HomeMy WebLinkAboutNon-Profit Grant Application Packet FY2013-2014
County of Hawaii
Finance Department
25 Aupuni Street, Room 2103 Hilo, Hawaii 96720
(808) 961-8234 Fax (808) 961-8569
Hawai‘i County is an Equal Opportunity Provider and Employer
Nancy E. Crawford
Director William P. Kenoi
Mayor
Deanna S. Sako
Deputy Director
November 20, 2012
TO: Nonprofit Grant Applicant
FROM: Nancy Crawford, Finance Director
SUBJECT: Grant Application and Procedures
Thank you for your interest to apply for a County of Hawai‘i nonprofit grant. Please be aware that
there are multiple changes in the application and award requirements beginning this fiscal year. We strongly advise that you carefully review the updated Nonprofit Grants Program Submittal Checklist for FY 2013-14 which must be submitted with your application, as well as the Application itself. It
is your responsibility to be in full compliance. Failure to do so may result in the disqualification of
your application. In addition to changes in the Application and associated documents, a new
requirement for FY 2013-14 is that you will be required to enroll with Hawai‘i Compliance Express, and be compliant prior to receiving final payment. To register, go to http://vendors.ehawaii.gov,
complete the easy step-by-step process, and pay the annual registration fee online using a credit card.
Pursuant to Chapter 2, Article 25, of the Hawai‘i County Code relating to appropriation of funds to nonprofit organizations, the County of Hawai‘i is soliciting grant applications from qualified nonprofit organizations (501(c)(3)), for fiscal year 2013 - 14 (July 1, 2013 - June 30, 2014). For
more specific information about the County’s nonprofit organization grant program, please refer to
Chapter 2, Article 25 of the Hawai‘i County Code, which is available on the County of Hawai‘i’s
website at http://www.hawaiicounty.gov/lb-countycode/#countycode.
This application is based upon performance measurement systems used throughout the nation and in
local government. By using performance indicators, the County will be able to examine how well
programs are meeting the purposes they intended to fulfill, and determine whether continuous improvement is being made in terms of efficiency and effectiveness.
Regardless of the postmark date, your application, along with all of the required supporting
documentation, must be submitted to and received by the Department of Finance’s Administration,
25 Aupuni Street, Room 2103, Hilo, Hawai‘i 96720, no later than 4:30 p.m. on Thursday, January 31, 2013. Absolutely no exceptions or extensions will be granted. Your application will not be
reviewed by the County employee receiving your submittal. Please allow yourself sufficient time to
submit a complete application, as incomplete applications will be disqualified.
Any questions on the preparation and submission of the application or the overall grant process should be directed to Ted Schrey of the Finance Department at 961-8489, until the Council
Committee Chair has been selected.
Hawai‘i County is an Equal Opportunity Provider and Employer
COUNTY OF HAWAI‘I
NONPROFIT GRANTS PROGRAM (FY2013-14)
NOTICE TO APPLICANTS
Key Changes for FY2013-14:
1. You will be required to enter into a written contract to accept an award.
2. You will be required to provide proof of authorization of binding signature(s). 3. Council will be able to specify changes to your grant allocation(s) of program expenditures
and program measures, and to provide additional directives regarding your award.
4. Changes to the County Code affects you in the following ways: a. Failure to submit a Final Report to council within 60 days after June 30 of the
contractual year will result in the requirement that awardees return all grant funds
awarded and that they will not be eligible to receive future grant awards for at least
the following fiscal year and for all subsequent fiscal years until such a time as that written report is submitted to, and accepted by, the council.
b. The application contains a right to audit clause.
c. The application includes a clause restricting administrative and overhead costs to 10%. d. You will be required to complete an Organization Conflict Disclosure Form.
5. You will be required to enroll with Hawai‘i Compliance Express and be compliant prior to
final payment (to register, go to: http://vendors.ehawaii.gov).
1.) Regardless of postmark date, applications must be received by the Department of Finance, no
later than 4:30 p.m. on Thursday, January 31, 2013. Please drop off or mail your application(s) to 25 Aupuni Street, Room 2103, Hilo, Hawai‘i 96720. We are located on the second floor of the County Building.
Applicants shall be responsible to ensure that their application(s) arrive at the proper
location by January 31, 2013. Applications will not be accepted at any other County location. Applications will not be reviewed by County personnel receiving your County Nonprofit Grant submittal. Applicants have full responsibility to ensure that all documents are
complete and accurate prior to submittal.
2.) Please be sure to carefully read the application instructions and to submit all of the requested supporting documentation.
All documents requiring a current signature must be the ORIGINAL, SIGNED
document. Unsigned documents will be disqualified. Faxed or copied documents will not
be accepted as original documents.
3.) To familiarize yourself with the County’s Nonprofit Grant Program, we suggest you take a
look at Chapter 2, Article 25 of the Hawai‘i County Code, available on the County of
Hawai‘i’s website, http://co.hawaii.hi.us/countycode/chapter02.pdf.
Hawai‘i County is an Equal Opportunity Provider and Employer
Timeline of nonprofit grants program
January 31, 2013, 4:30PM – cut-off for receipt of application.
March 2013 – nonprofit interviews and selected site visits.
Between March and the end of June, the awards determination process is being
conducted and the fiscal year budget is being determined. At conclusion, a contract
and award letter is sent to those nonprofits receiving an award.
Final reports are due within 60 days of the contractual year. No late or incomplete
report will be accepted; unspent grant funds must be returned with final report. The final report template will be available at: http://www.hawaiicounty.gov/fn-nonprofit-grant-forms/.
Any questions on the preparation and submission of the application or concerning the overall grant process should be directed to Ted Schrey, Budget Specialist at 961-8489 until the Council
Committee Chair has been selected.
APPLICATION INSTRUCTIONS
County of Hawai‘i
Nonprofit Grants Program
* NOTICE! * There are multiple changes in the application and award requirements beginning this fiscal year. You are strongly advised to carefully review the Application Submittal Checklist for FY
2013-14 and the Application itself. It is your responsibility to be in full compliance. Failure to do so
may result in the disqualification of your application and/or in penalties applied to you which may require your organization to return funds awarded and be ineligible for future County grant awards.
Policies
1. Only one (1) application will be accepted per program.
2. Agencies administering multiple programs must submit a separate grant application for each individual program. Service descriptions and budget tables must reflect the full scope of each
program’s operations.
General Requirements
1. The application, nonprofit grants program submittal checklist, and instructions can be downloaded from the Finance - Nonprofit Grant Forms on the County of Hawai‘i’s website:
http://www.hawaiicounty.gov/fn-nonprofit-grant-forms/
2. Maintain a minimum font size of 10 points or larger.
3. County Code specifies that you must use the application form provided by the County. If you
obtain the application form from the County of Hawai‘i website, Adobe Acrobat (PDFs) are
used. If you are unable to use Adobe Acrobat, you may pick up an application packet from the Finance Department which you may manually complete.
4. Use spell check, edit/proof read and recheck the addition for budget tables. Double check your work before submitting.
5. The Submittal Checklist must be returned with your application packet.
6. Do NOT place the completed proposal in a binder or folder of any kind.
7. Do NOT enclose or attach any of the following items to the application:
Brochures, flyers, photos, letters of support client testimonies, maps, menus, evaluation tools, graphs/tables/charts, etc.
Application Preparation (#s in this section correspond to the #s in the Application)
** Enter your Agency Name and Program Name to the top of every page. **
1. Prior Year(s) Award(s)
a. Report previous year(s) nonprofit grant award(s) received 2. Agency Mission Statement
a. A brief narrative describing your Agency’s mission.
3. Program Description
a. Briefly describe the program for which you are seeking funds.
4. Total Budget and Position Count
a. Total Program Budget applies to the program seeking County grant funding. b. Total Agency Budget applies to the entire agency.
c. Total Program Position Count means number of positions that are in the
program for which you are seeking funds. d. Total Agency Position Count means positions in the entire agency.
5. Program Funding Sources
a. List all sources of funds that you anticipate will fund your program budget, including state and/or federal grants, other specific grants, fundraising events, etc.
6. Explain what plans your agency or program has to increase revenues to support this program.
7. Program Objectives Using County Grant Program Funds
a. Summary of the objectives the program is designed to accomplish which are specific to the use of County grant funds.
8. Program Performance Measures
a. Quantifiable indicators of public and client benefits from your program’s actions,
and/or the number of goods or services your program produces. 9. Program Expenditures
a. If agency costs are attributable to more than one program, please estimate the
amount allocated to the program to which you are seeking funds. For example, if personnel (Salary and Wage cost) utilized by this program are also used by your
organization in other functions or programs, report only the portion allocated to the
program to which you are seeking funds. b. For columns 1 and 2 (FY 12-13 Actual & FY 13-14 Total Budget), reflect your
program’s total budget, including all revenue sources.
c. For column 3 (FY 13-14 Grant Request), report only the portion of your budget for which you expect to be funded by County grant funds.
10. Complete the Organization Conflict Disclosure Form.
a. The “Name” and “Position” section at top refers to the organization’s member who may have a Conflict of Interest. Leave blank if no member of organization
has a potential Conflict of Interest.
b. Signature of Authorized member of organization. Must be signed regardless of whether or not a conflict exists. Proof of Authorization (as indicated in bylaws,
resolution, etc.) to sign must be provided.
11. Certification of Understanding
a. Signature required. Proof of Authorization (as indicated in bylaws, resolution, etc.)
to sign must be provided. 12. Exhibit “B” – Council Award Worksheet
a. Complete the applicant section of Table I and Table II in Exhibit “B”. (do not
complete the “Council Award” column). This should be identical to the information provided in Table I and Table II in Exhibit “A” of the application.
Submission Format
Please complete, sign, and date the Nonprofit Grants Program Submittal Checklist and include this with your application packet. The checklist refers to specific requirements that should be accompanied with
supporting documentation. Your application packet should be submitted in the following order:
a. Submittal Checklist
b. One (1) original grant application – completed with appropriate signatures affixed and dated.
c. Two (2) copies of the signed, completed grant application. We are requesting
hardcopies of the application. The electronic version of your document should
not be submitted to us.
d. Proof of Authorization (as indicated in bylaws, resolution, etc.) which indicates
that the member of your organization who’s signature appears within the application and contract is authorized to do so, is required.
*Note: Only one (1) set of supporting documents needs to be provided.
e. Annual Financial Statements – Two most recent years required. These statements
must reflect finances within the last three year period. The preparer’s name, title, address and signature must appear on the financial statements. The Executive
Director or authorized member of the organization – see item “d” above (title
must be indicated, with explanation) must approve and sign those financial statements that are not prepared by a CPA to certify accuracy. As a minimum, a
comprehensive Profit and Loss statement is required and up to (if available) an Independently Audited Financial Statement.
Note: if the organization has been incorporated for less than two years, a waiver
may be granted to provide one year’s information.
f. Page 1 and 2 of IRS Form 990. If you file electronically, it is your responsibility to
obtain a print out of these pages.
g. IRS letter verifying agency’s tax-exempt status (IRS 501c3).
h. Articles of Incorporation. This must have a signature of the Executive Director
or highest ranking member of the organization (title must be indicated, with
explanation). This signature may be from the initial documents of incorporation or by the current Executive in charge if these are not available.
i. By-laws. This must have a signature of the Executive Director or highest ranking member of the organization (title must be indicated, with explanation).
This signature may be from the initial documents of bylaw adoption or by the current Executive in charge if these are not available.
j. Document Page(s) containing nepotism and conflict of interest clauses. If your
NEPOTISM and CONFLICT OF INTEREST clauses do not appear in
your by-laws, but in some other document(s), please identify the document and submit a copy of the page(s) in which they appear. Highlight the
appropriate clause(s). There must be specific reference indicating that your
organization does not allow Nepotism or Conflicts of Interest as defined below.
*NOTE: the Conflict of Interest form required to be completed in the application does NOT take the place of the requirement that your organization have these clauses within the organization’s published rules.
“Nepotism” means appointing persons to positions on the basis of their blood or marital relationship to the appointing authority, rather than on
merit or ability.
“Conflict of interest” means a substantial probability that action taken by
an individual will result in measurable direct benefits accruing to the individual as opposed to benefits accruing in general to an industry.
After the January 31st deadline, no modifications or corrections can be made towards your application. What you submit is what the County Council will receive. Errors, missing documents and/or other areas of noncompliance may result in the disqualification of your
application. We urge you to review your packet with extreme care, and to contact (Temporary
Contact: Ted Schrey, Budget Specialist at 961-8489 until the Council Committee Chair has been
selected) if you have any questions regarding award criteria, the selection process or application content. Contact Ted Schrey, Budget Specialist, at 961-8489 if you have any questions regarding the documents required to be submitted with your application and/or about the application
submission process.
Applications will not be reviewed by County personnel receiving your County Nonprofit Grant submittal. Applicants have full responsibility to ensure that all documents are complete and accurate
prior to submittal.
All documents requiring a current signature must be the ORIGINAL, SIGNED document. Unsigned documents will be disqualified. Faxed or copied documents will not be accepted as original documents.
Nonprofit Grants Program Submittal Checklist for FY 2013-14
Please go through each item on this checklist and put an “x” in the box to show what is being submitted. Fill in the other blank fields and be sure it meets the listed requirements. Include comment(s) if you’re unable to submit requested documentation or to explain special
circumstances, financial cycle, etc. Sign and date the bottom and return this checklist along with your application. * Failure to include this completed and signed checklist with your application packet or to provide required
supporting documents or to provide acceptable explanations of exceptions will result in the disqualification of
your application.
Application (Signed original and two (2) additional copies): *Only applications which utilize the official County of Hawai`i application form will be accepted. You may not alter the content or format of this application form other than to complete each
section. Additional pages may, however, be attached. Comments:
Proof of Authorization (Bylaws, Resolution, etc.) for binding signature.
Supporting Documentation: One (1) copy of each of the following required documents:
Annual Financial Statements: You are required to provide Financial Statements (Comprehensive Profit & Loss Statement or better required; Audited Statements if available) from the two most recent years. They must reflect financial operations within the past three year period (1/1/2010 – 12/31/12). (Name, title, address, and signature of preparer
must appear on statement). If not prepared by a licensed CPA, Must be signed by the Executive Director or authorized member of your organization (title must be indicated, with explanation) to certify accuracy.
A waiver may be granted to provide (a minimum of) one year’s information if organization’s date of
incorporation is after January 1, 2011. Please indicate date of incorporation:
Indicate below the periods reported in your Financial Statements. Explain any exceptions.
1. For Period: Comments:
2. For Period: Comments:
Pages 1 & 2 of your most recent IRS Form 990. Must be for a period within the past 24 months (1/1/11 – 12/31/12). Period: Comments:
IRS letter verifying agency’s tax-exempt status (IRS 501(c)(3)). Dated: Comments:
Articles of Incorporation. Signed Copy Comments:
By-laws. Signed Copy Comments:
Document Page(s) containing nepotism and conflict of interest clause(s): Specific reference indicating that your
organization does not allow Nepotism or Conflicts of Interest must be within organizational documents (By-Laws,
Official Employee handbook, employee signoff, etc.). Documents must be provided.
Nepotism is defined as: appointing persons on the basis of their blood or marital relationship to the appointing
authority, rather than on merit or ability. Indicate Document:
Conflict of Interest is defined as: a substantial probability that action taken by an individual will result in
measurable direct benefits accruing to the individual as opposed to benefits accruing in general to an industry. Indicate Document:
Submitted by: _____________________________________ Date: _________________________ (Authorized Signature)
EXHIBIT A
NONPROFIT GRANT APPLICATION FY 2013-2014 Page 1 of 7
Agency Name: Program Name:
Agency Director: Phone No.: ( ) –
Contact Person: Phone No.: ( ) –
Mailing Address:
Facility Address:
Email Address: Fax No.: ( ) –
Accountant/CPA: Phone No.: ( ) –
Firm (if applicable):
Mailing Address:
YOU ARE RESPONSIBLE TO KEEP THE ABOVE INFORMATION CURRENT
Amount of Request for County Nonprofit Grant Program Funds:
1. Prior Year Award of County Nonprofit Grant Program Funds:
FY 09-10 FY 10-11 FY 11-12
2. Agency Mission Statement:
Address:
Address:
City, ST, Zip
Address:
Address:
City, ST, Zip
Address:
Address:
City, ST, Zip
EXHIBIT A
NONPROFIT GRANT APPLICATION FY 2013-2014 Page 2 of 7
Agency Name: Program Name:
3. Program Description:
4. Total Budget & Position Count:
Total Program Budget: Total Program Position Count:
Total Agency Budget: Total Agency Position Count:
5. Program Funding Sources (identify all sources of funding applied to this program):
Revenue Source
FY13-14
Estimate
TOTAL:
Attach additional pages, if needed.
6. Explain what plans your agency or program has to increase revenues to support this program:
EXHIBIT A
NONPROFIT GRANT APPLICATION FY 2013-2014 Page 3 of 7
Agency Name: Program Name:
7. Program Objectives Using County Nonprofit Grant Program Funds:
8. TABLE I:
What are the intended measurable outputs or outcomes that would be achieved with this funding?
PROGRAM PERFORMANCE MEASURES
(i.e.: Number of clients served, workshops or events held, volunteer hours, etc. Describe, be specific.) Applicant Projected Results
Attach additional pages as necessary.
9. TABLE II:
PROGRAM EXPENDITURES FY 12-13
Actual*
FY 13-14
Total Budget
FY 13-14
Grant Req
Salary and Wages
Professional Fees
Operations
Supplies
Equipment
Other:
Other:
Other:
Other:
Other:
TOTAL
*If applicable
EXHIBIT A
NONPROFIT GRANT APPLICATION FY 2013-2014 Page 4 of 7
Agency Name: Program Name:
10. ORGANIZATION CONFLICT DISCLOSURE FORM
Please disclose any conflicts or potential conflicts of interest that any board member, officer, director,
or administrator of your organization may have with the County of Hawai‘i. Only those listed below
need to be disclosed. One form per conflict is needed. Please duplicate as needed to fully disclose. All
disclosure forms must be signed, regardless of whether a conflict exists.
NAME:
POSITION:
May have a conflict or potential conflict of interest, including any familial relationship, with any of the
following (check all that apply):
No conflicts exist (No further information required. Please sign form at the bottom.)
Member or members of the Council
Staff appointed by a member of the Council
The Mayor
The Managing Director
The Director of Finance
The Corporation Counsel, the Assistant Corporation Counsel, or a Deputy Corporation
Counsel
Conflict of Interest is defined as: a substantial probability that action taken by an individual will result in measurable direct
benefits accruing to the individual as opposed to benefits accruing in general to an industry.
Please specify any and all mitigation measures to avoid, in fact or appearance, any conflicts or potential
conflicts of interest:
Signature of Authorized Person (specify title) Date
EXHIBIT A
NONPROFIT GRANT APPLICATION FY 2013-2014 Page 5 of 7
Agency Name: Program Name:
11. Certification of Understanding
I (we) have read and understood all of the eligibility requirements; grant conditions; award procedures;
and records, reporting, and fiscal accountability requirements as mandated in Article 25, Sections 2-
135 – 2-142.1, Hawai‘i County Code, relating to Appropriation of Funds to Nonprofit Organizations.
I (we) agree to allow the County (the Legislative Auditor, the Department of Finance, designated
Council representative, or expending/oversight agency) full, free, and unrestricted access and authority
to examine and inspect any facility, equipment, property, or records pertinent to the grant, contract, or
program for which funds were used.
I (we) hereby certify that information supplied herein, including all supporting documents, is correct
and that I (we) have the authority and ability to fully administer the program(s) pursuant to law.
I (we) understand that information supplied herein shall be made public according to Chapter 92F,
Hawai‘i Revised Statutes.
I (we) understand that applications will not be reviewed by County personnel receiving our County
Nonprofit Grant submittal, and that we have full responsibility to ensure that all documents are
complete and accurate prior to submittal.
I (we) understand that all documents requiring a current signature must be the ORIGINAL, SIGNED
document. Unsigned documents will be disqualified. Faxed or copied documents will not be accepted
as original documents.
If awarded a grant from the County of Hawai‘i, I (we) understand and will comply with the requirement
to enroll with Hawai‘i Compliance Express, and be compliant prior to final payment. To register, go
to http://vendors.ehawaii.gov, complete the easy step-by-step process, and pay the annual
registration fee online using a credit card.
If awarded a grant from the County of Hawai‘i, I (we) understand and will comply with the requirement
to submit a year-end report to the County Council within 60 days after June 30 of the contractual year
for which the grant was awarded. The report shall include an explanation of the public benefits derived
from the awarding of the grant (focusing on specific, measurable outcomes), a complete accounting of
all expenditures supported by County of Hawai‘i grant funds, and a listing of other funding sources and
amounts obtained during the award period. Failure to submit a timely, complete, and accurate year-
end report will impact the evaluation of your program’s or agency’s future funding requests.
EXHIBIT A
NONPROFIT GRANT APPLICATION FY 2013-2014 Page 6 of 7
I (we) understand that failure to submit the final report within 60 days of June 30th shall result in loss
of all grant funds received during the grant period (must be refunded to County) and exclusion from
future grant participation for a minimum of one year or until a written report is submitted to, and
accepted by, the council.
I (we) understand there is no provision for further notification to submit the final report. Information
and instructions are available at http://www.hawaiicounty.gov/fn-nonprofit-grant-forms/ on or about
May 30 of the year the final report is due.
As part of this application, you acknowledge that any funds awarded will be restricted for the purposes
stated in the application, except for a maximum ten percent (10%) for administrative and overhead
costs. Any funds unused by June 30, 201 must be returned to the County of Hawai‘i with the final
report. Failure to return these funds in a timely manner will impact the evaluation of your agency’s
future funding request and may result in actions taken to recover these funds.
By signing below, you are acknowledging that you have read and understood these requirements.
Signature of Authorized Person (specify title) Date
EXHIBIT B
NONPROFIT GRANT APPLICATION FY 2013-2014 Page 7 of 7
Agency Name: Program Name:
12. COUNCIL AWARD WORKSHEET
TABLE I:
PROGRAM PERFORMANCE MEASURES Applicant
Projected Results
Council Proposed
Projected Result
TABLE II:
PROGRAM EXPENDITURES FY 13-14
Grant Request
Council
Award
Salary and Wages
Professional Fees
Operations
Supplies
Equipment
Other:
Other:
Other:
Other:
Other:
TOTAL
Additional Council directives regarding award: