iii. october 27, 2020, 6:30 p.m. meeting with capital ......2020/10/27  · town of southborough, ma...

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Town of Southborough, MA Meeting of the Board of Selectmen October 27, 2020, 6:30 P.M. Pursuant to Governor Baker’s March 12, 2020 Order Suspending Certain Provisions of the Open Meeting Law, G.L. c. 30A, §18, and the Governor’s March 15, 2020 Order imposing strict limitation on the number of people that may gather in one place, this meeting of the Southborough Board of Selectmen will be conducted via remote participation to the greatest extent possible. Specific information and the general guidelines for remote participation by members of the public and/or parties with a right and/or requirement to attend this meeting can be found on the Town of Southborough’s website, at https://www.southboroughtown.com/. for this meeting, members of the public who wish to watch or participate in the meeting may do so in the following manner by finding the meeting at; https://www.southboroughtown.com/remotemeetings. No in-person attendance of members of the public will be permitted, but every effort will be made to ensure that the public can adequately access the proceedings in real time, via technological means. In the event that we are unable to do so, despite best efforts, we will post on Southborough’s website an audio or video recording, transcript, or other comprehensive record of proceedings as soon as possible after the meeting. I. Call Meeting to Order II. Public Comment III. Scheduled Appointments (Board may vote) a. 6:30PM Joint Meeting with Capital Planning Committee i. Review and Discussion, RE: Proposed FY22 Capital Plan ii. Discussion, RE: Proposed Capital Planning policy b. Review of latest VMUD draft for Downtown Initiative IV. Consent Agenda a. Accept $100.00 donation for Fire Department Ambulance Fund V. Other Matters Properly Before the Board (Board may vote) a. Rent & Mortgage Assistance program approval VI. Public Comment VII. Adjournment Martin Heatey, Chairman UPCOMING MEETINGS WEDNESDAY November 1, 2020 November 17, 2020

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Page 1: III. October 27, 2020, 6:30 P.M. Meeting with Capital ......2020/10/27  · Town of Southborough, MA Meeting of the Board of Selectmen October 27, 2020, 6:30 P.M. Pursuant to Governor

Town of Southborough, MAMeeting of the Board of Selectmen

October 27, 2020, 6:30 P.M.

Pursuant to Governor Baker’s March 12, 2020 Order Suspending Certain Provisions of the Open Meeting Law, G.L. c. 30A, §18, and the

Governor’s March 15, 2020 Order imposing strict limitation on the number of people that may gather in one place, this meeting of theSouthborough Board of Selectmen will be conducted via remote participation to the greatest extent possible. Specific information and the

general guidelines for remote participation by members of the public and/or parties with a right and/or requirement to attend this meeting can

be found on the Town of Southborough’s website, at https://www.southboroughtown.com/. for this meeting, members of the public who wish

to watch or participate in the meeting may do so in the following manner by finding the meeting at;

https://www.southboroughtown.com/remotemeetings. No in-person attendance of members of the public will be permitted, but every effort

will be made to ensure that the public can adequately access the proceedings in real time, via technological means. In the event that we are

unable to do so, despite best efforts, we will post on Southborough’s website an audio or video recording, transcript, or other comprehensive

record of proceedings as soon as possible after the meeting.

I. Call Meeting to Order

II. Public Comment

III. Scheduled Appointments (Board may vote)a. 6:30PM — Joint Meeting with Capital Planning Committee

i. Review and Discussion, RE: Proposed FY22 Capital Planii. Discussion, RE: Proposed Capital Planning policy

b. Review of latest VMUD draft for Downtown Initiative

IV. Consent Agendaa. Accept $100.00 donation for Fire Department Ambulance Fund

V. Other Matters Properly Before the Board (Board may vote)a. Rent & Mortgage Assistance program approval

VI. Public Comment

VII. Adjournment

Martin Heatey, Chairman

UPCOMING MEETINGSWEDNESDAY November 1, 2020 November 17, 2020

Page 2: III. October 27, 2020, 6:30 P.M. Meeting with Capital ......2020/10/27  · Town of Southborough, MA Meeting of the Board of Selectmen October 27, 2020, 6:30 P.M. Pursuant to Governor

Capital Planning CommitteeBoard of Selectmen Update – FY22 Capital Recommendations

October 27th, 2020

1

Page 3: III. October 27, 2020, 6:30 P.M. Meeting with Capital ......2020/10/27  · Town of Southborough, MA Meeting of the Board of Selectmen October 27, 2020, 6:30 P.M. Pursuant to Governor

Committee Members

• Jason Malinowski, Chair• Kathy Cook, Vice Chair• Jeff Hark, Clerk• Lisa Braccio• Joseph Palmer• Andrew Pfaff• OPEN SEAT

2

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Committee Actions Since August Meeting

• Facilitated Town House CPA Application with Facilities Director• Facilitated Solid Waste Disposal Analysis which led to significant reduction in capital requests for FY22 and FY23

• Formed School Research Subcommittee• Set up Capital Module in ClearGov, almost ready to go live• Reviewed and voted on all FY22 Capital Items which includes votes of approval, deferral, and acceleration

3

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Process

• All items presented have unanimous support of Capital Planning Committee

• All Department Heads were notified of Capital Planning meetings and BOS meeting

• Committee held in some instances multiple meetings with Dept. Heads to determine proper timing of some items

• Adjustments were made to long term capital plan based on these discussions.

• All modifications that were not proposed by Dept. Heads will be outlined in the presentation

• Items subject to bonding open for further analysis

4

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Comparison of FY21 to FY22 General Fund

FY21 FY22

Total Cost of Capital 1,372,660 1,533,200

Amount Spent ‐ Appropriation 747,757 1,533,200

Amount Spent – PY Bonds 3,115,803 3,243,101Total 3,863,560 4,766,301

5

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FY22 Capital Expenditures –Previously Authorized

6

Department Project Amount

Recreation DEPIETRI FIELD REPAIRS 45,750 

Recreation TROTTIER TRACK 63,250 

Recreation 911 Field 122,000 

DPW DPW FUEL TANK 136,500 

Facilities PUBLIC SAFETY BUILDING 1,553,086 

Facilities GOLF COURSE REPAIRS/ALTERATIONS 57,500 

Schools FINN ‐ BOILER 89,049 

Schools TROTTIER/FINN/WOODWARD 1,112,400 

Schools NEARY RENOVATIONS PHASE 2 25,628 

Schools NEARY RENOVATIONS PHASE 3 37,939 

Total 3,243,101 

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Summary of FY22 Capital Items

Total Cost Amount to be Spent in FY 22

General Fund 1,533,200 1,533,200

Potential CPA 2,438,750 421,417

Ambulance Fund 287,000 13,354

Water Fund 130,000 130,000

Total 4,388,950 2,097,971

7

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FY22 Capital Summary ‐ DPW

Item Amount Funding Bonded

CHIPPER  30,000  General Fund NEQUIPMENT TRAILER (2006 ‐REPLACEMENT) 12,000  General Fund N

HOOK LIFT TRUCK ‐General 165,000  General Fund N

HOOK LIFT TRUCK‐Water  60,000  Water NPick‐up Diesel (Service Body) (Highway) (12/10) (2008/2012) 70,000  General Fund NUtility/Service Diesel (water) (30) (Replacing a 2011 ) 70,000  Water N

REPLACE 3 LARGE PLOWS 40,000  General Fund N

ROAD MAINTENANCE – FY22 325,000  General Fund N

SIDEWALK MAINTENANCE‐ FY22 200,000  General Fund N

8

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FY22 Capital Summary ‐ Facilities

Item Amount Funding BondedLIBRARY ‐ INTERIOR RENOVATIONS, FLOOR COVERINGS AND PAINTING 115,000  General Fund NTOWN HOUSE ‐ BATHROOM AND INTERIOR RENOVATIONS 80,000  General Fund NTOWN HOUSE ‐ EXTERIOR RENOVATION AND WINDOW WORK 2,238,284  CPA Y

FACILITIES MAINTENANCE‐ FY22 100,000  General Fund N

9

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FY22 Capital Summary ‐ Fire

Item Amount Funding Bonded

CHIEF VEHICLE C20 60,000  General Fund N

THERMAL IMAGING CAMERAS 30,000  General Fund NSELF CONTAINED BREATHING APPARATUS GRANT MATCH 13,000  General Fund NSELF CONTAINED BREATHING APPARATUS/CYLINDERS 10,000  General Fund N

IV PUMPS 12,000  Ambulance Fund NFIRE HOSE/NOZZLE REPLACEMENT ‐ FY2022 20,000  General Fund N

FIRE TURNOUT GEAR FUND ‐ FY22 40,000  General Fund N

AMBULANCE 275,000  Ambulance Fund Y

10

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FY22 Capital Summary ‐MIS

Item Amount Funding BondedSERVER & STORAGE INFRASTRUCTURE UPGRADE 90,000  General Fund N

11

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FY22 Capital Summary ‐ Police

Item Amount Funding Bonded

DEFIBRILATORS 18,200  General Fund N

POLICE CRUISERS (2) 115,000  General Fund N

12

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FY22 Capital Summary ‐ Recreation

Item Amount Funding Bonded

KALLANDER FIELD 238,750  CPA N

13

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Summary of Items Deferred

• Summary of Items Deferred or Removed:• Cordaville Road Project (deferred)• Cordaville Hall Project (deferred)• Town House – Emergency Generator (removed)

• Looking for approval to declare old fire station generator as surplus property

14

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Items in the Works

• South Union School• School‐related capital items• Discussion of maintenance articles (Facilities and DPW) in terms of whether they should be operating or capital expenses

• Discussion of re‐purposing Fire Vehicle and its future to achieve net zero increase to town vehicle fleet

15

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Requests of BOS

• Vote on FY22 Capital Items• Vote related to support of warrant article to set up Fire Turnout Gear replacement fund

• Vote to declare emergency generator from old Fire Station at 21 Main Street as surplus property

• Provide feedback on potential Capital Planning policy• Discuss and prioritize staff and committees to streamline grant applications

16

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Thank You!

17

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DRAFT Downtown Business Village District v.2

October 20, 2020

fit I. Amend § 174-2 Definitions by adding the folLowing new term and definition inappropriate alphabetical order.

BED AND BREAKFAST

Bed and breakfast is an establishment in an owner-occupied residence providing not morethan four guest rooms for overnight lodging, with food service limited to breakfast for

guests.

MICROBREWERY

A microbrewery is a licensed establishment that produces and distributes beer, ale, orother malt beverages, and which may include accessory uses such as tours of the

microbrewery, retail sales, and a taproom for on-site consumption. In addition to sellingbeer at retail on the premises, a microbrewery may act as wholesaler for beer of its ownproduction for off-site consumption if it has a valid pub brewery license from theCommonwealth of Massachusetts.

MIXED-USE DEVELOPMENT

Mixed-Use Development: A development that includes both residential uses and

nonresidential uses within a single structure, with nonresidential uses occupying theground floor (street level) and residential uses above on the upper floors. The total gross

floor area of the nonresidential uses shall be at least 10 percent of the gross floor area ofthe structure.

Part 2. Amend § 174-3 Districts enumerated by adding the following new district:

K. Downtown Business Village District, referred to as DVB District.

Part 3. Amend § 174-$(C )(2) as follows (amendment shown in italics)

Not more than one principal permitted use shall be located on any lot, provided that amultiple occupancy building used for the same category of use, such as retail sales andservices, light manufacturing or offices in a business district or Industrial Park District, ora mixed-use development in the Downtown Village Business District, shall be deemed tobe in a single principal permitted use. .

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Draft Southborough Town Center Districtlv2/10-16-2020

Part 4. Amend Article III, Use Regulations, by adding the following new section:

§ 174-8.4.1 Downtown Village Business District

A. Permitted uses are as follows:

(1) All uses permitted in the residential districts (RA and RB)

B. Permitted uses are as follows, up to a maximum floor area ratio of 0.35:

(1) Mixed-use development

(2) Professional or business office, or bank, but not including a medical or dental office

(3) Custom manufacturing of custom goods sold primarily on the premises, such as awoodworking shop, shop for artisan or craftsperson, or bakery

(4) Craft brewery or distillery

(5) Bed and breakfast

(6) Art gallery

(7) Child care center

(8) Co-work center

C. Permitted uses, up to a maximum of 3,000 square feet per establishment:

(1)

(2)

Retail sales

Ice cream shop, sandwich shop, candy shop, other specialty food service establishmentserving walk-in customers (drive-through service is prohibited)

(3) Restaurant, with indoor seating and outdoor seating on an adjacent patio (drive-throughservice is prohibited)

(4) Personal services such as barber shop, hair salon, tailor, or shoe repair

D. Permitted uses by special permit from the Planning Board are as follows:

(1) Any use listed in Subsection B that exceeds a maximum floor area ratio of 0.35 or underSubsection C exceeding 2,000 sq. ft. per establishment

(2) Veterinarian, animal hospital, dog kennel.

(3) Medical or dental office

DRAFT Sec 1 74TownCtrDistrict v2 .docx 2

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Draft Southborough Town Center District/v2/10-16-2020

(4) Multifamily housing, up to eight units.

(5) Private garage or parking for more than three cars or more than one truck or othercommercial vehicle.

(6) Indoor recreation, athletic or exercise facility.

E. Uses by special permit from the Zoning Board of Appeals are as follows:

(1) Accessory apartment.

(2) Conversion of a one-family house in existence for two years or longer to a two-familydwelling, on a lot with a minimum of 15,000 square feet.

(3) A mobile home or travel trailer used as a dwelling or business quarters for more than 30days in a year.

F. Prohibited uses. All uses which are not listed above, legally nonconforming or otherwiseallowable by the provisions of the zoning regulations are prohibited.

G. Development standards (Note: Also refer to § 174-10.1, Village Business District planreview) are as follows:

(1) Minimum lot area: 5,000 square feet.

(2) Minimum frontage: 60 feet.

(3) Minimum setbacks:

(a) Front: 10 feet.

(b) Rear: 35 feet.

(c) Side: 10 feet; 25 feet if adjacent to a residential district.

(U) Other street: 10 feet

(4) Maximum front setback: 20 feet

(5) Minimum façade Buildout (% Lot Width):

(a) With less than 50 feet of frontage: N/A

(b) 50-80 feet of frontage: 60%

(c) Over 8 1-100 feet of frontage: 70%

(d) 100 feet or more of frontage: 75%

DRAFT Sec l74TownCtrDistrict v2.docx 3

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Draft Southborough Town Center Districtlv2/ 10-16-2020

(6) Height regulations:

(a) Maximum building height: 40 feet and three stories, except as provided in Section Hbelow

(b) Minimum ground floor height: 12 feet

(c) Maximum ground floor height: 1 $ feet

(7) Residential dwellings. Single-family or two-famiLy dwellings in the Downtown BusinessVillage District shall comply with RB District standards.

H. Special Permit for Height Increase. The Planning Board may grant a special permit toincrease the maximum building height to 45 feet and four stories, provided that theminimum rear setback shall be increased at a 1-to-I ratio, e.g., an additional one foot ofsetback for every one additional foot in building height.

I. Additional Standards for Development in the DVB District.

(1) Building Regulations

(a) The principal entrance(s) to the building shall be on the front façade, which shall facethe street.

(b) The maximum distance between street-level entrances shall be 35 feet unless waivedby the Planning Board.

(c) The maximum depth of street-level commercial spaces shall be the lesser of 30 feet or60 percent of the depth of the building.

(d) The maximum front setback in Section G(4) may be increased for purposes ofamenities such as a plaza. square. courtyard. recessed entrance, sidewalk, multi-usepath, raised terrace, façade offsets, or outdoor dining, but not for automobile use.

(2) On any lot with 10,000 square feet in more in area, at least 5% of the lot shall havelandscaped open space or public amenities (such as an outdoor seating area with parkbenches) between the front building line and front lot line.

(3) Affordable housing. In any multifamily or mixed-use building with eight or more units. atleast 12.5 percent of the units shall be affordable housing that is eligible for the Chapter40B Subsidized Housing Inventory (SHI) in accordance with the Chapter 40B regulationsand Guidelines of the Massachusetts Department of Housing and CommunityDevelopment (DHCD). In consultation with the Southborough Housing OpportunityPartnership Committee (SHOPC), the Planning Board may adopt a guidance documentinterpreting the Chapter 40B Guidelines as they apply to development under this section.

J. The operation of any marijuana establishment as defined in MGL c. 94C, § 1, including

DRAFT Sec l74TownCtrDistrict v2.docx 4

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Draft Southborough Town Center District/v2/10-16-2020

without limitation a marijuana cultivator, marijuana testing facility, marijuana productmanufacturer, marijuana retailer or any other type of licensed marijuana facility is

prohibited in all zoning districts of the Town. This prohibition shall not apply to the sale,distribution or cultivation of marijuana for medical purposes, licensed under Chapter 369of the Acts of 2012 and currently permitted in the Town of Southborough. [Added 4-25-2017 ATM by Art. 321

DRAFT Sec l74TownCtrDistrict v2.docx 5

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Draft Southborough Town Center D istrict/v2/ 10-16-2020

Part V. Amend Section 174-10.1, Village Business District plan review, as follows(amendments in the first paragraph shown in italics).

§ 174-10.1 Village Business District plan review.

Except as provided below in Subsection D, within the Village Business District, major site planapproval shall be by special permit from the Planning Board, subject to the proceduralrequirements and decision criteria of § 174-9, Special permit requirements, and § 174-10, Siteplan approval, and the following in addition to the above

D. In the Downtown Village Business District, major site plan approval shall be by specialpermit from the Planning Board for any use requiring a special permit. In such cases, thesubmission requirements, procedures, and decision criteria under Subsections A throughC above shall apply. The Planning Board may adopt design guidelines and apply them tomajor site plan approval applications regardLess of whether a special permit is required.

Part VI. § 174-12 Parking and loading regulations. Amend the parking and loadingregulations, as follows. Note that existing Section F should be renumbered to Section G.

F. Exceptions in the Downtown Village Business District. Off-street parking requirements fordevelopment in the Downtown Village Business District shall comply with Section E aboveexcept for the following uses:

(1) Dwellings: two spaces for each dwelling unit, plus one space for each 80 square feet offloor area devoted to a customary home occupation or a professional use.

(2) Bed and breakfast: one space for each guest room plus two spaces for the owners andoperators of the premises.

(3) Restaurants and other places serving food or beverages: one space for each four seats.

(4) Mixed-use development: one space per dwelling unit and one space per 300 square feet ofnonresidential floor area.

(5) Professional or business office: one space per 300 square feet for ground floor offices andone space per 350 square feet for offices above the first floor.

DRAFT Sec l74TownCtrDistrict v2.docx 6

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Board of SelectmenTown of Southborough17 Common StreetSouthborough, MA 01772

TOWN OF SOUTHBOROUGH

FIRE DEPARTMENT32 CORDAVILLE ROAD

SOUTHBOROUGH, MA 01772(508) 485-3235 (508) 485-3887 (ix)

Dear Town of Southborough Board of Selectmen,

Enclosed, please find the following donation made to the Town of Southborough foryour acceptance.

RECEIVED FROM: AMOUNT: ACCOUNT SPECIFIED:

Susan & John Wood $100 Ambulance Fund(2659-4-220-483-48310)

Thank you for your consideration in this request.

Sincerely,

/Steven E. AchillesSouthborough Fire Chief

Thursday, October 15, 2020

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ouG

NCOPORATEO

JULY 61727. Town of Southborough%SAcHUP

Rental/Mortgage Assistance Guidelines IIn response to the loss of income to households due to COVID-19, this program has been createdand funded by the CARES Act funds granted to the Town of Southborough. This program seeksto be efficient and responsive. It is temporary in nature. Applicants that have been residents ofSouthborough for at least six (6) months are eligible for:

• Up to two months rental or mortgage assistance• Assistance can be used to pay current rent/mortgage or pay rent/mortgage that is past due

since 4/1/2020• Mortgage assistance can be used to pay the mortgage principal and interest, it cannot be

applied to escrow or homeowner’s insurance.• Amounts available are:

• $1200 / month for an efficiency/studio• $1400 / month for a 1-bedroom• $1600 / month for a 2-bedroom• $2000 / month for a 3+-bedroom

Please visit https://www.southboroughtown.com/town-admilator/cov id-i 9-information-center or contact Sarah Cassell, Director of Youth and Family Services, atscasseIl(southboroughma.com or (508) 481-5676 for an application.

IAll applications must be receivV7Tuesdav December], 2020.

Household EllgibiHty“Eligible” HouseholdAn eligible household is one that:

• Has reduced income because of COVID-19• Earns less than 80% of Area Median Income• Households currently receiving government-funded rental assistance such as Section 8,

MRVP are not eligible. Households that have received RAFT assistance since April 1,2020 are not eligible. Households living in units subsidized with Project Based Section $shall not be eligible.

A “household” shall mean an individual or two or more persons who will live regularly in theunit as their principal residence and who are related by blood, marriage, law, or who haveotherwise evidenced a stable inter-dependent relationship.

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Town of Southborough

Income EligibilityThe total income of the applicant and all other members of the applicant’s household over theage of eighteen (1$) may not exceed 80% of the Area Median Income for the greater Bostonarea adjusted for family size. An applicant’s total household income cannot exceed the followinglimits:

Personc in family1 2 3 4 5 6 7 8

IncomeLimit: 80%

$67,400 $77,000 $86,650 $96,250 $10’ 0 $111,650 $fl9,350 $127,050Area

MedianException: A member of/he household that is over the age ofeighteen (18, and is pursuing post-secondary education on a full-time basis is exempt from being included in the total householdincome. Please provide proofofenrollment with application.

Process• All potential participants must complete an application and attach requested documents

prior to the deadline. The applications will be processed on a rolling basis.• If you need a copy of the information contact Sarah Cassell, Director of Youth and

Family Services, at [email protected] or (508) 481-5676.• Applicants have the right to request a reasonable accommodation(s), which may include a

change to a rule, policy, procedure or practice to afford a person with a disability an equalopportunity to participate fully in the housing program or to use and enjoy the housing.

• free language assistance is available to households with limited English proficiency.

Affirmative MarkeMThe Town of Southborough does not discriminate on the basis of race, color, religion, nationalorigin, disability, familial status, sex, age, marital status, children, sexual orientation, geneticinformation, ‘gender identity, ancestry, veteran/military status or membership.

Marketing ActivitiesMarketing activities will be conducted for a one-month period beginning November 1,2020 — December 1, 2020. Efforts consist of:

1. Town COVID-19 Response website pages2. Notices on Town social media3. Press releases to local newspaper4. Utilizing the distribution lists for schools, Recreation Department and Youth and Family

Services.

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JULY 6727. Town of Southborough

Applications will be available online at the Town of Southborough website, or a hard copy maybe requested from the Youth and Family Services department. In all cases, the process beginsby contacting the Youth and Family Services office. The Youth and Family Services staff isavailable to assist individuals in the completion of their application and are able toaccommodate households with disabilities that may impede their ability to complete theapplication. Staff can also arrange for assistance for households that have limited Englishproficiency. Applicants have the right to request a reasonable accommodation, which mayinclude a change to a policy, procedure or practice to afford a person with a disability an equalopportunity to participate fully in the housing program or to use and enjoy the housing.

Please contact Sarah Cassell, Director of Youth and Family Services, atscassellsouthboroughma.com or (50$) 481-5676 for assistance or inquiries.

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4

Eligibility ChartGOVID Rent/Mortgage Relief

Options Southborough

L

r.

Not Eligible

This household is eligible for ent/Mortgage Relief Options

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Town of Southborough

State

Applicant’sTelephone: Home

_________________

Work

Co-Applicant’sTelephone: Home

_________________

Work

Applicant’sE-Mail Address Re-enter E-mail:

Co-Applicant’sE-Mail Address Re-enter E-mail:

Language Preference (if other than English):

How long have you been a Southborough resident________________

Total number of people in household (including yourself)

_________

Total number in household 18 years or older

_______________

Total number in household under 18 years

_______________

Total number in household 18 years or older AND enrolled full-time in post-secondary

education

(must be at least 6 months)

Are you self-employed?

_______yes _______no

This program is for people who have lost income due to COVID-19 related circumstances. Doesyour household meet this eligibility?

_____

yes

_____

no

What is your household’s current monthly income (please include all income types from allhousehold members 18 years and older)

$____________________

Mortgage / Rent Assistance ApplicationApplication Deadline: Tuesday, December 1, 2020

Applicant’s First Name

_________________________Last

Name —

Co-Applicant’s First Name_______________________ Last Name

Street Address

City/Town Zip Code —

_____

Cell

Cell

Number of bedrooms in your home?

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Do you have a Section 8 Voucher or other housing assistance such as RAFT? yes

______

noIf yes, what type of assistance_______________________________________________

If you have a MORTGAGE:Is your mortgage currently under forbearance? yes no

What is your current mortgage payment each month, excluding escrow and homeowner’sinsurance?

$________________

Do you owe past mortgage payments? yes no tf yes, how much$________________

If you are RENT[NG:What is your current rent payment each month? $______________

Do you owe back rent? If yes, how much$______________

I have an application for Unemployment Assistance pending

_____

yes

______

no

Types of income being received by the household:

Yesi NoWagesUnemployment BenefitsSocial SecuritySSI/DisabilityChild SupportAlimonyPension/RetirementTANFOther

Lender / Landlord* Contact Information:

Name:

Street Address

City/Town

_____________________________

State

____________

Zip Code

__________________

Best Phone Number

_________________________________

Email

________________________________

* Landlord MUST participate in this program. If this is left blank the application is incomplete andwill not be considered.

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Certifications

Certflcation ofInformation

• I/We certify that all information furnished in this application for affordable housing assistanceis true and complete to the best of my/our knowledge.

• I/We certify that our household is not receiving any other government-funded rental ormortgage assistance.

• I/We certify that our household does not have access to other resources sufficient to cover themortgage.

• I/We understand that any false statement, made knowingly and willfully, will be sufficientcause for rejection of my/our application.

• I/We understand that ANY false information on this application or statements given arepunishable by law and will lead to cancellation of this application and mortgage assistance.

Applicant’s Signature

_____________________________________________

Date

Co-Applicant’s Signature

_________________________________________

Date

______________

Release ofInformation

I/We understand that this authorization or the information obtained with its use may be given toand used to administer and enforce program rules and policies in compliance with HUD orMassachusetts DHCD or any other federal or state housing program guidelines

I/We agree that a photocopy or facsimile or other electronic transmission of this authorizationmay be used for the purposes stated above.

I/We understand that all decisions made by the Town of Southborough are final and that anyappeals must be submitted in writing to the Southborough Youth and Family Services Directorat:

Applicant’s Signature

__________________________________________

Date

Co-Applicant’s Signature

_________________________________________

Date

______________

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APPLICATION CHECKLIST

Q Application

Income Verification — provide ALL of the following:

Q One most recent paystub for all employed household members over the age of 1$.

- Ifovertime is a part of the household income, please provide the most recent threemonths ofpa3sttths. Income will be calculated based on the average monthlyincome.

Q Evidence of any other income sources (unemployment, child support, alimony,

pension/retirement, etc.)

lJ Most recent bank statement for all bank accounts for all household members over the age

of 18.

- Ifa member of the household is over the age ofeighteen (18.) and is pursuing post-secondary education on afull-time basis, please provide proofofenrollment. Anyincome from this household member will not be included as a part of the incomeverUlcation.

Residence Verification — provide ONE of the following:

121 Rent/Mortgage receipt/cancelled check

121 Current utility bill

Evidence of Reduced Income — provide ONE of the following:

Q A second paystub showing reduced hours

Q A lay-off notice from your employer

121 Multiple month’s bank statements

Q Notices from Unemployment Assistance

IJ Statement from employer stating reduction in hours

Rent/Mortgage Payment Verification — provide ONE of the following:

Q Copy of lease or letter from landlord evidencing monthly rent amount

121 Current mortgage statement

THESE MUST BE INCLUDED WTH YOUR APPLICATION OR IT WILL BE DEEMEDINCOMPLETE

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