CDBG‑CV Food Programs (Public Service) is sponsored by New York State Homes and Community Renewal (HUD CDBG‑CV). Funding to expand food distribution to low‑ and moderate‑income communities to improve health outcomes and address food insecurity.

# C OMMUNITY D EVELOPMENT B LOCK G RANT (CDBG) PROGRAM # CORONAVIRUS AID , RELIEF AND ECONOMIC SECURITY ACT (CARES ) # C OMMUNITY F OOD SERVICE P ROVIDERS # G RANT APPLICATION & INSTRUCTIONS Table of Contents I. Application Checklist .................................................................................... 3 II.

Application Forms ......................................................................................... 4 A. Project Contact Information .............................................................................

4 B. Project Proposal.............................................................................................. 5 1.

Project Summary ...................................................................................... 5 2. Current Activities and Service Area ..........................................................

5 3. Proposed Activities/Project and Need for CDBG-CV Funding .................. 6 4.

CDBG National Objective ......................................................................... 7 5. Capacity .................................................................................................

10 6. Budget Narrative .................................................................................... 11 III.

Budget Table – Use of Funds ..................................................................... 13 IV. Budget Table - Funding Sources ...............................................................

13 V. Duplication of Benefits Worksheet ............................................................ 14 VI.

Certifications................................................................................................ 15 VII. Application Instructions .............................................................................

17 CDBG-CV – Community Food Services Application Page 3 - Project Contact Information - Project Proposal (1-5) Responses to section 1 -5 are limited to space provided, do not attach additional pages.

- Activity Detail Sheet(s) - Budget Table – Use of Funds - Budget Table – Funding Sources - Duplication of Benefits Worksheet - Tax Exemption Determination Letters - List of Board of Directors - National Objective Compliance Supporting Documentation - NYS Vendor Responsibility Questionnaire https://www. osc. ny.

gov/state-vendors/vendrep/not-profit-non- construction-questionnaire CDBG-CV – Community Food Services Application Page 4 A. PROJECT CONTACT INFORMATION 2. Contact Authorized to Execute Contract with HTFC 3.

Primary Contact for Correspondence Related to this Application 4. Representative Districts Congressional District(s) Type of Applicant Incorporated Not -for -profit organization Email CDBG-CV – Community Food Services Application Page 5 Provide a one paragraph abstract of the proposed project . The abstract provided may be included in press materials.

The abstract should include, but not be limited to organization name, service area, requested amount of funds, main goals(s) of the program, and proposed accomplishments. Sample abstract: The Sample Food Bank will use $300,000 in NYS CDBG-CV funding to expand hours of operation and purchase inventory. Sample Food Bank distributes food and supplies to families in low-and moderate-income areas.

2. Current Activities and Service Area Describe the current services offered by the Applicant and describe the population served. Include detail on the service area and geographic reach.

CDBG-CV – Community Food Services Application Page 6 3. Proposed Activities/Project and Need for CDBG-CV Funding a. Describe the project and/or activities to be expanded as a result of the CDBG -CV funding .

b. Provide a brief description of need for the project, including any quantifiable information (for example, the number of people affected, area affected, etc.) Explain the increase in demand experienced by the Applicant, for which is the basis of this application. The description, to the extent possible, should be based on verifiable documentation.

c. Describe why CDBG-CV funding is necessary to complete this project. How will the project prevent, or prepare for another pandemic event?

How does the project respond to the conditions created from the COVID-19 pandemic? CDBG-CV – Community Food Services Application Page 7 4. CDBG National Objective To be eligible for a grant under this program, a project must meet the HUD required objective of benefiting low- to-moderate income (LMI) persons.

An application that does not meet this criteria cannot be undertaken with CDBG funds and should not be submitted. A project can meet this objective by fitting into one of the following categories: Area Benefit / Census Data, or Limited Clientele – based on HUD Presumed Benefit. Select the category that best demonstrates the National Objective and attach the documentation listed to demonstrate compliance.

1. Area Benefit / Census Data : If the Applicant’s service area is located within a census tract or block group where at least 51% of the population is classified as LMI, or if the Applicant serves multiple census tracts that together have a cumulative LMI percentage of at least 51%, then this national objective applies. Check here to see if your service area meets this LMI National Objective: LMISD Map Application 2016 .

• Map with boundaries of the services area; • Documentation that the area is primarily residential (this can be demonstrated by highlighting the service area map); • Print out of the Census data/American Community Survey data documenting at least 51% of the residents are LMI; and • Fill in the Racial/Ethnic Composition and Clientele Income charts with service area census data .

If the Applicant serves more than one census tract, combine data from all census tracks served. Area Benefit / Census Data RACIAL/ETHNIC COMPOSITION American Indian/Alaskan Native Native Hawaiian/Other Pacific Islander American Indian/Alaskan Native and White Black/African American and White American Indian/Alaskan Native & Black/African American > HISPANIC* = HUD has designated Hispanic as an ethnic group.

A household can be identified as both a member of a racial group and an ethnic group but cannot be designated only as an ethnic group. MEDIAN INCOME (% OF HUD ADJUSTED MEDIAN INCOME) PERSONS 0 - 3 0% (Extremely Low Income) 31 - 50 % (Very Low Income) OF THE TOTAL BENEFITING, THE NUMBER OF: Female Head of Household CDBG-CV – Community Food Services Application Page 8 2. Limited Clientele – based on HUD Presumed Benefit.

For purposes of this program, the Applicant’s project is eligible under this category if it meets one of the criteria listed below. Choose either (a) or (b), complete the charts on the following page and attach the required documentation. a) Exclusively benefit a clientele who are generally presumed by HUD to be principally LMI listed below.

Applicants must demonstrate their program is specifically designed for and used predominately by one of these groups, and they must document that their clients fit the presumed category.

• Elderly person (62 and older) • Severely disabled adults • Persons living with AIDS • Residents of an affordable housing development • Documentation showing that the services provided by the Applicant are designed for exclusive use by a specific group listed above, or by describing how the nature and the location of the services establishes that it will be used predominantly by a specific LMI presumed group (ex.

Food pantry located adjacent to public housing complex that’s designed to serve its resident; public services for the homeless; and meals on wheels for the elderly); • Provide the average number of customers served on an annual basis; and • Complete the Racial/Ethnic Composition and Income Data charts below. b) Household Size and Income .

If an Applicant collects information on family size and income so that it is evident that at least 51% of the clientele are persons whose family income does not exceed the LMI limit, the national objective is met. OCR will accept proxy documentation to verify clientele income eligibility. c) Documentation required • The organization must provide data showing the household size and annual income of each person receiving the benefit.

(Reporting to other state or federal agencies on participant household size and income for programs such as SNAP, USDA or FEMA are acceptable.) • Provide the average number of customers served on an annual basis; and • Complete the Racial/Ethnic Composition and Income Data charts below.

CDBG-CV – Community Food Services Application Page 9 Limited Clientele – based on HUD Presumed Benefit RACIAL/ETHNIC COMPOSITION American Indian/Alaskan Native Native Hawaiian/Other Pacific Islander American Indian/Alaskan Native and White Black/African American and White American Indian/Alaskan Native & Black/African American HISPANIC* = HUD has designated Hispanic as an ethnic group.

A household can be identified as both a member of a racial group and an ethnic group but cannot be designated only as an ethnic group. MEDIAN INCOME (% OF HUD ADJUSTED MEDIAN INCOME) PERSONS 0 - 3 0% (Extremely Low Income) 31 - 50 % (Very Low Income) OF THE TOTAL BENEFITING, THE NUMBER OF: Female Head of Household CDBG-CV – Community Food Services Application Page 10 a.

Provide a project timeline and describe how the proposed project will be completed within 6-8 months of award. Include estimated completion timeframes for key project milestones must include as a minimum: grant agreement execution, procurement process, first payment request. b.

Identify the specific staff assigned to work on the proposed project and detail their role(s). Including but not limited to: purchasing, disbursement of funds, CDBG-CV program reporting. Ensure separation of duties and strong internal controls.

c. Summarize the Applicant’s relevant grant administration experience demonstrating administrative capacity and readiness. CDBG-CV – Community Food Services Application Page 11 a.

Explain how costs were determined and describe the method used to determine the best approach and cost-effective method to address the need. b. Describe any administrative soft costs and how the budget for those costs were developed.

CDBG-CV – Community Food Services Application Page 13 III. BUDGET TABLE – USE OF FUNDS LIST OF ACTIVITIES CDBG $ Requested (From Table E Below ) TOTAL FUNDING Source #___ Source #___ ALL SOURCES 3 Small Furniture Purchases 6 Total Amount of Funding 7 % of Total Project Cost 100% *10 % of the grant award may be used for grant administration expenses. IV.

BUDGET TABLE - FUNDING SOURCES Source of Funding Codes: Federal (F), State (S), Private (P), Local (L), Other (O) Type of Funding Codes: Loan (L), Grant (G), Cash Equity (EQ) Funding Status Codes : Committed (C), Pending (AP) (Months) CDBG-CV – Community Food Services Application Page 14 V.

DUPLICATION OF BENEFITS WORKSHEET A duplication of benefits (DOB) occurs when a person, household, business, government, or other entity receives financial assistance from multiple sources for the same purpose within the same time period, and the total assistance received for that purpose is more than the total need for assistance.

To comply with DOB requirements, grantees are required by the CARES Act to establish and follow procedures to ensure that DOB does not occur. Grant Recipients must ensure multiple active funding streams related to coronavirus response and effectively target CDBG-CV resources to meet unmet needs within the community. HUD’s resources 1.

Identify Total Financial Need 2. Identify Total Assistance Available National Flood Insurance Program (NFIP) Private Insurance (applicant must submit a claim if covered) SBA Grants/Loans (includes PPP and EIDL) Other Federal, State or Local Government Assistance Other private assistance including charitable contributions 3. Identify the Amount of Total Assistance to Exclude as Non-duplicative.

Explanation of non-duplicative funds: 4. Identify Total DOB Amount (item 2 minus item 3) 5.

Calculate Maximum Amount of Award (item 1 minus item 4) CDBG-CV – Community Food Services Application Page 15 I am a member of the Applicant organization, or an authorized representative and have been designated as the signatory authorized to execute a contract if awarded through this application and have the authority to make these certifications for the proposed program.

The Applicant organization is authorized to carry out the proposed activities, is familiar with, and will comply with all applicable statutes, rules, and regulations established. The Office of Community Renewal (OCR) is authorized to forward this application to any other State agency which administers a program for which a funding request is indicated in this application.

The information and supporting documentation contained in this application is true, complete, and accurate to the best of all knowledge. Falsification of information now or in the future will result in the disqualification of application, denial of funding, rescinding of subsequent award and contract, and/or required repayment of funds disbursed for any OCR Program.

The Applicant organization is obligated to notify OCR, in writing, within five (5) business days of any subsequent events or information which would change any statements or representations submitted with this application or would impact the Applicant organization’s ability to carry out this award. This includes notification of any change of staff related to the program award and administration.

No member of the Board of Directors or staff of the Applicant organization will directly or indirectly benefit financially from administration of the program. Any matter regarding any potential conflict of interest or appearance of impropriety arising in connection with this program must be disclosed at the time of application or when the conflict is identified.

The Applicant organization will disclose in this application if it or any of its affiliates has filed for bankruptcy in the last seven (7) years. OCR reserves the right to deny the Applicant organization's request for funding based on concerns for the Applicant organization's overall fiscal health and / or capacity.

The Applicant organization has not experienced any of the following and shall notify OCR within five (5) calendar days after obtaining knowledge of: a) the commencement of any investigation or audit of its activities by any governmental agency, specifically housing discrimination; or b) the alleged default by the Applicant organization under any mortgage, deed of trust, security agreement, loan agreement or credit instrument executed; or c) the allegation of ineligible activities, misuse of any award, or failure to comply with the terms of the Application.

Upon receipt of such notification, OCR may, in its discretion, withhold or suspend payment of some or all of the Award and reserves the right to deny application for funds for any OCR program.

CDBG-CV – Community Food Services Application Page 16 Neither the Applicant organization, nor any principal, partner, or staff member of the Applicant organization has experienced default, non-compliance, debarment, suspension or termination of funds, or been otherwise restricted by DOL, HUD, USDA, ESDC, HFA, HTFC, DHCR, AHC or other federal, state, or local authority.

Applicant organization does not have unresolved findings raised as a result of audits, management reviews, or other investigations concerning projects, contracts, or programs for which the Applicant organization is involved, and Applicant organization has not been the subject of a claim under employee fidelity insurance.

As a condition of award, OCR may seek to verify certain financial, credit and related information contained in the application concerning the project Applicant organization and other members of the project /program team. If the Applicant organization is unable to select “Agree” to any of the items or must disclose information required by the clause a detailed explanation must be provided as an attachment to this form.

As an applicant of a federal award, I certify to the best of my knowledge and belief that the information provided herein is true, complete, and accurate.

I am aware that the provision of false, fictitious, or fraudulent information, the omission of any material fact, may subject me to criminal, civil, or administrative consequences including, but not limited to violations of U.S. Code Title 18, Sections 2, 1001, 1343 and Title 31, Sections 3729-3730 and 3801-3812.

As an applicant of a federal award, I certify to promptly disclose whenever, in connection with the Federal award (including any activities or subawards thereunder), credible evidence exists of the commission of a violation of Federal criminal law involving fraud, conflict of interest, bribery, or gratuity violations found in Title 18 of the United States Code or a violation of the civil False Claims Act (31 U.S.C. 3729-3733).

Signature of Authorized Representative Applicant Organization Name CDBG-CV – Community Food Services Application Page 17 VII. APPLICATION INSTRUCTIONS Project Contact Information UEI or Unique Entity Identifier, enter the UEI number assigned from SAM. gov .

• The UEI is a 12-character, alphanumeric value generated while registering in SAM. gov. If you are registered in SAM. gov (active or not), you already have a Unique Entity ID.

It is viewable at SAM. gov. If you are new to SAM. gov and will be registering for the first time, you will get your Unique Entity ID during registration.

Receiving this ID is required prior to contract execution. • Use these instructions for look up your UEI number - GSAFSD Tier 0 Knowledge Base -How can I view my Unique Entity ID? - Linked to the applicant organization - Registered with an address that matches the application - Shows that the SAM.

gov registration is currently active - Publicly accessible so if awarded it can be verified by HCR upon contract execution Fill out Sections 1-6 completely and accurately. Answer all questions thoroughly and succinctly. Avoid extensive historical descriptions of the project area or information unrelated to the project.

It is particularly important that the proposed project concretely show the way in which it will prevent, prepare for, and/or respond to Coronavirus. The description of impact and budget must match the information provided throughout the application. All activities proposed as part of the project must meet a CDBG National Objective that benefits low-and moderate-income (LMI) persons.

Under this program, there are three ways a project will comply: a. If the Applicant’s service area is located within census track(s) or block group(s) where at least 51% of the population is classified as LMI; b. Applicant’s services exclusively benefit a clientele who are generally presumed to be principally LMI or be of such a nature and in a location that it may be concluded that the Applicant’s clientele are LMI; or c.

Have income-eligibility requirements which limit the service to persons meeting the LMI income requirement, as evidenced by the administering agency’s procedures, intake/application forms, income limits, and other sources of documentation. In additional to the written narrative requested in the application, documentation in support of National Objective compliance must be provided with the application.

Documentation includes completion of charts in Section II. B. 4 and inclusion of supporting documentation.

CDBG-CV – Community Food Services Application Page 18 The budget form must be filled out completely for the proposed project. Note that CDBG-CV will allow up to 10% of the total award for administration. Leveraged funds are not required, but if funds in addition to CDBG-CV funds are necessary to complete the project they must be identified in the budget.

All sources must be listed on the budget form and be documented as necessary as an attachment to the application. Duplication of Benefits (DOB) Worksheet All applicants must complete the DOB worksheet. In some respects, this sheet allows for a restatement of the budget, but more concisely demonstrates that no duplication of benefits is occurring.

(1) In Line 1, enter total outstanding need for the project/business. (2) In Line 2, enter all sources, excluding CV funds, in the different categories below. (3) In Line 3, identify any of the sources listed above that cannot actually be allocated toward the need identified in Line 1 (4) Line 4 auto calculates total amount of potentially duplicative funds.

Line 5 auto calculates the maximum award, or the total outstanding need for the project/business. Recipients may elect to award a lesser amount based on local guidelines/limits.

The Office of Community Renewal Program Applicant Certification must be fully completed and signed by a member of the applicant organization designated as the authorized signatory for the contract (if awarded) and/or who has the authority to make the certifications for the proposed project. This form cannot be signed by administrative staff or consultants.

If the applicant cannot “Agree” to all certifications and responds “Do Not Agree”, a full explanation and supporting documentation must be uploaded as part of this attachment for review and consideration. • Cost Estimates – While not required, certain projects may involve the purchase of equipment or other services. Where relevant, please attached cost estimates related to your project.

• NYS Vendor Responsibility Questionnaire (VRQ ) - Provide a PDF of the Not-for-profit, Non-Construction VRQ. The Questionnaire must be dated within the calendar year of the application and include the VRQ Contract History Form if the organization has received state funds in the last three years.

If an Applicant is required to file a VRQ through the VendRep system for other state funding sources, a PDF of a the full VendRep submission with a certification dated in the calendar year of this application is acceptable. Screenshots of a confirmed VendRep submission are not adequate. Further instructions and VRQ forms are available on the Office of the State Comptroller’s website: https://www.

osc. ny. gov/state-vendors/vendrep/vendor-responsibility-forms