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CC 2020-06-09_11a JGCSGP Allocations_2020 MEMORANDUM TO: CITY COUNCIL FROM: WHITNEY McDONALD, ACTING DEPUTY CITY MANAGER/ COMMUNITY DEVELOPMENT DIRECTOR BY: ANDREW PEREZ, ASSISTANT PLANNER SUBJECT: CONSIDERATION OF JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM ALLOCATIONS FOR YEAR 2020 DATE: JUNE 9, 2020 SUMMARY OF ACTION: Approving the 2020 Jim Guthrie Community Service Grant Program allocations will assist local non-profit organizations implement various service programs that directly benefit Arroyo Grande residents. IMPACT ON FINANCIAL AND PERSONNEL RESOURCES: The City Council approved $20,000 in the FY 2019-20 Budget for the Jim Guthrie Community Service Grant program. There is no other fiscal impact other than staff time related to administering the program. RECOMMENDATION: It is recommended the City Council adopt a Resolution approving projects to be funded through the Jim Guthrie Community Service Grant Program funds. BACKGROUND: In response to federal Community Development Block Grant (CDBG) funding limitations and restrictions, the City established the Jim Guthrie Community Service Grant Program (JGCSGP) in 2014 as a means of providing funding for community service projects 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 residents. This year, the City received a total of sixteen (16) applications requesting a total of $66,630. For comparison, a total of ten (10) applications were submitted in 2019, requesting a total of $30,210. Applications for JGCSGP are reviewed by the Community Service Grant Committee (Committee). The Committee consists of one member from the Planning Commission, Item 11.a. - Page 1 CITY COUNCIL JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM ALLOCATIONS FOR YEAR 2020 JUNE 9 , 2020 PAGE2 one m embe r from t he A rchitectura l Review Comm ittee, one m embe r from t he Dow ntow n Pa rking Adv isory Board , one membe r from the Arroyo Grande Tourism Bus iness Improvement District Boa rd, and one member from t he South County Chamb er of Commerce Boa rd of Directors . T his Committe e convened on May 28 , 2020 , v ia tel econ fe re nce , to review t he applicat ions and make f undin g recom mendations to City Co unci l. ANALYSIS OF ISSUES: T he Committe e voted to present the follow ing fu nd ing recommendat ions listed in Tab le 1 be low (re com mendations a re in the far right co lumn) for app rova l by Co unci l : Table 1: 2020 JGCSGP Summarv of APPiications (Listed in Order Received GRANT GRANT NAME OF NON-PROJECT SUMMARY AREA AMOUNT AMOUNT REVIEW PROFIT SERVED RECEIVED REQUESTED PANEL IN 2019 IN 2020 1) Arroyo Grande 5 electrical uti lity boxes AG $750 $6,000 $0 Public Art to be pa inted as public art exhibits. 2) SCORE San Entrepreneu r SLO n/a $1,000 $500 Luis Obispo education. Cou nty 3 ) Five Cities Purchase f ood for Five Cit ies n/a $4 ,000 $2,500 Meals on Wheels res idents in A r royo Grande. 4) Big Brothers Staff time f o r t ra ining, SLO $3,000 $5,000 $0 Big Sisters of screening, en roll ing County SLO County and matching f amilies (e mphas is and volu nteers w ith in on City of the City of AG . AG ) 5) Assistan ce Ope ration School Bell SLO $3,000 $3,000 $2,500 League of SLO (clo thing for Cou nty County impoverished K-1 2th arade students ). 6) Five Cities Education and tra ining Five Cit ies $1,000 $2 ,500 $1,000 Diversity progra m . Coalition 7) Shower the Provi d ing hot show ers SLO $2,500 $2 ,500 $2,500 People f or the home less. Cou nty 8) Meals That Meals for 5 sen iors in SLO $4 ,375 $5,000 $2,500 Connect AG for a yea r. Cou nty (Senior Nutrition Program) Item 11.a. -Page 2 CITY COUNCIL JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM ALLOCATIONS FOR YEAR 2020 JUNE 9, 2020 PAGE3 GRANT GRANT NAME OF NON-PROJECT SUMMARY AREA AMOUNT AMOUNT REVIEW PROFIT SERVED RECEIVED REQUESTED PANEL IN 2019 IN 2020 9) Tra ns it ions Funding for a S LO $750 $750 $0 Me nta l Hea lth Computer Skills County Associati o n Workshop in t he Safe Haven Wellness Cente r. 10) CASA of S a n Recru itment, S LO n/a $3,000 $1,500 Luis Obis po screening, t raining and County supervising commun ity (em phas is volunt eers to advocat e on AG) for abused and neglected ch il d ren w ho are unde r t he j ur isd ict ion of t he Juven ile Dependency Court . 11 ) Ocean Vi ew Implement Ed ibl e AG n/a $3,900 $0 El e me ntary PTO Schoo lyard Program. 12) Food Ba nk Staffing to coordinat e AG n/a $2,000 $1,0 00 Coalit io n of SLO food distribution. Co unty 13) 5 Citi es Rap id rehousing and Five Cit ies n/a $2 0,00 0 $5,500 Ho me less eviction prevention, Coali t io n w arm ing center, an immed iat e needs. 14) Life S teps T raining for 24 staff S LO n/a $3,000 $50 0 Found ation members. County Ce nt ral Co ast Adul t Se rvi ces 15) Ca mp Fire Program S LO n/a $4 ,480 $0 Ce nt ral Co ast of adm inistration . County Ca liforni a 16) Five Ci ties Liabi lity insu rance and Five Cit ies n/a $500 $0 Re pai r Caf e repai r suppli es . TOTAL: $66,630 $20 ,000 In mak ing t he recomme ndat ions iden t ified above , t he Committee w ished to foc us prima rily on funding projects and programs t hat direct ly ass ist ind ivid uals t hat have been affected by the c urrent COV ID-19 pandemic . T he Committee specifically prio ri t ized organizat ions t hat provide food , she lter, and clothing for t hose in need and t hat can Item 11.a. -Page 3 CITY COUNCIL JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM ALLOCATIONS FOR YEAR 2020 JUNE 9, 2020 PAGE 4 effectively render their services during the COVID-19 pandemic. Other screening criteria included: whether the funds go directly to products and services for clients (versus administration costs); how many local Arroyo Grande residents are served; an organization’s existing funding base (whether the requested funds are necessary for the project or program to succeed); and whether volunteers and/or fundraising efforts could accomplish the project or program goal(s) in-lieu of the grant funds. Staff recommends that Council approve the JGCSGP funding recommendations made by the Committee, as detailed in the table above and in the accompanying resolution. ADVANTAGES: The City’s JGCSGP provides a funding opportunity, separate from the CDBG program, for local public service programs that address unmet needs in the community. DISADVANTAGES: Due to an increase in the number of non-profit agencies that submitted applications, the COVID-19 pandemic, and the total amount of funds requested ($66,630) compared to requests received in 2019 ($30,210), six (6) of the sixteen (16) non-profit agencies are not recommended to receive funding. In 2019, every request was at least partially funded and three (3) requests were fully funded. ALTERNATIVES: The following alternatives are provided for the Council’s consideration: 1. Approve JGCSGP funding for the projects as proposed for the Year 2020; 2. Modify and approve JGCSGP funding for projects for the Year 2020; or 3. Provide direction to staff. ENVIRONMENTAL REVIEW: The allocation of JGCSGP funds is not considered a project under the California Environmental Quality Act (CEQA). PUBLIC NOTIFICATION AND COMMENTS: The Agenda was posted at City Hall and on the City website in accordance with Government Code Section 54954.2. Attachment: 1. 2020 JGCSGP Applications (less financial statements) Item 11.a. - Page 4 RESOLUTION NO. A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF ARROYO GRANDE APPROVING JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM PROJECTS FOR YEAR 2020 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 sixteen (16) applications for the 2020 JGCSGP; and WHEREAS, the City Council established a JGCSGP Community Service Grant Committee (the "Committee") consisting of one member from each of the City’s current advisory boards and the South County Chamber of Commerce Board of Directors; and WHEREAS, the Committee convened via teleconference on May 28, 2020, in compliance with all applicable laws and orders, including the Ralph M. Brown Act as modified by the Governor’s Executive Order N-29-20, to review the applications and recommended funding allocations, as indicated in Exhibit "A"; and WHEREAS, on June 9, 2020, the City Council considered the recommendations of the Committee and approved funding for certain proposed JGCSGP projects. NOW, THEREFORE, BE IT RESOLVED that the City Council of the City of Arroyo Grande hereby approves funding for the 2020 JGCSGP projects as set forth in Exhibit “A" attached hereto and incorporated herein by this reference, subject to all of the rules, requirements, and regulations applicable to the JGCSGP and its grant recipients. On motion by Council Member_______, seconded by Council Member_______, and by the following roll call vote, to wit: AYES: NOES: ABSENT: the foregoing Resolution was adopted this 9th day of June, 2020. Item 11.a. - Page 5 RESOLUTION NO. PAGE 2 ____________________________________ CAREN RAY RUSSOM, MAYOR ATTEST: ____________________________________ KELLY WETMORE, CITY CLERK AS TO CONTENT: ____________________________________ BILL ROBESON, ACTING CITY MANAGER APPROVED AS TO FORM: ____________________________________ TIMOTHY J. CARMEL, CITY ATTORNEY Item 11.a. - Page 6 RESOLUTION NO. PAGE3 EXHIBIT 'A ' Arroyo Grande 2020 Jim Guthrie Community Service Grant Program NAME OF NON-AREA APPROVED PROJECT SUMMARY GRANT PROFIT SERVED AMOUNT SCORE San Luis En trep reneu r SLO County $500 Obispo education . Five Cities Meals on Purchase food fo r Five Cities $2,500 Wheels resident s in Arroyo Grande . Assistance League Operati on School Be ll SLO County $2,500 of SLO County (cl othing fo r impoverished K-12th g rade students). Five Cities Diversity Education and t ra ining Five Cities $1,000 Coalition prog ram . Shower the People Provid ing hot show e rs SLO County $2,500 for the homeless. Meals That Connect M eals fo r 5 seniors in SLO County $2,500 (Senior Nutrition AG for a year. Program) CASA of San Luis Recruitment , SLO County $1,500 Obispo screen ing , t ra ining and (emphasis su pervis ing co mmunity on AG ) voluntee rs to advocat e for abused and neglected children w ho are unde r the jurisdiction of the Juvenile Dependency Court. Food Bank Coalition Staffing to coord inate AG $1,000 of SLO County food d istribution . 5Cities Homeless Rapid rehous ing and Five Cities $5,500 Coalition evic ti on prevent ion , w a rm ing center, an immed iat e needs. Life Steps T ra ining f o r 24 staff SLO County $500 Foundation Central membe rs . Coast Adult Servi ces Totals: $20,000 Item 11.a. -Page 7 Item 11.a. - Page 9 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON-PROFIT ORGANIZATION: (broken down by age groups if available). Virtually all 18,000 residents and the 15,000 annual out of town tourists (Source: 2016 -2017 Arroyo Grande Tourism Business Improvement District, https://www.arroyogrande.org/AgendaCenterNiewFile/ltem/52757filelD==9286) benefit from all art installations as they enhance the aesthetics of the City of Arroyo Grande, promote civic pride, and make our city even more appealing and engaging to residents and tourists alike. I VI. $6,000 AMOUNT OF FUNDS REQUESTED: 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). AGPA has identified five (5) electrical utility boxes throughout Arroyo Grande, four (4) of which are on the West Side of Arroyo Grande where there is currently minimal public art, that would be painted with art that also adheres to the Public Art Guidelines put forth by the Community Development Department of the City of Arroyo Grande. The monies will be used to fund $1,200 per utility box inclusive of all artist' s fees, art "ownership" stipend, paints, and materials. 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). September 18, 2019: AGPA received $750 for the Monarch Butterfly Sculpture at the South County Regional Center IX. SUPPLEMENTAL DOCUMENTATION: Ii] Past two (2) years financial statements, including the current year with the balance sheets and the profit/loss statements. [i] Information indicating the percentage of revenue received that is used for administration, salaries, and program costs. lil Breakdown and description of non-profit organization's sources of revenue. [i] 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 an organization chart. Item 11.a. - Page 10 X. CERTIFICATION: I certify on behalf of Arroyo Grande in Bloom/ Arroyo Grande 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 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 2019 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: /!U~/;r Signature: l/ Executive Din{ or o(!?esignee Board of Dire~ Item 11.a. - Page 11 RECEIVED NOV 1 4 2019 COMMUNI TY DEVE LO PME NT CITY OF ARROYO GRANDE CI T Y OF ARROYO GHANDE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM APPLICATION FORM 2019-20 Please complete the following sections: (use additional sheets as necessary) I. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION: (must be the local branch) San Luis Obispo SCORE Chapter 597 1228 Broad St. San Luis Obispo , Ca.93401 II. GRANT APPLICANT REPRESENTATIVE'S NAME, ADDRESS, EMAIL ADDRESS AND TELEPHONE NUMBER: (must be the Executive Director or their designated representative). Bob Kerwin Arroyo Grande 93420 bob.kerwin@scorevolunteer.org . Ill. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: SCORE is a national non-profit SBA resource organization . SCORE's mission is to foster v ibrant small business communit ies through mentoring and education. Our loca l SCORE chapter has 30 volunteer members who work to help and advise owners who are already in business and people that want to start a business. Why do we feel we can and will help our clients? Our chapter is an award winn ing chapter. We placed 2nd in the most recently released 20 18 Price Waterho use Coopers Client Satisfaction survey. We have also received a top National award for the last 5 years, which places us in th e top 4% of all 300 National SCORE chapters. In 2019 we held 668 mentoring sessions, 66 workshops, for a t otal of 1616 services performed . SCORE Mentors provide confidential face -to -face mentoring sessions including follow-up sessions , monthly workshops, E-mail and phone mentoring , and we are add ing video mentoring. We also provide a v ariety of training materials on our website. Item 11.a. - Page 12 Continued from: Ill. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: SCORE is unique in a number of ways: We will mentor anyone who asks for help, we have no screening requirements. We co-mentor our clients; our early mentoring sessions are always with two mentors. We strongly believe two heads are better than one. We will mentor our clients for as long as the client needs our support. We have clients that stay with us for years. Our motto is: "For the life of your business". We give our clients our home phone numbers and email addresses so that they can get help more easily and quickly when necessary. No SCORE San Luis Obispo chapter client ever pays for a local SCORE service. SCORE Mentors are all volunteers, receiving no compensation. Every penny we receive from our sponsors goes to help reach and support our clients. Our mentors volunteer specifically because they want to help our clients be successful. That is our reward. 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). San Luis Obispo County SCORE is the local chapter of the national SCORE organization. We have provided service in the SLO area, including Arroyo Grande for over 37 years. Locally we offer free mentoring services and free workshops to clients that are considering starting a small business or already have a business that they are looking to grow. We service the entire SLO County area plus the Santa Maria Valley. The clients that we help include small business owners, individuals preparing to form a new company and anyone with an idea for a new product or service that needs professional advice. We have 30 active SCORE mentors. Although many of our volunteers are retired, some are still working and also volunteer for SCORE. V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON-PROFIT ORGANIZATION: (broken down by age groups if available). We held 15 new mentoring sessions and 35 follow on sessions with Arroyo Grande residents. Since our workshop attendees often do not indicate their city of residence we estimate the number of Arroyo Grande workshop attendees to be approximately 71. Age is even more difficult, however we mentor and see workshop clients ranging from early 20's to over 60's. 42% of our clients are already in business. Item 11.a. - Page 13 VI. AMOUNT OF FUNDS REQUESTED: We are requesting a donation of $1,000. 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). These funds will be used to continue supporting and expanding our services to all businesses in our service area. Funds will be used to support workshop offerings. In particular to support workshops in the areas of financial education, the critical role of Social Media in small business operations today and how to use technology to retool existing businesses to take advantage of the opportunities available to them through e-commerce. To provide clients with copies of our printed booklets, publications, workshop materials and educational software. To continue to update our ability to make online data and resources, training and information more accessible to clients and to be able to provide virtual workshops and webinars. To acquire and train additional local SCORE members to provide the mentoring and workshop services needed by our clients throughout the County and to each local community we serve, including Arroyo Grande. No funds donated to our chapter will be used by the national office, they are funded by the SBA. 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). 2015 $450, 2016 $500, 2017 $500, 2018 $500, 2019 $0 (missed deadline, My fault) All funding was utilized to support our normal operating costs: workshops (rental and handout material), face face mentoring (office rent and handout materials) and general overhead expenses. Item 11.a. - Page 14 IX. 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 San Luis Obispo SCORE 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 2019 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. I Date: //j;~/J.01 ~ Signature: ;::zL,2i,,_,,,__________ J-k_,_.,,, < -"' "" Executive Director or Designee -CA"'V<... t3 J2 J-(.P'W'~ (?\.,._,;'- Board of Director or Officer Item 11.a. - Page 15 RE(;E IV ED NOV 2 G 20 19 CITY OF ARROYO GRANDE COMMUNITY DEV ELO PMENT JIM GUTHRIE COMMUNITY SERVICE GRANT PROG (MTY OF ARROYO GRANDE APPLICATION FORM 2019-20 Please complete the following sections: (use additional sheets as necessary) I. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION: (must be the local branch) Five Cities Meals on Wheels P.O. Box 156 Pismo Beach , CA 93448 II. GRANT APPLICANT REPRESENTATIVE'S NAME, ADDRESS, EMAIL ADDRESS AND TELEPHONE NUMBER: (must be the Executive Director or their designated representative). Kathy Bear, Director P.O . Box 156 Pismo Beach , CA 93448 5citiesmowpb@gmail .com 111. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: We are a non-profit organization , that has served a hot meal to homebound clients in the Five Cities area for the past 43 years . Clients that are qualified as homebound , either temporarily or long-term , sign up to receive a hot meal , delivered to their door, Monday through Friday. Our services make quite an impact on our clients , sometimes serving as the only person they may see that day , and for some , sadly, the on ly food they have to eat for the day. Our services often allow our c lients to remain in thei r homes lo nger, as they are able to have a complete meal each weekday . Many of our clients have chronic illnesses t hat keep them from standing for a prolonged period of time , so cooking a meal is difficult or even impossible for them . Some have no access to obtain food at the grocery store. The social connection we make each day is a big part of our service as wel l. It helps ease loneliness and isolation. Our clients share tha t it means so much to them, to know someone cares. At times, we have found clients in distress, and have been able to place a 911 call to help the person rece ive medical care in time . Item 11.a. - Page 16 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). Five Cities Meals on Wheels serves Arroyo Grande, Grover Beach, Oceana, Pismo Beach, and Avila Beach. Over the past year, 37% of our clients, the most of any city we serve, reside in Arroyo Grande. We served 55 people residing in Arroyo Grande. This year we have had an increase in the number of clients in Arroyo Grande and also an increase in very low-income referrals we are receiving from outside agencies for clients in Arroyo Grande. The funds we receive for this grant enable us to purchase food to serve our clients in Arroyo Grande, and will allow us to purchase the food needed for these additional clients that have very low, or no income to contribute toward their meals. V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON-PROFIT ORGANIZATION: (broken down by age groups if available). We served over 13,200 meals to 55 Arroyo Grande residents during 2019. Our clients age groups are as follows: 90+: 14 70-89: 22 59-69: 10 Under59: 9 VI. AMOUNT OF FUNDS REQUESTED: $4,000 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). We are requesting $4,000 to help us purchase food for our residents in Arroyo Grande. The additional funding would allow us to reach more clients in Arroyo Grande, especially those that are low income. 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). We thank you for granting us $4,000 in 2018 to help us serve our clients. We have chosen to use that money to serve residents in Arroyo Grande, by purchasing food needed to cook our meals. We are extremely grateful for these funds. We hope you will consider granting us $4,000 in 2020 as it goes a long way to purchase much needed food for residents of Arroyo Grande. Item 11.a. - Page 17 IX. SUPPLEMENTAL DOCUMENTATION: .@ Past two (2) years financial statements, including the current year with the balance sheets and the profit/loss statements. 1M 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 Five Cities Meals on Wheels 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 2019 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: f 1/~/19, l::r_1-4~XQtJ?~ Board of Director 6r Officer I Item 11.a. - Page 18 RECEIVED NOV 2 7 2019 CITY OF ARROYO GRANDE COMMUNITY DEVELOPMENT CITY OF ARROYO GRANDE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM APPLICATION FORM 2019-20 Please complete the following sections : (use additional sheets as necessary) ll A-f'v'\ I. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION: (must be the local branch). Ocean View Elementary PTO 1208 Linda Drive Arroyo Grande, CA 93420 II. GRANT APPLICANT REPRESENTATIVE 'S NAME , ADDRESS , EMAIL ADDRESS AND TELEPHONE NUMBER: (m ust be the Executive Director or the ir designated representative). K ari Si nner, P TO Secretary and Board member Ar royo Grande, CA 93420 Ill . DESCRIPTION OF COMMUNITY SERVICES PROVIDED: The Ocean View Elementary PTO provides students and teachers with extra support tha t will further enhance their education . This grant proposal will support the implementation of the-PTO 's Edible Schoolyard project which w ill give students access to a technology -based home-grown garden as well as the hands-on experience of growing fruits and vegetables. The attached pamphlet provides additional details. including our long term vision of teaching nutrition and food science with a kitchen classroom. The future Edible SChoolyard is located in a unique ·re cyciect· space. previou sly unused for many yea rs. In an old handball court , the asphalt was recently removed and recycled for other projects around the county . The concrete wa ll will be upcycled into a canvas with art, garden rules. inspirational quotes and a learning curriculum wh iteboard. We plan to create a "Li ving Classroom" in the Edible Schoolyard with this grant including: 1. Two outdoor educational classrooms with whiteboards on either side of the concrete block wan. This will enable garden educators/teachers to spm into stations/groups and rotate between different lessons. 2. Multiple gar den beds surrounding each whiteboard with built-in seating for classroom instruction. 3. Row covers for each garden bed to grow seeds and plants in winter, extending the growing season throughout the school year . IV. LIST AREA(S) SERVED BY NON-PROFIT ORGANIZATION: (i nclude a brief description of the relationship o f your non-p rofit o rganiza tio n to the res idents of the City of A rroyo Grande). The Edible Schoolyard project will primarily be used to teach garden-based science, mathe matics, engineer ing, art and social studies curriculum to students at Ocean View Elementary, including all grades Kindergarten -6th grade. In other similar school gardens, the result has been that families c r eate edible gardens at home and eat healthier as wel l. It will also encourage other groups and schools to implement simil ar projects. The Edible Schoolyard will serve as a gathering place for local schools and service groups to join together to build and maintain a sustainable garden for the community. We envision a garden where community members w ill help maintain the space during summer months w h en students are not on campus. while growing their own fruits and vegetables for their families and neighbors . Item 11.a. - Page 19 RECEIVED NOV 2 o 2019 COMMU NITY DEVEL OPME N T C ITY O F AR RO YO G RANDE C ITY OF ARROYO GRAND~~--------=:J JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM APPLICATION FORM 2018-20 Please complete the followi ng sections: (use additional sheets as n ecessary) 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 t he Executive Director or their designa ted represen tative). Helen Robertson P.O. Box 14260, San Luis Obispo, CA 93406 Ill. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: Assistance League of San Luis Obispo County was incorporated in 1991 and chartered as the 95th cha pter o f National Assistance League in 1996. Operation School Bell was adopted in 1995 as its philant hropic program. Operation Schoo l Bell provides a most bas ic need-clothing. Since 1995 more than 28,000 students from low-income families have been provided with school appropriate clothing in San Luis Obispo County. A ss istance League provides to Kindergarten -12th grade students in need, living and attending school in all ten school districts in the County: new, school-appropriate clothing; a dental hygiene kit; a grade-appropriate book of each student's choosing; and a tote filled with grade-appropriate school supp lies . Tue 2019-20 program budget will provide school clothing to 2 ,0 00 underserved students . At the end of the fiscal year, our chapter will access the program database to confirm the number of students clothed, their age, gender, grade in school, school and city o f residence. Item 11.a. - Page 20 DESCRIPTION OF COMMUNITY SERVICES PROVIDED: (cont.) Operation School Bell was founded with the belief that for students to succeed academically and socially they need to have appropriate clothing which positively affects their educational experience through regular attendance. In November of 2018, the chapter conducted a Measured Outcomes Survey for the second year. All schools in the ten school districts were asked about the impact of Operation School Bell on their students. The chapter again. received a 100% response from the schools. 70% indicated they observed a positive change in classroom behavior; 10% observed a significant change. 67.5% reported that they observed a positive change in student confidence; 24.7% observed a significant change. 71 % observed a positive change in the level of engagement with peers and/or school activities. 15/6% observed a significant change. There were no negative responses. Assistance League wants each student to be able to maximize his/her educational opportunities and succeed academically and socially. San Luis Obispo County schools have so many strong programs for these students to use their natural talents and creative abilities to shine -athletics, band, choir, drama, FF A. We want them to feel confident enough to participate. 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 187 students from the City of Arroyo Grande. Assistance League member volunteers provide the referring entities with the referral dates and times for students to be clothed. The students are met by Assistance League volunteers at a retail store location, Kohl's in North County and Old Navy in South County. Our direct contact with students and their families is becoming more and more rare in the nonprofit world. With our tax-exempt status and store discounts each K-5th Item 11.a. - Page 21 LIST AREA(S) SERVED BY NON-PROFIT ORGANIZATION: (cont.) grade referred student receives $150 in clothing and shoes, and each 6th-12th grade student receives a $185 in clothing and shoes. The San Luis Obispo County Office of Education reports that 40% of students attending school in San Luis Obispo County are living in poverty. That totals 13,102 underserved students. Of that number 4,434 are from the Lucia Mar Unified School District. V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON- PROFIT ORGANIZATION: (broken down by age groups if available). We currently have 135 members. We are scheduled to clothe 221 students from the City of Arroyo Grande this school year. That is a dollar amount of $31,590. 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 Operation School Bell grant funds received would be used only to purchase clothing for students residing in the City of Arroyo Grande. We are an all-volunteer organization. We have no paid staff and do not fund salaries. The $3,000 grant would enable us to clothe thirteen Kindergarten -5th grade students, and ten 6th through 12th grade students. 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 2018-19 fiscal year, Assistance League clothed 2,180 which exceed our budgeted goal of2,000. Of the 2,180 students, 187 were from the City of Arroyo Grande. Item 11.a. - Page 22 ADDITIONAL DOCUMENTATION: (cont.) In the 2018-19 school year we received $3,000 from the City of Arroyo Grande for Operation School Bell. This allowed us to clothe thirteen Kindergarten -5th grade students and ten 6th through 12 grade students. IX. SUPPLEMENTAL DOCUMENTATION: ~ Past two (2) years financial statements, including the current year with the balance sheets and the profit/loss statements. 0 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. 0 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. Item 11.a. - Page 23 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 2019 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 26, 2019 Signature: Executive Director or Designee Pre/~-6 ~ Board of Director or Officer Item 11.a. - Page 24 CITY OF ARROYO GRANDE RECEIVED NOV 1 8 2019 COMMUNIT Y DEVELOPMENT CITY O F ARROYO GRAN DE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM APPLICATION FORM 2019-20 Please complete the follow ing s ections : (use additional sheets as necessary) I. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION : (must be the local branch). Diversity Coalition San Lu is Obispo County PO Box 376 Arroyo Grande , CA 93421 II. GRANT APPLICANT REPRESENTATIVE 'S NAME, ADDRESS, EMAIL ADDRESS AND TELEPHONE NUMBER: (must be the Executive Director or their designated representative). Joe Whitaker, Board of Directors Member Arroyo Grande, CA 93420 Ill . DESCRIPTION OF COMMUNITY SERVICES PROVIDED: Form ed in 2011, as th e Five Cities Diversity Coalition, du e to a community wide reaction to an infamous hate crime in Arroyo Grand e, th e Coalition for past eight years, has been providing programs and resources promoting and advocating fo r the ineluslon and affirmation of Diversity In our community and countering any negative acts or prejud ice or bias aga inst ou r citizens . The Coalition's Boa rd and Members inclu de representatives from local government, education , business, r eligious and non-p rofit organizations , plus the comm un ity at-la rg e. The Coalition is responsib le for th e major pub li c arts proje ct. "Arboring Our Roots of Di versity" sculpture , now resid ing at the entrance of Arroyo Gra nde High School, an enduring sym bol of the impo rtance of Divers ity In ou r co mmunity. The Coalition's highly sucoessful "Community Diversity Educatio n and Trai ning Program", as detail ed below. ls now comp le ting Its third year. In Janua ry , 2019 , the Coalition, in recognition of its efforts now rea ching well beyond the Five Cities area, renamed itself, Diversi ty Coalition Sa n Luis Obs ipo County. IV. LIST AREA(S) SERVED BY NON-PROFIT ORGANIZATION: (include a brief description of the relationship of your non-profit organiz ation to the residents of the City of Arroyo Grande). The Coalition will continue to focus its efforts in the entire Five Cit.Jes area (Arroyo Grande, Grover Beach , Pismo Beach , Oceana, and Halcyon) plus N lpomo , but now als o includes the ci ties o f San Luis Obispo an d Morro Bay, pl us the a reas of Avila Beach and Los Osos. In general, the Coaliti on's efforts serve t he e nt ire popu lation of Arroyo Grande, adding to our community's spirit , hea lth , well-being a nd econom ic future . Specificall y, components of the principa l Coalition's 2019-2020 effort, its "Community Diversity Education and Training Progra m•, wi ll continue to serve the City of Arroyo Gran de's schoo l age population and their teachers. Item 11.a. - Page 25 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON-PROFIT ORGANIZATION: (broken down by age groups if available). By the end of the 2018-19 school term, the School Speakership component of the Program served 1660 total Arroyo Grande students. During the 2019-20 school year (details below in section VII), the program will serve an estimated additional 1000 students attending Arroyo Grande High School, Paulding and Mesa Middle Schools. The Teacher Training component of the Program will continue to serve the entire teaching staff of City of Arroyo Grande's schools. VI. $2500.00 AMOUNT OF FUNDS REQUESTED: 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 sheet for this section's text. 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 2013 the City of Arroyo Grande donated $1000 to the Coalition's Sculpture Fund and an additional $500.00 in 2015. These funds were used to design, build and install the "Arboring Our Roots of Diversity" statue at the entrance of Arroyo Grande High School. In March, 2019 the city appropriated $1000.00 towards the Coalition's 2018-19 "Community Diversity Education and Training Program". These funds were used to send Ocean View and Harloe Elementary School teachers to the Los Angeles Museum of Tolerance's two-day diversity training class. These teachers in tum shared this information and insights with their colleagues. 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 11.a. - Page 26 Section VII The 2019-20 COMMUNITY DIVERSITY EDUCATION AND TRAINING PROGRAM is composed of two functions: 1. SCHOOL SPEAKERSHIP. The Coalition funds appearances of nationally and internationally known authors, speakers and playwrights, whose one and two day visits provide a culmination to rich, extensive units of diversity study; all in all, a meaningful and impactful experience for their student audiences. Oln September,our most recent speaker, Fanshen Cox, performed her one-woman play, "One Drop of Love", her journey as a mixed-race woman in America, before hundreds of students at the Clark Center. In Spring 2020, the Program will visit Arroyo Grande schools at least three times. In January, Leslie and Rita Lurie, Holocaust survivors, will speak before the 8th grade classes at Paulding and Mesa Middle Schools. In March, Joseph Jok, a former refugee and International Rescue Committee executive, will speak to the 7th graders at t~ese same schools. In May, Karl-Emmanuel Nkezimana and Davy Nzigamasabo, Burundian refugees, will appear before the 10th grade students of Arroyo Grande and Ni porno High Schools. In the future, the Program will be extended to Arroyo Grande's 5th and 6th grade elementary school students, with speakers deemed appropriate. As always, all speakers are chosen in consultation with and approved by Lucia Mar School District officials and principals. 2. TEACHER TRAINING. The goal of this Program component is to instill an awareness of human rights and the importance of diversity into their daily instruction. The Coalition funds selected teachers to visit such sites as Los Angeles Museum ofTolerance's two-day seminar designed to "advance anti-bias education and promote inclusive and equitable schools" and attend such events as the annual Human Rights Watch award dinner in Santa Barbara. A stipulation of this funding is these teachers share what they learned with their colleagues. Any monies granted the Coalition go directly to these ends. Coalition Board Members receive no salary, no overhead expenses, and as an independent organization, have no national office. Item 11.a. - Page 27 X. CERTIFICATION: I certify on behalf of .P\vaL5t-"fY GJJ At)1iaJ..:5'w ct:iu!J'-Cyflon-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 2019 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: Joe Whitaker Board of Director or Officer Item 11.a. - Page 28 CITY OF ARROYO GRANDE JIM GUTHRIE COMMUNITY SERVICE GRANT PR APPLICATION FORM 2019-20 F?E CE IVED NOV 2 6 2019 COMMU NITY DE VELOPM ENT CI T Y OF ARF~OYO GRANDE 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 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). Gwen Watkins Ill. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: Shower the People is a mobile shower program that provides access to a hot shower to the homeless in our community. We are an all volunteer nonprofit organization that is funded by local churches, organizations, donors and by grants. We have given over 2,000 showers to date this year. Our data shows that guests range from 7 months old to 89. Most of our shower guests are from 24 to 65 years old. 30% of our guests are women. We refer all new guests to the 5 Cities Homeless Coalition for additional services. The Transition 's Mental Health mobile unit is on site every Thursday during our showe r hours. Every shower guest gets a new pair of underwear, new socks, biodegradable soap/shampoo , a toothbrush and toothpaste, a comb and a razor. . ··-·--. . 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 homeless population tends to be transient. During the day they travel the length of Grand Ave and rest in the public parks. Our shower sites at People's Kitchen in Grover Beach and in the CHC parking lot in Oceana are located in areas where the homeless already gather for food or services. We consider our 5 Cities work to include Arroyo Grande. Item 11.a. - Page 29 X. CERTIFICATION: ,~ ( . ··• ,___,. th I certify on behalf of t;) H {) WE R ----r7v / € c) e... non-profit organization, that I have read, understand and agree that the afresaid 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 2019 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 ,__)=1_ .. f;--+1~0a-+--1_ I I I Boa,r.d-6f Director or Officer l Item 11.a. - Page 30 CITY OF ARROYO GRANDE NOV 2 5 20 19 COMMUNJT Y DEVELGr->MENT CI TY O F ARRO YO GRAND~j JIM GUTHRIE CO MMUNITY SERVICE GRANT PROGRAM APPLICATION FORM 2019-20 Please complete the following sections: (use additional sheets as necessary) I. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION: (must be the local branch). Senior Nutrition Program/Meals That Connect, 2180 Johnson Avenue, San Lui s Obispo , CA 93401 II . GRANT APPLICANT REPRESENTATIVE'S NAME, ADDRESS, EMAIL ADDRESS AND TELEPHONE NUMBER: (must be the Executive Director or their designated representative). Elias Nime h, Executive Director· 2180 Johnson Avenue, Sa n Luis Obispo. CA 93401 ; elias@mealsthatconnect.org; Ill. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: Meals T hat Connect/Senior Nutrition Program of SLO County provides free, hot. nutritious noon-time meal s to sen iors who are at least 60 years old. Sen iors who are able to attend can eat m eals at 11 community sites throughout the county in congregate dining . We also deliver meals, with frozen meals for Saturd ay and Sunday, to q ualified seniors who are homebound. We rel y on over 300 volunteers to deliver meals. We are the only program serving senior meals th roughout San Luis Obispo County and the o nly program that includes congregate dining and an opportunity for socialization among the seniors. All of our meals are free to those who are eligible, a lthough some clients choose to make voluntary anonymous donations. Our program has three goals: nutrition. socialization. and safety. Both the congregate d ining 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 physi cal or financial abuse. All staff and volunteers are mandated to re port any suspected abuse. IV. LIST AREA(S) SERVED BY NON-PROFIT ORGANIZATION: (include a brief description of th e relationship of your non-profit orga nization to the residents of the City of Arroyo Grande). MTC serves congregate and home -d elivered mea l s at 11 dining sites throughout the county: in Sa n Luis Obispo at th e Anderson Hotel, the United Church of Christ Congregational, and Judson Terrace; Ata scadero; Ca mbria; Los Osos; Morro Bay; Nipomo; Oceano; Paso Robles ; Santa Margarita. W e serve re sidents of Arroyo Grande through our dining site in Ocea no . Arroyo Grande seni ors ca n eat at our Oceano dining site or receive h ome-delivered meals through that site . Item 11.a. - Page 31 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON-PROFIT ORGANIZATION: (broken down by age groups if available). In fiscal year 2018/19, Meals That Connect served a total of 232 seniors in Arroyo Grande, an increase over the previous year. Of these, 7158 received home-delivered meals and 80 participated in congregate dining. These Arroyo Grande seniors received 22,294 meals in fiscal year 2018/19, at a total cost of $220,710, again an 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). Meats That Connect will use the $5,000 grant to help cover the cost of food. food containers, and labm" costs for serving seniors in the Arroyo Grande community. Grant funding m the amount of $5000 w1U provide meals for 5 seniors in need of good nutritious hot lunch on a daily basis for a full year. The cost of food and food supplies., including labor costs, usually makes up 60% of our total budgel MTC total annual administrative salaries make up 12% of the total budget Budget Plan Food and Food Supplies $1,100 Labor & Benefits $3,000 All other costs $900 Total $5,000 {cost of meals to 5 seniors for full 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 2017 we were awarded $4000. In 2018 we received $4375. In all of those years, the funds were used to purchase food and food supplies for program clients in Arroyo Grande. IX. SUPPLEMENTAL DOCUMENTATION: if Past two (2) years financial statements, including the current year with the balance sheets and the profit/loss statements. ~nformation indicating the percentage of revenue received that is used for administration, salaries, and program costs. ~reakdown and description of non-profit organization's sources of revenue. ~roof of 501 (c)(3) status with a copy of the letter from the IRS. ~opy of the non-profit organizations Board of Directors, Officers and an organization chart. Item 11.a. - Page 32 X. CERTIFICATION: MeJi""lk:t,~~ I certify on behalf of s..,: • ~~ <2~ / non-profit organization, that I have read, understand and agree that the afon:fsaid 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 2019 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: Item 11.a. - Page 33 CITY OF ARROYO GRANDE RECEIVED NOV 2 7 2019 COM MUNITY D EVE LOPMEN T C IT Y OF A R RO YO GRAN DE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM APPLICATION FORM 2019-20 Ple ase complete the f ollowi ng sections: (use additional sheets as necessary) I. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION : (must be the local branch). Transitions-Men tal Health Association 784 High Street San Luis Obispo, CA 93401 On behalf of Life House of Arroyo Grande 203 BridQe Street Arroyo Grande. CA 934 20 II . GRANT APPLICANT REPRESENTATIVE 'S NAME, ADDRESS , EMAIL ADDRESS AND TELEPHONE NUMBER: (must be the Executi ve Director or their designated representative). Barry Johnson, Director -Education and Advocacy Transitions-Mental Health Association 784 High Street San Luis Obis po, CA 93401 biohnson@t-mha.org Ill. DESCRIPTION OF COMMUNIT Y SERVICES PROVIDED: Saf e Haven Wellness Center is a supportive, safe meeting p lace with regu lar activities designed to promote social interaction, independence and menta l health recovery . These include programs in interpersonal re lation sh ips , effective commun ication and confl ict resolution, and the accessing of community resources (therapeutic, hea lth, vocational, educational ). Ind ividu a ls with menta l illness can participa te in cooking c lasses and budgeting classes, receive cop ing ski ll s educat ion , gai n support toward their life goals, enjoy recreationa l activ ities like yoga , connect with others li ving w ith menta l illness , and serve as peer resources . Many have the opportunity to deve lop leadership skills by participating in the Program's operations, and can participate in various j ob skill s needed for Wellness Cente r Employmen t. 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 Barba ra County. We have operat ed a Wellness Center in t he City of Arroyo Grande for 37 years, and Safe Haven opened its doors at its c urrent 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 tha t is located in the City of Arroyo Grande and fami ly support services. Item 11.a. - Page 34 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON-PROFIT ORGANIZATION: (broken down by age groups if available). In 2018-19, Safe Haven Wellness Center served 267 unique participants. Our consumers are either Transitional Age Youth or Adults, participating in cooking classes, yoga, support groups, and other activities. AMOUNT OF FUNDS REQUESTED: 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). We will devote all grant funds to our popular computer Skills Workshop in the Safe Haven Wellness Center. $750 will pay for 50 hours of one-on-one instruction. 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). For the past four years, we have been honored to receive Community Service Grants from the City of Arroyo Grande. The first three were for $500, and last year we were awarded $750. 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. IX. SUPPLEMENTAL DOCUMENTATION: Ii] 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. Ii] 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 organization chart. Item 11.a. - Page 35 X. CERTIFICATION: I certify on behalf of lf<:1N':>ITioN-:,-/t,"i"Jt1... HMt-Tl'I ~11'tl1orJ 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 2019 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: Executive Director or Designee Item 11.a. - Page 36 SAN LUIS OBISPO COUNTY November 26, 2019 City of Arroyo Grande Community Development Department 300 E. Branch Street Arroyo Grande, CA 93420 A ttn: Camilla Karamanlis, Program Analyst RECEIVED NOV 2 6 2019 COMMUN ITY DEVELOPMENT CITY OF ARROYO GRANDE RE: CASA of San Luis Obispo County/ Application for 2019-2020 Jim Guthrie Community Service Grant Dear Ms. Karamanlis: Enclosed please find the original and 11 copies of our grant application and accompanying documents. We appreciate the opportunity to apply forfunding from the City of Arroyo Grande. We value the long- term and supportive re lationship we have with the City of Arroyo Grande. If you need more information or have questions, please contact me or our Executive Director, Teresa Tardiff. Sincerely, Susan Graves Grants & Development Coo r dinator Encl osures United ((;[~ Way ~ P. 0. Box 1168, San Luis Obispo, CA 93406 CASA of San Luis Obispo County (805) 541-6542 FAX 541-5637 • email: staff@slocasa.org • www.slocasa.org A Member of the National CASA Association Item 11.a. - Page 37 ORIGINAL CITY OF ARROYO GRANDE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM APPLICATION FORM 2019-20 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). Court Appointed Special Advocates of San Luis Obispo County, Inc. (CASA), 75 Higuera Street, #180, San Luis Ob ispo, CA 93401 GRANT APPLICANT REPRESENTATIVE'S NAME, ADDRESS, EMAIL ADDRESS AND TELOPHONE NUMBER: (must be the Executive Director or their designated representative). Teresa Tardiff, Executive Director, CASA, P.O. Box 1168, San Luis Obispo, CA 93406, ttardiff@slocasa.org, (805) 541- 6542 ext. 103 DESCRIPTION OF COMMUNITY SERVICES PROVIDED: (See Attachment A) 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). (See Attachment A) NOV 2 6 2019 COMMUNITY DEVEL\_ •q.,;- CITY OF ARROYO GRr. -:.c j Item 11.a. - Page 38 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON- PROFIT ORGANIZATION : (broken down by age groups i f available). (See Attachment A) VI. AMOUNT OF FUNDS REQUESTED: CASA of San Luis Obispo County is requesting $3,000 from the City of Arroyo Grande 2019-2020 Jim Guthrie Community Service Grant Program. These funds will be used to provide a dedicated CASA volunteer to· a court-dependent child for one year. The CASA volunteer will be supervised by a staff CASA Advocate Supervisor, receive ongoing training and continuing education, and case management assistance. 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). (See Attachment A) 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). (See Attachment A) IX. SUPPLEMENTAL DOCUMENTATION: xD Past two (2) years financial statements , including the current year with the balance sheets and the profit/loss statements. xD Information indicating the percentage of revenue received that is used for administration, salaries, and program costs. xD Breakdown and description of non-profit organization's sources of revenue . xD Proof of 501 (c)(3) status with a copy of the letter from the IRS. Item 11.a. - Page 39 xD Copy of the non-profit organizations Board of Directors, Officers and an organization chart. X. CERTIFICATION : I certify on behalf of CASA 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 furthe r 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 2019 Community Service Grant Program including, but not limited to , maintaining non -discrim inatory policies, practices and intent. I also, on behalf of our non-profit organization, indemnify, defend, and hold ha rmless the City of Arroyo Grande relative to any and all liab ility that may arise as a res ult of the use of the City of A rroyo Grande Commun ity Service Grant Fund mon ies. Date : 11 · \ ~ · \ "\ Signature ~--==-=-~~~-=----1---~~ Executive Director or Design Item 11.a. - Page 40 RECEIVED NOV 2 7 2019 CITY OF ARROYO GRANDE COMM UNITY DEVELO P MENT CITY OF ARROYO GRANDE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM APPLICATION FORM 2019-20 Please complete the following sections : (use additional sheets as necessary) i l A--·fV\ I. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION : (must be the local branch). Ocean View Elementary PTO 1208 Linda Drive Arroyo Grande, CA 93420 11. GRANT APPLICANT REPRESENTATIVE'S NAME, ADDRESS, EMAIL ADDRESS AND TELEPHONE NUMBER: (must be the Executive Director or their de signated representative). Kari Sinner, PTO Secretary and Board member Arroyo Grande, CA 93420 Ill. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: The Ocean View Elementary PTO provides students and teachers with extra support that will further enhance their education. This grant proposal will support the implementation of the PT O's Edible Schoolyard project which will give students access to a technology-based home-grown ganien as well as th e hands-on experience of growing fruits and vegetables. The attached pamphlet provides additional details, including our long term vision of teaching nutrition and food science wit h a kitchen classroom. The future Edible Schoolyard is located in a unique ·recycled' space, previously unused for many years. In an old handball court, the asphalt was recently removed and recycled for other projects around the county. The concrete wall will be upcycled into a canvas with art, garden m ies, inspirational quotes and a learning curriculum whiteboard. We plan to create a "Living Classroom" in the Edible Schoolyard with this grant including: 1. Two outdoor educational classrooms with whiteboards on either side of the concrete block wall. This w ill enable garden educators/te achers to split into stations/groups and rotate between different lessons. 2. Multiple garden beds surrounding each whiteboard w ith built-in seating for classroom instruction. 3. Row covers for each garden bed to grow seeds and plants in winter, extending the growing season throughout the school year. 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 Edible Schoolyard project will primarily be used to teach garden-based science, mathematics, engineering , art and social studies curriculum to students a t Ocean View Elementary, including a ll grades Kindergarten . 6th grade. In other similar school gardens, the result h as been that families create edible gardens at home and eat healthier as well. It will also encourage other groups and schools to implement similar projects. The Edible Schoolyard will serve as a gathering place for local schools and service groups to join together to build and maintain a sustainable garden for the community. We envision a garden where community members will help maintain the space during summer months when students are not on campus, while growing their own fruits and vegetables for their families and neighbors. Item 11.a. - Page 41 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON-PROFIT ORGANIZATION: (broken down by age groups if available). Kindergarten -6th grade students: 640 students, plus their families Teachers and administrators: Approximately 30 teachers and administrators, plus their families Examples of community groups we plan to contact for collaboration opportunities: Arroyo Grande High School FFA, 5 Cities Men's Club, Boy Scouts, Girl Scouts, Campfire, Arroyo Grande in Bloom, Tree Guild of Arroyo Grande AMOUNT OF FUNDS REQUESTED: 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). ITEM DESCRIPTION BUDGET BENEFIT Teaching canvas 2 Outdoor whiteboards $1000 Essential teaching tool for Living Classroom 6 Garden beds Wood garden beds and soil 2100 Student seating for classroom and planting/harvest Row covers Covers to create mini greenhouses 800 Extend growing season throughout winter TOTAL $3900 No funds will be used for other purposes. 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 Edible Schoolyard is in its first year of implementation and has not received funds from the City of Arroyo Grande Jim Guthrie Community Service Grant Program in the past. Additional project information can be found in the attached project pamphlet. IX. SUPPLEMENTAL DOCUMENTATION: [j] Past two (2) years financial statements, including the current year with the balance sheets and the profit/loss statements. [j] Information indicating the percentage of revenue received that is used for administration, salaries, and program costs. [j] 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 11.a. - Page 42 X. CERTIFICATION: I certify on behalf of Oc..e.g O V\ e.. LA) f T Q 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 2019 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 \ \ } J. 7 L I G\ Signature g()..,t,t, ~.Pl, Exewtive Direcor orDesignee Board of Director or Officer Item 11.a. - Page 43 RECEIVED NOV 2 7 20i9 CO MM U NITY DEVE LOPM E NT CITY OF ARROYO GRANDE CITY O F ARROYO GRAN DE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM IL·. 4 O P iv'\ APPLICATION FORM 2019-20 Please complete the following sections: (use additional sheets as necessary) I. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION: (must be the local branch). Food Bank Coalition of San Luis Obispo Cou nty 1180 Kendall Road, San Lu is Obispo, CA 93401 II . GRANT APPLICANT REPRESENTATIVE'S NAME , ADDRESS, EMAIL ADDRESS AND TELEPHONE NUMBER: (must be the Executive Director or their designated representative). Kevin Drabinski, CEO, kdrabinski@slofoodbank.org , 11 80 Ke ndall Road, San Luis Obispo, CA 93401 Ill. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: The Fo od Bank feeds Arroyo Grande res idents through several programs . Our six month ly Nei ghborhood Food Distributions support ind ivi duals and fam il ies with USDA commodities (s helf-stable foods) and fresh produce. A summer Children's Farmers Market brings a "choose your own fruits and vegetables" style of free produce distribut ion to children so they can take food home to their families, get excited about choosing healthy foods, and engage in nutrition education. A concurrent Breakfas t Bags distribution sends home nu tr iti ous breakfast foods. Our Sen ior Farmers Market provides "choose your own" produce for low-income seniors, along with shelf-stable foods , while home delivery volunteers serve a smal l number of homebound residents . We also work with four agency partners in Arroyo Grande who distribute food to their cl i ents, providing them with low-cost staples and free produce to distribute. 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). Th e Food Bank serves all communities in the County. In the City of A rroyo Grande, we have Neighborhood Food Distributions weekly at Soto Park and monthl y at the Arroyo Grande Care Center that are open to all low-income individuals. T he Chi ldren's Farmers Market and Breakfast Bags program serves children in t he summer at Harlee E lementary. A monthly Senior Farmer's Market at Cortina d'Arroyo Grande Senior Apartments serves low-income seniors, and homebound residents are located throughout t he city. Our six agency partners in the City of Arroyo Grande have pantries open throughout the week. Item 11.a. - Page 44 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON-PROFIT ORGANIZATION: (broken down by age groups if available). Our Neighborhood Food Distributions serve approximately 400 residents and their households each week. Harloe Elementary distributions serve 70 children and their families during the summer. The Cortina d'Arroyo Grande Senior Farmers Market serves 25 seniors and their households monthly. Twenty homebound residents receive deliveries, and we provide food to six agency partners who serve Arroyo Grande residents. I VI. $2,000 AMOUNT OF FUNDS REQUESTED: 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). Grant funds will pay for program staffing to coordinate all of the distributions described above in the City of Arroyo Grande. 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 Jim Guthrie Community Service Grant funds have been received in the past. IX. SUPPLEMENTAL DOCUMENTATION: [i] Past two (2) years financial statements, including the current year with the balance sheets and the profit/loss statements. [i] 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. [i] 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 an organization chart. Item 11.a. - Page 45 X. CERTIFICATION: I certify on behalf of Food Bank Coalition of SLO 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 2019 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 1l J· ~ Executiv irector or Designee Item 11.a. - Page 46 RE CEI VE D NOV 2 7 201 9 COM MUNITY DEVELOPMENT CITY OF ARROYO GRANDE C IT Y OF ARROYO GRANDE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM 2 >\C~> Pfv'\ APPLICATION FORM 2019-20 Please complete the following sections: (use additional sheets as necessary) I. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION : (must be the local branch). 5Cities Homeless Coalition II. GRANT APPLICANT REPRESENTATIVE'S NAME, ADDRESS, EMAIL ADDRESS AND TELEPHONE NUMBER : (must be the Executive Director or their designated representative). Janna Nichols, Execu t ive Director PO Box 558 , Grover Beach CA 93483 -Maili ng; 1566 W. Gr and , Grover Beach, CA -Physical Janna.Nic ho ls @5 CHC .org Ill. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: Please see attached supplemental informati on . 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 supplementa l information. Item 11.a. - Page 47 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON-PROFIT ORGANIZATION: (broken down by age groups if available). Please see attached supplemental information. AMOUNT OF FUNDS REQUESTED: 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 supplemental information. 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 supplemental information. IX. SUPPLEMENTAL DOCUMENTATION: [j] Past two (2) years financial statements, including the current year with the balance sheets and the profit/loss statements. [j] Information indicating the percentage of revenue received that is used for administration, salaries, and program costs. [j] 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 11.a. - Page 48 X. CERTIFICATION: I certify on behalf of 5Cities Homeless Coalition 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 2019 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: 11/7/2019 Board of Director or Officer Item 11.a. - Page 49 Ill. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: 5Cities Homeless Coalition is transforming the lives of those who are homeless or facing homelessness in Southern San Luis Obispo County from Avila to Nipomo. Our work goes beyond the immediate, to ensure that clients have the plan, skill sets, education and financial means to be successful and self- sufficient. We are proud to share that more than 90% of the households that we have helped to house (or prevented from eviction) remain in their home. We do this by providing intensive case management and supportive services. We work with clients to develop their own unique plans as well as the resources and skills needed for them to be successfully housed and remain housed. Programs include coordinated assessment, information and referral, medical respite, benefits advocacy (SSI, Medicare, etc.), homeless youth outreach, winter warming center, rapid re-housing search and stabilization services and homeless prevention (including budget counseling and financial literacy), and direct financial assistance for immediate needs, rents and deposits. A complete list of services provided by 5CHC is attached and described in our mid-year 2019 and full-year 2018 program reports. The Coalition works closely with local government, business, community agencies and organizations to assess current homeless services and opportunities for collaboration to provide for immediate needs and to maximize our efforts without duplication to cooperatively assist those in need. We are now fielding requests for assistance each month from about 350 callers and approximately 250 office visits per month. The Coalition recognizes the impact of homelessness not only to those who are displaced but the community as a whole. Our efforts are focused on preventing homelessness in addition to assisting those who have lost their homes. The cost of living here on the Central Coast for those "living on the edge" is extremely challenging. Rental rates have increased over 50% since 2013 in San Luis Obispo County; this is the highest increase in the State -and leaves our region among the least affordable in the country. A recent report by the National Low Income Housing Coalition, (Out of Reach 2019) noted that a minimum wage earner would have to work 99 hours per week to afford a 2-bedroom apartment in San Luis Obispo County. This challenge has a direct affect on the City's strategic economic development efforts to encourage development for maintaining a vibrant tourist-based economy, which is dependent on service industry workers whose wages are not keeping up with housing cost increases. These are among the community members who are seeking our assistance almost daily. 5CHC services directly benefit very-low and extremely-low income households. For a family of four this equates to an annual income limit of slightly less than $45,000 and $27,000 respectively. As housing costs continue to rise, 5CHC is seeing a growing need for rental assistance for residents to remain housed and for those seeking housing. This application focuses on three key programs: • Rapid Re-Housing & Eviction Prevention; • Winter Warming Center; and • Direct Financial Assistance for limited one-time needs. 5Cities Homeless Coalition Supplemental Information -City Of Arroyo Grande Grant Program Application Form 2019-20 Page 1 of 5 Item 11.a. - Page 50 Rapid Re-Housing and Eviction Prevention: Through 5CHC's Emergency Housing & Assistance Fund we are able to offer a lifeline after unforeseen and temporary financial setbacks, acting as a bridge between crisis and stability. Currently per- household assistance for housing is averaging $3,400 for deposits and $1,700 for rental assistance, and $3,000 in eviction prevention rental assistance. This level of support is nearly double what was needed per family in 2015. As rents have increased more than 50% in the last five years we are being asked to spend nearly double the amount of rental assistance than in years past. Likewise rising rents have also affected the amount of deposit required (based on a value of twice the monthly rent). Of those 5CHC has provided housing assistance services to in this calendar year, approximately 50% are families with children of which more than 1/2 (or +25%) are single parent households. Below is a breakdown of those from Arroyo Grande who have been served this 2019 calendar year: • Move-In (Rent and Deposit) -36 Households from Arroyo Grande • Eviction Prevention (Rent) -19 Households from Arroyo Grande The Rapid Re-Housing and Homelessness Prevention Activities proposed in this application (coupling short-term financial assistance for rent with housing stabilization services of case management, deposits, and housing search expenses) have been documented to be cost-effective in both preventing the occurrence of homelessness, and ensuring that homelessness is brief and a one-time occurrence. Services assist those who are homeless and those at risk of homelessness to develop a housing stability plan, and provide short-term emergency homeless prevention rental assistance or move-in deposits and first month's rent. This program is augmented by other services also provided by 5CHC. With the support and guidance of case management, homeless residents and those facing homelessness are assisted in finding new housing and maintaining their housing. Clients receive coaching, financial literacy, advice on credit repair, and life and job skill guidance coupled with short- term financial assistance for move-in expenses or homeless prevention rental assistance. More than 90% of the 5CHC clients receiving this assistance remain housed for more than one year after exiting the program (which is the length of time clients are currently tracked). This program meets the needs of those who are newly homeless due largely to financial difficulty and who do not need added supports of permanent housing (such as Section 8). Leverage: State and federal grants that make up a large portion of our funding for this program require a dollar for dollar match of from local sources for like activity. In other words, we must be able to demonstrate that we are spending an equal amount of dollars on rapid re-housing and homeless prevention from local sources as we receive in federal or state funding. The City of Arroyo Grande's past contributions have served as key source that we have been able to use to demonstrate this match. We have used these past grants to enormous benefit to Arroyo Grande residents. As one of many examples, for the grant period July 2018-June 2019, 5Cities Homeless Coalition was awarded $8,688 from the City of Arroyo Grande's CDBG allocation. In addition to leveraging the dollars as noted above with other federal funds, 5CHC was able to leverage additional funds for this grant, resulting in over $30,000 to 15 very-low and low-income Arroyo Grande households. 5Cities Homeless Coalition Supplemental Information -City Of Arroyo Grande Grant Program Application Form 2019-20 Page 2 of 5 Item 11.a. - Page 51 Winter Warming Center -South County's Only Winter Shelter: Our partnership with the City of Arroyo Grande has included your annual support of our winter warming center for the last several years. We are again requesting assistance for the current winter season 2019-20 in the renewal amount of $7,500. Attached you will find an operational overview for the current program, being offered in partnership with the Five Cities Ministerial Association. The City of Arroyo Grande's support this last season assisted us in serving 166 unique individuals over 60 nights for a total guest count of 1,325 (averaging 25 guests per night). It should be noted that 49% of these guests were over the age of 50. The primary goal of the warming center is to keep people from falling ill or dying due to seasonal elements. That said, the Coalition's goals are far broader, in that we endeavor with all of our programs to assist people in transforming their lives and regaining housing. Please note that 7 of this past winter's warming center guests have moved into housing, in addition to one newborn; 5 have been connected to drug and alcohol services and are currently in sober living environments, and 7 have been reconnected with family that is willing to provide a stable living situation. Direct Financial Assistance For Limited One-Time Needs: Our work is about helping people who come to us in crisis to figure out how to resolve their housing problem. Funds from this $2,500 grant request will specifically be used for purposes not otherwise covered by other funding sources, enabling us to utilize all of our resources for the maximum benefit, without duplication. Direct financial assistance such as that described below is offered as part of a coordinated entry process that includes short and long-term goals and a plan of progressive engagement. • Automotive Registration and Repair An increasing number of area residents are now forced to live in their car, due to rising housing costs. Often though the vehicle is an older model, in poor repair, and hasn't been registered or insured. When faced with limited means, families are forced to make choices of what bills to pay and or not, and oftentimes it is car registration and/or insurance that lapses. As there is no shelter in South County their car is their best option. Likewise, if able to keep their vehicle, people are far more likely to find success in securing and maintaining employment. As such one of the highest priorities for providing direct financial assistance is to support vehicle repair, registration and insurance. • Reunification -Transportation to Family/Friends Out of Area Oftentimes someone in crisis may have friends or family in other parts of the country or state who could assist them in providing a place to stay or finding employment. 5CHC works to determine the best path forward in helping them resolve their situation, including "rebuilding relationship bridges." 5CHC doesn't simply buy people a "bus ticket out of town," but if we can affirm the client has a safe place to go whereby they will be in a stronger position to find stable housing, we will provide transportation. • Education, Job, & Licensing Assistance Many times a job certification, training course, or license fee is all that stands between on-going homelessness and a path to home. Housing stability is directly affected by one's economic means, and as such requests that have an immediate affect on income are of high priority for direct financial assistance. 5Cities Homeless Coalition Supplemental Information -City Of Arroyo Grande Grant Program Application Form 2019-20 Page 3 of 5 Item 11.a. - Page 52 • Utility Assistance Oftentimes when there is a loss of income (either loss of job, reduced hours, or family break-up) people are forced to choose which bills to pay or not pay. The inability to pay a utility bill is one of the most important indicators of high risk for homelessness. • Transportation (Gas Card, Bus Pass) 5CHC provides bus passes to clients as part of their case plan. Oftentimes a client will need to go to Social Security or the Department of Social Services in San Luis Obispo; or make a court- appearance. We provide one-day bus passes to assist with this. Likewise, if a client has a vehicle, and can actively demonstrate they are engaged in a job search, or appointments, we will provide a limited gas card. Oftentimes due to illness, assistance is requested for travel to UCLA or Stanford where they are seeking medical services. 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). 5CHC serves the communities of southern San Luis Obispo County, including Arroyo Grande, Avila Beach, Grover Beach, Oceano, Pismo Beach and Nipomo. These services, which are made available to residents of all of these communities, are made possible in part through the financial support of individuals, businesses, service clubs and the faith community in all parts of the South County, including Arroyo Grande. Volunteers from throughout the South County support the work of 5CHC. In Arroyo Grande in September, for example, the eighth annual Empty Bowls fundraiser benefiting 5CHC was held at St. Patrick's Catholic Church with the help of hundreds of volunteer servers, artists, restaurants and donors. Additionally many Arroyo Grande residents have stepped forward to assist those less fortunate by volunteering and donating to our winter warming center. V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON- PROFIT ORGANIZATION: (broken down by age groups if available). Arroyo Grande residents comprise 21 % of the clients served by 5CHC. Thus far this year in 2019 5CHC has provided services to 214 Arroyo Grande households, including 280 adults and 145 children, with more than $143,500 spent in direct financial assistance for housing and immediate needs apart from case management services, warming center sheltering, and 5CHC operational costs. In the full year of 2018, the Coalition provided the following services in South County, in addition to the winter warming center. Approximately 21 % were residents of Arroyo Grande. • 100 homeless families received deposit and/or rental assistance to regain housing • 54 families avoided eviction with short-term rental support • 520 households received coordinated assessment and funding for immediate needs • 51 clients received guidance and help applying for or receiving Social Security, Disability and MediCal benefits to which they are entitled • 234 individuals received financial assistance to overcome one-time barriers • 77 homeless youth received case management with job, education and housing support VI. AMOUNT OF FUNDS REQUESTED: $20,000 5Cities Homeless Coalition Supplemental Information• City Of Arroyo Grande Grant Program Application Form 2019-20 Page 4 of 5 Item 11.a. - Page 53 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). $10,000 $7,500 $2,500 $0 Rapid Re-Housing And Eviction Prevention Direct Financial Assistance Warming Center 2019-20 -Direct Program Expenses Including Personnel Immediate Needs -Direct Financial Assistance Administrative, Facility Or Fundraising Expense 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). Prior Funding Support: 2019-20 2018-19 2017-18 Warming Center $7,500 $7,500 Community Grant $2,500 $2,500 Youth Outreach (PD) $7,000 CDBG $8,688 $16,188 $17,000 $2,500 Additional Documentation • Program Reports: 2019 Mid-Year; 2018 Full-Year • Audit: 2018 • Warming Center: 19-20 Operational Overview 5Cities Homeless Coalition Supplemental Information -City Of Arroyo Grande Grant Program Application Form 2019-20 Page 5 of 5 Item 11.a. - Page 54 LIFE STEPS F O U N D AT I O N® November 26, 2019 City of Arroyo Grande Community Development Department Camilla Karamanlis, Program Analyst 300 E. Branch Street Arroyo Grande CA 93420 Dear Ms. Karamanlis: CENTRAL COAST ADULT SERVICES J 431 POMEROY ROAD, ARROYO GRANDE, CA 93420 r --------- ! \ NOV 2 7 2019 I lcoMr,,iiJNITY I C!TY or: ARROYO GRANDE '----·- It is my pleasure to submit an application seeking a $3,000 grant from the City of Arroyo Grande through the Jim Guthrie Community Service Grant Program. A grant awarded by the City would support programs and services provided by Life Steps Foundation Central Coast Adult Services to adults with developmental disabilities and seniors residing in Arroyo Grande. Please find the original application and requisite documents enclosed along with 11 copies. Life Steps Foundation has been providing services to the City of Arroyo Grande since 1990. We are grateful for the opportunity to apply for grant support from the City and hope to build on an enduring partnership. Should you have any question, please feel from to contact me by telephone at (805) 762-4500 or by email at ccollins@lifestepsfoundation.org. I look forward to your response. Sincerely, _ ·'i ~" / .--j,/ -· ) . I / .. V / :_ . • . (/(~ Cyt-ia Collins t Program Manager www.rnmns.o1G FAX (805) 474-8431 Item 11.a. - Page 55 RECEIVED NOV 2 7 2019 COMMUN ITY DEVELOPM ENT CITY OF ARROYO GRANDE C ITY OF ARf~OY O GR ANDE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM ;:·co \"IV\, APPLICATION FORM 2019-20 Please complete the following sections : (use additional sheets as necessary) I. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION: (must be the local branch). Life Steps Foundation Central Coast Adult Services 1431 Pomeroy Roa d, 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). Cynthia Collins, Program Manager 1431 Pomeroy Road , Arroyo Grande, CA 93420 ccollins@lifestepsfounda tion.org Ill. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: Life Steps Foundation Central California Adu lt Services (LSF CCAS) provides both supportive living services and fosters independent Living skills for adu lts with physica l and developmental disabilities in th eir own homes. Our programs help our partici pants by teach ing them daily l ife skills, providing th em with in-home assistance, and he lping them to live as fully and independently as possible in their own community. We al so assist seniors through our Senior Homemaker Program. LSF CCAS offers two main programs . Please see the attached sheet for a description. 1. Supportive Living Services (SLS) and Independent Living Services (ILS) focused on adults with physical and developmental disabilities ages 18 years and older. 2 . Homemaker Services and Personal Care Services focused on seniors age 60 years and older. (P lease see attachment with additional i nformation) IV. LIST AREA($) 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). LSF Central Coast Adult Services is based in the City of Arroyo Grande and supports the County of San Luis Ob ispo . The SLS and ILS programs offered by LSF Central Coast Adult Services are in partnership with the Tri-Counties Reg ional Center. For sen iors , the programs provided by LSF Central Coast Adult Services are through the Senior Homemaker and Personal Care Program under Title 1118 in partnership with the Area Agency on Aging. Life Steps Foundation is the on ly agency to p rovide Title 111B services to seniors in our area . Life Steps Foundation has been serving the community of Arroyo Gande since 1990 . Item 11.a. - Page 56 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON-PROFIT ORGANIZATION: (broken down by age groups if available). LSF Central Coast Adult Services served 70 unduplicated participants in the last fiscal year in the County of San Luis Obispo. Within the City of Arroyo Grande, LSF Central Coast Adult Services supports 2 adults, 18 years of age and older, through our Independent and Supportive Living Skills program. We also support 5 seniors, ages 60 years and older, via our Senior Homemaker and Personal Care Program. 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). Grant funds will be used to provide immersive professional training for 24 staff members to develop direct support skills such as communication, medication management, and program evaluation to name a few examples. Staff will also receive training to gain knowledge in areas such as food safety, rights of program participants, senior disorders and diabetes, and goal setting. 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). LSF Central Coast Adult Services has not received any funds from the City of Arroyo Grande or any of its community services grant programs. We are a first time applicant. Please find two brochures enclosed with this application. IX. SUPPLEMENTAL DOCUMENTATION: [j] Past two (2) years financial statements, including the current year with the balance sheets and the profit/loss statements. [j] Information indicating the percentage of revenue received that is used for administration, salaries, and program costs. [j] 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 11.a. - Page 57 X. CERTIFICATION: I certify on behalf of Life Steps Fou nd ation 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 2019 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: \\ { ;2..7/ ,q I Item 11.a. - Page 58 RECEIVED NO V 2 7 2019 CO M MUNIT Y DEV ELO PMENT CITY OF ARROYO GRANDE C!TY O F A R ROYO GRAN DE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM 3·:2.5 'P(\/\ APPLICATION FORM 2019-20 Pl eas e complet e th e following section s: (use additional sheets as necessary) I. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION : (must be the local branch). Camp Fi re Central Coast o f Cali fornia, Inc. 230 North 9th Street, Gro ver Beach, CA 93433 P.O. Box 1269. A rro yo G rande, CA 9342 1-1269 11. GRANT APPLICANT REPRESENTATIVE'S NAME , ADDRESS , EMAIL ADDRESS AND TELEPHONE NUMBER: (must be the Executive Director or their de siqnated representative). Office Manager: Rebecca McClintock, P 0 . Box 1269, A rroyo Grande , CA 9342 1-1269 -mail com 111. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: Ca mp Fire Centr al Coast p ro vides o pportun ities fo r Pre-K throug h 12th graders to fi nd th e ir S pa rk, lift th eir V oice, a nd Thrive. Our cou ncil h as b ee n servin g area y outh and fa m il ies s ince 1923 w ith outdoo r learning. creativi ty , comm u nity service , and leade rship experiences. Boy s and g irl s pa rticipate in Afterschool Clubs, S u mme r Daycamps: Tac annkeo W a l aKi, and Junio r Coll eg e fo r Kids -a co llab orativ e with C uesta Colleg e, Community H ikes, Camp Cielo -o ur Sp ring weel<end fa mily cam p , our A nn ua l Sleepo ver Trip , as well as variou s parades. comm u nity service projects. · Camp Fire curre ntly has 155 Ad ult Members i ncluding 45 w ho resid e in the City o f Arroyo Gran de. A du lts includ ing Members, Club parents. Adult Members, Alumni of our coun cil. and other community members are served throu g h An nual Mee ti ngs, Holl yberry , and vari o u s fu nd ra ising and volunte er opportunities includi ng Fireworks, Poi nsettia sa le , Alum n i eve nts, Com mun ity Hik ing Prog ram , etc. 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 th e City of A rroyo Grande). Cam p Fi re Central Coast serves youth , families, and individuals in the Arroyo Grande comm unity as w ell a s through out t he 5 Cit ies a long w ith SLO Co unty and portions of Sa n ta Bar bara County (Santa Maria and Lo mpoc). Camp Fire o ffe rs p rogram ming fo r children a n d tee n s from PreK-12 grades. One o f Camp F ire's most successful progra ms is Camp Tacanneko, a weeklong su mmer day ca mp that h as been held at Ca mp Arr oyo Grande for over 50 years and serves 200 children annu ally , pl us about 100 fa mily members du ring ou r fina l day celebratio ns. Ca mp Fire 's C lub season oper ates alon gsi de local school cale ndars with 117 yo u th in 19 Clu bs -many of whom a re a r e residents of A rroyo Grand e . Four of these Clubs co nduct weekl y meetin gs in Arro yo Gr ande incl uding one a t Oceanview Elementary School, two at th e Hillside Church property, and one ho me g roup . Camp Fire has a fifth Club p repar ing to s tart meeting at H illside by year e nd. Item 11.a. - Page 59 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON-PROFIT ORGANIZATION: (broken down by age qroups if available). Camp Fire serves approximately 533 total Arroyo Grande residents [1-99 years of age]: 130 [4-18] through weekfy activities, annual sleepover, etc.; 130 youth [4-18] and 60 adults [18-65] through Camp Tacanneko: 10 [5-12] through Camp WalaKi; 20 youth [4-16] and 8 adults [18-65] through Clubs Sleepover; 25 families [2-80] through Camp Cielo; 300 [18-100] through alumni activities including Annual Meeting, Hollyberry, Grand Council Fire, etc. and Club's Community Service including Halloween, Thanksgiving. Cookies for Hospice, Center Crafts, etc VI. AMOUNT OF FUNDS REQUESTED: Camp Fire has requested $4,480, which will allow us to expand our program offerings to additional K-12th graders via our Enrichment Clubs. Clubs meet once weekly and the cost for Camp Fire to offer this program is approximately $280 per child/teen each year A typical Club consists of 8-10 youth. $280 x 8=$2240 x 2 = $4,480. We would like to add at least two new Clubs at elementary, middle. or the high school in the city of Arroyo Grande. 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 find attached budget worksheet ' 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). 2014-15 $1,500 I Grant funding from the City of Arroyo Grande has been used to support youth programs for Pre-K 2015-16 $1,500 I through 12th graders. Because of this grant funding. caring adults are able to support youth as 2016-17 $1,500 I they find their Sparks and learn to Thrive through outdoor learning. community service, creativity, 2017-18 $1,500 I etc. Youth spent time at care homes, tying blankets for homeless kids, cookies for Hospice+more IX. SUPPLEMENTAL DOCUMENTATION: ~ Past two (2) years financial statements, including the current year with the i balance sheets and the profit/loss statements. [!I Information indicating the percentage of revenue received that is used for administration, salaries, and program costs. [0 Breakdown and description of non-profit organization's sources of revenue. / DZ( 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. ~--~---------------------------------------···-·-" --- Item 11.a. - Page 60 X. CERTIFICATION: I~ '✓--I C", ~ • ~ J ,,, ± r\ ,,.l _ 1;-~Yf\lvv I certify on behalf of \1,1}\(2 il\'C \J;V~D~ U::[i'S~ 0± uun \_;'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 2019 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: \ \ J Z:1 / / c·\ -'-'--t;-=--'--+-'1 ~-- 1 Signature: --kf Cfu~iflrt (1JJ vr1zt:;-· Executive Director q-,Designe~ , --------- ~6£¼/t BoardofOirector Officer Item 11.a. - Page 61 RECEIVED NOV 2 7 2019 CO MM UN ITY DEVELOP M EN T CITY OF ARROYO GRANDE C ITY OF ARROYO GRANDE JIM GUTHRIE COMMUNITY SERVICE GRANT PROGRAM 4 . 2_c:__; ffV'l APPLICATION FORM 2019-20 Please complete the following sections: (use additional sheets as necessary) I. NAME AND ADDRESS OF NON-PROFIT ORGANIZATION: (must be the local branch). Five Cities Repair Cafe c/o South County Visitor Services, Inc. (501 (c)(3). 237 W. Tefft St., Nipomo II. GRANT APPLICANT REPRESENTATIVE'S NAME, ADDRESS , EMAIL ADDRESS AND TELEPHONE NUMBER: (must be the Executive Director or their designated representative). Linda Busek G fivecitiesrepaircafe@gmail .com I Ill. DESCRIPTION OF COMMUNITY SERVICES PROVIDED: FREE quarterly, community service where volunteers repair broken items for neighbors. We repai r bikes, small appliances (fans, blenders, vacuums, etc.), computers, printers , furniture, clothing, jewelry, and sharpen tools and knives. Neighbors bring their items to our event and sit with the "Fixer" to see how problems are diagnosed and how items are repaired . It gives folks confide nce to try to resolve repairs themsel ves and keeps a great amount of stuff from being landfilled. (Californians a re throwing away 6 lbs of stuff every day -the annual equivalent of a small car. We are recycling fewer items in 2019 than we did in 2015 -and this is not sustainable. CA has a goal to recycle 75% in 2020. Five Cities Repair Cafe can help IV. LIST AREA($) SERVED BY NON-PROFIT ORGANIZATION: (include a brief description of the rela tionship of your non-profit organization to the residents of the City of Arroyo Grande). Five Cities Repair Cafe re aches out to neighbors from Arroyo Grande, Grover Beach, Pismo Beach , Avila, and Nipomo who bring us their broken items. We have volunteer "Fixers " from each of those cities who freely g ive thei r time and talent to help their neighbors with repairs and encourage a more sustainable lifestyle. Item 11.a. - Page 62 V. NUMBER OF CITY OF ARROYO GRANDE RESIDENTS SERVED BY NON-PROFIT ORGANIZATION: (broken down by age groups if available). Five Cities Repair Cafe was inaugurated October 6, 2019 -the 9th in CA. Nearly 2,000 Repair Cates are operating internationally since the first one was founded ten years ago in Amsterdam. Our first Cafe had Arroyo Grande volunteer Fixers from the ages of 23 to 83! We operate quarterly and welcome all residents. VI. AMOUNT OF FUNDS REQUESTED: $500 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). Five Cities Repair Cafe is an all volunteer group of community-minded folks who donate their time and talent to help their neighbors repair items instead of landfilling them. We would use the funds to help cover the cost of liability insurance and repair supplies. 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). N/A 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 orqanization chart. Item 11.a. - Page 63 X. CERTIFICATION: (, / /1 , , G' I certify on behalf of ;( 1 "'{, Gt ·n Ef., (<t tA\ ?!.. \f Ei 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 2019 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: it I 21 /m11 I I Signature: Executive Director or Designee Board of Director or Officer THIS PAGE INTENTIONALLY LEFT BLANK Item 11.a. - Page 64