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❑ Yes E No Have a financial interest or reap a financial benefit from this <br /> activity? <br /> ❑ Yes ® No Have an interest in any contract, subcontract, or agreement with <br /> respect to this application either for themselves or those with <br /> whom they have family or business ties during the program year <br /> and for one year thereafter? <br /> Project Select the type of beneficiaries this project will address and the number of expected <br /> accomplishments. <br /> Beneficiaries ❑ Area or Spot designation ❑ Housing Units - Enter # units <br /> ® Households - Enter 25 households ❑ Jobs - Enter # jobs <br /> ❑ People - Enter # unduplicated people ❑ Public Facilities - Enter # facilities <br /> ❑ Businesses - Enter # businesses ❑ Demolition /clearance - Enter # units <br /> ❑ Planning: Outline the community benefit in a brief narrative. <br /> Use of In accordance with federal regulations, CDBG funds may not be used to directly or <br /> Contractors, indirectly employ, award contracts to, or otherwise engage the services or any <br /> contractor or Subrecipient during any period of debarment, suspension, or <br /> Consultants placement of ineligibility status. <br /> Will you hire a contractor or consultant? ® Yes ❑ No <br /> If yes, complete the following information: <br /> 1. Name of consultant /firm and owner: <br /> 2. How were they selected? <br /> 3. Is the consultant /firm already under contract with your organization? <br /> ❑ Yes ❑ No <br /> 4. Is this consultant /firm a women or minority owned business? <br /> ❑ Yes ❑ No <br /> If you are unable to complete this section at the time of application, all contracts <br /> must be reviewed for debarment before a CDBG release of funds. Contact Anoka <br /> County as soon as possible with the information. <br /> Data Describe the process for collecting beneficiary data, including who will collect it and <br /> Collection how the data will be controlled to eliminate duplicated data. <br /> Utilizing the City's utility billing financial system a listing of all residents currently not hooked <br /> up to city water will be constructed. From there, all those not hooked up, but have the ability <br /> to be hooked into the city watermain will be mailed a income qualifier survey. Of the 180 <br /> residents that were mailed a survey, 25 met the income requirements of low /moderate. <br /> These residents would be the beneficiaries of this project. <br /> 6 Anoka County CDBG Project Application <br />