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Home My WebLink AboutQUARTERLY EXPENDITURE AND PROGRESS REPORT• Ir •�'fa C_n1JNTy J Recipient Name: Activity Name: Activity ID #: HUD Activity Matrix Code: HUD Matrix Code Description: _ Performance & Benefit Data: Housing Supplement to Quarterly Expenditure and Progress Report ■ FY 2010 Activity Category: Accomplishment Type: 'Reportin' tg f'_ rk' I'M 1st Quarter [Jan -Mar] ❑ 2nd Quarter [Apr -Jun] ❑ 3rd Quarter [Jul -Sept) ❑ 4th Quarter [Oct -Dec) / Annual Report ❑ ❑ Rental - 9 Rental Set Up & Completion Form ❑ Tenant -Based Rental Assistance - 8 Tenant Based Rental Assistance Set Up Form ❑ Homebuyer - 6 Homebuyer Set Up & Completion Form ❑ Homeowner Rehab - 0 Homeowner Rehab Set Up & Completion Form ❑ Construction of Rental Units ❑ Rehabilitation of Rental Units ❑ Acquisition l Construction New Homeowner ❑ Homeowner Rehab Units ❑ Direct Financial Assistance to Homebuyers Units Total Occupiedccupted . Low l.Mod Number of Units at Start Number of Units Expected at Completion Number of Units Actually Completed Of LACBMf_IV�;-INFQRM.ATIQN Total number of Rental Units: Total number of Owner Units: Total number Homebuyer Households: Instructions: Indicate if this activity Is limned to one of more of the items listed below by placing an T (of each that apotes. C:DBG Houstn .fehabilitaEion installing Security Devices Installing Smoke Detectors Performing Emergency Housing Repairs Providing Supplies and Equipment for Painbng Houses Operating a Tool Lending Library Typp Cens.ps Tract dr City White :Black ibis .anic Asian (:Radific American: Indian ffAlaskan Displaced From Remaining In Relocated To `t{EPLACEMENTIhiF0121111AilON ;'` a .. Number of Bedrooms Agreement Execution DaAvailable te lI#FIGtRfg1ANC1 IVI(4`ASEI�J[1VT AI�,Gtti[PLiI[1)1)rf�T iNF�OajVIAT(QN [Rlpficab��tty XTS seitiolr must,gp comp�et�d f4 aU ferlf�l ani Humeaymer aCtrvrtieS�„ 1. Number of Affordable Units: a) Units occupied by elderly: c) Number of Bedrooms: b) Years of Affordability: d) Number of units subsidized with project -based rental assistance by another Federal, state or local program: e) Number of units designated for persons with HIV/AIDS, including units receiving assistance for operations: / Number of units for the chronically homeless: f) Permanent housing units designated for homeless persons & families, including units receiving assistance for operations: 1 Number of units for the chronically homeless: 2. Number of Section 504 Accessible Units: 3. Number of Units qualified as Energy Star: Performance & Benefit Data: Housing [LR 12-10-08112-23-09R Page 1 of 3 Supplement to Quarterly Expenditure & Progress Report Performance & Benefit Data: Housing MIAM =AD Supplement to Quarterly Expenditure and Progress Report ■ FY 2010 N �. TAt. Jam.Thegl.owin 'uesti�ns'ate,o:. Re,abiJia.ton.Acti`'vrttesorj:[„, 4. Number of units brought from substandard condition (HQS or local code): 5. Number of units brought into compliance with lead safety rules (24 CFR Part 35): ;"_ ,y �M�rS'�"M''gr� c.iy�, r:��Y .�a!•.tl�. I,Qt.��Wl � � estfot�`Js,- o�RentalRel�ab';Ii�attq�n X+cttvai[e�:ohJ� �► a , fr..-. f i � �,.;::z. 6. Number of units created through conversion of non-residential to residential buildings: WN(aWifi` uestroij"Is fofi'Ac u sittbn'� C ns rrlcttot�". ,e Nomeoviner Acttuiti..es_onl' _� t.,u.mr,? �. s 7. Number of households previously living in subsidized housing: 1. Number of first-time homebuyers: Qf12ECT FIR4. P1AL AS$ 4TA;NCET4_f a) Of those, number receiving housing counseling: 2. Number receiving Down Payment Assistance / Closing Costs: pIRECT#J^NEFICIARY:IiVFpRIATIQN .Nt1MER QF HOU5F�101 [I5 AS$ISTt~D Instructions: Indicate the total number of households or persons served in each Racial Category for this reporting period and the cumulative total. From the total number depicted in each Racial Category, indicate the numbers that are of Hispanic Ethnicity for this reporting period and the cumulative total. c _Ta,�s' �..�r-7� ' M � .. KaC[t.,CxTEGO.RI€. < _ ;.: 'S';: ..;EThIN1CCAT 4 - Total Number State / Local Funds Racial Cate Categories [Households or Persons) Total Number Hispanic This Quarter Cumulative This Quarter I' Cumulative White [11] Black / African American [12] Aslan [13] American Indian /Alaskan Native [14] Native Hawaiian 1 Other Pacific Islander [15] American Indian./ Alaskan Native& White [16] Aslan & White [17] Black / African American & White [18] American Indian or Alaskan Native & Black / African [19] Other Multi Racial [20] 4 Totals / Total #, Hot fflol6Inco a � Extremely Low 30% or less Low (31% - 50%) Moderate (51%- 80%) Non Low/Mod (81% orgreater) Total Total Number of Households Benefiting from the Activity Number of Female Headed Households __CDBG-Funds __1._$ _ ___ Other Federal_ Funds _5._$._ HOME Funds 2, $ State / Local Funds 6, $ ESG Funds 3. $ Private Funds 7. $ Section 108 Loan Guarantee Funds 4. Other 8. Total Funds Description of Other Funds ( #8 ) M.� Report Prepared by: Title: Date: Print Name Signature of Certifying Official: Title: Date: Performance & Benefit Data: Housing [LR 12-10-08] 12-23.09R Page 2 of 3 Supplement to Quarterly Expenditure & Progress Report "71 Performance & Benefit Data: Housing Supplement to Quarterly Expenditure and Progress Report ■ FY 2010 Performance & Benefit Data; Housing [LR 12-10-08112-23.09R Page 3 of 3 Supplement to Quarterly Expenditure & Progress Report M IAM11-DARE QUARTERLY EXPENDITURE AND PROGRESS REPORT• FY 2010 ❑ 1 s' Quarter [Jan -Mar] ❑ 2"d Quarter [Apr -Jun] ❑ 3rd Quarter [Jul -Sept] ❑ 4' Quarter [Oct -Dec] /Annual Report Recipient Name (Organization): Contact Person (Name & Title): Activity Name (Project Title) Activity Address: Activity Description: Activity I D # : Index Code: Funding Source: Telephone Number, Funded Amount: $ Activity Category: ❑ Administration ❑ Capital Improvement ❑ Economic Development ❑ Historic Preservation ❑ Housing ❑ Public Service Objective: ❑ Create suitable living environments ❑ Provide decent affordable housing ❑ Create economic opportunities Outcome: ❑ Availability/Accessibility ❑ Affordability ❑ Sustainability Se�floh.�II;.,Finape[�li�JlA.rt af�,Or� "•�. t�y5z�"'"' r °nt.`��x.�=� ,t._��.2.F :�. =c. v.��`4v _ ,fur.:. -r.. ` �+�Zr:x:+,.� y ,�,.,�` fir, tw:.�.,��: A B C D E F G H Program Income* The disposition of Program Income not specifically listed in the approved Program Income budget requires prior written approval from DHCD, 1. Does this activity generate Program Income? ❑ Yes ❑ No 2. If yes, indicate the amount generated this quarter. $ 3. if yes, was written approval granted by DHCD to use the Program Income generated from this activity? ❑ Yes ❑ No ❑ N1A - If yes, 9 attach copy of approval letter and related documents. If no; a written request for approval to use -the Program Income must be submitted to DHCD -or- a check payable to Miami- - - Dade County for the generated Program Income must be submitted quarterly in accordance wlth the terms of the contract. ■ Check Attached? 1771 Yes ❑ No ❑ N/A IYITY ST;?� �J .A _ACCO`MPLfSt Ctlf — INEQRMAT[Of�l 1. Activity Status: ❑ Cancelled ❑ Underway ❑ Completed 2. Environmental Status: ❑ A=Exempt ❑ C=Completed ❑ D=Underway 3. Is this activity still in compliance with the original project schedule? ❑ Yes ❑ No t Sectiori;lll ❑Work to Proyr�ss*[c gofngA,ctvsties) ❑ AceAmpltshment Narraftve (AdivityQorrpleted] r { :check appropriateAx`2od Tett f�nCe;lhe Scro>of ServlcesT,ridltle�d.imyour e$njrapt as ffier�asts�fnrrepditlnefi7Q1n pro reds or adcomplishedJn a bnef:narrMGve format ( Attach Scope of serSces� _ - w _ r -!N (Section I� I�therSuppoIngEffortsy� P4vtdeadesartphon using;Au�n�fjabletlatapfelloitjersuppA. 9rlingef[oris(hafhav6bsgumpatliaTlyfpletnenied drbomplet�ddUnngthrspepp�d Department of Housing and Economic Development Page 1 of 2 Quarterly Expenditure & Progress Report (LR12-15-08)12.23-09R APPROVED TOTAL ACTUAL EXPENDITURES REIMBURSED CUMULATIVE PROJECTED PROJECTED CUMULATIVE CATEGORY BUDGET EXPENDED CUMULATIVE CUMULATIVE PERCENTAGE EXPENDITURES EXPENDITURE [This Quarter] [Through end of this quarter) [Through end of this quarter] P & of fNext ouarterf Jay end of Contract•Pedodl Personnel $ $ $ $ % $ $ Contractual $ $ $ $ % $ $ Operating Costs $ $ $ $ % $ $ Commodities $ $ $ $ % $ Is Capital Outlay $ $ $ $ % $ $ TOTAL $ $ $ $ % $ $ Program Income* The disposition of Program Income not specifically listed in the approved Program Income budget requires prior written approval from DHCD, 1. Does this activity generate Program Income? ❑ Yes ❑ No 2. If yes, indicate the amount generated this quarter. $ 3. if yes, was written approval granted by DHCD to use the Program Income generated from this activity? ❑ Yes ❑ No ❑ N1A - If yes, 9 attach copy of approval letter and related documents. If no; a written request for approval to use -the Program Income must be submitted to DHCD -or- a check payable to Miami- - - Dade County for the generated Program Income must be submitted quarterly in accordance wlth the terms of the contract. ■ Check Attached? 1771 Yes ❑ No ❑ N/A IYITY ST;?� �J .A _ACCO`MPLfSt Ctlf — INEQRMAT[Of�l 1. Activity Status: ❑ Cancelled ❑ Underway ❑ Completed 2. Environmental Status: ❑ A=Exempt ❑ C=Completed ❑ D=Underway 3. Is this activity still in compliance with the original project schedule? ❑ Yes ❑ No t Sectiori;lll ❑Work to Proyr�ss*[c gofngA,ctvsties) ❑ AceAmpltshment Narraftve (AdivityQorrpleted] r { :check appropriateAx`2od Tett f�nCe;lhe Scro>of ServlcesT,ridltle�d.imyour e$njrapt as ffier�asts�fnrrepditlnefi7Q1n pro reds or adcomplishedJn a bnef:narrMGve format ( Attach Scope of serSces� _ - w _ r -!N (Section I� I�therSuppoIngEffortsy� P4vtdeadesartphon using;Au�n�fjabletlatapfelloitjersuppA. 9rlingef[oris(hafhav6bsgumpatliaTlyfpletnenied drbomplet�ddUnngthrspepp�d Department of Housing and Economic Development Page 1 of 2 Quarterly Expenditure & Progress Report (LR12-15-08)12.23-09R QUARTERLY EXPENDITURE AND PROGRESS REPORT• FY 2010 Ct?UN�`Y ....:?T RAM- I_.:' e�oid-111 1 t'2G.ii 1[CIS II> e„_f ypfSr.pfganaa ion h2s.a e d: Qt aDtiej p e heed toilecdt�iCgl'§ssl l�n� ,d pn tt is pe od please lescnbe:thgfiatUre of fty ssistagGBsr.$, l 31 :;” ny` r - d t - � ..�k -� 1 A �. ^. (g F -O�tiq UII wPe A ;ina ce ea ` :e e t a u! ..L � �.. , 3 v h o.P.ti „s Accomplishment Type: ❑ People [01] ❑ Households [oa) ❑ Businesses [08) ❑ Organizations [09] ❑ Housing Units [to) ❑ Public Facilities [11] ❑ Jobs [13] National Objective: ❑ Area Wide Benefit [e.g. LMA, LMAFI, LMASA, SBA] -or- ❑ Direct Benefit [e.g. LMC, LMH, LMJ] •^�"' ' a 6 �_,.No�.�..aln��'�,��R"� Projected Housing_ Units Ow'r—Rent—al Jobs Retained FT Jobs Low 1 Mod PT Jobs Low f Mod Total �--Bu er— Total Projected Goal II Actual This Quarter* I I d I l Actual Cumulative *Supplemental form.0 Required –Attached Y I N (1) Performance & Benefit Data Housing Note; HOME funded projects must submit applicable activity set-up form. -44 _ - People. Total People Tot � ILJ Jobs Retained FT Jobs Low 1 Mod PT Jobs Low f Mod Total _...,.Households Low! Mod, Total Law 1 Mod Households !� Female Headed ; Protected Goal Actual This Quarter* r Actual Cumulative .. _ ..._..._.._._.__ _ ....... . *Supplemental Form LgRequired Attached Y 1 N (1) Performance & Benefit Data: Public Service & Administration ❑ -or- (2) Performance& Benefit Data: Capital Improvement & Public Facilities ❑ -or- (3) Performance & Benefit Data Housing ❑ -44 Jobs Created FT Jobs Low I Mod ; PT Jobs , Low I Mod Total Projected Goal ILJ Jobs Retained FT Jobs Low 1 Mod PT Jobs Low f Mod Total Actual This Quarter* Actual Cumulative_ *Supplemental Form Lg Required _ Performance & Benefit Data; Economic Development – Attached Y 1 N PERFORMANCE CERTIFICATION: ❑ This certifies that No Accomplishments occurred during this Quarter. Initials NOTE; Submittal of Supplemental Form — Performance & Benefit Data is not required at this time based on the certification that no accomplishments occurred during this quarter. CERTIFICATION This Is to certify that the data and other information provided in this Report is correct, based on official accounting system and records, and that expenditures and obligations shown have been made for the purpose of and In accordance with applicable Terms and Conditions of the Contract and Funding Requirements. Report Prepared by: Title: Date: Signature of Certifying Official: Title: Date: -FOR DH,D USONLY' ;5' n , .3 ��z 'rEr.;_ "; Activity IDIS Number: Report ❑ is 1 ❑ is not complete Report ❑ is I ❑ is not accurate Initial review for completeness and accuracy completed by: Name: Date: Name: Date: Contracts Officer Team Leader I Supervisor Department of Housing and Economic Development Page 2 of 2 Quarterly Expenditure & Progress Report (LR12-15-08)12-23-09R QUARTERLY EXPENDITURE AND PROGRESS REPORT INSTRUCTIONS, DEFINITIONS & ACRONYMS Reporting Period: Enter "X" in the box that corresponds with the appropriate reporting period for this report. Section I: General Information 1. Recipient Name: Fill in the appropriate Agency/ Organization Name. 2. Contact Person: Fill in the Contact Person's Name and Title, 3. Telephone Number: Fill in the Telephone Number of the Contact Person. 4. Activity Name (Project Title): Enter the name of the activity. 5. Activity Address: Enter the complete address of the location where the activity is taking place. 6. Activity Description: Enter brief description of the activity (120 characters maximum). 7. Activity ID #: Enter Activity ID No. of the activity. 8. Index Code: Enter the Index Code from FAMIS. 9. Funding Source: Enter the funding source (e.g. CDBG 06, CDBG DR 07, ESG 07, HOME 98, HOME CHDO 08, etc.). 10. Funded Amount: Enter the total funded amount of the activity, include additional awards (same funding source) if applicable, 11. Activity Category: Enter 'Win the box that corresponds with the appropriate Category of the activity (e.g. Housing, Economic Development, etc.). 12. Objective: Enter "X" in all that apply for the primary objective the activity is designed to provide. 13. Outcome : Enter "X" in all that apply for the primary outcome the activity is designed to provide. Section II: Financial Information 1. Column B: Enter amount budgeted for the activity in each category of the approved budget (or most recent approved budget amendment). 2. Column C: Enter amount expended for the activity in each category during this reporting period. 3. Column D: Enter the actual cumulative expenditures from beginning of the contract through the end of this reporting period for each category, 4. Column E: Enter the cumulative amount reimbursed from beginning of the contract through the end of this reporting period for each category. 5. Column F: Enter the cumulative percent of expenditures for each category by dividing each amount in column D (Actual Cumulative Expenditures) by the corresponding amounts as shown in column B (Approved Budget). Example — If Column D shows $5,000 expended to date in the Personnel Category and Column B shows $20,000 in the Approved Budget for this category, then the percentage in Column F would be 25%. 6. Column G: Enter amount of projected expenditures in each category for the next quarter (reporting period). 7. Column H: Enter amount of projected cumulative expenditures in each category from beginning of the contract through the end of the contract period. 8. Total: Please include totals at the bottom of each column B through H. 9. Generate Program Income?: Enter "X" in the "Yes" box if this activity is expected to generate Program Income; otherwise enter "X" in the "No" box. 10. If the response is "Yes" to Program Income: Indicate the amount of program income generated during this reporting period; if the answer was "No" enter NIA. 11. If Program Income is generated: Enter "X" in the "Yes" if DHCD approved use of the Program Income & provide copy of written approval letter along with all related documents. Otherwise, enter "X" in the "No" box and submit a written request for approval —or— a check payable to Miami -Dade County for the generated Program Income. 1. Activity Status: Enter "X" in box that corresponds with the appropriate status of the activity [Cancelled, Underway, or Completed]. Please note that an activity is considered complete once it meets its national objective, all accomplishments have been reported, and all the funds are drawn from IDIS. 2. Environmental Status: Enter "X" in the box that corresponds with the appropriate status of the activity [A=Exempt, Wompleted, or D=Underway] 3. Compliance with Original Project Schedule: Enter "X" in the "Yes" box if the activity complies with the original project schedule; if not enter "X" in the "No" box. Section III: Work in Progress Provide -a brief narrative description of .work in progress during this reportingperiod. For example • Housing - During this period architectural drawings were completed, building department approved drawings, environmental approval received, plat filed with the County, and construction is expected to begin next quarter. • Economic Development - Fifteen jobs were created during the reporting period, five additional jobs are expected to be created by next quarter. • Capital Improvement - 75% of construction of the childcare center completed this reporting period. Project on schedule and is expected to be completed by next quarter. Section IV: Other Supporting Efforts Provide a brief narrative description of all other supporting efforts that have begun, partially implemented, or completed during this reporting period. Include quantifiable data whenever appropriate. In addition, other expenditures of funds, including local match and leverage contributions, should be depicted here. Section V: Problems Encountered Provide a brief narrative description of any problems or delays that may have been encountered during this reporting period or that are anticipated in the next quarter, Report any problems that may impact the project as originally proposed, including but not limited to changes in Scope of Services, beneficiaries, target area, or other proposed outcomes. Recipients are encouraged to notify the Contracts Officer to report/discuss any problems encountered in order to resolve them as quickly as possible, Section Vi: Technical Assistance This section is reserved for recipients to request Technical Assistance of any nature related to the funded activity. Instructions, Definitions & Acronyms [created 6130108) revised 12122109 R1 Page 1 of 5 QUARTERLY EXPENDITURE AND PROGRESS REPORT INSTRUCTIONS, DEFINITIONS & ACRONYMS Section VII: Performance Measurement Accomplishment Type: Enter "X" in the box that corresponds to with the actual accomplishment type of this activity [People, Households, Businesses, Organizations, Housing Units, Public Facilities, or Jobs]. National Objective: Enter "X" in the box that corresponds with the National objective of this activity. Refer to Attachment A in the Contract to locate the National Objective far the activity -or- contact the Contracts Officer to obtain this information. Code Beneficiary Type Description 24 CFR Citation LMA Area Basis Benefit Low/Mod Area Benefit 570.208(a)(1) LMAFI Area Basis Benefit Low/Mod Area Benefit, Community Development Financial Institution (CDFI) 570.208(d)(6)(1) LMASA Area Basis Benefit Low/Mod Area Benefit, Neighborhood Revitalization Strategy Area 570.208(d)(5)(i) LMC Direct Benefit Low/Mod Limited Clientele Benefit 570208(a)(2) LMCMC Direct Benefit Low/Mod Limited Clientele, Microenterprise 570.208(a)(2)(iii) LMCSV Direct Benefit Low/Mod Limited Clientele, Job Service Benefit 570.208(a)(2)(iv) LMH Direct Benefit Low/Mod Housing Benefit 570208(a)(3) LMHSP Direct Benefit Low/Mod Housing Benefit, CDFI or Neighborhood Revitalization Strategy Area 570208(d)(5)(ii) 570.208(d)(6)(11) LMJ Direct Benefit Low/Mod Job Creation/Retention 570.208(a)(4) LMJFI Direct Benefit Low/Mod Job Creation/Retention, Public Facility/Improvement Benefit 570.208(a)(4)(iv)(F) LMJP Direct Benefit Low/Mod Job Creation, Location Based 570.208(a)(4)(iv) SBA Designated Area Basis Slum/Blight Area Benefit 570.208(b)(1) SBR Urban Renewal Area Slum/Blight in an Urban Renewal Area 570.20B(b)(3) SBS Spot Basis Slum/Blight Spot Basis 570,208(b)(2) URG Urgent Need Urgent Need 570.208(c) The data in this section is required on a quarterly basis for the reporting period and cumulative (from the beginning of the contact period through the quarter being reported). If there are no accomplishments during the reporting period, the data for this Quarter and Cumulative may be left blank, and the Recipient must complete the Performance Certification check box for "No Accomplishments" 3. Total Housing: Housing activities that Construct or Rehabilitate Rental Units, Acquire and/or Construct New Homeowner Units, Rehabilitate Homeowner Units, or provide Homeowner Counseling and Direct Financial Assistance to Homebuyers must complete this section if any accomplishments are achieved in the reporting period and complete the Supplemental Form, "Performance and Benefit Data: Housing", 4. Total People or Households: Activities that provide Public Services or Administrative (e.g., Fair Housing Activities) must complete this section if any accomplishments are achieved in the reporting period and complete the Supplemental Form, "Performance and Benefit Data: Public Services -or- Administration". Capital Improvement and Public Facilities Activities must complete this section if any accomplishments are achieved in the reporting - period and complete. the Supplemental Form, -"Performance and Benefit Data: CapitalImprovement&-Public Facilities". ------ - - - - -- - 5. Total Jobs: Activities that create or retain jobs, and/or provide assistance to businesses, must complete this section if any accomplishments are achieved in the reporting period and complete the Supplemental Form, "Performance and Benefit Data: Economic Development", 6. Performance Certification: The Performance Certification check box for "No Accomplishments" must be checked and initialed by the Certifying Official if there have been no accomplishments during the reporting period. This item certifies that there have been no accomplishments during the reporting period and the Recipient is excused from providing any further accomplishment information on the activity status as required by HUD. Reference HUD "Notice of Outcome Performance Measurement System for Community Planning and Development Formula Grant Programs." A copy of the Notice and additional information about performance measurements is available at the following link: http://www.hud.gov/officeslcpd/abouVperformance/ . 7. Report Prepared By: The name and title of the report preparer, along with the date, must be completed. 8. Signature of Certifying Official: The Certifying Official of the Recipient must sign the report, his or her title must be entered, and the certification must be dated. This Performance and Benefit Data Report must be completed and provided to DHCD for any quarter when actual accomplishments are achieved, the activity is completed, and the national objective is met. In addition, direct benefit or area benefit data must be provided as well. Please fill out the requested information completely and accurately as applicable for the funded activity. The following general information is available on Attachment A in the contract: Activity ID, Activity Category, HUD Activity Matrix Code and Description (HUD Activity Type), Accomplishment Type, and National Objective. All reports must include the name of the person preparing the report and the Certifying Official of the Recipient must sign the report, his or her title must be enter, and the report must be dated. Instructions, Definitions & Acronyms [created 6130/081 revised 12/22109 R1 Page 2 of 5 QUARTERLY EXPENDITURE AND PROGRESS REPORT INSTRUCTIONS, DEFINITIONS & ACRONYMS Project Category [required]: Enter "X" in the box that corresponds with the funded project type. Accomplishment Type I Measures [required]: Enter "X" in the box that corresponds with the funded project type. Accomplishment Units Completed [required]: Indicate the number of persons or households served and number that are low/mod income, Performance Measurement & Accomplishment Information [required] (1) Indicate the total number benefiting from the activity. (2) Indicate method used to count the number benefiting from the activity - by Households served or Persons served. (3) Of those assisted, responds to each inquiry - a through c - by providing the number that benefited, and provide the total for all. Direct Benefit Information [required]: Beneficiary information must be provided in this section for activities having a national objective of LMC, LMCMC, LMCSV, LMH, LMHSP, LMJ, LMJFI, or LMJP. Otherwise, complete the Area Benefit Information section. Provide information for actual number of households or persons assisted, for this reporting period and the cumulative total. Also, provide requested information in the Income Category and Other Beneficiary Data Sections. Area Benefit Information [required]: If applicable for funded activity. -i.Ciw5.6_6- -6.641+-'i-6.6.6.6- -641-i<_i-+<_'+_t<,'.w % 4i -6%1i Funding Sources / Leveraging of Funds [required] HOME Funded Projects Only [required]: Enter W in the box that corresponds with the funded HOME tenure type, complete the corresponding Form, & attach It to the report, Project Type [required]: Enter °X" in the box that corresponds with the funded project type. Number of Units Completed [required]: Indicate total number of Rental Units, Owner Units, or Homebuyer Households completed for the funded activity. CDBG Multi -Unit Activity, if applicable: Provide all requested information for both charts in this section. Displacement Information, if applicable: Provide all requested information in the chart. Replacement Information, if applicable: Provide all requested information in the chart. Performance Measurement & Accomplishment information [required], all applicable sections must be completed (1) Provide number of Affordable Units -and -respond to each Inquiry - a through f - by providing the requested information (2) Provide number of Section 504 Accessible Units (3) Provide number of units qualified as Energy Star (4) Provide number of units brought up to HQS/Local Code (Rehab only) (5) Provide number of units brought in compliance with lead safety (Rehab only) (6) Provide number of units created through conversion of non-residential to residential buildings (Rental Rehab only) (7) Provide number of households previously living in subsidized housing (Acquisition/Construction New Homeowner only) Direct Financial Assistance to Homebuyers, if applicable (1) Provide number of first-time homebuyers and of those, indicate number that received housing counseling (2) Provide number receiving Down Payment Assistance/Closing Costs Direct Beneficiary Information [required] - must be completed for the actual number of households assisted, for this reporting period and the cumulative total. Also, provide requested Information in the Household Income Category and Other Beneficiary Data Sections. Funding Sources I Leveraging of Funds [required] Required Attachments must be provided, if applicable. Project Type [required]: Enter "X" in the box that corresponds with the funded project type, Measures: Acquisition/Disposition and Clearance/Demolition activities only - Enter "X" in the box that corresponds with the funded activity. Accomplishment Units Completed [required]: Indicate the number of units completed [Structures, Parcels, or Facilities] , number of persons served, and number that are low/mod income Performance Measurement & Accomplishment Information [required] (1) Enter total number benefiting from the activity for the program year. (2) Indicate if the count is by Household or Persons. (3) Of those assisted, respond to each inquiry - a through h - by providing the number that benefited, and provide the total for each section. Direct Benefit Information [required]: Beneficiary information must be provided in this section for activities having a national objective of LMC, LMCMC, LMCSV, LMH, LMHSP, LMJ, LMJFI, or LMJP. Otherwise, complete the Area Benefit Information section, Provide information for actual number of households or persons assisted, for this reporting period and the cumulative total. Also, provide requested information in the Income Category and Other Beneficiary Data Sections. Area Benefit Information [required]: if applicable for funded activity. Funding Sources I Leveraging of Funds [required] Required Attachments must be provided, if applicable Note: Jobs data should be prepared as accomplishments take place (as jobs are created) or on a quarterly basis, at a minimum. Job Creation and/or Job Retention Information [responses required for this Accomplishment Type] (1) Complete the Job Creation area if the activity is expected to create jobs; otherwise, complete the Job Retention area if the activity is expected to retain jobs. (2) Indicate the number of jobs created or retained, as applicable, by job type for this reporting period and the cumulative total. (3) Direct Benefit Information —must be completed for the actual jobs created or retained, as applicable, for this reporting period and the cumulative total. Also, provide requested information in the Income Category and Other Beneficiary Data Sections, (4) Number of jobs created with employer sponsored health care benefits (5) Number unemployed prior to taking job created (6) Number of jobs -retained with employer sponsored health care benefits - (7) Provide explanation if proposed goals are not met Assistance to Businesses [responses required for this Accomplishment Type] (1) Indicate total number of business assisted, of that amount indicate how many are new businesses and the number of existing businesses (2) Of the existing businesses, indicate how many were expanding businesses and the number that were relocating (3) Indicate the number of businesses assisted with fagade treatment or business building rehab (4) Indicate the number of businesses that provide goods or services to meet the needs of a service area, etc. (5) Provide the DUNS number for each business assisted [a requirement for any business that receives Federal assistance] Area Benefit Information [required] Funding Sources 1 Leveraging of Funds [required] Required Attachments must be provided, if applicable. Instructions, Definitions & Acronyms [created 6/30/08] revised 12122/09 R1 Page 3 of 5 QUARTERLY EXPENDITURE AND PROGRESS REPORT INSTRUCTIONS, DEFINITIONS & ACRONYMS Area Benefit: Those activities having a national objective of LMA, LMAJI, and LMASA.rBeneficiary data is reported by Survey or Census data for the percentage of low- and moderate -income persons in the service area. CDBG regulations specify that 51 percent of the residents of the service area must be LMI. Examples of area benefit activities include street/sidewalk improvements, water/sewer lines, neighborhood facilities, and fagade improvements in neighborhood commercial districts. Census Block: A geographic area bounded by visible and/or invisible features shown on a map prepared by the U.S. Census Bureau. A block is the smallest geographic entity for which the Census Bureau tabulates decennial census data: Census Tract: A small, relatively permanent statistical subdivision of a county or statistically equivalent entity, delineated for data presentation purposes by a local group of census data users or the geographic staff of a regional census center in accordance with Census Bureau guidelines. CDBG National Objectives: The authorizing statute of the CDBG program requires that each activity funded except for program administration and planning activities must meet one of three national objectives. All CDBG activities must achieve one or more of these national objectives. • Benefit to low and moderate -income (LMI) persons, • Aid in the prevention or elimination of slums or blight, and • Meet a need having a particular urgency (referred to as urgent need), e.g., existing conditions pose a serious and immediate threat to the health or welfare of the community, In addition, a minimum of 70% of the CDBG program expenditures must meet the LMI benefit national objective. Direct Benefit: Those activities having a national objective of LMC, LMCMC, LMCSV, LMH, LMHSP, LMJ, LMJFI, or LMJP, Beneficiary data is reported by the total number of persons or households benefitting from an activity. DUNS Number: Data Universal Numbering System (DUNS) number is a requirement for any business that receives Federal assistance. If a business does not have one, it should call the DUNS number request line at 1-866-705-5711 to obtain a number. The process is free and takes about ten minutes. ENERGY STAR: ENERGY STAR is a joint program of EPA and DOE to help us all save money and protect the environment through energy efficient products and practices, HUD encourages incorporation of ENERGY STAR qualified products and practices when conducting rehabilitation or constructing new housing. Likewise, ENERGY STAR is a data element for energy conservation activities for the housing indicator categories in the performance measurement system. Extremely Low -Income: Households with annual income less than 30% of the area median income, as established by HUD, The number of household members is used in the determination. Ethnic Categories: HUD and grantees are required to treat ethnicity as a separate category. "Hispanic or Latino' and "Not Hispanic or Not Latino" are designated as separate ethnicity categories. • Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. The term, "Spanish origin," can be used in addition to ".Hispanic or Latino:' • Not Hispanic or Not Latino: A person not of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. Family: All persons living in the same household who are related by birth, marriage, or adoption, Household: All persons occupying the same housing unit. The occupants may be a single family, one person living alone, two or more families living together, or any group of related or unrelated persons who share living arrangements. Housing Quality Standards (HQS): HQS are set acceptable conditions for interior living space, building exterior, heating and plumbing systems, and general health and safety. The purpose of HQS is to determine whether a housing unit is decent, safe and sanitary. Income: (1) Annual income as defined under Section 8; (2) Annual income as reported under the Census long form; or (3) Adjusted gross income as defined by the IRS Form 1040. Low Mod Job Creation or Retention (LMJ): An activity designed to meet the National Objective of creating or retaining permanent jobs, at least 70 percent of which (computed on a full-time equivalent basis) will be made available to or held by LMI persons. Low Mod Limited Clientele (LMC): An activity carried out to meet the National Objective of benefit to LMI persons. Activities under the LMC category must meet one of the following criteria: - •-Benefit- clientele that is generally presumed -to be principally LMI (abused children battered spouses, elderly persons; severely disabled adults, - homeless persons, illiterate adults, persons living with AIDS and migrant farm workers); or • Require documentation on family size and income in order to show that at least 70 percent of the clientele are LMI; or • Have income eligibility requirements limiting the activity to LMI persons only; or • Be of such a nature and in such a location that it can be concluded that clients are primarily LMI. Low Mod Income Area Benefit (LMA): An activity carried out to meet the National Objective of benefit to LMI persons that benefits all residents in a particular target area, where at least 51 percent of the residents are LMI persons. Low and Moderate Income (LMI): Low and moderate income means family or household annual income less than the Section 8 Low Income Limit, generally 80 percent of the area median income, as established by HUD. Low -Income Household/Family: A household/family having an income equal to or less than the Section 8 Very Low Income limit (50% of the area median income) as established by HUD. Low Income: Households with annual income less than 50% of the area median income, as established by HUD. Low Mod Housing (LMH): An activity carried out to meet the National Objective of benefit to LMI persons/households, e,g., acquisition, construction, or improvement of permanent, residential structures which, upon completion, will be occupied by LMI households. Matrix Codes: The matrix code indicates how the activity is eligible under CDBG regulations, it generally identifies the purpose for which assistance was provided, and determines the type of accomplishment units that should be reported. Microenterprise: A business that has five or fewer employees, one or more of whom owns the enterprise. Moderate -Income Household/Family: A household/family having an income equal to or less than the Section 8 Low Income limit (80% of area median income) established by HUD, but greater than the Section 8 Very Low Income limit (50% of area median income) established by HUD. Instructions, Definitions & Acronyms [created 6/30108] revised 12122109 R1 Page 4 of 5 QUARTERLY EXPENDITURE AND PROGRESS REPORT INSTRUCTIONS, DEFINITIONS & ACRONYMS Objectives: The objectives capture the range of community impacts that are expected to occur as a result of program activities. There are three possible objectives for each activity: 1) Creating Suitable_ Living Environments, 2) Providing Decent Housing, and 3) Creating Economic Opportunities. Outcomes: The program outcome helps further refine the activity's objective and captures the nature of the type of change sought or the expected result of the activity. There are three possible outcomes: 1) Availability/Accessibility, 2) Affordability, and 3) Sustainability. Period of Affordability: The number of years a homeowner or homebuyer must reside in and retain ownership of an assisted housing unit before the unit may be sold without penalty to the homeowner. Program Income: Any gross income received by the sub recipient that was directly generated from the use of CDBG funds (24 CFR 570.500(a)), Racial Categories: HUD data requests for racial information provides the option of selecting one or more of nine racial categories to identify the racial demographics of the individuals and/or the communities they serve, or are proposing to serve. 1. American Indian or Alaska Native, A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment. 2. Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. 3. Black or African American. A person having origins in any of the black racial groups of Africa. Terms such as "Haitian" or Negro" can be used in addition to "Black or African American." 4. Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. 5, White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. 6. American Indian or Alaska Native & White. A person having these multiple race heritages as defined above. 7. Asian & White. A person having these multiple race heritages as defined above. 8. Black or African American & White. A person having these multiple race heritages as defined above. 9. American Indian or Alaska Native & Black or African American. A person having these multiple race heritages as defined above. 10, Other Multi -Racial. A person reporting multi -race heritages not included in any of the other nine categories listed above, and that have a total count that exceeds one percent of the population served. Section 504: Section 504 of the Rehabilitation Act of 1973 prohibits discrimination in Federally assisted programs on the basis of handicap. It imposes requirements to ensure that "qual'i ied individuals with handicaps" have access to programs and activities that receive Federal funds. Minimum requirements include, but are not limited to: 1) Removal of Physical Barriers, 2) Provide Program Accessibility, 3) Make Employment Accessible, and 4) Administrative Requirements. Sub recipient: An entity that assists the recipient to implement and administer its program. Sub recipients are generally nonprofit organizations that assist the recipient to undertake one or more activities on behalf of the grantee, such as administer a home rehabilitation loan pool or manage a job -training program. Sub recipients are also referred to as sub grantees. Survey: The survey instrument and methodology must be approved by HUD for the purpose of establishing the percentage of LMI persons in a service area. A survey must meet standards of statistical reliability that are comparable to that of the Decennial Census data for areas of similar size. Additional guidance is available in CPD Notice 05-06. Instructions, Definitions & Acronyms [created 61307081 revised 12/22109 R1 Page 5 of 5 n i g cit.iitr.li'il`f L L MIAMI-DADE OFFICE OF COMMUNITY & ECONOMIC DEVELOPMENT (OCED) INFORMATION FOR ENVIRONMENTAL REVIEW FORM INSTRUCTIONS: Per 24 CFR Part 58, the purpose of the environmental review procedures is to foster the implementation of environmentally compatible activities. As a grant or loan recipient, Miami -Dade County will not fund projects that will negatively impact clients, communities, or the environment. Part 1. AGENCY AND PROJECT DETAIL 1. Indicate Funding Source: ❑ CDBG ❑ HOME ❑ HOPE VI ❑ HOMELESS (SRO/SHP) ❑ EDI ❑ BED/ 2. Indicate Fiscal Year: FY 20 3.. Name of SubrecipienUAgency: 4: Name of Proposed Activity: 5. Location Address with City, ST and Zip of Activit .or Project: 6. Site Folio Number(s): 7. Commission District(s): 8. 'Direct Contact information of loan/grant recipient: Name: Address: Ci State: Zip: Phone: Fax: Form Revised 10/12107 9. Detailed description of activity or project: 10. What is the purpose of the activity or project? For example, Public Service, Economic Development, Historic Preservation, Capital Improvement, Housing, etc. 11. What is the status of activity or project? For example, Pre -Development Phase, Rehab/Construction Underway, Rehab/Construction Completed, etc. Part 11. PROJECT OUTCOME Will the activity or proiect result in the followinq? YES NO 1. Change in use 2. Sub -surface alteration (i.e. excavations) 3. New construction . 4. Renovation or demolition 5. Site improvements (utilities, sidewalk, landscaping, storm draina e, parkingareas, drives, etc. 6. Building improvements (windows, doors, etc.) 7. Displacement of persons, households or business 8 Increase in population working or living on site 9. Land acquisition 10.. Activity in 100 -year floodplain 11. A new nonresidential use generating at least 1,375,000 gallons of water or 687,500 gallons of sewage per day. 12. Use requiring operating permit (i.e. for hazardous waste, retreatment of sewage, etc. 13. A sanitary landfill or hazardous waste disposal site 14. Tree removal or relocation 15. Street. improvements 16. The impounding of more than 10 acre feet of water (e.g. digging a lake or diverting or deepening of a body of water). 2 Part 111. SITE SPECIFIC INFORMATION 1. Land Use: Describe the existing and. proposed land use: • Existing? Proposed? 2. -Site Plan: Does the proposed activity include a new structure(s) or site improvements on a site of one (1) acre or more? ❑ YES ❑ NO If yes, a site plan must be provided. Project(s) will not be environmentally reviewed without a site pian. 3. Photographs: Does the activity include new construction, renovation or rehabilitation? ❑ YES ❑ NO If yes, photographs must be provided of each side (front, rear and sides) of the structure(s) proposed for assistance and the buildings on the adjacent lots. The photographs shall be identified -by address.- In addition, provide for each existing structure on the site, the following information: • Existing structure(s) on site? ❑ YES ❑ NO • Estimated age of structure(s)? 4. Value of Improvements: Does the proposed activity include rehabilitation or renovation of structure(s)? ❑ YES ❑ NO 3 If yes, what is the estimated cost of rehabilitation or renovation? What is the amount sought for funding? In addition, indicate if the estimated value of the improvement represents: ❑ 0 to 39.9 percent of the market value of the structure(s) ❑ 40 to 49.9 percent of the market value of the structure(s) ❑ 50 to 74.9 percent of the market value of the structure(s) ❑ 75 percent or more of the market value of the structure(s) 5. Phase] Environmental Audits: Does the proposed activity involve the transfer of any property, new construction, major renovations of 75% or _more of the structures' market value, or a securing of a loan for. nonresidential parcel? ❑ YES ❑ NO If yes, a copy of Phase I Environmental Audit certified to Miami -Dade County must be submitted to determine the .likely presence of either a release or threatened release of Hazardous substance. An audit is a review of a site and adjacent properties and involves preparing a history of ownership, land use and zoning. for the last 50 years; researching environmental records for infordiation on hazardous waste sites, hazardous facilities, solid waste/landfill facilities and underground storage tanks (available through the Department of Environmental Regulations acid Management (DERM), Florida Department of Environmental Protection (FDEP) and U.S. .Environmental Protection Agency. (EPA)); and site inspection for physical evidence of contamination such as damaged vegetation or stains in the soil. Has a Phase I been performed? ❑ YES ❑ NO 6. .Environmental Health Information: If a residential site, and the activity includes or involves rehabilitation, has it been inspected for defective paint surfaces? ❑ YES ❑ NO If yes, please submit the results. • Have any child under the age of seven at the site been tested. for elevated levels of lead in the body? ❑ YES ❑ NO If yes, please submit the results. 4 7. Other Site Information: Part IV. SUPPLEMENTAL REQUIRED DOCUMENTS Required Submittal Documents: For all projects: Submit street/plat maps that depict location of property in the County and/or City with the location or lot clearly pointed out. 2. For new construction projects: Submit a scope of service, an itemized budget, and a site plan. 3. For housing/building rehabilitation projects. only: Submit a scope of service, an itemized budget describing the major components of the rehabilitation program planned, and a photograph of the property. 4'. For historic proprieties, include: Submit photographs of the property, and a description of any adjacent historic properties that may be affected by your activity. Part V. CERTIFICATION I certify to the accuracy of the information provided. I understand that all funded activities must have an approved environmental review clearance prior to the commencement of projects, l clearly understand that any omitted and/or incorrect information will delay the initiation of the environmental review process by the OCED staff. As such, I am aware that omitted information could delay the commencement of my organization's project. . I understand _ all approved - environmental -reviews are valid for one (i) year maximum. Print Name Signature Name of Organization or Corporation Unless otherwise indicated, return completed form and attachments to: Community and Economic Development Division Director Office of Community and Economic Development 741 NW 12f Court -14th Floor . Miami; Florida 33136 Title Date YES N0 1. Flood insurance required? 2. Public water available on site? 3. Public sewer available on site? 4. Children under 7 years of age residing on site or relocating to site (including day care facility)? 5. Hazardous waste disposal facility? 6. Storage of hazardous materials on site? 7. Abandoned structure(s) on site? Part IV. SUPPLEMENTAL REQUIRED DOCUMENTS Required Submittal Documents: For all projects: Submit street/plat maps that depict location of property in the County and/or City with the location or lot clearly pointed out. 2. For new construction projects: Submit a scope of service, an itemized budget, and a site plan. 3. For housing/building rehabilitation projects. only: Submit a scope of service, an itemized budget describing the major components of the rehabilitation program planned, and a photograph of the property. 4'. For historic proprieties, include: Submit photographs of the property, and a description of any adjacent historic properties that may be affected by your activity. Part V. CERTIFICATION I certify to the accuracy of the information provided. I understand that all funded activities must have an approved environmental review clearance prior to the commencement of projects, l clearly understand that any omitted and/or incorrect information will delay the initiation of the environmental review process by the OCED staff. As such, I am aware that omitted information could delay the commencement of my organization's project. . I understand _ all approved - environmental -reviews are valid for one (i) year maximum. Print Name Signature Name of Organization or Corporation Unless otherwise indicated, return completed form and attachments to: Community and Economic Development Division Director Office of Community and Economic Development 741 NW 12f Court -14th Floor . Miami; Florida 33136 Title Date TYPES OF ACTIVITIES AND ENVIRONMENTAL GUIDELINES TRIGGERED: Type of Activity EXEMPT* CENST** CEST*** EA**** Economic Development Notice/No NoticeiNo RROF (No Statutory FONSI and New Construction RROF RROF Requirement Triggered) X Rehab X1 XZ Non-Construction/Expansion X Publish NOURROF Housing (Statutory Requirement Single Family Rehab X Multi -Family Rehab X1 X2 New Construction X Homeownership Assistance X Affordable Housing Pre-Dev. X Capital Improvement Handicapped Access X Public. Facilities X1 X? Infrastructure X1 X2 Public Services Employment X Crime Prevention X Child Care X Youth or Senior Services X Supportive Services X Type of Publication No Public No Public No. Public Notice/No Publish Tri erect Statutes). Notice/No NoticeiNo RROF (No Statutory FONSI and RROF RROF Requirement Triggered) NOURROF Or Publish NOURROF (Statutory Requirement Triggered) Estimated Time Frame (Excluding 30-45 Days 3045 Days 45-90 Days 90 Days Tri erect Statutes). Minimum X1 If for continued use and change in density (or size) of less than 20% XZ Change in density (or size) of more than 20% Exempt Exempt Activities ** CENST Categorically Excluded and. Not Subject io 58.5 ** CEST Categorically Excluded Subject to 58.5 *'* EA Environmental Assessment (Format 11) 6 A FACHMENT E CERTIFICATION REGARDING LOBBYING Certification for Contracts., Grants, Loans and Cooperative Agreements The undersigned certifies, to the best of his or her knowledge and belief, that: No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any. Federal loan, the entering into df , any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. 2. If any of the funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete_ and submit Standard Form LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. 3. - The undersigned shall require that the language of this certification be included in the award documents for all subawards at all. tiers (including subcontracts, subgrants, and contracts under grants, loans, and- cooperative agreement in excess of $100,000) and that all subrecipients shall certify and disclose accordingly. 4.. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering .into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. By: (Signature of Authorized Representative) Print: (Print Name of Firm and Authorized Representative) Title: Date: coimty carvaouefion. are Qaff"' Afi afcz. 443yor f3a5taaP� J., Jordan' .Corti,N.D, Rook! Outda a sally. A, Hoym" Oruno A, Purralra DiOict.11. GBrfos A. Katy tem .f;ofef. O.'squip Cifstti�i gip' 46- A, M , dfuAex.. Dkpfj?qp-1 ,jov*,.Pl 611,14X�Zlll Aafm`alleli ATTACHMENT F Q. Rwagomoixtw Cl, New'-st'sn Pn6lod Malhap"r Njunibtr IN EM PLAM.."AC-A-1-1 This Fo'rrn to be FAxeJ. too. 305-375-11-2.5 Attentlo.m. Michaial 0. Smart Sigh )Gcation. addres-s Plus. gp6clft.4C locatlon of sign plaoamcht