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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 LFW Covid-19 Emergency Eviction Defense <br /> Purpose Eviction Defense Bridge <br /> Amount $125,000.00—fund expire 12/2021 and will not renew <br /> ❑Government Loan ❑ Government Grant ❑Government Forgivable Loan <br /> ® Nonprofit Grant 0 Nonprofit Loan El Nonprofit Forgivable Loan <br /> ❑Private Loan El Other:Click or tap here to enter text. <br /> Source of Funds#2 <br /> Lender/Grant Provider Name Click or tap here to enter text. <br /> Purpose Click or tap here to enter text. <br /> Amount Click or tap here to enter text. <br /> ❑Government Loan ❑ Government Grant ❑Government Forgivable Loan <br /> ® Nonprofit Grant 0 Nonprofit Loan ❑Nonprofit Forgivable Loan <br /> El Private Loan ❑Other:Click or tap here to enter text. <br /> Source of Funds#3 <br /> Lender/Grant Provider Name Click or tap here to enter text. <br /> Purpose Click or tap here to enter text. <br /> Amount Click or tap here to enter text. <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 /> Duplication of Benefits Reporting Form <br />