5013c Application for the City of Riviera Beach Community Grant Program

Application for the City of Riviera Beach Community Grant Program

Applicant Information
Project Title:
Organization Name: *
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Person: *

First NameLast Name
Secondary Contact Person:

First NameLast Name
Email*
example@example.com
Phone Number:*
Please enter a valid phone number.
501(c)(3) Status:*

Yes, incorporated in Florida and listed on sunbiz.orgNo
Employer ID Number*
Project Overview
Project Budget: *
Amount Requested:*

Up to $3,000Up to $5,000
Project Start Date: *

MonthDayYear
Date
Project End Date: *

MonthDayYear
Date
Project Funding Sources:*
Project Summary (250 words or less): Provide a brief description of your project, its objectives, and the community need it addresses. *
Project Details
1. Project Goals
What are the specific goals of your project? (Please list up to three.) *
2. Community Benefit
Outline how your project will provide a clear public benefit to the community *
3. Community Support
Describe the support you've received from the community (e.g., letters of support, partnerships). *
4. Partnerships
Identify any partnerships you have formed or will form to leverage resources for the project. *
5.Project Implementation
Describe how you plan to implement the project, including timelines and activities. *
6.Budget
Provide a detailed itemized budget for your project, including the source of matching funds (volunteer time, in-kind donations, or financial contributions). *
7.Sustainability
Explain how you will ensure the sustainability of the project after the grant period. *
8.Maintenance Responsibility
Confirm your organization's responsibility for project maintenance post-completion.*

YesNo
Insurance Requirement
Confirm your ability to provide proof of insurance (certificate of liability)*

YesNo
Document Upload Instructions:

Applicants are required to submit all supporting materials as part of their application. Please compile the following items into one combined document before uploading:

Organizational Documentation

Verification of Nonprofit Status – Proof confirming the organization’s nonprofit designation.

Proof of Non-Discrimination Policy – A copy of the organization’s current policy ensuring equal opportunity.

501(c)(3) Determination Letter – IRS letter verifying the organization’s tax-exempt status.

Letter of Compliance or Receipt of Filing of Solicitation License – Proof of compliance with state charitable solicitation requirements.

Project Documentation

Budget – Detailed outline of projected costs and funding sources.

Certificate & Liability Insurance – Proof of current coverage naming the City of Riviera Beach as additionally insured.

Project Timeline – Schedule showing key milestones and completion dates.

Letters of Support – Statements from partners, sponsors, or community stakeholders.

Waiver, Release, and Hold Harmless Agreement – Signed acknowledgment form.

Note:

Please ensure all documents are merged into one file before uploading to complete your submission.
Supporting Documents:*

Cancelof
Misc

Cancelof
By signing below, you certify that the information provided in this application is accurate and complete to the best of your knowledge.
Authorized Signature: *

Clear
Printed Name and Title*
Date*

MonthDayYear
Date
Submission Instructions

For any questions regarding the application process, please contact the Assistant to the City Manager’s Office at lhayes@rivierabeach.org.

Thank you for your dedication to enhancing the Riviera Beach community!
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