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2020 CDBG-CV Agreement <br /> Exhibit C <br /> City of Everett <br /> Community Development Block Grant Program CARES Funds (CDBG-CV) <br /> Duplication of Benefits Reporting Form <br /> The Duplication of Benefits (DOB) Reporting form is used to assist the City of Everett in administering <br /> the Community Development Block Grant-CV to subrecipients. Forms will help to verify all funding an <br /> agency has received for COVID-19 Pandemic National Emergency in order to eliminate any duplication <br /> of benefits. You should only report on the information related to the program supported by this <br /> agreement. <br /> Instructions: <br /> Identify below all sources of active federal, state, or other public fund awards that the agency has <br /> received as a result of the COVID-19 Pandemic National Emergency to support the program within this <br /> agreement. If you received COVID-19 funds and they do not support the program receiving City of <br /> Everett CDBG-CV funds, please do not list them below. <br /> Source of Funds#1 <br /> Lender/Grant Provider Name Commerce Emergency Solutions Grant <br /> Purpose Employ 1.0 FTE Shelter Advocate and Legal Advocate, 625 hrs. of <br /> Shelter Relief Staff,$12K for Hotels Vouchers county-wide,Air Filters <br /> for Shelter and 16 Bedrooms <br /> Amount $146,506 <br /> ❑Government Loan ® Government Grant ❑Government Forgivable Loan <br /> ❑ Nonprofit Grant ❑Nonprofit Loan ❑Nonprofit Forgivable Loan <br /> ❑Private Loan ❑Other:Click or tap here to enter text. <br /> Source of Funds#2 <br /> Lender/Grant Provider Name ARPA-FVPSA <br /> Purpose 20 hrs.a week Relief Staff,Hotel Vouchers countywide,Zoom Costs, <br /> Rent Assistance,Cleaning Service Center, Racial Equity Training <br /> Amount $80,000 _ <br /> ❑Government Loan ® Government Grant ❑Government Forgivable Loan <br /> ❑ Nonprofit Grant ❑Nonprofit Loan ❑Nonprofit Forgivable Loan <br /> ❑Private Loan ❑Other: tap here to enter text. <br /> Source of Funds#3 <br /> Lender/Grant Provider Name ARPA-City of Everett <br /> Purpose Shelter Staff and Community Advocacy <br /> Amount $90,000 <br /> ❑Government Loan ® Government Grant ❑Government Forgivable Loan <br /> ❑ Nonprofit Grant ❑Nonprofit Loan ❑Nonprofit Forgivable Loan <br /> ❑Private Loan ❑O ther: :Jick or tap here to enter text. <br /> Duplication of Benefits Reporting Form <br />