PY2020 Joint City/County ESG Program Application

FUNDING REQUEST FORM 

BERKS COUNTY & CITY OF READING 

EMERGENCY SOLUTIONS GRANT (ESG) PROGRAM 

FFY2020 

 

Assistance in completing this request is available by calling the Berks Redevelopment Authority at 610-478-6325 between the hours of 8:00 a.m. and 5:00 p.m. Please answer all questions applicable to your project as specifically as possible (print or type).

All projects funded by the ESG Program must be consistent with the City & County Comprehensive and the Five Year Consolidated Plans.

 

I. GENERAL INFORMATION 

 

A. Date: ___________________ 

 

B. Submitted By: ___________________________________Title: ____________________ 

 

C. Organization: ____________________________________________________________ 

 

D. Address: ________________________________________________________________ 

 

________________________________________________________________________ 

 

E. Telephone: _________________________FAX: ________________________________ 

 

F. Contact Person: __________________________________________________________ 

 

G. Contact Person Telephone: _________________________________________________ 

 

H. DUNS Number: __________________ IRS Tax Number: _____________________ 

 

I. Email: __________________________________________________________________ 

 

 

J. Total Budget: _______________ Amount Requested: _______________ 

 

K. Project Name: ____________________________________________________________ 

 

L. Brief Description of Project: ________________________________________________ 

 

________________________________________________________________________ 

 

________________________________________________________________________ 

 

________________________________________________________________________ 

 

M. Project Service Area: ______________________________________________________ 

 

N. Project Location: _________________________________________________________

 

 

II. CHECKLIST OF REQUIRED DOCUMENTS 

 

Organizations currently being funded by the ESG Program do not need to submit documents No. 2, 3, 4, 7, 8, 9, or 10 if they are on file in both the Berks Redevelopment Authority Office and the City Community Development Department and they have not been changed since initially submitted.

 

_____ 1. Narrative data on project and applicant 

 

_____ 2. Articles of Incorporation and Bylaws 

 

_____ 3. State and Federal Tax Exemption Determination letters 

 

_____ 4. List of Board of Directors 

 

_____ 5. Board of Directors' authorization to request funds 

 

_____ 6. Board of Directors' designation of authorized official 

 

_____ 7. Organizational chart 

 

_____ 8. Resume of program administrator 

 

_____ 9. Resume of fiscal officer 

 

_____ 10. Financial statement and most recent audit 

 

_____ 11. Copy of most recent strategic plan or similar planning document. 

 

____________12. Performance Measurement Form. 

 

____________13. Current Salary of Executive Director 

 

 

III. NARRATIVE 

 

The County and City do not require a particular format for this section however, the narrative may be typewritten and not exceed 10 pages. 

 

A. Project Summary 

 

Briefly describe the proposed project. The narrative should include the need or problem to be addressed in relation to the Comprehensive Plan and Consolidated Plan, as well as the population to be served or the area to benefit. Describe the work to be performed, including the activities to be undertaken or the services to be provided, the goals and objectives, method of approach, and the implementation schedule. Include the proposed budget, specifying line item costs such as personnel, supplies, equipment, travel, etc. Discuss the intended staffing pattern, and finally other sources of funding sought and secured.

 

B. Performance/Outcome Measurement 

 

Human Service agencies are in the midst of a major shift from focus on activities to a focus on results. The potential benefits of this shift to a focus on outcomes are broad. Agencies will have invaluable information for increasing the quality of their programs. Program participants will receive services that are shown to produce positive results. 

 

Using your organization’s planning document, please provide appropriate performance/outcome measurements for the project you are requesting funds for. 

 

C. Organization Information 

 

Background 

Include the length of time the organization has been in operation, the date of incorporation, the purpose of the organization, and the type of corporation. Describe the type of services provided, the organization's capabilities, the number and characteristics of clients served, and license to operate (if appropriate). 

 

Personnel 

Briefly describe the organization's existing staff positions and qualifications, and state whether or not the organization has a personnel policy manual with an affirmative action plan and grievance procedure. 

 

Financial 

Describe the organization's current operating budget, itemizing revenues and expenses. Identify commitments for ongoing funding. Describe the organization's fiscal management including financial reporting, record keeping, accounting systems, payment procedures, and audit requirements. 

 

Audit Requirements 

The Organization is informed that if funded by the ESG Program, the Organization may be subject to the audit requirements of OMB Circular A-133. 

 

Insurance/Bond/Worker's Compensation 

State whether or not the organization has liability insurance coverage, in what amount, and with what insuring organization. State whether or not the organization pays all payroll taxes and worker's compensation as required by Federal and State Law. State whether or not the organization has fidelity bond coverage for principal staff who handle the organization's accounts, in what amount, and with what insuring organization. 

 

Additional Information 

Include any other pertinent information.

 

IV. STANDARD REQUIRED DOCUMENTS 

 

A. Articles of Incorporation/Bylaws 

 

Articles of Incorporation/Bylaws Articles of incorporation are the documents recognized by the State as formally establishing a private corporation, business or organization. 

 

B. Non-profit determination 

 

Non-profit organizations must submit tax-exempt determination letters from the Federal Internal Revenue Service and the State Franchise Tax Board. 

 

C. List of the Board of Directors 

 

A list of the current board of directors or other governing body of the organization must be submitted. The list must include the name, telephone number, address, occupation or affiliation of each member and must identify the principal officers of the governing body. 

 

D. Authorization to Request Funds 

 

Documentation must be submitted of the governing body's authorization to submit the funding request. Documentation of this requirement consists of a copy of the minutes of the meeting in which the governing body's resolution, motion or other official action is recorded. 

 

E. Authorized Official 

 

Documentation must be submitted of the governing body's action authorizing the representative of the organization to negotiate for and contractually bind the organization. Documentation of this requirement consists of a signed letter from the Chairperson of the governing body providing the name, title, address and telephone number of each authorized individual. 

 

F. Organizational Chart 

 

An organizational chart must be provided which describes the organization's administrative framework and staff positions, which indicates where the proposed project will fit into the organizational structure, and which identifies any staff positions of shared responsibility. 

 

G. Resume of the Chief Program Administrator 

 

H. Resume of the Chief Fiscal Officer 

 

I. Financial Statement and Audit

 

V. BUDGET SUMMARY 

 

Provide financial data requested below. Costs should be based on the best information available at the time of the request. 

 

Total estimated cost of project: $_________________ 

 

Amount of funds requested: $_________________ 

 

Amount of required matching funds ($1.00 for $1.00): $ _________________ 

 

It is important to try to obtain funds to offset the demand for the limited amount of ESG Program funds. If the project requires a renewal of funds every year, the County and City cannot guarantee that renewal. 

 

A. List the amount and source of other funds that will be used in addition to the ESG Program funds being requested. 

 

B. If ESG Program funds are needed to secure matching funds from another source, state the source and the amount of funds to be matched. 

 

VI. CERTIFICATION 

 

This funding request for ESG Program funds was discussed at a public meeting held on (date) ______________________and was approved by the Governing Body on (date) ____________. 

 

____________________________________ ______________________________ 

Signature Title 

 

Deadline for completed request and supporting documentation is June 30, 2018 and must be sent to: 

 

For City ESG Funding – 

City of Reading Community Development Office 

City Hall Office 3-12 

815 Washington Street 

Reading, PA 19601 

 

For County ESG Funding - 

Berks County Redevelopment Authority 

606 Court Street, 3rd Floor 

Reading, PA 19601

 

 

 

For Municipal Staff Use Only

Project # 

Date Received: 

Eligible: 

Regulation: