13-140 Resolution No. 13-140
RESOLUTION
AUTHORIZING EXECUTION OF A COMMUNITY DEVELOPMENT
BLOCK GRANT SUB-RECIPIENT AGREEMENT WITH SENIOR SERVICES
ASSOCIATES, INC. FOR REIMBURSEMENT OF MONTHLY RENTAL COSTS
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF ELGIN, ILLINOIS,
that Sean R. Stegall, City Manager, and Kimberly A. Dewis, City Clerk, be and are hereby
authorized and directed to execute a community development block grant agreement with Senior
Services Associates, Inc. on behalf of the City of Elgin for reimbursement of monthly rental
costs associated with the lease of the facility at 205 Fulton Street, a copy of which is attached
hereto and made a part hereof by reference.
s/David J. Kaptain
David J. Kaptain, Mayor
Presented: August 28, 2013
Adopted: August 28, 2013
Omnibus Vote: Yeas: 9 Nays: 0
Attest:
s/Kimberly Dewis
Kimberly Dewis, City Clerk
AGREEMENT
BETWEEN THE CITY OF ELGIN, AND
SENIOR SERVICES ASSOCIATES, INC.
This AGREEMENT is entered into as of the 28th day of August , 2013, by and
between the CITY OF ELGIN, an Illinois municipal corporation(hereinafter called "GRANTEE" or"CITY") and
SENIOR SERVICES ASSOCIATES, INC., a not-for-profit corporation incorporated pursuant to the laws of the
State of Illinois, (hereinafter called "SUB-RECIPIENT") having a principal place of business at 101 South Grove
Avenue,Elgin, Illinois 60120.
I. RECITALS
A. CITY has applied for Community Development Block Grant Funds (hereinafter referred
to as "CDBG funds") from the United States Department of Housing and Urban Development
(hereinafter called "HUD") as provided by the Housing and Community Development Act of
1974, as amended (P.L. 93-383) (hereinafter called "ACT").
B. CITY has considered and approved the application of SUB-RECIPIENT for CDBG funds
allotted to CITY for distribution to SUB-RECIPIENT.
C. The CITY and SUB-RECIPIENT enter into this Agreement pursuant to their respective
powers to enter into such Agreements, as those powers are defined in the Illinois Constitution and
applicable statutes.
II. SCOPE OF THE PROJECT
A. SUB-RECIPIENT hereby agrees to perform, in a timely fashion, the activities provided
for herein; and those previously defined and identified in the Project Application and project
description submitted by the SUB-RECIPIENT, dated December 14, 2012, and entitled "Elgin
Senior Center Support," a copy of which is attached hereto as Exhibit "A" and incorporated
herein by this reference(hereinafter referred to as the"PROJECT").
B. All funding provided to SUB-RECIPIENT shall be used solely to reimburse SUB-
Z,
RECIPIENT for monthly rental costs associated with the lease of the facility at 205 Fulton Street,
Elgin; Illinois. This facility is to be used exclusively for the provision of educational,recreational
socialization and wellness programs in a safe, inviting and accessible setting for senior citizens.
Services provided at the facility are to be consistent with the scope and intent of the PROJECT.
All individuals served by SUB-RECIPIENT pursuant to this agreement will be low and moderate
income persons as defined by 24 CFR 570.208 (a)(2)(1)(A).
C. Prior to the expenditure of CDBG funds, SUB-RECIPIENT shall meet with the City's
Community Development Department staff to establish acceptable documentation and guidelines
regarding requests for payment for the activities described in the Scope of Work. No payment of
CDBG funds will be made by City without the required documentation.
D. SUB-RECIPIENT shall return to the CITY any program income; as defined in 24 CFR
Part 570.500(a), which is generated as a result of this PROJECT. All written requests for an
exception to this agreement shall be made, in writing, to the City's Community Development
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Department explaining why the SUB-RECIPIENT needs the income, the specific activities the
SUB-RECIPIENT will undertake with the funds and how the SUB-RECIPIENT will report the
income and expenditures to the CITY. A written response to the request will be provided to
SUB-RECIPIENT from the CITY.
III. Quarterly Progress Reports.and Disclosure of Client Data
A. The SUB-RECIPIENT shall develop and submit to the CITY an Outcome Performance
Measurement Statement that establishes project goals and objectives, identifies performance
indicators, and estimates the number of clientele to be served. The SUB-RECIPIENT shall
provide Quarterly Progress Reports to the CITY each quarter, reporting on the status of the
PROJECT in relation to the percent of project completion, accomplishments, effectiveness of the
project as related to the goals and objectives, and the clientele served, including number served,
client access to the service (either new or improved access), and demographics. The quarterly
progress reports shall begin upon the signing of this Agreement, and be based on the CDBG
program year, beginning on June 15` and ending on May 31" of the following year. The quarterly
progress report shall continue until the completion of this project or until directed to discontinue
such reports in writing by the CITY.
B. Quarterly progress reports shall be due on the 10h day of the month following, the end of the
quarter, for the previous quarter's activities. The SUB-RECIPIENT shall use a form provided by
the Community Development Department and shall include all required information about the
number of clients served each quarter(by race, household income; household size and the number
of female headed households).
C. The SUB-RECIPIENT shall maintain on the premises of their principal place of business client
data demonstrating client eligibility for services provided, and any other demographic
information as requested in the City's Quarterly Progress Reports. Such information shall be
made available to the City's monitors for review upon request.
D. The SUB-RECIPIENT shall furnish and will permit the City, HUD or its agents, or other
authorized federal officials, access to clients' records for the purpose of household size and
income verification to ascertain compliance with the rules,regulations and provision of the Act.
TV. AMOUNT AND TERMS OF GRANT
A. The CITY shall distribute to SUB-RECIPIENT, as SUB-RECIPIENT'S portion of the
total grant received by the CITY and in consideration of the SUB-RECIPIENT'S undertaking to
perform the PROJECT, a maximum of $29,250 (hereinafter "Grant Funds"), to be paid in the
manner provided for herein at Sections I1 (D) and VII. Prior to the initial payment of Grant
Funds, SUB-RECIPIENT shall submit, to the CITY, their Outcome Performance Measurement
Statement and progress report indicating client demographics and program status. SUB-
RECIPIENT shall submit quarterly progress reports, by the 10b day following the end of the
preceding quarter, to the CITY. The amount to be paid to SUB-RECIPIENT will be based upon
the work completed and the submittal of employee work reports in support of the invoiced
amount.
B. This PROJECT shall be identified as Project No. 154952 and Account No. 230-0000-
791.30-99, which identifying numbers shall be used by SUB-RECIPIENT on all payment
requests.
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V. SUB-RECIPIENT'S COMPLIANCE WITH THE ACT
A. CITY shall assist SUB-RECIPIENT in making application for CDBG funds.
B. SUB-RECIPIENT shall abide by the Act and all HUD rules and regulations promulgated
to implement the Act.
C. SUB-RECIPIENT shall, upon request of the CITY, (1) assist in the completion of an
environmental review and (2) complete certifications showing equal employment opportunity
compliance including equal employment opportunity certifications with reference to the
PROJECT, as set forth in Exhibit"C" attached hereto and made a part hereof.
D. SUB-RECIPIENT, in performing under this Agreement, shall:
1. Not discriminate against any worker, employee, or applicant, or any member of
the public, because of race, creed, color, sex, age or national origin, nor otherwise
commit an unfair employment practice; and
2. Take affirmative action to insure that applicants are employed without regard to
race, creed, color, sex, age or national origin, with such affirmative action including, but
not limited to the following: Employment, upgrading; demotion or transfer, termination,
recruitment or recruitment advertising, layoff or termination, rates of pay or other forms
of compensation, selection for training, including apprenticeship.
E. SUB-RECIPIENT shall permit the CITY and the Department of Housing and Urban
Development to conduct on-site reviews, examine personnel and employment records and to
conduct any other procedures or practices to assure compliance with the provisions of this
agreement. SUB-RECIPIENT shall post in conspicuous places available to employees and
applicants for employment notices setting forth the provisions of Section IV (D) above.
F. SUB-RECIPIENT shall not violate any laws, state or federal rules or regulations,
including but not limited to those regarding a direct or indirect illegal interest on the part of any
employee or elected official of the SUB-RECIPIENT in the PROJECT or payments made
pursuant to this Agreement.
G. SUB-RECIPIENT hereby warrants and represents that neither the project, including but
not limited to any funds provided pursuant thereto, nor any personnel employed in the
administration of the program shall be in any way or to any extent engaged in the conduct of
political activities in contravention of Chapter 15 of Title 5, United States Code, commonly
known as the Hatch Act.
H. SUB-RECIPIENT shall maintain records to show actual time devoted and costs incurred,
in relation to the PROJECT, and shall prepare and submit quarterly progress reports which
describe the work already performed and anticipated during the remaining time of the PROJECT.
Upon fifteen (15) days notice from the CITY, originals or certified copies of all time sheets,
billings, and other documentation used in the preparation of said progress reports shall be made
available for inspection, copying, or auditing by the CITY at any time during normal busiriess
hours, at 150 Dexter Court, Elgin, Illinois.
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I. SUB-RECII'IENT shall adopt the audit requirements of the Office of Management and
Budget (hereinafter "OMB") Circular A-133, "Audits of Institutions of Higher Learning and
Other Non-Profit Institutions." SUB-RECIPIENT shall submit to the CITY one copy of said
audit report. SUB-RECIPIENT shall permit the authorized representatives of the CITY, HUD
and the Comptroller General of the United States to inspect and audit all data and reports of the
SUB-RECIPIENT relating to its performance under the Agreement.
J. SUB-RECIPIENT and CITY shall at all times observe and comply with Title 24 CFR
Part 570 and all applicable laws, ordinances or regulations of the Federal, State, County, and local
government, which may in any manner affect the performance of this Agreement.
K. SUB-RECIPIENT shall transfer to the.CITY any unused CDBG funds and submit all
billings attributable to this Project at the time this Agreement expires.
L. SUB-RECIPIENT will .ensure that any real property under the SUB-RECIPIENT'S
control that was acquired and/or improved in whole or in part with CDBG funds in excess of
$25,000 is used exclusively for the benefit of Jow and moderate income persons as defined by
HUD, for a period of 15 years after the expiration of this agreement
M. If during the 15 year period after the expiration of this Agreement, the SUB-RECIPIENT
disposes of any property under the SUB-RECIPIENT'S control that was acquired and/or
improved in whole or in part with CDBG funds in excess of 525,000, then the SUB-RECIPIENT
will reimburse the CITY in the amount of the current fair market value of the property less any
portion of the value attributable to expenditures of non-CDBG funds for acquisition of, or
improvement to,the property in accordance with 24 CFR 570.503(b)(8) and 24 CFR 570.505.
V1. RIGHTS TO SUBCONTRACT
A. SUB-RECIPIENT shall not assign, transfer, subcontract or otherwise convey its rights or
obligations under this Agreement without the prior written consent of the CITY, which consent
may be withheld in the CITY'S sole discretion.'
B. Administration of any subcontracts by the SUB-RECIPIENT shall be in conformance
with 24 CFR Part 570.200(d)(2) and Part 85.36.
VII. SUB-RECIPIENT'S AUTHORIZATION TO ACCEPT PROPOSALS
A. After the CITY has received notification that funds for the PROJECT have been released
by HUD, the SUB-RECIPIENT shall be authorized to accept the proposal of any subcontractor
for the PROJECT.
VIII. BILLING PROCEDURE
A. Upon Release of Grant Funds by HUD for the PROJECT, the CITY shall make
disbursements to the SUB-RECIPIENT as either reimbursement for advances made by SUB-
RECIPIENT or as advances for specific cash requirements of SUB-RECIPIENT for the
PROJECT. All claims of SUB-RECIPIENT, whether for reimbursement or advancement, shall
comply with the following requirements:
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1. SUB-RECIPIENT shall submit a listing of all disbursements of CDBG Funds, on
a form provided by the CITY.
?. Any claim for advancement of CDBG Funds shall be limited to an amount
necessary for SUB-RECIPIENT to meet specific cash requirements for the PROJECT
and shall be disbursed by SUB-RECIPIENT within three (3) working days of receipt by
SUB-RECIPIENT.
3. Any request for reimbursement or advancement pertaining to work under
contracts from the SUB-RECIPIENT shall include the following:
a. For interim payments to contractors and subcontractors, certification that
the work for which payment is requested has been performed and is in place and
to the best of SUB-RECIPIENT'S knowledge, information and belief that, the
quality of such work is in accordance with the contract and subcontracts, subject
to: (1) any evaluation of such work as a functioning PROJECT upon substantial
completion; (ii) the results of any subsequent tests permitted by the.subcontract;
and (iii) any defects or deficiencies not readily apparent upon inspection of the
work; and
b. For final payment, that the work has been performed in a satisfactory
manner and in conformance with the contract.
4. Processing of all requests for payment shall be contingent upon the submission of
the required documentation by the contractor and subcontractor to the CITY that fully
complies with federal labor standards, uniform relocation act or any other applicable
federal, state, or local statutes, rules or regulations.
5. SUB-RECIPIENT shall forward to the CITY all-billings, vouchers, and other
documents representing any accounts payable, in such timely and reasonable manner as
both parties shall determine; provided, however, that in no event shall such documents be
forwarded to the CITY later than twenty-one (21) days after SUB-RECIPIENT'S receipt
of such documents.
6. SUB-RECIPIENT shall cooperate with the CITY to facilitate the maintenance of
financial records by the CITY as required by Title 24 CFR 85.
B. Upon submission of an acceptable claim for Grant Funds, the CITY shall process such
claim and shall approve such claim for payment following approval by the City's Community
Development Department, for compliance with this Agreement and applicable HUD
requirements.
C. Except as provided for in Sections X and XI hereof; the CITY shall pay all required
payments against eligible project costs, as described in Section 11.13, incurred by SUB-
RECIPIENT under this Aureement.
IX. ADMINISTRATION AND REPORTING REQUIREMENTS
A. SUB-RECIPIENT shall administer the Grant Funds in conformance with the regulations,
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policies, guidelines and requirements of OMB Circular numbers A-110, and A-122, as they relate
to the acceptance and use of federal funds for the PROJECT.
B. SUB-RECIPIENT shall submit all required information to show compliance with
applicable laws, rules and regulations, as specified in this Agreement and shall submit to the
CITY a quarterly progress report, by the 10"' day following the end of the preceding quarter.
Other reporting requirements are specified in Exhibit "B" attached hereto and made a part of this
Agreement.
X. TERMINATION OF AGREEMENT OR SUSPENSION OF PAYMENT
A. During the implementation of the PROJECT, the CITY may terminate this Agreement or
may suspend payment of Grant Funds to SUB-RECIPIENT for SUB-RECIPIENT'S substantial
breach of the Agreement, abandonment of the PROJECT or occurrence rendering impossible the
performance by SUB-RECIP ENT of this Agreement.
B. During the implementation of the PROJECT, the CITY may suspend payments of Grant
Funds, due to use of funds in a manner unrelated to SUB-RECIPIENT'S performing the
PROJECT, failure by SUB-RECIPIENT in submitting supporting information or documentation
for a claim, submission by SUB-RECIPIENT of incorrect or incomplete reports, or SUB-
RECIPIENT'S suspension of its pursuit of the PROJECT.
C. In the event the CITY elects to terminate this Agreement or to suspend payments, for any
reason stated hereinabove in paragraph A-and B of this Section X, it shall notify the SUB-
RECIPIENT, in writing; of such action, specifying the particular deficiency, at least five (5)
working days in advance of any such action and establishing a time and a place for the SUB-
RECIPIENT to refute the alleged deficiency at a time prior to the CITY'S taking such action.
After allowing the SUB-RECIPIENT the opportunity to refute or correct the alleged deficiency, if
the alleged deficiency continues to exist, in the reasonable opinion of the CITY, the CITY may
withhold payment of the Grant Funds until such time as the violation or breach is remedied. No
action taken or withheld by the CITY under this paragraph shall relieve the SUB-RECIPIENT of
its liability to the CITY for any funds expended in violation of any of the terms of this
Agreement.
D. Unless terminated pursuant to the provisions of paragraph X herein, this agreement shall
terminate on December 31,2014.
XI. REMEDIES
A. To the fullest extent permitted by law, SUB-RECIPIENT agrees to and shall indemnify,
defend and hold harmless the CITY, its officers, employees, boards and commissions from and
against any and all claims, suits,judgments, costs, attomeys fees, damages or any and all other
relief of liability arising out of or resulting from or through, or alleged to arise out of, any breach
of this agreement; misuse or misapplication of funds derived pursuant to this agreement by SUB-
RECIPIENT, violation of any statutes, rules and regulations, directly or indirectly, by SUB-
RECIPIENT and/or any of its agents or representatives; or any negligent acts or omissions of
SUB-RECIPIENT or of SUB-RECIPIENT'S officers; employees, agents or subcontractors. In
the event of any action against the CITY, its officers, employees, agents, boards or commissions
covered by the foregoing duty to indemnify, defend and hold harmless; such action shall be
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defended by legal counsel of the CITY'S choosing. The provisions of this paragraph shall
survive any termination and/or expiration of this Agreement.
B. In the event of loss of approved Grant Funds for the PROJECT as a result of any
violation or breach of this Agreement by the CITY, misuse or misapplication of funds received
from HUD unrelated to the PROJECT, or any violation of the statutes, rules and regulations of
HUD, directly or indirectly, the CITY and/or any of its agents or representatives, the CITY'S
liability to SUB-RECIPIENT shall be limited to any funds which have previously been provided
to SUB-RECIPIENT pursuant to this agreement. SUB-RECIPIENT hereby waives and releases
the CITY from any and all other liability pursuant to any such breach, misuse, misapplication or
violation of statutes, rules or regulations.
C. In the event HUD, or any other federal agency, makes any claim which would give rise to
invoking the remedy provisions, as set forth in paragraphs A or B of this Section XI, then the
CITY or SUB-RECIPIENT shall immediately notify the other party, in writing,providing the full
details of the alleged violation. To the extent that any such matter is not subject to exclusive
federal jurisdiction, venue for the resolution of any disputes or the enforcement of any rights
arising out of or in connection with this Agreement between the CITY and SUB-RECIPIENT
shall be in the Circuit Court of Kane County, Illinois.
D. In addition to any other remedies available to the CITY, if the CITY has lost or been
prevented from receiving any federal funds, other than the Grant Funds, as a result of any alleged
violation of law or other breach of this Agreement by SUB-RECIPIENT, the SUB-RECIPIENT
shall repay, upon demand by the CITY, such amount of Grant Finds previously disbursed or
allegedly due to the SUB-RECIPIENT.
XII. TIMELINESS
A. Time is of the essence of this agreement. SUB-RECIPIENT shall meet the schedule
deadlines listed below. Any milestone which the SUB-RECIPIENT does not achieve within two
months of the date listed will result in the SUB-RECIPIENT submitting a revised implementation
schedule for approval by the City's Community Development Staff. Failure to achieve these
deadlines may result in the loss or reduction of grant funds at the CITY'S discretion.
Actions Date
1. Provide a Center for Elgin Senior Citizens June 1, 2013 —May 31, 2014
2. Provide Educational & Recreational June 1,2013 —May 31, 2014
and Wellness Programs
3. Rental Reimbursement June 1,2013—May 31, 2014
B. Total Number of Months Required for Project Completion 12 Months
X1II. MISCELLANEOUS PROVISIONS
A. AMENDMENTS - This Agreement constitutes the entire Agreement between the parties
hereto. Any proposed change in this Agreement shall be submitted to the other party for prior
Page 7 of 16
approval. No modifications, additions, deletions, or the like, to this Agreement shall be effective
unless and until such changes are executed, in writing,by the authorized officers of each party.
B. SUBJECT TO FINANCIAL ASSISTANCE AGREEMENT - This Agreement is made
subject to financial assistance agreements between the CITY and the United States Department of
Housing and Urban Development, with the rights and remedies of the parties hereto being in
accordance with any such agreements.
C. ASSIGNMENT - except as provided in Section VI hereof; SUB-RECIPIENT shall not
assign this Agreement or any part thereof and SUB-RECIPIENT shall not transfer or assign any
Grant Funds or claims due or to become due hereunder, without the written approval of the CITY
having first been obtained.
D. ATTORNEY'S OPINION - If requested, SUB-RECIPIENT shall provide an opinion of
its attorney, in a form reasonably satisfactory to the CITY, that all steps necessary to adopt this
Agreement, in a manner binding upon SUB-RECIPIENT, have been taken by SUB-RECIPIENT,
and that SUB-RECIPIENT is in compliance with applicable local, state and federal statues, rules
and regulations for the purpose of complying with this Agreement.
E. HEADINGS - The section headings of this Agreement are for convenience and reference
only and in no way define, limit, or describe the scope or intent of this Agreement, and should be
ignored in construing or interpreting this Agreement.
F. The terms of this agreement shall be severable. In the event any of the terms or
provisions of this agreement are deemed to be void or otherwise unenforceable for any reason,the
remainder of this agreement shall remain in full force and effect.
G. This agreement shall not be construed to create a joint venture, partnership, employment
or other agency relationship between the parties hereto.
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the dates recited below.
CITY OF ELGIN, an Illinois Municipal Corporation
BY: AZ�60'�
Sean tegall, City Manag
DATE: August 28, 2013
ATTEST:
Kimberly Dewis, C' Clerk
SUB-RECIPIENT: Senior Services Associates,Inc.
10011 S. Grove Avenue, Elgin, Illinois 60120
BY: C' -
Bette Schoenholtz, Executive DD ector
DATE:
ATTEST:
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EXHIBIT A
SUB RECIPIENT'S CDBG APPLICATION
Page 10 of 16
THE COMMUNITY DEVELOPMENT-BLOCK GRANT (CDBG)
'PROPOSAL APPLICATION FOR CDBG FUNDING:
ENTITLEMENT PROGRAM
FISCAL YEAR-2013=2014
JUNE 1, 20137HROUGH-MAY 31, 2014 DEC 14 2011 1
f.
Organization Name: Senior Services Associates,Inc.
Project Name: Elgin Senior Center Support
Project Address: 205 Fulton Street,Elgin IL 60120
Exec Director Name: Bette Schoenholtz
Address: 101 S.Grove Avenue,Elgin IL 60120
Telephone Number: 847-741-0404 Fax Number: 847-741-2163
E-Mail Address: bmcclory@seniorservicesassoc.org Web-site(if applicable): www,.seniorservicesassoc.org
Employer(IRS)ID f: I36-2775102 I DUNS Number; X024043754 j
Contact Name: Beth McClory Title: Chief Administrative Officer
Contact Telephone tt: 847-741-0404 Contact Fax Number: 847-741-2163
Contact E-Mail: bmcclory @seniorservicesassoc.org Website(if applicable): www.seniorservicesassoc.org
(PROJECT FUNDING REQUEST
I
CDBG Funds Requested $35586.00 Funding Leveraged from other Sources 1 510000.00
Check the category,which describes the type of funding,requested:
OHousing Public Facility O Infrastructure
OEconomic Development O Public Service C Other
BRIEF PROJECT DESCRIPTION:
Pieose orovide a one-sentence statement about oY uraroiecr-notyourorganizatian,
The Elgin.senior center provides a place for Elgin senior citizens to gather offering educational,exercise and wellness programs and
opportunities for recreation and socialization in a safe,inviting and accessible setting.
City of Elgin CDBG.Application FY 2013-2014 Application Page 14 of 32
CAPITAL PROJECTS ONLY
Public Improvements/Construction Activity Application Form
Project Namelfitle:
Agency Name:
Agency Address:
City: State: Zip Code:
1. Project Description(Additional sheets are on the last page of this document if needed.]
a. Provide a detailed description of the facilities to be provided or improved. Identify major components of proposed work and state
estimated quantities:
b. Indicate the primary function of the facilities to be provided or improved:
c. Readiness to Proceed:
(i) Do you have an architect/engineer under contract? n Yes n No
If,yes please provide name,
(ii) Do you have preliminary plans/drawings completed(If yes,please scan and attach)? n Yes n No
(iii) Do you have project cost estimates completed(if yes,please scan and attach)? n Yes n No
(using Davis Bacon Wage Rate and Labor Standards)
tPlease note.thatany costs incurred prior to the award and environmental review process cannot be reimbursed to the applicant.
d. Provide evidence of site control. (Please scan and attach)
Copy of deed.
If property is not owned provide a copy of the lease.
Agreement and letter from owner approving proposed work.
City of Elgin CDBG Application FY 2013-2014 Application Page 15 of 32
CAPITAL PROJECTS ONLY
'2. Project Location:
a. Project Address/Location: (Scan and attach photographs)
I
I
Census Tract(s): Block Group(s):
b. Indicate if the project is located in,or will have any impact on,the following: (Please indicate Yes or No)
(i) Do you have an architect/engineer under contract? O Yes O No
If yes,explain:
(ii) Designated Wetlands Area: 0 Yes O No
If yes,explain:
(iii) Land Use/Zoning Charge: Q Yes O No
If yes,explain:
(iv) Environmental Hazards: 0 Yes 0 No
If yes,explain:
c. Provide a time line for the project and current status of project progression:
Construction Bid Period: Start Date: Completion Date:
Status:
13. Project Benefit' (Additional sheets at the end of the document.)
a. Describe the existing problems or conditions to be corrected by the proposed activity. Identify the persons affected by these
conditions. Explain how the project benefits low and moderate income people.
b. Describe in quantifiable terms the goals to be achieved by your project during the proposed funding period,and how the recipients of
your services will be benefited or changed.
City of Elgin CDBG Application FY 2013-2014 Application Page 16 of 32
CAPITAL PROJECTS ONLY
Project.Budget
ACTIVITY CDBG FUNDS OTHER NOW OTHER FEDERAL TOTAL
I FEDERAL FUNDS FUNDS
Acquisition Costs
Land
Existing structures
Other.acquisition costs
Site.Work(not in construction contract)
Demolition/clearance
Other site costs
Construction/Project Improvement Costs
New construction
Rehabilitation
Performance bond premium
(Construction continency
Other
Architectural and Engineering
Architect fees
Engineering fees
Other A&E fees {
Other Owner Costs
Appraisal fees
Survey
Soil boring/environmental/LBP evaluation
.Tap fees and impact fees
Permitting fees
ILegal fees
Other
Miscellaneous Costs
Developer-fees
Project reserves
Relocation costs
Project Administration&Management Costs
Marketing/management
Operating
I
;Taxes
Insurance j
Other
GRAND TOTALS
1 ,
City of Elgin CDBG Application FY 2013-2014 Application Page 17 of 32
CAPITAL PROJECTS ONLY
1. CAPITAL PROCUREMENT GUIDELINES FOR PRIVATE NON-PROFIL CONSTRUCTION PROJECTS:
All construction contracts in excess of S2,000 will be subject to federal Davis-Bacon Wage Rates and Labor Standards
provisions. A schedule of current prevailing wage rates and fringe benefits is available at the Illinois Department of Labor at
www.state.il.us\aaencv\idol\rates\evenmo\kane9999.htm.
$25,000-$99,999
Projects over 525,000 require Newspaper Advertisement Public Solicitation of Contractor Bids in Elgin Standard Times.
Federal requirements for Davis-Bacon and Minority and Women Business Enterprise Participation(MBE/WBE)compliance
will be applicable.
Federal Section 3 and City of Elgin Minority Workforce Requirements are not applicable for contracts under$100,000.
The lowest qualified bid representing the complete scope of work from a QUALIFIED CONTRACTOR will be considered.
$100,000+
Projects over $100,000 require Newspaper Advertisement Public Solicitation of Contractor Bids in Elgin Standard Times.
Federal requirements for Davis-Bacon and Minority and Women Business Enterprise Participation MBE/MBE)compliance
will be applicable.
Federal Section 3 and City of Elgin Minority Workforce Requirements will be applicable for contracts over$100,000.
Bond Requirement- 100%Payment and Performance Bonds.
The lowest qualified bid representing the complete scope of work from a QUALIFIED CONTRACTOR will be considered,
C¢v of=loin CDEG Application=Y 2013-2014 Application Page 18 of 32
2. PROJECT ELIGIBILTY.SECTION:
-A. This project is.located in 8,512 .Census Tracts) (Identify tract by number)
(website-Factfinder.census.gov
B. This project meets.at least ONE of the HUD national objectives listed below (please check all applicable;
discussion and definitions available on page 6 of the packet):
O1. Benefits low/moderate income individuals/households
O2. Addresses the prevention or elimination of slums or blight
O3. Meets a particularly urgent community development need
C. Check all statements that describe HOWthis project or activity-meets-one of the National Objectives above:
OUM Area Benefit: the project meets the identified needs of UM income persons residing in
`/ .an area where at least 51%of those residents are UM income persons. The benefits of this
type.of activity are available to all persons in the area regardless of income. Examples:
street improvements,water/sewer lines,neighborhood facilities,facade improvements in
neighborhood commercial districts.
n UM Limited Clientele:the project benefits a specific group of people (rather than all the
residents in a particular area), at least 51% of whom are UM income persons. The
following groups are presumed to be UM: abused children, elderly persons, battered
spouses, homeless, handicapped, illiterate persons. Examples: construction of a senior
center,public services for the homeless, meals on wheels for elderly, construction of job
training facilities for the handicapped.
OLAM Housing: the project adds or improves permanent residential structures that will be
occupied by UM income households upon completion. Housing can be either owner or
renter occupied units in either one family or multi-family structures. Rental units for UM
income persons must be occupied at affordable rents. Examples: acquisition of property
for permanent housing, rehabilitation of permanent housing, conversion of non-
residential structures into permanent housing.
OL/MJobs: the project creates or retains permanentjobs,at least 51%of which are taken by
L/M income persons or considered to be available to UM income persons. Examples:
loans to pay for the expansion of a factory, assistance to a business which has publicly
announced its intention to close w/resultant loss of jobs,a majority of which are held by U
M persons.
OMicro-Enterprise Assistance. the project assists in the establishment of a micro-enterprise
or assists persons developing a micro-enterprise. (A micro-enterprise is defined as having
five or fewer employees, one or more of whom owns the business.) This activity must
benefit low/moderate income persons,area orjobs as defined in previous sections.
Slum or Blighted Area:the project is in a designated slum/blight area and the result of this
project addresses one or more of the conditions that qualified the area.
OSpot Blight: the project will prevent or eliminate specific conditions of blight or physical
decay outside a slum area. Activities are limited to clearance, historic preservation,
rehabilitation of buildings, but only to extent necessary to eliminate conditioned
detrimental to public health and safety. Examples:.historic preservation of a public facility
threatening public safety,demolition ofa deteriorated,abandoned building.
City of Elgin CDBG Application FY 2013-2014 Application Page 19 of 32
D. Project Category(check one):
OAcquisition of Real Property
0 Disposition of Real Property
OPublic Facilities and Improvements(e.g.,homeless shelter,water and sewer facilities,flood
and drainage improvements,fire protection facilities/equipment,community,senior and
health centers,parking,streets,curbs,gutters and sidewalks,parks and playgrounds.)
OPrivately-Owned Utilities
(1 Public Service(i.e.,a new service or an increase in the level of a service
ORelocation Payments and Assistance to Displaced Persons
ORemoval of Architectural Barriers,Handicapped Accessibility
OHousing Rehabilitation
OHistoric Preservation
0 Commercial or Industrial Rehabilitation, including facade improvements and corrections
of code violations.
Special Economic Development or assistance to micro-enterprises
City of Elgin CDBG Application=Y 2013-2014 Application Page 20 of 32
3. IMPACT ON APPLICABLE GOALS,NEEDS,AND OBJECTIVES:
The Five-Year Consolidated Plan identifies both priority needs in the community and strategies to address these needs. The
need for your proposed project will be determined by identifying how-the project impacts upon the adopted Consolidated
Plan Priority Needs.
Therefore, applications should provide a clear explanation of how the project impacts upon the adopted Consolidated Plan
Priority Needs. Greater consideration will be given to projects that provide a clear description of the project with supporting
data and methodology of how the project will meet the Consolidated Plan Priority Needs.
Please identify the category and activity applicable to your proposal,using that table as your guide:
IExampie:
11 @ "Public Service -Activity: Rental Reimbursement
OAcquisition of Real Property Activity:
OInfrastructure Activity:
OAffordable Housing Activity:
OPublic.Servide Activity: Rent for accessible senior center
O Planning&Capacity Building Activity:
The City of Elgin has identified ten strategic goals to reflect the City's ongoing commitment to the community.
Greater consideration will be given to projects that provide a clear description of the project with supporting data and
methodology of how the project will meet the City's strategic goals.
Please identify ALL the categories applicable to your proposal:
OA Safe Community O Quality Housing
ONeighborhood Vitality O River as a Resource
OEconomic Growth and Diversified Tax Base O Alive Downtown
Recreational,Leisure and Cultural Opportunities for all Citizens O Financially Stable City Government
OAcquisition of Real Property O Diverse Management Staff
PROPOSED PROJECT ACCOMPLISHMENTS
Please briefly describe proposed accomplishment(s)if funding is awarded:
(Accomplishments must be described in terms of households served, people served, businesses created, housing units
created,,jobs created or public facilities undertaken. Example: This program will serve 48S LMI individuals, this program
will create 25 jobs, etc.)
This facility, in fiscal 2012, served 3,443 Elgin seniors, providing wellness, recreation and education programs as well as
providing protective services.We served over 3000 LMI Elgin Seniors providing 35,000 units(senior attending one class/event)
of service. Of this number 321 were Hispanic and 226 were of Laotian decent, these numbers are growing rapidly. We
anticipate a typical 5%to 10%increase in fiscal.2013.
Please answer the following Questions:
A. What is the total estimated number of persons to be served by this project? 4151
B. What is the total estimated number of LMI persons to be served by this project? 4151
C. What is the anticipated percentage of LMI persons to be served by this project? 101 0 I
City of Elgin CDBG Application FY 2013-2014 Application Page 21 of 32
4. ACTIVITY DESCRIPTION:
Please answer the following questions in the spce provided.
A. Provide a detailed description of the proposed activity including ow the activity will address the community need you
have indicated. Identify whether the activity is new,ongoing,or expanded from previous years.
The center will be open from 8 AM to 4 PM Monday through Friday,closed on holidays;for open games,parties,evidence based
fitness programs,educational lectures,lunch,and special events.in addition to the wellness,education and recreation activities
provided,the expanded space will also house 2 case managers. The case managers will provide information and assistance and
protective services to seniors visiting the center as well as others, by appointment. The space will also provide income tax
(preparation (through AARP),Triad meetings and events, volunteer recruitment for Senior Services and other agencies and
government offices and legal assistance(from volunteer attorneys)for seniors. We partner with local clubs,groups and other
agencies,allowing use of this space and plan to continue this policy. All programs are an expansion of previous programming,
however now that the programs have settled in the new center new recreation programs are being planned for next year
including "fishing"and bean bag tournaments with nearby centers. The additional space allows Senior Services to serve over
(300 persons at a time,our previous capacity was 82. We can also offer up to three activities at a time addressing the community
need for recreational and leisure activities,in this case for seniors and the disabled and a special outreach into the Hispanic and
Laotian communities. The center attracts from 100 to over 400 seniors to downtown Elgin each week adding vitality to our
neighborhood, downtown Elgin. Our programming brings the senior community together; many renew old acquaintances
while making new friends. Alive Downtown is another community need we address.
B. Identify who will benefit from the proposed activity(e.g.,homeless,youth,seniors,disabled,et cetera). if designed to
benefit persons of L/M income, describe the process you will use to identify these persons and ensure that the activity
meets this objective. (An LMI certification form is included in the RFP Pocket).
!Our contract with the Northeastern Illinois Area on Aging, who provides a grant that covers the salaries involved with the
!center, states that we open our activities to persons age 60 and older: Senior Services administers the VIP (Veterans
independence Program),for disabled veterans of ail ages,for that reason we recently changed our by-laws to allow us to serve
the disabled of any age. Changes in the State of Illinois service delivery will likely add case management of the disabled to our
service.
I
HUD presumes that the elderly and disabled persons are low income, although we are required to verify income when
determining eligibility for many State of Illinois services and federal programs, including VIP.Verified data is recorded in our
State of Illinois mandated data system,CMiS,and copies are kept of income verification.
I
C. Identify the accomplishments you intend to achieve with this activity. Provide an activity time-frame/schedule(include
start,completion dates,and other significant stages). Please note that the fiscal year does not star until Junel,2013.
This program began,with support from the City of Elgin and Elgin Township,on June 1,2011 when we occupied the space at
205 Fulton Street in Elgin. At that time we requested a three year lease with renewal options. With the popularity of this
program and the increase in the senior population we don't see an end to the need for a senior center in Elgin. In 2012 we
added the evidence based program"Fit and Strong"to our existing fitness programs and Latin Dance and will continue to add
programs as funding is acquired and demand dictates. We will also seek partners,other clubs and organizations that could use
the space. In 2013 our goals include increasing volunteerism by an additional 10°r�, seniors knowing where to seek needed
;services and benefits by 10%and program participants feeling less isolated, lonely and more active, healthy and confident by
110%. We will use the Northeastern Illinois Area Agency on Aging"Quality of Life"assessment to track these accomplishments.
City of=loin CDBG Application 7)'20'1 3-2014 Application Page 22 of 32
5. ORGAN IZATIONAL.CAPACITY:
Please answer the following questions in the spce provided.
A. Provide an overview of your organization including length of time in existence. Attach a list of current officers and
board members with terms.
Senior Services Associates,Inc.is a non-profit agency dedicated to sustaining and improving the quality of life for individuals 60
and over,the disabled and their caregivers by providing access to the social services they need. To accomplish this goal we
provide case management and an assessment to determine in-home services that may be needed,information and assistance
completing forms and accessing 1 needed benefits, outreach to the home bound, elder abuse investigation, nursing home
ombudsman.,recreation,education, health and wellness programs,fall prevention program,chronic disease self management
program and numerous volunteer opportunities that assist-Senior Services as well as other non-for-profits and government
offices. We have been serving Elgin for nearly 40 years,incorporated in Illinois on August 30,1973.
B. Describe your organization's experience in successfully conducting this type of activity. Identify any skills, current
services,or special accomplishments that demonstrate your capacity for success.
Senior Services began operations in 1973 as an adult day center, providing day care and activities for seniors needing
stimulation,care and activity daily. After adding many other services,in 1984 we opened an activity center for more mobile and
active seniors in Elgin when we relocated to downtown Elgin where we had additional space. The Elgin center has grown from
an average of 20 persons to often over 100 to 200 daily. Senior Services operates active senior centers today in Yorkville,Crystal
Lake,McHenry,Woodstock,Harvard,Richmond and recently,an expanded center in Aurora. Many of these towns approached
Senior Services to provide activities in their communities and we are looking at other cities in our service area that have
requested our services because of word of mouth and our reputation for offering quality senior programming and our ability to
accomplish this in a cost effective manner.
C. Identify the person(s) responsible for program and financial management of the activity. Identify all other persons
involved in this activity noting whether these positions are current or new,pending this award.
All persons and positions responsible for the program and financial management of this activity are current. The activity
director is Ramona (Minnie) Vasquez; her supervisor is Beth McClory, Chief Administrative Officer; the front office manager
(reception)is Kris Waisted;and the Chief Financial Officer is Mutt Schoenholtz. Minnie is assisted by our bilingual(Spanish and
Laotian)case managers when required. Staff are assisted by.a strong and active volunteer advisory council with representatives
from the Senior Provider Network,the Elgin Police Department,Kane County Sheriff's office and area seniors. Also advising
with programming and assisting with fund raising;a volunteer board comprised of seniors active in the center.
City of Elain CDBG Application FY 2013-2014 Application Pace 23 of 32
D. Identify any other agencies/partners in this activity and define the roles and responsibilities of these partners.
jSeveral times each week lunches are served by the Salvation Army Golden Diners, special events are contracted with local
restaurants. Many events are sponsored by members of the Senior Provider Network,including local nursing homes and home
health agencies, members of Triad;the Kane County Sheriff's office, Elgin Township and the Elgin Police Department. Elainj
Township also assists with rent of the space and programming.
i
I
Demonstrate that the proposed activity is economically feasible and can be implemented in a timely cost effective
manner within the proposed program year.
Senior Services has occupied the space at 205 Fulton Street since June 1,2011. The City of Elgin assisted in negotiating the
lease for three years. The renewal,June 1, 2013 through May 31, 2014 requests a 3% increase in the rent with no change in
terms,utilities are included. Staff are paid by a grant from the Northeastern Illinois Area Agency on Aging,approved for the
coming year,and by Elgin Township. The program operates within the approved budget.
i
I
F. Oftentimes projects that receive an award of CDBG funding are actually awarded less than the amount originally
requested. This requires the submission of a revised budget and a description of how it will carry out the proposed activity
with reduced funding prior to the commitment of any funding. Please indicate here whether your proposed activity could
be undertaken with a reduced commitment of funding and if so, please highlight how that would affect the scope o-
services you are proposing.
Senior Services would be obligated to complete the lease as agreed. Should we be awarded less than the amount requested
we would seek other options for funding,but if we did not receive funding from another source there is a strong possibility we
would have to give up the space at 205 Fulton Street,depending on how much of a reduction in our request we receive. The
result would be returning to one activity each day and allowing participation by 'a maximum of 82 persons.
I
I
C'ry of Elgin CDBG Application FY 2013-2014 Application Page 24 of 32
6. FINANCIAL:
The City encourages CDBG funds-to be utilized as gap funding. A gap is defined as the amount of funding necessary to
run a program after all other funding sources have been identified,thus leveraging is very important in the application
process.
ACTIVITY BUDGET
Please -answer the following questions in the space provided. You may reference and attach an additional page if
necessary.
A. Complete the Budget.Summary chart. More detailed budgets may be scanned and attached (and are strongly
recommended) in.support of the proposal.
B. Identify sources of leveraged funding for this activity. Include the status of these funds(i.e. cash on hand,
grants received,planned fund-raising, etc.). Scan and attach copies of funding commitment letters or other
evidence of funding support.
C. Leverage-Consideration will be given to the amount of non-CDBG funds committed to the project.
BUDGET SUMMARY 1
9urce of Leveraged
Category Breakdown CDBG Leverage funds Totai Funds
Personnel* 1
Contractual Services 1
(Specify
l
I ,
I f
Rent and Utilities $35586.00 $10000.00 ElginTownship $45586.00
Communications
Travel
I I
Other(Specify)
l
I
TOTALS $35586.00 $10000.00
NOTE: Please complete Budget Detail.Chart on Page 26 if personnel costs
are included in your proposal.: Grand Total' $45586.00.
City of Elgin CDBG Application FY 2013-2014 Application Page 25 of 32
(BUDGET DETAIL
This section provides back-up for each line item shown in the Budget Summary Chart. Please make certain this detailed breakdown
is consistent with the Program Budget. Round up to the nearest hundred.
Please Note: A job description for each person much be provided.
A Note about the Staff/Salary Breakdown: Please show all proposed staff positions funded with CDBG funds that relate to the
proposed activity. If multiple staff members have the same position/title,list separately(For example: Counselor, 1,Counselor 2).
Use the additional space at the end of this document if necessary. You must submit iob descriptions with your application for
each position title identified below.
os#tOn Title a °` Snnuaf 'ary �> �=s 3 DtI t15 CDBCi >rO�S `e(U25LE
-�4 �- '-�'�=� - �?� ��c',.;-'!s... `'"" --$._ '-rte'"''. _ �- `��;— .'`_-'� _ _ ��•;:-.
( X �i I II
XI I - I
X
IX
IX — !
l lX =i
A. Oftentimes projects that receive an award of CDBG funding are actually awarded less than the amount originally
requested. This requires the submission of a revised budget and a description of how it will carry out the proposed activity
with reduced funding prior to the commitment of any funding. Please indicate here whether your proposed activity could
be undertaken with a reduced commitment of funding and if so, please highlight how that would affect the scope of
services you are proposing.
I
City of Elgin CDBG Application F y 2013-2014 Application?age 26 of 32
A, THRESHOLD CERTIFIGATIOIV
In order for your application to be accepted,in addition to the application itself,your organization must submit the following items to
the City of Elgin Community Development Department no later than 5:00 PM on FRIDAY,DECEMBER 14,:2012.
lJ An original application with all questions completed (single sided, not bound) of the
completed application. (Only the original must include the requested support documents such as
the articles of incorporation and the current list of your Board of Directors.)
The following attachments/certifications: (if you have not submitted an application in the last
two years OR if the information has changed)
OArticles of incorporation
OArticles of Incorporation
Current List of Board of Directors
OCertified Organization Audit/Financial Statements of most recent year
A, Copy of OMB A-133-Audit(Required if$300,000 in aggregate Federal funds
expended),or
B. Financial statements audited by a CPA (only if not qualified for A-133,)or
C. Profit and Loss Statement for most recently completed fiscal year and General
Ledger printout(only first time applicants or those who do not meet above
criteria may submit)
OIRS 201(c)(3)Designation Letter(Pending letters will notbe accepted)
® Current Fiscal Year Agency Budget,includin.g.all funding sources
OJob Descriptions per budget detail.
OAn Executed Statement of Applicant Form.
OAn Executed Signature Authorization Form,
OConflict of Interest Disclosure Form.
I hereby confirm that this.p(accpn/k.et/ccoonnttains all materials required.
Iz�i3�r.Z
City of Eloin CDBG Application FY 2013-2014 Application Page 27 of 32
|
|
The undersigned acknowledges the following:
1. That,oo the best nf its knowledge and belief,al|factua|infonnahnnpmvdedbtrueandcbrrectanda||estinnatesancreaumable.
2. That no revised Proposals/applications may be made in connection with this application once the deadline for applications has
passed.
3. That the City of Elgin may request or require changes in the information submitted, and may substitute its own figvms,which it
deems reasonable for any or all figures provided. That the applicant will participate in required interview for project assessment
and cooperatively assist in the review process.
4. That, if the pmject($ b recommended and appmvedby the Mayor and[hyCnund|'�e[hynesemesthe hgh,medmzand/or
cancel the aUocmionifhedem|entit|emen�am cancelled,reduced,o,rescinded.
5. The City of Elgin reserves the right not to fund any submittals received.
6. By submission of this application,the organization agrees to abide by the federal regulations applicable to this program.
7. That,if the project(s)is funded,the organization agrees to abide by the City's locally established policies and guidelines
S. That past program and financial performance will be considered in reviewing this application.
g. That services are tn be provided at no cost to citizens during the grant period. All program income (i.e.: fees, repayments,
foreclosures,ercj must be remitted nx the City.
10. That,if the project(s) is funded,the City or a clesionated agency may conduct an accounting system inspection to review internal
controls,including procurement and uniform administrativeProcedures,prior to issuance of payments for projected expenditures.
1 i. That,if project(s)is funded,the City will perform an environmental review prior to the obligation of funds.
�2. That if project is funded, a written agreement that includes u statement of work, records retention and reporting, program
income procedures, local and federal requi,enems, circumstances that would trigger grant suspensions and terminations, and
reversions of assets would be required between the organization and the City.
13. That a project's funding does not guarantee its continuation in subsequent action plans.
14. Provide written signatory authority from the organization's governing body indicating who can execute contracts and
amendments on its behalf.
li Agrees to abide by the City of Elgin's Conflict of Interest policy. Items of concern would include staff members servingon the
Board of Directors,staff members'families serving on the Board of Directors,and other matters that may give the appearance of
a conflict ctinterest.
PENALTY FOR FALSE OR FRAUDULENT STATEMENT
U.S.Code Title 18,Section 1001, provides that a fine of up to 510,000 or imprisonment for a
period not to exceed five years, or both, shall be the penalty for willful misrepresentation
and the making of false,fictitious statements, knowing same to be false.
City o/oomcoaoxnn//catmnFvzm3'2o14- ApPom,iu"Noe 28 of 32
`
' .
By signature below,the applicant acknowledges the above in its name on this thirteenth
day of, December 2012.
Senior Services Associates,Inc.
Name of Organization
(Signature)
Executive Director
(Title)
City of Elgin CDBG Application FY 2013-20i 4 Application Page 29 of 32
C SIGNATLiREAUTHORIZATIQN FORM
The Board of Directors of Senior Services Associates,Inc. does hereby resolve that on December 5th,2012
the Board reviewed the Application for Community Development Block Grant Funds to be submitted to the City of Elgin Community
Development Department for funding consideration for the fiscal year 2013-2014 and in a proper motion and vote approved this
application for submission.
The Board further certifies that the organization making this application has complied with all applicable laws and regulations pertaining
to the application and is a non-profit organization,tax-exempt and incorporated in the State of Illinois.
Senior Services Associates,Inc. (Name of organization requesting CDBG funds) hereby proposes to provide the
services or project identified in the Scope of Services in accordance with this application for Community Development Block Grant Funds.
If this application is approved and this organization receives CDBG funding from the City of Elgin,this organization agrees to adhere to all
relevant Federal, State and local regulations and other assurances as required by the City. Furthermore, as the duly authorized
representative of the organization,I certify that the organization is fully capable of fulfilling its obligation under this application as stated
herein.
I further certify that this application and the information contained herein are true,correct and complete.
I also authorize the following person(s)to have signatory authority regarding this grant:
Bette Schoenholtz Executive Director
Name Title
Beth McClory Chief Administrative Officer
Name Title
� , _} Al--v
4sidentJBil of Directors(or other authorized person)
December 13,2012
Date
PENALTY FOR FALSE OR FRAUDULENT STATEMENT
U.S. Code Title 18,Section 1001, provides that a fine of up to$10,000 or imprisonment for a
period not to exceed five years, or both, shall be the penalty for willful misrepresentation
and the making of false,fictitious statements, knowing same to be false.
City of 9-gin CDBG Application FY 2013-2014 Application Pace 30 of 32
CONFLICT OF INTEREST
The standards in OMB Circular A-110,Subpart C, provide that no employee,officer,or agent shall participate in the selection,award,or
administration of a contract supported by Federal funds if a real or apparent conflict of interest would be involved.Such a conflict would
arise when an employee, officer, or agent, any member of his or her immediate family, his or her partner, or an organization which
employs or is about to employ any of the parties indicated herein,has a financial or other interest in the firm selected for an award.
The CDBG regulations at 24 CFR 570.611 and HOME regulations at 24 CFR 92.356 provide that no person who is an employee, agent,
consultant,officer,or elected official or appointed official of the recipient or subrecipient that are receiving CDBG or HOME funds and(1)
who exercises or has exercised any functions or responsibilities with respect to activities assisted with CDBG funds; or (2) who is in a
position to participate in a decision-making process or gain inside information with regard to these activities, may obtain a financial
interest from a CDBG-assisted or HOME-assisted activity, or have any interest in any contract, subcontract, or agreement with respect
'thereto,or the proceeds there under,either for themselves or those with whom they have family or business ties,during their tenure or
for one(1)year thereafter.
A disclosure of the nature of any perceived or actual conflict must be made priorto the execution of agreements utilizing CDBG or HOME,
IF NO CONFLICT EXISTS,COMPLETE THE FOLLOWING:
OI certify that no conflict of interest exists between the City of Elgin and(name of organization)
Senior Services Associates,Inc.
OI certify that no conflict of interest exists between the subcontractors of the(name of organization)
Senior Services Associates,Inc.
IF A POTENTIAL CONFLICT EXISTS,COMPLETE THE FOLLOWING:
O . I certify that a potential conflict of interest may exists between the City of Elgin and(name of organization)
GI certify that a potential conflict of interest may exist between
(name of subcontractor)
and(name of organization.
Describe the nature of the conflict of interest below. Identify the individual,employment and the conflict or potential conflict,and
their affiliation with your organization.
Signature of Authorized k9t:nc-y_official and bate
City of Elgin CDBG Application FY 2013-2014 Application Page 31 of 32
FY 2013-Senior Services Associates,inc.I KANE ;t KENDALLIMCHENRYi RSVP i AGENCY
REVENUE i
TOTAL
4.700 i 8.000 i 6.700
19.400
3020 MernDershiDs I 5.900 1 00 0 14.700
_.�,2 6, 0
9
.0,)C 9%
3&76 c6majons 24.000 I od 42.000
3060 Interest ! 150 60 0 330
3070 Fscffitv Usage 1 2501 - 250
3090 Actedtias __ 25,500 1 5,000 i 34.000 I 84.50b
3100 Newsletter 300 450
3.050
3120 Website Advertising
Giants 97.097 i 51 192; 25.000 i 173,289
3230 Client Service Grants
2225 Vftow-sDnn Fan
324 L
Grand Victoria Fan
3245
Bethlehem
3250 Eisenberg-on.
3255VDT Personal Comoartior. 4.000
00iher2roject Income i 5,100
?310-Hcm-p.Reoair Project Income
_3400 Trip Commissions
3500 Kendall County Nutrition
3600 Fundraising i 80.000 1 10.000 I 45,000 1 i 135.000
3700 Trans.Proiect Inc, 1 7,000 1 5.0001
i 16.DGO
4010 Corporation for National Service - 93.987 93.967_
74,806 1 73!,295
435.068 120,421 1
4106 NEIL AAA-111? - --
41 1.0 NEIL AAA-E.A.
268.680 34O 929227 143_247
4114 NEIL-ANE EIS ---B.BDD 600 2.5W 1^,.900
_L,15 NELL.ESS j 20.- 10.000 16,000 'C'&i
41118 NEIL CMP OmouasmarV Bad Tax 1 27.421, 1 5.262 1 12.5727 I 45,255
4 1.iYNf11--AAA 1 4.296 1 1.227 2.074 7.557
4.21 NEIL FICS 15.954 1 4.927E 7,703 28.584
1
----
4 1,22 NEIL VII&AAFP 27,108! 4.794 11. ----
x123 NEIL SHAD 30,382 9.382 i i4.666i 54,432
60 3,366
12�Nf[L DID Fall Preventio�e5 1 10,9
4126 SMP 3.126
4545 Gap-Fitl 10.021.1 1C00 1 4,000
4146 Legal•111E I - . !
-ZikCaregiver Respite 52,560 17.326 1 26.215 95.101
Respite Assistance 24,337 7,515 I 11.750 43,603
4160 Pioneer Ornovasman
4200 IDO�, 43.�H2 22.01,! 1.501,884
4215 NRS-State of IL 23.000 I 3,000 11,500 37.500
4275 Meatal Health Resource I 14, 14.500
x300 Elgin Unlled WaY 3
30.000 0.000
4310 Central Kane United Way 15.000 15.000
4320 Fox Valley ied Way I 40,700 i i 1 40.766
4323 Fox Valley UW SR Func
-4336EFazavia United way 2.000 1 2.000
4335 Metro Chicago United Way I 10.(00
,��(�eneva Community Cnesi �) 1.400
360 mc- We 35.c,40 1 1.5,940
440Z�VVrora Townstur 15.000
15.000
4406 El ai Tcm�u 30,�00 1
__q__ 30.WO
'4408 Hanover Townshic, 1 -
4435_Dundee Tawnshic
4440 Kendafl Tc;;,nshm 500
4489 Geneva Toymshio
94 Retirement Research 22.L73 22.473
4495 Nunda 1 awnship
km
3.200 1 3,200
4+500 Kendall Count.,Sr Ref 120.500 1 - 120.500
4505 705 Board 7.000 1 2.000 9.000
_4550 Ci. of Elgin 39,0101 39,01
4555 McHenry County Sr Ref i 1 I 462,175
4560 Kane County Riverboat
4600 Title V
TOTAL REVENUE:
TOTAL EXPENSES: 2,335,254 557.857 1.555,371 1 140,98',1 4.589,463
NET 01 0 C)i C, 0
FY 2013-Senior Services Associates,Inc. I
EXPENDITURES: I TOTAL I TOTAL TOTAL RSVP ' AGENCY
� I I TOTAL
5100 Salaries 1 1.492.113 1 302,962 960,300 79,366 2.834,742
5105 Temporary Personnel 71 20i -
_ -.>� �- I -11,207
5110 FICA 114.147 1 23.177 73,463 6,072 j 216,858_
5120 Health _114492 23,678 Be 116^5 1 8,802 I 263.558_
5130 Lrfe Insurance _ 8.691V! 2.191 4,999! 4,3 1 16.298
514bUernoloyment Insurance 17,459 j__--3.847 11,939 I 965 34,21 0
5150 Workmen's Comp. 6,849! 4.1X3 3,052 1 226 14.171
5160 Pension Plan Expense 19,143' 4,447 16,290 i 1,384 i 41.264
5170_Empwyeee Assistance 1.099 287 1 785 j 57 2,222
5175 Loss on Employee Plan ! - ! - _
_5180 Employment Costs 190 _ 198 _!�1.510
6105 Rent _--�I-89,611 8,577 51.921-I! 150,309
_5106 McHenry Rent
611C Gas/Bldn9 1 6,449 µ3,558l 1_379 i 12,386
6120 Electric 15,2522 929 1 2,633 j 21 1 18,835
6_30 Water 57-, 147 464 i 6 1 _ t�94
6 1e0 Exterminator ' 1 239
BldngLpen Liability Insurance 1 4,019: 12.092 840 i 33.597
6,646 I
6160 Janitorial/Maintenance 281 1 16 4,464 I. 4_761
6170 Disposal 387
6190 McHenry Utilities ! - - 15,031 15,031
7100 House Sullies ~ 4.252: 3,349 4,409 12,010
7200 Office Supplies 13,942' 5.764_i 8,198 j 50? 27.954
_ _
7300 Food_Supolies I Vending macriine 12,806: 20,775% 14,947 48_528
7400 Activity Supplies 7.636! 4,0339 3.495 15,365
7450 Activity Leader 9,071_ 1,200 17 B42
7500 Gaff SuDwes - - -
7600 Computer Supplies 4,328 838 t 3.915 w. 509 1 9,589
_8000 Other Expense
8100 Vehicle Insurance
8120 Prof Liability Ins 1 2_417 61 i 1,736 1_ 125 1 4,895
8125 Directors and Officers 1.536 390 1 I'060 80 1 3,066
8180 Volunteer Insurance - _ 1_ - 1,150 1,150
8200Travel _ 32,699 8.5941 30.779 Bel 1 72,954
_8205 Miscellaneous
_8220 AdveNsing _ 5,332 1.357_ 4,081 257 11,027
8225Markeli 1 3,213 .__-1;249 _ _3380 781 7,920
8230 Secuty Link Referral 1 - 350 316 - i 666
824_0 Audit _ 1 7,336 1 1.817 5.154 436 14.746_
18310 8260 Dues&Subs I 7,407 2 331 4,969 30 14,737
8280 Gas_&Oil _ 1.265 _ ! 1,265
1,114 1,114
Hired Vehicle I 555 i___ 289 _ 246 4 1 1,094
6320 Vehicle Maintenance f ( I
8340 Printing&DUp! 11 121 1 4,336 .7 290 141 i 23,489
8360 PostageV � I 11,225T_-2.919 11,278 577 26.069
8380 Telephone 1 18_383 8.738 15.300 944 4 1365
8385Cellular Phone Service 1?,939� ___-__3.718 I _8 719 83! 25,459
83901nternel 2 063 782 1 2,602 j 115 I 5,563
8400Train!n9 _ ?,635__L 2120_i_ 1,604 i 535: 6894_
8420 Convactural
19,127 1 6,321 ---14,776-� 557 ,782
40
8430 Proiessional Fees i 300 i 76 1 209 i 16 i 601
_8435 Eeuioment Lease ! 11,070 1 _2,704!_ 7,624�_ 388 21,786
84400o r Contracl ! 11,661 _ 5.938 9.108 227 26,934
8460 Pagi�Conrad 0000 _ - ! 324 - 324
_B480 Other Maintenance 9,820 2,011 2,896 21 ! 14,748
6500 Newsletter 2,704 _1,326 - 2,330 -�-- 14 i 6,374
8510 Kane Coin R ver Boar _
852umishinys/F- 42,500 ixures 42,500
0 F
853 V
0 ol pe
unteer Exnse
. - 8540 Volunteer Travel I - _L 4,220 29,001 1 33.221
8545 Elgin Empglency Client Exp. 663 I
8550 Volunteer Meats t - I - _ 1,258 i 1,258 '
8580 Volunteer RpS29r ft ion 859 _ 635 467 3,336 1 _5,296
8585 Volunteer Recruitment 1.266't 10 0! 3.2_6.6
86001nterest Expense
8605 Governance Expense
8610 III D Health Promo
8652 NE4L SPAP l SHAP
8614NER CAPACITY ONE-TIME
8615 ProjectExpense-One Time
8617 NEIL FCS 15,954 4.927 1 7.703! 28,584
8620111 Ble RasiderL I Reoeir 4.296 1,327 2.074 697
8625 VII Protective Services 1,800 -� 500 1 2300
926 NEIL ESS.FSS,AT&Legal 20,000 1Q000 16.000 1 46,000
e627_Ca egivef Resolte 52,560 17,326 I 23.667!� 93,553
8629 Nursing_Home Dtverslon I _
8631 NEIL One-time
_ _
8632 Gap Fill Expense i 10,021 2.000 4.000 16,021
8634 III D Medication Management i
8635 IL One-Time i
8638 NEIL GapF!II-Grandparents
8637 Tao/ACtivit Refund 97! 70 _ 115 j - 282
_
8640 Trips 4,885 7.000 6,493 1 - 18,378
_8650_P2x Valley U.Way Emem.Exp !
8660 EIS Client Services 8,800 I 600 1 2,500 j 11,900
8661 Client Services Funded by Grants 2,166! 2,166
8665 Mental Health Resource Lge
8670 Aurora Block Hsi n
8675 McHenry Emergency Funds - 5.000 5,000
8676 Home Repair Prolext Exp. - 3,000 - 3,000
8680 Fundretsing 27,000 4.000 11,000 42.000
B7D0 Services Restricted -
B720 Move&Renovation Expense
8730 Knox Box Purchases -
8735 Transportation,Rides I 30,388! 497 1 - 30,885
8740 Beth Aid --_ _
TOTAL EXPENSES: ! 2,335,254 557.857 1 1,555.371 1 140,981 ' 4.589 463
Senior Services Associates, Inc.
Board of Directors
President: Jane Johnson Secretary/Treasurer: Gil Nore
Vice President: Tom Aquilina Past-President: Tom Van Cleave
Tom Aquilina Jane Joluison
1.0/04/00— 10/01/09 10/1/10-10/1/13
10/01/10- 10/01/13 Law Elder Law
Aquilina&Associates; Inc. 2275 Church Road
6708 Rhode Island Trail Aurora IL 60502
Crystal Lake, II 60012 630-585-5200 Work
815-459-0881 Office 630-465-4447 Cell
815-459-8819 Fax l neTilawelderlaw.corn
81.5-621-3553 Cell
tmaquilina,'�7),comcastatet Jack Kreger; CSA
10/1/12— 10/01/I5
Identa Austin 1201 Banbury Circle
10/01/00— 10/01/13 Naperville;IL 60540
Plum.Landing Apt 508 630-219-3973 Phone
495 North Lake Street 630-363-6178 Cell
Aurora. I1 60506 866-653-0907 Fax
630-892-7829
630-896-5056 fax William Markison
10/1/10-10/1/13
Kevin Bam, 311 Maplewood Lane
10/01/11-10/01/14 Crystal Lake, IL 60014
1070 Larkin Avenue Retired
Elgin 1L 60123 815-459-5204
847-697-8900 mark ison z:sbcalobal.net
Kevin abarr-law.com
Frank Miller
Cory Freeman 10/01/94— 10/01/13
10/01/09— 10/01/15 534 Kingsway Drive
Vallee Estate Planners, Ltd Aurora,11 60506
141\1555 Tvrrel Road Retired AT&T PR
Elgin. IL 60124 RTA Board
847-888-3888 Work 630-896-81.11 home
corv�vallevestateplanners.com 630-896-5387 fax
Florida Address
Dr Alice Giese 10355 Paradise Blvd
10/01/12— 10 101 115 Treasure Island FL 33706
14052 Francesca Cove
H.untiev IL 60142-6324
847-669-7631 Home
630-302-5553 Cell
DrGiese(dtm.sn.com
Dr Mohammad Habibulla
10/01/12 - 10/01/15
1121 Waterford Ct
Crystal Lake, IL 60014
815-230-0634
Mhabibulla99(ib.hotmai l.com
Gerald Morrow
10/01/10 - 10/01/13 10/1/08— 10/1/11
Plum Landing Apt 209 10/01/11 — 10/01/14
495 N Lake Street 1.023 Lexington Lane
Aurora II, 60506 Batavia,Il 60510
Comptroller Retired Kane County Board
City of Aurora&Wadsworth 630-879-6344 home
630-896-0889 630=220-2736 cell
sainteerald26D.att.com 312-220-2736
thomasvan cleave(a-_)com cast.net
Kitty Nash
10/1/10- 10/1/13 BOARD EMERITUS
660 Butterfield Dr
Algonquin,IL Patricia Feeley
847-658-7071. Board Emeritus
Nash660g;sbcg lobal.net 10/01/06- 10/01/12
710 Pinliurst Lane
Gilbert Nore Oswego,11 60543
10/01/08— 10/01/14 773-590-4320 home
275 Waverly Drive 630-554-5602
Elgin., 11 60120 patfeelevtsbc!7loba.Lnet
Retired Accountant
847-741-2901 Tom Smith.
-noreCO)Peopiepc,com 10/01/06— 10/01/12
550 West Galena Blvd
Trinidad Rodriguez Aurora, I1. 60506
10/l/11-6/l/14 Private CPA
513 Fremont St 630-897-7781 home
Elgin, IL 601.20 630-897-7782 fax
847-888-9373 tesmit.hcpa.( ).sbcglobal.net
Cecelia Sanders Mark Weber
10/01/07— 10/01/13 10/1194— 10/1/12
1 108 Sunset Avenue 2210 North Bockman Road
Yorkville, Il 60560 Marengo, 11 60152
630-553-0151 home Castle Bank
Work info: Trust Department
Sun.nymere, Inc 81.5-245-7245 cell
Marketing mweber(ri.castlebank.com
925 Sixth Avenue
Aurora,11 60505
630-898-7844 work
sun.nymeremarketinat?;),sbcalobal.net Revised:
Steve Thoren 12/04/12
10/1/09— 10/1/12
Majestic Mortgage
5') S Union St
Elgin IL 60123
847-840-7319
wonase;a,,wowway.com
Tom Van Cleave .
SENIOR SERVICES ASSOCIATES, INC.
FINANCIAL STATEMENTS.
AS OF SEPTEMBER 30,2011 AND 2010
TOGETHER WITH AUDITOR'S REPORT
Dupe Lap4!lSa
Certified Public Accountants&Consultants
A Professional Corporation
Michael J.-Dugan 104 East Roosevelt Road T.Brett Flickinger
Jerry L.Lopatka Wheaton,Illinois 60187 Karen M.Olson
Mark F.Schultz (630)66,.5-4440 Hugh E.Elliott
Peter J.Zich Fax(630)665-5030 James P.Hofner
Leo M.Misdom www.duganlopatkacom
e-mail:info@duganlopatka.com Gwen S..Henry
INDEPENDENT AUDITOR'S-REPORT
To-the-Board of Directors of
Senior'Services Associates,-Inc.:
We -have :audited .the -accompanying statement of financial position of Senior Services
-Associates, 'Inc, (the Organization) as of:September 30, 2011 and 2010, and the related.statements of
activities and cash-flows for-the-years then ended:and the statement of functional expenses for the year
ended-September 30,.'2011. These financial .statements are the .responsibility of the Organization's
management. Our responsibility :is to.express:an opinion on.these financial statements based on our
.audit, The 2010 summarized comparative information on the statement of functional expenses has been
derive-d.from-the Organization's 2010 financial statements and, in our report dated December 7, 2010,
we expressed an unqualified opinion on those financial statements.
We conducted our:audits in accordance-with auditing standards generally accepted in the United
States of America;and the;standards applicable to financial audits contained in Government Auditing
Standards, issued by .the Comptroller General of the United States. Those standards require that we
plan and perform-the audit to.obtain reasonable:assurance about whether the financial statements are
free of material misstatements. An audit includes examining, on a test basis, evidence supporting the
amounts-and disclosures in the financial statements. An,audit also includes.assessing the accounting.
principles used :and significant estimates made by management, as well as evaluating the overall
financial statement presentation. We believe that our audits provide a reasonable basis for our opinion.
In our opinion, the financial statements referred to above present fairly, in-all material-respects,
the financial position of the Organization:as of September 30, 2011-and 2010 and the changes.in.its net
:assets and its cash flows for the years then ended, in conformity with accounting.principles generally
accepted in'the United States of America.
In :accordance with Government Auditing Standards, we have also issued our report dated
January 25, 2012, on our consideration of the Organization's internal control over financial reporting
and our tests on its compliance with certain provisions of laws, regulations, contracts, and grant
agreements and other matters. The purpose of that report is to describe the.scope of our testing,of
internal control over .financial reporting and compliance.and the results of that testing, and not to
.provide an opinion on the internal control over financial reporting.or on compliance. That report is an
integral part of-an audit performed in accordance -with Government Auditing Standards and should be
considered in assessing the•results of our audit.
APPILIATE
I kern A r �-
Independent Auditor's Report
Page two
Our audit was conducted for the.purpose of forming an opinion on the basic financial statements
of the Organization taken as a whole. The accompanying schedule of expenditures of federal awards is
presented for purposes of additional analysis as required by U.S. Office.of Management and Budget
Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations, and is not a
required part of the basic financial statements. The accompanying schedules of public support and
revenue by counties and functional expenses by counties on Schedules 1 through 6 is-presented-for
purposes of additional analysis, and is not a required part of the basic financial statements. Such
information has been subjected to.-the auditing procedures applied in the audit of the basic financial.
statements and, in our opinion, is fairly stated, in all material respects, in relation to the basic financial
statements taken as a whole.
DU & LOP TKA
Wheaton, Illinois
January 25, 2012
EXHIBIT 1
.SENIOR SERVICES ASSOCIATES INC
.STATEMENT OF FINANCIAL POSITION
SEPTEMBER"30.201.1 AND 2010
2011 2010
ASSETS
CURRENT ASSETS:
Cash and cash equivalents 1 656,111 $ 657,598
.Receivables- Grants 767;021 -853,642
-Other 6,325 8,344
Prepaid expenses 17,559 20,760
Total current assets 1,447,016 1;540,344
PROPERTY AND:EQUIPMENT:
Land 20,000 20,000
Buildings .153,953 153,953
Building.improvements 777,800 742,097
Furniture,fixtures.and equipment -514,865 461;259
Vehicles 246,975 246,975
i,713,593 1,624,284
Less-Accumulated depreciation (1,270,924) (1,224,197)
Net property and equipment 442,669 400,087
OTHER ASSETS:
Security.deposits 5,973 5,973
$ 1,895,658 $ "1,946,404
.LIABILITIES AND NET ASSETS
CURRENT LIABILITIES:
Accounts payable $ 60,156 $ 28,877
Accrued payroll 52,319 187,084
Accrued vacation 1019249 91,762
Grant advance - 57,103
Total liabilities 213,724 364,826.
COMMITMENTS
NET.ASSETS:
Unrestricted 1,681,934 1,581,578
$ 1,89508 $ 1,946,404
EXHIBIT-2
Pag.. 1 of 2
SENIOR SERVICES ASSOCIATES, INC.
STATEMENT OF ACTIVITIES
FOR THE YEARS ENDED SEPTEMBER 30, 2011 AND 2010
2011 2010
UNRESTRICTED ASSETS:
Public Support-
Northeastern Illinois Area on Aging $ 1,405,722 $ 1,409,116
Illinois Department on Aging 1,406,574 1,363,835
Grants 156,776 131,791
United Way 142,543 183,387
Counties, townships, and cities 679,582 701,170
Foundations .32,473 "10,000
Donations 40,782 56,274
In-kind contributions 742,670 741,441
Miscellaneous 75 1,343
Total public support 4,607,197 4,598,357
Revenue-
Transportation 14,820 12;033
Activities 115,045 .86;087
Trip commissions - 1,844
Membership dues 16,763 19,300
Fundraising 136,948 110,644
Project income 51,786 44,753
Newsletter 6,526 8,009
Miscellaneous 16,258 20,250
Total unrestricted revenue 358,146 302,920
Total unrestricted public support and revenue 4,965,343 4,901,277
Functional expenses -
Program services -
Transportation 154,731 169,306
Case Management 1,077,228 1,086,310
Information and Referral 976,905 929,685
Outreach 29,251 53,232
mom- ------^•'-•-^ --'-- -- -- ��_�t _-� _r�Lt- ..�_...___�
EXHIBIT 2
Pa 2e 2 of 2
SENIOR SERVICES ASSOCIATES, INC.
STATEMENT OF ACTIVITIES
FOR THE YEARS ENDED SEPTEMBER"30.2011 AND.2010
i
2011 2010
UNRESTRICTED ASSETS: (Continued)
Functional expenses-(Continued)
Program.services (Continued)
Ombudsman :$ 177,040 $ 145,532
'Multi-Pur pose 568,961 565,458
Neighbor-to.;Neighbor 21,171 32,687
Elder.Abuse 401,051 369,637
Deli Services 40,674 -
Senior Companion 214,906 194,220
.R.S.V.P. 91,742 85,003
Total unrestricted program services 3,753,660 3,631,070
Supporting services-
.Management and general 1,063,942 1,054,200
Fundraising 47,385 33;919
Total unrestricted supporting services 1,111,327 1,088,119
Total-unrestricted functional-expenses 4,864,987 4,719,189
CHANGE IN NET ASSETS 100,356 182,088
NET ASSETS, Beginning of year 1,581,578 1,399,490
NET ASSETS, End of.year $ 1,681,934 $ 1,581,578
'r'} a or•nnmr,�nvinn nntoo rara en snto nrar r�rt of tnie etotmm�nt
EXHIBIT 3
SENIOR SERVICES ASSOCIATES, INC.
STATEMENT OF CASH FLOWS
FOR THE YEARS ENDED SEPTEMBER 30, 2011 AND 2010
2011 2010
CASH FLOWS FROM OPERATING ACTIVITIES:
Cash received from public support and revenue $ 4,311,316 $ 4,254,867
Cash paid for program services, employees and suppliers (4,222,928) (3,825,522)
Cash paid for interest (566) (982)
Net cash-provided by operating activities 87,822 428,363
CASH FLOWS FROM INVESTING ACTIVITIES:
Purchases of property and equipment (89,309) (22,650)
NET CHANGE IN CASH AND CASH EQUIVALENTS (1,487) 405;713
CASH AND CASH EQUIVALENTS, Beginning of year 657,598 251,885
CASH AND CASH EQUIVALENTS, End of year $ 656,111 S 657,598
RECONCILIATION OF CHANGE IN NET ASSETS TO NET
CASH PROVIDED BY OPERATING ACTIVITIES:
Change in net assets $ 100,356 $ 182,088
Adjustments to reconcile change in net assets to
net cash provided by operating activities:
Depreciation 46,727 60,785
Change in assets and liabilities:
Decrease in receivables 88,640 95,029
(Increase) decrease in prepaid expenses 3,201 (7,703)
(Increase) in security deposits - (3,125)
Increase in accounts payable 31,279 . 18,713
Increase (decrease) in accrued expenses and grant advance (182,381) 82,576
Net adjustments (12,534) 246,275
Net cash provided by operating activities $ 87,822 $ 428,363
EXHIBI A
Pa'e t of
S -NiOR$�?RVI "Fl,S ASSQ�:IA_'i'FS�INC:_
S I AT 7L�FN I OF FUNCTIONA •B PRNM
F_OR THA,�F,}��NI?Bb MSER 30.2n11
(with Wiripargdve totals for 2010)
Case Information Multi- Neighboi to
Transportation Mamgeineut and Referral Outreach Ombudsman ERR se Neighbor
Salaries $ 51,961 $ 642,946 $ 435,814 ' $ 15,852 $ 108,281 $ 194,372 $' 7,483
Payroll taxes 3,555 49,057 35,238 1,364 7,300 14,456 604
Employee benefits 11,105 88,296 64,965 1:361 21,955 28,831 3,518
Training 417 3,574 2,967 207 537 1;406 72
Vehicle insurance - - - - - - -
Building insurance 614 7;560 5,762 359 1,259 3,474 252
Other insurance 151 1,512 1,113 64 248 471 52
Travel 965 23,073 10,760 492 4,997 5,866 313
Supplies 994 9,460 7,081 755 1;430 68,523 113
Maintenance and repairs 465 2,655 3,212 346 567 8,541 13
Occupancy 5,074. 27,616 24,417 2,783 4,602 65,170 9
Telephone 1,961 18,533 13,681 782 2,943 5,093 242
Ptinting and duplication 289 3,067 7,450 677 483 861 62
Dues and subscriptions 203 1,571 1,649 110 275 6,343 31
Advertising 505 4,438 3,953 211 727 1,681 134
Newsletter. - - 6,024 - - 3,534 -
Project expense - 167 3,337 - - 1,395 -
Postage 694 6,399 9,573 369 1,050 2,784 107
Professional services 340 3,419 2,518 146 562 1,063 118
Contactual services 2,115 23,647 20,026 1,396 3,737 7,859 386
In-kind-Personnel 35,595 44,696 286,727 1,425 13,551 106,858 6,343
Small fixtures 20 167 130 7 27 1,885 5
Interest - - - - - 526 -
Miscellaneous 527 5,372 3,914 229 874 2,097 182
Volunteer expenses 4,936 - - - - - 993
Omni funded client services - 4,405 - - - 846 -
Client services 22,129 94,511 - - - 3,194 -
Activity trips - - - - 28,276 -
Title III-b(e) - 1,095 - - - -
Other expenses - - 73 - - 884
Total before depreciation 144,815 1,067,236 970,384 28,935 175,425 566,289 21,032
Depreciation 9,916 9.992 6,521 316 1,615 2,672 139
Total functional expenses $ 154,731 $ 1,077,228 $ 976,905 $?9,251 $ 177,040 $ 568,961y $ 21,171
EXHIBIT 4
1'aBe.�-af.2
SENLO.��EE.YliaF�ASS�L'IA:1�S_.INS«
4rTAIEMEMOF FLI M' xPl3>yS
E08TI�YrAS pNn n SEM-MBER-30 XU
fx�ths�ml�rnriYe�osals�ut�41U1
Elder Deli Senior Management 2011 2010
Abuse Services Contpanlon _ RS.V.P. and General Fundraising Total Total
Salaries $ 255,825 $ 11,465 $ 72,996 $ 47,264 $ 591,965 $ 2,367 $ 2,458,591 $ 2,356,514
Payroll taxes 19,962 872 5.479 3,994 45,226 162 187,269 162,353
Employee benefits 32,955 1 8,328 4,876 82,371 46 348,608 262,553
Training 4,297 1 417 237 3,826 - 17,958 7,075
Vehicle insurance - - - - - - - 6,854
Building insurance 2,991 - 726 391 7,154 - 30,742 19,665
Other insurance 586 - 150 127 1,404 - 5,878 9,537
Travel 10,154 134 3,351 1,638 20,004 914 82,661 78,783
Supplies 3,379 17,928 1,231 88 13,693 - 124,695 105,539
Maintenance and repairs 009 830 170 11 3,391 21,510 16,770
Occupancy 11,224 749 3,207 23 31,091 - 175,965 169,874
Telephone 9,082 283 1,628 1,158 17,413 - 72,799 50,449
Printing and duplication 1,078 54 448 232 4,009 525 19,235 16,947
Dues and subscriptions 651 49 151 34 2,020 - 13,087 11,265
Advertising 1,719 190 491 168 4,299 - 18,516 22,679
Newsletter - - - - 1,634 - 11,192 15,545
ProJectexpense - - - - 972 - 5,871 63,523
Postage 2,496 162 804 390 7,111 130 32,069 38,853
Professional services 1,328 - 338 316 3,174 - 13,322 16,585
Contractual services 9,002 522 2,125 784 27,489 - 94,088 101,397
In-kind-Personnel 16,065 6,915 108.353 .4,297 111,845 - 742,670 741,441
Small fixtures 64 - 22 - 295 - 2,622 840
Interest - - - 40 - 566 982
Miscellaneous 2,064 524 404 5,005 27 21,219 13,194
Volunteer expenses - - 704 24,982 1,233 43,164 76,012 65,737
Grant funded client services 2,029 - - - 3,253 - 10,533 13,710
Client services 9,237 - 1,683 - 66,178 - 196,932 237,014
Activity trips - - - 328 2,138 50 30,792 48,146
Title 111-b(e) - - - 723 - 1,818 2,556
Other expenses - - - - 83 - I,040 2,024
Total before depreciation 397,497 40,155 213,326 91,742 1,054,039 47,385 4,818,260 4,658,404
Depreciation 3,554 519 1,580 _ - 9,903 - 46,727 60,785
Total functional expenses $ 401,051 $ 40,674 $ 214,906 $ 91,742 $ 1,063,942 $ 47,385 $ 4,864,987 $ 4,719,189
SENIOR SERVICES ASSOCIATES, INC.
NOTES TO FINANCIAL STATEMENTS
SEPTEMBER 30,.2011 AND 2010
(1) SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES:
Senior Services.Associates, Inc. (the Organization) .is.an Illinois non-profit corporation. The
Organization is.dedicated to sustaining:and improving the quality of life for mature adults throughout
'Kane, .Kendall, and McHenry Counties by providing access to the social services they need. The
Organization.is dedicated-to preserving independence, promoting mental and,physical well being, and
protecting the rights and.dignity of mature adults.
The -financial statements -were :available -to be issued on January 25, 2012, with subsequent
:events being.evaluated through this date.
The following.is a brief-summary of the_accounting policies adopted by the Organization:
Accounting Method-
The records.of the Organization are maintained and the financial statements have been prepared
on the accrual:basis of accounting.
Property and Eg ipment-
Propert;J and equipment is recorded at .cost or, if donated, at fair market value on the date
donated. The Organization generally-capitalizes additions of$500 or more. Depreciation is computed
using the straight-line method over the estimated.useful lives of the assets as follows:
Asset Type Life
Buildings 15 - 25 Years
Furniture, fixtures and equipment 5 - 10 Years
Vehicles 5 - 10 Years
Building improvements 10- 25 Years
Allocation of-Expenses -
Expenses are allocated to the various programs either directly as incurred and applicable or by a
percentage of staff time spent within each program area.
Credit Risk-
Financial instruments which potentially subject the Organization to concentrations of credit risk
consist principally of cash. The Organization places its cash and deposits with high credit quality
financial institutions; however, de posits may exceed the federally insured limits from time to time.
Cash and Cash Equivalents -
For purposes of the statement of cash flows, the Organization considers all highly liquid
instruments with an initial maturity of three months or less to be cash equivalents.
- 2 -
(1) SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: (Continued)
Restricted Resources-
Contributions that are restricted by the donor are reported as increases in unrestricted net assets
if-the restrictions expire in the reporting period in which the revenue is recognized. All other donor-
restricted contributions received are reported as increases in temporarily restricted or permanently
restricts.support, depending on the existence-and/or nature of any donor restrictions. When a donor.
restriction expires, :that is, when a stipulated-time restriction ends or the purpose of the restriction is
accomplished, temporarily restricted net assets are reclassified to unrestricted-net assets and reported in
the statement of activities as net.assets released from restrictions.
The Organization reports gifts of.land, buildings, and equipment as unrestricted support unless
explicit donor stipulations specify how the donated assets must be used. Gifts of long-lived assets with
explicit restrictions that specify how the assets are to be used and gifts of cash or other assets that must
be used to .acquire long-lived assets are reported as restricted support. Absent explicit donor
stipulations about how long those long-lived assets must be maintained, the Organization reports
expirations of donor restrictions when the donated or acquired long-lived assets are placed in service.
Estimates -
The Organization prepares its financial.statements according to accounting principles generally
accepted in the United States of America which require the use of estimates and assumptions that affect
certain reported amounts and disclosures. Actualresults could differ from those estimates.
Bad Debts -
The Organization utilizes the direct write-off method for bad debts. Significant losses are not
.anticipated from the present receivable balance.
Advertising -
Advertising expenses are charged as incurred. Advertising expenses for September 30, 2011
and 2010 were$18,516 and$22,679, respectively.
Comparative Information-
The financial statements included certain prior-year summarized comparative information in
total but not by net asset class. Such information does not include sufficient detail to .constitute a
presentation in conformity with generally accepted accounting principles. Accordingly, such
information should be read in conjunction with the Organization's financial statements for the year.
ended September 30, 2010, from which the summarized information was derived.
(2) LINE OF CREDIT: -
At September 30, 2011, the Organization has available a $300,000 line of credit due in
February, 2012. Interest is at prime and the line is secured by the Organization's assets. The
Organization has no outstanding balance on the line of credit as of September 30, 2011 and 2010.
(3) TAX-EXEMPT STATUS:
The Organization has been determined by the Internal Revenue Service_to be-exempt from
federal income.taxes under Section-501(c)(3) of the Internal Revenue Code. Accordingly, no provision
far income�tax has been-established.
The Organization files income tax returns'in:the"U.S. federal jurisdiction and Illinois. With few
.exceptions, the Organization.is no longer subject to U:S.federal, state and local, or non-U.S. income tax
examinations-by tax,authorities for years before 2007. 'The Organization does not expect a material net
changedn unrecognized:tax-benefits in-the next twelve months.
(4) COMMITMENTS:
The Organization is leasing additional office-space under operating leases that expire at various
.dates through December, 2016. .Rent expense for the.years ended September-30,2011 and 2010 was
-$125,113'and'$123,096, respectively.
The Organization also .leases office equipment .under operating leases that .expire at various
dates through November, 2015. Rent expense for the years:ended September-30,'201 l and 2010 was
:$20;495 and$10;559, respectively.
Future minimum rental commitments as of September:30, 2011 areas follows:
2012 $ 111,835
2013 '77,174
2014 66;576
2015 62,925
-2016 :58,820
Thereafter 14,679
392-OQ�
(5) IN-KIND CONTRIBUTIONS AND EXPENSES:
Certain contributed services and expenses have been recorded, based upon their estimated fair
market value, on the date of-contribution as.follows:
2011 2010
In-kind contributions 742.670 7Q-
In-kind expenses:
Personal services Q 74 44
-4-
(6) PROFIT-SHARING PLAN:
The Organization has a.defined contribution profit-sharing plan (401(k)) covering all full-time
employees who have met certain service requirements. The plan provides for discretionary matching
contributions up to 3% of-the employee's salary by the Organization, up to a maximum amount
permitted under the Internal Revenue Code. The profit-sharing expense for the years ended
September 30,2011 and 2010 is $42,835 and $41,098, respectively.
(7) CONCENTRATION OF GRANTS:
The Organization received approximately 57% of its total public support and revenue from-a
grant from Northeastern Illinois Area on Aging and Illinois Department on Aging for the years ended
September 30, 2011 and 2010.
Dugan Lopatka
Certified Public Accountants&Consultants
A Professional Corporation
Michael J.Dugan 104 East Roosevelt Road T.*ettFlickinger
Terry L.Lopatka Wheaton,Illinois 60187, Karen M:Olson
Mark R-Schultz (630)665-4440 Hugh E.Elliott
-Peter J.zich Fax(630)665-5030
James P.Hofner
Leo M.Misdom www.duganlopatka.com
e-mail:info®duganlopatka.com Gwen S.He
:INDEPENDENT AUDITOR'S REPORT
ON INTERNAL CONTROL OVER FINANCIAL:REPORTING
AND ON COMPLIANCE AND OTHER MATTERS BASED ON AN
AUDIT OF FINANCIAL STATEMENTS PERFORMED'IN ACCORDANCE
WITH GOVERNMENT A UDIFENG.STANDARDS
To the Board of Directors of
Senior Services Associates, Inc.:
We have.audited the financial:statements of Senior:Services Associates, Inc. (the Organization)
as of and for the year-ended September.30, 2011,and have issued our report thereon dated January 25,
2012. We.conducted our.audit in:accordance-with auditing standards,generally accepted in the United
States of America and the standards:applicable to financial.audits contained in Governmental Auditing
Standards, issued by the Comptroller General of the United States.
Internal Control Over Financial Reporting
In planning and-performigg our .audit, -we considered-the Organization's .internal control over
financial .reporting as a''basis for designing our -auditing procedures for.the .purpose of:expressing our
opinion on the financial statements,.but not for-the purpose of expressing an:opinion on the effectiveness of
the Organization's internal control over financial reporting. Accordingly, we.do not express an opinion on
the effectiveness of the Organization's internal control over financial reporting.
A deficiency in internal control exists when the design or operation of a control does not allow
management or employees,-in the normal course of performing their assigned functions,-to prevent or detect
and correct misstatements on a timely basis. A-rnaserial weakness is a deficiency, or:a combination of
deficiencies, in internal control such that there is.a reasonable possibility'that a material misstatement of the
entity's financial statements will not be prevented, or detected and corrected on-a timely basis.
Our consideration of internal control over financial reporting was for the limited purpose described
in the first paragraph of this section and would not necessarily identify.all deficiencies in internal control
over financial reporting that might be deficiencies, significant deficiencies or material weaknesses. We did
not identify any deficiencies in internal over financial reporting that we consider to be material weaknesses,
as defined above.
APFILI ATE
Independent Auditor's Report
on Internal Control Over Financial Reporting and
on Compliance-and Other Matters Based on an
Audit of Financial Statements Performed in
Accordance with Government Auditing Standards
Page two
Compliance and Other Matters-
As part of obtaining reasonable assurance about whether the Organization's financial statements.are
free of material misstatement, we performed tests of its compliance with certain provisions of-laws,
regulations, contracts, grant agreements, noncompliance with which could have a direct and material effect .
on the determination of financial statement amounts. However, providing an opinion on compliance with
those provisions was not an objective of our audit and, accordingly, we do not express such an opinion.
The results of our tests disclosed no ins== of noncompliance-or other matters that are required.to..be
reported under Government Auditing Standards.
This report is intended solely for the information and use of the Board of Directors, mamgement, 1
others within the Organization and federal awarding agencies and pass-through entities and is not intended
to be used by anyone other than these specified parties.
D GAN&LOPATKA
Wheaton, Illinois
January.25, 2012
Dugan, Lopatka
Certified Public Accountants.&Consultants
kProfessional Corporation
Kchael J.Dugan 104 East Roosevelt Road T.Brett Flickinger
Jerry.L.Lopatka Wheaton,Illinois 60187 Karen M.Olson
Mark F.Schultz. (630)665440 Hugh E.Elliott
Peter J.Zich Fax(630)665-5030 James P.Hofner
Leo M.Misdom www.duganlopatka.com
-e-mail:info@duganlopatka.com Gwen S.Henry
.INDEPENDENT AUDITOR'S REPORT
ON COMPLIANCE WITH REQUIREMENTS THAT
COULD HAVE A DIRECT AND MATERIAL EFFECT ON-EACH
MAJOR:PROGRAM.AND.INTERNAL CONTROL OVER
COMPLIANCE IN ACCORDANCE WITH OMB CIRCULAR A-133
To:the Board of.Directors of
Senior:Services Associates, Inc.
Campliance-
We -have audited :Senior Services Associates, Inc.'s (the Organization) compliance with the
types of compliance requirements described in OMB Circular A-133 Compliance Supplement that could
have,a direct and.material-effect on each of the Organization's major federal_programs for the.year
.ended September 30, 2011. The Organization's.major:federal programs.are identified in the summary
of auditor's results section of-the-accompanying schedule of findings and questioned costs. Compliance
with the.requirements of laws, regulations, contracts and grants applicable to each of its major federal
programs is the responsibility of the Organization's management. Our responsibility is to express an
opinion on the Organization's compliance based on our audit.
We conducted our-audit of compliance in accordance with auditing standards generally accepted
in the United States of America; the standards applicable to financial audits contained in Government
Auditing:Standards, issued by the Comptroller General of the United.States;:and OMB Circular A-133,
Audits of States, Local Governments, and .Non-Profit Organizations. Those .standards and OMB
Circular A-133 require that we plan-and perform the audit to obtain-reasonable assurance,about whether
noncompliance with the types of compliance requirements referred to above that could have.a direct,and
material effect on a major federal program occurred. - An audit includes examining, on a test basis,
evidence about :the Organization's compliance with .those requirements and..:performing such other
procedures as we.considered necessary in _the circumstances. We believe that our audit provides a
:reasonable basis for our opinion. Our audit .does not provide a legal determination on the
Organization's compliance with those requirements.
In. our opinion, the Organization complied, in all material respects, with the compliance
requirements referred to above that could have a direct and material effect on each of its major federal
programs for the year ended September 30; 2011.
AFFILIATE
1 .\ 1 'R .A T
Independent Auditor's Report
on Compliance with Requirements That Could
Have a Direct and Material Effect on Each Major
Program and Internal Control over Compliance
in Accordance with OMB Circular A-133
Page two
Internal Control Over Compliance -
Management of the Organization is responsible for establishing and maintaining effective
internal control over compliance with requirements of laws, regulations, contracts and grants applicable
to federal programs. In planning and performing our audit, we considered the Organization's-internal
control over compliance with requirements that could have a direct and material effect on a major
federal program in order to determine our auditing procedures for the purpose.of expressing our
opinion on compliance and to test and report on internal control over compliance in accordance with.
OMB Circular A-133, but not for the purpose of expressing an opinion on the effectiveness of internal.''
control over compliance. Accordingly, we do not express an opinion on the effectiveness of-.the .
Organization's internal control over compliance.
A deficiency in internal control over compliance exists when the design or operation of a control
over compliance does not allow management or employees, in the normal course of performing their
assigned functions, to prevent, or detect and correct, noncompliance with a type of compliance requirement
of a.federal.program on a timely basis. A material weabie-si in internal control over compliance is a
deficiency, or combination of deficiencies, in internal control over compliance, such that there is a
reasonable possibility-that material noncompliance with.a.We of compliance requirement of a federal
program will not be prevented, or detected and corrected on a timely basis.
Our consideration of internal control over compliance was for the limited purpose described in the
first paragraph of this section and was not designed to identify all deficiencies in internal control over
compliance that might be deficiencies, significant deficiencies or material weaknesses. We did not identify
any deficiencies in internal control over compliance that we consider to be material weaknesses, as defined
above.
This report is intended solely for the information and use of the Board of Directors, management,
others within the Organization and federal awarding agencies and pass-through entities and is not intended
to be and should not be used by anyone other than those s=ified parties.
D AN & LOPATKA
Wheaton, Illinois
January 25, 2012
EXHIBIT 5
Page 1 of 2
SENIOR SERVICES ASSOCIATES, INC.
SCHEDULE OF EXPENIATUR..ES OF FEDERAL AWARDS
FOR THE YEAR ENDED SEPTEMBER 30 2011
Federal Total
CFDA Program
Program Title Pass Through Agencies kWhber Expenditures
Department of Health and Human Services -
Special Programs for the Aging Title III,
Part B - Grants for Supportive Services
and Senior Centers Northeastern Illinois Area Agency on Aging 93.044 $ 698,087*
Special Programs for the Aging Title VII;
Chapter 3 Prevention of Elder Abuse;
Neglect, and Exploitation Northeasterri Illinois Area Agency on Aging 93.041 30,632
Special Programs for the Aging Title III,
Part D - Disease Prevention and Health
Promotion Services Northeastern Illinois Area Agency on Aging 93.043 9,884
National Family Caregiver Support,
Title III, Part E Northeastern Illinois Area Agency on Aging 93,052 133.932
Total Department of Health and
Hume n Services 872;535
Corporation for National and Community Service -
Retired Senior Volunteer Program 94.002 49;385
Department of Energy -
ARRA - Energy Efficiency and Conservation
Block Grant City of Elgin 81.12$ 6.000
TOTAL 2 20
*A/loinr 1)rnnrom
EXHIBIT 5
Page 2 of-2
SENIOR SERVICES ASSOCIATES, INC.
NOTES TO SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS
FOR THE YEAR ENDED SEPTEMBER 30, 2011
Note A - Basis of Presentation:
The accompanying schedule of expenditures of federal awards includes the federal grant activity
of Senior Services Associates, Inc. and is presented on the accrual basis of accounting. The information
in this schedule is presented in accordance with the requirements of OMB Circular A-133, Audits of
States, Local Governments, and Non-Profs Organizations. Therefore, some amounts presented in this
schedule may differ from amounts presented in, or used in the preparation of, the basic financial
statements.
Note B - Sub-Recipients:
Senior Services Associates, Inc, did not provide any federal awards to sub-recipients during the
year ended September 30, 2011.
Note C-Non-Cash Awards:
Senior Services Associates, Inc, did not have any outstanding federal loans or.loan guarantees
or insurance at September 30, 2011, and did not receive any federal non-cash awards during the year
ended September 30, 2011.
EXHIBIT 6
SENIOR SERVICES-ASSOCIATES. INC.
SCHEDULE OF FINDINGS AND QUESTIONED COSTS
FOR THE YEAR ENDED SEPTEMBER 30 2011
Part 1: SUNMARY OF AUDIT RESULTS
1. The:auditor's.report expresses-an unqualified opinion on the financial statements of
Senior Services Associates, Inc.
2. There were no significant .deficiencies disclosed :during the audit of the .financial
'statements.
=3, No instances of noncompliance:material-to the financial statements of Senior Services
Associates, Inc. were.disclosed.during the.audit.
4. There were no significant deficiencies .disclosed during-.the audit of the.major federal
award programs.
5. The auditor's report on compliance for.the major federal award programs for Senior
Services :Associates, .Inc. expresses :an .unqualified opinion on all major federal
programs.
6. Audit findings relative -to :the major federal award programs for Senior Services
Associates,.Inc..are reported in this Schedule.
7. The programs tested as major programs included:
Special Programs for the.Aging, Title III,
Part.B- Grants for.Supportive Services
.and Senior Centers 93.044
.8. 'The threshold for distinguishing Types A and B programs was $300,000.
9. Senior Services Associates,-Inc.-was determined to he a low-risk auditee.
Part 2: •FINDINGS FINANCIAL STATEMENTS AUDIT (GAGAS)-
None:
There were no audit findings or questioned costs.
Part 3: AUDIT FINDINGS AND QUESTIONED-COSTS (MAJOR PROGRAMS CIRCULAR A-133) -
None:
There were no audit findings or questioned costs.
EXHIBIT 7
SENIOR SERVICES ASSOCIATES, INC.
SUMMARY SCHEDULE OF PRIOR AUDIT FINDINGS
FOR THE YEAR ENDED SEPTEMBER 30, 2011
Summary of Prior Audit Findings -
There were no prior audit findings reported.
�chedulG I
a e I of 2
SBI�t OR SERVICES ASSOCIATES.INC.
SCHEDULE OF PUBLIC SUPPORT AND REVENUE
FOR THE YEAR ENDFD SEPTEMBER 30.2011
1 ANE COUNTY
Case Information Neighbor to Elder
Transportation .Management and Referral Outreach Ombudsman Multi-Purpose Neighbor Abuse
PUBLIC SUPPORT:
Northeastern Illinois Area on Aging $ 19,832 $ 114,j06 S 279,164 S 16,924 S 53,388 $ 133,170 S - S 222,036
Illinois Department on Aging - 801,957 - - 537 -
Grants - 22,592 12,800 - 23,000 14,000 6,000
United Way 36,965 45,611 3,000 5,250 109 - 5,250
Counties,townships,and cities - 15,500 2$,510 - 52,550 -
roundations - - -
Doirations - - - 2,401 - 14,480
In-kind contributions 7,485 44,190 25,252 902 9,808 39,837 6,391 11,544
Miscellaneous - - - - 75 - -
Total public support 27;317 1,035,510 391,337 14,826 68,446 251,679 20,391 259,310
REVENUE:
Transportation - - - - -
Activities - 41,304 _
Trip commissions
Membership dues - 6,717 1 -
Fundraising 7,807 - 4,567 20,472 - - 16,492
Project income - 14,339 - - 1,038 -
Newsletter - - 5,121 - - - -
Miscellaneous - 213 983 - Boo 4,794 800
Total revenue 7,807 213 31,727 - 21,272 46,099 1,038 17,292
Total public support and revenue 35,124 1,035,723 423,064 14,826 89,718 297,778 21,429 276,602
Rme
SENIOR SERVICES ASSOCLA'I'rg INC
SCIIEDULE OF PUBLIC SUPPORT AND REVENUE
1=QR'P11E YEAR ENDEl7 gL•P'1"EMBER 30 201 l
KANE Q QUN*rY
Senior
Fundtaising Deli Services Companion R.S.V.P. Total
PUBLIC SUPPORT:
Northeastern Illinois Area on Aging $ - S $ $ - S 832,820
Illinois Department on Aging - - - 802,494
Grants - 2,400 - 90,792
United Way - - 96,185
Counties,townships,and cities - - - - 96,560
Foundations - 22,473 - 22,473
Donations - - 16,881
In-kind contributions - - 19,160 164,569
Miscellaneous - - 75
Total public support - 44,033 - 2,112,849
REVENUF:
Transportation _ _ _ -
Activities - 41,304
Trip Commissions - -
Mernbership dues - - 6,718
Fundraising 17,373 66,711
Project income - - - 15,377
Newsletter _ _ - 5,121
Miscellaneous - - 7,590
Total revenue 17,373 142,821
Total public support and revenue 17,373 44,033 2,255,670
S,�che_dul�3
Pike I of 2
SENIOR SERVICES ASSOCIATES,INC.
SCHEDULE OF FUNCTIONAL EXPENSES
FOR THE YEAR ENDED SEPTEMBER 30 2011
Case Information Neighbor to Elder
Transportation Management and Referral Outreach Ombudsman Multi-Pulpose Neighbor Abuse
Salaries $ 18,103 $ 616,244 $ 252,226 $ 8,195 $ 51,375 $ 69,232 $ 7,540 $ 173,375
Payroll taxes 1,494 46,944 26,192 739 3,517 5,057 609 13,554
Employee benefits 4,387 82,804 34,555 411 10,112 10,022 3,545 21,452
Training 209 3,422 1,766 111 319 354 73 2,519
Vehicle insurance - - - - - -
Building insurance 134 7,025 3,584 135 757 1,037 254 1,990
Other insurance 39 1,413 682 23 150 98 52 388
Travel 65 17,000 4,047 269 2,880 2,103 315 6,894
Supplies 96 7,830 3,770 249 726 32,315 114 1,876
Maintenance and repairs 168 1,688 1,492 134 216 2,307 13 671
Occupancy 688 20,063 12,611 1,306 2,292 44,063 9 6,410
Telephone 184 13,868 7,278 330 1,510 1,358 244 6,089
Printing and duplication 46 2;540 3,987 324 267 229 62 655
Dues and subscriptions 60 1,122 941 35 128 3,774 31 357
Advertising 100 3,655 1,869 60 388 437 135 1,004
Neivsletler - - 2,845 - 3,800 - _
Project expense 277 4,094 - - 1,500 - -
Postage 80 4,642 6,107 139 493 860 108 1,276
Professional services 98 3,195 1,541 52 340 221 119 878
Contractual services 461 23,155 13,223 798 2,351 2,533 389 6,111
In-kind-Personnel 7,485 44,190 25,252 902 9,808 39,838 6,391 11,544
Small fixtures 3 122 59 2 13 1,976 5 33
Interest - - - - - 2139 - -
Miscellaneous 136 5,079 2,408 83 530 318 183 1,371
Volunteer expenses - - - - - - 1,000 -
Grant funded client services - 4,293 255 - 1,845
Client services 714 84,481 - - 2,961 6,890
Activity trips - - - 6,032 - -
Title Ill-b(e) - - - -
Other expenses - - 90 - - -
Total before depreciation 34,840 995,052 404,619 14,297 88,172 232,969 21,191 267,182
Depreciation 279 10,001 3,472 200 718 1,018 140 2,554
Total functional expenses 35,119 1,005,053 408,091 14,497 88,890 233,987 21,331 269,736
Change in net assets $ 5 $ 30,670 $ 14,973 $ 329 $ 928 S 63,791 $ 98 $ 066
!k edulc Z
Lgge 2 of 2
SENIUR SERVICES ASSUCl/1'fES.INC.
SCHEDUL L:OF FUNCTIONAL EXPENSES
FOR TIME YEAR ENDED SEPTEMBER 30.2011
KANE CO�L�I7-Y
Senior
fundraising Deli Services Companion MN.P. Total
SalFlries $ 723 $ - $ 19,271 $ - $ 1,216,284
Payroll taxes 51 - 1,463 93,620
Employee benefits 22 12 167,322
Training - 140 8,913
Vehicle insurance - - -
Building insurance - 15,016
Other insurance - - 21845
Travel 285 1,475 35,333
Supplies - - 132 - 47,108
Maintenance and repairs - - 6,689
Occupancy - 87,442
Telephone - - - 30,861
Printing and duplication 102 8,212
Dues and subscriptions - - 6,448
Advertising 7,648
Newsletter - 6,645
Project expense - - 5,871
Postage 130 13,835
Professional services - 6,434
Contractual services - - - 49,021
In-kind-Personnel - 19,160 164,570
Small fixtures - - 2,213
Interest - - 289
Miscellaneous 27 - - 10,135
Volunteer expenses 18,102 - 360 - 19,462
Grant lLnded client services - - - 6,393
Client services - 95,046
Activity trips 50 6,082
Title Ill-b(e) - -
Other expenses - _ _ _ 90
Total before depreciation 19,390 42,115 2,119,827
Depreciation - 519 18,901
Total tLnclional expenses 19,390 42,634 2,138,728
Change in net assets $ 2,017) $ - $ 1,399 $ _ $ 116242 42
Schedule 3
Page I of 2
SENIOR SERVICES ASSOCIATES.INC.
SCkEVULLE OF PUBLIC StjPPORT AND REVENUE
FOR THE YEAR ENDED SEPTEMBER 30.2011
MCHENRY COUNTY
Case Information Neighbor to Elder
Transportation Management and Referral Outreach Ombudsman Multi-Purpose Neighbor Abuse
PUBLIC SUPPORT:
Northeastern Illinois Area on Aging $ 25,169 S 54,475 S 146,994 $ 6,100 $ 25,454 $ 3,501 S $ 1 13,438
Illinois Department on Aging - 429,020 - - - - -
Gmnts 7,500 - 10,759 - - - -
tjnited Way - 17,475 7,629 3,022 12,236 296 -
Counties,townships,and cities 11,890 73,200 184,398 - 18,561 104,260 - 25,815
Foundations - - - - - 10,000
Donations 481 - - - - 5,330 -
In-kind contributions 30,365 24,260 309,314 361 3,788 55,257 5,682
Miscellaneous - - - - - -
Total public support 75,405 598,430 659,094 9,483 60,039 168,644 - 154,935
REVENUE:
Transportation 6,401 - -
Activities - - - 58,474 -
Trip commissions - -
Member3hip dues - - 71737
Fundraising - - - 8,179 -
Project income - 5,689 8,812 - - - - 125
Newsletter - - 965 - -
Miscellaneous - - - 5,558 -
Total revenue 6,401 5,689 9,777 - 8,179 71,769
Total public support and revenue 81,806 604,119 668,871 9,483 68,218 240,40 - 155,060
Schedule 3
Page 2 ore
SENIQRSERVICES ASSOCIATES.INC.
SCHEDULE OF PUBLIC SUPPORT AND REVENU-l•;
FOR THE YEAR E•NDLD SHPTgMW.R 3 ,-ZQI I
MCHENRY CS-UNEX
Senior
Fundraising Deli Services Companion R.S.V.P. Total
PUBLIC SUPPORT:
Northeastern Illinois Area on Aging $ $ $ $ - $ 375,131
Illinois Department on Aging - - 24,868 453,888
Grants - 3,500 49,835 71,594
United Way - 5,700 - 46,358
Counties,townshipS,and cities - - 30,253 13,034 461,411
Foundations - - - 10,000
Donations - - 250 6,061
hi-kind contributions - 73,204 4,419 506,650
Miscellaneous - - - -
Total public support - 112,657 92,406 1,931,093
REVENUE:
Transportation - - - 6,401
Activities 58,474
Trip conu»issions - -
Mcrnbership dues - 7,737
Fundraising 19,549 21,000 - 48,728
Project income - 476 95 15,197
Newsletter - - - 965
Miscellaneous - 8 - 5,566
Total revenue 19,549 21,484 95 143,068
Total public support and revenue 19,549 - 134,141 92,501 2,074,161
Schedule 4
Pin I oft
SENIOR SERVICES ASSOCIATES INC.
SCHEDULE OF FUNCTIONAL EXPENSES
FOR THE YEAR ENDED SEPTEMBER 30,2011
MCk1ENRY COUNTY
Case Information Neighbor to Eider
Transportation Management and Referral Outreach Ombudsman Multi-Purpose Neighbor Abuse
Salaries $ 34,499 $ 349,962 S 237,513 $ 5,286 $ 4$;728 $ 78,339 $ $ 97,095
PNyio11 taxes 2,077 26,356 1 8,161 451 3,198 5,720 7,476
Eriiployce benefits 6,448 53,399 M,854 611 9,828 10,172 14,476
Tiaining 181 1,812 1,437 55 163 684 - 1,765
Vehicle insurance - - - - - - -
Building insmance 555 4,200 2,826 138 406 1,591 1,083
Othei insurance 114 836 554 26 78 212 212
Travel 349 16,918 7,649 167 2,033 2,484 - 3,777
Supplies 734 5,4j5 3,621 170 509 35,137 1,374
Maintenance and repairs 113 1,960 1,683 139 304 5,906 663
Occupancy 2,639 21,913 15,420 862 2,330 17,873 5,940
Telephone 1,246 13,373 6,171 290 1,147 2,342 - 3,541
Ptinting and duplication 246 2,012 3,276 56 189 386 468
Dues and subscriptions 104 953 707 36 99 2,166 255
Advertising 367 2,682 1,801 83 251 681 696
Newsletter -
Project expense - - - - -
Postage 605 4,420 4,860 138 414 1,122 1,166
Professional set vices 258 1,889 1,254 59 177 480 480
Contractualsetvices 1,630 12,579 8,205 383 1,142 3,612 - 3,245
In-kind-Personnel 30,365 24,260 309,314 361 3,786 55,257 - 5,682
Small6xtures 18 133 89 4 12 34 - 34
Interest - - - - - 20j - -
Miscellaneous 399 2,919 1,937 91 274 1,146 - 741
Volunteer expenses 5,439 - - - - - -
Grant funded client services - 3,018 - 6M 467
Client services 126 47,588 - 473 3,136
Activity trips - - - - 16,769 -
Title 111-b(e) -
Otherexpenses - - __ - 600 -
Total before depreciation 88,512 598,607 663,808 9,400 75,070 244,043 153,766
Depreciation 419 5,367 2,953 80 838 1,157 - 1,257
Total functional expenses 88,931 603,974 666,761 9,480 75,908 245,200 - 155,023
Change in net assets $ (7,125) $ 145 $ 2,110 $ 3 $ (7,690) $ (4,787) $ - $ 37
Schedu_I�4
Page
SENIOR SERVICES A1%2Q 1,TF_S,-1N1_Q�
SCHEDULE OF FUNCTMAL EXPENSES
rOR THE YEAR ENDEQ SrPTEM91-'_R 3Q-ZO- .
MCHENRY COUNTY
Senior
Fundraising Deli Services Companion R-S.V.P. 'Total
Salaries $ 11135 $ $ 49,470 $ 48,601 S 950,648
Payroll taxes 77 3,685 4,107 71,308
Employee benefits 24 8,238 5,014 144,064
Training - 252 244 6,593
Vehicle insurance - - - _
Building insurance - 664 402 11,865
Other insurance - 137 131 2,300
Travel 374 1,622 1,684 36,457
Supplies - 984 91 48,045
Maintenance and repairs 136 11 10,915
Occupancy - 3,176 24 70,177
Telephone - 1,494 1,191 30,795
Printing and duplication 332 239 7,198
Dues and subscriptions 125 35 4,480
Advertising - 441 173 7,175
Newsletter - - - 2,076
Project expense _ _ _ -
Postage - 726 401 13,846
Professional services - 309 325 5,231
Contractual services - 1,959 806 33,561
In-kind-Personnel - 73,204 4,419 506,650
Small fixtwes - 22 - 346
Interest - - _ 202
Miscellaneous - 478 415 8,400
Volunteer expenses 17,919 360 25,688 49,406
Giant funded client services - - - 4,140
Client services - 1,722 - 53,045
Activity hips - - 337 17,106
Tide III-b(e) _ _ -
Other expenses - - - - 600
Total before depreciation 19,549 149,536 94,338 2,096,629
Depreciation _ 818 12,889
Total functional expenses 19,549 150,354 94,338 2,109,518
Change in net assets $ $ $ (16,2133 $ (1,837 $ (35,357)
' Sclt u 5
Peke I of 2
SENIOR SERVICES ASSOCIATES INC
SCHEDULE OF PUBLIC SUPPORT AND REVENUE
FOR THE YEAR ENDED SEPTEMBER 30.2011
LCBN ALL UI GS NTY
Case Infoirnkion Neighbor to Elder
Transpottation Management and Refertal Oulrcach Ombudsrim i Multi-Purpose Neighbor Abuse
PUBLIC SUPPORT_
Northeastern Illinois Area on Aging 4 28,t2 $ 26,747 $ 92,644 $ 4,762 $ 10.914 $ 2,252 $ - $ 32,331
Illinois Department on Aging - 150,192 - - -
Grants 4,390 - -
United Way - - - -
Counties,townships,and cities (16) 2,023 7,933 750 10,700 72,337 -
Foundaiions - - - - - w
Donations 6,922 - 10,918 -
In-kind contributions 1,373 5,735 17,246 180 631 19,806 - 1,082
Miscellaneous - - - - -
Total public support. 29,478 189,087 124,745 5,692 24245 105,313 - 33,413
REVENUE-
Transportation 8,419 - - - - -
Activities - 15,267 -'trio commissions - - - -
Membershipdues - - - 2i308
Fundtaising 8,559 - - 4,506 - -
Project income - 2,047 940 2,643
Newsletter - - 440 - - - -
Miscellaneous - - - - 3;102 -
Total revenue 16,978 2,047 080 - - 27,826 -
Total public support and revenue 46,456 191,134 126,125 5,692 22,245 133,139 - 33,413
�c�tgdule�5_
Pa e 2 oCl
SENIOR SERVICES ASSOCIATES,INC.
SCHEDULE QF PUBLIC 5 Pl PORT ANN)REVENUE
FOR THE YFAR ENDED SFPTFMBER 30.201 l
KENDALL COUNTY
Senior
Fundraising Deli Services Companion R.S.V.P. Total
PUBLIC SUPPORC:
Northeastem Illinois Arca on Aging $ $ $ $ $ 197,771
Illinois Department on Aging - 150,192
Grants - - - 4,390
United Way -
Counties,townships,and cities 18,802 9,082 - 121,611
Foundations - - - -
Donations - - 17,840
In-kind contributions 6,915 18,483 - 71,451
Miscellaneous - - -
'Total public support 25,717 27,565 563,255
REVENUE:
Transportation - - - - 8,419
Activities - 15,267
Trip connnissions -
Mernbership dues 2,308
Fundraising 8,444 - - 21,509
Project income - 15,582 - 21,212
Newsletter - - - 440
Miscellaneous 3,102
'Total revenue 8,444 15,582 72,257
Total public support and revenue 8,444 41,299 27,565 635,512
Schedule 6
b9c l of 2
SENIOR SERVICES ASSOCIATES KC
SCHEDULE OF Fl,j_NQTIONAL EXPENSES
FOR THE YEEAR ENDED SEPTEMBER 30 201 l
KFINOALL , jUNTY
Case Informatiori 146iglrboi to Elder
Transportation Management and Referral Outreach Ombudsman Multi-Purpose Neighbor Abuse
Salaries $ 4,655 S 100,924 S 69,542 S 2,572 S 13,578 S 61,431 S S 21,668
Payroll taxes 346 8,122 4,884 191 949 4,767 1,719
Employee benefits 1,402 10,347 0,303 356 3,110 10,807 1,628
Training 70 698 438 44 82 474 613
Vehicle insurance - - - - - - -
Building insurance 108 1,322 660 91 159 1,107 335
Other insurance 13 261 130 16 32 196 - 68
Travel 649 4,378 2,107 62 333 1,721 900
Supplies 265 2,447 1,297 346 287 6,229 601
Mainicnance and repairs 231 759 766 77 75 971 158
Occupancy 2,264 3,859 1,929 650 Z10 8,139 441
Telephone 731 3,519 3,338 172 433 1,776 720
Printing and duplication 27 538 1,878 312 51 311 106
Dues and subscriptions 60 533 375 40 62 880 - 130
Advertising 89 1,029 1,180 71 124 689 259
Newsletter - 2,471 - - - -
Project expense's - - - - - -
Postage 80 1,558 779 97 195 1,012 408
Professional services 29 590 294 37 73 442 155
Contractual services 240 3,514 3,144 233 430 2,305 903
Registration and license - - - - - -
In-kind-Personnel 1,373 5,735 17,246 190 631 19,806 1,082
Small fixtures 1 23 11 1 3 17 6
Interest - - - - - 75 -
Miscellaneous 46 918 458 58 114 791 240
Volunteer expenses - - - - - -
Client services 23,545 24,796 - - - 500
Activity trips - - - 7,603 - -
Title 11I-b(e) 1,818 - - -
Otherei;penses - - - 350 - -
Total before depreciation 36,224 177,688 122,230 5,606 20,931 131,899 32,040
Depreciation 10,229 1,217 1,576 40 140 698 - 239
Total functional expenses 46,453 l78,905 123,806 5,646 21,071 132,597 32,279
Change in net assets $ T S 12,229 $ 2,319 S 46 $ 1,174 $ 542 . $ - $ 1,134
$clledule 6
Page 2 of 2
SENIORURV10ES ASSOCIATES.INC.
SCIIEDULE OF FUNCTIONAL EXPJT�SE
FOR THE YEAR,ENDEll SEPrEMI3GR 30.2011
KLNUALCOUNTY
Senior
Fundraising Deli Services Companion R.S.V.P. Total
Salaries $ 489 S 11,465 $ 5,9.35 $ $ 291,659
Payroll taxes 34 872 457 22,341
Employee benefits - 1 270 37,224
Training 1 35 2,455
Vehicle insurance - - -
Building insurance - - 79 3,861
Other insurance - - 16 732
Travel 255 134 331 - 10,870
Supplies - 17,928 143 - 29,543
Maintenance and repairs - 830 38 3,905
Occupancy - 749 105 18,346
Telephone - 283 171 11,143
Printing and duplication 525 54 24 3,826
Durs and subscriptions - 49 29 2,158
Advertising - 190 61 3,692
Newsletter - - - 2,471
Project expenses - - -
Postnge - 162 97 4,388
Professional services - - 37 1,657
Contractual scrvices - 522 215 - 11,506
Registration and license - - - -
ln-kind-Personnel - 6,915 18,483 - 71,451
Small flxtures - - I - 63
Interest - - 75
Miscellaneous - :i8 2,683
Volunteer expenses 7,143 - - 7,143
Client services - - 48,841
Activity trips - - 7,603
Title 111-b(e) - - 1,818
Other expenses - - - - 350
Total before depreciation 8,446 40,155 26,585 601,8U4
Depreciation - 519 279 - 14,937
"rota)runclional expenses 8,446 40,674 26,864 616,741
Change in net assets $ (2) $ 6_25 $ 701 $$ $ 18,771
EXHIBIT B
ASSURANCES
The SUB-RECIPIENT hereby assures and certifies that it will comply with the regulations, policies, guidelines
and requirements with respect to the acceptance and use of CDBG funds in accordance with the ACT and City of
Elgin policies. Also,the SUB-RECIPIENT certifies with respect to the grant that:
1. It possesses legal authority to make a grant submission to the City and to execute a community
development and housing program:
2. Its governing body has duly adopted or passed as an official act, a resolution, motion or similar action
authorizing the person identified as the official representative of the SUB-RECIPIENT to execute the
Agreement, all understandings and assurances contained herein, and directimg the authorization of the
person identified as the official representative of the SUB-RECIPIENT to act in connection with the
execution of the Agreement and to provide such additional information as may be required.
3. Prior to submission of its application to the City, the SUB-RECIPIENT has:
(A) Met the citizen participation requirements of 570.301(b) and has provided citizens with:
(1) The estimate of the amount of CDBG funds proposed to be used for activities that will
benefit persons of low and moderate income; and
(2) Its plan for minimizing displacement of persons as a result of activities assisted with
CDBG funds and to assist persons actually displaced as a result of such activities:
(B) Prepared its application in accordance with the policies of the City of Elgin and made the
application available to the public;
4. The grant will be conducted and administered in compliance with:
(A) Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352 42 U.S.C. Sec 2000d et seq.) and
implementing regulations issued at 24 CFR Part 1;
(B) Title VIII of the Civil Rights Act of 1968 (Pub. L. 90-208), as amended; and that the SUB-
RECIPIENT will administer all programs and activities related to housing and community
development in a manner to affirmatively further fair housing;
(C) Section 109 of the Housing and Community Development Act of 1974, as amended; and the
regulations issued pursuant hereto;
(D) Section 3 of the Housing and Urban Development Act of 1968, as amended:
(E) Executive Order 11246-Equal Opportunity, as amended by Executive Orders 11375 and 12086,
and implementing regulations issued at 41 CFR Chapter 60;
(F) Executive Order 11063-Equal Opportunity in Housing; as amended by Executive Order 12259,
and implementing regulations at 24 CFR Part 107;
(G) Section 504 of the Rehabilitation Act of 197') (Pub. L. 93-112), as amended, and implementing
Page 11 of 16
i
regulations when published in effect;
(H) The Age Discrimination Act of 1975 (Pub.- L. 94-135), as amended, and implementing
regulations when published for effect;
(1) The relocation requirements of Title II and the acquisition requirements of Title III of the
Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as amended,
and the implementing regulations at 24 CFR Part 42; as required under 24 CFR 570.606;
(J) The labor standards requirements as set forth in 24 CFR Part 570, Subpart K and HUD
regulations issues to implement such requirements;
(K) Executive Order 11988 relating to the evaluation of flood hazards and Executive Order 11738
relating to the prevention, control and abatement of water pollution;
(L) The flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act
of 1973 (Pub. L. 93-234);
(M) The Fair Housing Act(42 U.S.C. 3601-20);
5. Its notification, inspection, testing and abatement procedures concerning lead-based paint will comply
with 570.608.and 24 CFR Part 35; and
6. When a grant is in excess of $100,000 it will comply with all applicable standards, orders, or
requirements issued under Section 308 of the Clean Air Act (42 U.S.C. 1857(h), Section 508 of the Clean
Water Act (33 U.S.C. 1368), Executive Order 11738, and Environmental Protection Agency regulation
(40 CFR Part 15), which prohibit the use under nonexempt Federal contracts, grants or loans, of facilities
included on the EPA list of Violating Facilities. The provision shall require reporting of violations to the
City, HUD, and to the AESOP Assistant Administrator for Enforcement (EN-329).
7. It has developed its application so as to give maximum feasible priority to activities which benefit low
and moderate income families or aid in the prevention or elimination of slums or blight; (the application
may also include activities which the SUB-RECIPIENT certifies are designed to meet other community
development needs having a particular urgency because existing conditions pose a serious and immediate
threat to the health or welfare of the community, and other financial resources are not available);
8. It is following the current City of Elgin Consolidated Plan which has been approved by HUD pursuant to
570.306; and
9. It will not attempt to recover any capital costs of public improvements assisted in whole or in part with
funds provided under Section 106 of the ACT or with amount resulting from a guarantee under Section
108 of the ACT by assessing any amount against properties owned and occupied by persons of low and
moderate income, including any fee charged or assessment made as a condition of obtaining access to
such public improvements, unless: (1) funds received under Section 106 of the ACT are used to pay the
proportion of such fee or assessment that relates to the capital costs of such public improvements that are
financed from revenue sources other than under Title I of the ACT; or (2) for purposes of assessing any
amount against properties owned and occupied by low and moderate income persons, the SUB-
RECIPIENT certifies that it lacks sufficient funds received under Section 106 of the ACT to comply with
the requirements of subparagraph (1) above.
10. The SUB-RECIPIENT certifies that it will provide a drug-free workplace by:
Page 12 of 16
(A) Publishing a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession or use of a controlled substance is prohibited in the SUB-RECIPIENT'S
workplace and specifying the actions that will be taken against employees for violation of such
prohibition;
(B) Establishing a drug-free awareness program to inform employees about:
(1) The dangers of drug abuse in the workplace;
(2) The SUB-RECIPIENT'S policy of maintaining a drug-free workplace;
(3) Any available drug counseling, rehabilitation, and employee assistance programs; and
(4) The penalties that may be imposed upon employees for drug abuse violations occurring
in the workplace.
(C) Making it a requirement that each employee to be engaged in the performance of the grant be
given a copy of the statement required by paragraph (A);
(D) Notifying the employee in the statement required by paragraph (A) that, as a condition of
employment under the grant, the employee will:
(1) Abide by the terms of the statement; and
(2) Notify the employer of any criminal drug statute conviction for a violation occurring in
the workplace no later than five days after such conviction;
(E) Notifying the City of Elgin's Community Development Department within ten (10) days after
receiving notice under subparagraph (D)(2) from an employee or otherwise receiving actual
notice of such conviction:
(F) Taking one of the following actions, within 30 days of receiving notice under subparagraph
(D)(2), with respect to any employee who is so convicted:
(1) Taking appropriate personnel action against such an employee, up to and including
termination: or
(2) Requiring such employee to participate satisfactorily in a drug abuse assistance or
rehabilitation program approved for such purposes by a Federal, State, or local health;
law enforcement, or other appropriate agency;
(G) Making a good faith effort to continue to maintain a drug-free workplace through implementation
of paragraphs (A), (B), (C), (D), (E) and(F).
11. It has adopted and is enforcing a policy prohibiting the use of excessive force by law enforcement
agencies within its jurisdiction against any individuals engaged in nonviolent civil rights demonstrations.
12. In regards to lobbying,the SUB-RECIPIENTT certifies:
(A) No Federal appropriated funds have been paid or will be paid, by or on behalf of the SUB-
RECIPIENT, 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 the awarding of any Federal contract, the making of any
Federal grant, the making of any Federal loan, the entering into of any cooperative agreement,
and the extension, continuation, renewal, amendment, or modification of any Federal contract,
Page 13 of 16
i
grant, loan, or cooperative agreement.
(B) If any 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 the 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.
(C) The SUB-RECIPIENT 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 agreements) and that all sub-recipients shall certify and
disclose accordingly.
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.
Page 14 of 16
EXHIBIT C
EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION
Community Development Block Grant Program
City of Elgin
The undersigned understands and agrees that it is a SUB-RECIPIENT of the Community Development Block
Grant Program of the City of Elgin. The undersigned also agrees there shall be no discrimination against any
employee who is employed in carrying out work from the assistance received from the City of Elgin and the
Department of Housing and Urban Development, or against any applicant for such employment, because of race,
color, religion, sex, age or national origin, including but not limited to employment, upgrading, demotion or
transfer; recruitment or recruitment advertising; lay off or termination: rates of pay or other forms of
compensation, and selection for training, including apprenticeship.
The SUB-RECIPIENT further agrees to the following:
(1) It will incorporate or cause to be incorporated into any grant contract, loan, grant insurance or guarantee
involving Federally assisted construction work, or modification thereof, which is paid for in whole or in
part with funds obtained from the Community Development Block Grant program, the language
contained in HUD Equal Employment Opportunity Regulations at 42 CFR 130.15(b), in Executive Order
11246, as amended by Executive Orders 11375 and 12006, and implementing regulations issued in 41
CFR Chapter 60.
(2) It will be bound by said equal opportunity clause with respect to its own employment practices when it
participates in any Community Development Block Grant Program construction.
(3) It will assist and cooperate actively with the City of Elgin, the Department of Housing and Urban
Development and the Secretary of Labor in obtaining the compliance of contractors and subcontractors
with the equal opportunity clause and the rules, regulations and relevant orders of the Secretary of Labor.
(4) It will furnish the City of Elgin, the Department of Housing and Urban Development and the Secretary of
Labor such information as they may require for the supervision of such compliance, and will otherwise
assist the City of Elgin and the Department of Housing and Urban Development in the discharge of
primary responsibility for securing compliance.
(5) It will refrain from entering into any contract or contract modification subject to Executive Order 11246
of September 24, 1965, with a contractor debarred from or who has not demonstrated eligibility for
government contracts and federally assisted construction contracts pursuant to the Executive Order.
(6) It will carry out such sanctions and penalties for violation of the equal opportunity clause as may be
imposed upon contractors and subcontractors by the Secretary of Labor, the City of Elgin or the
Department of Housing and Urban Development.
(7) In the event that SUB-RECIPIENT fails or refuses to comply with the undertaking, the City of Elgin, or
the Department of Housing and Urban Development may take any or all of the following actions: cancel,
terminate or suspend, in whole or in part, this grant, refrain from extending any further assistance to the
SUB-RECIPIE?NiT until satisfactory assurance of future compliance has been received; and refer the case
to the Department of Housing and Urban Development for appropriate legal proceedings.
Page 15 of 16
I
SUB-RECIPIENT: Senior Services Associates, Inc.
101 South Grove Avenue,Elgin, Illinois 60120
BY:(:]j2> o_
Bette Schoenholtz, Executive birector
DATE:
r
ATTES 72 --
Page 16 of 16
ELGIN
THE CITY IN THE SUBURBS-
DATE: September 5, 2013
TO: Denise Momodu, Associate Planner
FROM: Jennifer Quinton, Deputy City Clerk
SUBJECT: Resolution Nos. 13-136 through 13-140 Adopted at the August 28, 2013, Council
Meeting
Enclosed you will find the agreement listed below. Please distribute this agreement to the other
party and keep a copy for your records if you wish. If you have any questions please feel free to
contact our office 847-931-5660 and we will do our best to assist you. Thank you.
• Resolution 13-136 Adopted Authorizing Execution of a Community Development
Block Grant Sub-Recipient Agreement with P.A.D.S. of Elgin, Inc. for
Reimbursement of Monthly Rental Costs
• Resolution 13-137 Adopted Authorizing Execution of a Community Development
Block Grant Sub-Recipient Agreement with Renz Addiction Counseling Center
for Asphalt Entrance Driveway and Parking Lot
• Resolution 13-138 Adopted Authorizing Execution of a Community Development
Block Grant Sub-Recipient Agreement with Wayside Cross Ministries for
Reimbursement of Monthly Rental Costs
• Resolution 13-139 Adopted Authorizing Execution of a Community Development
Block Grant Sub-Recipient Agreement with Well Child Center, Inc. for HVAC
Replacement
• Resolution 13-140 Adopted-Authorizing Execution of a Community Development
Block Grant Sub-Recipient Agreement with Senior Services Associates, Inc. for
Reimbursement of Monthly Rental Costs