104-Attachment C.pdf
ATTACHMENTC
Community Development Block Grant Program Application
City of Cupertino
Fiscal Year 2011/2012
SECTION 1: COVER SHEET
A. Applicant Information
Legal Name of Organization:Senior Housing Solutions
Mailing Address:512 Valley Way
City, State, Zip Code:Milpitas, CA, 95035
Web Address:www.srhousingsolutions.org
Contact Person:Bob CampbellTitle:Executive Director
Email Address:bob@srhousingsolutions.org
Telephone Number:408-416-0271Fax Number:408-416-0278
Executive Director:Bob CampbellEmail:bob@srhousingsolutions.org
B. Project Overview
Project Name:Price Avenue Senior Residence Project
Location of Project Activity:19935 Price Avenue
City, State, Zip Code:Cupertino, CA 95014
Brief Project Description:
Senior Housing Solutions (SHS) is applying for $196,195 in rehab funds to complete Phase II of our Price Avenue
Senior Residence Project which will provide 5 units of affordable housing for extremely low-income seniors in the
City of Cupertino. In partnership we purchased the property and in January completed Phase I rehab. SHS will
develop the project to serve independently functioning seniors 60 years of age and older whose income is $1,500 a
month or less. Rent will be held to 30% of income and include utilities, phone, cable and laundry facilities.
C. Cupertino Funds Requested
CDBG Funding Request, FY 11/12:$196,195
Total Project Cost, FY 11/12:$196,195
Cost per unit (housing/services), FY 11/12:39,239
Is the Organization currently receiving funding?Yes
CDBG Funds Requested in FY10/11:$271,003
CDBG Funds Received in FY10/11:$0
SECTION 2: PROJECT INFORMATION
A. Project Overview and Target Population
1. Provide a brief description of the proposed Project including the specific activities to be undertaken and services
to be provided using funds from this application.
The mission of Senior Housing Solutions (SHS) is simple: To develop affordable housing to help extremely
low-income seniors improve their quality of life. Our innovative model combines housing, property management and
case management to achieve positive health and quality of life outcomes for our residents. Today the SHS provides
57 units of affordable housing for extremely low-income seniors in twelve single-family homes throughout Santa
Clara County.
The Price Senior Residence Project will use funds requested for Phase II rehab activities. The property located at
19935 Price Ave in the City of Cupertino was purchased with City BMR and Phase I construction was completed in
January. Upon completion of rehab the Project will provide affordable housing to 5 extremely low-income seniors.
Rents will be held at 30% of the seniors income. Our target is City of Cupertino residents who are seniors 60 years
of age and older who function independently and whose income is $1,500 per month or less.
At the completion of Phase II rehab actives will have added 1 bedroom and 1 bathroom in the existing footprint and
include installation of solar panels and exterior and interior rehab so that the house can adequately house 5
independently functioning seniors. Specific work includes kitchen remodel, remodel of the common areas of the
house, bathroom remodel, new windows, floor coverings, floor covering, interior and exterior paint, new HVAC
system as well as modifications and remodel of the kitchen and common areas in the house. Assuming funds are
available not later than April 1 we anticipate Phase II construction to be completed by June 15.
2. Describe the need(s) that the proposed Project addresses, its community impact, and how it addresses a need or
problem in relation to the Consolidated Plan.
The senior population in Santa Clara County is growing, and so is the number of seniors who struggle economically.
Based on research by Dr. Steven P. Wallace, Ph.D. UCLA School of Public Health, the estimated monthly income
needed for a senior to be Self-Sufficient in Santa Clara County is $1,928 per month. Fifty-five percent ($1,068) of
the cost is for housing. The average income of seniors living on Social Security Retirement in Santa Clara is $1,503
a month. In the County, there are 70,000 seniors living on Social Security whose monthly income is below $1,503. In
the City of Cupertino, income and housing trends are similar to those of the county except that the cost of housing
tends to be a bit higher.
Senior Housing Solutions addresses the underlying problem facing these seniors: poverty. Lack of stable housing,
threat of evictions, insufficient food, poor health, isolation, a lack of safety and security, and an endless stream of
financial emergencies are symptoms of poverty. Our unique housing model provides a permanent solution to these
quality of life problems for our residents. The outcome is sustainable permanent housing for seniors in a setting that
supports key quality of life indicators including economic, social, health and psychological factors as they age in
place.
The Price Avenue Senior Residence Project will have a positive impact on those we serve and the surrounding
community. Senior Housing Solutions provides the primary stabilizing factor in a seniors life housing that they can
afford within a comprehensive program that addresses continued housing security, safety, reduced dependence on
family members, increased access to needed services, maintained disposal income, improved social support, daily
household and community interaction and emotional support from peers and professional staff. Resident Outcomes:
our innovative housing and support services model continues to achieve positive outcomes for our residents including
a reduction in the feeling of loneliness, a decrease the occurrence of depression, an increase in physical activity, a
sense of safety and an overall increase in their quality of life. Community Outcomes: (1) Age/economic diversity of
neighborhoods in preserved. (2) The supply of affordable senior housing in Santa Clara County in increased through
program expansion. (3) Replication in other communities.
Throughout the Citys Consolidated Plan affordable housing and support service needs for seniors are rated as High.
Specifically: Priority Needs table 1B pg.45, Table 2A pg.46, Table 2B pg. 47 show HIGH priority need. Also related
is Goal A Policy 3.3 pg.17, Policy 3.4 pg.18, Policy 3.9 Implementation Prog. 26 on pg. 20-21, Goal D Policy 3-11
Implementation Prog. 32 pg. 22 all relate to affordable housing for extremely low-income seniors.
3. Describe the Project’s target population, including client eligibility requirements. Discuss how and if they are an
at-risk and/or under-served population.
The Price Avenue Senior Residence Project will serve seniors 60 years of age and older who are functionally
independently. We will target those among this population whose income is $1,500 or less monthly or about 20% of
the median. Most will have been living in temporary housing including with friends or family just prior to moving into
the Senior Residence. The project will result in the development of 5 units of affordable housing and include services
designed to achieve positive health and quality of life outcomes for our residents. Rent is kept at just 30% of income
ensuring our residents will never have to worry about a rent increase beyond their ability to pay.
4. What other private or government organizations are now or will be addressing the same needs identified herein?
List and describe the services provided by each in relation to the needs addressed. Explain how the proposed
program/project augments rather than duplicates the services of others. Describe how your agency collaborates with
other service providers.
There are numerous nonprofit and government organizations addressing the housing and support service needs of
seniors in our community. Our unique housing model has not been duplicated. From the design of the floor plan in the
house to the collaboration between our case management and property management services we are striving to
provide a permanent solution to those seniors in our community who are most challenged economically.
We leverage our organizational operations and service model with our strategic alliances. We have a broad array of
community agencies with whom our case management interfaces. Some common resources and partners used by
our case management include the Social Security and Veterans Administration, Indian Health Center, East Valley
Clinic, East Valley Mental Health, Mental Health Advocacy Project, Project Sentinel Valley Medical Center, In Home
Support Services, Multi-Service Senior Program, Senior Care Connection, VTA Outreach, Alcoholics Anonymous,
Meals on Wheels, Catholic Charities, and City Team, to highlight a few. In addition the Mt. View Community Services
Agency has provided us a letter of support for our project. We have also formed a formal collaborative project with
the Family and Children Services Agency designed to increase the resilience and communication skills of housing
residents.
Organizationally, our partnerships with the Cities of Campbell, Sunnyvale, Santa Clara, Milpitas, Los Gatos,
Cupertino, San Jose and County of Santa Clara Office of Affordable Housing are significant. Without them, our
housing opportunities would not be possible as they provide property acquisition and rehabilitation grants and
deferred loans.
5. State the number of unduplicated clients to be served by the proposed Project in the fiscal year.
Cupertino Clients:5Total Project Clients:5
6. Project Client Breakdown for Funding Requested:
2010-20112011-20122010-20112011-2012
ActualProposedActualProposed
CupertinoCupertinoCupertinoCupertino
TotalTotalTotalTotal
Extremely Low Income
5 62 5 72Youth (0-18 years)
(0%-30% AMI)
Very Low Income
Adults (19-62 years)
(31%-50% AMI)
Low Income
Seniors (63+ years) 5 62 5 72
(51%-80% AMI)
Moderate Income
Total All Ages
5 62 5 72
(81%-120% AMI)
Above Moderate
IncomeDisabled Individuals
(120%+ AMI)
Other Special
Total All Incomes
5625 72
Needs
B. Numeric Goals
1. For each activity, please indicate the goal for number of service units to be served.
1st2nd3rd4th
Annual
Activity
QuarterQuarterQuarterQuarter
complete rehab activieies 5 5
C. Project Administration and Monitoring
1. Use the table and space below to briefly describe how the project will be managed and administered, included
proposed staff time and staff functions.
TotalTotal% TimeCDBG
Position TitleProgram/Project DutiesAnnualHoursFor CDBGSalary
Salary/WeekActivityRequest
Executive Director manage construction $0
2. How will the effectiveness of your project be measured?
Jed Emerson Bloomberg, Senior Research Fellow in Philanthropy, Harvard Business School, speaks of SROI or
Social Return on Investment, which is a measure of social value creation resulting from the investment of financial or
social capital. Based on this concept, we developed a Logic Model that is our plan for success.
In the past two years, over 80% of our residents have responded to our evaluation which is completed each year
between November and January. Following are 12-month goals we will target for residents at the Price Avenue
house measured through our annual survey:
46% of residents report a decrease in depression
60% of residents report a decrease in feeling lonely
74% of residents report an increase in quality of life
79% of residents report they have another house mate they can confide in when feeling troubled
95% of residents report that they feel safe
Over what time frame? 12 months
3. Describe your written policies and/or established procedures for assuring persons with disabilities and/or limited
English proficiency access to services and benefits.
Non-discrimination Policies and Reasonable Accommodation Policies are in place. We face several institutional
restrictions in what we can know about a client before they move in to our housing. Because we receive HUD funding
for the capital projects we must follow fair housing practices regarding discrimination.
Our current residents speak primary languages that include Farsi, Chinese, Japanese, English, Bulgarian and
Russian. We cannot manipulate the residences so that Chinese speakers can live with Chinese speakers or Russian
speakers can live with Russian speakers. However, our Case Manager works to continue to support residents to
remain connected to their communities. Most have rather strong connections with their ethnic communities and
families. In fact, the most reliable source for translation support we have found comes readily through these
resident's community and family.
Our office hours are Monday Friday 8:00-4:30. Seniors do not have to come into the office in order to gain access to
our services. We do our eligibility screening over the phone. Upon becoming eligible, seniors are put on the waiting
list until a vacancy occurs. All of the seniors entered onto our waiting list receive a brochure that describes our
housing and services. We encourage seniors on the waiting list to contact us whenever they want to and especially
to let us know if their contact information has changed. When a vacancy occurs we contact the senior at the top of
the waiting list to make an appointment to show the room and see house. If they like it we take a deposit, complete
our application process that includes a criminal background and credit check and then they move in.
Though we do not require anyone to come to the office for the initial eligibility screening the office is physically
accessible. Houses are designed to facilitate accessibility and functionality. Individual accommodations are made to
ensure access to our housing.
4. Provide a brief general description of your agency and the services provided. Include a description of your
agency’s experience in providing the proposed services. If previously funded, what were the goals and
accomplishments of CDBG projects?
The mission of Senior Housing Solutions is to develop affordable housing to help extremely
low-income seniors improve their quality of life. Our innovative model combines shared housing
in single-family homes, property management and case management to achieve positive health
and quality of life outcomes for independent seniors whose income is less than $18,000
annually. Rent is kept at just 30% of income ensuring our residents will never have to worry
about a rent increase beyond their ability to pay.
By providing the primary stabilizing factor in a seniors life housing that they can afford within a
comprehensive program that addresses continued housing security, safety, reduced
dependence on family members, increased access to needed services, maintained disposal
income, improved social support, daily household and community interaction and emotional
support from peers and professional staff, Senior Housing Solutions achieves its primary goal:
to have a positive impact on the economic, social, health and psychological needs of our
residents.
Today, there are 12 SHS homes in operation throughout Santa Clara County. An additional
three houses will open by December 2011. Currently there are 57 seniors residing in our
housing. The average age of current residents is 72 years; the average monthly income of our
residents is $987. Rent in our houses, including utilities, cable, laundry facilities and phone is
just $296 a month!
5. Explain how your agency collects income and race/ethnicity data.
As mentioned above we have certain restrictions prior to residency in our housing. As part of the application process
income eligibility is established by checking 2nd party documents i.e. SSI letters, bank accounts, pay stubs etc. This
is then done annually to ensure continued eligibility in our housing.
Our application process also asks for race and ethnicity data. However, due to fair housing requirements, we cannot
require this information is completed.
D. Consolidated Plan Goals
1. Please indicate which Consolidated Plan Goals will be met by the Project and briefly describe how your
Project/Activity meets the Goals.
Goal #1: Assist in the creation and preservation of affordable housing for lower-income and special needs
households.
Goal #2: Support activities to end homelessness.
Goal #3: Support activities that provide basic services, eliminate blight, and/or strengthen neighborhoods.
Goal #4: Promote fair housing choice.
Goal #5: Expand economic opportunities for low-income households.
Goal #6: Promote environmental sustainability.
2. Explain how you will meet these goals.
We will conduct rehab activities to complete Phase II construction activities for our Price Avenue Senior Residence
Project. Rehab activities in Phase II include metal work, decking, finishing work in bathrooms, bedrooms, utility
room, common areas and exterior, installation of appliances, exhaust ducting, ducting, plumbing, HVAC system,
electrical and utility hookups.
We have already begun affirmative marketing of the house to the Cupertino community. Initially there were 28
residents who indicated an interest in the house. Over the past month we have contacted each of these original 28.
To date a total of 12 Cupertino residents have indicated that they remain interested in living at the house. Once
Phase II funding is secured we will begin showing the house to these 12 perspective residents. We hope to begin
rent up not later than June earlier if possible.
Once residents move in we will begin our property management and case management services.
E. HUD Performance Measures
HUD requires that recipients of federal funding assess the outcomes of their programs. Please identify which HUD
objective and HUD outcome will be addressed by this project.
1. Objectives:Provide Decent Affordable Housing
2. Outcomes:Improve affordability
SECTION 3: FINANCIAL AND OTHER ORGANIZATION INFORMATION
A. Agency Information
Non-profit with 501(c)(3) Status? YesFaith-based organization? No
Community Based Development Organization (CBDO)? No
Community Housing Development Organization (CHDO) ? Yes
Other Type of Organization? Describe:
DUNS Number: 19778672
B. Total Agency Budget
2011-20122010-20112009-20102008-2009
Budget Item
Administration $91,161 $59,615 $27,859 $61,369
Fundraising $33,149 $19,872 $6,965 $18,492
Proposed Project (Total budget) $196,195 $0 $0 $0
All Other Programs $704,426 $582,902 $661,660 $536,263
Total Agency Budget
$1,024,931$662,389$696,484$616,124
C. Program Budget (Fiscal Year 2011-2012)
2010-2011% Change from
2011-2012
CDBGFY 10/11 - FY
Proposed Project Expenses
CDBG Request
Allocation11/12
Salaries/Benefits/Payroll/Taxes
Office Supplies
Communication
Publications/Printing/Advertising
Travel
Rent/Lease/Mortgage
Utilities
Insurance
Equipment Rental/Maintenance
Audit/Legal/Professional Services (for
CDBG portion only)
Direct Services (Funding for specific
service such as a meal, ride)
Contracted Services
Other $0 $196,195
Total Expenses
$0$196,195
List below your funding sources for 2011/12 by jurisdiction and source:
FY2011/12 Revenue Source
CDBG AmountOther SourceOther AmountTotal
by Jurisdiction
Cupertino $196,195 $196,195
Total
$196,195 $0 $196,195
1. Does the Organization have a HUD-approved indirect cost plan? No
2. Does your agency charge fees for the services that you are requesting funding for? If so, please attach a fee
schedule. No
3. If your organization is not leveraging the requested CDBG funds with other funds, please explain why.
This request is for Phase II construction of our Price Avenue Senior Residence. The City assisted with BMR funds
for Acquisition. These funds were leveraged by the Housing Trust. The City provided Phase I construction funds from
CDBG and CDBG-R. Phase II Construction funds via this CDBG application have no leveraged funds.
D. Other Information - Attachments
Check each line item that you will attach. Attachments must be uploaded(?).
1. Please submit the following documents in support of your application:
Articles of Incorporation/Bylaws.BYLAWS_Senior_Housing_Solutions_Revised_January_25_2007.pdf
SHS_Articles_of_Incorporation.pdf
Authorization - Download this document,Authorization_Attachment_for_Cupertino_CDBG_March_2011.doc
print and sign it, and upload the signed
document.
2. If your application is selected for funding, you will be required to submit the information below at a later
date:
Policy & Procedures Manual. Include policy
prohibiting discrimination, grievance
procedures, and conflict of interest.
Nonprofit Determination. Submit
determination letters from the Federal
Internal Revenue Service and the State
Franchise Tax Board documenting the
organization is tax exempt.
List of Board of Directors. Include the
name, telephone number, address, and
occupation or affiliation of each member.
Identify the principal officers of the
governing body.
Authorization to Request Funds.
Documentation must be submitted of the
governing body's authorization to submit the
funding request. This consists of a copy of
the minutes of the meeting in which the
governing body's resolution, motion, or
other official action is recorded.
Designation of Authorized Official.
Documentation must be submitted of the
governing body's action authorizing the
representative of the agency to negotiate
for and contractually bind the agency. This
consists of a signed letter from the
Chairperson of the governing body providing
the name, title, address, and telephone
number of each authorized individual.
Organizational Chart. Include the
organization's administrative framework and
staff positions.
Financial Statement and Audit. Describe any
findings or concerns that were cited in the
audit or in any accompanying management
letter, particularly pertaining to the use of
CDBG funds. Also, describe any actions
taken to correct identified findings or
concerns.
Resume of Chief Program Administrator.
Resume of Chief Fiscal Officer.
Proof of Liability Insurance.
Program Manager SignatureBob Campbell
Date Signed03/01/2011
Community Development Block Grant Program Application
City of Cupertino
Fiscal Year 2011/2012
SECTION 1: COVER SHEET
A. Applicant Information
Legal Name of Organization:Rebuilding Together Silicon Valley
Mailing Address:2827 Aiello Drive
City, State, Zip Code:San Jose, CA 95111
Web Address:
Contact Person:Bev JacksonTitle:Executive Director
Email Address:bjackson@rebuildingtogether-sv.org
Telephone Number:(408) 578-9519Fax Number:
Executive Director:Beverley JacksonEmail:bjackson@rebuildingtogether-sv.org
B. Project Overview
Project Name:Rebuilding Housing Repair and Rehabilitation Program
Location of Project Activity:2827 Aiello Drive
City, State, Zip Code:San Jose, CA 95111
Brief Project Description:
Rebuilding Together will preserve affordable housing by providing safety, energy efficiency, accessibility and mobility
repairs and improvements for low income homeowners in Cupertino. Our project strengthens the resiliency of
low-income homeowners as well as the neighborhoods in which they live.
C. Cupertino Funds Requested
CDBG Funding Request, FY 11/12:$60,000
Total Project Cost, FY 11/12:$60,000
Cost per unit (housing/services), FY 11/12:12,000.
Is the Organization currently receiving funding?
CDBG Funds Requested in FY10/11:$56,400
CDBG Funds Received in FY10/11:$56,400
SECTION 2: PROJECT INFORMATION
A. Project Overview and Target Population
1. Provide a brief description of the proposed Project including the specific activities to be undertaken and services
to be provided using funds from this application.
Rebuilding Together (RT) will provide home safety repairs and mobility and accessibility improvements for five or
more homes (5-8 unduplicated beneficiaries) for very low-income people in Cupertino in 11/12, with the primary
consideration being the correction of safety hazards. All work is at no cost to the clients and can include: wheelchair
ramps, grab bars, railings, improved lighting installations, stair and step modifications for walkers, bath chairs, hand
held shower adapters, tub cut outs, door handle and faucet replacement for accessibility, smoke alarms, door,
window and lock repairs, roof repairs and replacement, interior and exterior painting, yard cleanup, minor plumbing
repairs, minor electrical repairs, appliance replacement, flooring (linoleum, carpet, or tile) repairs and replacement,
heating installation and repairs, outdoor lighting and fencing improvements for safety, elimination of tripping hazards,
replacement and/or repair of windows, earthquake proofing of water heaters. We improve the safety of the living
environment by fixing hazardous conditions.
The majority of repairs are completed by volunteers. Some of the specialized work, such as electrical, roofing,
carpet installation and plumbing involve contract staff of Rebuilding Together. Rebuilding Together program staff
schedule and coordinate all repair work utilizing either volunteers or skilled trade contractors.
Each October and April, groups of volunteers armed with paintbrushes, saws, hammers and shovels join together
over one or two Saturdays to repair and rebuild homes and community facilities, dedicating their time in the spirit of
service and community during Rebuilding Day Projects.
Additionally, our Safe At Home program leverages our skilled volunteers that wish to contribute on a weekly basis,
by providing home modifications and minor safety repairs throughout the year.
2. Describe the need(s) that the proposed Project addresses, its community impact, and how it addresses a need or
problem in relation to the Consolidated Plan.
The Rebuilding Housing Repair and Rehabiliation Program will allow very low-income homeowners to remain in
affordable, safe and decent housing. Residents of Cupertino who live on a fixed income may be less able to afford
little beyond the most basic needs. On fixed incomes, even necessary expenses such as prescription medications
can be difficult to afford while other important expenses, such as repairs to resolve unsafe or unsightly conditions,
may be near impossible for older homeowners to afford. Older adults are more likely to live in homes that they own,
with homeownership rates over 80% for Americans over 55 years of age, more than any other age group in 2008
(U.S. Census Bureau, 2008). A significant portion of Cupertino older persons are aging in place in homes they
purchased more than 30 years ago. Although the homes may have increased in value, residents find that their fixed
income is less able to cover routine upkeep or repairs. Most do not want to move from their homes, but others find
they could not afford to move even if they would choose to do so. Benefits of aging in place including maintaining
seniors social networks and limiting the negative effects of relocation and dramatic transitions, including the financial
expense of relocating (Joint Center for Housing Studies of Harvard University, 2001). The Housing Repair Program
addresses this problem by allowing homeowners to remain in safe and affordable housing for as long as possible.
Rebuilding Together is the only community-based non-profit organization providing repairs to homeowners in need at
no cost to the homeowner.
Our projects are life-changing for the residents and the neighborhood. Imagine finally feeling warm and safe in your
own home: your heater now works, and youre no longer afraid of falling on torn carpet or curling linoleum. Imagine
the change to your outlook on life when living in surroundings that nourish your spirit and make you feel better about
yourself.
3. Describe the Project’s target population, including client eligibility requirements. Discuss how and if they are an
at-risk and/or under-served population.
The target population are low-income, homeowners that require safety and accessibility repairs and modifications to
provide for decent, affordable and safe housing. On average, a Rebuilding Together client is 72 years of age, has
lived in their home for over 26 years and has an annual income of about $21,000.
Homeowners submit an application to initiate the intake process. Rebuilding staff/volunteer conducts a telephone
interview and schedules a site visit to determine project need and process for repair completion. The focus of
interviews and visits is to evaluate the financial and repair needs of the client and the impact the repairs will make on
homeowners safety, warmth, and independence. Once a homeowner has been approved for the program, they must
submit proof of home ownership and income verification (accepted documentation includes social security benefits
statements, the most recent tax return, or recent pay stubs) before repairs can be made. Determinations of income
eligibility are made using the U.S. Department of Housing and Urban Developments income limits. Once homeowners
are approved for the program and their documentation has been submitted, homeowners information and application
are maintained in Rebuilding Togethers secure database to ensure accurate tracking of all clients.
4. What other private or government organizations are now or will be addressing the same needs identified herein?
List and describe the services provided by each in relation to the needs addressed. Explain how the proposed
program/project augments rather than duplicates the services of others. Describe how your agency collaborates with
other service providers.
Rebuilding Together Silicon Valley is the only organization that provides free home repairs for low-income
homeowners in the City of Cupertino, leveraging the skills and energy of volunteers, community groups and local faith
communities and corporations.
5. State the number of unduplicated clients to be served by the proposed Project in the fiscal year.
Cupertino Clients:6Total Project Clients:10
6. Project Client Breakdown for Funding Requested:
2010-20112011-20122010-20112011-2012
ActualProposedActualProposed
CupertinoCupertinoCupertinoCupertino
TotalTotalTotalTotal
Extremely Low Income
3 3 Youth (0-18 years)
(0%-30% AMI)
Very Low Income
2 2 Adults (19-62 years) 2 2
(31%-50% AMI)
Low Income
1 1 Seniors (63+ years) 4 4
(51%-80% AMI)
Moderate Income
Total All Ages
10 0 10 0
(81%-120% AMI)
Above Moderate
IncomeDisabled Individuals 4 4
(120%+ AMI)
Other Special
Total All Incomes
606 0
Needs
B. Numeric Goals
1. For each activity, please indicate the goal for number of service units to be served.
1st2nd3rd4th
Annual
Activity
QuarterQuarterQuarterQuarter
Homes Completed with Repairs 1 2 1 2 6
Repairs 4 8 4 8 24
C. Project Administration and Monitoring
1. Use the table and space below to briefly describe how the project will be managed and administered, included
proposed staff time and staff functions.
TotalTotal% TimeCDBG
Position TitleProgram/Project DutiesAnnualHoursFor CDBGSalary
Salary/WeekActivityRequest
Executive Director Overall Agency supervision 2 $0
Client Services client outreach, application processing
4 $0
Coordinatorand selection
Oversees S@H repair work, reviews
Safe At Home Managerwork scope, and supervises contract and 2 $0
volunteer repairs.
Coordinates logistics, work scope and
Program Director 2 $0
Rebuilding Day Program
Completes safety repairs and supervises
Repair Technician 4 $0
volunteer work projects
2. How will the effectiveness of your project be measured?
Homeowners, project management staff and volunteer project leaders sign off on completed work. This has the
effect of (1) assuring that the project and components have been completed and (2) provides an opportunity to
assess the results via our five criteria: safety, warmth, independence, financial status, and neighborhood health and
vitality. Our results have indicated that our efforts have been effective, have provided a targeted solution (address
the need), and have been life-changing for everyone involved. Respondents have said that they feel safer in their
homes because repairs have been made to crumbling steps, leaking roofs, and other dangerous conditions.
Over what time frame?
3. Describe your written policies and/or established procedures for assuring persons with disabilities and/or limited
English proficiency access to services and benefits.
Rebuilding Together Silicon Valley Program staff speaks Spanish and Tagalog languages and both are available for
these oral translations. Accomodations are made for persons with diabilities that additional assistance with
application process and completion. Rebuilding Together volunteers are on-call for oral translation in Vietnamese,
Mandarin and Portuguese and are scheduled through Rebuilding Together Program staff. Partnerships with other
senior services and centers have also assisted with client interviews. Rebuilding Together has also been successful
in matching the language needs of the clients with community service clubs and corporate teams to support the
client, during Rebuilding service days. Many of our volunteers from the local Silicon Valley, high tech corporate
community are pleased to share their language skills and translate for Vietnamese and Mandarin clients.
4. Provide a brief general description of your agency and the services provided. Include a description of your
agency’s experience in providing the proposed services. If previously funded, what were the goals and
accomplishments of CDBG projects?
Rebuilding Together Silicon Valley has been in operations since 1991. Since our inception, we
have mobilized 23,900 volunteers to repair and upgrade 1201 homes and nonprofit facilities
throughout Santa Clara County. In the first two quarters of 2010-11 RT provided 205 repairs to
6 low-income Cupertino homes. In total our work impacted over 9,523 County residents in 2010
through 223 project locations. Rebuilding projects leverage community dollars with the
experience and willingness of Rebuilding volunteers to impact the health and safety of area
residents. Our projects are life-changing for the residents, the neighborhood, and the
volunteers. Imagine finally feeling warm and safe in your own home: your heater now works,
and youre no longer afraid of falling on torn carpet or curling linoleum. Imagine the change to
your view of the world to live in surroundings that nourish your spirit and make you feel better
about yourself. We can all identify with feeling good about where we live, and volunteers
complete a project and leave tired but with big smiles. They know they have profoundly
changed the quality of daily experience for someone else. In so doing, they change the quality
of their own lives as well.
5. Explain how your agency collects income and race/ethnicity data.
All clients submit proof of household income and homeownership prior to work completion. Race and ethnicity data
survey is collected at the time of program application.
D. Consolidated Plan Goals
1. Please indicate which Consolidated Plan Goals will be met by the Project and briefly describe how your
Project/Activity meets the Goals.
Goal #1: Assist in the creation and preservation of affordable housing for lower-income and special needs
households.
Goal #2: Support activities to end homelessness.
Goal #3: Support activities that provide basic services, eliminate blight, and/or strengthen neighborhoods.
Goal #4: Promote fair housing choice.
Goal #5: Expand economic opportunities for low-income households.
Goal #6: Promote environmental sustainability.
2. Explain how you will meet these goals.
Rebuilding Together will repair and rehabilitate owner occupied housing units for extremely, very, and low-income
homeowners who are often seniors and/or families with disabled family members. All work is completed at no cost
to the client. Repairs remediate health and safety issues in the home, necessary for the owner to continue living
there. This project will service residents from the entire City of Cupertino. 100% of RT clients have incomes 80% or
less of the median income.
E. HUD Performance Measures
HUD requires that recipients of federal funding assess the outcomes of their programs. Please identify which HUD
objective and HUD outcome will be addressed by this project.
1. Objectives:Create Suitable Living Environments
2. Outcomes:Improve affordability
SECTION 3: FINANCIAL AND OTHER ORGANIZATION INFORMATION
A. Agency Information
Non-profit with 501(c)(3) Status? YesFaith-based organization? No
Community Based Development Organization (CBDO)? No
Community Housing Development Organization (CHDO) ? No
Other Type of Organization? Describe:
DUNS Number: 017547055
B. Total Agency Budget
2011-20122010-20112009-20102008-2009
Budget Item
Administration $75,200 $75,200 $70,276 $62,708
Fundraising $71,000 $73,873 $81,779 $57,914
Proposed Project (Total budget) $60,000 $56,400 $40,000 $40,000
All Other Programs $880,000 $840,557 $796,621 $927,888
Total Agency Budget
$1,086,200$1,046,030$988,676$1,088,510
C. Program Budget (Fiscal Year 2011-2012)
2010-2011% Change from
2011-2012
CDBGFY 10/11 - FY
Proposed Project Expenses
CDBG Request
Allocation11/12
Salaries/Benefits/Payroll/Taxes
Office Supplies
Communication $0 $0
Publications/Printing/Advertising $900 $900 0%
Travel
Rent/Lease/Mortgage $4,260 $4,400 3%
Utilities $1,000 $1,000 0%
Insurance $800 $900 12%
Equipment Rental/Maintenance $750 $800 7%
Audit/Legal/Professional Services (for
CDBG portion only)
Direct Services (Funding for specific
service such as a meal, ride)
Contracted Services $12,000 $13,000 8%
Other $36,690 $39,000 6%
Total Expenses
$56,400$60,000 6%
List below your funding sources for 2011/12 by jurisdiction and source:
FY2011/12 Revenue Source
CDBG AmountOther SourceOther AmountTotal
by Jurisdiction
Cupertino $60,000 $60,000
Total
$60,000 $0 $60,000
1. Does the Organization have a HUD-approved indirect cost plan? Yes
2. Does your agency charge fees for the services that you are requesting funding for? If so, please attach a fee
schedule. No
3. If your organization is not leveraging the requested CDBG funds with other funds, please explain why.
D. Other Information - Attachments
Check each line item that you will attach. Attachments must be uploaded(?).
1. Please submit the following documents in support of your application:
Articles of Incorporation/Bylaws.Articles_of_Incorporation.pdf
Authorization - Download this document, print and sign it, andsignature.pdf
upload the signed document.
2. If your application is selected for funding, you will be required to submit the information below at a later
date:
Policy & Procedures Manual. Include policy prohibiting
discrimination, grievance procedures, and conflict of interest.
Nonprofit Determination. Submit determination letters from the
Federal Internal Revenue Service and the State Franchise Tax
Board documenting the organization is tax exempt.
List of Board of Directors. Include the name, telephone number,
address, and occupation or affiliation of each member. Identify
the principal officers of the governing body.
Authorization to Request Funds. Documentation must be
submitted of the governing body's authorization to submit the
funding request. This consists of a copy of the minutes of the
meeting in which the governing body's resolution, motion, or
other official action is recorded.
Designation of Authorized Official. Documentation must be
submitted of the governing body's action authorizing the
representative of the agency to negotiate for and contractually
bind the agency. This consists of a signed letter from the
Chairperson of the governing body providing the name, title,
address, and telephone number of each authorized individual.
Organizational Chart. Include the organization's administrative
framework and staff positions.
Financial Statement and Audit. Describe any findings or concerns
that were cited in the audit or in any accompanying management
letter, particularly pertaining to the use of CDBG funds. Also,
describe any actions taken to correct identified findings or
concerns.
Resume of Chief Program Administrator.
Resume of Chief Fiscal Officer.
Proof of Liability Insurance.
Program Manager SignatureBeverley Jackson
Date Signed03/04/2011