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Backup Documents 12/13/2022 Item #16D 5 1605 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. Judith Sizensky Community and Human S4 12/8/2022 Services 2. County Attorney Office County Attorney Office0 or Z I,k Ii.L 3. BCC Office Board of County 44f Commissioners (u/I I L(1t9/ z- 4. Minutes and Records Clerk of Court's Office rn nr I )-2- 01:LP PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Judith Sizensky/CHS Phone Number 252-2590 Contact/Dept trnent Agenda Date Item was 12.13.2022 Agenda Item Number 16.D.5 Approved by the BCC Type of Document Amendment to(1)Agreement Number of Original 2 Attached Documents Attached PO number or account Document to be sent to Judy Sizensky- number if document is to CHS Building H-Rm 215 once be recorded signatures attained. INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A" in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature?(Stamp ok) N/A 2. Does the document need to be sent to another agency for additional signatures? If yes, N/A provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be JS signed by the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's NA Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the JS document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's JS signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip NA should be provided to the County Attorney Office at the time the item is input into SIRE. Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on 12/13/2022 and all changes made during N/A is not the meeting have been incorporated in the attached document. The County n an option for Attorney's Office has reviewed the changes,if applicable. 10,V this line. 9. Initials of attorney verifying that the attached document is the version approved by the r N/A is not BCC,all changes directed by the BCC have been made,and the document is ready for the (� ( to option for Chairman's signature. �f this line. I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12 1605 FAIN# B-20-UC-12-0016 B-20-UW-12-0016 Federal Award Date EST 10/20 &9/20 Federal Award Agency HUD CFDA Name Community Development Block Grant&Community Development Block Grant-CV CFDA/CSFA# 14.218 Total Amount of Federal $ 00 O09 Funds Awarded $691,679 Subrecipient Name Rural Neighborhoods Incorporated UEI# DWYGVXLUGJM5 FEIN 65-1238417 R&D No Indirect Cost Rate No Period of Performance 10/1/2020-12/31/2022 6/30/2023 Fiscal Year End 12/31 Monitor End: 6/28 SECOND AMENDMENT TO AGREEMENT BETWEEN COLLIER COUNTY AND RURAL NEIGHBORHOODS INCORPORATED THIS AMENDMENT is made and entered into this 13th day of December 2022,by and between Collier County, a political subdivision of the State of Florida("COUNTY"), having its principal address at 3339 Tamiami Trail East, Naples FL 34112, and Rural Neighborhoods, Incorporated ("SUBRECIPIENT"), having its principal office at P.O. Box 343529, 19308 SW 380111 Street,Florida City, FL 33034. RECITALS WHEREAS, on June 23, 2020, Agenda Item 11.J the COUNTY has entered into an Agreement for awarding a Community Development Block Grant (CDBG) Program to the Rural Neighborhoods, Incorporated; and WHEREAS, the COUNTY has entered into an Agreement with the United States Department of Housing and Urban Development(HUD)for a grant for the execution and implementation of a Community Development Block Grant Program in certain areas of Collier County, pursuant to Title I of the Housing and Community Development Act of 1974(as amended); and 122-SOC-00972/I754207/II RURAL.NEIGHBOR!IOOI)S,INCORPORATED CD20-0 I Page I Esperanza Community Center-Second Amendment Q Lr 1613 5 WHEREAS, the Board of County Commissioners of Collier County ("Board") approved the Collier County Consolidated Plan—One-year Action Plan for Federal Fiscal Year 2019-2020 for the CDBG Program on June 25,2019—Agenda Item 16.D.2; and WHEREAS,the Board of County Commissioners of Collier County approved the Collier County Consolidated Plan—One-year Action Plan for Federal Fiscal Year 2020-2021 for the CDBG Program with Resolution 2020-109 on June 23,2020—Agenda Item 11.I; and WHEREAS. in accordance with HUD regulations and the Collier County Consolidated Plan concerning the preparation of various Annual Action Plans, the COUNTY advertised the 2019 — 2020 Annual Action Plan,on April 21,2020,with a 5-day Citizen Comment period from April 21,2020 to April 26,2020; and WHEREAS, in accordance with HUD regulations and the Collier County Consolidated Plan concerning the preparation of various Annual Action Plans,the COUNTY advertised the 2020/2021 Annual Action Plan, on May 23, 2020, with a 30-day Citizen Comment period from May 23, 2020, to June 23, 2020; and WHEREAS. on May 12, 2020, Agenda Item 16.F.1(f), the Board ratified the County Manager's action to amend the 2019-2020 One-Year Action Plan to recognize CDBG COVID-19 funding. WHEREAS, On November 10, 2020, Agenda item 16.D.8, the Board approved a substantial amendment recognizing further CDBG COVID-19 funding. bringing the total amount to $4,232,728 respectively. WHEREAS,the COUNTY established a program to provide assistance to qualified agencies from its Community Development Block Grant (Program) due to the circumstances of the COVID-19 health crisis; and WHEREAS, on September 27, 2022. Agenda Item 16.D.3 the Board approved the First Amendment to modify the period of performance,and consolidate(3)payment deliverables and incorporate Leveraged Funds language. WHEREAS, on October 11, 2022. Agenda Item 1 6.D.4 the Board of County Commissioners of Collier County approved a substantial amendment to Collier County's U.S Department of Housing and Urban Development FY2019-2020 Annual Action Plan. and authorized the Chariman to execute an Amendment reallocating$291,679 of CDBG-CV funds to a still to be determined Public Facilities project. WHEREAS,the parties wish to further amend this Agreement to increase the award by$291,679 utilizing CDBG-CV funds for a total project award amount of$691.679 for the Rural Neighborhoods,Inc.- Eden Park-Esperanza Community Center and extend the period of performance to 06/30/2023 at the request of the subrecipient. [22-SOC-00972/I754207/I1 RIIRAI,NEIGIIBORIIOODS,INCORPORATED CD20-0 I Page 2 Esperanza Community Center-Second Amendment coo 1 60 5 NOW, THEREFORE, in consideration of foregoing Recitals, and other good and valuable consideration, the receipt and sufficiency of which is hereby mutually acknowledged,the Parties agree to amend the Agreement as follows: Words S`Euck Through are deleted;Words Underlined are added PART I SCOPE OF WORK The SUBRECIPIENT shall,in a satisfactory and proper manner and consistent with any standards required as a condition of providing CDBG&CDBG-CV assistance as provided herein and,as determined by Collier County Community and Human Services (CHS) Division, perform the tasks necessary to conduct the program as follows: Description of project and outcome: The cost to include but not limited to the development and construction of a community center space in the Eden Park- Esperanza Place neighborhood. The center will serve low and moderate-income neighborhoods and offer housing assistance in the prevention, preparation, and response to COVID-19, to better support residents in Immokalee, a low-to moderate-income area of Collier County. 1.2 PROJECT DETAILS A. Project Description/Project Budget Description Federal Amount Project Component I: Building construction and all related costs, including but not $4907080 limited to construction material, installation, advertising, bonds, labor, permits and $691,679.00 tees. Total Federal Funds: $400 000:99 $691,679.00 LMA: Must document where at least 51 percent of the residents are LMI persons, based on HUD determined eligible census tracts. Failure to achieve the national objective under this Agreement will require repayment of the CDBG &CDBG-CV investment under this Agreement. LMC: Must document that at least 51 percent of persons served, are low to moderate income persons or households, in order to meet a CDBG&CDBG-CV National Objective. Failure to achieve the national objective under this Agreement will require repayment of the CDBG & CDBG-CV investment under this Agreement. LMH: Must document providing or improving permanent residential structures, which upon completion will be occupied by LM1 households. Structures with three or more units must have at least 51 percent occupied by LMI households and structures with less than three units must [22-SOC-00972/1754207/I J RURAL NEIGIIBORHOODS,INCORPORATED CD20-O 1 Esperanza Community Center-Second Amendment l'age 3 1 60 5 be occupied by 100 percent LMI households. Failure to achieve the national objective under this Agreement will require repayment of the CDBG&CDBG-CV investment under this Agreement. LIM: Must document job creation and retention. The LMI benefit national objective addresses activities designed to create or retain permanent jobs, at least 51 percent of which (computed on a full-time equivalent basis) will be made available to or held by LMI persons. Failure to achieve the national objective under this Agreement will require repayment of the CDBG &CDBG-CV investment under this Agreement. 1.4 AGREEMENT AMOUNT The COUNTY agrees to make available SIX HUNDRED NINETY-ONE THOUSAND SIX HUNDRED AND SEVENTY-NINE ($691,679.00) Dollars ($400,000.00)for use by the SUBRECIPIENT,during the term of the Agreement(hereinafter,shall be referred to as the"Funds"). Modification to the"Budget and Scope"may only be made if approved in advance.Budgeted fund shifts among line items shall not be more than 10 percent of the total funding amount and does not signify a change in scope. Fund shifts that exceed 10 percent of the Agreement amount shall only be made with Board of County Commissioners(Board)approval. The COUNTY shall reimburse the SUBRECIPIENT for the performance of this Agreement upon completion or partial completion of the work tasks, as accepted and approved by CHS. SUBRECIPIENT may not request disbursement of CDBG & CDBG-CV funds until funds are needed for eligible costs, and all disbursement requests must be limited to the amount needed at the time of the request. SUBRECIPIENT may expend funds only for allowable costs resulting from obligations incurred during the term of this Agreement. Invoices for work performed are required every month.If no work has been performed during that month,or if the SUBRECIPIENT is not yet prepared to send the required backup, a $0 invoice is required. Explanations may be required if two consecutive months of$0 invoices are submitted. Payments shall be made to the SUBRECIPIENT, when requested, as work progresses but not more frequently than once per month. Reimbursement will not occur if SUBRECIPIENT fails to perform the minimum level of service required by this Agreement. X K * 3.2 GENERAL COMPLIANCE The SUBRECIPIENT agrees to comply with the requirements of Title 24 of the Code of Federal Regulations, Part 570 (the U.S. Housing and Urban Development regulations concerning Community Development Block Grants(CDBG)),including subpart K of these regulations,except that (1) the SUBRECIPIENT does not assume the recipient's environmental responsibilities described in 24 CFR 570.604; (2) the SUBRECIPIENT does not assume the recipient's responsibility for initiating the review process under the provisions of 24 CFR Part 52; (3) the [22-SOC-00972/I754207i I I RURAL.NEIGIII3ORIIOODS,INCORPORATIiI) CD20-01 Esperanza Community Center-Second Amendment Page 4 coo 1 60 5 SUBRECIPIENT is required to follow federal procurement process; and (4) for Developers, revenue generated is not considered program income. The CDBG & CDBG-CV program was funded through the Housing and Community Development Act of 1974.The SUBRECIPIENT also agrees to comply with all other applicable laws, regulations, and policies governing the funds provided under this Agreement. The SUBRECIPIENT further agrees to utilize funds available under this Agreement to supplement rather than supplant funds otherwise available. * * * 3.5 AVAILABILITY OF FUNDS The parties acknowledge that the Funds originate from HUD CDBG&CDBG-CV grant funds and must be implemented in full compliance with all of HUD's rules and regulations and any agreement between COUNTY and HUD governing CDBG&CDBG-CV funds pertaining to this Agreement. In the event of curtailment or non-production of said federal funds, or the reduction of funds awarded by HUD to Collier County,to a level determined by the County Manager to be insufficient to adequately administer the project, the financial sources necessary to continue to pay the SUBRECIPIENT all or any portion of the funds will not be available.In either event,the COUNTY may terminate this Agreement, which termination shall be effective as of the date that it is determined by the County Manager or designee, in his/her sole discretion and judgment, that the funds are no longer available. In the event of such termination,the SUBRECIPIENT agrees that it will not look to, nor seek to hold the COUNTY, nor any individual member of the County Commissioners and/or County Administration, personally liable for the performance of this Agreement, and the COUNTY shall be released from any further liability to SUBRECIPIENT under the terms of this Agreement. * * * 3.9 REVERSION OF ASSETS In the event of a termination of this Agreement and in addition to any and all other remedies available to the COUNTY (whether under this Agreement, or at law, or in equity), the SUBRECIPIENT shall immediately transfer to the COUNTY any property on hand at the time of termination(or expiration)and any accounts receivable attributable to the use of CDBG &CDBG- CV funds,per 24 CFR 570.503(b)(7). The COUNTY's receipt of any funds on hand at the time of termination shall not waive the COUNTY's right (nor excuse SUBRECIPIENT's obligation) to recoup all or any portion of the funds or property, as the COUNTY may deem necessary. Regulations regarding real property are subject to 2 CFR 200.311 and as otherwise provided at 24 CFR 570.503(b)(7). 3.13 PROGRAM GENERATED INCOME [22-SOC-00972/175420TI I RURAL NEIGHBORHOODS,INCORPORATED CD20-0I Esperanza Community Center-Second Amendment Page 5 coo 1 60 5 No Program income is anticipated. in the event Program income is derived from the use of CDBG &CDBG-CV funds disbursed under this Agreement,such Program income shall be utilized by the SUBRECIPIENT for CDBG & CDBG-CV-eligible activities, approved by COUNTY. Any "Program Income"(as such term is defined under applicable Federal regulations)gained from any activity of the SUBRECIPIENT funded by CDBG & CDBG-CV funds shall be reported to the COUNTY through an annual program income re-use plan, utilized by the SUBRECIPIENT accordingly, and shall be in compliance with 2 CFR 200.307 and 24 CFR 570.503(c) in the operation of the Program. When program income is generated by an activity that is only partially assisted with CDBG & CDBG-CV funds,the income shall be prorated to reflect the percentage of CDBG& CDBG-CV funds used. In the event there is a program income balance at the end of the Program Year, such balance shall revert to the COUNTY's Community Block Grant Program, for further reallocation. Public Facilities and Improvements: Public facilities that are acquired,constructed,rehabilitated, or otherwise improved with CDBG & CDBG-CV funds are subject to this requirement. This includes parks, libraries, community centers, and any other facility whose primary purpose is a public one. For these facilities, program income is the income generated by the use of the facility, less the operating costs associated with generating the income. The COUNTY considers utilities, property insurance, and facility maintenance to be operating costs that should be subtracted from revenue to determine net program income. For each funded project, the SUBRECIPIENT must submit a list of proposed costs incidental to the generation of the program income for the COUNTY's approval. Additionally, real property under the SUBRECIPIENT'S control that was acquired or improved, in whole or in part, with CDBG & CDBG-CV funds shall be used to meet one of the CDBG & CDBG-CV National Objectives pursuant to 24 CFR 570.208, during the continued use period, as referenced in section 3.14(Grant Closeout Procedures)of this Agreement. If the SUBRECIPIENT sells,transfers,disposes of,or otherwise fails to continue to use the CDBG&CDBG-CV-assisted real property in a manner that meets a CDBG & CDBG-CV National Objective, the SUBRECIPIENT shall pay the COUNTY an amount equal to a percentage of the current fair market value of the property, after subtracting disposal costs. Such percentage shall have as its basis,the percentage of the appraised value attributable to CDBG&CDBG-CV and non-CDBG& CDBG-CV funds expended for the original acquisition of, or improvement to,the property under the terms of this Agreement. Such payment shall constitute program income to the COUNTY. 3.20 RELIGIOUS ORGANIZATIONS CDBG & CDBG-CV funds may be used by religious organizations or on property owned by religious organizations only in accordance with requirements set in Section 24 CFR 570.200(j). The SUBRECIPIENT shall comply with First Amendment Church/State principles as follows: [22-SOC-00972/I754207/1]RURAL NEIGHBORHOODS,INCORPORATED CD20-0i Esperanza Community Center-Second Amendment Page t' l 60 5 A. It will not discriminate against any employee or applicant for employment on the basis of religion and will not limit employment or give preference in employment to persons on the basis of religion. B. It will not discriminate against any person applying for public services on the basis of religion and will not limit such services or give preference to persons on the basis of religion. C. It will retain its independence from Federal, State, and Local governments and may continue to carry out its mission, including the definition, practice, and expression of its religious beliefs, provided it does not use direct CDBG&CDBG-CV funds to support any inherently religious activities, such as worship,religious instruction, or proselytizing. D. The funds shall not be used for the acquisition,construction,or rehabilitation of structures to the extent that those structures are used for inherently religious activities. Where a structure is used for both eligible and inherently religious activities, CDBG& CDBG-CV funds may not exceed the cost of those portions of the acquisition, construction, or rehabilitation that are attributable to eligible activities in accordance with the cost accounting requirements applicable to CDBG&CDBG-CV funds in this part.Sanctuaries, chapels,or other rooms that a CDBG& CDBG-CV funded religious congregation uses as its principal place of worship, however, are ineligible for CDBG & CDBG-CV funded improvements. IN WITNESS WHEREOF,the SUBRECIPIENT and COUNTY, have each respectively, by an authorized person or agent, hereunder set their hands and seals on the date first written above. ATTEST: AS TO COUNTY: CRYSTAL K. KINZEL,CLERK 01-f1/(} BOARD OF COU► Y I MISSIONERS OF COLLIER CO FLORI D • Deputy Clerk 6 O,' / C• _ � Attest as to Chairman' By: • signature.Only. WIL - AM L.MCDANIEL,JR., h� � �� CH��RPERSON Dated: t (SEA ) Date: December 13, 2022 [22-SOC-00972/1754207/I]RURAL NEIGHBORIIOODS,INCORPORATED CD20-01 Esperanza Community Center-Second Amendment Page 7 co 160 5 AS TO SUBRECIPIENT: WITNESSES: RURAL NEIGHBORH DS, INC. ( Itness#1 Signature By STE E K,PRESIDENT c-1-- f 3 A l c c-Q4S Witne #1 Printed Name Date: ///e/Z I-4c'CL":. pWi ness#2 Signature L/ Witness#2 Printed Name Aled as to form and gality: 0 ,Wihm.-111 (10/ D•r7 ). Perry ^\N Assistant County Attorney N Date: /2 //t{ /ZZ [22-SOC-00972/1754207/I I RURAL.NEIGIIHORHOODS,INCORPORATED CD20-0 I pa-c 8 Esperanza Community Center-Second Amendment O Vp 14105 EXHIBIT C QUARTERLY PERFORMANCE REPORT DATA GENERAL-COUNTY is required to submit to HUD,through the Integrated Disbursement and Information System(IDIS) Performance Reports.The COUNTY reports information on a quarterly basis. To facilitate in the preparation of such reports, SUBRECIPIENT shall submit the information contained herein within ten (10) days of the end of each calendar quarter. At COUNTY's discretion, SUBRECIPIENT may be required to enter the information collected on this exhibit into an online grant management system. Agency Name: Rural Neighborhoods,Inc Date: Project Title: Eden Park-Esperanza Place Community IDIS#: 619 Center Program Contact: Steve Kirk Telephone Number: (239)324-0317 Activity Reporting Period Report Due Date October 1"—December 31" January 10'h January Is'—March 31" April le April ls'—June 30'h July 10'h July 1"—September 30'h October 10'h REPORT FOR QUARTER ENDING:(check one that applies to the corresponding grant period per Amendment #2): 12/31/22 3/31/23 6/30/23 9/30/23 Final XX/XX/XX Please note: The CDBG/HOME/ESG Program year begins',October I,2020 December 31,2022.Each quarterly report must include cumulative data beginning from the start of the program year October I,2020. 1. Please list the outcome goal(s)from your approved application and SUBRECIPIENT Agreement and indicate your progress in meeting those goals since October 1,2020. a. Outcome Goals:list the outcome goal(s)from your approved application and SUBRECIPIENT Agreement Outcome 1: Building construction and all related costs, including but not limited to construction material, installation, advertising, bonds, labor, permits and fees. Outcome 2: Meet National Objective for LMA Outcome 3: b. Goal Progress: Indicate the progress to date in meeting each outcome goal. Outcome 1: Outcome 2: Outcome 3: 2. Is this project still in compliance with the original project schedule: Yes No If No,Explain: 3. Since October 1,2020;of the persons assisted,how many... Answer ONLY for Public Facilities&Infrastructure Activities *03 Matrix Codes a. ...now have new access(continuing)to this service or benefit? 0 b. ...now have improved access to this service or benefit? 0, c. ...now receive a service or benefit that is no longer substandard? 0 Total 0 4. What funding sources did the SUBRECIPIENT apply for this period? Section 108 Loan Guarantee $ CDBG $ Other Consolidated Plan Funds $ HOME $ Other Federal Funds $ ESG $ $ HOPWA $ [22-SOC-00972/I754207/I i RURAL.NEIGIIBORI[DODS.INCORPORATED CD20-0 I Esperanza Community Center-Second Amendment Page 9 160 5 $ I Total Entitlement I $ Funds 5. What is the total number of UNDUPLICATED Persons(LMC)or Households(LMH)served this QUARTER,if applicable? Answer question 5a or 5b;NOT both For LMC activities: people,race/ethnicity,and income data are reported by persons. For LMH activities: households,race/ethnicity,and income level are reported by households,regardless the number of persons in the household. a. Total No.Persons/Adults served(LMC) 0 Total No. persons served under 18 0 (LMC) Quarter Total No.of Persons '0 Quarter Total No.of Persons 0 b. Total No.of Households served 0 Total No.of female head of household 0, (LMH) 6. What is the total number of UNDUPLICATED clients served since:October,if applicable? Answer question 6a or 6b,NOT both For LMC activities:race/ethnicity and income data are reported by persons. a. Total No.Persons/Adults served(LMC) 0 Total No Persons served under 18 0 (LMC) YTD Total: 0 YTD Total 0 b. Total No.Households served(LMH) 0 Total No.female head of household(LMH) 0 YTD Total 0 YTD Total '0 Complete EITHER question 7 or 8,NOT both Complete question 7a and 7b if your program only serves clients in one or more of the listed HUD Presumed Benefit categories. 7. PRESUMED BENEFICIARY DATA ONLY: PRESUMED BENEFICIARY DATA ONLY (LMC)Quarter (LMC)YTD Indicate the total number of UNDUPLICATED persons Indicate the total number of UNDUPLICATED served this quarter who fall into each presumed benefit persons served since October 1'who fall into each category(the total should equal the total in question#6a presumed benefit category(the total should equal the or 6b): total in question#6a or 6b): a Presumed Benefit Activities Only(LMC)QTR b Presumed Benefit Activities Only(LMC)YTD 0 Abused Children ELI 0 Abused Children ELI 0 Homeless ELI 0 Homeless Person ELI Person 0 Migrant Farm LI 0 Migrant Farm Workers LI Workers 0 Battered LI 0 Battered Spouses LI Spouses 0 Persons LI 0 Persons w/HIV/AIDS LI w/HIV/AIDS '0 Elderly Persons LI or MOD 0 Elderly Persons LI or MOD '0 Illiterate Adults LI 0 Illiterate Adults LI ;0 Severely LI 0 Severely Disabled Adults LI Disabled Adults 0 Quarter Total 0 YTD Total 8. Complete question 8a and 8b if any client in your program does not fall into a Presumed Benefit category. Other Beneficiary Data: Income Range Other Beneficiary Data: Income Range Indicate the total number of UNDUPLICATED persons Indicate the total number of UNDUPLICATED served this Quarter who fall into each income category persons served since October 1 (YTD)who fall into s 122-SOC-00972/175,1207/I I RURAL.NEIGt1BORLLOODS,INCORPORATED CD20-o L Esperanza Community Center-Second Amendment Page 10 �. 1 60 5 (the total should equal the total in question#6): each income category(the total should equal the total in question#6): a ELI Extremely Low Income(0-30%) 0 b ELI Extremely Low 0 Income(0-30%) LI Low Income(31-50%) 0, LI Low Income 0 MOD Moderate Income(51-80%) 0 MOD Moderate Income 0 (51-80%) NON-L/M Above Moderate Income(>80%) 0 NON-UM Above Moderate 0 Income(>80%) Quarter Total ;0 YTD Total 0 9. Is this project in a Low/Mod Area(LMA)? YES I NO Was project completed this quarter? YES NO If yes,complete all of this section 9. Date project completed Block Group Census Tract Total Beneficiaries Low/Mod Low/Mod Percentage Beneficiaries 0 0 0 0 0 Date LMA Narrative approved by CHS? What documentation supports project completion? (i.e., Certificate of Completion or Certificate of Occupancy, etc.) 10. Racial&Ethnic Data(if applicable) Please indicate how many UNDUPLICATED Please indicate how many UNDUPLICATED clients clients served this Quarter fall into each race served since October(YTD)fall into each race category.In category.In addition to each race category,please addition to each race category please indicate how many indicate how many persons in each race category persons in each race category consider themselves consider themselves Hispanic. (Total Race column Hispanic.(Total Race column should equal the total in should equal the total in question 6.) question 6.) a. RACE ETHNICITY b. RACE ETHNICITY /HISPANIC /HISPANIC White 0 0 White 0 0 Black/African American 0 0 Black/African American 0 0 Asian 0 0 Asian 0 0 0 0 American Indian/Alaska 0 0 American Indian/Alaska Native Native Native Hawaiian/Other Pacific Islander 0 Native Hawaiian/Other Pacific 0 0 Islander Black/Africau American&White 0 0 Black/African American& 0 ,0 White 0 0 American Indian/Alaska 0. 0 American Indian/Alaska Native& Native&Black/African Black/African American American Other Multi-racial 0 0 Other Multi-racial 0 0 0 0 0 0 Name: Signature: Title: Your typed name here represents your electronic signature [22-SOC-00972/1754207/I]RURAL NEIGHBORHOODS,INCORPORATED CD20-0 I Esperanza Community Center-Second Amendment I'`r'c I I o ci 1 60 5 EXHIBIT C-1 Community Development Block Grants(CDBG) Leveraged Funds Report Leveraged Funds must be identified, tracked, and verifiable. Resources must be fully identified and described as submitted with SUBRECIPIENT's application. Subrecipient Name: Rural Neighborhoods, Incorporated Report Period: Fiscal Year: Contract Number: CD20-01 Program: CDBG &CDBG-CV Contact Name: Steve Kirk, President Contact Number: (239)324-0317 Leveraged Funds See EXAMPLE below for how to complete this form. Source Amount Type Use Total Project Cost Ratio: EXAMPLE Source Amount Type Use CDBG $1,000,000 Other Federal Land Acquisition Funds HOME $870,000 Federal Funds Infrastructure Private Donation $1,200,000 Cash& In-Kind Infrastructure Philanthropic $3,500,000 Cash—local funds 52 units Affordable Housing Total Project Cost $6,570,000 Ratio: $1 Federal Dollar $2.51 Local Funds [Signature Page to Follow[ [22-S0C-00972/1754207/1]RURAL NEIGHBORHOODS,INCORPORATED CD20-0 I Esperanza Community Center-Second Amendment Page 12 cd p 1 60 5 I hereby certify the above information is true and accurate. Signature: Date: Printed Name: Title: Your typed name here represents your electronic signature. [22-SOC-00972/I754207/11 RURAL NEIGIIBOKI I )O1)S.INCORI'ORA I GO CD20-O 1 Esperanza Community Center-Second Amendment Page 13 Gt,O