Attachment_B-_FY_26-27_HCD_CDBG-HR_Application_Final.pdf

Attachment B HR Application

OC HOUSING & COMMUNITY

HOUSING REHABILITATION

FY 2026-27

APPLICATION

Bid # 012-000089-NC

SUPPORTING DOCUMENTS CHECKLIST

Applicants must submit complete Housing Rehabilitation (HR) Applications electronically to Nina Campmas (hereinafter may also be referred to as “Contract Administrator”) via www.OpenGov.com, RFA No. 012-000089-NC. Please confirm all Parts with supporting documentation are submitted prior to the RFA deadline. Applicants may submit Applications for one HR service requested using the Housing Rehabilitation Application (Attachment B). A separate Public Facilities & Improvements Application (Attachment A) is required for each PF&I project (i.e. Primary Project and Waitlisted Project/ Expanded Scope Project).

Capitalized terms not otherwise defined in the body of this Attachment B (HR Application) will have the meanings set forth in the body of the RFA.

Applicants must answer all questions within each section as applicable, as outlined in the following key:

ALL APPLICANTS MUST COMPLETE PART I

APPLICANTS SUBMITTING APPLICATIONS FOR HOUSING REHABILITATION MUST COMPLETE

PART II.

PART I: MINIMUM REQUIREMENTS

ALL HR APPLICANTS MUST COMPLETE PART I AND PART II

A: Applicant Information

B. Applicant Profile

C: Project Information

D: Organizational Background

E: Civil Rights Laws Compliance and HUD Standing

F: Signature and Assurances http://www.opengov.com/

OC Housing & Community Development Housing Rehabilitation Application

HR – FY 2026-27

OC Community Resources Page 2 of 35 HR APPLICATION RFA Bid # 012-000089-NC

PART II: HOUSING REHABILITATION

(HOUSING REHABILITATION APPLICANTS MUST COMPLETE PART I AND PART II)

A: Priority Needs, HUD Eligibility Requirements and National Objective

B: Funding Request, Accomplishment Budget, Leveraging and Project Budget

C: Performance Objectives and Outcomes

D: Organizational/Project Capacity and Experience

E: Organizational/Project Readiness

F: Environmental Information Form

Supplemental Document Instructions: Parts requesting supplemental or narrative information should be formatted per the following:

1. Each response must be typewritten; double-spaced; and in Arial font, size 12-point print.

2. Not to exceed one (1) page per question.

3. Responses should include the question and be concise but detailed enough to address what is being asked.

4. Failure to completely answer all items and/or provide the required documents may result in your application being disqualified from consideration.

5. Hardcopies of Single Audit Reports and/or Audited Final Statements will not be accepted.

Electronic copies of these documents must be uploaded via www.OpenGov.com as a separate attachment from the Application.

6. For your convenience, the Application will be available on OpenGov.com in Word format to allow for responses to be provided directly on the Application.

New Performance Requirements:

The County is initiating a three-year performance metric beginning in the 2026-2027 FAPP/RFA process for Public Facility and Improvement and Housing Rehabilitation/Façade Rehabilitation Applications. Based on calculations, using three previous years, if a participating Non-Metro City has not drawn down 80% of their awarded funds excluding the current fiscal year, by the time applications are due for the RFA process (generally in October) they may not apply for funding for a one-year period for PF&I projects. Although not a part of the RFA process, Metro Cities that have not drawn down 80% of funds over the previous and current fiscal year, by the time applications are due for the RFA process (generally in October) may not request funding for a one-year period for projects other than Public Services.

Project remains in compliance with contractual milestones.

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1. All projects must expend 50% of their contractual funds or obligate the funds by January 15th, of the contract year. If a project’s performance does not comply with these stipulations, the contract will be cancelled, and the remaining funds will be recaptured and allocate to other performing projects.

2. The second and third milestones are 70% by February 15th of the contract year; and 80% by March 15th of the contract year.

3. In addition to expenditure deadlines, PF&I projects must complete the design of the project by September 30th and bid package process completed by November 15th of the program year or the Subrecipient (City) will not be eligible for a new award for one year.

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A. APPLICANT INFORMATION

1. Applicant Name:

Address:

City/State/Zip:

Phone: Fax:

Applicant Website: Email:

*UEI Number: *D-U-N-S Number:_______________________

W-9(Federal ID Number):

*The County requires a valid UEI number and DUNS number upon application submittal. If needed, your organization may obtain one at no cost at SAM.gov and www.dnb.com.

2. Authorized Person: For the purposes of this RFA, the “Authorized Person” is the individual within your organization who has the authority to enter into a contract. The authorized person will be copied on all correspondence.

Authorized Person’s Name:

Authorized Person’s Title:

(i.e., Executive Director, Organization’s Signature Authority)

Email:

☐ Check here if the address for the Authorized Person is the same as that of the organization.

3. Contact Person: For the purpose of this RFA, the “Contact Person” will be the primary recipient for all correspondence related to this RFA. The contact person should be available to respond to any inquiries throughout the RFA process.

Contact Person’s Name:

Contact Person’s Title:

PART I

http://www.dnb.com/

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Email:

☐ Check here if the address for the Contact Person is the same as that of the organization.

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B. APPLICANT PROFILE

1. Applicant’s Legal Name:

2. Business Address:

3. Telephone Number: Fax:

4. Website Address: Email Address:

5. Years in Operation: Length of time in current location:

6. Is your firm:

Non-Profit 501(c)(3) ☐Yes ☐No

For-Profit ☐Yes ☐No

Local Government ☐Yes ☐No

Faith-based ☐Yes ☐No

Sole Proprietorship ☐Yes ☐No

If yes, indicate if doing business under a different name:

Incorporated ☐Yes ☐No

If yes, State of Incorporation:

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C: PROJECT INFORMATION

1. Project Title:

Project Address:

FY 2026-27 Housing Rehabilitation Amount Requested $

• Maximum initial funding amount for Housing Rehabilitation projects

$200,000.

If additional funds became available, would your organization be able to use up to $100,000 in additional funding for Housing Rehabilitation?

☐ YES ☐ NO

The Orange County Urban County Program is comprised of 12 cities with populations under 50,000 (participating cities). The 12 participating cities include Brea, Cypress, Dana Point, Laguna Beach, Laguna Hills, Laguna Woods, La Palma, Los Alamitos, San Juan Capistrano, Seal Beach, Stanton, and Villa Park. Along with 2 participating metro cities with populations over 50,000 – Placentia, and Yorba Linda, which are funded using their own HUD allocation and are exempt from the RFA process.

2. Urban County Program

a. Is your agency a participating city in the County of Orange Urban County Program that will be submitting an application as part of this RFA?

☐ YES ☐ NO

b. If not, since one (1) primary Application per three (3) year cycle, per jurisdiction, for

Housing Rehabilitation will be accepted, please attach written documentation (from an authorized person) from either the participating City or the County of Orange OCCR/HCD advising the County to accept your proposal as part of this RFA.

3. Provide a detailed summary description of your project.

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D: ORGANIZATIONAL BACKGROUND

Answer each question below in approximately one to four paragraphs, not to exceed one (1) page per question. I f a spec i f ic ques t ion is no t app l icab le to your organ izat ion, p lease answer wi th “Not App l icab le” . Each response must be typewritten; double-spaced; and in Arial, size 12-font. Your responses should include the question, be concise but detailed enough to address what is being asked. For your convenience, the Application will be provided on OpenGov in Word format to allow for responses to be provided directly on the Application.

1. Does your organization expend $750,000 or more a year in federal funds?

☐ Yes ☐ No

2. Is the applicant a Non-Profit organization? ☐ Yes ☐ No

3. Describe the organization’s goals, objectives, and mission.

4. Provide a brief description of your organization’s accounting system and controls in place.

5. Describe the organization’s fund development method.

6. List the person(s) who have legal authority to sign contracts and other legal documents, payment requests, and checks related to this Application. Provide a copy of the Board Resolution/Meeting Minutes which grants signing authority to these individuals for all contracts, amendments, extensions, and renewals resulting from this RFA process.

7. Audit Requirements as defined in Fiscal Requirements Section of the RFA:

Audits must be conducted by an independent CPA and must include a description of corrective action taken for any findings identified by the auditor, both of which will be reviewed by the OC Housing & Community Development Accounting Manager or designated staff. Submit required audited documents electronically via OpenGov.com as it relates to your organization:

a. Applicants who have expended Federal funds in excess of $750,000 are required to submit two (2) years of Single Audit reports (FY 2022/23 and FY 2023/24). Refer to Audit Section of the RFA document for more details related to Single Audit requirements.

Or

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b. Applicants who are not subject to Single Audit reports requirements are required to submit two (2) years of audited financial statements (FY 2022/23 and FY 2023/24).

Audited Financial Statements will include:

• Balance Sheet (Statement of Financial Position) – Including all supporting schedules (i.e., Detailed Aged Payables, Aged Receivables, Notes Payable, etc.)

• Income Statement (Profit and Loss Statement)

• Statement of Cash Flow

• Retained Earnings

• Any footnotes to the statements.

Submit Single Audit reports and Audited Financial Statements electronically via OpenGov.com as a separate attachment from the Application. Paper copies will not be accepted.

8. In the past ten years, has your organization ever had its non-profit status revoked or withheld by the IRS, the Secretary of State, the State Attorney General, or the Franchise Tax Board? If yes, please provide an explanation. (Proof of Non-Profit Status or Business License.)

9. Current/Past Litigation or Judgements: Has your organization been sued as defendant or sued another entity as a plaintiff, in the last five (5) years? If yes, provide detailed information regarding litigation (Court and case number), judgements involving your organization(s) or any company your organization holds a controlling interest in, or any company that holds an interest in your organization(s), or any of the principal officers of the organization(s).

10. Current/Past Liens or Monetary Judgements: In the last five (5) years, has your organization had any liens or monetary judgements issued against your organization or any company your organization holds a controlling interest in, or any company that holds an interest in your organization, or any of the principal officers of the organization. Include in your response date of lien(s)/judgement(s) issued, date closed, dollar amount(s) and description/explanation. The County, at its discretion, may request additional information or back-up material.

11. Are any of your managers or staff with fiscal responsibilities involved in litigation presently that has any bearing on fiduciary trust or employee relations? If yes, please provide an explanation.

12. Have any unfavorable rulings been handed down by any court against your organization or executive director in the past five years? If yes, please provide an explanation.

13. Does your organization currently have any unresolved fiscal, reporting or program issues with any of its funding sources? If yes, please provide an explanation.

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14. Provide an organizational chart of your organization, including key staffing for the project.

15. Provide a copy of your organization’s Board of Director’s list.

16. If your organization is a non- profit, please. Provide a copy of your organization’s 501(c)(3) Tax Exempt Letter. Also provide an IRS tax-exempt letter dated no later than December 2024, or a Certificate of Status provided by the Secretary of State, Business Programs Division. Online Certificates of Status can be found on the Internet at:

http://www.sos.ca.gov/business/pdf/be_ircform.pdf. (Process may take up to 24 calendar days).

In the event your Letter is not available by the due date, attach your current letter as a place holder, along with a copy of the request form. The new Tax-Exempt letter must be submitted as soon as available, and no later than April 1, 2026.

17. Provide a copy of your organization’s Articles of Incorporation and By-Laws.

18. Provide a copy of the minutes of your organization’s board meeting where the proposed project was discussed.

19. Provide IRS 990 form “Return of Organization Exempt from Income Tax”, if applicable.

http://www.sos.ca.gov/business/pdf/be_ircform.pdf.

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E: CIVIL RIGHTS LAWS COMPLIANCE AND HUD STANDING

1. Has your organization been a past recipient of assistance under a HUD McKinney Act program or the HUD Single Family Property Disposition Homeless Program?

☐Yes ☐No

2. If you have been a recipient under either of these programs, has your organization experienced any project or construction delay, HUD finding or outstanding audit that HUD deems serious regarding the administration of HUD McKinney Act programs or the HUD Single Family Property Division Homeless Program?

☐Yes ☐No

If you answered “Yes,” please attach a brief description of the circumstances and outcomes.

3. Applicants must be in compliance with applicable civil rights laws and Executive Orders.

Applications will be rejected if your agency has any of the following: (1) Any pending civil rights lawsuits instituted by the U.S. Department of Justice; (2) Any non-compliance with civil rights statutes, Executive Orders or regulations as a result of formal administrative proceedings, unless the applicant is operating under a HUD-approved compliance agreement designed to correct the area of non-compliance or is currently negotiating such an agreement; (3) Any unresolved secretarial charge of discrimination issues under Section 810 (g) of the Fair Housing Act, as implemented by 24 CFR 103.400; (4) Any adjudication of a civil rights violation in a civil action brought against the agency by a private individual, unless the applicant is operating in compliance with a court order designed to correct the area of non-compliance or the applicant has discharged any responsibility arising from such litigation; (5) Any deferral of the processing of applications from the sponsor imposed by HUD under Title VI of the Civil Rights Act of 1964, the Attorney General’s Guidelines (28 CFR 50.3) or the HUD Title VI regulations 24 CFR 1.8) and procedures, or under Section 504 of the Rehabilitation Act of 1973 and HUD Section 504 regulations (24 CFR 8.57).

If one or more of the above five situations exist within your agency/organization, please attach a brief description.

Authorized Signature Date

Print Name Title

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F: SIGNATURES AND ASSURANCES

1. Non-Discrimination: This agency will, through all possible means, ensure equal opportunity for all persons to receive services, to participate in the volunteer structure, and to be employed regardless of age, handicap, national background, race, religion, or sex.

An existing sectarian nature of the agency shall not suffer impairment under this agreement, but participation in religious observances, rituals or services will not be required as a condition of receiving food, services, or shelter paid for by this grant.

2. Accountability: We commit this agency, of a grant is received, to provide all reports to the County of Orange as required; to expend monies only on eligible cost’ to keep complete documentation (copies of all canceled checks, invoices, receipts, etc.) on all expenditures for a minimum of three years; to spend all funds and close out the program on the required date; to return any unused funds to the County of Orange; to cooperate with monitoring or site visits, and; to provide complete documentation of expenses to the County of Orange, if requested, by the required date.

3. Non-collusion: This Application is genuine, and not sham or collusive, nor made in the interest or on behalf of any person not herein named; the Applicant has not directly induced or solicited any other Applicant to put in a sham Application, or any other person, firm or corporation to refrain from submitting an Application; the Applicant has not in any manner sought by collusion to secure for him/herself an advantage over any other applicant.

We affirm that all information in this Application is true and correct to the best of our knowledge and that the Applicant under our authority will execute its responsibility under the proposed contract and fully adhere to all other applicable rules and regulations possible.

First Authorized Person Signature Date

Print First Authorized Person’s Name Title

Second Authorized Person Signature Date

Print Second Authorized Person’s Name Title

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F: SIGNATURES AND ASSURANCES (Continued)

4. I am authorized by my Board of Directors, Trustees, or other legally qualified officer to submit this application on behalf of the “Applicant.”

5. Applicant is not currently on any Federal, State of California or local Debarment List.

6. Applicant will provide records to show fiscal solvency, if required.

7. Applicant will meet all applicable Federal, State, and local compliance and regulatory requirements including, but are not limited to the following:

a. Ensuring that records accurately reflect actual performance

b. Maintaining record confidentiality, as required

c. Reporting financial, participant, and performance data, as required

d. Meeting requirements of Section 504 of the Rehabilitation Act of 1973

e. Meeting all applicable labor laws, including Child Labor Law standards

f. Meeting all lobbying certification and disclosure of lobbying activities requirements.

I recognize that I must give assurance for each item above, ‘a’ through ‘f’, as applicable. If I cannot, this Application will be automatically rejected.

8. Applicant will not use funds for customers in the construction, operation, or maintenance of any part of a facility to be used for sectarian instruction or religious worship.

Signature Required Date Signed

Print Name Print Title

9. Validity of Application

The County requires that all Applications be valid for at least three hundred sixty-five (365) days from this RFA’s closing date. Applications which are not valid for at least three hundred sixty-five (365) days will be considered non-responsive and subject to rejection.

Applicant hereby certifies that the Application is valid for three hundred sixty-five (365) days from the RFA Closing Date.

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10. Certification of Understanding

The County assumes no responsibility for any understanding of the Applicant or representation made by any of the County’s officers, employees, or agents during or prior to the execution of any Contract resulting from this RFA unless:

a. Such understanding or representations are expressly stated in the final executed contract; and

b. The final executed contract expressly provides that the County assumes such responsibility.

By signing below, Applicant certifies that such understanding has been considered in this Application.

11. Minimum Qualifications Statement

Applicant hereby certifies that it meets all minimum qualifications and requirements as set forth in this RFA.

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12. Certificate of Insurance

Applicant hereby certifies Applicant’s willingness and ability to provide the required insurance coverage and certificates as set forth in the attached Model Contract, by signing below.

13. Conflict of Interest

Applicant hereby certifies that: (I) Applicant has provided the County with the disclosures required in (a) and (b) below as part of its Application, or (II) that no relationships as outlined in (a) and (b) exist.

a. Disclose any financial, business, or other relationship with the County, any other entity that the County Board of Supervisors governs, or any County Board member, officer, or employee, which may have an impact, effect, or influence on the outcome of the services you propose to provide. Provide a list of current clients, employees, principals, or shareholders (including family members) who may have a financial interest in the outcome of services you propose to provide.

b. Disclose any financial, business, or other relationship within the last three (3) years with any firm or member of any firm who may have a financial interest in the outcome of the work to be performed under the RFA or Model Contract.

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14. Statement of Compliance

A statement of compliance with all parts of this RFA or a listing of exceptions and suggested changes must be submitted in response to this RFA.

Applicant hereby certifies (Applicant must certify either a or b by signing below):

a. This Application is submitted in strict compliance with the terms and requirements of the RFA and by submitting this Application, Applicant agrees to all terms and requirements of the RFA including, but not limited to, the terms and conditions set forth in the Model Contract and its Attachments and Exhibits that are made part of the RFA, and no exceptions are proposed.

Signature required

OR

b. This Application is submitted in strict compliance with the terms and requirements of the RFA, including the terms and conditions set forth in the Model Contract and its Attachments and Exhibits that are made part of the RFA, except for those exceptions expressly listed as required by this RFA and attached hereto.

Signature required

The parts for each proposed exception to this RFA, including, but not limited to the Model Contract, must include:

1. The complete provision Applicant is taking exception to;

2. The RFA page number and section of the provision Applicant is taking exception to;

3. The suggested rewording by way of track changes (Microsoft Word format);

4. Reason(s) for submitting the proposed exception; and

5. A description of any impact the proposed exception may have on the services to be provided.

15. Exceptions to the RFA Requirements

Exceptions that the Applicant has to any of the RFA requirements must be discussed under this section. Exceptions will be reviewed by OC Community Resources (OCCR) staff to evaluate the qualifications of the Applicant to meet program and service requirements. The OCCR reserves the right to reject an Application that is not consistent with the requirements of this RFA.

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PART II: HOUSING REHABILITATION

A. PRIORITY NEEDS, HUD ELIGIBILITY REQUIREMENTS AND NATIONAL OBJECTIVE

1. Refer to Part II. B: Funding Request, Accomplishment Budget, Leveraging & Project

Budget, enter the total dollar amount of Urban County funds that will be used by this project next to the community development need that best fits your project’s scope.

Projects may address more than one community development need; however, in order to be considered as addressing a “High Priority” community development need, at least 51% of the Urban County’s funds must be applied towards a high priority need.

Priority Needs Check Box

Priority Housing Rehabilitation Needs

Priority Needs Level

Urban County Funds

Leveraged Funds

Owner – Single Family

High Owner – Multi Rehab Renter High Renter – Single Family Rehab

High Renter - Multi Family Rehab High Special Populations High

• Projects must meet a national objective as identified by HUD Regulations Criteria for National Objectives (24 CFR 570.208).

• Depending on funding source, the proposed activity must be eligible as defined by HUD Regulations under Basic Eligible Activities (24 CFR 570.201)

• The population to be served or to benefit from the project must principally be low to moderate-income as defined by HUD. See HUD Income Limits for Housing Rehabilitation Projects chart below.

PART II

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2. HUD Demographics:

a. Does this project help prevent homelessness? Yes☐ No☐

b. Does this project help the homeless? Yes☐ No☐

c. Does this project help those with HIV or AIDS? Yes☐ No☐

d. Does this project primarily help persons with disabilities? Yes☐ No☐

3. Answer the following:

a. Summarize the Scope of Services for your project including the minimum number of units to be assisted by federal funding.

b. Why is the project needed?

c. Describe how the project preserves a low and moderate-income neighborhood or provides other community benefits.

4. Answer each question below in approximately one to four paragraphs.

a. Based upon your description of this project in Section A: Priority Needs Chart, state how your organization will address meeting a priority need with your performance and outcomes. In your description, state how your performance objectives and performance outcomes apply to the project’s beneficiaries and specifically explain how this project will affect the beneficiaries.

HUD Low-Mod Income Limits (Maximum Levels) Median Income $ 136,600 Household Ext. Low Very Low Low

Size 30% 50% 80% 1 $35,500 $59,250 $94,750 2 $40,600 $67,700 $108,300 3 $45,700 $76,150 $121,850 4 $50,750 $84,600 $135,350 5 $54,850 $91,400 $146,200 6 $58,900 $98,150 $157,050 7 $62,950 $104,850 $167,850 8 $67,000 $111,700 $178,700

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b. Describe what tools your organization will utilize to measure this project’s effect on the intended beneficiaries. In your description include how your organization will measure its success in meeting the needs of the project’s beneficiaries.

c. Describe the specific population that your project will serve (i.e., low to m oderate-income).

d. Describe the intended benefits to the population being served (i.e., preservation of a low to moderate-income neighborhood).

e. Describe the ramifications if your project is not recommended for funding in this fiscal year.

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B: FUNDING REQUEST, ACCOMPLISHMENT BUDGET, LEVERAGING AND PROJECT

BUDGET

FY 2026-27 Funding Request and Accomplishment Budget is a snapshot of your minimum and maximum requested project budget. Complete the chart by providing the minimum and maximum requested amount for your project, leveraged amount for your project, and accomplishment level for your project.

1. Complete table below.

FY 2026-27 FUNDING REQUEST AND ACCOMPLISHMENT BUDGET

Minimum Funds Request

Example 2026-27 Project

A. Minimum Funds Request $ 75,000

B. Leveraging Subrecipient Funds $ 50,000

C. Total Minimum Funds Request (A+B) $ 125,000

D. Goals/Accomplishments 15 Units

Maximum Funds Request

A. Maximum Funds Request $ 200,000

B. Leveraging Subrecipient Funds $ 60,000

C. Total Maximum Funds Request (A+B) $ 260,000

D. Goals/Accomplishments 30 Units

For FY 2026-27 if new allocation funding does not increase or decrease, the estimated funding amount for (HR) activities would be the same. However, this is also dependent on how many (HR) project applications are submitted in the FY 2026-27 RFA and the amount of unallocated funding availability.

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B: FUNDING REQUEST, ACCOMPLISHMENT BUDGET, LEVERAGING AND PROJECT

BUDGET (Continued)

FY 2027-28 Funding Request and Accomplishment Budget is a snapshot of your minimum and maximum requested project budget. Complete the chart by providing the minimum and maximum requested amount for your project, leveraged amount for your project, and accomplishment level for your project.

2. Complete table below.

FY 2027-28 FUNDING REQUEST AND ACCOMPLISHMENT BUDGET

Example FY 2027-28 Project

A. Minimum Funds Request $ 75,000

B. Leveraging Subrecipient Funds $ 50,000

C. Total Minimum Funds Request (A+B) $ 125,000

D. Goals/Accomplishments 15 Units

Maximum Funds Request

A. Maximum Funds Request $ 200,000

B. Leveraging Subrecipient funds $ 60,000

For FY 2027-28 funding will be estimated as being the same as FY 2027-28, dependent on HUD allocations and unallocated funding availability.

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A. FUNDING REQUEST, ACCOMPLISHMENT BUDGET, LEVERAGING AND PROJECT

FY 2028-29 Funding Request and Accomplishment Budget is a snapshot of your minimum and maximum requested project budget. Complete the chart by providing the minimum and maximum requested amount for your project, leveraged amount for your project, and accomplishment level for your project.

3. Complete table below.

FY 2028-29 FUNDING REQUEST AND ACCOMPLISHMENT BUDGET

Example FY 2028-29 Project

A. Minimum Funds Request $ 75,000

B. Leveraging Subrecipient Funds $ 50,000

C. Total Minimum Funds Request (A+B) $ 125,000

D. Goals/Accomplishments 15 Units

Maximum Funds Request

A. Maximum Funds Request $ 200,000

B. Leveraging Subrecipient funds $ 60,000

For FY 2028-29 funding will be estimated as being the same as FY 2028-29, dependent on HUD allocations and unallocated funding availability.

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B. FUNDING REQUEST, ACCOMPLISHMENT BUDGET, LEVERAGING AND PROJECT

FY 2026-27 Complete Project Budget Chart below, by listing the specific activities that will be paid for by Urban County funds and your leveraged dollars for each phase of this project (complete this activity by using the information you provided in the Funding Request and Accomplishment Budget portion of Part II.B).

4. Complete table below.

FY 2026-27 PROJECT BUDGET CHART

Example Project Costs Urban

County F d

Leveraged Resources Total

Project Activity: Design/Project

$ 50,000 $ 30,000 $ 80,000 Project Activity: Construction $ 25,000 $ 20,000 $ 45,000 Total Project Cost $ 75,000 $ 50,000 $ 125,000

Project Costs Urban

Funds

Leveraged

Project Activity: Construction Project Activity:

Project Activity:

Project Activity:

Project Activity:

Project Activity:

Project Activity:

Project Activity:

Total Project Cost

5. Provide a detailed description of each project activity listed in above table.

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FY 2027-28 Complete Project Budget Chart below, by listing the specific activities that will be paid for by Urban County funds and your leveraged dollars for each phase of this and Accomplishment Budget portion of Part II.B.

6. Complete table below.

FY 2027-28 PROJECT BUDGET CHART

Project Costs Urban

Funds

Leveraged

Project Activity:

Project Activity:

Project Activity:

Project Activity:

Project Activity:

Project Activity:

7. Provide a detailed description of each project activity listed in above table.

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FY 2028-29 Complete Project Budget Chart below, by listing the specific activities that will be paid for by Urban County funds and your leveraged dollars for each phase of this and Accomplishment Budget portion of Part II.B.

8. Complete table below.

FY 2028-29 PROJECT BUDGET CHART

Project Costs Urban

Funds

Leveraged

Project Activity:

Project Activity:

Project Activity:

Project Activity:

Project Activity:

Project Activity:

9. Provide a detailed description of each project activity listed in above table.

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C: PERFORMANCE OBJECTIVES AND OUTCOMES

1. Using the definitions below, complete the Performance Objectives and Outcomes table below by stating project activity, output, performance objectives and performance outcomes.

Activity Identify project activities geared towards completing project, set quantifiable units of accomplishments (e.g., planning, construction, inspections).

Output Identify project outputs such as proposed units of accomplishments (what do you hope to achieve from your project, (e.g., complete 1,000 linear feet of sidewalk).

Performance Objectives

a. Suitable Living Environment: In general, this objective relates to activities that are designed to benefit communities, families, or individuals by addressing issues in their living environment.

b. Decent Affordable Housing: The activities that typically would be found under this objective are designed to cover the wide range of housing possible under HOME, CDBG, HOPWA, or ESG. This objective focuses on housing programs where the purpose for the project is to meet the individual family or community needs, not programs where the housing is an element of a larger effort.

c. Creating Economic Opportunities: This objective applies to the types of activities related to economic development, commercial revitalization, or job creation.

Performance Outcomes

a. Availability/Accessibility: This outcome category applies to activities that make services, infrastructure, housing, or shelter available or accessible to low and moderate-income people, including persons with disabilities. In this category, accessibility does not refer only to physical barriers, but also to making the affordable basics of daily living available and accessible to low and moderate-income people.

b. Affordability: This outcome category applies to activities that provide affordability in a variety of ways in the lives of low and moderate-income people. It can include the creation or maintenance of affordable housing, basic infrastructure hook-ups, or services such as transportation or day care.

c. Sustainability (Promoting Livable or Viable Communities): This outcome applies to projects where the activity or activities are aimed at improving

OC Community Resources Page 27 of 35 HR APPLICATION communities or neighborhoods, helping to make them livable or viable by providing benefits to persons of low and moderate-income or by removing or eliminating slums or blighted areas, through multiple activities or services that sustain communities or neighborhoods.

2. Complete table below.

PERFORMANCE OBJECTIVES AND OUTCOMES

Activity Outputs Performance Objectives Performance Outcomes

Inspection

15 Units

Suitable Living Environment

Availability/Accessibility

Construction 15 Units Decent Affordable Housing Sustainability

Activity Outputs Performance Objectives Performance Outcomes

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D: ORGANIZATIONAL/PROJECT CAPACITY AND EXPERIENCE

1. Has your organization received funding for this type of activity during the previous three years?

☐Yes ☐No If you answered, “Yes”, complete Previous Funding Table below by identifying the contract number, award amount, program income, if generated; and any unspent funds.

If you answered “No” above, submit a letter signed by this Applicant’s authorized person that identifies one reference from three different funding sources from whom you have received funding in the past three years. The letter must include contact information for the three references (funding source), the amount of funding awarded from each reference, explanation of the use of funds, duration of funding awarded, and state whether or not contractual performance measures were achieved.

PREVIOUS FUNDING TABLE

Year

Contract Number

Award

Amount Program Income

Generated (If Applicable)

Unspent Funds from Award

2025-26

2024-25

2023-24

2. Describe the reason why funds remain unspent in the Previous Funding Table above. Include an explanation of how the organization intends to complete the project.

3. Describe the role of key administrators, staff members, contractors, and volunteers within your organization and their role in implementing the proposed project. Include experience, education, and licensing qualifications in your description.

4. Describe the organization’s experience administering this type or similar project.

5. Please submit a copy of your most recent audit (within the last two years) by an independent CPA and a description of corrective action taken for any findings identified by the auditor, both of which will be reviewed by the OC Housing & Community Development Accounting Manager or designated staff.

Applicants who have expended Federal funds in excess of $750,000 are required to submit two (2) years of Single Audit reports (FY 2022/23 and FY 2023/24). Refer to the Audit Section of the RFA document for more details related to Single Audit requirements.

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D: ORGANIZATIONAL/PROJECT CAPACITY AND EXPERIENCE (Continued)

Or

Applicants who are not subject to Single Audit report requirements are required to submit two (2) years of audited financial statements (FY 2022/23 and FY 2023/24).

Audited Financial Statements will include:

• Balance Sheet (Statement of Financial Position) – Including all supporting schedules (i.e., Detailed Aged Payables, Aged Receivables, Notes Payable, etc.);

• Income Statement (Profit and Loss Statement);

• Statement of Cash Flow;

• Retained Earnings; and

• Any footnotes to the statements.

Submit Single Audit reports and Audited Financial Statements electronically OpenGov.com as a separate attachment from the Application. Paper copies will not be accepted.

Applicants who have expended Federal funds in excess of $750,000 please see PART I: D:

Organizational Background, Item 7.

OC Community Resources Page 30 of 35 HR APPLICATION

E: ORGANIZATIONAL/PROJECT READINESS

1. Project milestones are an effective method of demonstrating overall project readiness. Enter the date the milestone action was completed in column 1.

If the milestone action is in progress, enter the start and end dates in columns 2 and 3. If the action is not applicable to your project, check column 4.

PROJECT/ORGANIZATION READINESS CHART

Action

Complete

Action

In Progress Start Date

Action

In Progress End Date

Action N/A

Milestone Actions A. Governing Body approval to apply for funds B. Minute Order/Board Resolution C. Project found in current annual budget

Staffing/Consultant assigned for design/ Implementation

D. Feasibility Study Design Project in concept phase RFP/RFQ process administered Consultant contract with design engineer Negotiated

Final plans and specifications written Finals plans and specifications approved Environmental Approvals (CEQA/NEPA)

E. Acquisition/Rehabilitation

2. Include in your Application documentation regarding all completed milestone actions (i.e., Minute Order/Board Resolution, public hearing notice, closed session notice and/or Agenda and applicable documentation for Milestone Actions, A through E). All Applicants must immediately schedule meetings with your organization’s boards to ensure, if selected, all council/board approvals are submitted prior to contract signing by your organization. Please include any prepared staff report as a response to this RFA and identify your council/board schedule meeting date.

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E: ORGANIZATIONAL/PROJECT READINESS (Continued)

For Applicants: When submitting to your council/board, the approval via a resolution/board approval-minutes should include:

[Sample Council/Board Resolution]

The [agency name] submitted (or will be submitting) an application under FY 2026-27, FY 2027-28

AND FY 2028-29 FOR HOUSING REHABILITATION AND REQUEST FOR APPLICATION RFA NO.

012-000089-NC.

The [agency name] desires to accept the award of CDBG funds and authorizes the execution of the necessary agreements, contracts and amendments and other corresponding documentation to accept the CDBG funds.

NOW, THEREFORE, THE [agency name], HEREBY, RESOLVES, AND ORDERS AS FOLLOWS:

1. The [agency name] hereby accepts the award of CDBG funds through the County’s Urban Counties Program, which will be used to support the [agency name] Housing Rehabilitation [project name] Project under RFA No. 012-000089-NC.

2. The [agency name] authorizes the [ Individual Title] or his/her designee to execute, for and on behalf of the [agency name], the necessary agreements(s) and/or any other documents or instruments required by the County and/or the United States Department of Housing and Urban Development for participation in the Urban Counties Program and/or for acceptance of the CDBG funds under RFA No. 012-0000893-NC.

3. Include in your application a written status for all milestone actions marked as “In Progress.”

Include supporting documentation to support progress.

4. Include in your application a brief explanation as to why a given milestone action is not applicable to the project, if necessary.

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F: ENVIRONMENTAL INFORMATION FORM

OC Housing & Community Development and Community Services 1501 E. Saint Andrew St, First Floor, Santa Ana, CA 92705

Environmental Information Form NEPA (24 CFR Part 58)

Project Title:

Program Activity (ies):

Name of Subrecipient:

Fund Type (s): � CDBG � HOME � ESG � NSP � OCHA/Operating Reserves � CoC � General Fund Contract Number (s):

Contract Amount: $______________________

Project Location: (Provide precise address and include Census Tract No... If confidential, please insert “Suppressed” and provide Census Tract No.)

Project Activity Level Description: (Please provide in detail the level of services you provide or the scope of rehabilitation and/or construction your project will involve. If needed, please use attachments.)

(Projects involving new construction, rehabilitation or acquisition activities must complete the Supplemental Site Information portion of this form)

Existing Environmental Conditions: (Please, describe the surrounding environment around your project)

OC Community Resources Page 33 of 35 HR APPLICATION

Previous Governmental Actions/Approvals Received on your Project: (If applicable, please list and attach a copy of any discretionary approvals you received on your project from a City or other County Agency.)

Discretionary Approval(s) Needed From City/County to Complete your Project(s):

I hereby declare that the statements furnished above, including any exhibits attached hereto represent all information required for this assessment. Said statements together with any exhibits attached hereto are true and correct.

Signature Title Date

Supplemental Site Information

PLEASE PROVIDE ALL INFORMATION AS REQUESTED – CHECK ALL BOXES THAT APPLY

All HR Activities must include site photos and site plan

Proposed Project Type:

Description of the Application: Include all contemplated actions, which logically are either geographically, or functionally a composite part of the project, regardless of the source of funding. [24

CFR 58.32, 40 CFR 1508.25]

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F: ENVIRONMENTAL INFORMATION FORM (Continued)

Proposed Site: Zoning Designation: _______________________________________________

General Plan Land Use Designation: _______________________________________________

Is project in a floodplain? _______________ FEMA Map No: ___________________ (attach copy) (https://msc.fema.gov/portal/home)

Existing Use(s): ☐ Vacant ☐ Residential ☐ Commercial ☐ Industrial

Other:____________________ ____________________________

Size of Site: ________ Acres ________ Sq. Ft. Assessor’s Parcel No: ___________

Age of Existing Structures: _____________ years Year built:

Prior Use(s)/Development(s):

☐ Residential ☐ Industrial ☐ Commercial ☐ Agriculture Other:____________________

If residential use, number of units: Proposed _____________ Existing _______________

Studio # of Units __________ 1 Bedroom # of Units___________

2 Bedroom # of Units _________ 3 Bedroom # of Units _________ 4+Bedroom # of Units_______

Total Number of Units: __________________ Total Number of Buildings: ______________________

Existing Conditions and Trends: Describe the existing conditions of the project area and its surroundings. [24 CFR 58.40(a)] https://msc.fema.gov/portal/home

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F: ENVIRONMENTAL INFORMATION FORM (Continued)

Is current zoning and use appropriate for the proposed site? If not, present a plan for obtaining any discretionary approvals.

Prior Analysis:

Have there been any prior Environmental Reviews completed for the proposed site or project within the last five (5) years. If yes, please attach copies of the Environmental Review. ☐ Yes ☐ No

Has the site been involved in any other applications previously submitted to this office?

☐ Yes ☐ No

Title of Prior Application: __________________________________________________________

Applicant’s Name: _____________________________________________________________

Eventual Result: ☐ Project Not Funded

☐ Project Funded $_____________________________________

☐ Project Completed Date Completed ________________

☐ Project Cancelled Date Cancelled _________________

Describe why project was cancelled: