ࡱ>    %` 5bjbjٕ P4xxxhdDNH, "֜֜֜˝ K,wLLLLLLL$CQhSL˝˝L֜֜N|֜֜LLb7@֜ ^xx<:VD$N0N(;TT@T@z)ݾ1LL^XND_Te$$Te  City of Waterbury CDBG and ESG Nonprofit Application for CDBG and ESG Public Facilities and Improvement Projects 2008-2009  Instructions and Application Form INSTRUCTIONS FOR PUBLIC FACILITIES AND PUBLIC IMPROVEMENTS CDBG/ESG APPLICATIONS PREPARATION OF APPLICATIONS Applications are designed to be filled in electronically. Applications must be complete and answer all questions fully in order to be considered. Please consider submitting t applications in advance of the deadline if you want your application reviewed for completeness. Applications must have all required supporting documentation and certifications in order to be considered. Applicants must not have any tax delinquencies. Application proposals must meet with HUD national objectives, be eligible activities, have measureable objectives, outcomes and indicators, provide a performance measurement outcome statement, and comply with Waterburys 2008-2013 Consolidated Plan in order to be considered. One (1) original application marked original with attached supporting documentation and twenty (20) copies without supportive documentation must be mailed or hand-delivered to: Waterbury Development Corporation 24 Leavenworth Street Waterbury, CT 06702 No later than: Wednesday, May 14, 2008 at 3:00 p.m. All original applications will be time-stamped. Late applications will not be accepted! APPLICATION ASSISTANCE: WDC staff is available for assistance or general questions relating to the application. Please call Kathleen McNamara at 203-346-2607 Ext. 115 or Geoff Green at Ext 109. Technical assistance workshops will be held on Wednesday, April 30, 2008 in the WDC 2nd floor Brass City Room from 4:00 to 5:30 p.m. and also on Wednesday, May 7, 2008 (same location and time). APPLICATION EVALUATION CRITERIA (100 point cumulative plus 20 point bonus) Applications deemed complete and meeting all requirements will be scored upon the following criteria: 1. Critical Need: 15 points How critical is the need for these services? Does the proposed activity fill an identified gap? Does the benefit in terms of numbers of clients served or type of services provided rise to a priority in terms of funding, considering the many requests received for CDBG/ESG? 2. Service Duplication: 10 points Does the program provide an unduplicated service in the City or defined service area? Are the service recipients primarily Waterbury residents? How has the applicant insured that duplication of services with other agencies is not occurring? Is the applicant making efforts to collaborate with other providers of similar services? 3. Service/Activity Quality: 15 points If the service/activity is a renewal, has it performed well and met community needs in the past? Does the service have a successful track record? Has it met its set goals in the past (performance outcome measurement statements). If the service/activity is a new proposal, is it well-thought out, with identified and scheduled goals? Has the applicant clearly identified all tasks/and objectives and set a schedule of goals to be completed? Is the applicant able to demonstrate how it meets its program outputs / outcomes in a measurable manner? Will the program/project be ready to operate at the beginning of the program year and be completed within the program year? Does the organization have a system for monitoring and evaluating the quality and outcomes of the services provided? 4. Budget: 10 points Has an estimate of necessary resources been compiled into a realistic budget? Have the proposed expenses been justified as they relate to the purpose of the funding? Are the expenses itemized in the overall budget essential to the proposed project? If the service or activity is a renewal, is the budget in line with the prior years final actual expenses? Are CDBG/ESG funds essential, or could this program be run without CDBG/ESG funds? 5. Financial Soundness: 15 points Does the financial documentation provided demonstrate that the applicant is financially sound at the time of the application? If the applicant has encountered financial difficulty in the past, has the organization taken adequate steps to provide for its future operating needs and expenses? What financial practices are in place to assure that the organization will be able to deliver the services for which it is applying? 6. Organizational Capacity: 10 points Does the agency have the organizational capacity to deliver the proposed program? Are staffing levels sufficient on both the paid and volunteer levels? Are staff properly trained and qualified to deliver the programs and services? Does the agency have the capacity to handle financial resources with adequate internal control and acceptable accounting procedures? 7. Past History (Negative 0-10 points) If the agency received funding in the past were all reporting and contractual requirements met in a timely manner? If not, was the agency interested in improving its performance and showing diligence in improving its record keeping and reporting by requesting technical assistance? Were invoices submitted correctly and in a timely fashion? What was the quality of the reporting? 8. Leveraging: 15 points Has the organization demonstrated the ability to use other city, federal or private funds or hold fundraisers/seek donations to leverage CDBG/ESG funding? What percentage of the budget does CDBG/ESG comprise? If applicant is receiving other funds have commitment letters been attached? If applicant has applied to seek other funds, have copies of application cover letters to other fund sources been attached? (Organizations that seek additional funds will be given priority) 9. Program/Project Readiness: 10 points Is the program or project ready to move forward? If a building project, have site selection, acquisition, specifications, and feasibility studies prepared? If a program or activity has the program been well-though out, program staff designated and program materials been drafted? Does the design of the program/project seem feasible? 9. Consolidated Plan Targeted Area: Bonus 20 points If the project or service falls within a local target area or HUD approved Neighborhood Revitalization Strategy Area the application will receive a bonus of 20 points. Preliminary Consolidated Plan target areas include the Brooklyn neighborhood in the vicinity of Duggan School, the North Main Street neighborhood in the vicinity of the proposed North Main Street school, and the upper South End neighborhood, as well as the South Main Street corridor. CDBG / ESG Public Facilities and Improvement Project Application Cover Waterbury Development Corporation 24 Leavenworth Street Waterbury, CT. 06702 Website: www.wdconline.org COMMUNITY DEVELOPMENT BLOCK GRANT(CDBG) and EMERGENCY SHELTER GRANT (ESG) PROGRAMS APPLICATION FOR FUNDING ASSISTANCE Due Date: Wednesday, May 14, 2008 at 3:00 p.m.PROGRAM YEAR OCTOBER 1, 2008-SEPTEMBER 30, 2009 Agencys Legal Name:  FORMTEXT       Project Title:  FORMTEXT      Agency s Mailing Address: Street: FORMTEXT       City  FORMTEXT       State FORMTEXT       Zip  FORMTEXT       Tel.  FORMTEXT      Ext.  FORMTEXT      Project Site Address: Street: FORMTEXT       City  FORMTEXT      State:  FORMTEXT     Zip  FORMTEXT       Tel:  FORMTEXT       Ext.  FORMTEXT       Person Authorized To Sign Contract: Name: FORMTEXT       Title:  FORMTEXT       Tel:  FORMTEXT       Fax:  FORMTEXT       Email:  FORMTEXT       Person Managing Project: Name: FORMTEXT       Title:  FORMTEXT       Tel: FORMTEXT       Fax:  FORMTEXT       Email:  FORMTEXT      Status of Agency:  FORMCHECKBOX  Nonprofit (Attach proof)  FORMCHECKBOX  Pending  FORMCHECKBOX  Approved  FORMCHECKBOX  Type of Nonprofit (Identify):  FORMCHECKBOX  State of Connecticut Incorporation (Attach proof)  FORMCHECKBOX  Employer Identification Number FORMTEXT       Project Category:  FORMCHECKBOX  Public Facility  FORMCHECKBOX  Improvement Project See separate application for Public Services, Economic Development and HousingCDBG FORMCHECKBOX  ESG FORMCHECKBOX  Funding Request: $ FORMTEXT       Total Project Cost: $ FORMTEXT       If the amount of the CDBG/ESG grant is less than the amount requested, will the program be implemented?  FORMCHECKBOX  Yes or  FORMCHECKBOX No Is the funding request  FORMCHECKBOX  FORMTEXT new or  FORMCHECKBOX  continued? 2008-2009 CDBG/ESG APPLICATION fill out application electronically. check all boxes as you complete each section. print original and attach supportive documentation. mark original application with the word original on the cover sheet. attach supportive documentation to the original only. copies do not need supportive documentation. submit one (1) original with attached supportive documentation and twenty (20) copies of the application by hand or mail to: waterbury developmentcorporation, 24 leavenworth street, waterbury, ct 06702 by wednesday, may 14, 2008, at 3:00 p.m. all originals will be time-stamped. no applications will be accepted after the deadline! Each application will be scored based upon a 100 point Criteria (See attached Criteria) plus a 20 point possible target bonus for a total of 120 possible points. only complete applications with all supportive documents will be considered. each application proposal each must meet a HUD national objective, be a HUD-eligible Activity, show objectives, Outcomes, and Indicators, Provide a performance outcome measurement Statement, and comply with the City of waterbury Consolidated Plan. The applicant must have no city of waterbury delinquencies  FORMCHECKBOX  SECTION I. ORGANIZATION/AGENCY SUMMARY: Please provide a summary of your organization that includes a mission statement, a description of your organizations staffing capacity (paid and volunteer), an overview of your organization s programs and activities, accomplishments.  FORMTEXT        FORMCHECKBOX  SECTION II. FACILITY/ IMPROVEMENT PROJECT DESCRIPTION AND WORKPLAN: If your organization is awarded funding, the WDC will require that an architect/ licensed design professional complete the Contract Bidding Documents, which shall include the front end contractual language; zoning information; use group; site survey; environmental report, soils report (if needed), architectural, structural, mechanical, electrical, plumbing, construction manual / specifications; drawings; and probable cost estimate. Please provide the architects name, address, telephone number and professional license number. Have the architect describe the improvement project to be undertaken. Provide the current square footage of the building/site and the amount of square footage affected by the proposed improvement. Why does the building/site need improvement? Which clients shall benefit from the services to be carried out in the space your agency proposes to renovate? Is the facility open to the general public during normal hours (8:00 a.m. - 5:00 p.m.)? Which programs will be carried out in the space your agency proposes to renovate? Has the project already gone out to bid and/or is it in the process? Projects previously bid or currently underway will not be considered for funding because they would not have complied with the Citys procurement process and Federal regulations. Projects having various phases would be considered if the phase to be funded were not currently underway. Have the architect provide the projects timetable. List major tasks; include the projected start and completion dates for each task with regard to CDBG funds being available after October 1, 2008. The project must be completed within two years of the CDBG allocation. Who is the legal owner of the site? If leased, is it a long-term lease of 15 years or longer? Does it allow your agency to make improvements to the site? Attach a photocopy of the lease. Is the proposed site currently zoned for the improvement and program your agency wishes to undertake? Is your agency seeking funding assistance for soft costs (predevelopment design etc.), hard costs (construction), or both? Draw down of CDBG funds is on a reimbursement basis, provided that an executed funding agreement is in place and the project is in compliance with all terms/conditions of said agreement. Five percent of the CDBG allocation is withheld pending successful completion of the project. Expenditures incurred prior to the effective date of the allocation are ineligible for reimbursement.  FORMTEXT       SECTION 1II. ENVIRONMENTAL REVIEW REQUIREMENTS CDBG projects are subject to an extensive environmental review process. To this end, provide answers to the following questions. Is the building listed on the National Register of Historic Places? Is it part of a local historic district? What year was the building constructed? What was/were the previous use(s) of the building/site (residential, commercial, industrial)? Does your agency have any information concerning previous or existing environmental conditions at the site? If so, provide a description. Have any environmental studies been conducted at the site (e.g. asbestos/lead-based paint inspection, Phase I, II, or III Assessments)? If so, provide a description. If awarded funding your agency will be required to provide a copy of environmental reports. If there are any suspicious building materials included in the scope of work, or suspicious building materials to be disturbed as a result of the work, environmental testing must be completed prior to the project going out to bid. Depending upon the test results, mitigation measures are required prior to the bid/commencement of the project, or must be included in the scope of the project/contract bidding documents. Has your agency already done any site remediation and/or abatement activities at the site? If so, provide a description. If awarded funding, a copy of the final closure reports must be provided.  FORMTEXT        FORMCHECKBOX  SECTION IV. PROGRAM / PROJECT BENEFIT: Describe the public benefit that your program/project will provide. Choose one of the following three sections to complete:  FORMCHECKBOX  If you will provide public services to low-moderate income clients: Describe your intended client demographics using as much hard census data as possible. Will they be 51% low-and-moderate income? How will you track this? If your program primarily serves a neighborhood, provide an overview of your neighborhood demographics Estimate the total number of clients you will serve. Given you budget, what is the CDBG/ESG cost per client? Estimate the percentage of Waterbury residents served. How will clients be recruited and/or for the program? How will you track client satisfaction and/or progress? Discuss your system for monitoring and evaluating the quality and outcomes of services provided (e.g. staff management and training, quality assurance programs, client feedback, evaluation plans) How are you collaborating with other service providers within the community? Given the array of social service programs, describe what processes are used to avoid duplication of effort.  FORMTEXT        FORMCHECKBOX  If your project/program will benefit an identified service area benefit where 51% of the service area s users or those who benefit from the program/project are 51% low- and moderate-income: Describe the nature of the activity and its exact service area How does your service area meet the 51% requirement? (Remember service areas are areas served by the project, not necessarily the immediate area surrounding the project)  FORMTEXT        FORMCHECKBOX  SECTION V. ORGANIZATION / AGENCY FINANCIAL AND ORGANIZATIONAL CAPACITY AND ITEMIZED BUDGET: Discuss how your program/project will use CDBG/ESG funds. Provide an explanation of each CDBG/ESG budget line item indicated on your itemized budget. Justify the need for each item, the relevance and the cost effectiveness of the requested item for the successful implementation of the program/project. The Itemized Budget should cover the design/development phase (soft costs) as well as the proposed estimate of the improvements (hard costs). CDBG assisted improvement projects costing $2,000+ are required to pay federal prevailing wage rates (Davis-Bacon). Davis Bacon wages add 40% to the labor cost. In- kind income and the use of volunteer labor are not allowed on a CDBG assisted project. The required bonds (bid, performance, and labor & material payment) add 15% to the project cost. Architectural and engineering fees add 15% to the project cost. Be sure to take these into account in the project budget. Provide a statement as to the financial capacity of your organization to deliver the proposed program/project. Provide a discussion of your ability to handle financial resources with adequate internal controls and acceptable accounting procedures. Discuss staff procedures. If financial difficulties have occurred in the past please explain how these challenges have been met and resolved. Explain all non-cash support that you receive (services, volunteers, use of facilities).  FORMTEXT        FORMCHECKBOX  SECTION VI. UNMET NEEDS: Discuss how your program or project meets needs that are not being met either by other programs or elsewhere in Waterbury? Provide data if possible as to the need for your services. Discuss how you judge the priority of this program in terms of Waterbury s needs? How does your program /project collaborate with similar service providers in Waterbury in meeting these needs?  FORMTEXT        FORMCHECKBOX  SECTION VII. LEVERAGING OF OTHER FUNDS: Indicate sources to which you have committed, already applied to, or plan to apply to for funding before October1, 2008. (If there are committed funds you will need to provide letters of commitment; if you indicate you have applied for other funds, you will need to provide a copy of application cover letter. Indicate what measures you will take to raise funds through fund-raising activities. If CDBG/ESG funds are the sole source of funds, explain why. What will be the impact if your project/program is not awarded funds? What percentage of your budget does CDBG/ESG funding comprise?  FORMTEXT        FORMCHECKBOX  SECTION VIII. NATIONAL CDBG / ESG OBJECTIVE: CDBG: Check one of the following:  FORMCHECKBOX Benefits low  and moderate- income persons (client benefit, area benefit, housing benefit, jobs) Applies to most public/social services and housing  FORMCHECKBOX Aids in the prevention or elimination of slum and blight on a spot or area basis  FORMCHECKBOX Meets an urgent need or imminent threat (natural disaster) ESG: Check one of the following  FORMCHECKBOX  Renovates or rehabilitates emergency shelter facility  FORMCHECKBOX Provides essential services, maintenance and operation of emergency shelter facility  FORMCHECKBOX  Develops / implements homeless prevention activities  FORMCHECKBOX  SECTION IX. ELIGIBLE CDBG OR ESG ACTIVITY: Choose a HUD Eligible activity for CDBG or ESG that your proposal meets CDBG: Acquisition of Real Property Disposition of CDBG property Public Facilities and Improvements: streets, curbs, sidewalks, parks, public facilities etc. Demolition: Interim Assistance: Relocation: Removal of Architectural Barriers: Housing Rehabilitation: New Construction: CDBG funds may be used for new construction when undertaken by a certified Community Based Development Organization (CBDO) Special Economic Development Activities Public Service Activities: Public service programs (including labor, supplies and materials) which is directed toward improving the communitys public services including, but not limited to: job training, job-readiness placement, homeless and special needs programs, crime prevention, child care, health, substance abuse, education, transportation, fair-housing counseling, homeownership counseling, energy conservation, and recreational needs. Public Service funding must not exceed 15% of the total annual funds. Planning/Program Administrative Costs (City Use Only): Limited to 20% of the entitlement grant ESG Rehabilitation that includes conversion of a building for use as a shelter, replacement of principal fixtures, installation of security devices, energy efficiency improvements, handicapped accessibility Renovations Essential Services concerned with employment, health, drug abuse and education Maintenance and operation of a an emergency shelter facility for the homeless Homeless Prevention Programs  FORMTEXT        FORMCHECKBOX  SECTION X. CDBG and ESG OBJECTIVES, OUTCOMES AND INDICATORS: Objective: Check One:  FORMCHECKBOX Creates a Suitable Living Environment  FORMCHECKBOX Decent Housing  FORMCHECKBOX Creates Economic Opportunities Outcome: Check One  FORMCHECKBOX Improve/increase Availability or Accessibility (creating, providing a service)  FORMCHECKBOX Affordability  FORMCHECKBOX Sustainability (applies to multiple services for a targeted area) Indicator: Check One  FORMCHECKBOX Number of persons assisted  FORMCHECKBOX Number of households assisted  FORMCHECKBOX Number of housing units created or rehabilitated  FORMCHECKBOX Number of businesses assisted  FORMCHECKBOX Number of jobs created or retained  FORMCHECKBOX Acreage, square foot, or linear footage of infrastructure improvements  FORMCHECKBOX Number of homeless persons assisted; homeless sheltered; homeless receiving permanent housing  FORMCHECKBOX Number of commercial facades improved or structures rehabilitated  FORMCHECKBOX  Number of persons assisted with new or improved access to a public facility or infrastructure or number of people that no longer only have access to a substandard facility or infrastructure  FORMCHECKBOX Number of acres of brownfields remediated  FORMCHECKBOX  SECTION XI. PERFORMANCE OUTCOME MEASUREMENT STATEMENT: Provide a Program Performance Outcome Measurement Statement using above objectives, outcomes and indicators that applies to your project / program following the models below. Be specific but realistic. Sample Outcome Measurement Statement: With improved access to after-school recreation programs for the purpose of creating a suitable living environment, fifty lo- and moderate income youth will have improved physical health and social skills Sample: With improved affordable free roofing repair to their homes for the purpose of providing decent housing, thirty households will have retained their homes by the number of roofs completed.  FORMTEXT        FORMCHECKBOX  SECTION XII: COMPLIANCE WITH WATERBURY CONSOLIDATED PLAN: How does your program meet one or more of the stated Preliminary 2008-201Consolidated Plan Goals from the list below. Goals are preliminary and subject to approval of the Plan. Preliminary 2008-2013 Consolidated Plan Goals Neighborhood Development: Creating healthy neighborhoods in which people choose to live, work and invest. Goals  Redevelop vacant lots and dilapidated structures Create off-street parking lots/facilities Enhance and expand neighborhood parks and open space resources Improve neighborhood streets and sidewalks Improve the exterior conditions of residential and commercial buildings Improve or develop public and community facilities that provide educational recreational opportunities or offer needed services Stimulate neighborhood commercial development Maintain historic assets and architectural fabric of the city Improve the attractiveness of the community by eliminating blighting influences (e.g. abandoned buildings, graffiti, litter, debris, etc.) Address potential targeted neighborhoods such as the Brooklyn Neighborhood near the new Duggan School, North Main Street neighborhood near proposed new elementary school, the upper South End neighborhood and South Main Street corridor Housing: Encouraging homeownership and providing affordable, safe and decent housing with an emphasis on homeownership Goals Increase the number of owner-occupied housing units Improve the condition of the existing housing stock Provide an adequate supply of affordable housing Promote and maintain safe and decent housing conditions Expand housing opportunities through rehabilitation and new construction Support the development and rehabilitation of supportive housing to end homelessness and support people with disabilities or special needs Support housing homeownership, mortgage, and foreclosure counseling assistance Provide emergency housing and services to homeless or near homeless individuals, families seeking shelter services or residents displaced from their homes Economic Development: Increasing the Citys grand list and create living-wage jobs for Waterbury residents. Goals Attract new businesses by acquiring, assembling and remediating key development opportunity sites Stimulate business creation and expansion by developing and marketing incentive packages for targeted business development Assist businesses with exterior building improvements Human Development: Assisting Waterbury residents to achieve their potential as independent and self-sufficient citizens Goals Provide for the basic human needs of Waterburys disadvantaged residents, e.g. food, shelter, health and dental care, etc. Assist adults to secure and hold jobs that pay a living wage through literacy services, English-as-a-second language classes, counseling, job training, job placement services, child care, case management, etc. Assist elders to remain in their homes and neighborhoods and participate in community life Expand public transportation services (routes and hours of operation) and support elderly transportation services Assist youth to become responsible, self-sufficient adults through school readiness programs, truancy programs, after-school and summer programs, recreation programs. and programs that further educational opportunities Support programs that are aimed at crime prevention Assist families and children in crisis Provide services to families and individuals to reduce the risk of becoming homeless Provide for psychiatric treatment, rehabilitation and support services as well as community education, training consultation and advocacy to assist in transition and re-entry into the community Support programs that benefit victims of abuse Support programs that meet the needs of handicapped/special needs persons  FORMTEXT        FORMCHECKBOX  SECTION XIII. TARGETED NEIGHBORHOODS AND HUD-APPROVED NEIGHBORHOOD REVITALIZATION STRATEGY AREAS (NRSAs) Does your project /program take place in or primarily serve a neighborhood area identified by the 2008-2013 Consolidated Plan as a local targeted area or HUD- approved Neighborhood Revitalization Strategy Area? If so, describe how your program/project is beneficial to the revitalization of that area. Preliminary Consolidated Plan target areas include the Brooklyn neighborhood in the vicinity of Duggan School, the North Main Street neighborhood in the vicinity of the proposed North Main Street School, and the upper South End neighborhood as well as the South Main Street corridor.  FORMTEXT        FORMCHECKBOX  SECTION XIV:ITEMIZED BUDGET  All Sources of Funding Amount Committed  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       TOTAL FUNDING Line Items CDBG Other Total HARD COSTS DIVISION 1-General Conditions (Mobilization, Bonds, Supervision, Labor, Permit, Temporary Protection, Dumpster, etc.)  FORMTEXT        FORMTEXT        FORMTEXT       DIVISION 2-Site Work (including any environmental mitigation measures)  FORMTEXT        FORMTEXT        FORMTEXT       DIVISION 3-Concrete  FORMTEXT        FORMTEXT        FORMTEXT       DIVISION 4-Masonry  FORMTEXT        FORMTEXT        FORMTEXT       DIVISION 5-Metals  FORMTEXT        FORMTEXT        FORMTEXT       DIVISION 6-Wood and Plastics  FORMTEXT        FORMTEXT        FORMTEXT       DIVISION 7-Thermal and Moisture Protection  FORMTEXT        FORMTEXT        FORMTEXT       DIVISION 8-Doors & Windows  FORMTEXT        FORMTEXT        FORMTEXT       DIVISION 9-Finishes  FORMTEXT        FORMTEXT        FORMTEXT       DIVISION 10-Specialties  FORMTEXT        FORMTEXT        FORMTEXT       DIVISION 11-Equipment (NOT CDBG ELIGIBLE UNLESS PERMANENTLY AFFIXED)  FORMTEXT        FORMTEXT        FORMTEXT       DIVISION 12-Furnishings (NOT CDBG ELIGIBLE UNLESS PERMANENTLY AFFIXED)  FORMTEXT        FORMTEXT        FORMTEXT       DIVISION 13-Special Construction  FORMTEXT        FORMTEXT        FORMTEXT       DIVISION 14-Conveying Systems  FORMTEXT        FORMTEXT        FORMTEXT       DIVISION 15-Mechanical  FORMTEXT        FORMTEXT        FORMTEXT       DIVISION 16-Electrical  FORMTEXT        FORMTEXT        FORMTEXT       Contingency (5% of above hard costs)  FORMTEXT        FORMTEXT        FORMTEXT       SOFT COSTS  FORMTEXT        FORMTEXT        FORMTEXT       Architectural/ Engineering/Environmental Consultant Fees (15% of the project cost)  FORMTEXT        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Davis-Bacon Wages add 40% to the labor cost. Have you taken this into account in the budget? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Required bonds add 15% to the cost of the project. Have you taken this into account in the budget? Yes  FORMCHECKBOX  No  FORMCHECKBOX   FORMCHECKBOX  SECTION XV: CERTIFICATION: The Applicant: Agrees to accept and follow management direction from the City and specifically, the Waterbury Development Corporation. Agrees to conform to all applicable laws and ordinances and statutes of the Federal Government, State of Connecticut and the City of Waterbury, including but not limited to the following: Americans with Disabilities Act of 1990; a clear and comprehensive prohibition of discrimination on the basis of disability; Civil Rights Act of 1964 as amended; Executive Orders Numbers 3 & 17 of the State of Connecticut. Agrees that throughout the period of an agreement with the City, all taxes, contractual obligations, audit responsibilities and any other obligations (e.g. sewer and water, parking tickets etc.) owed to the City shall be and remain current; Agrees that all services required of the Applicant under an agreement with the City will be performed with professional skill and competence; Agrees that if allocated to the Applicant, and if for any reason these federal funds become unavailable, the Applicant will only be allowed to drawdown funds for legitimate services and activities provided and all further obligations of the Applicant and the City under a resultant agreement will cease; Agrees that the City reserves the right to terminate the resultant agreement at any time, for the Citys convenience, with the assurance that the sub-recipient shall be entitled to reimbursement for approved services rendered prior to date of termination; Agrees that the Applicants relationship with the City under an agreement will be that of an independent sub-recipient and that the agreement will be a contract for completion of activities with allocated funds and not a contract of employment with the City and no attended benefits shall be bestowed thereby; Agrees to comply with all requirements promulgated by HUD, including, but not limited to: Federal Labor Standards (29 CFR Parts 3, 5, and 5a) Davis Bacon Act, as amended (40 USC 327-330) Copeland Anti-Kickback Act (18 USC 874), as supplemented in the Dept. of Labor regulations (20 CFR-Part 3) Architectural Barriers Act of 1969 (42 USC) Environmental Review (24 CFR- Part 58) Lead Based Paint Poisoning Prevention Act of 1971 (24 CFR - Part 35) Flood Disaster Protection Act (PL 93-291) Section 504 of the Rehabilitation Act of 1973 The undersigned hereby certifies that s/he is duly authorized to negotiate, execute and deliver agreements, documents and other instruments in the name of and on behalf of the organization submitting this application for grant funds, and that the information contained in this application is, to the best of his/her knowledge, true, correct, complete, and represents the true intended usage of the funds for which the application is being submitted under penalty of law. ____________________________ ________________________ ___________ Authorized Signature (Blue Ink) Print Name Date  FORMCHECKBOX  SECTION XVI: DECLARATION OF DELINQUENCIES: DECLARATION OF DELINQUENCIES  Please answer yes or no to each question. For all yes answers, please provide an explanation below. DELINQUENCIESYESNO1.Is your agency delinquent in the payment of any real or personnel property taxes to the City of Waterbury FORMCHECKBOX  FORMCHECKBOX 2.Is your agency delinquent in the payment on any loans received through the City of Waterbury? FORMCHECKBOX  FORMCHECKBOX 3.Is your agency delinquent in any rental payment to the City of Waterbury? FORMCHECKBOX  FORMCHECKBOX 4.Does your agency have any outstanding housing or building code violations with respect to property located in the City of Waterbury? FORMCHECKBOX  FORMCHECKBOX 5.Is your agency in violation of or delinquent under the terms and conditions of any executed contract or agreement with the City of Waterbury, including reports due the City hereunder? FORMCHECKBOX  FORMCHECKBOX 6.Is your agency delinquent in any other obligations to the City of Waterbury (e.g. water and sewer, parking tickets etc.)? FORMCHECKBOX  FORMCHECKBOX   FORMCHECKBOX  SECTION XVII: ATTACHMENTS: The following supporting documents are required as attachments of every applicant. Attach these documents only to your original application that you have clearly marked with the word original on the front. The additional 20 copies need not have these attachments. Please check off each attachment to insure that it has been provided:  FORMCHECKBOX  Up-to-date (2008 year) Proof of current approved or pending nonprofit designation from the IRS. If applicant has nonprofit certificate from 2007, that will be sufficient for the May 14, 2008 application deadl