for work in connection with
the
project be awarded in substantial part to persons
residing in the area of the project.
It will comply with Section 504 of the
Rehabilitation Act of 1973 (29 U.S.C. 794), as
amended, and with implementing regulations at 24
CFR Part 8, which prohibit dìscrimination based on
disability in Federally-assisted and condncted
programs and activities.
It will comply with the Age Discrimination Act of
1975 (42 US.C. 6101-07), as amended, and
implementing regn1ations at 24 CFR Part 146, which
prohibit discrimination because of age in projects and
activities receìvmg Federal financial assistance.
It will comply with Execntive Orders 11625,
12432, and 12138, which state that program
participants shall take affirmative action to encoorage
participation by businesses owned and operated by
members of nrinority groups and women.
If persons of any particular race, color, religion,
sex, age, national origin, familial status, or disability
who may qnalify for assistance are nnlikely to be
reached, it will establish additional procedures to
ensure that interested persons can obtain infonnation
con.cernìng the assistance.
It will comply with the reasonable modification
and accommodation requirements and, as appropriate,
the accessibility reqlrirements of the Fair Housing Act
and section 504 of the Rehabilitation Act of 1973, as
amended.
Additional for S+C:
If applicant bas established a preference for targeted
populations of disabled persons pursuant to 24 CFR
582.330(a), it will comply with this section's
nondiscrimination requirements within the designated
popnlation.
2. Drug - Free Workplace.
It will provide drng-ftee workplaces in accordance
with the Drug-Free Workplace Act ofl988 (41
US.C. 701) by:
(a) publishing a statement notifying employees that
the nnJawful mannfactnre, distribution,
dispensing, possession, or use of a controlled
snbstance is prohibited in the grantee's workplace
and specifying the actions that will be taken
against employees for violation of sneh
prohibition;
(b) establishing an ongoing drng-ftee awareness
program to inform employees abont:
FOIID HUD-40076-CoC (2003)
(1) the dangers of drug abuse in the workp1ace;
(2) the grantees policy of maíntaíning a drug-
ftee workplace;
(3) any available drug counseling, rebabilitation,
and employee assistance programs; and
(4) the penalties that may be imposed upon
employees for drug abuse violations
occuning in the workplace;
(c) making it a requjrement that each employee to be
engaged in the performance of the grant be given
a copy of the statement reqWred by paragraph (a);
(d) notiJYing the employee in the statement req1rired
by paragraph (a) that, as a conditiou of
employment under the grant, the employee will:
(I) abide by the terms of the statement; and
(2) notilY the employer in writing of his or her
conviction for a violation of a criminal drug
statute occurring in the workplace no later
than five calendar days after such conviction;
(e) rotiJYing the agency in writing, within ten
calendar days after receiving notice under
subparagraph (d)(2) ftom an employee or
otherwise receiving actual notice of such
conviction. Employers of convicted employees
must provide uotice, illclucling position title, to
every grant officer or other designee ou whose
grant activity the convicted employee was
working. unless the Federal agency has
designated a cen1ra! point for the receipt of such
notices. Notice shall illclude the identification
mnnber( s) of each affected grant;
(I) taking one of the following actions, within 30
calendar days of receiving notice under
subparagraph (d)(2), with respect to any
employee who is so convicted:
(1 ) taking appropriate personnel action against
such an employee, up to and inclucling
termination, consistent with the
requjrements of the Rebabilitation Act of
1973 , as amended; or
(2) requITing such employee to participate
satisfactorily in a drug abuse assistance or
rehabilitation program approved for such
purposes by a Federal, State or local health,
law enforcement, or other appropriate
agency;
(g) making a good faith effort to continue to maintain
a drug-fiee workplace through implementation of
paragraphs (a), (b), (c), (d), (e) and (I);
(h) provicling the street address, city, county, state
and zip code for the site or sites where the
performance of work in connection with the grant
will take place. For some applicants who have
functions carried out by employees in several
departments or offices, more than one location
may need to be specified. 1l is further recogrrized
that States and other applicants who become
grantees may add or change sites as a result of
changes to program activities during the course of
grant-funded activities. Grantees, in such cases,
are reqWred to edvise the HOD Field Office by
submitting a revised P1ace of Performance funn.
The period covered by the certification extends
until all funda under the specific grant have been
expended.
3. Anti-Lobbying.
(a) No Federally appropriated fundahave 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 Cøngress, an officer or employee of
Congress, or an employee of a Member of
Congress in connection with the awarding of any
Federal contract, the making of any Federal grant,
the making of any Federal loan, the entering into of
any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification
of any federal contract, grant, loan, or cooperative
agreement.
(b) If any funda other than Federally 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 an 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-IlL, Disclosure Form to
Report Lobbying, in accordance with its
instructions.
(c) The undersigned shall require that the language of
this certification be included in the award
documents for all snb awarda at all tiers (illcluding
subcontracts, subgrants, and contracts under
grants, loans, and cooperative agreements) and that
all subrecipients shall certifY and disclose
accordingly.
This certification is a material representation
offuct upon which reliance was placed when this
transaction was made or entered into. Submission
of this certification is a prerequisite for making or
entering into this transaction imposed by section
1352, title 31, u.S. Code. Any person who fails to
file the requtted certification shall be subject to a
civil penalty of not less than $10,000 and of more
than $100,000 for each such fuilme.
4. Debarment.
1l and its principals (see 24 CFR24.1O5(p»:
( a) are not presently debarred, suspended, proposed
for debarment, declared ineligible, or voluntarily
excluded ftom covered transactions (see 24 CFR
24.110) by any Federal department or agency;
(b) have rot within a three-year period preceding this
proposal been convicted of or had a civil judgment
rendered against them for commission of
embezzlement, theft, forgery, bribery, fulsification
Fonn HUD-40076-CoC (2003)
(I) the dangers of drug abuse in the workplace;
(2) the grantees policy of maintaining a drug-
free workplace;
(3) any available drug counseling, rehabilitation,
and employee assistance programs; and
(4) the peDJÙties that may be imposed upon
employees for drug abuse violatious
occuning in the workplace;
(c) making it a requjrement that each employee to be
engaged in the perfO111WIlce of the grant be given
a copy of the statement requITed by paragraph (a);
(d) uotifYing the employee in the statement requITed
by paragraph (a) that, as a coudition of
employment under the grant, the employee will:
(1) abide by the tenus of the statement; and
(2) notiJy the employer in writing of his or her
couviction for a violation of a criminal drug
statute occurring in the workplace no later
than five calendar days after such conviction;
(e) notifYing the agency in writing, within ten
calendar days after receiving notice under
subparagraph (dX2) wm an employee or
otherwise receiving actual notice of such
convictioIL Employers of convicted employees
must provide notice, including position title, to
every grant officer or other designee on Whose
grant activity the convicted employee was
worlring. unless the Federal agency has
designated a central point for the receipt of such
notices. Notice shaIl include the identification
number(s) of each affected grant;
(f) takillg one of the following actious, within 30
calendar days of receiving notice under
subparagraph (dX2), with respect to any
employee Who is so convicted:
(I) taking appropriate personnel action against
such an employee, up to and including
termination, consistent with the
requjrements of the Rehabilitation Act of
1973 , as amended; or
(2) requiring such employee to participate
satisfactorily in a drug abuse assistance or
rehabilitation program approved for such
pmposes by a Federal, State or local health,
law enforcement, or other appropriate
agency;
(g) making a good fuith effort to continne to maintain
a drug-free workplace through implementation of
paragraphs (a), (b), (c), (d), (e) and (f);
(h) providing the street address, city, county, state
and zip code for the site or sites Where the
perfO111WIlce of work in connection with the grant
will take place. For some applicants Who have
functions camed out by employees in several
departments or offices, more than one location
may need to be specified. It is further recognized
that States and other applicants Who become
grantees may add or change sites as a result of
changes to program activities during the course of
grant-funded activities. Gnmtees, in such cases,
are required to advise the BUD Field Office by
submitting a revised Place of Performance ÍÌ>rII1-
The period covered by the certification extends
until all funds under the specific grant have been
expended.
3. Anti-Lobbyùlg.
(a) No Federally 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, the making of any Federal grant,
the making of any Federal loan, the entering into of
any cooperative agreement, and the extension,
continuation, renewal, amendment, ormodification
of any federal contract, grant, loan, or cooperative
agreement.
(b) If any funds other than Federally 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 an employee
of a Member of Congress in connection with this
Federal contract, grant, loan, or cooperative
agreement, the undersigned shaIl complete and
submit Standard Form-ilL, Disclosure Form to
Report Lobbying, in accordance with its
instructions.
(c) The undersigned shall require that the language of
this certification be included in the award
documents for all sub awards at all tiers (including
subcontracts, subgrants, and contracts under
grants, loans, and cooperative agreements) and that
all snbrecipients shall certify and disclose
accordingly.
1his certification is a material representation
offact upon which reliance was placed When this
transaction was made or entered into. Submission
of this certification is a prerequisite for making or
entering into this transaction imposed by section
1352, title 31, u.S. Code. Any person Who fails to
file the requITed certification shall be subject to a
civil peDJÙty of not less than $10,000 and of more
than $100,000 for each such failure.
4. Debarment.
It and its principals (see 24 CFR 24.1O5(p»:
(a) are not presently debarred, suspended, proposed
for debarment, declared ineligible, or voluntarily
excluded fi:om covered transactions (see 24 CFR
24. I 10) by any Federal department or agency;
(b) have not within a three-year period preceding this
proposal been convicted of or had a civil judgment
rendered against them for commission of
embezzlemen1, theft, furgery, bribery, falsification
FonnHUD-40076-CoC (2003)
\
infonnation necessary for HUD to perfonn any
applicable environmental review when requested
under 24 CFR 583.225(a); and (iii) carry out
mitigating measures required by HUD or ensure
that altemate sites are utilized.
D. For SRO Only.
1. Standards, Definitions, and $3,000 Minimum.
The proposed site meets HUD's site and
neighborhood standards (24 CFR 882.803(b)(4)),
meets the regulatory definition of single room
occupancy housing (24 CFR 882.802), and the
rehabilitation costs wil1 met the per unit rehabilitation
minimum of $3,000.
2. Environmental Rnle.
It will comply with the environmental review
requirement for the SRO Program at 24 CFR
882.804(d).
H. Explanation.
E. For SHP and SRO
1. Nonprofit Board ofDirectors.
For private nonprofit applicants, members of its
Board of Directors serve in a voluntary capacity and
receive no compensation, other than reimbursement
for expenses, for their services.
F. For SHP and S+C.
1. Lead-Based Paint.
It will compiy with the requirements of the Lead-
Based Paint Poisoning Prevention Act, 42 US.c.
4821-4846, and implementing regulations at 24 CFR
Part 35.
G. For S+C and SRO.
1. PHA Qualification.
For PHA applicants, that it qualifies as a Public
Housing Agency as specified in 24 CFR 882.102 and
is legally qualified and authorized to carry out the
proposed project(s).
Where the applicant is unable to certifY to any of the statements in this certification, such applicant shall attach an
explanation behind this page.
Signature of Authorized Certifying Official:
Title:
Terrance M. Duggan, Mayor
! Date:
I
For PHA Applicants Only: (PHA Number)
Applicant:
City of Dubuque, lA
Fonn HUD-40076-CoC (2003)