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CC 2019-03-12_09a Final CDBG and JGCSGP for Year 2019MEMORANDUM TO: CITY COUNCIL FROM: TERESA MCCLISH, COMMUNITY DEVELOPMENT DIRECTOR BY: MATTHEW DOWNING, PLANNING MANAGER SUBJECT: CONSIDERATION OF COMMUNITY DEVELOPMENT BLOCK GRANT PROJECTS AND JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM ALLOCATIONS FOR YEAR 2019 DATE: MARCH 12, 2019 SUMMARY OF ACTION: Approving the 2019 Community Development Block Grant (CDBG) funding allocations will help the City further its goal of removing architectural barriers on public property to assist the mobility of persons with disabilities as well as assisting persons in the community that have special needs. Approving the 2019 Jim Guthrie Community Service Grant Program allocations will assist local non-profit organizations implement various public service programs that directly benefit Arroyo Grande residents. IMPACT ON FINANCIAL AND PERSONNEL RESOURCES: The County has estimated that $79,560 in CDBG funds will be available to the City in the Fall of 2019. Overall, the amount of CDBG funding the City has received over the last fifteen (15) years has consistently decreased due to Federal budget cutbacks to the CDBG program. Similar to last year, the County will help administer the CDBG program for the City which will reduce City staff time involved. County staff will be paid through the CDBG program funds allocated to the City. Per the Cooperation Agreement between the County and the City entered into on July 11, 2017(Attachment 1), 65% of the total administration funds, or $10,343 of the City’s allocation for CDBG funds, will be deducted by the County to meet its obligations under the terms of the agreement for administrative costs. Based on preliminary Council action on November 13, 2018, it is recommended that the City receive the remainder of its administrative funds ($5,569). Since 2014, $20,000 has been allocated annually from the City Council Budget for the Jim Guthrie Community Service Grant Program (JGCSGP). RECOMMENDATION: It is recommended the City Council: 1) adopt a Resolution approving projects to be funded with the City’s allocation of CDBG funds for the Year 2019 as shown in the table below; and 2) adopt a Resolution approving projects to be funded with the City's Jim Guthrie Community Service Grant Program funds. Item 9.a. - Page 1 CITY COUNCIL CONSIDERATION OF COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROJECTS AND JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM ALLOCATIONS FOR YEAR 2019 MARCH 12, 2019 PAGE 2 Recommended 2019 CDBG Allocation Project and Category 2018 Allocation 2019 Requested Proposed 2019 Allocation Public Services (15% Cap - $11,934) 5Cities Homeless Coalition (5CHC) $7,294 $7,500 $7,500 Subtotal $7,294 $7,500 $7,500 Public Facilities (No Cap) City of Arroyo Grande – Barrier Removal Projects $0 $56,148 $56,148 Subtotal $0 $56,148 $56,148 Economic Development (No Cap) Subtotal $0 $0 $0 Area Benefit (30% Cap - $23,868) Subtotal $0 $0 $0 Housing Rehabilitation (No Cap) Family Care Network, Inc. $58,000 $0 $0 Administration (20% Cap - $15,912) City Administration $1,000 $5,569 $5,569 County Administration $9,906 $10,343 $10,343 Subtotal $10,906 $15,912 $15,912 Total $79,560 BACKGROUND: As mentioned above, the City Council approved a Cooperation Agreement with the County in July 2017 for the joint participation in the CDBG Program for fiscal years 2018 through 2020. The City, as a participant in the Housing and Urban Development (HUD) designated Urban County program, receives an annual formula-based allocation of CDBG funds. These funds are available for a variety of Community Development activities as long as the activities meet at least one of three national objectives. The objectives are: 1. Benefit low- and moderate-income persons; 2. Aid in the prevention or elimination of slums or blight; or Item 9.a. - Page 2 CITY COUNCIL CONSIDERATION OF COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROJECTS AND JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM ALLOCATIONS FOR YEAR 2019 MARCH 12, 2019 PAGE 3 3. Address urgent community development needs that pose a serious or immediate threat to public health or welfare. The County distributed a Request for Proposals (RFP) and notified the public that the County and participating cities would accept applications for funding until October 19, 2018. In addition, County staff held a “Needs Assessment Workshop” on September 11, 2018 to gather input from the public regarding the allocation of CDBG funds. The second CDBG public workshop to discuss the Draft 2019 Action Plan funding recommendations was held on January 16, 2019. On November 13, 2018, the City Council considered preliminary CDBG funding recommendations and received public input. Council provided preliminary approval of the proposed funding allocations, including funding a project submitted by the 5Cities Homeless Coalition (5CHC) as shown in the table above. Council considered the original proposal to utilize the Public Facilities funding for curb ramp installation on the forthcoming Castillo Del Mar extension project adjacent to the high school, but directed staff to bring back a “menu” of barrier removal projects to fund instead. In total, three (3) applications were submitted for funding from the City’s allocation of CDBG funds, including Public Services, Program Administration, and Public Facilities. ANALYSIS OF ISSUES: The following criteria set forth by the County in the RFP are used to make funding recommendations: 1. Consistency with Federal regulations and laws; 2. Community support (for example, approval of project by a City Council); 3. Seriousness of community development need proposed to be addressed by project; 4. Degree to which project benefits low-income and very low-income families or persons; 5. Feasibility of the project to be completed as budgeted and by December 31, 2018; 6. Cost effectiveness of funds requested and leveraging of other funds; and 7. Organization's experience or knowledge regarding CDBG or HOME Program requirements. The Cooperation Agreement between the County and the City gives discretion regarding allocation of funds. Unless the City’s recommendation to the County for funding is clearly in conflict with CDBG regulations, the County will approve the recommendation. The County Board of Supervisors will make its final decision for funding priority in the coming months. Item 9.a. - Page 3 CITY COUNCIL CONSIDERATION OF COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROJECTS AND JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM ALLOCATIONS FOR YEAR 2019 MARCH 12, 2019 PAGE 4 Public Services The competitiveness for public service funds, which is capped at 15 percent, has historically been strong with requests far exceeding available funds. As discussed in recent years regarding CDBG allocations, HUD has significantly increased its monitoring efforts of jurisdictions participating in the CDBG program, which means that local jurisdictions must increase their monitoring efforts of recipients as well. As stated in the Cooperative Agreement, only activities that can either individually or cumulatively receive more than $8,000 in CDBG funding will be considered due to the staff cost of processing such awards in compliance with federal requirements. Because public service organizations are more aware of the stricter CDBG regulations, funding opportunities through the City’s Jim Guthrie Community Service Grant Program (JGCSGP), and because the Council had previously directed to apply CDBG funds toward Public Facility projects, the City has received very few applications over the past several years for CDBG funding for public services. This year, the City received one (1) CDBG public service application from 5CHC for a program that provides subsistence payments for eviction prevention and security deposits (Attachment 2). This program would assist those who are homeless and those at risk of homelessness by developing a housing stability plan and providing short-term emergency eviction prevention grants or move-in deposits. The program will be augmented by other services provided by 5CHC. The total amount of CDBG public service funds that 5CHC has requested from local agencies is provided in Table 2 below. Although the City would be allocating less than $8,000 to 5CHC, the cumulative amount of CDBG funding to this agency would exceed $8,000 according to County staff. Table 2: 2018 CDBG Public Service Funds Requested from 5CHC Agency Amount Requested City of Arroyo Grande $7,500 City of Pismo Beach $5,500 County of San Luis Obispo $37,000 Total: $50,000 During its previous review, the City Council provided preliminary approval to allocate $7,500 to 5CHC. At that time, it was also recommended the Council direct staff to focus CDBG funds back toward Public Facility projects in future years. This direction would not preclude the Council from taking alternate action based on future applications received, but does aid staff in developing funding recommendations in the future. Public Facilities One of the City’s highest priorities is addressing Americans with Disabilities Act (ADA) accessibility deficiencies. During the last several years, with Year 2018 being the exception, the City Council has allocated the majority of CDBG funds to help pay for Item 9.a. - Page 4 CITY COUNCIL CONSIDERATION OF COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROJECTS AND JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM ALLOCATIONS FOR YEAR 2019 MARCH 12, 2019 PAGE 5 disabled access barrier removal projects throughout the City. These projects include Hoosegow Park ADA improvements, mid-block crosswalk ADA improvements, the Arroyo Grande Woman’s Club building barrier removal project, and various barrier removal projects at the Soto Sports Complex. In an effort to prioritize future ADA compliance projects, City staff is pursuing assistance through the California Joint Powers Insurance Authority to update the City’s ADA Transitions Plan in 2019. In light of this effort, it was previously recommended that CDBG funds be utilized along Castillo Del Mar. Subsequent to this original recommendation, there has been a concern raised that applying CDBG funds to Castillo Del Mar would Federalize the project and increase costs. As a result, this is no longer recommended. At the direction of Council, a list of curb ramp locations has been included for Council consideration (Attachment 3). These areas were ranked by the Public Works Department several years ago. Staff responsible for Capital Improvement Projects recommends the Council direct CDBG funds to be utilized on the first priority location of Valley Road/Tiger Tail Drive. It is estimated that the project will cost more than the available CDBG funding, but will be supplemented by the Concrete Repairs budget to make up any difference. Selection of this location will implement the Council goal to support City infrastructure. Housing Rehabilitation The City did not receive any requests for housing rehabilitation projects. Economic Development The City did not receive any requests for economic development projects. Area Benefit Projects qualifying under the area benefit category are limited to a 30 percent cap ($22,860). Area benefit refers to activities that are available to benefit all residents of an area that is primarily residential where at least 51 percent of the residents are low or moderate income persons. In the past, the City considered efforts to eliminate slums and blight, such as code enforcement activities to remove illegal signs and providing funds for façade improvements, as valid activities. HUD determined in 2013 that the City’s code enforcement and façade improvement programs are invalid based on the lack of blight, and therefore these programs have been discontinued. The City did not receive any funding requests for this category. JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM (JGCSGP) In response to CDBG funding limitations and restrictions, the City established the JGCSGP in 2014 separate and apart from the CDBG program. This local grant program provides $20,000 to eligible non-profit organizations that offer specialized social service, educational, cultural, beautification and recreational programs and projects benefitting Arroyo Grande citizens. Last year, the City received a total of sixteen (16) applications totaling $56,850. Item 9.a. - Page 5 CITY COUNCIL CONSIDERATION OF COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROJECTS AND JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM ALLOCATIONS FOR YEAR 2019 MARCH 12, 2019 PAGE 6 This year, the City received ten (10) applications totaling $28,410 (see Attachment 4 for applications). A six-member Community Service Grant Review Panel was established consisting of one member from each of the City’s current and former boards, commissions and committees. This panel convened on February 7, 2019 to review the applications and recommended to City Council the funding allocations listed in Table 3 below (recommendations are in the far right column). Table 3: 2019 JGCSGP Summary of Applications (Listed in Order Received) NAME OF NON- PROFIT PROJECT SUMMARY AREA SERVED GRANT AMOUNT RECEIVED IN 2018 GRANT AMOUNT REQUESTED 2019 REVIEW PANEL 1) Arroyo Grande Public Art Monarch Butterfly sculpture at South County Regional Center AG n/a $2,000 $1,500 2) Family Care Network, Inc. Fence replacement AG $0 $3,500 $1,250 3) Big Brother Big Sisters of SLO County Staff time for training, screening, enrolling and matching families and volunteers within the City of AG SLO County (emphasis on City of AG) $1,500 $5,000 $3,000 4) Assistance League of SLO County Operation School Bell (clothing for impoverished K-12th grade students) SLO County $1,500 $3,000 $3,000 5) Five Cities Diversity Coalition Education and training program Five Cities $0 $2,500 $1,000 6) Shower the People Providing hot showers for the homeless SLO County n/a $2,500 $2,500 7) SLO Noor Foundation Healthcare for uninsured individuals in AG SLO County / AG $2,000 $4,000 $2,000 8) Meals that Connect (Senior Nutrition Program) Meals for 5 new seniors in AG SLO County / AG $4,000 $5,000 $4,000 9) Transitions Mental Health Association Funding for a Computer Skills Workshop in the Safe Haven Wellness Center SLO County / AG $500 $750 $750 10) HomeShare SLO Match home seekers with home providers SLO County $0 $1,960 $1,000 TOTAL: $28,410 $20,000 Item 9.a. - Page 6 CITY COUNCIL CONSIDERATION OF COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROJECTS AND JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM ALLOCATIONS FOR YEAR 2019 MARCH 12, 2019 PAGE 7 These recommendations were primarily based on funding projects and programs that directly assist individuals having the most critical need, specifically the need for food, shelter and clothing. Other screening criteria included: whether direct support is given to the clients (versus given to the agency for general administration); how many local Arroyo Grande residents are served; existing funding base (are the requested funds necessary for the project or program to succeed); and could volunteers and/or fundraising efforts accomplish the project or program goal(s) in-lieu of the grant funds. ADVANTAGES: The recommended 2019 CDBG allocations fund important City priorities and are consistent with the Cooperation Agreement between the County and City. The City’s JGCSGP provides a funding opportunity, separate from CDBG, for local public service programs that address unmet needs in the community. Because of the reduced number of non-profit agencies that submitted applications and the total amount of funds requested ($28,410) compared to available funds ($20,000), the recommended JGCSGP funding allocations provide funding to all applications as compared to 2018, when six (6) of the sixteen (16) non-profit agencies did not receive funding. Additionally, the recommendation provides full funding for three (3) of the applications received for 2019 when no applications received full funding in 2018. DISADVANTAGES: Providing CDBG funding to 5CHC requires the agency to seek additional funding to meet the $8,000 minimum to complete the project as proposed. If 5CHC does not receive additional funding, the City would be allocating CDBG funds that 5CHC cannot use. However, it is very unlikely this will occur due to the funds requested from Pismo Beach and San Luis Obispo County. ALTERNATIVES: The following alternatives are provided for the Council’s consideration: 1. Approve funding for CDBG and JGCSGP projects for the Year 2019 as proposed; 2. Modify and approve funding for the CDBG and JGCSGP projects for the Year 2019; or 3. Provide direction to staff. ENVIRONMENTAL REVIEW: The allocation of CDBG and JGCSGP funds is not considered a project under the California Environmental Quality Act (CEQA) and National Environmental Policy Act (NEPA). Specific projects that may have environmental impacts will be reviewed under CEQA and NEPA prior to implementation. Item 9.a. - Page 7 CITY COUNCIL CONSIDERATION OF COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROJECTS AND JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM ALLOCATIONS FOR YEAR 2019 MARCH 12, 2019 PAGE 8 PUBLIC NOTIFICATION AND COMMENTS: A public hearing notice was published in The Tribune and at City Hall and on the City’s website on Friday, March 1, 2019. The Agenda was posted in accordance with Government Code Section 54954.2. ATTACHMENTS: 1. Cooperation Agreement 2. 5CHC 2018 CDBG Application 3. ADA Curb Ramp Ranking Log (locations ranked 1-3) 4. 2018 JGCSGP Applications (less financial statements) Item 9.a. - Page 8 RESOLUTION NO. A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF ARROYO GRANDE APPROVING COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) PROJECTS FOR YEAR 2019 WHEREAS, via a Cooperative Agreement with the County of San Luis Obispo (hereafter referred to as “County”) executed by the City of Arroyo Grande (“City”) on July 11, 2017, the City agreed to become a participant for a period of three years with the County and other cities therein as an “Urban County” under the Federal Department of Housing and Urban Development (hereafter referred to as “HUD”) Community Development Block Grant (CDBG) program; and WHEREAS, under the Cooperative Agreement, the City retains the authority to determine which projects are to be funded with its allotment of CDBG funds; and WHEREAS, the City expects to receive $79,560 in CDBG funds in 2019; and WHEREAS, in 2018, the County published a “Request for Proposals” for projects to be funded under the 2019 CDBG Programs, which provided that proposals were to be submitted by October 19, 2018; and WHEREAS, on September 11, 2018, the County conducted a public workshop to ascertain the housing and community development needs to be addressed in the document entitled the “One-Year Action Plan” for Program Year 2019; and WHEREAS, at its meeting of November 13, 2018, the City Council gave preliminary approval to a proposed listing of 2019 CDBG projects; and WHEREAS, on March 12, 2019 the City Council held a duly noticed public hearing to further consider the City’s Program Year 2019 CDBG projects. NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Arroyo Grande, California, to recommend that the Board of Supervisors for the County of San Luis Obispo adopt the 2019 One-Year Action Plan, which shall include the programs listed in Exhibit “A” attached hereto and incorporated herein by this reference, to be funded with the City’s allocation of CDBG funds. On motion of Council Member ______________, seconded by Council Member ___________, and on the following roll call vote, to wit: AYES: NOES: ABSENT: the foregoing Resolution was passed and adopted this 12th day of March, 2019. Item 9.a. - Page 9 RESOLUTION NO. PAGE 2 _____________________________________ CAREN RAY RUSSOM, MAYOR ATTEST: _____________________________________ KELLY WETMORE, CITY CLERK APPROVED AS TO CONTENT: _____________________________________ JAMES A. BERGMAN, CITY MANAGER APPROVED AS TO FORM: _____________________________________ HEATHER K. WHITHAM, CITY ATTORNEY Item 9.a. - Page 10 RESOLUTION NO. PAGE 3 EXHIBIT “A” 2019 ONE YEAR ACTION PLAN ALLOCATION OF PROGRAM YEAR 2019 COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) FUNDS Project and Category 2018 Allocation 2019 Requested Proposed 2019 Allocation Public Services (15% Cap - $11,934) 5Cities Homeless Coalition (5CHC) $7,294 $7,500 $7,500 Subtotal $7,294 $7,500 $7,500 Public Facilities (No Cap) City of Arroyo Grande – Barrier Removal Projects $0 $56,148 $56,148 Subtotal $0 $56,148 $56,148 Economic Development (No Cap) Subtotal $0 $0 $0 Area Benefit (30% Cap - $22,860) Subtotal $0 $0 $0 Housing Rehabilitation (No Cap) Family Care Network, Inc. $58,000 $0 $0 Administration (20% Cap - $15,240) City Administration $1,000 $5,569 $5,569 County Administration $9,906 $10,343 $10,343 Subtotal $10,906 $15,912 $15,912 Total $76,200 Item 9.a. - Page 11 RESOLUTION NO. A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF ARROYO GRANDE APPROVING JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM PROJECTS FOR YEAR 2019 WHEREAS, on September 23, 2014, the City Council approved the Community Service Grant Program process and annually allocates $20,000 to implement the program; and WHEREAS, on March 14, 2017, the City Council renamed the Community Service Grant Program the Jim Guthrie Community Service Grant Program (JGCSGP); and WHEREAS, the City received a total of ten (10) applications for the 2019 JGCSGP; and WHEREAS, the City Council established a JGCSGP Review Panel (the “Panel”) consisting of one member from each of the City’s current and former boards, commissions and committees; and WHEREAS, this Panel convened on February 7, 2019 to review the applications and recommended funding allocations, as indicated in Exhibit “A”; and WHEREAS, on March 12, 2019 the City Council held a duly noticed public hearing to consider proposed JGCSGP projects. NOW, THEREFORE, BE IT RESOLVED that the City Council of the City of Arroyo Grande, California, hereby approves the 2019 JGCSGP projects as set forth in Exhibit “A” attached hereto and incorporated herein by this reference. On motion of Council Member ______________, seconded by Council Member ____________, and on the following roll call vote, to wit: AYES: NOES: ABSENT: ABSTAIN: the foregoing Resolution was passed and adopted this 12th day of March, 2019. Item 9.a. - Page 12 RESOLUTION NO. PAGE 2 _____________________________________ CAREN RAY RUSSOM, MAYOR ATTEST: KELLY WETMORE, CITY CLERK APPROVED AS TO CONTENT: _____________________________________ JAMES A. BERGMAN, CITY MANAGER APPROVED AS TO FORM: HEATHER K. WHITHAM, CITY ATTORNEY Item 9.a. - Page 13 RESOLUTION NO. PAGE 3 EXHIBIT “A” Arroyo Grande 2019 Jim Guthrie Community Service Grant Program NAME OF NON-PROFIT PROJECT SUMMARY AREA SERVED GRANT AMOUNT REQUESTED GRANT AMOUNT APPROVED Arroyo Grande Public Art Monarch Butterfly sculpture at South County Regional Center AG $2,000 $1,500 Family Care Network, Inc. Fence replacement AG $3,500 $1,250 Big Brother Big Sisters of SLO County Staff time for training, screening, enrolling and matching families and volunteers within the City of AG SLO County (emphasis on City of AG) $5,000 $3,000 Assistance League of SLO County Operation School Bell (clothing for impoverished K-12th grade students) SLO County $3,000 $3,000 Five Cities Diversity Coalition Education and training program Five Cities $2,500 $1,000 Shower the People Providing hot showers for the homeless SLO County $2,500 $2,500 SLO Noor Foundation Healthcare for uninsured individuals in AG SLO County / AG $4,000 $2,000 Meals that Connect (Senior Nutrition Program) Meals for 5 new seniors in AG SLO County / AG $5,000 $4,000 Transitions Mental Health Association Funding for a Computer Skills Workshop in the Safe Haven Wellness Center SLO County / AG $750 $750 HomeShare SLO Match home seekers with home providers SLO County $1,960 $1,000 TOTAL: $28,410 $20,000 Item 9.a. - Page 14 A COOPERATIO N AGREEMENT BETWEEN T HE COUNTY OF SAN LU IS OB ISPO AND THE CITY O F ARROYO GRANDE FOR JOINT PARTICIPATION I N THE COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM, THE HOME I NVESTMENT PARTNERSHIPS PROGRAM, AND THE EMERGENCY SOLUTIONS GRANT PROGRAM FOR FISCAL YEARS 2018 THROUGH 2020 THIS AGREEMENT is made and entered into this ~ day of truly , 2017, by and between the County of San Luis Obispo, a political subdivision of the State of California, hereinafter called "County," and the City of Arroyo Grande, a municipal corporation of the State of California , located in the County of San Luis Obispo, hereinafter called "City;" jointly referred to as "Parties." WITNESSETH WHEREAS, in 1974, the U.S. Congress enacted and the President s igned a law entitled , The Housing and Community Development Act of 1974 , herein called the "Act." The Act is omnibus legislation relating to federal involvement in a wide range of housing and community development activities and contains eight separate titles; and WHEREAS , Title I of the Act is entitled "Community Development" and governs programs for housing and community development within metropolitan cities and urban counties or communities by providing financial assistance annually for area-wide plans and for housing, public services and public works programs; and WHEREAS, the Community Development Block Grant Program (hereinafter referred to as "CDBG"), the HOME Investment Partnerships Act Program (hereinafter referred to as "HOME"), and the Emergency Solutions Grant Program (hereinafter referred to as "ESG") are consolidated under Title I of the Act; and WHEREAS, the County has requested of the federal Department of Housing and Urban Development, hereinafter referred to as "HUD ," designate the County as an "urban county;" and WHEREAS , the County needs to requalify as an urban county and will be eligible to receive CDBG funds provided that the County's entitled cities defer their entitlement to the County to enable both the County and the entitlement cities to jointly participate in the program; and WHEREAS , the City desires to participate jointly with the County in said program ; and Page I ATTACHMENT 1 Item 9.a. - Page 15 WHEREAS, if HUD redesignates the County as an urban county , then the County may also be eligible to receive funds from the HOME Program and the ESG Program ; and WHEREAS , the CDBG Regulations issued pursuant to the Act provide qualified urban counties must submit an application to the HUD for funds , and cities and smaller communities within the metropolitan area not qualifying as metropolitan cities may join the County in said application and thereby become a part of a more comprehensive County effort ; and WHEREAS, as the urban county applicant, the County must take responsibility and assume all obligations of an appl icant under fede ral statues, including : the analysis of needs , the setting of objectives , the dev elopment of community development and housing assistance plans, the consolidated plan , and the assurances of certificat ions ; and WHEREAS , by executing this Agreement , the Parties hereby give notice of their intention to participate in the urban county CDBG , HOME , and ESG Programs. NOW TH EREFO RE , in consideration of the mutual promises , recitals and other provisions hereof, the Parties agree as follows : SECTI O N I. Ge ne ra l. A. Res po nsibl e Offi ce rs . The Director of the County of San Luis Obispo Department of Planning and Building (hereinafter refe rred to as "Director") is hereby authorized to act as applicant for the CDBG, HOME , and ESG Programs and to administer funding and activities under the programs . The City Manager is hereby authorized to act as the responsible officer of the City under the programs. B. Full Coope rati on. Parties agree to fully cooperate and to assist each other in undertaking eligible grant programs or projects , including but not limited to community renewa l and lower income housing assistance activities , specifically urban renewal and publ icly-assisted hous ing; public services ; and economic development. C . T e rm of Agreeme nt -Auto mati c Re newal Prov is io n. The term of this Agreement shall be for a period of three (3) years commencing July 1, 2018 throug h June 30 , 2021. In addition , this Agreement provides for automatic renewal for participation in successive three-year qualification periods , unless the City provides written notice at least 60 days prior to the end of the term that it elects not to participate in a new qualification pe riod . Before the end of the first three-year term , the County will notify the City in Page2 Item 9.a. - Page 16 writing of its right not to participate in the urban county for a successive three-year term. The Parties agree to adopt amendments to this Agreement incorporating changes necessary to meet the requirements for cooperation agreements set forth in an Urban County Qualification Notice by HUD for a subsequent three-year urban County qualification period, prior to the subsequent three-year extension of the term . Any amendment to this Agreement shall be submitted to HUD as required by the regulations and any failure to adopt required amendments will void the automatic renewal of this Agreement for the relevant qualification period. This Agreement remains in effect until the CDBG, HOME , and ESG Program funds and income received with respect to the three-year qualification period, and the subsequent three-year renewals are expended and the funded activities are completed . The Parties may not terminate or withdraw from this Agreement while this Agreement remains in effect. D. Scope of Agreement. This Agreement covers the following formula funding programs administered by HUD where the County is awarded and accepts funding directly from HUD: the CDBG Program, the HOME Program, and the ESG Program. SECTION II. Preparation and Subm itta l of CDBG Funding Applications. A. In cl usion of City as App li can t. The Parties agree the City shall be included in the application the County shall submit to HUD for Title I Housing and Community Development Block funds under the Act. B. Consolidated Plan. The City shall assist the County by preparing a community development plan , for the period of this Agreement, which identifies community development and housing needs, projects and programs for the City; and specifies both short and long-term City objectives, consistent with requirements of the Act. County agrees to: (1) include the City plan in the program application , and (2) include City's desired housing and community development objectives , policies , programs, projects and plans as submitted by the City in the County's consolidated plan . C. Application Submitta l. The County agrees to commit sufficient resources to completing and submitting the Consolidated Plan and supporting documents to HUD in time for the Parties to be eligible to receive funding beginning July 1, 2018 , and to hold public hearings as required to meet HUD requirements . Page 3 Item 9.a. - Page 17 D. County Res pons ibility. Parties agree the County shall, as applicant , be respons ible for holding public hearings and preparing and submitting the CDBG funding appl ication and supporting materials in a timely and thorough manner, as required by the Act and the federal regulations established by HUD to secure entitlement grant fund ing beginning July 1, 2018. E. G rant E ligibility. In executing this Agreement , the Parties understa nd they shall not be eligible to apply for grants under the Small Cities or State CDBG Programs for appropriations for fiscal years during the period in which the Parties are participating in the urban county CDBG entitlement program ; and further, the City shall not be eligible to participate in the HOME , or ESG Programs except through the urban county . S ECTIO N Ill. Prog ram Adm inistrati on. A. Prog ra m A uth ori za ti on . The Director is hereby authorized to carry out activities that will be funded from the annual CDBG , HOME , and ESG Programs from fiscal years 2018, 2019 , and 2020 appropriations and from any program income generated from the expenditure of such funds. B. Res pons ibiliti es of Pa rti es . The Parties agree the County shall be the governmental entity required to execute any grant agreement received pursuant to the CDBG , HOME , and ESG applications, and subject to the limitations set out in this Agreement , the County shall thereby become liable and responsible thereunder for the proper performance of the plan and CDBG , HOME , and ESG under County programs . County ag rees to perform program administrative tasks such as environmental clearance under the National Environmental Policy Act (NEPA), subrecipient agreements and monitoring of subrecipients. The City agrees to act in good faith and with due diligence in performance of the City obligations and responsibi lities under this Agreement and under a ll subrecipient agreements . The City further agrees that it shall fully cooperate with the County in all th ings required and appropriate to comply with the provisions of any Grant Agreement received by the County pursuant to the Act and its Regulations . C. City Ass istan ce . The City agrees to undertake , conduct, perform o r assist the County in performing the essential community development and housing assistance activities identified in the City's community development plan . Pursuant to the Act and pursuant to 24 CFR 570.501 (b), the City is subject to the same requirements applicable to subre ci pients , including the requirement of a written agreement with the County as set forth in 24 CFR 570 .503. Page 4 Item 9.a. - Page 18 SECTI ON IV. Use of P rogram Fund s. A. All oca t ion o f CDBG f unds. All funds received by the County pursuant to this Agreement shall be identified and allocated , as described below, to the specific projects or activities set out in the application, and such allocated amounts shall be expended exclusively for such projects or activities; provided, however, that a different distribution may be made when required by HUD to comply with Title I of the Housing and Community Development Act of 1974, as amended . 1) Me tropolita n C iti es ' All ocation. The Parties agree the County shall make available to the City a tota l amount of CDBG funds equal to that which the City would have been entitled had it applied separately as a "metropolitan city," using HUD allocation formulas as applied by the County, except that an amount equal to thirteen (13) percent of the Metropolitan Cities' allocations of CDBG funds will be deducted by the County to meet its ob ligations under the terms of this Agreement and/or HUD requ irements for administrative costs. Further, with respect to the availability of the funds , the County agrees to fully cooperate and assist the City in expending such funds. 2) No n-Metropo lita n Cities ' All ocati on. The County agrees to allocate a portion of CDBG program funds to the non-Metropolitan , incorporated cities participating in the program. The amount of allocation per city shall be equal to that which the urban county formula award from HUD increases as a result of the HUD allocation formulas as applied by the County, except that an amount equal to thirteen (13) percent of the Non-Metropolitan Cities ' allocations of CDBG funds will be deducted by the County to meet its obligations under the terms of this Agreement and/or HUD requirements for administrative costs. 3) Urba n Coun ty. Parties shall not recommend a CDBG award of less than $8 ,000 for any one project or program due to the staff cost of processing such awards in compliance with federal requirements. A project or program recommended to receive an amount less $8,000 can still receive an award if any other Party or Parties make an award , which is aggregated to be greater than $8 ,000. B . Ava il a bility of Fund s. The County agrees to make CDBG funds available to all participating incorporated cities as set out here when HUD makes the CDBG funds available to it. The County shall immediately notify the participating incorporated cities of the availability of the funds . P age 5 Item 9.a. - Page 19 It is understood by the Parties , hereto , the CDBG fu nds be ing used for the purposes of this Agreement are funds furnished to the County, through HUD , pursuant to the provisions of t he Act. Notwithstanding any other provision of this Agreement, the liability of the County shall be limited to CDBG funds available for the Project. The City understands that the County must wait for release of CDBG funds from HUD before CDBG funds may be advanced or reimbursed . The County shall incur no liabil ity to the City, its officers , agents , employees , suppliers , or contractors for any delay in making any such payments. C. Admini stra ti ve a nd Publi c Se rvi ces Costs. The County hereby acknowledges the City, as subrecipient, incurs certain admin istrative costs in preparing housing and econom ic development plans , program planning , management and accounting , professional support services, and other reasonable and necessary ex penses to carry out the City's plan; and further, the County agrees that after the availabi lity of CDBG program funds to the City , the County shall not use its remain ing balance of funds in any way that would lim it the City's ability to use its CDBG funds to the maximum extent allowed by HUD for administrative, public service , or program purposes . D. Inco me Ge ne rated . The City sha ll notify the County of any income generated by the expenditure of CDBG funds received by the City . Such program income may be retained by the City subject to the provisions of this Agreement, the Act and its Regulations. Any program income reta ined must only be used for eligible activities in accordance with all CDBG requirements as they apply. E. Use of Prog ram In co me. The County shall monitor the use of any program income, requi ring appropriate record-keeping and reporting by the City as may be needed for this purpose , and shall report the use of such program income to HUD. In the event of close-out or change of status of the City, all program income on hand or received by the City subsequent to the close-out or change of status shall be paid to the County. In the event that the City withdraws from the urban county to become an entitlement grantee , as provided under 24 CFR 570 .504 , all program income on hand or received by the City from urban county activities shall be retained by the City to be used as additional CDBG funds subject to all appl icable requirements governing the use of CDBG funds . F. C ha ng e in Use of Property . The City shall notify the County of any modification or change in the use of real property acqu ired or improved in whole or in part using CDBG funds that is within the control of the Page6 Item 9.a. - Page 20 City, from that use planned at the t ime of acquisition or improvement including disposition . Such notification shall be made within thirty (30) calendar days of such change of use and comply with the provisions of 24 CFR 570 .505 . G. Fair Ho us in g Imple me ntation. The Parties agree no urban county funding shall be allocated or expended for activities in or in support of any cooperating unit of general local government that does not affirmatively further fair housing within its own jurisdiction or that impedes the County's actions to comply with its fair housing certification . H. Conflict R eso luti on. In the event of disagreement between the County and the City as to the allocations , disbursement, use , or reimbursement of CDBG funds , the Parties agree to accept HUD 's written determination as to the appropriate resolution or disposition of funds to the extent HUD is willing to resolve such disagreement. I. Consolid ate d a nd Furth e r Continuing Ap p ro pri ati o ns Ac t. The C ity may not sell, trade , or otherwise transfer all of any portion of CDBG funds to another metropolitan city , urban county , unit of general local government, or Indian tribe , or insular area that directly or indirectly receives CDBG funds in exchange for any other funds , credits or non- Federal considerations, but must use such funds for activities e ligible under Title I of the Act. J . S pecia l Provis io ns fo r th e Urb a n Co unty. (1) To affirmatively further fair housing and implement the Analys is of Imped iments to Fair Housing Choice or better known as the Fa ir Housing Plan , the c ities are encouraged to contribute CDBG funds to affordable housing projects when there is an eligible CDBG component in the proposal that is located within the city's jurisdiction . (2) The County will enforce remedies for noncompliance pursuant to 2 CFR Part 200.338 and allowed per 2 CFR Part 200.207 by pulling CDBG funds for underperforming projects or programs not implemented during agreed timeframe identified in the subrecipient agreement. SECTI O N V. Am e ndm e nt or Ex te ns ion of Agree me nt. A. S ubrecipi e nt Ag ree me nt. For each fiscal yea r during the term of th is Agreement, t he County and the City shall enter into a Subrecipient Agreement, prepared jo intly by the County and the C ity , which identifies a project or program that the County will administer with the City's CDBG entitlement funds during that program year. The Page 7 Item 9.a. - Page 21 Subrecipient Agreement will set forth the project changes, time schedule for completion of the project(s), deliverable checklist, and additional funding sources , if any. If substantial compliance with the completion schedule cannot be met by the City due to unforeseen or uncontrollable circumstances, then the County may extend the schedule for project completion , as allowed by federal regulations. B . Am e ndm ents. Any amendments to this Agreement shall be in writing . Parties agree any such fully executed amendment or amendments to this Agreement may be entered into at any time if required or necessary to implement the plans contemplated hereunder, or to comply with any grant agreement or the regulations issued pursuant to the Act. SECTI O N VI. Com pli a nce w ith Fede ra l Regu la tio ns . A. Genera l. The Parties agree to take all actions necessary to assure compliance with the urban county 's certifications required by section 104(b) of Title I of the Housing and Community Development Act of 1974, as amended , regarding Title VI of the Civil Rights Act of 1964 , the Fair Housing Act , affirmatively furthering fai r housing , Section 109 of Title I of the Housing and Community Development Act of 1974 ; the National Environmental Policy Act of 1969; the Uniform Relocation Assistance and Real Property Acquisition Act of 1970; and other applicable laws . B. Citize n Pa rti cipati on. The Parties agree to comply with federal citizen participation requirements of 24 CFR Part 91 , and provide citizens with : 1) An estimate of the amount of CDBG funds proposed to be used for activities that will benefit persons of low and moderate income; and 2) A plan for minimizing displacement of persons as a result of CDBG- assisted activities and programs, and to provide assistance to such persons. C . C it ize n Pa rti c ipa ti o n Pla n. The Parties agree to follow a citizen participation plan which: 1) Provide for and encourages citizen participation , particularly those of low or moderate income who reside in slum or blighted areas where CDBG fun ds are proposed to be used ; 2) Provide citizens with reasonable and timely access to local meetings, staff reports, and other information relating to grantee's proposed use of funds , as required by HUD regulations related to the actual use of funds under the Act; Page 8 Item 9.a. - Page 22 3) Provides for public hearings to obtain citizen views and to respond to proposals and questions at all stages of the community development program, including at least: 1) formulation of needs; 2) review of proposed grant activities; and 3) review of program performance ; for which public hearings shall be held after adequate notice , at times and locations convenient to potential or actual beneficiaries, and with accommodation of handicapped persons ; 4) Provides for a timely written answer to written complaints and grievances, within 15 working days where practicable; 5) Identifies how the needs of non-English speaking residents will be met in the case of public hearings where a significant number of non-English speaking residents can be reasonably expected to participate. 6) Identifies the use of non-traditional methods of community outreach , including the provision of CDBG documents in a user- friendly format, including but not limited to Braille , large print, oral format, and delivering copies to homebound individuals. D . The Parties hereby certify, to the best of their knowledge an d belief, that: 1) Confli ct of Interest. No federal grant monies have been paid or will be paid, by or on behalf of the Parties , to any officer or employee or 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 or modification of any federal contract, grant, loan , or cooperative agreement. 2) Influ e nce. 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 shall complete and submit standard form LLL, "Disclosure Form to Report Lobbying ," in accordance with its instructions. 3) Certifi cations Disclosure. Parties agree to include this certification in the award documents for all subawards at all tiers Page 9 Item 9.a. - Page 23 (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements), and that all grant subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was entered into. E. Certificati on Rega rdin g Poli cies Prohibitin g Use of Excess ive Force a nd Rega rdin g Enfo rce me nt of State a nd Loca l Laws Ba rrin g Ent ra nces. In accordance with Section 519 Public Law 101-144 (the 1990 HUD Appropriations Act), the City certifies that it has adopted and is enforcing . 1) A policy prohibiting the use of excessive force by law enforcement agencies within their respective j urisdictions against any individuals engaged in non-violent civil rights demonstrations; and 2) A policy of enforcing applicable State and local laws against physically barring entrance to or exit from a facility or location which is the subject of such non-violent civil rights demonstrations within their jurisdictions. S ECTIO N VII. Exec uti on of Agree me nt a nd Reco rdkeepin g. A. HUD Certi ficati o n. The Director is hereby authorized to execute and submit to the County the HUD Certification Form with respect to the community development activities carried out within the boundaries of the City. It is further understood that the County will rely upon the certification executed by the Director for purposes of executing a certification form for submission to HUD . B . M ainte na nce of Record s . The City shall maintain records of activities for any projects undertaken pursuant to the program , and said reco rds shall be open and available for inspection by auditors assigned by HUD and/or the County on reasonable notice during the normal business hours of the City . Page 10 Item 9.a. - Page 24 NOW, THEREFORE, the Parties hereto have caused this Agreement to be executed and attested by their proper officer thereunder duly authorized, and their official seals to be hereunto affixed, all as of the day first above written . County Counsel Certification The Office of the County Counsel hereby certifies that the terms and provisions of this Agreement are fully authorized under State and local laws, and that the Agreement provides full legal authority for the County to undertake or assist in undertaking essential community development and housing assistance activities , specifically urban renewal and publicly assisted housing. APPROVED AS TO FORM AND EFFECT: RITA L. NEAL County Counsel BY: DepuCounty Counsel DATED: 7. ~-l7 ATTEST: upervisors ft,/: = 4vmr,s I "Dep..>tU UcrlLJ ~ Gong , County Clerk Coun!Y Clerk and Ex-O ffic• Cl rk County of San Luis o&?sp~ st:~~P 8~rWifn1f is ors Date: rnll'I 11, ZQl-f: Page 11 Item 9.a. - Page 25 NOW, TH EREFORE , the Parties hereto have caused this Agreement to be executed and attested by their proper officer thereunder duly authorized , and their official seals to be hereunto affixed, all as of the day first above written . CITY OF ARROYO GRANDE JI HILL, MAYOR Date: U -I 3 - / 7 ATTEST: Date: _ _...,lt_--__;{:....::3:;._-----'-1 J--L..-____ _ APPROVED AS TO CONTENT: Date: (cz · l 5 · 2ol7 APPROVED AS TO FORM : HEATHER K. WHITHAM , CITY ATTORNEY Date : &.,-,IJ---&O Page 12 Item 9.a. - Page 26 ATTACHMENT 2 Item 9.a. - Page 27 Item 9.a. - Page 28 Item 9.a. - Page 29 Item 9.a. - Page 30 Item 9.a. - Page 31 Item 9.a. - Page 32 Item 9.a. - Page 33 Item 9.a. - Page 34 Item 9.a. - Page 35 Item 9.a. - Page 36 Item 9.a. - Page 37 Item 9.a. - Page 38 Item 9.a. - Page 39 Item 9.a. - Page 40 Item 9.a. - Page 41 Item 9.a. - Page 42 Item 9.a. - Page 43 Item 9.a. - Page 44 Item 9.a. - Page 45 Item 9.a. - Page 46 Item 9.a. - Page 47 Item 9.a. - Page 48 Item 9.a. - Page 49 Item 9.a. - Page 50 Item 9.a. - Page 51 Item 9.a. - Page 52 Item 9.a. - Page 53 ADA Curb Ramp LocationsSchool ZoneCommercial/ RetailPark/City FacililtyResidential ZoneExisting SidewalkExisting CR: No DomesExisting CR w/ DomesCatch Basin conflictFire Hydrant conflictUtility Pole conflictDamagedDate EvaluatedRankingCost EstimateValley Road / Tiger Tail Drive (E) MBX9/24/2013 16,500.00$ Valley Road / Tiger Tail Drive (W) MB X 9/24/2013 16,500.00$ Ash St / Spruce Street (S,1) MB (NW) X X 9/24/2013 1 6,500.00$ Streetside (12-01-2016) Compliant curb ramp installed for PW 2015-03.Ash St / Spruce Street (S,2) MBXX 9/24/2013 16,500.00$ Parking lot sideAlder Street / Farroll Avenue (SE)XXX9/16/2013 25,000.00$ Alder Street / Farroll Avenue (SW)X9/16/2013 25,000.00$ (11-15-2018) Compliant curb ramp installed for PW 2018-03.Arroyo Avenue / W Cherry AvenueX9/18/2013 25,000.00$ Arroyo Avenue / W Cherry AvenueX9/18/2013 25,000.00$ Branch Street East / Huasna RoadX9/18/2013 25,000.00$ Branch Street East / Stanley AveX9/18/2013 25,000.00$ Brighton Ave / No Elm StreetXX9/16/2013 25,000.00$ California St / W Cherry AveXX X9/16/2013 25,000.00$ California St / W Cherry AveX9/16/2013 25,000.00$ Cherry Avenue West / Orchard StX9/16/2013 25,000.00$ Crown Hill / PauldingX1/29/23/2013 25,000.00$ dwaCrown Hill / PauldingXX9/23/2013 25,000.00$ dwaCrown Hill / PauldingXX9/23/2013 25,000.00$ dwaCrown Hill / PauldingXX9/23/2013 25,000.00$ dwaCrown Hill / Le Point Terr. (W)X9/20/2013 25,000.00$ Crown Hill / Le Point Terr. (W)X9/20/2013 25,000.00$ Crown Hill / Crown Terr. (E)X9/20/2013 25,000.00$ Crown Hill / Crown Terr. (W)X X1/29/20/2013 25,000.00$ Elm Street North / Linda DriveXXX9/16/2013 25,000.00$ Elm Street North / Linda DriveXX9/16/2013 25,000.00$ Elm Street North / Linda DriveX9/16/2013 25,000.00$ Sheet 1 of 2ATTACHMENT 3Item 9.a. - Page 54 ADA Curb Ramp LocationsSchool ZoneCommercial/ RetailPark/City FacililtyResidential ZoneExisting SidewalkExisting CR: No DomesExisting CR w/ DomesCatch Basin conflictFire Hydrant conflictUtility Pole conflictDamagedDate EvaluatedRankingCost EstimateFarroll Ave / Gaynfair Terr (SE)XX9/17/2013 25,000.00$ (11-15-2018) Compliant curb ramp installed for PW 2018-03.Hillcrest Dr / Newport Ave (?)X9/23/2013 25,000.00$ Huasna Rd / Stanley AveX9/19/2013 25,000.00$ Huasna Rd / Stanley AveX1/29/19/2013 25,000.00$ Larchmont Dr / Vernon StX9/18/2013 25,000.00$ Larchmont Dr / Vernon StX9/18/2013 25,000.00$ Branch Street West/ LibraryX8/19/2015 35,000.00$ Bennett Avenue / N Halcyon RoadX9/17/2013 35,000.00$ planter boxBennett Avenue / N Rena StreetX1/29/17/2013 35,000.00$ Branch Street West / Vernon StreetX9/18/2013 35,000.00$ Branch Street West / Vernon StreetX9/18/2013 35,000.00$ Branch Street West / Old Ranch RdX9/18/2013 35,000.00$ Branch Street West / Old Ranch RdX9/18/2013 35,000.00$ Branch Street West / Rodeo DriveXX9/18/2013 35,000.00$ Branch Street West / Rodeo DriveX9/18/2013 35,000.00$ Sheet 2 of 2Item 9.a. - Page 55 .• -· .. -------~~----·---·-·· 4 ···•-.. ~-~-.··---··" ,; a.,., .,, .... .,._ ,_..-.P,...-:::. ~-...:_•- -· Arroyo Grande Public Art October 29, 2018 City of Arroyo Grande Community Development Department Matt Downing Planni_ng Manager 300 E. Branch Street Arroyo Grande, CA 93420 ''4t'\". Dear Mad, .,;,;;?' . OCT 31 2018 COMMUN ITY DEVELOPMENT CITY OF ARROYO GRANDE Enclosed is the Arroyo Grande Public Art (AGPA) proposal for the Jim Guthrie Community Service Grant Program. We hope you will giv.e. our proposal thoughtful consideration. Thank You, Arroyo Grande Public Art (AGPA) ATTACHMENT 4 Item 9.a. - Page 56 -' .~ '. ·• ~.:.::;_,·-,.---.-•• • •• •-,----.~, •"•! .••• • - CITY OF ARROYO GRANDE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM APPLICATION FORM 2018-19 Please complete the following sections: ·(use additional sheets as necessary) I. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION: (must be the local branch). Arroyo Grande in Bloom & Arroyo Grande Public Art II. GRANT APPLICANT REPRESENTATIVE'S NAME, ADDRESS, EMAIL ADDRESS AND TELOPHONE NUMBER: (must be the Executive Director or their designated representative). · Bob Lund . 214 E. Branch St., Arroyo Grande, CA 93420 shop@lundsgift.com 805-710-4049 Ill. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: The Arroyo Grande Public Art Program (AGPA) was created by Arroyo Grande in Bloom {AGIB) in late 2012 by mayoral request, and it is collaboration between AGIB, the City of Arroyo Grande, and the public. AGIB is a 501c3 public l:ienefi1 corporation and the Federal ID Number is 27-3797711. AGPA envisions beautiful, engaging open spaces with public art woven into the public infrastructure where public art defines and reflects our community. AGPA's mission is to encourage and support public art projects that stimulate a cultural environment that reflects the city's heritage and character. Our services include, but not limited to: identification, funding, implementation, and installation of public works of art. IV. LIST AREA(S) SERVED BY NON-PROFIT ORGANIZATION: (include a brief ·description of the relationship of your non-profit organization to the residents of the City of Arroyo Grande). AGPA's program is supported by a strong membership program. The planning committee consists of reside.nts of Arroyo Grande who provide.time and services on a voluntary basis in support of community pride, education, and appreciation of the community's culture and history through public art. Completed projects include: · 1. The Mural on the Mason Street building 2. The Japanese Lantern sculpture 3. Harriet Quimby bench 4. 5 Cities Diversity Coalition 5. Hands of Future Leaders on Council wall (Sweet Pea Alley) Item 9.a. - Page 57 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON- PROFIT ORGANtZA TION: (broken down by age groups if available). All Arroyo Grande residents are served by AGPA. Our projects reflect the city's heritage and deep commitment to the entire community. VI. AMOUNT OF FUNDS REQUESTED: $2,000 VII. P~OPOSED USE AND BUDGET PLAN FOR GRANT FUNDS: (indicate if any of the grant funds will be use<! for any other purpose than those designated such as overhead, national office, administrative salaries). The fu:nds wi1I be used for a new piece of pubtic art in front of the South County Regiona1 Center (SCRC). The SCRC is a SLO County property located within the city limits of Arroyo Grande. Our project i"ndudes commissioning of a local. SLO County artist to complete a beautiful Monarch Butterfly sculpture. The art piece will be surrounded by drought tolerant plants. The educational component will consist of a natural path to the sculpture and will provide children the ability to learn about Monarchs and plants. Budget is: Artist $30,000,Prep & Landscape $15,000, Contingency $5,000. VIII. ADDITIONAL DOCUMENTATION: (if you have received funds in the past, please indicate the amount of funds received (indicate what year) and how the funds were utilized). Arroyo Grande in Bloom & A!royo Grande Public Art have not received funds in the pasl . IX. SUPPLEMENTAL DOCUMENTATION: [iJ Past two (2) years financial statements, including the current year with the balance sheets and the profiVloss statements. • --.i,; ..... _. Iii Information indicating the percentage of revenue received that is used for administration, sa1aries, and program costs. Iii Breakdown and description of non-profit organization's sources of revenue. Iii Proof of 501 (c)(3) status with a copy of the letter from the IRS. [i] Copy of the non-profit organizations Board of Directors, Officers and ~n organization chart. Item 9.a. - Page 58 ;r• X. CERTIFICATION: I certify on behalf of Arroyo Gra nd e Public Art non-profit organization, that I have read, understand and agree that the aforesaid information is accurate, factual and current. I understand that an award of funds, if granted, will be for the sole use -as reflected in this• appli~tion form. I further certify that as a condition of receiving funds, an agreement with the City of Arroyo Grande, in a form and content provided by the City of Arroyo Grande, will be signed and executed by a duly authorized representative of said non-profit organization. I am aware of and certify that our non-profit organization will adhere to all City regulations regarding the 2016 Community Service Grant Program including, but not limited to, maintaining non-discriminatory policies, practices and intent. I also, on behalf of our non-profit organization, indemnify, defend, and hold harmless the City of Arroyo Grande relative to any and all liability that may arise as a result of the use of the City of Arroyo Grande Community Service Grant Fund monies. Signature: ~ ~ ~ive Director or Designee Board of Director or Officer Item 9.a. - Page 59 Arroyo Grande in Bloom, Inc & Arroyo Grande Public Art Responses to City of Arroyo Grande 2018-2019 Jim Guthrie Community Service Grant Program Section IX -Prior and current financial statements attached There is zero percentage of revenue received that is used for administration and salaries. All revenues are expended to cover the costs of operating the in bloom and art programs. Arroyo Grande in Bloom's sources of revenues are: 1. Public Contributions 2. Monthly contribution from the Arroyo Grande Village Improvement Association 3. 4th of July fund raiser 4. Reimbursements from the City of Arroyo Grande for direct costs to improving city properties 5. Contributions from· the public to commemorate the loss of the Village fox 6. Sale of raffle tickets at the AGVIA Summer Concert Arroy_o Public Art source·s of revenues are: 1. Individual and business contributions 2. Public Art membership fees 3. Sale of tiles as a fund raiser 4.· ·sale of raffle tickets afthe AGVIA Summer Concert Proof of 501©(3) status copy ofthe letter from the IRS attached Arroyo Grande in Bloom Board of Directors and Officers: • Bob Lund-Chairman ofthe Board, President and Treasurer • Mary Hertel -Vice Chairman -Board member • Laurie Waller -Secretary -Board member Item 9.a. - Page 60 • David Hirsch -Board member • Judy Hirsch -Board member • Tom Goss -Board member Arroyo Grande Public Art is part of Arroyo Grande in Bloom and is governed by them. Item 9.a. - Page 61 --. KAMALA D. HARRIS Attorney General CLIENT COPY State of California DEPARTMENT OF JUSTICE • . ARROYO GRANDE IN BLOOM, INC. P.O.BOX-231 ARROYO GRANDE CA 93421 August 8, 2011 I JOO I SQ'l:Ct P. 0. 80119034◄1 Samimc:mo., CA 94203-4470 Tclcpho!IC: (916) 44S-2021 E1tt. 4 fill: (916) 444-36S I E-Mail Address : Rc,aiSll'lltion@doJ.ca .1ov CT FILE NUMBER: CTO 174236 RE: CONFIRMATION OF REGISTRATION WITH THE ATTORNEY GENERAL'S REGISTRY OF CHARITABLE TRUSTS The captioned entity is now registered with the Registry of Charitable Trusts and has been assigned the registration (''Cl") number set forth above. In order to complete the Registry file, please submit the following, together with a copy of this letter: _ · I. Registration Renewal Fee (RRF~l) Report (s), together with required renewal fee, for fiscal year(s) end1ng: 12/31/2010 2. Copies of IRS Form 990, 990-PF, or 990-EZ report(s) for fiscal. year(s) ending: 12/31/2010 The RRF-1 must be filed annually four months and IS days after the end of the organization's accounting pe~iod. If an extension was requested from IRS, please file the RRF-1 with the completed :., IRS informational return together with a copy of all extension requests. The organization's address of record is used to mail reporting fonns at the end of each accounting period. Please advise us~ in writing, of any address change . If the captioned organization contracts with a commercial fundraiser for charitable pwposes or fund.raising counseJ, that entity must also register and file annual repons with the Registry. RI<. t--I Doc CT-470 Confinnation ofRegistration(notificarion) Item 9.a. - Page 62 •. INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH 45201 Date: APR 2 ·-5 2011 1 ARROYO GRANDE IN BLOOM INC C/0 MICHAEL ZIMMERMAN PO BOX 970 . ARROYO GRANDE, CA 93420 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 27-3797711 DLN: . 17053327339040 Contact Person: JAMIE N HEITBRINK ID# 31644 Contact Telephone Number: (877} 829·5500 Accounting Period Ending: December 31 Public Charity Status: 170(b){l)(A)(vi) Form 990 Required: Yes Effective Date of Exemption: September 13, 2010 Contribution Deductibility: Yes Addendum Applie$: No We are pleased to inform you that upon reviev..i of your application for tax exempt status we have determined that you a re exempt from Federa 1 i ncooie tax ~ under section 501(c)(3) of the Internal Revenue Code. Contributions to you are· deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests. devises, transfers -or gifts under section 2055, 2106 or 2522 of the .Code. Because this letter could help resolve any questions regarding your exempt status. you should keep it in your permanent records. Organizations exempt under section 50l(c)(3) of the Code are further classified as either public charities or private foundations. We determined that ·you are a public charity under the Code section(s) listed in the heading of this· letter. · Pl ease see enclosed Pub 1 i cation 4221-PC: Compliance Gui de for 501( c )( 3) Pub 1 i c Charities, for some helpful infonnation about your responsibi1ities as an exempt organization. Letter 947 COO/CG) Item 9.a. - Page 63 FAMILY CARE NETWORK, INC. November 14, 2018 City of Arroyo Grande Community Development Department Attn: Matt Downing, Planning Manager Dear Mr. Downing, RECEIVED NOV 1 6 2018 COMMUNITY DEVELOPMENT CITY OF ARROYO GRANDE Thank you for the opportunity to apply for a City of Arroyo Grande Jim Guthrie Community Services grant. You will find enclosed the original application and 11 additional three-hole punched copies. I have included copies of Family Care Network, lnc.'s audited financial statements for the past two years to meet the requested financial documentation specifications. Should you require any additional information or clarification, please do not hesitate to contact me at the number/email below. a Balsamo-Lilien Property Management Specialist 805-503-26268; jlilien@fcni.org \.805 .781.3535 ~ 805.503 .6499 ~ www.fcni .org 9 1255 Kendall Road, San Luis Obispo, California 93401 Item 9.a. - Page 64 CITY OF ARROYO GRANDE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM APPLICATION FORM 2018-19 Please complete the following sections: (use additional sheets as necessary) I. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION: (must be the local branch). Family Care Network, Inc. 1255 Kendall Road San Luis Obispo, CA 93401 II. GRANT APPLICANT REPRESENTATIVE'S NAME, ADDRESS, EMAIL ADDRESS AND TELOPHONE NUMBER: (must be the Executive Director or their designated representative). Jim Roberts, CEO c/o Joanna Balsamo-Lilien 1255 Kendall Road, San Luis Obispo, CA 93401 jlilien@fcni.org, 805-530-6268 Ill. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: Please see attached. IV. LIST AREA(S) SERVED BY NON-PROFIT ORGANIZATION: (include a brief description of the relationship of your non-profit organization to the residents of the City of Arroyo Grande). Please see attached. Item 9.a. - Page 65 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON- PROFIT ORGANIZATION: (broken down by age groups if available). Please see attached. VI. AMOUNT OF FUNDS REQUESTED: Family Care Network, Inc. is requesting $3,500 to replace dilapidated fencing at our property located at 201 S. Halcyon Road. VII. PROPOSED USE AND BUDGET PLAN FOR GRANT FUNDS: (indicate if any of the grant funds will be used for any other purpose than those designated such as overhead, national office, administrative salaries). Please see attached. VIII. ADDITIONAL DOCUMENTATION: (if you have received funds in the past, please indicate the amount of funds received (indicate what year) and how the funds were utilized). Please see attached . IX. SUPPLEMENTAL DOCUMENTATION: Iii Past two (2) years financial statements, including the current year with the balance sheets and the profit/loss statements. Iii Information indicating the percentage of revenue received that is used for administration, salaries, and program costs. Ii] Breakdown and description of non-profit organization's sources of revenue. Iii Proof of 501 (c}(3) status with a copy of the letter from the IRS. Iii Copy of the non-profit organizations Board of Directors, Officers and an organization chart. Item 9.a. - Page 66 X. CERTIFICATION: I certify on behalf of Family Care Network, Inc. non-profit organization, that I have read, understand and agree that the aforesaid information is accurate, factual and current. I understand that an award of funds, if granted, will be for the sole use as reflected in this application form. I further certify that as a condition of receiving funds, an agreement with the City of Arroyo Grande, in a form and content provided by the City of Arroyo Grande, will be signed and executed by a duly authorized representative of said non-profit organization. I am aware of and certify that our non-profit organization will adhere to all City regulations regarding the 2016 Community Service Grant Program including, but not limited to, maintaining non-discriminatory policies, practices and intent. I also, on behalf of our non-profit organization, indemnify, defend, and hold harmless the City of Arroyo Grande relative to any and all liability that may arise as a result of the use of the City of Arroyo Grande Community Service Grant Fund onies. Date: ll /14 /ff} I I J&i:1.rin&<. ~if/J'{ WW - 1-1.1,b, r or Officer Item 9.a. - Page 67 CITY OF ARROYO GRANDE JIM GUTHRIE COMMUNITY SERVICES GRANT PROGRAM Ill. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: Family Care Network, Inc. (FCNI) was founded in 1987 under the mission "to enhance the wellbeing of children and families in partnership with our community." Founder and CEO, Jim Roberts, established FCNI with the purpose of providing family-based treatment programs as an alternative to group home or institutional care for children and youth. Over our 31 plus years, FCNI has grown to encompass five service divisions that provide 21 distinct programs designed to strengthen and preserve families and individuals who have been impacted by trauma. Our service divisions include: Behavioral Health Services, offering mental health treatment programs designed to heal, empower and stabilize families, children and youth; Community Resources Development, providing opportunities for individuals, organizations and businesses to partner with FCNI to better serve children, youth and families; Education Support Services, supporting current and former foster youth with education and training programs allowing them to transition to independence; Family Support Services, empowering families and stabilizing children and youth; and Housing and Support Services, assisting homeless and at-risk households to identify and/or secure affordable housing while offering supportive services to ensure success. FCNI is the only agency of our kind on the Central Coast to earn accreditation from The Joint Commission, a national accreditation agency for providers serving in the behavioral health field. We have been a leader in our community, providing housing and services to at-risk families and Transitional Age Youth. Over the years, FCNI has successfully served over 20,000 individuals. In the 2017-18 fiscal year, we served over 2,021 individuals and families, with an overall success rate of 93%. Our success rate is based on real, life-changing successes, such as: children and youth being reunited with family; youth successfully transitioning to independent living; and homeless families or those at-risk, being moved to safe and stable housing. IV. LIST AREA(S) SERVED BY NON-PROFIT ORGANIZATION: (include a brief description of the relationship of your non-profit organization to the residents of the City of Arroyo Grande). FCNI serves San Luis Obispo County and implements more limited programming in Santa Barbara County. We own and operate eight properties for families and youth who are coming out of homelessness or at imminent risk. Two of these complexes are designated for youth aging out of the foster care system and are located in the City of Arroyo Grande. Transitional Age Youth (TAY), ages 18 to 25, face many challenges . Data show that their educational attainment tends to be lower than their peers, and they often lack the familial and monetary supports available to other youth. In San Luis Obispo County, TAY compete with college students for minimum wage jobs and access to the few opportunities for affordable housing. FCNI has the only program in our service area which provides housing and wrap-around services designed to assist TAY in transitioning to self-sufficiency. Our properties in Arroyo Grande are comprised of nine units serving up to 18 youth and their dependents, if any, as well as two Resident Advisors. Over the past two years, we have worked to improve the quality of these buildings both inside and out, increasing the longevity and curb appeal for the benefit of our clients and the community. Additionally, in August 2018, we entered into a lease for office space in the City of Arroyo Grande, so that we can expand our services and better serve our Arroyo Grande and South SLO County clients. Item 9.a. - Page 68 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON-PROFIT ORGANIZATION: (broken down by age groups if available). Last fiscal year, FCNI was able to house 24 youth, ages 18 to 24, at our two properties in Arroyo Grande. These properties offer transitional housing for youth who have become homeless, or are at-risk of homelessness as they age out of the foster care system. Youth gain skills and become ready to move-on at different rates, and cycle in and out frequently, thus we have a greater number of youth than units. Also, foster families connected to FCNI within the City house an average of 15 children, ages 3 to 18, each year. FCNI also offers services to a number of youth in the Arroyo Grande school system, and supports homeless families seeking affordable housing with the City. VII. PROPOSED USE AND BUDGET PLAN FOR GRANT FUNDS: (indicate if any of the grant funds will be used for any other purpose than those designated such as overhead, national office, administrative salaries). FCNl's Halcyon Transitional Housing property is in need of a new fence along the side of the building, separating the driveway area from the adjacent property. The current fence was in place at the time FCNI purchased the building in 2004, and is now dilapidated and beyond repair. We anticipate that a budget of $3,500 would allow us to replace the approximately 90-foot length of the fence, improving its visual appeal and creating a better barrier between the properties that will improve safety and ensure maintenance and upkeep requirements are met on both sides. VIII. ADDITIONAL DOCUMENTATION: (if you have received funds in the past, please indicate the amount of funds received (indicate what year) and how the funds were utilized). In 2014, FCNI received an award of $735.50 for installation of a new 12 door USPS approved mailbox at the Halcyon Transitional Housing property. In response to a 2015 application, we received $500 to support landscaping efforts at our Elm Street Transitional Housing property. These funds have been an essential means of support for projects at our properties in Arroyo Grande, and we hope to have the opportunity to continue to partner with the City of AG to ensure we are able to maintain these valuable resources appropriately. Item 9.a. - Page 69 ,.,&t. IRS Department of the Treasury tdJl!IJ Internal Rennne Ser,·lct ~ ~ 061866 CINCINNATI OH 45999-0038 FAMILY CARE NETWORK INC 1255 KENDALL RD SN LUIS OBISP CA 93401-8750 Employer ID Numberi 77-0159090 Form 990 required: yes Dear Taxpayer: In reply refer to: 0248222025 Feb. 01, 2017 LTR 4168C 0 77-0159090 000000 00 Input Op: 0248222025 00022336 BODC: TE This is in response to your request dated Jan. 23, 2017, regarding your tax-exempt status. We issued you a determination letter in June 1992, recognizing you as tax-exempt under Internal Revenue Code (!RC) Section 501Cc) ( 3) • Our records also indicate you're not a private foundation as defined under IRC Section 509Cal because you're described in IRC Sections 509Ca)Cl) and 170Cb)Cl)CAJ(vi). Donors can deduct contributions they make to you as provided in IRC Section 170, You're also qualified to receive tax deductible bequests, legacies, devises, transfers, or gifts under IRC Sections 2055, 2106, and 2522. In the heading of this letter, we indicated whether you must file an annual information return. If a return is required, you must file Form 990, 990-EZ, 990-N, or 990-PF by the 15th day of the fifth month after the end of your annual accounting period. IRC Section 5033(j) provide& that, if you don't file a required annual information return or notice for three consecutive years, your exempt status will be automatically revoked on the filing due date of the third required return or notice, For tax forms, instructions, and publications, visit www.irs.gov or call 1-800-TAX-FORM (l-800-829-3676). If you have questions, call 1-877-829-550D between 8 a.m. and 5 p.m., local time, Monday through Friday <Alaska and Hawaii follow Pacific Time). Item 9.a. - Page 70 FAMILY CARE NETWORK INC 1255 KENDALL RD SN LUIS OBISP CA 93401-8750 0248222025 Feb. 01, 2017 LTR 4168C 0 77-0159090 000000 00 Input Op: 0248222025 00022337 Sincerely yours, Kim A. Billups, Operations Manager Accounts Management Operations l Item 9.a. - Page 71 ( ev.de,of'S: ~ ~ C; ,; ,,_ . ' c~:!}-~CJ ~,.'.! >'~ ~ v'1'1'~ 'o/✓.1-. ,,. • A .'.'-Y-CARf-'i--v ~~om(.~ Shay Peck Cameron Ingalls Richard Foster Ann Becker Dan Rowe Family Care Network, Inc. Board Roster as of July 1st, 2018 691 Hanford Street FCNI Chair Pismo Beach, CA 93449 Vo I u nteer /Retired (805} 441-4256 teacher shay 12e c k@ly ahoo.com Represents SB County 731 Grove Street Past Employee/ Vice Chair San Luis Obispo, CA 93401 Photographer (805} 471-7056 cameron@ca me ro n in galls.com 1178 Longview Avenue Retired Business Treasurer Pismo Beach, CA 93449 Executive (805} 773-0858 rofoster@earthlink.net 330 W. Hwy 246, Space 202 Past Board Buellton, CA 93426 Member Secretary (805} 698-5002 einnabecker@.comcast.net C/0 Trinity Lutheran Church Foster/ Adoptive 2102 Summit Drive Parent Paso Robles, CA 93446 Pastor of Paso (805} 238-3702, Robles Lutheran drowe @trinity lutheran 12 aso.org Church 8/2011 6/30/2019 Audit Committee 1/2014 6/30/2019 12/2006 6/30/2020 Finance/Chair of Audit Committee 10/2014 6/30/2020 Incident Reports 7/2001 6/30/2020 Audit Committee Item 9.a. - Page 72 Kim Oldfield 101 Callie Court San Luis Obispo 8/2011 6/30/2019 Arroyo Grande, CA 93420 Community (559) 280-6707 Member kimoldfield @crownle gac y.com Brian Tietje 197 Rennell Street Vice Provost for 1/2014 6/30/2020 Morro Bay, CA 93442 International, (805) 423-1847 Graduate and btiet j@ cal pol y.edu Extended Education, Cal Poly Jim Roberts 3181 Cielo Grande FCNI CEO 7/2002 6/30/2019 Atascadero, CA 93422 Administration (805) 801-9777 jim@fcni.org Craig Gill 2778 Reservoir Cyn Retired law 12/2015 6/30/2019 San Luis Obispo, CA 93401 enforcement (805) 544-2081 (hm) (503) 228-7385 (cell) lowera nch@yahoc.com MarcAmesse 1650 10th Street Local business 6/2018 6/30/2020 Los Osos, CA 93402 owner (insurance) (805) 305-3139 (cell) Past employee marcamesse@gmail.com TWO VACANIES Evan Wride 358 Via El Cielo, Retired Systems 8/2012 Director Emeritus Arroyo Grande, Ca 93420 Executive evanlwride@gmail.com 805-474-1159 Cell: 213-280-1907 Item 9.a. - Page 73 .,1<,c,,4,, /. ,,r,J> PROGRAM ADMINISTRATION { ~, ·•st·-'·· t A 'i ;,{ .,. 'v. >-CAiu. • ~R.¥-,~v & ORGANIZATIONAL STRUCTURE SHAY PECK Chair CAMERON INGALLS Vice-Chair RICHARD FOSTER Treasurer ANNE BECKER Secretary KIM OLDFIELD DAN ROWE CRAIG GILL BRIAN TIETJE MARC AMESSE )IM ROBERTS CEO )IM ROBERTS CEO )ON NIBBIO COO BOBBIE BOYE!l CFO /UI.IANNA WHITE Director of HR SARAH DAVENPORT Director of Corporate Affairs RALPH PEREZ Director of IT & Facilities Family Support Services Division Resource Family Services Santa Barbara County Services Education Support Services Division Housing and Support Services Division Community Resources Development Division Financial & Administrative Services Division Facilitie!i Staff Human Resources Supervisor Slaff Development Administrative Manager Services Web Design, IT & Facilities Supervisor Supervisor System Analysis& Programmers IT Support Internal Auditing/ CQI Item 9.a. - Page 74 RECEIVED NOV 21 2018 COMMUNITY DEVELOPMENT CITY OF ARROYO GRANDE CITY OF ARROYO GRANDE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM APPLICATION FORM 2018-19 Please complete the following sections: (use additional sheets as necessary) I. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION: (must be the local branch). Big Brothers Big Sisters of San Luis Obispo County P.O. Box 12644, San Luis Obispo, CA 93406 II. GRANT APPLICANT REPRESENTATIVE'S NAME, ADDRESS, EMAIL ADDRESS AND TELOPHONE NUMBER: (must be the Executive Director or their designated representative). Jenny Luc iano, CEO PO Box 12644 San Luis Obispo, CA 93406 Jenny@SLObigs.org 805-781-3226 x17 Ill. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: Big Brothers Big Sisters is a donor and volunteer supported organization proven to help vulnerable children of single, low-income and/or incarcerated parents succeed. We create professionally supported one-to-one relationships between children facing adversity and trained and supervised volunteer role models. Funding provides for targeted recruiting, screening, training and matching, as well as ongoing support, safety training and supervision for volunteers, children and families. Grants and donations allow us to ensure child safety and sustain successful, long-term relationships with positive outcomes. We have two programs, both designed to build resiliency and long term success in vulnerable children through role models and mentor relationships. Our School Based program pairs high school and college students with elementary students for weekly supervised group and individual activities taking place at the elementary school campus. Our Community Based Program creates strong and enduring relationships by connecting vulnerable local youth with thoroughly screened and trained adults who enrich their lives by modeling healthy choices and providing connection with their community. In both programs, our staff provides individualized case management to each match relationship and hosts educational and enriching group activities for all participants. The agency conducts regular Youth Outcome Surveys to ensure lasting positive impacts. This model has been demonstrated to increase children's confidence and aspirations, improve their relationships, decrease risky behaviors, and result in greater educational success. IV. LIST AREA(S) SERVED BY NON-PROFIT ORGANIZATION: (include a brief description of the relationship of your non-profit organization to the residents of the City of Arroyo Grande). Big Brothers Big sisters of San Luis Obispo County serves families throughout the County. Since opening for service in 1995, we have created more than 2,600 mentor relationships. Approximately 5% of the families we serve reside within the City of Arroyo Grande. Claire Vollmer, Big Brothers Big Sisters board member and CEO Jenny Luciano are both Arroyo Grande residents who represent the area during our board meetings. Item 9.a. - Page 75 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON- PROFIT ORGANIZATION: (broken down by age groups if available). We served 11 children residing in Arroyo Grande between the ages of 6 and 18 in our Community Based mentoring programs. Of the 11 children, eight were male and three were female. We served an additional 8 children through our School Based Program, totaling 19 youth. In addition to the children served through our youth programs, Big Brothers Big Sisters of San Luis Obispo County also had the pleasure of working with 18 volunteers from Arroyo Grande as well. Nearly 20% of those served were living in monolingual Spanish speaking households. The majority of children -nearly two-thirds -in our program come from low-income. single parent homes. Tlleir family is most often headed by a single mother ( 43.39% ). single father (3.48%) grandparenUs (2.78% ). missing an incarcerated parent (5.57% ), or including them as a foster child ( 1.39%). Two parent homes make up the balance of those served. However, in many cases, both parents work multiple minimum wage jobs, keeping ttiem away from home for extended amounts of time. I VI. $5,000 VII. AMOUNT OF FUNDS REQUESTED : PROPOSED USE AND BUDGET PLAN FOR GRANT FUNDS: (indicate if any of the grant funds will be used for any other purpose than those designated such as overhead, national office, administrative salaries). Directly impacting a child's life is a long-term endeavor. The Big Brothers Big Sisters model allows our four program staff to oversee nearly 300 volunteer mentors who spend over 32,000 hours per year connecting with vulnerable children. Our request consists exclusively for funds to pay for staff time associated with training, screening, enrolling and matching families and volunteers who reside within the City of Arroyo Grande, and supporting those matches to meet child safety and program standards. It does not include any outreach, overhead, national dues or administrative salaries or other costs associated with activities such as screening, insurance, supplies, etc. Our professional staff members are highly trained and must have a minimum of a BA. Their time is billed at $22 an hour. VIII. ADDITIONAL DOCUMENTATION: (if you have received funds in the past, please indicate the amount of funds received (indicate what year) and how the funds were utilized). Past fu~ding has been for similar projects to the one outlined above. We were awarded: $1,500 in 2018, $2,000 in 2017, $2,000 in 2016 and $1,700 in 2015. CDBG support ranged from $876 to $2,722. IX. SUPPLEMENTAL DOCUMENTATION: [j] Past two (2) years financial statements, including the current year with the balance sheets· and the profit/loss statements. Ii] Information indicating the percentage of revenue received that is used for administration, salaries, and program costs. Iii Breakdown and description of non-profit organization's sources of revenue. [j] Proof of 501 (c)(3) status with a copy of the letter from the IRS. [j] Copy of the non-profit organizations Board of Directors, Officers and an organization chart. Item 9.a. - Page 76 IN'!'ERNAL REVENUE SERVICE DISTRICT DIRECTOR 2 CUPANIA CIRCLE MONTEREY PARK, CA 91755-7406 Date: MAR 2 5 1994 BIG BROTH'ERS/BIG SISTERS OF SAN LUIS OBISPO COUNTY C/0 WILLIAM JODRY 628 SPRING STREET PASO ROBLES, CA 93446 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 77-0348487 Case Number: 954063067 Contact Person: TYRONE THOMAS contact Telephone Number: (213) 894-2289 Accounting Period Ending: December 31 Form 990 Required: Yes Addendum Applies: No Based on information supplied, and assuming your operations will be as stated in your application for recognition of exemption~ we have determined you are exempt from Federal income tax under section SOl(al of the Internal Revenue Code as an organization described in section SOl(c) (3). We have further determined that you are not .a private foundation within the meaning of $ection 509(a) of the Code, because you are an organization described in sections .509 (a} (1) and 170 (b) (1) (A) {vi) . If your sources of support, or your pi.irposes, character, or metho.d of ope.ration change, please le~ us ·i,_,c,.-? ,<:<" we can c ::msider t!-J.e effect of the change on your exempt status and foundation status. In the case of an amend- ment t .o your organizational document or bylaws, please send us a copy of the amended document or bylaws. Also, you should inform us of all changes in your name or address. , As of January 1, 1984, you are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $100 or more. you pay to each of your employees during a calendar year. You are not liable for the tax imposed under the Federal Unemployment Tax Act {FUTA). Since you are not a private foundation, you are not subject to the excise taxes under Chapter 42 of the Code. However, you are not automatically exempt from other Federal excise taxes. If you have any questions about excise, employment, or other Federal taxes, please let us know. Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of Code sections 2055, 2106, and 2522. Contribution deductions are allowable to donors only to the extent that their contributions are gifts, with no consideration received. Ticket pur- chases and similar payments in conjunction with fundraising events may not necessarily qualify as deductible contributions, depending on the circum- Letter 947 (DO/CG) Item 9.a. - Page 77 -2- BIG BROTHERS/BIG SISTERS OF SAN stances. See Revenue Ruling 67-246, published in Cumulative Bulletin 1967-2, on page 104, which sets forth guidelines regarding the deductibility, as chari- table contributions, of payments made by taxpayers for admission to or other participation in fundraising activities for· charity. In the heading of this letter we have indicated whether you must file Form 990, Return of Organization Exempt From Income Tax. If Yes is indicated, you are required to file Form 990 only if your gross receipts each year are normally more than $25,000. However, if you receive a Form 990 package in the mail, please file the return even if you do not exceed the gross receipts test . If you are not required to file, simply attach the label provided, check the box in the heading to indicate that your annual gross receipts are normally $25,000 or less, and sign the return. If a return is required, it must be filed by the 15th day of ·the fifth month after the end of your annual accounting period. A penalty of $10 a day is charged whe.n a return is filed late, Wlless there is reasonable cause for the delay. However, the maximum penalty charged cannot exceed $5,000 or 5 per- cent of your gross receipts for the year, whichever is less. This penalty may also be charged if a return is not complete, so please be sure your return is complete befor~ you file it. You are not required to file Federal income tax returns ~less you are subject to the tax on unrelated business income under section 511 of the Code . If you are subject to this tax, you mu::it file an in::ome ta:~ ret1.,rn on Form 990-T, Exempt Organization Business Income Tax. Return. In this letter we are not determining whether any of your present or proposed activities are unre - lated trade or business as defined in section 513 of the Code . You need an employer identi;fication number even if you have no employees. If an employer identification number was not entered on your application, a number will be assigned to you and you will be advised of it. Please use that number on all returns you file and in all correspondence with the Internal Revenue service. This determination is based on evidence that your funds are dedicated to the purposes listed in section S0l(c} (3) of the Code .. To assure your continued exemption, you should maintain records to show that funds are expended only for those purposes. If you distribute funds to other organizations, your records should show whether they are exempt under section S0l·(c) (3). In cases where the recipient organization is not exempt under section S0l(c) (3), there should be evidence that the fWlds will remain dedicated to the required purposes and that they will be used for those purposes by the recipient. If we have indicated in the heading of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. Because this letter could help resolve any questions about your exempt status and foundation status, you should ke.ep it in your permanent records. Letter 947 (DO/CG) Item 9.a. - Page 78 -3- BIG BROTHERS/BIG SISTERS OF SAN If you have any questions, please contact the person whose name and telephone number are shown in the heading of this letter . Sincerely yours, ~R~ Richard R. Orosco District Director Letter 947 (DO/CG) Item 9.a. - Page 79 2018 Board of Directors Big Brothers Big Sisters~ SAN LUIS OBISPO COUNTY President, Dave Axberg, San Luis Obispo, Farm Credit West, 10 years Vice President & Immediate Past President, Christie Clemons, San Luis Obispo, Fidelity National Title, 11+ years Secretary, Hal Sweasey, San Luis Obispo, RE/Max Del Oro, 11+ years Treasurer, Erin Nagle, Los Osos, Glenn Burdette, 1 year Board Members: Mike Belezzuoli, San Luis Obispo, Central Coast Lending, 2 years Monique Carlton, San Luis Obispo, San Luis Obispo Realty, 11+ years Karen Colombo, San Luis Obispo, Retired Financial Analyst, 10 years Machele DuBois, San Luis Obispo, Rabobank, 4 years C.M. Florence, San Luis Obispo, Oasis Associates, 11+ years Holly Holliday, San Luis Obispo, Create Promotions, 4 years Ryan Miller, San Luis Obispo, Etna Interactive, 4 years Ziyad N accasha, San Luis Obispo, Carmel & N accasha LLP, g years JED Nicholson, Paso Robles, Attorney at Law, 11+ years Eric Pinckert, San Luis Obispo, Central Coast Realty Group, 3 year Phillip Sullivan, San Luis Obispo, Heritage Oaks Bank, 4 years Claire Vollmer, Arroyo Grande, Century 21, 10+ years Item 9.a. - Page 80 Development Director Patty Carpenter 1-3 Cal Poly interns or volunteers j ~ Big Brothers Big Sisters . SAN LUIS OBISPO COUNTY Org anizational Chart Board of Directors Executive Director Jenny Luciano Program Director Sarah Rudd School Based Coordinator, Alison Denner Community Based Specialist, Diane Backens Bilingual Community Based Specialist, Karin Trub 4-6 Cal Poly interns Office Manager Dawn Siegmund Item 9.a. - Page 81 All positions are full time equivalent unless otherwise noted. CEO -Leads the Big Brothers Big Sisters agency to ensure that the mission, strategy, values and goals of the organization are achieved. / Development Director-Special event planning, donor stewardship and cultivation, donor database management. Program Director -Assist in the strategic direction for the program function and oversees program design and implementation to ensure achievement of annual goals. Ensures collaboration and alignment with other internal departments and advocates for support from community partners. Assures program compliance with program guidelines established by BBBS National. Assist with caseload/service delivery as needed. Office Manager -Donor stewardship, Reception, and donor database management. Community Based Specialists -Ensure that children are appropriately enrolled, matched and supported while executing a high degree of independent judgment when utilizing BBBS standards and practices and provide match support to ensure child safety, positive impacts for youth, constructive and satisfying relationships between children and volunteers, and a strong sense of affiliation with BBBS on the part of volunteers. School Based Specialist -Responsible for Site Based recruiting, interviewing, matching, providing guidance and support, conducting regularly scheduled case management, in person contact with mentors and mentees as well as regularly interfacing with and presenting to school administrators and corporate partners. Item 9.a. - Page 82 X. CERTIFICATION: I certify on behalf of l,i ~~ =Be 86'os ~profit organization, that I have read, unders and and agr that the aforesaid information is accurate, factual and current. I understand that an award of funds, if granted, will be for the sole use as reflected in this application form. I further certify that as a condition of receiving funds, an agreement with the City of Arroyo Grande, in a form and content provided by the City of Arroyo Grande, will be signed and executed by a duly authorized representative of said non-profit organization. I am aware of and certify that our non-profit organization will adhere to all City regulations regarding the 2016 Community Service Grant Program including, but not limited to, maintaining non-discriminatory policies, practices and intent. I also, on behalf of our non-profit organization, indemnify, defend, and hold harmless the City of Arroyo Grande relative to any and all liability that may arise as a result of the use of the City of Arroyo Grande Community Service Grant Fun Date: Item 9.a. - Page 83 CITY OF ARROYO GRANDE RECEIVED NOV 2 9 2018 COMMUNITY DEVELOPMENT CITY OF ARROYO GRANDE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM APPLICATION FORM 2018-19 Please complete the following sections: (use additional sheets as necessary) I. II. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION: (must be the local branch). Assistance League® of San Luis Obispo County P.O. Box 14260 San Luis Obispo, CA 93406 GRANT APPLICANT REPRESENTATIVE'S NAME, ADDRESS, EMAIL ADDRESS AND TELOPHONE NUMBER: (must be the Executive Director or their designated representative). Sue Pino, President P.O. Box 14260, San Luis Obispo, CA 93406 president , alslocount .org 805-474-0448 111. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: Assistance League® of San Luis Obispo County was incorporated in 1991 and chartered as the 95th chapter of National Assistance League in 1996. Operation School Bell ® was adopted in 1995 as its philanthropic program which provides a most basic need -clothing. Operation School Bell provides new, school-appropriate clothing to Kindergarten- 12th grade students in need, living and attending school in all ten school districts in San Luis Obispo County. The 2018-19 program budget will provide school clothing to 2,000 students. Operation School Bell was founded by a teacher, with the belief that when students can go to school dressed appropriately, it positively affects their attendance. She knew that if students could not attend school, they could not achieve academically and/or socially. We now have official confirmation of that belief. In November of 2017, our chapter conducted a Measured Outcomes Survey for the first time. All schools in the ten Item 9.a. - Page 84 DESCRIPTION OF COMMUNITY SERVICES PROVIDED (con't) school districts were asked about the impact of Operation School Bell on their students. The chapter received a 100% response rate from the schools. 72% indicated they observed a positive change in classroom behavior; 73% reported that they observed a positive change in student confidence; 61 % observed a positive change in the level of engagement with peers and/or school activities. There were no negative responses received. The impoverished child comes to know exactly where he/she fits into the world based on superficial qualities like clothing, and appearance; and the most painful thing is these feelings of inadequacy are often reflected back to them from the words and actions of their classmates and peers. Social acceptance begins at that first glance ... clothing. Clothing is the tangible resource we provide to students, but a focused education is the ultimate goal. IV. LIST AREA(S) SERVED BY NON-PROFIT ORGANIZATION: (include a brief description of the relationship of your non-profit organization to the residents of the City of Arroyo Grande). Operation School Bell provides new, school-appropriate clothing to disadvantaged students who live in and attend school in Arroyo Grande as well as all ten school districts in San Luis Obispo County. Students are referred by school personnel. They are the ones best qualified to determine the students most in need. Social service agencies and shelters direct families to their children's school for clothing referrals. There is no other program in the County that operates throughout the entire school year to ensure that students living in poverty will have sufficient clothing to attend school. Last year we clothed 188 students from the City of Arroyo Grande. Assistance League members provide the referring entities with the referral dates and times for students to be clothed. The students are met at a retail store location, Kohl's in North County and Old Navy in South County. With our tax-exempt status and store discounts each K-5th grade referred student receives a $150 in clothing and shoes each 6th -12th grade student receives a $185 in clothing and shoes. The San Luis Obispo County Office of Education reports that 39% of students attending school in San Luis Obispo County are living in poverty. That totals 13,560 underserved students. Of that number 680 are from the Lucia Mar Unified School District. Item 9.a. - Page 85 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON- PROFIT ORGANIZATION: (broken down by age groups if available). As ofthis writing Assistance League has 133 members. We are scheduled to clothe 159 students from the City of Arroyo Grande this school year. To date we have clothed 122 of those Kindergarten through 12th grade students. We are still in the process of clothing students. VI. AMOUNT OF FUNDS REQUESTED: $3,000 VII. PROPOSED USE AND BUDGET PLAN FOR GRANT FUNDS: (indicate if any of the grant funds will be used for any other purpose than those designated such as overhead, national office, administrative salaries). The requested funds would be used exclusively to clothe the students residing in the City of Arroyo Grande. None of the money goes toward salaries or administrative expenses. We have no paid staff. A grant of$3,000 would allow us to clothe 13 Kindergarten through 5th graders and ten (10) 6th through 12 th graders. VIII. ADDITIONAL DOCUMENTATION: (if you have received funds in the past, please indicate the amount of funds received (indicate what year) and how the funds were utilized). In our 2017-18 fiscal year, Assistance League clothed 2,323 children. Of that number 188 were from the City of Arroyo Grande. For the 2017-2018 school year we received $1,500 from the City of Arroyo Grande for Operation School Bell. This allowed us to clothe five (5) Kindergarten through 5th grade students and six (6) 6th through 12th grade students. Item 9.a. - Page 86 IX. SUPPLEMENTAL DOCUMENTATION: D Past two (2) years financial statements, including the current year with the balance sheets and the profit/loss statements. D Information indicating the percentage of revenue received that is used for administration, salaries, and program costs. D Breakdown and description of non-profit organization's sources of revenue. D Proof of 501 (c)(3) status with a copy of the letter from the IRS. D Copy of the non-profit organizations Board of Directors, Officers and an organization chart. X. CERTIFICATION: certify on behalf of Assistance League of San Luis Obispo County non-profit organization, that I have read, understand and agree that the aforesaid information is accurate, factual and current. I understand that an award of funds, if granted, will be for the sole use as reflected in this application form. I further certify that as a condition of receiving funds, an agreement with the City of Arroyo Grande, in a form and content provided by the City of Arroyo Grande, will be signed and executed by a duly authorized representative of said non-profit organization. I am aware of and certify that our non-profit organization will adhere to all City regulations regarding the 2016 Community Service Grant Program including, but not limited to, maintaining non-discriminatory policies, practices and intent. I also, on behalf of our non- profit organization, indemnify, defend, and hold harmless the City of Arroyo Grande relative to any and all liability that may arise as a result of the use of the City of Arroyo Grande Community Service Grant Fund monies. Date: November 29, 2018 Signature: _____________ _ Executive Director or Designee Item 9.a. - Page 87 r;M I RS Dq,anmolll or lhe TNUw:y WA, lnr,mal Rt"••a• SH-.IH P.O. Box 2508 Cincinnati Off 45201 NATIONAL ASSISTANCE LEAGUE ~100 W BURBANK BLVD STE 100 BURBANK CA 91505-2348 In reply refer to; 0248162349 Aug. 07, 2009 LTR 4167C E0 95-1945908 oonooo oo 00015740 BODC: TE Employer ld•ntification Number; 95-1945908 Group Exemption Number: 4176 Perspn to Contact: Mr. Crouch Toll Free Telephone Number: l-877-829-5500 Dear Taxpayer: This is in response tp your July 29, 2009, request for information about your tax-exempt status. Our records indicate that you were issued a determination letter in May 1994, and that you are c.urrently exempt under section 50 He> (3) of the Internal Revenue Code. Based on the information su.pplied, we recognized the subordinates named on the list you submitted as exempt from Federal income tax under section 501Cc> (3) of the Code. Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provi.sions of sections 2055, 2106 and 2522 of the Code. If you have any questions, please call us at the telephone number shown in the heading of this letter. Sincerely yours., Michele H. Sullivan, Oper. Mgr. Accounts Management Operations I Item 9.a. - Page 88 January 3, 2017 Dear Assistance League of San Luis Obispo County: This letter is to confirm that Assistance League of San Luis Obispo County is a§§ift9R€@ league registered with the Internal Revenue Service as a 501 (c}(3) under Group · a•,· Exemption Number 4176. The parent (central) organization is National Assistance League . Parent and the subsidiary organizations are registered as follows: Parent: National Assistance league 3100 W. Burbank Blvd., Suite 100 Burbank, CA 91505-2348 EIN: 95-1945908 GEN:4176 Subsidiary: Assistance League of San Luis Obispo County PO Box 14260 San Luis Obispo, CA 14906 EIN: 77-0337378 ..,_ ... The Internal Revenue Service recognizes Assistance League of San Luis Obispo County as a subordinate organization. Therefore, Assistance League of San Luis Obispo County can provide this letter to donors, along with the accompanying Internal Revenue Service Group Exemption Determination letter for the parent organization, as verification of exemption status. As such, Assistance League of San Luis Obispo County may use and provide donors with the enclosed Group Exemption Number 4176 and the chapter's Federal Identification Number 561781080. Donors to Assistance Leagu~ of San Luis Obispo County may deduct contributions to the chapter under the Group Exemption Number 4176 and the Federal Identification Number 561781080 as provided in Section 170 of the Internal Revenue Code. In addition, the chapter qualifies for the charitable contribution deduction under Section 170(b)(l)(A) and has been classified as an organization that is not a private foundation under Section 509(a)(2). Please keep this letter with other legal documents and/or in a safe deposit box. If you have further questions, please contact me at: National Assistance League 3100 W. Burbank Blvd., Suite 100 Burbank, CA 91505-2348 or by phone at 818-846-3777 or by e-mail at Treasurer @assistancelea gue.ora. Item 9.a. - Page 89 NAME Sue Pino Karin Morris Janeen Schiff Bonnie Long Francie Levy Jan Hutchinson Pam Zweifel Mary Bingham Jo Anne Painter assistance league" San Luis Obispo County 2018-19 Board of Directors POSITION President VP Membership VP Philanthropic Programs VP Marketing and Communications VP Resource Development VP Strategic Planning Recording Secretary Corresponding Secretary Treasurer Item 9.a. - Page 90 I assistance league' Assistance league® of San Luis Obispo County 2018 -2019 Organization Chart PRESIDENT Sue Pino I ' I I VP PHILANTHROPIC VP MARKETING AND VP RESOURCE VP MEMBERSHIP PROGRAMS COMMUNICATIONS DEVELOPMENT Karin Morris Janeen Schiff Bonnie Long Francie levy TREASURER RECORDING CORRESPOND I NG Jo Anne Painter SECRETARY SECRETARY Pam Zweifel Mary Bingham \ VP STRATEGIC PLANNING Jan Hutchinson Item 9.a. - Page 91 11/29/18 Subj: Five Cities Diversity Coalition, Grant Application for the 2018-19 Jim Guthrie Community Service Grant Program To: City of Arroyo Grande, Community Development Dept. Attn: Matt Downing, Planning Manager Please see attached grant application submission. RECEIVED NOV 2 9 2018 COMMUNITY DEVELOPMENT CITY OF ARROYO GRANDE If you have any questions or need for additional information, contact me at 805-284-2641 or email joewhitaker@aol.com Thank you, Joe Whitaker Board Member, Five Cities Diversity Coalition Item 9.a. - Page 92 CITY OF ARROYO GRANDE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM APPLICATION FORM 2018-19 Please complete the following sections: (use additional sheets as necessary) I. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION: (must be the local branch). The Five Cities Diversity Coalition, 1145 Stonecrest Drive, Arroyo Grande, CA 93420 II. GRANT APPLICANT REPRESENTATIVE'S NAME, ADDRESS, EMAIL ADDRESS AND TELEPHONE NUMBER: (must be the Executive Director or their designated representative). Joe Whitaker, Board Member 2356 Willet Way Arroyo Grande, CA 93420 joewhitaker@aol.com 805-284-2641 Ill. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: Formed in 2011, as a community wide reaction to an infamous incident of racial bias in Arroyo Grande, the Coalition has been providing programs and resources promoting the inclusion and affirmation of Diversity in our community and countering any negative acts of prejudice or bias against its citizens. The Coalition's 50 members include representatives from local government, education, business, religious and non-profit organizations, and the community at-large. The Coalition successfully raised funds and project managed a major public arts project, resulting in the "Arbo ring Our Roots of Diversity" sculpture, now residing at the entrance of Arroyo Grande High School, an enduring symbol of the importance of diversity to our community. The Coalition's successful School Speakership Program began in 2017 and will by 2019 encompass both Lucia Mar District middle and elementary schools, as detailed below. IV. LIST AREA(S) SERVED BY NON-PROFIT ORGANIZATION: (include a brief description of the relationship of your non-profit organization to the residents of the City of Arroyo Grande). The Coalition serves the entire South San Luis Obispo County area, with emphasis on the "Five Cities" (Arroyo Grande, Grover Beach, Pismo Beach, Oceano and Halcyon) plus Nipomo. In general, the Coalition's efforts serve the entire population of Arroyo Grande, adding to our community's spirit, health, well-being and economic future. Item 9.a. - Page 93 Specifically, the Coalition's principal 2018-19 program detailed below in section VII, for which it is requesting grant funds, will serve the city's school age population. CITY,()f ARROYO GRANDE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM APPLICATION FORM 2017-18 PAGE 2 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON-PROFIT ORGANIZATION: (broken down by age groups if available). The School Speakership component of the program, in Spring '18 term, served 560 Paulding Middle School students, who studied a semester long curriculum class built around our invited speaker. During the Fall '18 term, an additional 555 students attending Paulding and Mesa Middle Schools will, in December, receive the same benefits. In Spring '19 term an additional 555 students will engage in a similar semester long study built around our speaker's visit to these schools. Total Arroyo Grande students served=1660. The Teacher Training component of the program, begun in November, 2018 and continuing in the Spring '19 term will serve every teacher and principal in the Paulding and Mesa Middle Schools. In the future, a broad expansion of the Program will eventually have a positive effect on the entire 500 member teaching staff and 10,700 students in the Lucia Mar School District. VI. AMOUNT OF FUNDS REQUESTED: $2500.00 VII. PROPOSED USE AND BUDGET PLAN FOR GRANT FUNDS: (indicate if any of the grant funds will be used for any other purpose than those designated such as overhead, national office, administrative salaries). The 2018-19 COMMUNITY DIVERSITY EDUCATION AND TRAINING PROGRAM Is currently composed of two functions: 1. SCHOOL SPEAKERS provide a culmination to rich, extensive units of study, making the learning experience more meaningful and impactful. During the last school term, Alepho Deng, one of the Lost Boys of Sudan, author of "They Poured Fire on Us From the Sky", spoke in February at Paulding and Judkins Middle Schools. The seventh graders at both schools studied the U.N. Declaration of Human Rights and read the book "I Am Malala" prior to his arrival. In March, Dr. Henry Oster, a Holocaust survivor and author of "Kindness of the Hangman", spoke to the eighth graders at the same two schools. In preparation, students read either "Night" by Eli Wiesel or the "Diary of Anne Frank". In December, 2018 Dr. Oster will return and speak to the new students in both schools. In February, 2019. Mr. Deng will return and also speak to these students. As before, their teachers will use these visits as a cornerstone for curriculum study about the importance of Diversity of all sorts in our lives and community. During the Spring 2019 school term, additional speakers will be scheduled as the program expands to Mesa Middle School, thus reaching all local middle school Item 9.a. - Page 94 students. In the future, the program will ultimately also include both elementary school and high school students: 2. TEACHER TRAINING has the goal of our school teachers infusing an awareness of human rights into their daily instruction. To accomplish this goal, teachers need be motivated and inspired to do so and instructed how to seamlessly weave these topics into their current instruction. In November, 2018, the Coalition hosted eight local educators, including the Principals of Paulding and Mesa School, plus three of their teachers, at the annual Human Rights Watch fundraiser dinner in Santa Barbara. This event commemorated the 70 th Anniversary of the U.N . Declaration of Human Rights. In January or February, 2019, two teachers from each Lucia Mar District Elementary School will travel to Los Angeles, for a two-day training class at the Museum of Tolerance, designed to "advance anti-bias education and promote the creation of inclusive and equitable schools". The Coalition is providing the funds to pay substitute teachers during their absence. A stipulation for this funding is these teachers share what they learned at staff meetings. 2018-19 Community Diversity Education and Training Program Operating Budget Guest Speaker Fees Guest Speaker Costs-travel, lodging, per diem Teacher Training----pay for substitute teachers Budget Cost $10,000.00 8,000.00 5,000.00 Total budget cost $23,000.00 VIII. ADDITIONAL DOCUMENTATION: (if you have received funds in the past, please indicate the amount of funds received (indicate what year) and how the funds were utilized). The City of Arroyo Grande, in October 2013, donated$1000.00 to the Coalition's Sculpture Fund. In August 2015, an additional $500.00 was donated to the Sculpture Fund. These funds were utilized to design, build and install the "Arboring Our Roots of Diversity" public arts project, at the entrance of Arroyo Grande High School. Item 9.a. - Page 95 CITY OF ARROYO GRANDE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM APPLICATION FORM 2017-tS PAGE 3 IX. REQUIRED SUPPLEMENTAL DOCUMENTATION: -Past two (2) years financial statements, including the current year with the balance sheets and the profit/loss statements. -Information indicating the percentage of revenue received that is used for administration, salaries, and program costs. -Breakdown and description of non-profit organization's sources of revenue. -Proof of 501 (c)(3) status with a copy of the letter from the IRS. -Copy of the non-profit organizations Board of Directors, Officers and an organization chart. X. CERTIFICATION: I certify on behalf of ______________ non-profit organization, that I have read, understand and agree that the aforesaid information is accurate, factual and current. I understand that an award of funds, if granted, will be for the sole use as reflected in this application form. I further certify that as a condition of receiving funds, an agreement with the City of Arroyo Grande, in a form and content provided by the City of Arroyo Grande, will be signed and executed by a duly authorized representative of said non-profit organization. I am aware of and certify that our non-profit organization will adhere to all City regulations regarding the 2016 Community Service Grant Program including, but not limited to, maintaining non-discriminatory policies, practices and intent. I also, on behalf of our non-profit organization, indemnify, defend, and hold harmless the City of Arroyo Grande relative to any and all liability that may arise as a result of the use of the City of Arroyo Grande Community Service Grant Fund monies. Date: ~I) -P~........._.\ _'}(:_ Signature: ________________ _ Executive Director or Designee ¢~ Board of Director or Officer Item 9.a. - Page 96 Five Cities Diversity Coalition Board of Directors November, 2018 Name/Title Rudy Xavier, President, Michael Boyer, Member Kathleen Minck, Member Cornel Morton, Member Joe Whitaker, Member City of Residence Profession/Expertise Arroyo Grande Corporate Marketing Executive (Ret.) Former University Assistant Dean Arroyo Grande President, Doc Burnstein's Arroyo Grande Teacher (Ret.) Member, CTA State Council Human Rights Committee San Luis Obispo University Administrator/Educator Workforce Diversity Specialist Arroyo Grande Corporate Marketing Executive (Ret.) Member, San Luis Obispo SCORE Item 9.a. - Page 97 INTERNAL REVENUE SERVICE P. 0. BOX 2S08 CINCINNATI, OH 45201 Date: AUG 09 2018 PIVE CITS DIVERSITY COALITION 1145 STONBCREST DRIVE ARROYO GRANDE, CA 93420-0000 Dear Applicant: DEPAR'n4BNT OF THE TREASURY Employer Identification Number: 82-2075135 DLN: 26053618007978 contact Person: CUSTOMBR SERVICE Contact Telephone Number: (877) 829-5500 Accounting Period Ending: June 30 Public Charity Status: 170(b) (1) (A) (Vi) IDJ 31954 Form 990/990-EZ/990-N Required: Yes Effective Date of Exemption: June 15, 2011 Contribution Deductibility: Yes Addendum Applies: No We're pleased to tell you we determined you•re exeq,t from federal income tax under Internal Revenue Code (IRC) Section SOl(c) (3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106, or 2522. This letter could help resolve quest.ions on yout exempt status. Please keep it for your records. organizations exempt under IRC Section SOl(c) (3) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter. If we indicated at the top of thia letter tbat you•re required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (Pot111 990 or Form 990-EZ) or electronic notice (Form 990-N, thee-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charitiee. Enter "4221-PC• in the search bar to view Publication 4221-PC, Compliance Guide for SOl(cJ (3) PUblic Charities, which describes your recordkeeping, reporting, and disclosure requirements . Letter 947 Item 9.a. - Page 98 i Lt-rt 1 • !::xt-mp, \rq.t11: "!.-i ! i<ui ui.1s -.md Aqr~ement:-0 Item 9.a. - Page 99 NOV 2 9 2018 CITY OF ARROYO GRANDE COMMUNITY DEVELOPMENT CITY OF ARROYO GRANDE JIM GUTHRIE COMMUNITY SERVICE GRANT PROG R-a1M-------...J APPLICATION FORM 2018-19 Please complete the following sections: (use additional sheets as necessary) I. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION: (must be the local branch). Shower the People, PO Box 516, Arroyo Grande, CA 93421. II. GRANT APPLICANT REPRESENTATIVE'S NAME, ADDRESS, EMAIL ADDRESS AND TELOPHONE NUMBER: (must be the Executive Director or their designated representative). Penny Platt, Treasurer, PO Box 1612, Arroyo Grande, CA 93421, email empressp3@aol.com, phone 805-440-6327 OR Gwen Watkins, President, 1133 Vard Loomis Lane, Arroyo Grande, CA 93420, email gwn.watkins@gmail.com, phone 408-914-8080 Ill. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: Shower the People's mission is to provide access to a hot shower to the homeless in our community. We have a new trailer that has 3 individual showers each with toilet, sink and mirror. Shower the People (STP) partners with sites where the critically low income and homeless currently gather for food or services. We have a team of 20 multi-talented volunteers who designed the 3 shower unit and developed policies and procedures that are currently used in our highly successful sister organization, Santa Barbara's Showers of Blessing. We started our first shower operation at the Veterans' Stand Down where we were proud to serve the Central Coast Veterans. Currently, we have partnered with LifePoint Church and South County People's Kitchen to provide showers for 3 hours two times a week. Each of our guests receive new underwear, socks, a comb, toothbrush and toothpaste. Each shower unit has a supply of biodegradable soap/shampoo. We have partnered with Arroyo Grande Community Hospital to provide us with clean towels. We are 100% volunteer operated. Website info www.ShowerThePeopleslo.org. IV. LIST AREA(S) SERVED BY NON-PROFIT ORGANIZATION: (include a brief description of the relationship of your non-profit organization to the residents of the City of Arroyo Grande). Shower the People provides access to a warm shower to the homeless and critically low income in San Luis Obispo's South County. The 2017 Point-in-Time census for SLO County indicated 359 homeless individuals were living in South County. 88% of these individuals were living on the street, in encampment areas and in cars. There are no shower facilities that are available to these individuals. A shower confers health benefits and it allows those without homes an opportunity to once more take part in community programs, and to find work. Shower the People is supported and funded by many Arroyo Grande churches and organizations. Item 9.a. - Page 100 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON- PROFIT ORGANIZATION: (broken down by age groups if available). We are keeping data of the showers we provide, the number of new individuals to the showers, the breakdown of male/female/veteran that have taken showers and the age ranges of those served. We are glad to share our ongoing data with you. We are a new enterprise but preliminanry date indicates that approximately 80% are men, 20% women with an age range of an 18 month old child who took a shower with his mother to a veteran who was 88 years old. VI. AMOUNT OF FUNDS REQUESTED: We are requesting $2,500. We are an all volunteer run non-profit so all of your donation will go toward maintaining our shower operations, STP 2019 budget (having capital expenditure completed in 2018} is $18,173 with current activity. We hope to increase locations to Oceana shortly. VII. PROPOSED USE AND BUDGET PLAN FOR GRANT FUNDS: (indicate if any of the grant funds will be used for any other purpose than those designated such as overhead, national office, administrative salaries). All of the grant would be used for operational costs including propane, trailer transportation gas, trailer maintenance, insurance, communications, (website, brochures) and washing materials (soaps/towels) VIII. ADDITIONAL DOCUMENTATION: (if you have received funds in the past, please indicate the amount of funds received (indicate what year) and how the funds were utilized). Have not received any Jim Guthrie funds in the past. IX. SUPPLEMENTAL DOCUMENTATION: D Past two (2) years financial statements, including the current year with the balance sheets and the profit/loss statements. D Information indicating the percentage of revenue received that is used for administration, salaries, and program costs. D Breakdown and description of non-profit organization's sources of revenue. D Proof of 501 {c)(3) status with a copy of the letter from the IRS. D Copy of the non-profit organizations Board of Directors, Officers and an organization chart. Item 9.a. - Page 101 X. CERTIFICATION: I certify on behalf of She 1., 1 '2..(2.. d I\<-P lu:(/i(J non-profit organization, that I have read, understand and agree that t e aforesaid information is accurate, factual and current. I understand that an award of funds, if granted, will be for the sole use as reflected in this application form. I further certify that as a condition of receiving funds, an agreement with the City of Arroyo Grande, in a form and content provided by the City of Arroyo Grande, will be signed and executed by a duly authorized representative of said non-profit organization. I am aware of and certify that our non-profit organization will adhere to all City regulations regarding the 2016 Community Service Grant Program including, but not limited to, maintaining non-discriminatory policies, practices and intent. I also, on behalf of our non-profit organization, indemnify, defend, and hold harmless the City of Arroyo Grande relative to any and all liability that may arise as a result of the use of the City of Arroyo Grande Community Service Grant Fund monies. Signature: _____________ _ Executive Director or Designee Officer Item 9.a. - Page 102 tivT.E.RN2\L R.BVENUE SER VICE !?. C. BOX 2508 CINCXNNATI, '.JH 452.0l Date: MAY 2 4 2017 SHOWER '.i".H:E PEO~hE ll 3.3 VARD LOOMIS LN ib-.RROYO GRANDlE, CA 93420-000u Dear Applicant: Employe.r Identif.ication Numb.er; 82~1552557 DLN: 260S3538003337 CorH:act. Pe;rsc.m: CUSTOMER SERVlPE Contact Telephone NUmbecr, rnrn s29~ssoo Accqunting Pel.'.,iod Ending: nec:ember 31 Forni 990~PF Required: Yes Effective bate ot :Exemption: Ma.y 16, 20J.7 Addendum Applies.: Mo ID# 31954 We'.re pleased to tell you we determined you ' re exempt from federal i.:n.c:otne tax under Internal Revenue code URC} section :501. tel (3.J .. Donors can deduct cont.rimition:s they make: t .o you under .lRC Section J.70. Y:c:,u 're also qualified to recieive tax deduc.tib.le bequests , devises; transfers 01; gifts under section 2055~ 2106; or 2522. This le.tter could help resolve qoestio.ns on yo.ur exempt status; Please keep it for your records. Qrganiz?tion.s exe!itlit \lridifr :nK sect1on sorrc:1 en a .re further class1.fied ;is either public= c!iar1tfes d:t pri:iicite foundat::ion:S. W1;/ i:ieter:miried you I re a orivat.e foundation• withirt the meaning of section 50:9 {a} . .. You're requiried to file Form 9.SO~PF;. R.et.urn .of Private Pound.at.ion or Sec:t.ion 4941 la} i1.J Trust 'I'"rea.ted as Private F6undation , annu:ali y .;. whether or not you h:ave income 6::' a.ct:ivity du$ing the year. rf you don't fi.le a required return or .notice for three c:or:isecut.ive years., your exempt status will ·be aut:.Cif'.(1citic::ally revoked. If we indicated at tlietop of thit-lettei ':hat an add,eridumapplies, the e .nclosed add~ndum .is a~ iritegral p~t of t 'his. !:~tter. Po.r important itifdrrria.ti on about your . respon.sib:±:ltties as a ta.x"-exempt organization, go to. w·,.;\.;.;::.:rs.gov/:cha't::itie.s. Enter "422.;;~PF'' i.n the search bar to view Pi.ililication 4221 /pp, · Co\tipli$ce G:.i:ide for SOl(cl O} Private Fpu.ridations,. which describes yoUi r~cordkeeping, reporting, and disclosute requirements. Letter 10'16 Item 9.a. - Page 103 / I ... Working Committees Operations/Shower Unit- Bill Crewe / Rick Grether Marketing- Lindsey Byers Fundraising - Sandy Underwood Finance- Penny Platt ..... Board of Directors (5) President -Gwen Watkins ,...__. Secretary -Kalleen Corely Treasurer -Penny Platt Not yet appointed Not yet appointed / Maintenance -11 Operations Manager Bill Crewe Rick Grether ,, I Moving Trailer I Volunteer Onsite Supervisor (1 per shift) 1. Rick Grether 4. Gary Petersen 2. Bill Crewe 5. Guy Sturgell 3. LI Platt 6. Duane Leib I I I Administration Support L Operations I ..... I / --= -...... ' Volunteer Coordinator I I Barbara Owen \.. / I I I I ---------1 / -...... / ' Volunteer Volunteer Intake and Shower Ambassadors Homeless intern I (all cross trained) (Future Opportunity 2019) Anticipate 20 volunteers for startup/ minimum 2 p er shift ' Organizational Chart Item 9.a. - Page 104 CITY OF ARROYO GRANDE- RECEIVED NOV 2 9 2018 COMMUNITY DEVELOPMENT CITY OF ARROYO GRANDE 201 &19 JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM DESCRIPTION OF PROGRAM: The City's 2018-19 Jim Guthrie Community Service Grant Program is intended to provide monetary grants to ~ligible community non-profit orga·nizations. The City recognizes the value of such groups that provide specialized social service, educational, cultural,' beautification and recreation programs and projects benefitting its citizens. Grants awarded will be in minimum amounts of not less than .$250. Funding is limited to $20,000 for Grant Year 2018-19. ELIGIBILITY STANDARQS: To be eligible to apply' for grant ·monies under the City's 2018-19 Jim Guthrie Community Service Grant Program, a community orQanizatiori must satisfy the following standards: .1. operate asa non-profit 501(c)(3); 2. serve the Arroyo Grande community; 3. use funds provided to directly provide a social service, educational, cultural, beautification or recreation pr09ram or project to Arroyo Grande residents and/or businesses; 4. not restrict participants based upon race, · religion, gender, sexual orientation, marital status, national origin, ancestry, disability, medical condition or age; and 5. not use grant monies for specifically religious activities. · "Directly provide" means that the community non;.profit organization ·conducts the social service(s) or cultural program(s) itself rather than through. a separate entity to which it sub-awards grant monies. APPLICATION PROCESS: I. Completion of Application Form All · interested non-profit organizations must complete the attached application .form -(an online copy of the form can be accessed at the City's website at www.arroyogrande.org), including: Item 9.a. - Page 105 • Name and address of the non-profit organization (applicant is required to list the local branch if it represents a national or statewide organization). • Description of community services provided. • Relationship of non-profit organization to the community. • Current membership figures and approximate number of City of Arroyo Grande residents served by the non-profit organization. • Amount of funds requested. • Proposed project and budget plan for the use of the grant funds. • Proof of 501 (c}(3} status with a copy of the letter from the IRS. • Past two years financial statements including the current year with balance sheets, profit/loss statements and indicating the percentage of revenue that is used for administration, salaries and program costs (Please denote what salaries are directly related to administration and/or program costs). • Applicants are requested to provide information on their annual sources of revenue received. • Any applicant who received grant funds from the City in the past is to indicate when. the funds were received, the amount of funds received and document how the funds were utilized. • In addition to the original application, please submit eleven (11) additional copies: double-sided, 3-hole punched and paper clipped. II. Application Deadline Completed application forms along with supplemental documents must be submitted by 5:00 p.m., Friday, November 30. 20 18 addressed to: City of Arroyo Grande Community Development Department Attention: Matt Downing, Planning Manager 300 E. Branch Street Arroyo Grande, CA 93420 Ill. Evaluation of Applications and Selection Process Following the application deadline, the City Council's appointed Jim Guthrie Community Service Grant Committee will review and consider proposals from community groups. All proposals will be evaluated to ascertain which non- profit organizations best meet the needs that the City seeks to satisfy. Factors to be considered include, but are not limited to, the following: Item 9.a. - Page 106 A. The non-profit organization's responsiveness in clearly stating the benefits to be derived by the resident ·of the City of Arroyo ·Grande, if grant funds are awarded; B. The number of City of Arroyo Grande residents . by age group served by the non-profit organization; geographic area(s) and total n·umber of clients served by the non-profit organization; C. The non-profit organization's history of providing community services to the residents of the City of A~yo Grande; a;nd D. The non-profit organization's financial need for grant funds to .service the City of Arroyo Grande residents. ··1v. Award of Funds .. V. Following the Jim Gu_,hrie Community Service· Grant Committee's scrE!ening -process, the Committee wiil present its recommendations t~ the · Cify-Council. The City Council will review the Committee's· report and consider award of funds to selected non-profit organizations. In all cases, the City ·Council retains sole and absolute discretion in administering this program, including which applicants will be awarded funds and the total level .of fl_.mding in each instance. Execution of Agreement Non;.profit organizations selected to receive funds will be required to sign and e?,<:ecute an agreement with .the City of Arroyo Grande; NOTE: If award of funds is made, .a recipient non-profit organization will be required to expend grant monies prior to the close of the calendar year. VI. For more information, contact Matt Downing, Planning Manager, at 473-5424. Item 9.a. - Page 107 CITY OF ARROYO GRANDE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM APPLICATION FORM 2018-19 Please complete the following sections: (use additional sheets as necessary) I. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION: (must be the local branch). SLO Noor Foundation, 1428 Phillips Lane Suite B4, San Luis Obispo, CA 93401 II. GRANT APPLICANT REPRESENTATIVE'S NAME, ADDRESS, EMAIL ADDRESS AND TELOPHONE NUMBER: (must be the Executive Director . or their desiaBated rearese.ntative>. Abe Lincoln, ExecutIve-1 irector,· Emau: arincbln@slonoorfoundation.org SLO Noor Foundation, 1428 Phillips Lane Suite B4, San Luis Obispo, CA 93401 Office phone:(805)439-0797 Direct line:(831 )402-9979 Ill. DESCRIPTION OF COMMUNITY SERVICES PROVIDED· SLO Noor Foundation was louncfed in 2009 by 1'r. Anmad Nooristani lo provide essential medical services to uninsured residents of San Luis Obispo County. In 2011, the SLO Noor Free Clinic formally opened; and in 2014, SLO Noor Free Dental Clinic was established. With a volunteer base of 80 professional healthcare providers, SLO Noor now provides high quality, free medical, dental and vision services to a diverse range of underserved, uninsured SLO County residents. Services include primary care, diagnostics, patient referrals, dental procedures, eye exams and glasses for vision patients, medical and dental supplies, and patient prescriptions. SLO Noor provides over 5,000 patient visits annually and is growing to meet the need in the San Luis Obispo region which has approximately 40,000 uninsured inviduals. IV. LIST AREA(S) SERVED BY NON-PROFIT ORGANIZATION: (include a brief description of the relationship of your non-profit organization to the residents of the Citv of Arrovo Grande). SLO Noor Clinics rS'gularly S'ee patient$ beyond San Luis Obispo, primarily Arroyo Grande, Atascadero, Grover Beach, Los Osos/Morro Bay, Nipomo/Oceano, Paso Robles, Pismo/Shell Beach, and San Miguel; and from the northern areas of Santa Barbara County. Arroyo Grande patients have historically needed mainly medical and dental services . A small number receive vision care services. Exceptional healthcare is provided from compassionate, dedicated professionals. Privacy is respected (and anonymity, as requested). Due to high demand, appointments are made, confirmed, and transportation can be provided free of charge. Item 9.a. - Page 108 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON- PROFIT ORGANIZATION· /broken down bv.aae nrcwBs ifa_,ltailable>. Arroyo Granae resIcfents servea·oy·~Lo ~oor are consIsrenny 5. -5.2 roonotal SLO Noor patients. In_ 2018, of approximately 5500 patient visits (medical, visio11 and dental), SLO Noor servi¢.eswill have.provided healthcare to Arroyo Grande _residents at over 250 pcitient visits , a 20% increase from 2017. Most patients are betwee'n' 18 and 64. • • • .··:. ·' •• : ,· .• • 1 • • • J r . ( '); VI. -AMOUNT Of FUNDS REQUESTED: ; _,. We respectt(my reques a Jim U-utline Community Service Grant .of $4,000.00 from the City of Arroyo Grande, an equivalent of 10% of our Arroyo Grande patients projected costs tor 2019, approximately $15 per patie'1t visit. VII. PROPOSED USE AND BUDGET · PLAN ·,fOR GRANT FUNDS: (indicate if any of the grant ·funds will be used ·fpf ~any ·other purpose · than · those desianatea such as overhead, national offiCIJ-. administrative salaries>. · · ·. SLO Noor wI11 Spena Jim Guthrie t;Ommunrcy SeMce Granl tunas solely on Arroyo Grande patient services / program expenses -specifically on medical costs associated with in-house laboratory procedures. All funds will .offset actual diagnostic lab costs required for laboratqry results. · VIII. ADD~TIONA~ DOCUMENTATION: (if you have received funds in the past, please indicate the amount of funds received (indicate what year) and how the. funds were utilized) . . . 2015-16: $r,ooo for MeaIca1 suppf,es and dIagnostIcs 2016-17: $2,000 for Medical supplies and diagnostics 2017-18: $2,000 for Diagnostic labs/phlebotomy services IX. SUPPLEMENTAL DOCUMENTATION: D Past two (2) years financial statements, including the current year with the balance sheets and the profit/loss statements. D Information indicating the percentage of revenue received that is used for administration, salaries, and program costs. D Breakdown and description of non-profit organization's sources of revenue. D Proof of 501(c)(3) status with a copy of the letter from the IRS. D Copy of the non-profit organizations Board of Directors, Officers and an organization chart. Item 9.a. - Page 109 X. CERTIFICATION: SLO Noor Foundation I certify on behalf of ______________ non-profit organization, that I have ·read, understand and agree that the aforesaid information is accurate, factual and current. I understand that an award of funds, if granted, will be for the sole use as reflected in this application form. I further certify that · as a condition of receiving funds, an agreement with the City of Arroyo Grande, in a form and content provided by the City of Arroyo Grande, will be signed and executed , by a duly authorized representative of said non_-profit_ orQanization. I am aware of and certify that our non-profit organization will adhere to all City regulations regarding the 2016 Community Service Grant Program including, but not limited to, maintaining non-discriminatory policies, practices and intent. I also, on behalf of our non-profit organization, indemnify, defend, and hold harmless the City of Arroyo Grande relative to any and all liability that may arise as a result of the use of the City of Arroyo Grande Community Service Grant Fund monies. Nov 28, 2018 Date: ------Signature: ____________ _ Executive Director or Designee Board of Director or Officer Item 9.a. - Page 110 . l ... 1 l:N'l'BlUfAL RBVBNOB .SERVICE P.O. BOX 2508 Cl:NC'INNATI, OH 4sio1 OCT 04 2010 Date: SLO NOOR 1"001'DATJ:ON A NON PROPI'l' CORPORA'l':tON C/0 JADB M 1CBLtiBY CHI.ISTI:AN &. AORR 225 BLAD STB 860 PASAI>BNA, CA .91101 near Applieatitt DBPAR'l'MBH'l' OP THB TRBAStJRY Bmployer Identification lfUmber: 27-1412176 DUii: 600110028 Contact Person: M!'.L'CHBLL P STBBLB contact Telephone NUmber: (877) 829-5500 Accounting Period Ending: December 31 PUl:)lic Charity Status: 170 (b) {;l.) (A) (iii) Porm. 99·0· Required: Yea lffective Date of Bxemption: November 19, 2009 Contribution Deductibility: Yes A,dde:ndwn J\pp1iee: No ll># 31.360 we are pleued to infom you that upon review of your application for tax exempt status we have d~texmined tbat yoq are ~empt :Crom l'ederal i.nooeie tax under eectiou 501 (c) (3) of tho. Internal Revenue Code. Contributiorua .to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises; transf~ or gifts under section 2055, 2106 or 2522 of the code. Bec:auae thia letter oould help reQolve .-ny queations regarding your exempt status, you should keep it 1n your pe:rmanent reco:r4a. Organiz~tione exempt under section S0l(e) (3) of the Code are further classified as either publio cl'larities or private foundations. we determined that you are a public ehaiity under-the Code sect:ion(s) listed in the heaMng of this lattsr. Please see enclosed Publication ,221-PC, conpliance Guide for S0l(c) (3) PUblic Cha:rit~ea, for •cme helpful im!ormation about your r$Pp0Mibilitie$ a• an exempt organi,:;ation ~ · -2- SLO NOOR POUNDATION A NON PROFl:T We have sent a copy of this letter to your representative as indicated in your power of attorney. Enclosure: Publication 4221-PC Sincerely, Robert Choi Director, BXempt organizations Rulings and Agreemente Item 9.a. - Page 111 SLO Noor Foundation Board of Directors as of December 2018 Ahmad Nooristani, MD Board President Tom Nuckols Board Treasurer Philip Cisneros, MA Patricia Herrera, MS Eugene Keller, MD, MBA James Scoolis, EdD Drew Washer, LCSW Board Vice President Elisa Moylan Board Secretary Joel Diringer, JD Stephanie Hunting, MA Linda Minton, MS Elizabeth Snyder, MHA Dean Wendt, PhD 1428 Phillips Lane, Suite B-4 I San Luis ObiSQ.Q,_CA:.93!dU.,J 'Jel: (805) 439-1797 I Fax: (SOS) 439-1799 ----. ··•~J'. SLONOQ.R~OUHDATION.ORG -< ...... ----..-=~""' .. _..,,.,....-Item 9.a. - Page 112 Medical Director Russell Ness, MD Medical Clinic Opened Oct. 2011 Tom Barber, Clinic Director Paso Robles Medical Clinic Opened May 2017 nA._ • .,..R V/~V~Y FO UNDATION SLO Noor Foundation Board of Directors See Attached List Executive Director Abe Lincoln Vision Director Rupert Chowins, OD Vision Clinic Opened Dec. 2010 Dental Director Ron Barbieri, DDS Dental Clinic Opened March 2014 Terri Bangert, Office Manager Financial and Legal, HR, Volunteer Coordination {Jim Eaton, Americorps Fellow), Systems, PR/Marketing, Development (Karenna Costa, Development Director) Item 9.a. - Page 113 RECEIVED NOV 3 0 2018 COMMUNITY DEVELOPMENT CITY OF ARROYO GRANDE CITY OF ARROYO GRANDE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM APPLICATION FORM 2018-19 Please complete the following sections: (use additional sheets as necessary) I. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION: (must be the local branch). SmartShare Housing Solutions/HomeShareSLO; P.O. Box 15034, San Luis Obispo, CA 93406 II. GRANT APPLICANT REPRESENTATIVE'S NAME, ADDRESS, EMAIL ADDRESS AND TELOPHONE NUMBER: (must be the Executive Director or their designated representative). Marcia Alter, Board Chair; 1268 Royal Oak Place, Arroyo Grande, CA. 93420 . marciahomeshareslo@gmail.com 805-458-1241 Ill. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: HomeShareSLO is currently the only program operated by SmartShare Housing Solutions, a San Luis Obispo County non-profit, whose mission is to provide housing solutions by connecting people and homes. In its 2 years of operations, the program has created 48 housing units, through enlistment of extra bedrooms; matched 66 clients together in safe, affordable housing, while assisting seniors to live at home; enrolled 174 Clients (89% low income); and provides housing information and training to 1,692 County residents at events, helping with individual housing needs. IV. LIST AREA(S) SERVED BY NON-PROFIT ORGANIZATION: (include a brief description of the relationship of your non-profit organization to the residents of the City of Arroyo Grande). HomeShareSLO serves residents of the County of San Luis Obispo, mostly lower-income seniors. Housing provision does not respect city boundaries, as AG residents seeking affordable housing may seek housing in other communities; similarly, AG home providers may provide housing for housing seekers from other communities. Thus, program efficiently serves a regional housing need, though not only AG need in isolation. This makes program funding challenging, though provides efficient service. Item 9.a. - Page 114 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON- PROFIT ORGANIZATION: (broken down by age groups if available). To date, the program has enrolled 8 Arroyo Grande households as home provider clients; 5 Arroyo Grande residents as home seeker clients; and matched 6 clients in AG homes. These homeshares bring a yearly estimated combined benefit of $13,000 ($8,000/year income to home providers and $5,000/year saved housing costs to seeker) totaling benefit to AG residents of approximately $39,000 per year. VI. AMOUNT OF FUNDS REQUESTED: HomeShareSLO requests $1,960 to help support affordable housing connections through coffee chat outreach events and cover screening costs for City of Arroyo Grande residents VII. PROPOSED USE AND BUDGET PLAN FOR GRANT FUNDS: (indicate if any of the grant funds will be used for any other purpose than those designated such as overhead, national office, administrative salaries). Homesharlng is not something most seniors have done before--and ii can be a little scary . Often, they have shared housing only with family members before, and they do not use computer website, sueh as Craigslist. Given this, the program recognizes that opportunities for potential clients to connect with other program participants, possible housemates, in an infonnai setting is an Important part of program success . Coffee chats have proven an effective way to introduce clients to the program if funded, HomeShareSLO would hold 12 monthly coffee Chats in AG at a cost of $80 per event or S960 peryear(3 hr. staff time plus expenses) and allocates $1000 to help cover the cost ofbackground screeing and intake processing for 2-4 Arroyo Grande Residents . No funds will be used tor overhead or administrative salaries. VIII. ADDITIONAL DOCUMENTATION: (if you have received funds in the past, please indicate the amount of funds received (indicate what year) and how the funds were utilized). No funds previously received; the program seeks to receive inclusionary housing funding from the City of AG to help cover AG share of countywide costs of operations, though has as of yet been unsuccessful. IX. SUPPLEMENTAL DOCUMENTATION: [i] Past two (2) years financial statements, including the current year with the balance sheets and the profit/loss statements. Ii] Information indicating the percentage of revenue received that is used for administration, salaries, and program costs. [i] Breakdown and description of non-profit organization's sources of revenue. Ii] Proof of 501 (c)(3) status with a copy of the letter from the IRS. Ii] Copy of the non-profit organizations Board of Directors, Officers and an orqanization chart. Item 9.a. - Page 115 X. CERTIFICATION: I certify on behalf of ___ H_o_m_e_S_h_a_re_S_L_O ___ non-profit organization, that I have read, understand and agree that the aforesaid information is accurate, factual and current. I understand that an award of funds, if granted, will be for the sole use as reflected in this application form. I further certify that as a condition of receiving funds, an agreement with the City of Arroyo Grande, in a form and content provided by the City of Arroyo Grande, will be signed and executed by a duly authorized representative of said non-profit organization. I am aware of and certify that our non-profit organization will adhere to all City regulations regarding the 2016 Community Service Grant Program including, but not limited to, maintaining non-discriminatory policies, practices and intent. I also, on behalf of our non-profit organization, indemnify, defend, and hold harmless the City of Arroyo Grande relative to any and all liability that may arise as a result of the use of the City of Arroyo Grande Community Service Grant Fund Date: 11 /29/18 oirector or Officer Item 9.a. - Page 116 ~ sTo Creating Housing Solutions by Connecting People and Homes Board of Directors (November 2018) Marcia Alter, Chair Marciahomeshareslo @gm ail.com: Retired; Owner-Laugh and Feel Good: Affiliations: SLO Chamber of Commerce; 1268 Royal Oak Place, Arroyo Grande, CA 93420 Marianne Kennedy, Vice-Chair mkennedyauthor@g mail.com Retired Executive Director of SLO Women's Shelter (now Stand Strong); Affiliations: Member of Housing Trust Fund (Secretary, B ofD); Homeless Services Coordinating Council; SLO Supportive Housing Consortium; 1787 Fearn Ave., Los Osos, CA 93402 Lisa Gonzalez, Treasurer lgonzo@fix.net Enrolled Agent, Bookkeeper & Notary Public; Owner-Controller-on-Call; Affiliations: St. Benedict's; Los Osos Cares; 1297 15th Street, Los Osos, CA 93402 Tim Waag, Secretary timwaag@gmail.com Manager: Light-Gabler Employment Law; Affiliations: Showers of Hope; Homeless Service Oversight Council (HSOC); HSOC Housing Committee; 1757 Frambuesa Drive, SLO, CA 93405 Grace Crittenden gcrittendenl@gmail.com Internist; Pacific Central Coast Health Centers; 1665 Tanglewood, SLO, CA 93401 Alan Prince a prince @rebuildforlife.com Occupational Therapist; Owner-Rebuild for Life; 1233 Santo Tomas Ct., Grover Beach CA 93433 Tom Potter tpotter@capslo.org Veteran-Landlord Liaison-CAPSLO; Affiliations: 4-H; SSVF Veteran Services 1050 Green Oaks Drive; Los Osos, CA 93402 Maggie Watson maggietdm@gmail.com; Customer Service: Whole Foods; 1665 Tanglewood, SLO 93401 Andrea LaRosa andreahomeshan;slo@.gmail.com; film producer; 3591 Sacramento Drive unit 12, San Luis Obispo, CA 93401 Technical Advisors: • Mariam Shah • Sky Bergman • Barbara Nicolls • Jo Oliver • Scott Smith-Cooke • Pavlo Rudakevych • Joanna Balsamo-Lilien • Janice Fong Wolf Item 9.a. - Page 117 ~ s Co Creating Housing Solutions by Connecting People and Homes H Organizational Chart/HomeShareSLO 9-15 member volunteer board of directors (funding and policy) t Executive Director t Operations Director; Outreach Director t Operational volunteers Funding Sources (2018 Estimate as of 11/29/18): Fees for service/program client matching fees: $15,000 Contributions/private donations: $50,000 Grants: $15,000 Government Grants: $33,000 (County/Cities: SLO, Grover Beach, Pismo Beach, Morro Bay) Total: $113,000 Item 9.a. - Page 118 INTERNAL REVENUE SERVICE P . 0. SOX 2 5 08 CINCINNATI, OH 45201 Date: NOV 15 2017 SMART SHARE HOUSING SOLUTIONS INC P O BOX 15034 SAN LUIS OBISPO, CA 93406-0000 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 82~31S1265 DLN: 26053696004927 Contact Person: CUSTOMER SERVICE IO# 31954 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Statue: 509 (a) (2) FQ.rm990/990-EZ/990-N Required: Yes Effective Date of Exemption: September 25, 2017 Contribution Deductibility: Yes Addendum Applies: No We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section S0l(c} (3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 205S, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records. Organizations exempt under IRC Section 501(c) (3) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter. If we indicated at the top of this letter that you•re required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, thee-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked . If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important info:rmation about your responsibilities as a tax-exempt organization, go to www .irs.gov/charities. Enter "4221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for S0l(c) (3) Public Charities, which describes your record.keeping, reporting, and disclosure requirements. Letter 947 Item 9.a. - Page 119 •· SMART SHARE HOUSING SOLUTIONS INC Sincerely, Director, Exempt Organizations Rulings and Agreements Letter 947 Item 9.a. - Page 120 RECE IV ED NOV 30 2018 COMMUNITY DEVELOPMENT CITY OF ARROYO GRANDE CITY OF ARROYO GRANDE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM APPLICATION FORM 2018-19 Please complete the following sections: (use additional sheets as necessary) I. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION: (must be the local branch). Meals That Connect/Senior Nutrition Program; 2180 Johnson Avenue, San Luis Obispo, CA 93401 II. GRANT APPLICANT REPRESENTATIVE'S NAME, ADDRESS, EMAIL ADDRESS AND TELOPHONE NUMBER: (must be the Executive Director or their designated representative). Elias Nimeh, Executive Director; 2180 Johnson Avenue, San Luis Obispo, CA 93401; elias@mealsthatconnect.org; 805-541-3312 Ill. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: Meals That Connect/Senior Nutrition Program of SLO County provides free, hot, nutritious noon-time meals to seniors who are at least 60 years old. Seniors who are able to attend can eat meals at 10 community sites throughout the county in congregate dining. We also deliver meals, with frozen meals for Saturday and Sunday, to qualified seniors who are homebound. We rely on over 300 volunteers to deliver meals. We are the only program serving senior meals throughout San Luis Obispo County and the only program that includes congregate dining and an opportunity for socialization among the seniors. All of our meals are free to those who are eligible, although some clients choose to make voluntary anonymous donations. Our program has three goals: nutrition, socialization, and safety. Both the congregate dining and the home delivery provide socialization and human contact to help break the cycle of isolation. Finally, the daily home deliveries by volunteers, along with regular assessments by site supervisors, provide both friendly human contact and a safety net from accidents or physical or financial abuse. All staff and volunteers are mandated to report any suspected abuse. IV. LIST AREA(S) SERVED BY NON-PROFIT ORGANIZATION: (include a brief description of the relationship of your non-profit organization to the residents of the City of Arroyo Grande). MTC serves congregate and home-delivered meals at ten dining sites throughout the county: in San Luis Obispo at the Anderson Hotel and the United Church of Christ Congregational; Atascadero; Cambria; Los Osos; Morro Bay; Nipomo; Oceana; Paso Robles; Santa Margarita. We serve residents of Arroyo Grande through our dining site in Oceano. Arroyo Grande seniors can eat at our Oceano dining site or receive home-delivered meals through that site. Item 9.a. - Page 121 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON- PROFIT ORGANIZATION: (broken down by age groups if available). In fiscal year 2017 /18, Meals That Connect served a total of 116 unduplicated clients in Arroyo Grande, a 3% increase over the previous year. Of these, 77 received home-delivered meals and 39 participated in congregate dining. These Arroyo Grande seniors received 12,638 meals in fiscal year 2017/18, at a total cost of $124,990, a 19% increase over the previous year, a reflection of our continually rising costs. VI. AMOUNT OF FUNDS REQUESTED: We are requesting $5000. VII. PROPOSED USE AND BUDGET PLAN FOR GRANT FUNDS: (indicate if any of the grant funds will be used for any other purpose than those designated such as overhead, national office, administrative salaries). Meals That Connect will use the $5,000 grant to help cover the cost of food, food container.;, and labor costs for serving senior.; in the Arroyo Grande community. Grant funding in the amount of $5000 will pro~de meals for 5 seniors in need of good nutritious hot lunch on a daily basis fora fUII year. The cost of food and food supplies, Including labor costs. usually makes up 60% of our total budget MTC total annual administrative salaries make up 12% of the total budget Budget Plan Food and Feed Supplies $1,100 Labor & Benefits $3,000 All other costs $900 Total $5,000 (cost of meals to 5 seniors forfUII year.) VIII. ADDITIONAL DOCUMENTATION: (if you have received funds in the past, please indicate the amount of funds received (indicate what year) and how the funds were utilized). In 2012, Senior Nutrition Program received $2501 in CDBG funding from the city of Arroyo Grande. In 2014 we received $3000, in 2015 $4000, and in 2016 $5000, all from the Arroyo Grande Community Service Grant Program. In all of those years, the funds were used to purchase food and food supplies for program clients in Arroyo Grande. In 2017 we were awarded $4000, but that money has not been received yet. IX. SUPPLEMENTAL DOCUMENTATION: 1-1 Past two (2) years financial statements, including the current year with the balance sheets and the profit/loss statements. 1-1 Information indicating the percentage of revenue received that is used for administration, salaries, and program costs. 1-1 Breakdown and description of non-profit organization's sources of revenue. /iJ Proof of 501 (c)(3) status with a copy of the letter from the IRS. /iJ Copy of the non-profit organizations Board of Directors, Officers and an organization chart. Item 9.a. - Page 122 X. CERTIFICATION: I certify on behalf of Mt~i/s Jktit' lonn-Rc1 non-profit organization, that I have read, understand and agree that the aforesaid information is accurate, factual and current. I understand that an award of funds, if granted, will be for the sole use as reflected in this application form. I further certify that as a condition of receiving funds, an agreement with the City of Arroyo Grande, in a form and content provided by the City of Arroyo Grande, will be signed and executed by a duly authorized representative of said non-profit organization. I am aware of and certify that our non-profit organization will adhere to all City regulations regarding the 2016 Community Service Grant Program including, but not limited to, maintaining non-discriminatory policies, practices and intent. I also, on behalf of our non-profit organization, indemnify, defend, and hold harmless the City of Arroyo Grande relative to any and all liability that may arise as a result of the use of the City of Arroyo Grande Community Service Grant Fund monies. Date: //lfr7 k,f Signature: ~-~ Executive Director or Designee Board of Director or Officer Item 9.a. - Page 123 INTERNAL REVENUE SERVICE DISTRICT DIRECTOR P.O. BOX 2508 CINCINNATI, OH 45201 Date: ,MAR 18 1999 SENIOR NUTRITION PROGRAM OF SAN LUIS OBISPO COUNTY 710 FIERO LANE STE 14 SAN LUIS OBISYO, CA 93401-7945 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 77-02_79528 .DLN: 1705305302.2009 Contact Person: ZENIA LUK Contact .Telephone Number: (877) 829-5500 Accounting Period Ending: June 30 Form 990 Required: Yes Addendum Applies: No ID# 31522 Based on information sup~lied, ana·assuming your operations will be aa stated in your application for ·recognition of exemption, we have determined you are exempt ·from federal income tax under section 50l(a) of the Internal Revenue Code as an organization des~ribed in section 50l{c) {3). •• I;, ,. • We have further.det'l!rmined that you are not a private foundation within the meaning.of section 509(a) of the Code, because you are an organization described in sections 50.9(a) (1) and 170(b) (l) (A} (vi). If your sources of support, or your purposes, character, or method of ope-ration change, please let us know so we can consider the effect of the change on your exempt status ·and foundation status. In the case of an amend- ment to your organizational document or bylaws, please send us a copy of the amended document or bylaws. Also, you.should inform us of all changes in your name or address. . . As of January 1, 1984, you are liable for taxes under the Federal Insurance contributions Act (social security taxes} on remuneration of $100 or more you pay to each of your employees during a calendar·year. You are not liable for the_tax imposed under the Federal Unemployment Tax Act (FUTA). Since you are not a private foundation, you are not subject to the excise taxes under Chapter 42 of the Code. However, if you are involved in an excess benefit transaction; that transaction might be subject to the excise taxes of sectio~ 4958. Additionally, you are not automatically exempt from other federal excise taxes. If you have any questions about excise, employment, or other federal taxes, please contact your key district office. Granters and· contributors may rely on this determination unless the Internal Revenue Service publishes notice to the contrary. However, if you lose your section 509(a) (1) status, a grantor or contributor may not rely on this determination if he or she was in part responsible for, or was aware of, the act or failure to act, or the substantial or.material change on the part of the organization that resuited in your loss of such status, or if he or she acquired knowledge that the Internal Revenue Service had given notice that you would no longer be classified as a section 509(a) (1) organization . Letter 947 (DO/CG) Item 9.a. - Page 124 -2- SENIOR NUTRITION PROGRAM OF SAN Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, .legacies, devises, transfers, or gifts to you or for your use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of.Code sections 2055, 2106, and 2522. Contribution deductions are allowable to donors only to the extent that their contributions are gifts, with no· consideration received. Ticket pur- chases and similar payments in conjunction with ·fundraising events may not necessarily qualify as deductible contributions, depending on the circum- stances. See Revenue Ruling 67-246, published in Cumulative Bulletin 1967-2, on page 104, which sets forth' guidelines regarding the deductibility, as chari- table contributions, of payments made by taxpayers for admission to or other participation in fundraising ac~ivitiee for charity. In the heading of this letter we have indicated whether you must file Form 990, Return of Organization Exempt From Income Tax. If Yes is indicated, you are required to file Form 990 only·if your gross receipts each year are normally more than ~25,000. However, if you receive a Form 990 package in the mail, please file the return even if you do not exceed the gross receipts test. If you are not required to file, simply attach the label provided; check the box in the heading to indicate that your annual gross receipts are normally $25,000 or leas,· and s.ign the return. If a return is required, it must be filed by the 15th day of the fifth month after the end of your annual accounting period. A penalty of $20 a day ie charged when a return 1~ filed late, unless-there is reasonable cause for the delay. However, .the maximum penalty charged cannot exceed $10,000 or 5 percent of your gross receipts for the y~ar, whichever is leas. For organizations with gross receipts exceeding $1,000,000 in any year, the penalty is $100 per day per return, unless there is reasonable cause fo~ the delay. The maximum penalty for an organization with gross receipts exceeding $1,000,000 shall not exceed $50,000. This. penalty may also be charged if a return is not complete, so be sure your return is complete before you file it. You are required to make your annual return available for public inspection for thre·e years after the return is due. You are also required to make available a copy of your exemption application, any supporting documents, and this exemption letter. Failure to make these documents available for public inspection may subject you to a penalty of $20 per day for each day there is a failure to comply (up to a maximum of $10,000 in the case of an annual return). You are not required to file federal income tax returns unless you are subject to the tax on unrelated business income under section Sll of the Code. If you are subject to this tax, you must file an income tax return on Form 990-T, Exempt Organization Business Income Tax Return. In this letter we are not determining whether any of your present or proposed activities are unre- lated trade or business as defined in section 513 of the Code. Letter 947 (DO/CG) Item 9.a. - Page 125 -3- SENIOR NUTRITION PROGRAM OF. SAN You need an employer identification number even if you have no employees. If an employer identification number was not entered on .your application, a number will be assigned to you and you will be advised of it. Please use that number on all returns you file and in all ·correspondence with the Internal Revenue Service. If we have indicated in the heading of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. Because this letter could help ree·olve any questions about your exempt status and foundation status, you should keep it in your permanent records. If you have. any questions, please contact the person whose name and telephone number are shown in the heading of this letter. Sincerely yours, /:'.., t: 1 "'. _,,~..,. ' / ··-r.J'-. ., j~ ,t,.. , ~ ~t;.~1 .,._.,;i;·. ,f~f-:1' / ~~;. ?-:~ Dl &1 trict Director: ,.:. :'r Letter 9~7 (00/CG) Item 9.a. - Page 126 Accounting - SAMS Reporting Manager Site Managers Site Cooks Site Dishwashers Volunteers Senior Nutrition Program Organization Chart Board of Directors Executive Director I Administrative Assistant Cooks Dishwashers Volunteers Volunteers Reg. Dietician I Kitchen Director I , Driver · Driver Item 9.a. - Page 127 RECEIVED NOV 30 2018 COMMUNITY DEVELOPMENT CITY OF ARROYO GRANDE CITY OF ARROYO GRANDE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRA APPLICATION FORM 2018-19 Please complete the following sections: (use additional sheets as necessary) I. II. Ill. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION: (must be the local branch). Transitions-Mental Health Association 784 High Street San Luis Obispo, CA 93401 On behalf of Life House of Arroyo Grande 203 Brid ge Street Arro yo Grande, CA 93420 GRANT APPLICANT REPRESENTATIVE'S NAME, ADDRESS, EMAIL ADDRESS AND TELOPHONE NUMBER: (must be the Executive Director or their designated representative). Barry Johnson, Division Director -Rehabilitation & Advocacy Services Transitions-Mental Health Association 784 High Street San Luis Obispo, CA 93401 bjohnson@t-mha.org 805 540-6540 DESCRIPTION OF COMMUNITY SERVICES PROVIDED: Safe Haven Wellness Center is a supportive, safe meeting place with regular activities designed to promote social interaction, independence and mental health recovery. These include programs in interpersonal relationships, effective communication and conflict resolution, and the accessing of community resources (therapeutic, health, vocational, educational). Individuals with mental illness can participate in cooking classes and budgeting classes, receive coping skills education, gain support toward their life goals, enjoy recreational activities, connect with others living with mental illness, and serve as peer resources. Many have the opportunity to develop leadership skills by participating in the Program's operations, and can participate in various job skills needed for Wellness Center Em plo yment. IV. LIST AREA(S) SERVED BY NON-PROFIT ORGANIZATION: (include a brief description of the relationship of your non-profit organization to the residents of the City of Arroyo Grande). Transitions-Mental Health Association serves all of San Luis Obispo County and portions of North Santa Barbara County. We have operated a Wellness Center in the City of Arroyo Grande for 376 years, and Safe Haven opened its doors at its current location on Bridge Street in 2007. We also provide access to SLO Hotline (a 24-hour crisis and support service phone line), as well as supportive housing that is located in the City of Arroyo Grande and family support services. Item 9.a. - Page 128 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON-PROFIT ORGANIZATION: (broken down by age groups if available). Safe Haven Wellness Center served the largest number of residents in our center's history. We had 421 unique participants in Fiscal Year 2017-18, participating in cooking classes, support groups, and other activities. Our consumers are either Transitional Age Youth or Adults. VI. AMOUNT OF FUNDS REQUESTED: $750.00 VII. PROPOSED USE AND BUDGET PLAN FOR GRANT FUNDS: (indicate if any of the grant funds will be used for any other purpose than those designated such as overhead, national office , administrative salaries). For the past three years, we have been honored to receive Community Service Grants from the City of Arroyo Grande. In that time, we have established a popular Computer Skills Workshop in the Safe Haven Wellness Center. Many adults with mental illness may experience challenges related to the development of job skills and keeping themselves better connected to the community at large, as well as their family and social circle through new social media avenues. Last year we received a $500 grant and, with an in- kind donation of another $250, we were able to provide a total of 48 one-hour sessions to 10 people, with each receiving individualized training that included basic computer skills, email skills, word processing assistance, and internet navigation training. Not only did the computer support services assist Arroyo Grande mental health community members in need, it also provided access to mental health services for those who were not connected. 6 new community members joined the Safe Haven community because of these services. We plan to continue offering this extremely helpful support service on a monthly basis to all members of Safe Haven. We will devote all grant funds to operating this program, and $750 will pay for 48-50 hours of one-on-one instruction, without our agency having to self- fund 1/3 of the project. In most cases, participants will receive 2 hours of instruction a week for 2-3 weeks . VIII. ADDITIONAL DOCUMENTATION: (if you have received funds in the past, please indicate the amount of funds received (indicate what year) and how the funds were utilized). TMHA received $500 grants in 2016, 2017 and 2018. All grants have been dedicated to our Computer Skills Workshop. Given the proven success, popularity and sustainability of the program , we respectfully request that you consider awarding a larger grant this year. Item 9.a. - Page 129 IX. SUPPLEMENTAL DOCUMENTATION: [gj Past two (2) years financial statements, including the current year with the balance sheets and the profit/loss statements. Please Note: We are currently in the process of completing our audit for Fiscal Year 2017-18, but it will not be ready for a November 30 deadline. We are providing audited financial statements from the previous two years [gj Information indicating the percentage of revenue received that is used for administration, salaries, and program costs. [gj Breakdown and description of non-profit organization's sources of revenue. [gj Proof of 501 (c)(3) status with a copy of the letter from the IRS. [gj Copy of the non-profit organizations Board of Directors, Officers and an organization chart. X. CERTIFICATION: I certify on behalf of Transitions-Mental Health Association non-profit organization, that I have read, understand and agree that the aforesaid information is accurate, factual and current. I understand that an award of funds, if granted, will be for the sole use as reflected in this application form. I further certify that as a condition of receiving funds, an agreement with the City of Arroyo Grande, in a form and content provided by the City of Arroyo Grande, will be signed and executed by a duly authorized representative of said non-profit organization. I am aware of and certify that our non-profit organization will adhere to all City regulations regarding the 2016 Community Service Grant Program including, but not limited to, maintaining non-discriminatory policies, practices and intent. I also, on behalf of our non-profit organization, indemnify, defend, and hold harmless the City of Arroyo Grande relative to any and all liability that may arise as a result of the use of the City of Arroyo Grande Community Service Grant Fund monies. Signature: &a~t: ~L£~ Ej ecutive Director or Designee Date: ~=1:k Board of Director or Officer Item 9.a. - Page 130 INTERNAL REVENUE SERVICE -DISTRICT ' DIRECTOR P _ Q_ BOX 2508 CINQNNATI, OH 45201 Date: JJN 7 i9S9 TRANSITIONS -MENTAL HEALTH ASSOCIATION PO BOX . 1540 8 SAN Lu IS OBISPO, CA 93406-54.08 Dear Applicant: - DEPARTMENT OF THE TREASURY Employer Identification Number: 95-3509040 DLN: 1.7053107705009 Contact Person: MARK BRECKNER. Contact Telephone Number: {877) 829-5S00 Date -of Exemption~ June 1980 Internal Revenue Code Section 501 (c) (3) · · ID#: 95217 Thank you for submitting t:he information shown on the enclosure_ We have -ma.de it a part of your file_ The changes indic;:ated do not. adversely af£ect your ~mpt: status and the exemption letter issued to you continues . in effect. Please iet us know about any future cllange i,n the chai;acter, purpose, method of operation, name or _address of your organization. This is ··a :i-~irement for retaining your exempt status. Thank you for your cooperation . . smrrs:~ . /(~ r~ District Director ·· . . . .. ' T,Rt:t:Pr g 7 6 (DO I a;) Item 9.a. - Page 131 TRANSITIONS -MENTAL HEALTH ASSOCIATION BOARD OF DIRECTORS (17) 0 CASEY APPELL Vice President I Relationship Manager Community West Bank 4464 Broad Streeet, Suite 110 San Luis Obispo, CA 93401 (805) 597-7784 -business (805) 440-0401 -cell e-mail: cappell@communitywestbank.com □ CAROLARMSTRONG,SECRETARY Educational Program Coordinator 1228 Manzanita Way San Luis Obispo, CA 93401 (805) 595-7060 -residence (805) 234-2636 -cell e-mail: cnda@charter.net 0 DAVE BERNHARDT Retired, Physician-Internal Medicine 5750 Balm Ridge Way San Luis Obispo, CA 93401 (805) 543-7694 -residence (805) 748-8865 -cell e-mail: bernhardt@fix.net 0 DARRYL ELLIOTT President, NAM/ San Luis Obispo County 3592 Broad Street, #202 San Luis Obispo, CA 93401 (805) 748-6611 -cell (805) 594-1056 -residence e-mail: elliottdarryl65@yahoo.com 0 BARBARA FISCHER, VP Director, Wyndham Residence 222 Elm Street Arroyo Grande, CA 93420 (805) 474-7260 -business (805) 474-7261 -fax/business (805) 235-9536 -cell e-mail: barb@wyndhamresidence.com □ JOSEPH C. GALLAS Attorney, Joseph C. Gal/as Law 401 E. Orange Street Post Office Box 1357 Santa Maria, CA 93456 (805) 925-9511 -business· (805) 925-4129 -residence (805) 925-2453 -fax/business e-mail: joegallas1@gmail.com 0 JAMES (JT) HAAS, PRESIDENT Industrial Power Engineer, PG&E 4325 S. Higuera Street San Luis Obispo, CA 93401 (805) 546-5234 -business (805 461-0621 -residence (805) 546-5207 -fax/business (805) 441-0568 -cell e-mail: JTH1@PGE.com Rev. 12ll/17 0 JEREL HALEY Chief of Police, Atascadero 5505 El Camino Real Atascadero, CA 93422 (805) 470-3200 -business (805) 470-3239 -fax/business (805) 598-1149 -cell e-mail: jhaley@atascadero.org 0 STEVE JOBST Retired, Physician 162 Bluff Drive Shell Beach, CA 93449 (805) 773-8922 -residence (805) 471-7540 -cell e-mail: jobstsb@gmail.com 0 CINDY JOHNSON, TREASURER Co-founder, Mindful Mothers 1767 Southwood Drive San Luis Obispo, CA 93401 (805) 439-0196 -residence (805) 550-2655 -cell e-mail: lucij@mac.com 0 LISA KATHERMAN Family Member 206 Indio Drive Shell Beach, CA 93449 (805) 773-3393 -residence e-mai I: lakatherman@aol.com 0 DEBORAH LINDEN Retired, SLO Chief of Police 4309 Edenbury Drive Santa Maria, CA 93455 (805) 937-5684 -residence (805) 598-5349 -cell e-mail: deljwt@comcast.net 0 BRADRUDD Licensed Marriage & Family Therapist 569 Higuera Street, Suite D San Luis Obispo, CA 93401 (805) 541-0553, x3-business (805) 801-2551 -cell e-mail: bradrudd@gmail.com 0 JEANIE SLEIGH Health Center Administrator, Lompoc Health Care Center 301 N. R Street Lompoc, CA 93436 (805) 737-6411 -business (805) 746-1542 -cell e-mail:jeanie.sleigh@sbcphd.org T:\Office Administration\ADMIN\BOARD OF DIRECTORS\8OD MEMBER ROSTER\8OD LISTS 2017 0 LISA THORNHILL, RN Sierra Vista Medical Center 1628 Rowland Drive Santa Maria, CA 93454 (805) 922-8032 -residence (805) 264-1715 -cell e-mail: lisaj1756@yahoo.com 0 TIM WILLIAMS CEO & Founder, Digital West 3620 Sacramento Drive, #102 San Luis Obispo, CA 93401 (805-441-6093-cell e-mail: tim.williams@digitalwest.net 0 STEPHANIE BAISA WILSON Licensed Marriage & Family Therapist 1190 Marsh St., Suite A San Luis Obispo, Ca 93401 (805) 594-1507 -residence (805-234-4484 -cell e-mail: stefwilson.5@icloud.com Item 9.a. - Page 132 Transitions-Mental Health Association Organization Chart DIVISION DIRECTORS (5 ): Meghan Boaz Alvarez, Clinical Director Joe Madsen, Division Director, Housing and Support Services Barry Johnson, Division Director, Adult Rehabilitation and Advocacy Frank Ricceri , Division Director, Vocational Advancement Christina Harney, Division Director, Northern Santa Barbara County Michael Kaplan , Community Engagement Director Full Service Partnership I Assj,t~ Program Manager (Doris Bell) Lead Clinician (Alicia Dueck) g_ult Full Service PartnershilllE§fl Slaff BOARD OF DIRECTORS (16) EXECUTIVE DIRECTOR (Jill Bolster-White) Executive Assistant (Loretta Doukas) nee Director !Rick Wolfe Finance Director (Raven Lopez) Finance Manager (Marci Johnson) Finance Clerical Assistant (Malt Brand) dministratlon Office Operations Coordinator (Adrianne Mosesian) Administrative Assistant (2) (Mindy Autin-Alfano & Carlyn Christianson) Office Maintenance (Sharon Samuel) Marketing & Outreach Mar1<eting & PR Coordinator (Bekkah Hopkins- Tucker) Prop erty Mana gement Property Manager (Rob Reynders) Maintenance (George Lepper) Clinical Di rector (Meg han Boaz Al varez) Quality Assurance Quality Assurance Specialist (Ly-Lan Lofgren) Personal Services Specialists (2) (Lori Munyon & Quentin Smith) Therapist (2) (Lindsay Wardlaw & Dan Gross) ~&\!!'porti ng all FSP Teams Psychiatrist (Dr. Elaine Remy) Program Mentors (3) (Sharleen Ua, DeAndre Brothers & Dawn Bumpus) Nurse Practitioner (Johanna Golston) Assisted Outpatient Treatment !AOTI Staff Therapist (Amanda Greenfield) Personal Services Specialist (Jennifer Eisen-Kearns) Medication Manager (Savannah Williams) Commynjty Residential Programs Program Manager (Phil Jones) Housing Coordinator (Vacant) FSP Adult Housing Division Director. Housing & Su pport Services (Joe Madsen) Jntensi ye Communi ty Services Program Manager (Miriam Vargas) Assistant Manager ( Nicole Holst) Forensics Re-En try Team Human Resources Human Resources Manager (Kristen Alexander) Human Resources Consultant (Kim Banks) Administrative Assistant (Connie Hasley) Youth Treatm ent Program Program Manager (Alley Jensen) Assistant Manager (2) (Laila Ness-PM & Jacob Holle-AM) Lead Clinician (Anna Yeackle) Residential Youth Counselors (Tricia Righetti, David Wishnewsky, Paloma Basulto, Ca ilyn Ortega, Max Grundmeier, Gail Burgess, Nia Bass, Anthony Mena) Homeless Services Programs Program Manager (Mari< Lamore) Assistant Manager (Jackie Andrews) 50 NOW Prog ram Community Ho using Residential Case Managers (2) Residential Case Mgr, Santa Ysabel Apts BHTC Personal Svc. Spec. (Mollie Field) Therapist (Lori Eisler) Pe rma!!,ent Su pportive Housi ng Residential Case Managers (2) (Victor Oneschuck & Andrew Anderson) Supply Delivery Driver ( Mario Perez) Housing Assistant (Vacant) Independent living SkiNs Specialist (Vacant) (Shani Klapheck) Independent living Skills Specialists SY Apts. (2) (Carole Wallace & Vacant) Residential Case Manager, SLO (2) (Lorraine Espana & Amanda Duda) Medication Manager (Joy McLeod) Program Mentors (2) (Vacant & Justin Holland) Nurse (Kana Esquivel) FRS Personal Svc. Spec. (2) Andrea Magnia & Anthony Benavidez $LO HUB-Therapist (Marie Cheney) CAT Social Worker-(John Klevins) Registered Nurse (Monica Diaz) Supporl Specialist (John Byers) HSP Program Mentor (Kathryn Mueller) Housing & Disability Advocacy Program Case Manager (Shon Hand) (Tony Arnold & Joe Eisler) PATH Me ntal Health Clinician Tim Connely Item 9.a. - Page 133 Division Director. Adult Rehabilitation & Advocacy (Barry Johnson} Mental Health Advocacy & Education Program Manager (Trista Ochoa) Mental Health Advocate (Danielle Friedrich, Renee Draga) Behavioral Health Navigator (2) (Tricia Righelti & Anthony Clementi) SLO Health Integration Project (SLO HIP) (Alexandria Kelso & Kelly Wilson) TARP Navigator (2) (Arthur Thompson & Vacant) PAAT Assistant (Renee Draga) Peer Advocacy & Advisory Team (PAAT) P"-!f.J11:mance/O~omes Performance & Outcomes Evaluator (Madeleine Smith) Community Outreach Outreach & Volunteer Coordinator (Caroline Cerussi) Volunteer Support (Caity Mccardell) In Our Own Voice Speakers Stamp Out Stigma Speakers SLO Wellness Ctr Hope House Supervisor (Julie Baker) SLO Wellness Ctr Hope House Assnt. Supv. (Joseph Stewart} SLO Wellness Ctr Hope House Support Aide (Steve Hrenak) Family Services Program Manager (Shawn Ison) Family Advocates (2) (Vivian Soul & Fernando Vasquez) Youth Family Partners (3), (Patty Ramirez, Laura Gaisie, & Jose Gonzalez} Temp Youth Family Partner (Linda Quesenberry} SLO Wellness Programs Program Manager (Meghan Madsen) Administrative Assistant (Judy Creason} AG Wellness Ctr Safe Haven Supervisor (Erika Duran} AG Wellness Ctr Safe Haven Assnt. Supv. (Hillary Lawson) AG Wellness Cir Safe Haven Support Aide (David Draggoo} Mental Health First Aid (MHFA) Wellness Recovery Action Plan (WRAP) Peer to Peer (P2P} Diylsjon Director. Vocational Advancement (Frank Riccerll SLOHotline Program Manager (lleara BrolMl) Call Handlers (5) (Kerianne DiTomasso, Victoria Mulhall, Shannan Bauman, Melody Grigg} High School Project Manager (Michael Kaplan) Trainer (Amy Waddle-contract) Mental Health Partner (Danielle Fliedrich} AdyJl Transitional Program (ATP) Program Manager (Tom Quintana) Residential Adult Counselors (Danny Bryant, Anne Harris, Phil Hill, Karen Larson, Justin Miller, Greg Dorman, Brittany OBIT, Karen Akre, Dot Lynch, Katy Hansen, Eric Urbain) Atasc. Wellness Ctr. Life House Supervisor (Susan Gaoiran) Atasc. Wellness Ctr. Life House Assnt. Supv. (Brandy Billington} Atasc. Wellness Ctr. Life House Support Aide (MaryGrace Valdez) Growing Grounds Downtowo Program Coordinator (Christine Story} Retail Sales Clerl<s (3) (Linda Neugent, Lela Whittier & Caitlin Cradick) Growing Grounds Farm & Nurs§CY. SLO Assistant Program Manager (Nick Deinhart) Nursery AssistanUDriver (\/1/ayne Tyo} Nursery Sales Representative (Mary Barnhill) Rehabilitation Supervisor (Dianne Pelletier) Weekend Caretakers (3) Growing Groynds Farm & Nursery. SM Program Manager (Ariela Gottschalk) Farm Supervisor (Christine Story) Program Supervisor (Anna Wiens) Rehabilitation Assistant (Shauna Conn) Farm Worl<ers PfT Vocational (20-50) Supported Employment Program Manager (Starr Cloyd) Vocational Specialist (3), (Garrett Frice, David Wheeler, & Megan Manuel) Assessment Specialist (Michelle Madgett) Job Coach (3) Supportive Community Services Team Leader (Jenna Reyes) Temp Lead Clinician (Megan McGuire) Office Coordinator (Alejandra Huitron} Rehabilitation Specialists (4) (Janine Jeter, Steve Sanvictores, Lisa Jimenez & Zondra Gonzales) Clinical Rehabilitation Specialist (2) (Raymond Cisneros & Adi Hendler} Psychiatric Nurse (Elvira Uribe Pantoja) Medication Support (Kimberly Cattaneo) Farm Worl<ers PfT Vocational (40-60) Division Director. Northern Santa Barbara County (Christina Hamey) Adult Wellness Programs Program Manager (Steve Greene} Recovory Le arning Communitv-SM Program Supervisor/ LEAD Outreach Coordinator (Denise Manriquez) Assistant Center Supervisor (Gabriela Chavez) Hosts (3-5) Computer Lab Technicians (2) Support Leader (Clara Cobb) Recovery Learning Community-Lompoc Program Supervisor (Sandy Rives) Assistant Center Supervisor (Milton Washington} Hosts (5-7) Computer Lab Technicians (2) Support Leader (Vacant) Partners In Hope Program Manager (Sha1M1 Ison) Family Partners (2) (Maria Perez & Janine Cruz) (Brie Phillips, Caitlin Cradick, Natalia Stmeson Training & Employment Specialist (Jorge Huerta) Lompoc Act Team Leader (Vacant) Lead Clinician (Mano] Sharma} Office Coordinator (Laura Hansen) Administrative Assistant (Stephanie Flores) Substance Abuse Specialist (2) (Chirala Pillay & Jane Darrah) Vocational Specialist (Meghan Bradley) Clinical Vocational Specialist (Shuriee Gioieni) Personal Services Coordinators (3) (Maria Martinez, Evelyn Valencia-bilingual-& Bob Strangfelcl-Russell} Clinical Personal Services Coordinator (1) (Seth Tucker} Item 9.a. - Page 134