HOME Application Stark County HOME Consortium
2017
HOME Investment Partnerships Application 2017 HOME Application
Please complete the following HOME application. An Application Guide is available with directions on completing the application, submission details and contact information for questions regarding the application.
Due Date: Friday, January 6, 2017 by 12:00 Noon NO FAXED OR EMAILED APPLICATIONS WILL BE ACCEPTED.
General Information
Program Title:
Applicant Organization/Agency:
Type of Organization: ☐ Local Government ☐ Community Housing Development Organization (CHDO) ☐ Public Agency ☐ Non-Profit Organization ☐ For-Profit Organization ☐ Other: (specify)
Federal Tax ID:
DUNS#:
SAMS# (CCR):
Contact Person: Title:
Address:
City: State: Zip:
Phone:
Email:
Fax:
Address program will operate from (if different from Agency Address):
2 Funding Request
Amount ($) of HOME Request $ Amount ($) of Community or Agency’s Commitment to Project $ Amount ($) from Other Sources $ Total Program Cost(s) $ Can this project be partially funded? ☐ Yes ☐ No If yes, explain how (max. characters 500)
Indicate if a loan or grant is preferred: ☐ Loan ☐ Grant Project Activity
Select the one activity that best describes the project: ☐ Rental ☐ Down Payment Assistance (DPA) ☐ Homeowner ☐ Tenant Based Rental Assistance (TBRA) Is this project CHDO eligible? ☐ Yes ☐ No Will CHDO act as: ☐ Owner ☐ Developer ☐ Sponsor Project Type and Narrative
Select all that apply: ☐ New Construction ☐ Acquisition of Property ☐ Rehabilitation ☐ Acquisition of vacant land ☐ Reconstruction ☐ Demolition ☐ Conversion ☐ Relocation Costs ☐ Site Improvements ☐ Project Related Soft Costs ☐ DPA ☐ TBRA ☐ CHDO Pre-Development Costs
Project Description: (maximum characters 500 for each question)
Provide a detailed description of your project; including project location (attach a map showing location).
Describe the need and urgency for the proposed project. What are the consequences if the project is not funded?
Describe how the location(s) of the housing opportunity, in whole or part, provides and promotes greater choice and will not create undue concentration of poverty in any given area?
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Describe how the project locations(s) will connect the population to jobs, transportation and community resources.
Describe how the project creates new affordable housing units, prevents the loss of viable units or significantly changes the composition of those units to meet the needs of the proposed population.
Describe the length of time the proposed project will provide long-term affordable housing and what mechanisms will ensure this.
Describe the outcomes expected to occur in the community as a result of the proposed activity. Describe how outcomes will be achieved.
Describe the organization’s fiscal management including financial reporting and recording keeping.
Is there a fiscal agent other than the applicant? ☐ Yes ☐ No If yes, name of fiscal agent
Provide a copy of the fiscal agency’s current auditor’s financial statement, audit report and Management and Compliance letter. Letter of commitment to act as fiscal agent must also be attached. Performance Measurement Standards (Definitions located in the Guide)
Objective – Select One ☐ Suitable Living Environments ☐ Decent Housing ☐ Economic Opportunity
Outcome – Select One ☐ Availability/Accessibility ☐ Affordability ☐ Sustainability Project Performance Measurement
Indicate the number of people/units expected and choose household type(s) this project will target: (Complete each box – leave no blanks)
People – Enter # of people Housing Units – Enter # of units
4 Small Households (2-4 individuals) – Enter # households Large Households (5 or more individuals) – Enter # of households Household Type: (Check all that apply) ☐ Single non-elderly ☐ Youth ☐ Elderly ☐ Disabled ☐ Families ☐ Homeless Commitment of Funds
If awarded funding for your project, will you be able to complete the project within 24 months of the project setup date? ☐ Yes ☐ No
If no, explain: (max. characters 500)
If applying for rehabilitation, new construction, or demolition, will you be able to break ground (start construction) within 12 months of the project setup date? ☐ Yes ☐ No ☐ Not Applicable Conflict of Interest
As an applicant requesting funding, will you, or any of your employees, agents, consultants, officers, or elected officials meet any of the following conflicts of interest:
☐ Yes ☐ No Participate in the decision making process for the approval of this application? (i.e., Stark County Commissioner or RPC staff) ☐ Yes ☐ No Have a financial interest or reap a financial benefit from this activity? ☐ Yes ☐ No Have an interest in any contract, subcontract, or agreement with respect to this application either for themselves or those with whom they have family or business ties during the program year and for one year thereafter? Data Collection
Describe the process for collecting income and beneficiary data, including who will collect it and how the Data will be stored. (max. characters 500)
Use of Contractors, Consultants
In accordance with federal regulations, HOME funds may not be used to directly or indirectly employ, award contracts to, or otherwise engage the services of any contractor or subrecipient during any period of debarment, suspension, or placement of ineligibility status. Housing Activities
Type of Housing: ☐ Single-family ☐ Townhome
5 ☐ 2-, 3-, or 4-plex ☐ Single-Room Occupancy ☐ Multi-family ☐ Other:
Tenancy: ☐ Owner-occupied ☐ Renter-occupied
Income Level of Clients: ☐ 0-30% Area Median Income ☐ 31-50% Area Median Income ☐ 51-60% Area Median Income ☐ 61-80% Area Median Income
Benefit to Homeless: ☐ Not applicable ☐ Homeless individuals ☐ Homeless families
Non-Homeless Special Need Population Served: ☐ Elderly (62 years +) ☐ Alcohol/drug abuse ☐ Developmentally disabled ☐ Physical disability ☐ Severe mental illness ☐ Victims of domestic violence ☐ HIV/AIDS ☐ Not applicable
MATCH (MATCH information located in the Guide)
Specify the type of MATCH Contribution the applicant will use to meet the 25% MATCH requirement. (max. characters 500)
Budget Narrative ProForma (Consult Application Guide for requirements of this section.)
The proforma is an Excel document available on the RPC website.
Funding Sources
Break down the funding sources, by funding type, and indicate the amount of funding that will be applied to the proposed project:
6 Amount of Funding Source of Funding Funding Committed Pending CDBG HOME Section 8 Federal McKinney-Vento LIHTC (Housing Tax Credits Other Federal
(Identify:______) State State Funds
Funds (Identify:______) City Funds
(Identify:______) Stark County Funds (non HOME Local or CDBG) Funds (Identify:______) Private Funds
(Identify:______) Other Other
Funds (Identify:______) Total Total Funding:
If you have firm commitments for financing, include commitment/award letter(s) from the source of financing. To be considered pending, agency has submitted an application for funding. Attach a copy of the applicant’s current auditor’s financial statements, audit report and Management and Compliance letter.
STOP! DPA and TBRA Applicants Proceed to the Certification Page (last page of application). All other Applicants Proceed in Completing the Remainder of this application. Acquisition, Rehabilitation, Demolition, Clearance, and Conversion Types of Land ☐ Single- or Multi-Family Housing ☐ Farm Land and structures ☐ Vacant land; free from any structures ☐ Business, commercial, or industrial
Site Control Indicate the status of the project site and attach documentation (lease agreement, purchase option, or property deed): ☐ Applicant owns property: Date acquired ☐ Lease: Expiration date ☐ Option to purchase: Expiration date ☐ Other: Describe
Zoning Is the site zoned for the proposed activity? ☐ Yes ☐ No
7 If no, provide an explanation and timetable to change zoning or obtain variance: (max. characters 500)
Appraisal If request is for property acquisition, has an appraisal been completed within the last 12 months? ☐ Yes; copy of appraisal attached ☐ No; if appraised value not known, what is the fair market value determination?
Relocation Does the project require relocation (moving) of occupants of a structure? ☐ Temporary ☐ Permanent ☐ No relocation necessary
General Information Notice Has a General Information Notice to sellers and/or tenants of Relocation or No Relocation benefits been completed? ☐ Yes; provided to occupants on Click here to enter a date. ☐ No; will be completed on Click here to enter a date. ☐ No relocation necessary
Number of units being created or rehabilitated (Leave no boxes blank)
Total # of Units to be created or rehabilitated: units
# of Units Being Created or Anticipated or Actual Unit Type Rehabilitated Monthly Rent
Efficiency 1 Bedroom 2 Bedroom 3 Bedroom 4 Bedroom 5 Bedroom 5 + Bedroom SRO Group Home
8 Units being created or rehabilitated
How many units will: 1. Meet Energy Star Standards: units 2. Be 504-accessible: units 3. Be made sensory accessible: units 4. Be designated for persons with HIV/AIDS: units 5. Be designated for the homeless: units Of these, how many will be designated for chronically homeless: units
Market Study
Any application for rental or homebuyer activities must include a recent (no more than 3 months old) market study verifying the need for the project. If required, provide a copy with your application.
Handicapped Accessible Units – 504 & Fair Housing
Is the project new construction or substantial rehabilitation (cost of rehab is 75% or more of the after rehab vale, as evidenced by an appraisal)? ☐ Yes ☐ No Are there five or more units in the total project? ☐ Yes ☐ No
If Yes to BOTH questions, the 504 requirements apply to your project. *
In addition, all new construction and rehabilitation projects involving buildings with four or more units, must also comply with the minimum accessibility requirements of the Fair Housing Act.* *(Reference Guide for details) Project Site Information
☐ Single Site Project OR ☐ Scattered Site Project
Has project site been determined? ☐ Yes ☐ No If yes, complete the following: a. Site address: b. Site will be acquired from a ☐ related party ☐ unrelated party c. Seller Name: d. Seller Address: Environmental Considerations
Is the project currently underway? ☐ Yes; and a federally-accepted environmental review has been completed. ☐ Yes; but there has not been an environmental review. ☐ No; project will not begin before an environmental review is completed by Stark County.
9 Noise Abatement and Control Distance from nearest railroad: ☐ More, or ☐ Less than 3,000 feet Distance from nearest major roadway: ☐ More, or ☐ Less than 1,000 feet Distance from nearest municipal or military airport ☐ More, or ☐ Less than 5 miles
Wetland Protection Is there wetland associated with the proposed project? ☐ Yes ☐ No
Flood Hazard Area Is there evidence or knowledge that a portion of the proposed project is located in a 100- or 500- year flood plain? ☐ Yes ☐ No Lead Hazards Is there any presence of lead or lead hazards within the property? ☐ Yes ☐ No
Historical Significance Does the project involve existing units that are 50 years old or older? ☐ Yes ☐ No If yes, does the property have historical significance? ☐ Yes ☐ No ☐ Unknown
Other Does the project: Include repair, rehabilitation, or conversion of existing building/facilities? ☐ Yes ☐ No Involve new construction, acquisition of undeveloped land or any construction that requires ground disturbance? ☐ Yes ☐ No Are there any wells on the project site? ☐ Yes ☐ No Is there visual evidence of mold growth on the interior surfaces or any known leaks in the building envelope that might contribute to concealed water damage or mold? ☐ Yes ☐ No ☐ Unknown Is there knowledge or evidence of former methamphetamine (meth) manufacturing labs within the subject property? ☐ Yes ☐ No ☐ Unknown Is there any presence of asbestos located within the property? ☐ Yes ☐ No ☐ Unknown
10 Project Team
Identify name and provide phone number for the following project team members:
Contact Phone Email Developer Name:
Project Manager:
Project Coordinator:
Legal:
Accountant:
Architect:
Construction Contractor:
Engineer:
Consultant:
Engineer:
Consultant:
Management Company:
Other:
11 Project Timeline
Estimated Project Start Date: Click here to enter a date. Estimated Project Completion Date: Click here to enter a date.
Applicants for acquisition, rehabilitation, demolition, conversion, or new construction must provide a schedule for the project and list major project activities and completion dates:
DO NOT leave any line blank, if not applicable enter NA.
Completed Prior to Scheduled Project Activity Application? Check Completion Date if “Yes” Predevelopment Market Study Click here to enter ☐ a date. Site Control Click here to enter a date. ☐ Phase I Environmental Click here to enter ☐ a date. Zoning Approval Click here to enter Site ☐ a date. Site Plan Approval Click here to enter ☐ a date. Site Purchase Click here to enter ☐ a date. Architect Selected Click here to enter ☐ a date. Preliminary Plans/Specs Click here to enter ☐ Plans & a date. Specifications Local Building Code Click here to enter ☐ Review a date. Final Plans/Specs Click here to enter ☐ a date. Financing Interim Applications Click here to enter ☐ Submitted a date. Interim Commitments Click here to enter ☐
12 received a date. Permanent Applications Click here to enter ☐ submitted a date. Permanent Commitments Click here to enter ☐ received a date. Bidding Completed Click here to enter ☐ a date. Contractor selected Click here to enter Construction ☐ a date. Construction/rehab to Click here to enter ☐ begin a date. Month and year Click here to enter ☐ marketing begins a date. Income Verification Click here to enter Marketing ☐ begins a date. Lease-up period begins Click here to enter ☐ a date.
Project Specification
Do you currently have project specifications, floor plans/line drawings? ☐ Yes* ☐ No *If yes, please attach document to this application.
Marketing Plan
Does your business/organization have a current Marketing Plan? ☐ Yes* ☐ No *If yes, please attach the plan to this application.
All applicants who are applying as a Community Housing Development Organization (CHDO) must complete an additional CHDO application in addition to this funding application. Applicable forms can be found at www. rpc.starkcountyohio.gov.
13 Certification
☐ I hereby acknowledge that by applying for HOME funds, this activity may require compliance in following areas: Utilization of minority and women contractors Labor Standards provisions (Davis-Bacon Act) Uniform Relocation Act and Section 104 (d) Section 3 Environmental Regulations Flood Insurance Lead-Based Paint Assessment and/or Remediation or Abatement Debarred, suspended and ineligible contractors and sub recipients Handicapped accessibility Title VI of the Civil Rights Act of 1964 Title VIII of the Civil Rights Act of 1969 – Fair Housing Act Federal Funding Accountability and Transparency Act
I certify that the information contained in this application is true and correct and that it contains no misrepresentations, falsifications, intentional omissions, or concealment of material facts and that the information given is true and complete to the best of my knowledge and belief. I further certify that no contracts have been awarded, funds committed or construction begun on the proposed program, and that none will be prior to issuance of a Release of Funds by the program Administrator.
Signature of Authorized Official
Name of Authorized Official
Title Click here to enter a date.
Date
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