HomeMy WebLinkAboutCAG2022-201 - Original - US Housing and Urban Development - CDBG Program 2022 Application for Federal Assistance - 01/01/2022ApprovalOriginator:Department:
Date Sent:Date Required:
Authorized to Sign:
Director or Designee Mayor
Date of Council Approval:
Grant? Yes No
Type:Review/Signatures/RoutingDate Received by City Attorney:
Comments:
Date Routed to the Mayor’s Office:
Date Routed to the City Clerk’s Office:Agreement InformationVendor Name:Category:
Vendor Number:Sub-Category:
Project Name:
Project Details:
Agreement Amount:
Start Date:
Basis for Selection of Contractor:
Termination Date:
Local Business? Yes No*
Business License Verification: Yes In-Process Exempt (KCC 5.01.045)
If meets requirements per KCC 3.70.100, please complete “Vendor Purchase-Local Exceptions” form on Cityspace.
Notice required prior to disclosure?
Yes No
Contract Number:
Agreement Routing Form
For Approvals, Signatures and Records Management
This form combines & replaces the Request for Mayor’s Signature and Contract Cover Sheet forms.
(Print on pink or cherry colored paper)
Visit Documents.KentWA.gov to obtain copies of all agreementsadccW22373_1_20
Budget Account Number:
Budget? Yes No
Dir Asst:
Sup/Mgr:
Dir/Dep:
rev. 200821
FOR CITY OF KENT OFFICIAL USE ONLY
(Optional)
* Memo to Mayor must be attached
5/16/22
OMB Number: 4040-0004
Expiration Date: 12/31/2022
* 1. Type of Submission:* 2. Type of Application:
* 3. Date Received: 4. Applicant Identifier:
5a. Federal Entity Identifier:5b. Federal Award Identifier:
6. Date Received by State:7. State Application Identifier:
* a. Legal Name:
* b. Employer/Taxpayer Identification Number (EIN/TIN):* c. UEI:
* Street1:
Street2:
* City:
County/Parish:
* State:
Province:
* Country:
* Zip / Postal Code:
Department Name:Division Name:
Prefix:* First Name:
Middle Name:
* Last Name:
Suffix:
Title:
Organizational Affiliation:
* Telephone Number:Fax Number:
* Email:
* If Revision, select appropriate letter(s):
* Other (Specify):
State Use Only:
8. APPLICANT INFORMATION:
d. Address:
e. Organizational Unit:
f. Name and contact information of person to be contacted on matters involving this application:
Application for Federal Assistance SF-424
Preapplication
Application
Changed/Corrected Application
New
Continuation
Revision
01/01/2022
B-21-MC-53-0017
City of Kent
916001254 GALJSHRB2EM6
220 4th Ave. South
Kent
WA: Washington
USA: UNITED STATES
98032-5895
Parks Human Services
Mrs Merina
Hanson
Human Services Manager
City of Kent Parks Department-Human Services Division
2538565077
mhanson@kentwa.gov
* 9. Type of Applicant 1: Select Applicant Type:
Type of Applicant 2: Select Applicant Type:
Type of Applicant 3: Select Applicant Type:
* Other (specify):
* 10. Name of Federal Agency:
11. Catalog of Federal Domestic Assistance Number:
CFDA Title:
* 12. Funding Opportunity Number:
* Title:
13. Competition Identification Number:
Title:
14. Areas Affected by Project (Cities, Counties, States, etc.):
* 15. Descriptive Title of Applicant's Project:
Attach supporting documents as specified in agency instructions.
Application for Federal Assistance SF-424
C: City or Township Government
Department of Housing & Urban Development
14218
Community Development Block Grant Entitlement Grants
n/a
Community Development Block Grant-Entitlement
Community Development Block Grant Entitlement funds (CDBG) will be allocated to sub-recipients &
within the Parks Division to provide public services and capital projects to Kent residents.
View AttachmentsDelete AttachmentsAdd Attachments
View AttachmentDelete AttachmentAdd Attachment
* a. Federal
* b. Applicant
* c. State
* d. Local
* e. Other
* f. Program Income
* g. TOTAL
.
Prefix:* First Name:
Middle Name:
* Last Name:
Suffix:
* Title:
* Telephone Number:
* Email:
Fax Number:
* Signature of Authorized Representative:* Date Signed:
18. Estimated Funding ($):
21. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements
herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to
comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may
subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001)
** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency
specific instructions.
Authorized Representative:
Application for Federal Assistance SF-424
* a. Applicant
Attach an additional list of Program/Project Congressional Districts if needed.
* b. Program/Project
* a. Start Date:* b. End Date:
16. Congressional Districts Of:
17. Proposed Project:
9th WA-9
Add Attachment Delete Attachment View Attachment
01/01/2022 12/31/2022
1,131,489.00
1,131,489.00
a. This application was made available to the State under the Executive Order 12372 Process for review on
b. Program is subject to E.O. 12372 but has not been selected by the State for review.
c. Program is not covered by E.O. 12372.
Yes No
Add Attachment Delete Attachment View Attachment
** I AGREE
Dana
Ralph
Mayor
2538565720
dralph@kentwa.gov
* 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.)
* 19. Is Application Subject to Review By State Under Executive Order 12372 Process?
If "Yes", provide explanation and attach
05/17/2022
Page 1 of 3 – 2022 AAP Cerfifications
CERTIFICATIONS
In accordance with the applicable statutes and the regulations governing the consolidated plan regulations,
the jurisdiction certifies that:
Affirmatively Further Fair Housing --The jurisdiction will affirmatively further fair housing.
Uniform Relocation Act and Anti-displacement and Relocation Plan -- It will comply with the
acquisition and relocation requirements of the Uniform Relocation Assistance and Real Property
Acquisition Policies Act of 1970, as amended, (42 U.S.C. 4601-4655) and implementing regulations at 49
CFR Part 24. It has in effect and is following a residential anti-displacement and relocation assistance
plan required under 24 CFR Part 42 in connection with any activity assisted with funding under the
Community Development Block Grant or HOME programs.
Anti-Lobbying --To the best of the jurisdiction's knowledge and belief:
1.No Federal appropriated funds have been paid or will be paid, by or on behalf of it, to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with the
awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the
entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any Federal contract, grant, loan, or cooperative agreement;
2.If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with this
Federal contract, grant, loan, or cooperative agreement, it will complete and submit Standard Form-LLL,
"Disclosure Form to Report Lobbying," in accordance with its instructions; and
3.It will require that the language of paragraph 1 and 2 of this anti-lobbying certification be included in
the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under
grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose
accordingly.
Authority of Jurisdiction --The consolidated plan is authorized under State and local law (as applicable)
and the jurisdiction possesses the legal authority to carry out the programs for which it is seeking funding,
in accordance with applicable HUD regulations.
Consistency with plan --The housing activities to be undertaken with Community Development Block
Grant, HOME, Emergency Solutions Grant, and Housing Opportunities for Persons With AIDS funds are
consistent with the strategic plan in the jurisdiction’s consolidated plan.
Section 3 -- It will comply with section 3 of the Housing and Urban Development Act of 1968 (12 U.S.C.
1701u) and implementing regulations at 24 CFR Part 135.
____________________________
Signature of Authorized Official
_________
Date
____________________________
Title
05/17/2022
Page 2 of 3 – 2022 AAP Cerfifications
Specific Community Development Block Grant Certifications
The Entitlement Community certifies that:
Citizen Participation -- It is in full compliance and following a detailed citizen participation plan that
satisfies the requirements of 24 CFR 91.105.
Community Development Plan -- Its consolidated plan identifies community development and housing
needs and specifies both short-term and long-term community development objectives that that have been
developed in accordance with the primary objective of the CDBG program (i.e., the development of
viable urban communities, by providing decent housing and expanding economic opportunities, primarily
for persons of low and moderate income) and requirements of 24 CFR Parts 91 and 570.
Following a Plan -- It is following a current consolidated plan that has been approved by HUD.
Use of Funds -- It has complied with the following criteria:
1. Maximum Feasible Priority. With respect to activities expected to be assisted with CDBG
funds, it has developed its Action Plan so as to give maximum feasible priority to activities which
benefit low- and moderate-income families or aid in the prevention or elimination of slums or
blight. The Action Plan may also include CDBG-assisted activities which the grantee certifies
are designed to meet other community development needs having particular urgency because
existing conditions pose a serious and immediate threat to the health or welfare of the community,
and other financial resources are not available (see Optional CDBG Certification).
2. Overall Benefit. The aggregate use of CDBG funds, including Section 108 guaranteed loans,
during program year(s) 2022, shall principally benefit persons of low and moderate income in a
manner that ensures that at least 70 percent of the amount is expended for activities that benefit
such persons during the designated period.
3. Special Assessments. It will not attempt to recover any capital costs of public improvements
assisted with CDBG funds, including Section 108 loan guaranteed funds, by assessing any
amount against properties owned and occupied by persons of low and moderate income,
including any fee charged or assessment made as a condition of obtaining access to such public
improvements.
However, if CDBG funds are used to pay the proportion of a fee or assessment that relates to the
capital costs of public improvements (assisted in part with CDBG funds) financed from other
revenue sources, an assessment or charge may be made against the property with respect to the
public improvements financed by a source other than CDBG funds.
In addition, in the case of properties owned and occupied by moderate-income (not low-income)
families, an assessment or charge may be made against the property for public improvements
financed by a source other than CDBG funds if the jurisdiction certifies that it lacks CDBG funds
to cover the assessment.
Excessive Force -- It has adopted and is enforcing:
1.A policy prohibiting the use of excessive force by law enforcement agencies within its
jurisdiction against any individuals engaged in non-violent civil rights demonstrations; and
Page 3 of 3 – 2022 AAP Cerfifications
2.A policy of enforcing applicable State and local laws against physically barring entrance to or
exit from a facility or location which is the subject of such non-violent civil rights demonstrations
within its jurisdiction.
Compliance with Anti-discrimination laws -- The grant will be conducted and administered in
conformity with title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d) and the Fair Housing Act (42
U.S.C. 3601-3619) and implementing regulations.
Lead-Based Paint -- Its activities concerning lead-based paint will comply with the requirements of 24
CFR Part 35, Subparts A, B, J, K and R.
Compliance with Laws -- It will comply with applicable laws.
_____________________________
Signature of Authorized Official
_____________
Date
________Mayor__________________
Title
05/17/2022
OMB Number: 4040-0009
Expiration Date: 02/28/2025
ASSURANCES - CONSTRUCTION PROGRAMS
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT
AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0042), Washington, DC 20503.
Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional
assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant:, I certify that the applicant:
NOTE:
1.Has the legal authority to apply for Federal assistance,
and the institutional, managerial and financial capability
(including funds sufficient to pay the non-Federal share
of project costs) to ensure proper planning,
management and completion of project described in
this application.
2.Will give the awarding agency, the Comptroller General
of the United States and, if appropriate, the State,
the right to examine all records, books, papers, or
documents related to the assistance; and will establish
a proper accounting system in accordance with
generally accepted accounting standards or agency
directives.
3.Will not dispose of, modify the use of, or change the
terms of the real property title or other interest in the
site and facilities without permission and instructions
from the awarding agency. Will record the Federal
awarding agency directives and will include a covenant
in the title of real property acquired in whole or in part
with Federal assistance funds to assure non-
discrimination during the useful life of the project.
4.Will comply with the requirements of the assistance
awarding agency with regard to the drafting, review and
approval of construction plans and specifications.
5.Will provide and maintain competent and adequate
engineering supervision at the construction site to
ensure that the complete work conforms with the
approved plans and specifications and will furnish
progressive reports and such other information as may be
required by the assistance awarding agency or State.
6.Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding agency.
7.Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.
8.Will comply with the Intergovernmental Personnel Act
of 1970 (42 U.S.C. §§4728-4763) relating to prescribed
standards of merit systems for programs funded
under one of the 19 statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C.F.R. 900, Subpart F).
9.Will comply with the Lead-Based Paint Poisoning
Prevention Act (42 U.S.C. §§4801 et seq.) which
prohibits the use of lead-based paint in construction or
rehabilitation of residence structures.
10.Will comply with all Federal statutes relating to non-
discrimination. These include but are not limited to: (a)
Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race,
color or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C. §§1681
1683, and 1685-1686), which prohibits discrimination
on the basis of sex; (c) Section 504 of the
Rehabilitation Act of 1973, as amended (29) U.S.C.
§794), which prohibits discrimination on the basis of
handicaps; (d) the Age Discrimination Act of 1975, as
amended (42 U.S.C. §§6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse
Office and Treatment Act of 1972 (P.L. 92-255), as
amended relating to nondiscrimination on the basis of
drug abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) §§523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee
3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the
Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statue(s)
under which application for Federal assistance is being
made; and (j) the requirements of any other
nondiscrimination statue(s) which may apply to the
application.
Previous Edition Usable Authorized for Local Reproduction Standard Form 424D (Rev. 7-97)
Prescribed by OMB Circular A-102
11.Will comply, or has already complied, with the
requirements of Titles II and III of the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of
1970 (P.L. 91-646) which provide for fair and equitable
treatment of persons displaced or whose property is
acquired as a result of Federal and federally-assisted
programs. These requirements apply to all interests in real
property acquired for project purposes regardless of
Federal participation in purchases.
12.Will comply with the provisions of the Hatch Act (5 U.S.C.
§§1501-1508 and 7324-7328) which limit the political
activities of employees whose principal employment
activities are funded in whole or in part with Federal funds.
13.Will comply, as applicable, with the provisions of the Davis-
Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract
Work Hours and Safety Standards Act (40 U.S.C. §§327-
333) regarding labor standards for federally-assisted
construction subagreements.
14.Will comply with flood insurance purchase requirements of
Section 102(a) of the Flood Disaster Protection Act of 1973
(P.L. 93-234) which requires recipients in a special flood
hazard area to participate in the program and to purchase
flood insurance if the total cost of insurable construction
and acquisition is $10,000 or more.
15.Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91-
190) and Executive Order (EO) 11514; (b) notification
of violating facilities pursuant to EO 11738; (c)
protection of wetlands pursuant to EO 11990; (d)
evaluation of flood hazards in floodplains in accordance
with EO 11988; (e) assurance of project consistency
with the approved State management program
developed under the Coastal Zone Management Act of
1972 (16 U.S.C. §§1451 et seq.); (f) conformity of
Federal actions to State (Clean Air) implementation
Plans under Section 176(c) of the Clean Air Act of
1955, as amended (42 U.S.C. §§7401 et seq.); (g)
protection of underground sources of drinking water
under the Safe Drinking Water Act of 1974, as
amended (P.L. 93-523); and, (h) protection of
endangered species under the Endangered Species
Act of 1973, as amended (P.L. 93-205).
16.Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. §§1271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.
17.Will assist the awarding agency in assuring compliance
with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U.S.C. §470), EO 11593
(identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of
1974 (16 U.S.C. §§469a-1 et seq).
18.Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMB Circular No. A-133,
"Audits of States, Local Governments, and Non-Profit
Organizations."
19.Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE
SF-424D (Rev. 7-97) Back
APPLICANT ORGANIZATION DATE SUBMITTED
Mayor
City of Kent
20.Will comply with the requirements of Section 106(g) of
the Trafficking Victims Protection Act (TVPA) of 2000, as
amended (22 U.S.C. 7104) which prohibits grant award
recipients or a sub-recipient from (1) Engaging in severe
forms of trafficking in persons during the period of time
that the award is in effect (2) Procuring a commercial
sex act during the period of time that the award is in
effect or (3) Using forced labor in the performance of the
award or subawards under the award.
05/17/2022
CERTIFICATIONS
In accordance with the applicable statutes and the regulations governing the consolidated plan regulations,
the jurisdiction certifies that:
Aflirmatively Further Fair Housing -The jurisdiction will affirmatively further fair housing.
Uniform Relocation Act and Anti-displacement and Relocation Plan -- It will comply with the
acquisition and relocation requirements of the Uniform Relocation Assistance and Real Property
Acquisition Policies Act of 1970, as amended, (42 U.S.C. 4601-4655) and implementing regulations at
49 CFR Part24.lt has in effect and is following a residential anti-displacement and relocation assistance
plan required under 24 CFR Part 42 in connection with any activity assisted with funding under the
Community Development Block Grant or HOME programs.
Anti-Lobbying ..To the best of the jurisdiction's knowledge and belief:
1 . No Federal appropriated funds have been paid or will be paid, by or on behalf of it, to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with the
awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the
entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any Federal contract, grant, loan, or cooperative agreement;
2. lf any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with this
Federal contract, grant, loan, or cooperative agreement, it will complete and submit Standard Form-LLL,
"Disclosure Form to Report Lobbying," in accordance with its instructions; and
3. It will require that the language of paragraph 1 and2 of this anti-lobbying certification be included in
the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under
grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose
accordingly.
Authority of Jurisdiction --The consolidated plan is authorized under State and local law (as applicable)
and the j urisdiction possesses the legal authority to carry out the programs for which it is seeking
funding, in accordance with applicable HUD regulations.
Consistency with plan --The housing activities to be undertaken with Community Development Block
Grant, HOME, Emergency Solutions Grant, and Housing Opportunities for Persons With AIDS funds are
consistent with the strategic plan in the jurisdiction's consolidated plan.
Section 3 -- It will comply with section 3 of the Housing and Urban Development Act of 1968 (12
U.S.C. l70lu) and regulations at 24 CFR Part75
gnature of
ffiO.rnr
al
b#{zz
ritle {J-
Specific Community Development Block Grant Certifications
The Entitlement Community certifies that:
Citizen Participation -- It is in full compliance and following a detailed citizen participation plan that
satisfies the requirements of 24 CFR 91.105.
Community Development Plan -- Its consolidated plan identifies community development and housing
needs and specifies both short-term and long-term community development objectives that that have been
developed in accordance with the primary objective of the CDBG progrcm (i.e., the development of viable
urban communities, by providing decent housing and expanding economic opportunities, primarily for
persons of low and moderate income) and requirements of 24 CFR Parts 9l and 570.
Following a Plan -- It is following a current consolidated plan that has been approved by HUD.
Use of Funds -- It has complied with the following criteria:
1. Maximum Feasible Priority. With respect to activities expected to be assisted with CDBG
funds, it has developed its Action Plan so as to give maximum feasible priority to activities
which benefit low- and moderate-income families or aid in the prevention or elimination of
slums or blight. The Action Plan may also include CDBG-assisted activities which the grantee
certifies are designed to meet other community development needs having particular urgency
because existing conditions pose a serious and immediate threat to the health or welfare of the
community, and other financial resources are not available (see Optional CDBG Certification).
2. Overall Benefit. The aggregate use of CDBG funds, including Section 108 guaranteed loans,
during program year(s)a period specified by the grantee ofone,
two, or three specific consecutive program years], shall principally benefit persons of low and
moderate income in a manner that ensures that at least 70 percent of the amount is expended for
activities that benefit such persons during the designated period.
3. Special Assessments. It will not attempt to recover any capital costs of public improvements
assisted with CDBG funds, including Section 108 loan guaranteed funds, by assessing any
amount against properties owned and occupied by persons of low and moderate income,
including any fee charged or assessment made as a condition of obtaining access to such
public improvements.
However, if CDBG funds are used to pay the proportion of a fee or assessment that relates to the
capital costs of public improvements (assisted in part with CDBG funds) financed from other
revenue sources, an assessment or charge may be made against the property with respect to the
public improvements financed by a source other than CDBG funds.
In addition, in the case of properties owned and occupied by moderate-income (not low-income)
families, an assessment or charge may be made against the properly for public improvements
financed by a source other than CDBG funds if the jurisdiction certifies that it lacks CDBG funds
to cover the assessment.
Excessive Force -- It has adopted and is enforcing:
1 . A policy prohibiting the use of excessive force by law enforcement agencies within its
jurisdiction against any individuals engaged in non-violent civil rights demonstrations; and
2. A policy of enforcing applicable State and local laws against physically baning entrance to or
exit from a facility or location which is the subject of such non-violent civil rights
demonstrations within its jurisdiction.
Compliance with Anti-discrimination laws -- The grant will be conducted and administered in
conformity with title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d) and the Fair Housing Act(42
U. S.C. 360 I -36 1 9) and implementing regulations.
Lead-Based Paint -- Its activities concerning lead-based paint will comply with the requirements of 24
CFR Part 35, Subparts A, B, J, K and R.
Compliance with Laws - It will comply with applicable laws.
t8 ZL
Signature of
IrnQr-rt"f
Title o-
OPTIONAL Community Development Block Grant Certification
Submit the following certification only when one or more of the activities in the action plan are designed
to meet other community development needs having particular urgency as specified in 24 CFR
570.208(c):
The grantee hereby certifies that the Annual Plan includes one or more specifically identified CDBG-
assisted activities which are designed to meet other community development needs having particular
urgency because existing conditions pose a serious and immediate threat to the health or welfare of the
community and other financial resources are not available to meet such needs.
6 L)ZL
S lgnature of Date
fna4an,
Title 0
Specific HOME Certifications
The HOME participating jurisdiction certifies that:
Tenant Based Rental Assistance -- If it plans to provide tenant-based rental assistance, the tenant-based
rental assistance is an essential element of its consolidated plan.
Eligible Activities and Costs -- It is using and will use HOME funds for eligible activities and costs, as
described in 24 CFR $$92.205 through 92.209 and that it is not using and will not use HOME funds for
prohibited activities, as described in $92.214.
Subsidy layering -- Before committing any funds to a project, it will evaluate the project in accordance
with the guidelines that it adopts for this purpose and will not invest any more HOME funds in
combination with other Federal assistance than is necessary to provide affordable housing;
Date
Title
D3
Emergency Solutions Grants Certifications
The Emergency Solutions Grants Program recipient certifies that:
Major rehabilitation/conversion/renovation - If an emergency shelter's rehabilitation costs exceed
75 percent of the value of the building before rehabilitation, the recipient will maintain the building as a
shelter for homeless individuals and families for a minimum of l0 years after the date the building is first
occupied by a homeless individual or family after the completed rehabilitation.
Ifthe cost to convert a building into an emergency shelter exceeds 75 percent ofthe value ofthe building
after conversion, the recipient will maintain the building as a shelter for homeless individuals and
families for a minimum of l0 years after the date the building is first occupied by a homeless individual
or family after the completed conversion.
In all other cases where ESG funds are used for renovation, the recipient will maintain the building as a
shelter for homeless individuals and families for a minimum of 3 years after the date the building is first
occupied by a homeless individual or family after the completed renovation.
Essential Services and Operating Costs - In the case of assistance involving shelter operations or
essential services related to street outreach or emergency shelter, the recipient will provide services or
shelter to homeless individuals and families for the period during which the ESG assistance is provided,
without regard to a particular site or structure, so long the recipient serves the same type of persons (e.g.,
families with children, unaccompanied youth, disabled individuals, or victims of domestic violence) or
persons in the same geographic area.
Renovation - Any renovation carried out with ESG assistance shall be sufficient to ensure that the
building involved is safe and sanitary.
Supportive Services - The recipient will assist homeless individuals in obtaining permanent housing,
appropriate supportive services (including medical and mental health treatment, victim services,
counseling, supervision, and other services essential for achieving independent living), and other Federal
State, local, and private assistance available for these individuals.
Matching Funds - The recipient will obtain matching amounts required under 24 CFR 576.201.
Confidentiality - The recipient has established and is implementing procedures to ensure the
confidentiality of records pertaining to any individual provided family violence prevention or treatment
services under any project assisted under the ESG program, including protection against the release ofthe
address or location of any family violence shelter project, except with the written authorization of the
person responsible for the operation ofthat shelter.
Homeless Persons Involvement - To the maximum extent practicable, the recipient will involve,
through employment, volunteer services, or otherwise, homeless individuals and families in constructing,
renovating, maintaining, and operating facilities assisted under the ESG program, in providing services
assisted under the ESG program, and in providing services for occupants of facilities assisted under the
program.
Consolidated Plan - All activities the recipient undertakes with assistance under ESG are consistent
with its consolidated plan.
Discharge Policy - The recipient will establish and implement, to the maximum extent practicable and
where appropriate, policies and protocols for the discharge ofpersons from publicly funded institutions
or systems of care (such as health care facilities, mental health facilities, foster care or other youth
facilities, or correctidn programs and institutions) in order to prevent this discharge from immediately
resulting in homelessness for these persons.
e f r"l lre,
Signature of
fnfu.-,Af
Date
Title (.)
Housing Opportunities for Persons With AIDS Certifications
The HOPWA grantee certifies that:
Activities - Activities funded under the program will meet urgent needs that are not being met by
available public and private sources.
Building -- Any building or structure assisted under that program shall be operated for the purpose
specified in the consolidated plan:
l. For a period ofnot less than l0 years in the case ofassistance involving new construction, substantial
rehabilitation, or acquisition of a facility,
2. For a period ofnot less than 3 years in the case ofassistance involving non-substantial rehabilitation
or repair ofa building or structure.
ZL
Signature of Date
fY\O\r-^\A !a
Title 0-
APPENDIX TO CERTIFICATIONS
INSTRUCTIONS CONCERNING LOBBYING CERTIFICATION
Lobbying Certification
This certification is a material representation of fact upon which reliance was placed when this transaction
was made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction imposed by section 1352,lille 31, U.S. Code. Any person who fails to file the required
certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for
each such failure.