Okaloosa County BOCC — May 17, 2016 — 2016 Emergency Solutions Grant App — reading text

Citrus, Hernando, Lake, Sumter P.O. Box 3031 Inverness, FL 34451-3031 P – 352/860-2308 F – 352/726-3280 Mfhc01@gmail.com 2016-17 Emergency Solutions Grant Application 18  Rita Dopp, Executive Director Columbia, Hamilton, Lafayette, United Way of Suwannee Valley Suwannee 871 SW State Road 47 Lake City, FL 32025-0433 P – 386/752-5604 x 104 F – 386/752-0105 rita@unitedwsv.org www.unitedwsv.org Rene Givens Collier Collier County Hunger and Homeless Coalition P.O. Box 9202 Naples, FL 34101 P – 239/263-9363 / F – 239/263-6058 executivedirector@collierhomelesscoalition.org Angelo Trunzo, Executive Director DeSoto, Glades, Hardee, Hendry, Highlands County Coalition for the Homeless Highlands, Okeechobee 134 N. Ridgewood Dr. Suite 12 Sebring Florida 33870 P – 863/314-8901 F – 863/314-8902 angelotrunzo@highlandshomeless.com www.highlandshomeless.com Dawn Gilman Duval, Clay, Nassau Changing Homelessness Inc. 660 Park Street Jacksonville, FL 32204 P – 904/354-1100 / F – 866/371-8637 dgilman@changinghomelessness.org www.changinghomelessness.org John Johnson Escambia, Santa Rosa EscaRosa Coalition on the Homeless P.O. Box 17222 Pensacola, FL 32522 P – 850/436-4646 / F – 850/436-4656 John.johnson@ecoh.org or www.ecoh.org Antoinette Hayes-Triplett Hillsborough Tampa Hillsborough Homeless Initiative, Inc. 601 East Kennedy Boulevard 24th Floor Tampa, FL 33602 P – 813/223-6115 F – 813/223-6178 tripletta@THHI.org www.THHI.org Louise Hubbard, Executive Director Indian River, Martin, St. Lucie Treasure Coast Homeless Services Council, Inc. 2525 St. Lucie Avenue Vero Beach, FL 32960 2016-17 Emergency Solutions Grant Application 19  P – 772/778-4234 F – 772/567-5991 irhsclh@aol.com Jeannie Sutton, Grants Coordinator Lee Lee County Department of Human Services 2440 Thompson Street Fort Myers, FL 33901 P – 239/533-7958 F – 239/533-7955 jsutton@leegov.com Sylvia W. Smith, Executive Director Leon, Franklin, Gadsden, Liberty, Big Bend Homeless Coalition Madison, Taylor, Jefferson, 2729 W. Pensacola Street Wakulla Tallahassee, FL 32304 P - 850/576-5566 F – 850/577-0586 ssmith@bigbendhc.org www.bigbendhc.org Leslie Loveless, Executive Director Manatee and Sarasota Suncoast Partnership to End Homelessness, Inc. 1750 17th Street, Bldg. K-1 Sarasota, FL 34234 P – 941/955-8987 F – 941/209-5595 Leslie@suncoastpartnership.org Karen Hill Marion Marion County Homeless Council, Inc. 1315 SE 25th Loop #104 Ocala, FL 34471 P.O. Box 162 Ocala, FL 34478 P – 352/732-1380 F – 352/622-2975 Karen@mchcfl.org www.mchcfl.org Victoria Mallette, Executive Director Miami-Dade Miami-Dade County Homeless Trust 111 NW 1st Street, Suite 27-310 Miami, FL 33128 P – 305/375-1491 F – 305/375-2722 vmallette@miamidade.gov www.miamidade.gov/homeless Elena George, Executive Director Monroe Monroe County Homeless Services CoC Inc. P.O. Box 2410 Key West, FL 33045 2016-17 Emergency Solutions Grant Application 20 P – 305/998-4663 F – 305/204-4150 Elena@monroehomelesscoc.org http://www.monroehomelesscoc.org/ Sarah Yelverton Okaloosa and Walton Okaloosa-Walton Homeless Continuum of Care P.O. Box 115 Ft. Walton Beach, FL 32549 P – 850/409-3070 sarah@hhalliance.org www.owhcoc.org Martha Are, Executive Director Orange, Osceola, Seminole Homeless Services Network of Central Florida 4065 McLeod Road Orlando, FL 32811 P – 407/893-0133 F – 407/893-5299 martha.are@hsncfl.org www.hsncfl.org Georgiana Devine, Program & Contract Manager Palm Beach Palm Beach County Division of Human Services 810 Datura Street, Suite 350 West Palm Beach, FL 33401 P - 561/ 355-4778 / F – 561/355-4801 gdevine@pbcgov.com Raine Johns, Executive Director Pasco Coalition for the Homeless of Pasco County, Inc. Pasco County Florida Continuum of Care P.O. Box 757, New Port Richey, FL 34656 P – 727/842-8605 x 7001 F – 727/842-8538 rainejohns@pascohomelesscoalition.org www.pascohomelesscoalition.org Susan Myers, CEO Pinellas Pinellas County Homeless Leadership Board 647 1st Avenue, North St. Petersburg, FL 33701 P – 727/582-7916 F – 727/528-5764 susanmyers@pinellashomeless.org Laura Lee Gwinn, Executive Director Polk Homeless Coalition of Polk County 107 Morningside Drive, Suite C Lakeland, FL 33803 P – 863/687-8386 / F – 863/802-1436 lgwinn@polkhomeless.org 2016-17 Emergency Solutions Grant Application 21  Gary Peterson, Executive Director St. Johns Home Again St. Johns County EFFECTIVE JULY 1, 2016 1850 State Road 207 St Augustine, FL 32086 P – 904/687-6043 Homeagainstjohns1@gmail.com Jeff White, Executive Director Volusia and Flagler Volusia/Flagler County Coalition for the Homeless P.O. Box 444 Deland, FL 32121-0444 P – 386/279-0029 / F – 386/279-0028 Jwhite@vfcch.org / www.vgcch.org 2016-17 Emergency Solutions Grant Application 22  Exhibit 2 Applicant Information Request 1. APPLICANT INFORMATION Name: ________________________________________________________________ Mailing Address: _______________________________________________________ City _______________________________ County: ____________________ Zip Code: ___________________ Telephone #: ____________________ Applicant’s E-mail Address:__________________________________________________ Federal Tax Identification: __________________________________________________ DUNS Number: ___________________________________________________________ 2. PROJECT ADMINISTRATOR Name: ________________________________________________________________ Mailing Address: _______________________________________________________ City: _____________________________ State: _______ Zip Code: ________ Phone: _________________________ Fax: __________________________ Email Address: _________________________________________________________ 3. CONTACT PERSON FOR THE APPLICATION Name: ________________________________________________________________ Phone: ________________________________________________________________ Email: ________________________________________________________________ 4. TARGET GROUP: ____ Adult ______ Youth ______ Families _____ Domestic Violence _____ Other (specify): ________________________________________________ 5. CoC AREA___________________ COUNTY(IES) AND CITY TO BE SERVED: ___________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 2016-17 Emergency Solutions Grant Application 23 6. Proposal includes FAITH BASED ORGANIZATIONS? YES NO 7. TOTAL ESG PROJECT FUNDS REQUESTED: $ ____________________________ Street Outreach $ ____________________________ Shelter Activities (Essential Services + Operations) $ ____________________________ Prevention $ ____________________________ Rapid Re-Housing $ ____________________________ HMIS $ ____________________________ Administration $ ____________________________ MATCHING FUNDS: $ ____________________________ TOTAL PROGRAM COST $ _____________________________ TOTAL SUB-PROVIDERS _____________________ To the best of my knowledge, I certify that the information in this application it true and correct and that the document has been duly authorized by the governing body of the applicant. I will comply with the program rules and regulations if assistance is approved. I also certify that I am aware that providing false information on the application can subject the individual signing such application to criminal sanction. Executive Director, or Board Chairman of the Lead Agency: Signature: ____________________________________________________ Typed Name: ____________________________________________________ Title: _______________________ Date: ________________ 2016-17 Emergency Solutions Grant Application 24  Exhibit 3 Completeness Checklist Lead Agencies must complete a checklist using this form to help assure that all required documents are contained in their grant application. Application Item Complete Initial Page Yes/No Number 1. Original Application, plus 1 copy _________ _________ N/A 2. Applicant Information Request _________ _________ _________ 3. Agency Profile _________ _________ _________ 4. Proposed Activities _________ _________ _________ 5. CoC Certification _________ _________ _________ 6. Budget and Match Form _________ _________ _________ 7. Budget Narrative _________ _________ _________ 8. Local Government Certification _________ _________ _________ (Emergency Shelters) 9. Certification Regarding Lobbying _________ _________ _________ 10. Written Standards _________ _________ _________ 11. 501(c)(3) for nonprofits _________ _________ _________ 12. MyFloridaMarketPlace Registration _________ _________ _________ 13. Lead Based Paint Form (if applicable) _________ _________ _________ 2016-17 Emergency Solutions Grant Application 25  Exhibit 4 Lead Agency Profile 1. Name and Address of Agency: 2. Attach the CoC Plan as related to the homeless activities proposed. 3. List providers working on homeless assistance programs in the CoC area: 4. List the providers of services under this application. Are these providers actively participating in the coordinated assessment for your area? 5. How often does the CoC meet with area service providers?