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EMERGENCY SHELTER GRANTS PROGRAM <br /> REHABILITATION ACTIVITIES FORM <br /> 063 <br /> A separate form should be filled out for each subrecipient. See pages 1 to 3 of <br /> the Application Guidelines for discussion of eligible activities, ineligible <br /> activities and federal restrictions. Instructions for filling out this form are <br /> found on pages 10 and 11 of the guidelines. <br /> A. Name of Applicant: County of Orange (Local Government) <br /> B. Name of Shelter: Interfaith Cosumity Shelter <br /> C. Name of Organization: Interfaith Coil, Incorporated <br /> 1. Amount requested for Rehabilitation: 42,000 <br /> 2. What kind of rehabilitation is to be performed with ESGP funds? <br /> Renovation? <br /> Major Rehabilitation? <br /> Conversion? <br /> 3. Describe the rehabilitation activities to be performed with ESGP funds. <br /> There is a need to removal all asbestos material from the building being <br /> occupied by the Community Shelter in order to eliminate the health hazard <br /> associated with asbestos materials. This project is estimated to cost <br /> approximately $54,000. The ESGP contribution of $12,000 will assist Inter- <br /> faith with this project. <br /> 4. Estimate and briefly explain the impact of ESGP-assisted rehabilitation <br /> on your organization's assistance to the homeless. Please include persons <br /> served and level of service provided where possible. <br /> Meet code <br /> Improve facilities Expand services <br /> Other (specify) Elimination of Health <br /> This rehabilitation will Hazard <br /> future homeless �e the facilities available to the present and <br /> population of the County. The naval of asbestos will also <br /> eliminate a potential health hazard. <br /> 5. Do you own your facility? <br /> Lease your facility? —g <br /> Other? <br /> ESGP #113-1 (10/87) <br />