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2. Purchase of Services Grant Pre-Award Agreement Consultation
   Information provided in this form will be used to develop outcomes and reporting indicators in the Purchase of Servcies Grant Agreement with the City of Dubuque. If you have questions completing this form, contact Alexis Steger, Housing & Community Development Director at 563-589-4230 or asteger@cityofdubuque.org
4. Agency/Organization Information
   This is how your agency/organization name, address, and the name of the authorized representative will appear in the grant contract.
6. Agency/Organization Name*
   As it should appear in contract
7. Name of Authorized Representative*
   Person authorized to legally contract on behalf of the agency/organization
8. Title of Authorized Representative*
   Ex: Executive Director, Board Chair
10. Agency/Organization Address*
11. Address2
13. City*
14. State*
15. Zip*
17. Primary Contact for Grant Agreement
19. Primary Contact for Grant Agreement*
20. Email Address*
22. Phone Number
23. Should the Grant Agreement be mailed to the Agency/Organization Address listed above?*

    1. Yes

    1. No
25. Mailing Address1*
26. Mailing Address2
28. City*
29. State*
30. Zip*
32. Indicators and Outcomes
34. Contract Service Period*

    The City's Fiscal year is July 1, 2018 - June 30, 2019. The contract period covered by this grant agreement is 12 months from the day of execution. Do you have eligible expenses you wish to bill for that occured between July 1, 2018 and November 5, 2018?

    1. Yes

    1. No
35. How will you document eligible expenses from this period?
37. Primary City Council Goal*
    -- Select One --Robust Local Economy: Diverse Businesses and Jobs with Economic ProsperityVibrant Community: Healthy and SafeLivable Neighborhoods and Housing: Great Place to LiveFinancially Responsible, High Performance City Organization: Sustainable, Equitable, and Effective Service DeliverySustainable Environment: Preserving and Enhancing Natural ResourcesPartnership for a Better Dubuque: Building our Community that is Viable, Livable, and EquitableDiverse Arts, Culture, Parks, and Recreation Experiences and ActivitiesConnected Community: Equitable Transportation, Technology, Infrastructure, and Mobility

    This should match the goal selected in the grant application. If you are uncertain what goal you selected, it is referenced in your award letter.
39. Primary Indicator:*
    -- Select One --Individuals ServedHouseholds Served (housing activities only)Area Basis (this is rare)

    In most cases, the indicator will be individuals served. Only organizations providing direct financial assistance for housing should select "households served". An example of an Area Basis indicator is a service designed to support a specific, definable area, such as a neighborhood clean-up.
41. Individuals served in 12 month period*
43. Households served in 12 month period*
45. Provide the Census Tracts and Block Groups of the service area*
    Not sure how to do this? Call or email Erica. She is here to help.
47. Choose an objective that best describes activity's purpose.*
    -- Select One --Suitable Living EnvironmentDecent HousingCreating Economic Opportunities
48. Choose an outcome that best reflects what you are trying to achieve.*
    -- Select One --Availability/AccessibilityAffordabilitySustainability: Promoting Livable or Viable Communities
50. Tips for Selecting Objectives:
    Suitable Living Environment - In general, this objective relates to activities that are designed to benefit communities, families, or individuals by addressing issues in their living environment. Decent Housing - The activities that typically would be found under this objective are designed to provide or improve housing or housing conditions. This objective focuses on housing programs where the purpose of the program is to meet individual family or community needs and not programs where housing is an element of a larger effort, since such programs would be more appropriately reported under Suitable Living Environment. Creating Economic Opportunities - This objective applies to the types of activities related to economic development, commercial revitalization, or job creation.
51. Tips for Selecting Outcomes
    Availability/Accessibility. This outcome category applies to activities that make services, infrastructure, public services, public facilities, housing, or shelter available or accessible to people, including persons with disabilities. In this category, accessibility does not refer only to physical barriers, but also to making the affordable basics of daily living available and accessible to people where they live. Affordability. This outcome category applies to activities that provide affordability in a variety of ways in the lives of people. It can include the creation or maintenance of affordable housing, basic infrastructure hook-ups, or services such as transportation or day care. Sustainability: Promoting Livable or Viable Communities. This outcome applies to projects where the activity or activities are aimed at improving communities or neighborhoods, helping to make them livable or viable by providing benefit to persons by removing or eliminating blighted conditions, through multiple activities or services that sustain communities or neighborhoods.
53. For organizations receiving a partial grant award:

    We recognize your organization may need to adjust match or service levels described in the application based on a partial award. Please check the box(s) below if adjustments are required to cash match, in-kind match, or the scale and scope of services.

    1. Cash match
    2. In-Kind match
    3. Scale and scope of services
55. Adjusted Cash Match*
56. Adjusted In-Kind Match*
57. Adjustments to scale and scope of services*
59. Congratulations! You have finished the preparation for the the Purchase of Services Grant Contract. We will be in touch soon.
    You are not required to be present during the meeting, but you are always welcome.
Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

* indicates a required field