Laserfiche WebLink
2022CDBG 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 />lnstructions: <br />ldentify 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 Emergencyto support the program within this <br />agreement. lf 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 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 <br />! Nonprofit Grant <br />nPrivate Loan <br />n Government Grant lGovernment Forgivable Loan <br />nNonprofit Loan nNonprofit Forgivable loan <br />nOther: Click or tap here to enter text. <br />Source of Funds #2 <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 />nGovernment Loan <br />n Nonprofit Grant <br />!Pr¡vate Loan <br />n Government Grant lGovernment Forgivable Loan <br />nNonprofit Loan lNonprofit Forgivable Loan <br />!Other: Click or tap here to enter text. <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 />IGovernment Loan <br />n Nonprofit Grant <br />nPrivate loan <br />n Government Grant nGovernment Forgivable Loan <br />nNonprofit Loan lNonprofit Forgivable Loan <br />nOther: Click or tap here to enter text. <br />Duplication of Benefits Reporting Form