HomeMy WebLinkAboutGrant Related - BOCCATTACHMENT I&A (1)
Department of Commerce
Community Development Block Grant
CONTRACT CLOSEOUT REPORT
contract Number: 19-62210-005
1. Grantee Jurisdiction: 2. Official Address:
.Grant County PO Box 37
Ephrata., WA 98823
3. Name of Chief Administrative Official: 4. Title:
Cindy Carter Chair, Board of County Commissioners
5. CDBG Contract End Date or Project Completion Date: 6. Final Public Hearing Dptp:
2/28/2021 March 10, 2020 for original grant
March 9, 2021 for Amendment A
7. Brief project summary and results achieved: (See instructions on following page)
Prosperity Center -Provides financial education & credit counseling services. 89 1st time home buy
classes, 462 counseling sessions (840 hrs),, 263 finan workshop students, 5I1y1ptrge)taj.p-Cep servie
e
Weatherization Program- Served 24 homes in Grant & Adams Counties
Energy Assistance -Served 1,066 clients in Grant County and 670 clients in Adams County
Health District COVID Response -1816 cases tracked for contact tracing, food & care kits provided,
information/efforts coordinated with medical providers & long term care facilities, planned mass testir
& vaccine clinics.
C] For construction projects, pictures of the completed project have been submitted toyour CDBG project
Manager
8. Physical address of the activity(s) if not available at start of project (See instructions)
01c, 903 W 3rd Ave, Moses Lake, WA Health District - Various locations throughout County
The chief administrative official of the grantee jurisdiction certifies that:
1. To the best of his/her knowledge and belief, the financial information and dataprovided in this report is true and
correct as of the signature date indicated below.
2. The project was completed in accordance with the grant contract and scope of work.
3. A final public hearing was conducted to assess project performance.
4. Records supporting the information provided in this report will be maintained for a minimum of six (6) years from
final closeout and made available upon request.
5. Cofisents to the use and reproduction by the CDBG Program or anyone authorized by CDBG, of any and all
provided audio or video recording or photographs without compensation.
In the event audits disclose disallowable costs, the Washington State Department Of Commerce shall retain the right
to recover an appropriate amount of costs after fully considering the recommendations on disallowed costs resulting
from the final au. *1 t
Signature:
A
Chief Adrnvfihiktrati v*'e Official Date
Cindy Carter, Chair
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CDBG Contract Closeout Report
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ATTACHMENT 16-A (2)
The Contract Closeout Report provides a format for grantees to certify and document project completion in
compliance with federal CDBG national objective and citizen participation requirements; and with the grant contract.
Data you provide is used to update, with actuals, what was anticipated at the beginning of the project and to
complete yearly reporting requirements.
Detailed instructions are included on the reverse side of forms that are not self-explanatory.
We recommend completing the report using the electronic version available at www.commercetwa.gQv/cdbg, or sent
by your CDBG project manager.
Please contact your CDBG project manager if you have questions
e
• Items 1-4 are self-explanatory.
• Item 5: Insert the end date listed on your contract face sheet or on the most recent amendment. For projects
completed prior to this end date, enter the date the project was completed.
• Item 6: Insert the date the required final public hearing was held to receive input from the public on the CDBG-
funded project. The public hearing must be held prior to submission of this report and meet public hearing
requirements.
• Item 7: Briefly describe the CDBG-funded activity(s), the original need that was met, project's actual
accomplishments compared to the CDBG contract's scope of work was accomplished, and project highlights. For
construction projects, submit digital photographs of the project by emailing, or sending a CD/flashdrive, to your
Project Manager.
• Item 8: Review the project address listed in your original application Project Summary. If it has changed, or if it
was not known at that time, provide the actual address(es) here.
• Signature Block: This is the signature of the grantee's chief administrative official or designee.
CoverPage and Certification.....................................................................................................................................1
Tableof Contents....................................................................................................................................................... 2
FinancialSummary..................................................................................................................................................... 3
ProgramIncome Summary........................................................................................................................................ 3
BenefitSummary....................................................................................................................................................... 5
• Benefit at Closeout Form...........................................................................................................................asses. 7
Minority Business Development, Section 3 and Labor Standards Reporting ..................................also...................... 9
• Contract and Subcontract Activity Form (Attachment 1)..............................................................................11
• Grantee Section 3 Closeout Summary Report (Attachment 2)... ............ 13
• Final Labor Standards Compliance Report (Attachment 3)...........................................................................15
CDBG Contract Closeout Report
ATTACHMENT 16-A (3)
FINANCIAL SUMMARY
4 -Any dollar amount refiected In the Total CDBG Balance column will be assumed as a de -obligation and returned to
the CDBG Program.
PROGRAM INCOME SUMMARY
WILL THIS PROJECT GENERATE PROGRAM INCOME F] Yes No
If you check "Yes," and request to retain program income you must submit a
Program Income Reuse Plan by closeout or receipt of first loan payment
(housing rehabilitation, microenterprise assistance or other), whichever is
earlier.
Program income (PI) is defined as the gross income received by a CDBG grantee or
subreciplent that was generated from the use of CDBG funds and equals or exceeds
$35,000 in a single calendar year. For detail on program income and content of a
Program Income Reuse Plan see Section 4 CDBG Management Handbook.
CDBG Contract Closeout Report
BUDGET SUMMARY .
HUD IDIS Activity Number,,
Budget Code & Activity Title
(See the project A-19 invoice voucher information)
Budget Amount
Funds Expended
Balance
7945 05Z Public Services
7946 21A General Admin
8100 05Z Outreach & Referral
8102 21A General Admin COVID
$117,558.00
$3,500.00
141,770.00
$-26-,.-x:00
$ 31500.00
$1177558
$ 31500
$14117-70
$
i 0 0
$ 0
$ 0
$ 0
$ 0
Total CDBG
$ 266,328.00
$ 2667328
Other Fu.nd"ng
$2 999 265.24
$1,066,641.21$14000000
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: �°���'.
01C has multiple funding sources
$2999,265.2 4
7
Health Dist has multiple funding sources
Ex: CARES Act through Grant County
.c
TOTAL PROJECT
--$4.665,993.241
332-2334-4.
4 -Any dollar amount refiected In the Total CDBG Balance column will be assumed as a de -obligation and returned to
the CDBG Program.
PROGRAM INCOME SUMMARY
WILL THIS PROJECT GENERATE PROGRAM INCOME F] Yes No
If you check "Yes," and request to retain program income you must submit a
Program Income Reuse Plan by closeout or receipt of first loan payment
(housing rehabilitation, microenterprise assistance or other), whichever is
earlier.
Program income (PI) is defined as the gross income received by a CDBG grantee or
subreciplent that was generated from the use of CDBG funds and equals or exceeds
$35,000 in a single calendar year. For detail on program income and content of a
Program Income Reuse Plan see Section 4 CDBG Management Handbook.
CDBG Contract Closeout Report
FINANCIAL SUMMARY INSTRUCTIONS:
Activities I Budget Codes I Title I I Amount I
CDBG Contract Closeout Report 4
Project
HU® Project, Activity and Budget
Code (s): The A19 voucher lists the
Project, Activity and Budget
Code(s) and Activity Title(s) for the
project.
each Activity assigned to the
project., its corresponding Budget
Amounts Funds Expended, and
remaining Balance(s).
Other Funding: List the other
funding sources identified in your
CDBG grant application and used
in conjunction with CDBG funds
for this project.
Sources include: State, Federal,
Local Private, and Other. Include
the Funds Expended and remaining
Balance for each source. /
WASHINGTON STATE
DEPARIMIENT OF COMMERCE
a
AGENCY NUMBER
1030
IDIS PROJECT YKIBER Commerce
Contract Number
18-62210-018
A19 VOUCHER DISTRIBUTION
AGENCY NAME
DEPART IEEINT OF COXn, IERCE
&M: CDBG
PO BOX 42.525
OL"i IPLk NV;l 9S.504-2-525
INSTRUCTION TO VENDOR OR CLAMANT:
Submitthls form to dalm payment for materfals, merchandis e orseMces.
Show complete delall for each item.
Vendor's Certificate: thereby certifyunderperjury that the items and totals listed hereinList
are proper chargesfor materials, merchandise or services furnished to the slate or
Wash Ington, and that all goods furnished and/or services rendered have been provided
without discrimination because of ag e, so); marital status, race, creed, color, national.
origin, handicap, relialon orVletnam era or disabled veterans status.
-
'VLND 0 R 0 R CLA LNILANT (W aff an t is t o, b e p iya b I e t o,)
SPRINGFIELD COUNTY
100 N. ACAIN ST.
SHELBY-V-MLE, NVA 99999
=0RnNC1 PERIOD:
BY:
(SIGN IN BLUE INK)
(TITLE) (DATE)
Description
QuAla" AMOUNT
PREVIOUSLY AMOUNT REMAINING
BUDGET REQUESTED THIS INVOICE BALANCE
7706
05 Public Services
35,539.001 $35,539.00
$0.00
$0.00
7707
2 1A &(10ral Admin
3,500.00 $3,500.00
$0.001
Activities I Budget Codes I Title I I Amount I
CDBG Contract Closeout Report 4
BENEFITSUMMARY
At CDBG application, the grantee identified and documented how each CDBG activity would benefit
low- and moderate -income (LMI) persons as well as the ethnic and racial breakdown. If activities
provided a benefit during the contracting period, actual beneficiary data was required during the
project. If benefit was not achieved until completion of the project, beneficiary' data is reported using
the attached Beneficiary at Closeout Form.
Follow these sequential steps to document the final project benefit(s) achieved,
1. Does your CDBG contract require you currently submit a beneficiary report for your project?
(Example Public Service Grants or Local Assistance Programs)*
If yes, STOP, submit a new report documenting the beneficiaries since last reported and proceed
to the Minority Business Development, Section 3 & Labor Standards Section.
® If no, proceed to #2.
2. Is the project for a planning -only activity? El Yes ❑ No
0 If yes, STOP, data is not required, proceed to the Minority Business Development, Section 3 &
Labor Standards Section
• If no, proceed to #3
3. Complete the Benefit at Closeout Form on the next page to document the benefit provided to LMI
persons at project completion.
*NOTE: Under limited circumstances, a project may have multiple activities that require beneficiary reporting
both during the project and at completion (i.e. sewer system improvements that include replacement of private
side services). In these instances, you will receive reporting guidance from your CDBG project manager prior to
closeout.
CDBG Contract Closeout Report
Note:
• General Administration and planning budget codes do not require reporting.
® Totals for Lines 1, 2, and 3 should be the same,
(Budget code and activity numbers can be found on the Contract Data Shp -pt sent with the Pyinriffinri rnRC, rnntrnt-f I
Budget Code 05 Urgent Need
Activity Number
��roject Beneficiary — Persons Served
New Access (i.e. first in area)
Access to services/facility is no longer substandard
Improved access (i.e. improved proximity)
1. Total Persons 1809 1834
Racial/Ethnic Breakdown
HUD has designated Hispanic as an ethnic group. A person can be identified as both a member of a racial group and an
ethnic group, but cannot be designated only as an ethnic aroup.
Low- and Moderate -income Breakdow�
Very Low Income (0-30% AMI)
# by
Race
# of
Hispanic*
# by # of
Race Hispanic
# by
Race
# of
Hispanic
White
1605
956
362
Served
Black/African American
39
Genpral
Non-LMI (81%AMI and above)
186
Asian
14
3. Total.
Population
American Indian/Alaskan Native
23
Se ed
Asian and White
31
Black /African American and White
11
American Indian/Alaskan Native & Black/African
American
18
Other Multi -Racial
68
2. Total
1,809
956
1
Low- and Moderate -income Breakdow�
Very Low Income (0-30% AMI)
761
General
Very Low to Low Income (31-50% AMI)
500
Population
Low to Moderate Income (51-80% AMI)
362
Served
Sub -Total
1,623
Non-LMI (81%AMI and above)
186
3. Total.
1,809
CDBG Contract Closeout Report