HomeMy WebLinkAbout20091017RESOLUTION
RE: APPROVE APPLICATION FOR FEDERAL ASSISTANCE FOR 2009 COST OF
LIVING ADJUSTMENT AND QUALITY IMPROVEMENT FUNDING GRANT FOR
MIGRANT AND SEASONAL HEAD START PROGRAM AND AUTHORIZE CHAIR TO
SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with an Application for Federal Assistance for
2009 Cost of Living Adjustment and Quality Improvement Funding Grant for the Migrant and
Seasonal Head Start Program from the County of Weld, State of Colorado, by and through the
Board of County Commissioners of Weld County, on behalf of the Department of Human Services,
Family Educational Network of Weld County, to the U.S. Department of Health and Human
Services, commencing January 1, 2009, and ending December 31, 2009, with further terms and
conditions being as stated in said application, and
WHEREAS, after review, the Board deems it advisable to approve said application, a copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Application for Federal Assistance for 2009 Cost of Living Adjustment
and Quality Improvement Funding Grant for the Migrant and Seasonal Head Start Program from
the County of Weld, State of Colorado, by and through the Board of County Commissioners of
Weld County, on behalf of the Department of Human Services, Family Educational Network of
Weld County, to the U.S. Department of Health and Human Services be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said application.
(lC •
2009-1017
HR0080
oS// mil /O 7
RE: APPLICATION FOR FEDERAL ASSISTANCE FOR 2009 COST OF LIVING ADJUSTMENT
AND QUALITY IMPROVEMENT FUNDING GRANT FOR MIGRANT AND SEASONAL HEAD
START PROGRAM
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 29th day of April, A.D., 2009, nunc pro tunc January 1, 2009.
BOARD OF COUNTY COMMISSIONERS
WELD CQH)JTY, COLORADO
ATTEST:
Weld County Clerk to th
BY.
o the Board
Deputy Cler
D AS T
ounty torney
Date of signature:
Q1� 11�fti'�u�
Douglas Rademacher, ro-Tem
� T v
Sea p P. Conway
-GuC-c1[
a Kirkmeyer
2009-1017
HR0080
MEMORANDUM
DATE: April 27, 2009
1119€ TO: William F. Garcia, Chair, Board of Coun Commission rst,�ti FROM: Judy A. Griego, Director, Human Servi Depa�tment ! I
COLORADO RE:
The Weld County Department of Human Services' Family
Educational Network's Migrant and Seasonal Head Start
Cost -of -Living Adjustment (COLA) and Quality
Improvement Funding Grant Application
Enclosed for Board Approval is the Department's Family Educational Network Program's
Migrant and Seasonal Head Start Cost -of -Living (COLA) and Quality Improvement Funding
Grant Application. This Grant Application was presented at the Board's April 27, 2009,
Work Session.
The grant authorizes the program to apply for $71,905 in COLA, 3.06% ($44,904) of which
is a permanent increase to the base and 1.84% ($27,001) of which is ARRA dollars. In
addition, the grant authorizes the program to apply for $81,112 for Quality Improvement,
50% of which must be committed to staff development and 50% of which may be committed
to program improvements.
If you have any questions, give me a call at extension 6510.
2009-1017
Family Educational Network of Weld County
COLA and Quality Improvement Funding Grant Application
Migrant and Seasonal Head Start
Narrative
Purpose:
1. to increase the salary base of all FENWC staffing positions nearer to
comparable salaries for qualified professionals in Early Childhood Education.
2. to maintain and enhance the program's professional development and
training system in order to support efforts to reach Federal credentialing
requirements within the prescribed timeframe.
3. to improve the program's effectiveness in the areas of Child Health and
Safety and Facilities.
COLA:
FENWC will invest 100% of permanent COLA funds in increasing staff wages in all
positions. FENWC will invest 100% of ARRA COLA funds in providing a one-time wage
bonus for all positions.
Training and Professional Development:
FENWC will partner with local post -secondary institutions to implement a Professional
Development Academy. Four local campuses are in Greeley, Fort Lupton and Fort
Collins, Colorado, which provides easy access for FENWC staff to both north and south
County sites. The PDA will oversee FENWC's staff credentialing efforts. It will also
provide oversight, scheduling, advising, coaching, mentoring, tracking and reporting
services to assist 21 teacher assistants, 21 teachers and 11 Family Service Workers to
complete their credentialing programs. The PDA will provide a Professional
Development Coordinator/Coach and two additional part-time Mentor/Coaches to serve
53 FENWC staff. The PDA will coordinate coursework at local, on-line and Spanish
language post -secondary institutions offering appropriate Early Childhood Education
credentialing and degrees. In addition, PDA staff will work with FENWC staff on
advising, coaching for best classroom practices, mentoring, scheduling and classroom
coverage. The Professional Development Academy will create and implement non-
traditional opportunities for full time staff to move on a fast track toward their degrees.
All staff participating in the PDA will have credentialing goals as a component of their
Professional Development Plans, and progress toward goals will be monitored closely.
Child Health and Safety:
The Family Educational Network of Weld County will improve the safety factors of ten
center playgrounds, including the installation of and/or replacement of State -licensing -
approved equipment at eight playgrounds and installation of a children's bike path at
two playgrounds. In addition, funds will be invested in refurbishing the kitchen areas of
five centers and upgrading safety door mechanisms at six centers.
Internal Health and Safety monitoring, ECERS monitoring, Qualistar Reviews, and the
Program Self Assessment identified four play areas with no appropriate preschool
equipment (Dos Rios, Centennial, Platteville, Gilcrest), and four play areas in need of
upgrading to meet licensing, quality, ADA and safety standards (Billie Martinez, Plaza
Del Milagro, Madison, Milliken.
The crumbling asphalt at the Hudson center has been removed. A concrete 75' x 6'
bike path will be installed to provide large motor opportunities for children. In addition, a
75' x 6' bike path will be installed at the play area at the Frederick center so that
children may use large motor riding equipment. Currently that center's play area has
only grass, sand and wood chips, with no bike path.
At 6 of the program's 7 modular centers, safety mechanisms on entry doors are
beginning to fail. These older units will be replaced with upgraded and more reliable
units to improve child safety factors at those centers.
Facilities:
FENWC has several aging modular classroom facilities which need some upgrades to
health and safety components to ensure that they meet Health Department and State
licensing standard for safety and cleanliness. FENWC is requesting funds to upgrade
the health and safety factors of the kitchen areas at 5 centers, Centennial, Dos Rios,
Jefferson, Madison and Hudson.
In addition, funds will be invested at 7 centers to install "Dutch Doors" on children's
bathrooms. This recommendation by State licensing will improve the safety of children
by making the facilities easier to supervise by teaching staff.
Grant Outcomes: The program's goals for these areas are:
To improve and expand program staff's opportunities to secure credentials that will
meet Federal qualifications requirements within the new timeframe.
To insure that playgrounds at FENWC centers meet and exceed changing State
licensing and Federal requirements for child safety and healthy play.
To insure that modular facilities continue to meet State licensing standards and meet or
exceed Head Start and licensing requirements for child health and safety and
accessibility.
Budget Narrative:
FENWC operates the Regional Head Start and the Migrant and Seasonal Head Start
programs for Weld County. Staff and facilities are used by both programs, as Regional
Head Start during the school year, and as Migrant and Seasonal Head Start from June
through September. Quality Improvement funds will be utilized for improvement in
professional development for shared staff and shared facilities for both programs. A
percentage of the total Quality Improvement award for both programs has been
assigned to each. For Regional Head Start, that amount is approximately 72% and
approximately 28% has been assigned to Migrant and Seasonal Head Start.
COLA
Permanent 3.06%
ARRA 1.84%
Total
Migrant Award
$44,904
$27,001
$71,905
velopment: Professional Development Academ
L
Location
Item
Salary/
Benefits
Other
MSHS
Share
RHS
Share
Total
Post -Sec. Professional
Development
Academy
partnership—
scheduling, advising,
coaching, coverage
and oversight of staff
credentialing
Training
Coordinator/
Mentor Coach
(No. County)
$40,638/
$12,191
$14,797
$38,035
$52,829
PDA
Mentor Coach
.5FTE (No.
County
$17,020
$4,766
$12,254
$17,020
PDA
Mentor Coach
.3FTE (So.
County)
$10,212
$2,860
$7,352
$10,212
PDA
Local mileage @
900m
$5,315
$1,488
$3,827
$5,315
PDA
Supplies
$2,910
$815
$2,095
$2,910
Tuition Aims
Community College
81.30/credit x
245 credits
$20,000
$5,600
$14,400
20,000
Tuition Community
College of Denver
(Spanish language
coursework)
$9,051
$2,675
$6,376
$9,051
Tuition Univ. of
Cincinnati
$2,400
$672
$1,728
$2,400
Tuition Univ. of No.
Colorado/ Colorado
State Univ./Univ of
Phoenix
$19,200
$5,206
$14,811
$20,017
Univ Book Stores
Textbooks
$7,000
$1,680
$5,320
$7,000
Total
40,556
$106,198
$146,754
Location
Item
Cost per
unit
Extended
MSHS
Share
RHS
Share
Total
Billie Martinez, Plaza
del Milagro, Dos Rios,
Centennial, Platteville,
Gilcrest, Madison
Outdoor Little
Buddy Sand
Table and
Water Table
(14 units)
$976 per
unit
$13,664
$3,757
$9,907
$13,664
Madison
Little Buddy
Polywv slide
$3,520
$968
$2552
$3,520
Dos Rios
Little Buddy
Play System
$18,200
$5,005
$13,195
$18,200
Centennial
Little Buddy
Play System
$18,200
$5,005
$13,195
$18,200
Platteville
Little Buddy
Play System
$18,200
$5,005
$13,195
$18,200
Gilcrest
Little Buddy
Play System
$18,200
$5,005
$13,195
$18,200
Hudson
Bike Path
$4,600
$1,265
$3,335
$4,600
Frederick
Bike Path
$4,600
$1,265
$3,335
$4,600
All Centers
Shipping and
installation
$3,355
$8,114
$11,469
Total
$30,630
$80,023
$110,653
Location
Item
Cost
Extended
MSHS
Share
RHS
Share
Total
Centennial, Dos Rios,
Jefferson, Madison,
Hudson
Cabinetry
work for 5
centers
$3,200
$16,000
$4,400
$11,600
$16,000
Centennial, Dos Rios,
Jefferson, Madison,
Hudson
Shelving
$900
$4,500
$1,236
$3,264
$4,500
Centennial, Dos Rios,
Jefferson, Madison,
Milliken, Hudson
Door Mech
$1,200
$7,200
$1,980
$5,220
$7,200
Centennial, Dos Rios,
Jefferson, Madison,
Milliken, Hudson,
Frederick
14 Dutch
Doors for
child
restrooms
$600
$8,400
$2,310
$6,090
$8,400
Total
$9;926
$26,174
$36,100
Total COLA MSHS:
Total Quality Improvement:
Total Award
$71,905
$81,112
$153,017
APPLICATION FOR
FEDERAL ASSISTANCE
2. DATE SUBMITTED:
Applicant Identifier
90CM0136
1. TYPE OF SUBMISSION
Application
Construction
Preapplication
❑ Construction
� Non -Construction
3. DATE RECEIVED BY STATE:
State Application Identifier
4. DATE RECEIVED BY FEDERAL AGENCY:
Federal Identifier
90CM0136 - 000
X Non -Construction
5. APPLICANT INFORMATION
Legal Name:
WELD COUNTY RESOURCES DEPARTMENT
Organizational Unit
Department HHS: Office of Head Start
Organizational DUNS: 139136811
Division: HHS: Office of Head Start
Address:
Name and telephone number of the person to be contacted on matters
involving this application (give area code)
Street: 1551 North 17th Avenue
P.O. Box 1805
Prefix: Dr. I Middle Name:
City: Greeley
First Name: Janet
County: N/A
Last Name: Flaugher
State: CO Zip Code: 80632
Suffix:
Country: N/A
Email: jflaugher@co.weld.co.us
6. EMPLOYER IDENTIFICATION NUMBER (EIN)
846000813
Phone Number (give area code)
(970)353-3800
Fax Number (give area code)
(970)304-6453
8. TYPE OF APPLICATION
New � Continuation
If Revision, enter appropriate letter(s) in
Other (specify)
Revision
❑
7. TYPE OF APPLICANT (enter appropriate letter
Other (specify)
in box) 8
X
box(es): A
9. NAME OF FEDERAL AGENCY:
HHS / ACF / OHS
10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:
93.600
TITLE (Name of Program):
Head Start / Early Head Start
11. DESCRIPTION TITLE OF APPLICANT'S PROJECT:
3.06% Permanent COLA Adjustment
12. AREAS AFFECTED BY PROJECT (Cities, Counties, States etc.):
Weld County
13. PROPOSED PROJECT:
14. CONGRESSIONAL DISTRICTS OF:
Start Date: 01/01/2009 Ending Date: 12/31/2009
a. Applicant: 4 b. Project:
15. ESTIMATED FUNDING
16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS?
a. Federal
$44,904
a. YES
STATE
b. NO
THIS PREAPPLICATION/APPLICATION
EXECUTIVE ORDER 12372
Date:
� PROGRAM IS NOT
WAS MADE AVAILABLE TO THE
PROCESS FOR REVIEW ON
COVERED BY E.O. 12372
NOT BEEN SELECTED BY STATE FOR REVIEW
b. Applicant
$11,226
c. State
$0
d. Local
$0
e. Other
$0
X OR PROGRAM HAS
f. Program Income
$0
17. IS THE APPLICANT DELINQUENT ON ANY
Yes If "Yes," attach an explanation.
FEDERAL DEBT?
g. Total
$56,130
X No
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, AU. DATA IN THIS APPLICATION ARE TRUE AND CORRECT. THE DOCUMENT HAS BEEN DULY AUTHORIZED
BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED
a. Authorized Representative
Prefix: Mr. I First Name: William
Middle Name:
Last Name: Garcia
Suffix:
b. Title: Authorizing Official �
c. Telephone number: (970)353-3800
/ d. Signature of Authorized Representative:
e. Date Signed: 05/08/2009 APR 2 9 ZUU9
Standard Form 424 (Rev.9-2003) Prescribed by OMB Circular A-102
a -/O,7
Applicant delinquent explanation of federal debt for line 17:
N/A
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
COMPENDIUM OF REQUIRED CERTIFICATIONS AND ASSURANCES
SF 4248
ASSURANCES - NON -CONSTRUCTION PROGRAMS
Note: Certain of these assurances may not be applicable to your project or program. If you have
questions, please contact the awarding agency. Further, certain Federal awarding agencies may require
applicants to certify to additional assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial
capability (including funds sufficient to pay the non -Federal share of project costs) to ensure proper
planning, management and completion of the project described in this application.
2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the
State, through any authorized representative, access to and the right to examine all records, books, papers,
or documents related to the award; and will establish a proper accounting system in accordance with
generally accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes
or presents the appearance of personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the
awarding agency.
5. Will comply with the intergovernmental Personnel Act of 1970 (42 U.S.C. 42784763) relating to
prescribed standards for merit systems for programs funded under one of the nineteen statutes or
regulations specified in Appendix A of OPM=s Standards for a Merit System of Personnel Administration (5
CFR 900, Subpart F).
6. Will comply with all Federal statutes relating to non-discrimination. These include but are not limited to:
(a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the bases of race,
color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. 1681-
1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the
Rehabilitation Act of 1973, as amended (29 U.S.C. 794), which prohibits discrimination on the basis of
handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. 6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as
amended, relating to non-discrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse
and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to
non-discrimination on the bases of alcohol abuse or alcoholism; (g) 523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee-3), as amended, relating to confidentiality of the
alcohol and drug abuse patient records; (h) Title VII of the Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.),
as amended, relating to non-discrimination in the sale, rental or financing of housing; (I) any other non-
discrimination provisions in the specific statute(s) under which application for Federal assistance is being
made; and Q) the requirements of any other non-discrimination statute(s) which may apply to the application.
7. Will comply, or has already complies, with the requirements of Titles II and Ill of the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and
equitable treatment of persons displaced or whose property is acquired as a result of Federal or Federally
assisted programs. These requirements apply to all interests in real property acquired for project purposes
regardless of Federal participation in purchases.
8. Will comply with the provisions of the Hatch Act (5 U.S.C. 1501-1508 and 7324-7328) which limit the
political activities of employees whose principal employment activities are funded in whole or in part with
Federal funds.
9. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C. 276a to 276a-7), the
Copeland Act (40 U.S.C. 276c and 18 U.S.C. 874), and the Contract Work Hours and Safety Standards Act
(40 U.S.C. 327-333), regarding labor standards for Federally assisted construction subagreements.
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood
Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to
participate in the program and to purchase flood insurance if the total cost of insurable construction and
acquisition is $10,000 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the following: (a)
institution of environmental quality control measures under the National Environmental Policy Act of 1969
(P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738;
(c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance
with EO 11988; (e) assurance of project consistency with the approved State management program
developed under the Coastal Zone Management Act of 1972 (16 U.S.C. 1451 et seq.); (0 conformity of
Federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955,
as amended (42 U.S.C. 7401 et seq.); (g) protection of underground sources d drinking water under the
Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of endangered species
under the Endangered Species Act of 1973, as amended, (P.L. 93-205)
12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 1271 et seq.) related to protecting
components or potential components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic
Preservation Act of 1966, as amended (16 U.S.C. 470), EO 11593 (identification and protection of historic
properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research,
development, and related activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. 2131
et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching,
or other activities supported by this award of assistance.
16. Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.) which
prohibits the use of lead based paint in the construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the single
Audit Act of 1984.
18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and
policies governing this program.
DRUG -FREE WORKPLACE REQUIREMENTS
GRANTEES OTHER THAN INDIVIDUALS
By signing and/or submitting this application or grant agreement, the grantee is providing the certification set out
below.
This certification is required by regulations implementing the Drug -Free Workplace Act of 1988, 45 CFR, Pad
76, Subpart F. The regulations published in the January 31, 1989 Federal Register, require certification by
grantees that they will maintain a drug -free workplace. The certification set out below is a material
representation of fact upon which reliance will be placed when HHS determines to award the grant. False
certification or violation of the certification shall be grounds for suspension of payments, suspension or
termination of grants, or government -wide suspension or debarment.
Workplaces under grants, for grantees other than individuals, need not be identified on the certification. If
known, they may be identified in the grant application. If the grantee does not identify the workplaces at the
time of application, or upon award, if there is no application, the grantee must keep the identity of the
workplace(s) on file in its office and make the information available for Federal inspection. Failure to identify all
known workplaces constitutes a violation of the grantee's drug -free workplace requirements.
Workplace identifications must include the actual address of buildings (or parts of building) or other sites where
work under the grant takes place. Categorical descriptions may be used (e.g. all vehicles of a mass transit
authority of State highway department while in operation, State employees in each local unemployment office,
performers in concert halls or radio studios).
If the workplace identified to HHS changes during the performance of the grant, the grantee shall inform the
agency of the change(s), it previously identified the workplaces in question (see above).
Definitions of terms in the Nonprocurement Suspension and Debarment common rule and Drug -Free Workplace
common rule apply to this certification. Grantees' attention is called, in particular, to the following definitions
from these rules:
"Controlled substance" means a controlled substance in Schedules I through V of the Controlled Substances
Act (21 USC 812) and as further defined by regulations (21 CFR, 1308.11 through 1308.15). "Conviction"
means a finding of guilt (including a plea of nolo contendere) or imposition of sentence, or both, by any judicial
body charged with the responsibility to determine violations of the Federal of State criminal drug statutes;
"Criminal drug statute" means a Federal or non -Federal criminal statute involving the manufacture, distribution,
dispensing use, or possession of any controlled substance; "Employee" means the employee of a grantee
directly engaged in the performance of work under a grant including: (i) All "direct charge" employees; (ii) all
"indirect charge" employees unless their impact of involvement is insignificant to the performance of the grant;
and (iii) temporary personnel and consultants who are directly engaged in the performance of work under the
grant and who are on the grantee's payroll. This definition does not include workers not on the payroll of the
grantee (e.g., volunteers, even if used to meet a matching requirement; consultants or independent contractors
not on the grantee's payroll; or employees of subrecipients or subcontractors in covered workplaces).
The grantee certifies that it will provide a drug -free workplace by:
a) Publishing a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession or use of a controlled substance is prohibited in the grantee's
workplace and specifying the actions that will be taken against employees for violation of such
prohibition;
b) Establishing a drug -free awareness program to inform employees about:
(1) The dangers of drug abuse in the workplace;
(2) The grantee's policy of maintaining a drug -free workplace;
(3) Any available drug counseling, rehabilitation, employee assistance programs; and
(4) The penalties that may be imposed upon employees for drug abuse violations
occurring in the workplace;
c) Making it a requirement that each employee to be engaged in the performance of the grant be
given a copy of be statement required by paragraph (a);
d) Notifying the employee in the statement required by paragraph (a) that as a condition of
employment under the grant, the employee will:
(1) Abide by the terms of the statement; and
(2) Notify the employer of any criminal drug statute conviction for a violation occurring in
the workplace no later than five days after such conviction;
e) Notifying the agency in writing within ten days after receiving notice under subparagraph (d)(2),
from an employee or otherwise receiving actual notice of such conviction. Employers of
convicted employees must provide notice, including position title, to every grant officer or other
designee on whose grant the convicted employee was working, unless the Federal agency has
designated a central point for the receipt of such notices. Notice shall include the
identification number(s) of each affected grant;
r) Taking one of the following actions within 30 days of receiving notice under subparagraph
(d)(2), with respect to any employee who is so convicted:
(1) Taking appropriate personnel action against such an employee, up to and including
termination, consistent with the requirements of the Rehabilitation Act of 1973, as
amended; or
(2) Requiring such employee to participate satisfactorily in a drug abuse assistance or
rehabilitation program approved for such purposes by a Federal, State, or local health,
law enforcement, or other appropriate agency.
g)
Making a good faith effort to continue to maintain a drug -free workplace through
implementation of paragraphs (a) through (0.
CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE
Public Law 103-227, also known as the Pro -Children Act of 1994 (Act), requires that smoking not be permitted
in any portion of any indoor facility owned or leased or contracted for by an entity and used routinely or regularly
for the provision of health, day care, early childhood development services, education or library services to
children under the age of 18, if the services are funded by Federal program either directly or through State or
local governments, by Federal grant, contract, loan, or loan guarantee. The law also applies to children's
services that are provided in indoor facilities that are constructed, operated, or maintained with such Federal
funds. The law does not apply to children's services provided in private residences; portions of facilities used for
inpatient drug or alcohol treatment; service providers whose sole source of applicable Federal funds in medicare
of medicaid; or facilities where WIC coupons are redeemed. Failure to comply with the provisions of the law
may result in the imposition of a civil monetary penalty of up to $1,000 for each violation and/or the imposition of
an administrative compliance order on the responsible entity.
By signing this certification, the offeror/contractor (for acquisitions) or applicant/grantee (for grants) certifies that
the submitting organization will comply with the requirements of the Act and will not allow smoking within any
portion of any indoor facility used for the provision of services for children as defined by the Act.
The submitting organization agrees that it will require that the language of this certification be included in any
subawards which subrecipients shall certify accordingly.
CERTIFICATION REGARDING DEBARMENT, SUSPENSION AND OTHER
RESPONSIBILITY MATTERS - PRIMARY COVERED TRANSACTIONS
By signing and submitting this proposal, the applicant, defined as the primary participant in accordance with 45
CFR Part 76 certifies to the best of his or her knowledge and believe that it and its principals:
(a)
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily
excluded from covered transaction by any Federal Department or agency;
(b) have not within a 3year period preceding this proposal been convicted or had a civil judgement
rendered against them for commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a
public transaction: violation of Federal or State antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false statement, or receiving stolen
property;
(c) are not presently indicted or otherwise criminally or civilly charged by a governmental entity (Federal,
State or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this
certification; and
(d) have not within a 3 -year period preceding this application/proposal had one or more public transaction
(Federal, State or local) terminated for cause or default.
The inability of a person to provide the certification required above will not necessarily result in denial of
participation in this covered transaction. If necessary, the prospective participant shall submit an explanation of
why it cannot provide the certification. The Department of Health and Human Services' (HHS) determination
whether to enter into this transaction. However, failure of the prospective primary participant to furnish a
certification or an explanation shall disqualify such person from participation in this transaction.
The prospective primary participant agrees that by submitting this proposal, it will include the clause entitled
"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered
Transactions," provided below without modification in all lower tier covered transactions.
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARY EXCLUSION - LOWER TIER COVERED TRANSACTIONS
(TO BE SUPPLIED TO LOWER TIER PARTICIPANTS)
By signing and submitting this lower tier proposal, the prospective lower tier participant, as defined in 45 CFR,
Part 76, certifies to the best of its knowledge and belief that it and its principals:
(a) are not presently debarred, suspended, proposed for debarment, declared ineligible, a voluntarily
excluded from participation in this transaction by any Federal department or agency.
(b) where the prospective lower tier participant is unable to certify to any of the above, such prospective
participant shall attach an explanation to this proposal.
The prospective lower tier participant further agrees by submitting this proposal that it will include this clause
entitled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier
Covered Transactions," without modification in all lower tier covered transactions and in all solicitations for lower
tier covered transactions.
CERTIFICATION REGARDING LOBBYING
FOR CONTRACTS, GRANTS, LOANS
AND COOPERATIVE AGREEMENTS
The undersigned certifies to the best of his or her knowledge and belief, that:
(1)
No Federal appropriate funds have been paid or will be paid, by or on behalf of the undersigned, to any
person for influencing or attempting to influence an officer or employee of any agency, a member of
congress, an officer or employee of congress, or an employee of a member of congress in connection
with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal
loan, the entering into of any cooperative agreement, and the extension, continuation, renewal,
amendment or modification of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person
influencing or attempting to influence an officer or employee or an agency, a member of congress, an
officer or employee of congress, or an employee of a member of congress in connection with this
Federal contract, grant, loan or cooperative agreement, the undersigned shall complete and submit
Standard Form LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3)
The undersigned shall require that the language of this certification be included in the award documents
for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was
made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification
shall be subject to a civil penalty or not less than $10,000 and not more than $100,000 for each such failure.
I hereby agree the above certifications and assurances.
APR 2 9 2009
ignature of Certifying Official Date
William F. Garcia, Chair
Title
Weld County Board of Commissioners
Applicant Organization
APPLICATION FOR
FEDERAL ASSISTANCE
2. DATE SUBMITTED:
Applicant Identifier
90CM0136
1. TYPE OF SUBMISSION
Application
Construction
Preapplication
� Construction
� Non -Construction
3. DATE RECEIVED BY STATE:
State Application Identifier
4. DATE RECEIVED BY FEDERAL AGENCY:
Federal Identifier
90CM0136 - 000
X Non -Construction
5. APPLICANT INFORMATION
Legal Name:
WELD COUNTY RESOURCES DEPARTMENT
Organizational Unit
Department HHS: Office of Head Start
Organizational DUNS: 139136811
Division: HHS: Office of Head Start
Address:
Name and telephone number of the person to be contacted on matters
involving this application (give area code)
Street: 1551 North 17th Avenue
P.O. Box 1805
Prefix: Dr. I Middle Name:
City: Greeley
First Name: Janet
County: N/A
Last Name: Flaugher
State: CO Zip Code: 80632
Suffix:
Country: N/A
Email: jflaugher@co.weld.co.us
6. EMPLOYER IDENTIFICATION NUMBER (EIN)
846000813
Phone Number (give area code)
(970)353-3800
Fax Number (give area code)
(970)304-6453
8. TYPE OF APPLICATION
New � Continuation
If Revision, enter appropriate letter(s) in
Other (specify)
7. TYPE OF APPLICANT (enter appropriate letter
Other (specify)
in box) B
X
Revision
box(es): A
O
9. NAME OF FEDERAL AGENCY:
HHS / ACF / OHS
10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:
93.600
TITLE (Name of Program):
Head Start / Early Head Start
11. DESCRIPTION TITLE OF APPLICANT'S PROJECT:
1.84% ARRA COLA Increase
12. AREAS AFFECTED BY PROJECT (Cities, Counties, States etc.):
Weld County
13. PROPOSED PROJECT:
14. CONGRESSIONAL DISTRICTS OF:
Start Date: 01/01/2009 Ending Date: 12/31/2009
a. Applicant: 4 b. Project:
15. ESTIMATED FUNDING
16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS?
a. Federal
$27,001
a. YES THIS
STATE EXECUTIVE
b. NO
PREAPPLICATION/APPLICATION
ORDER 12372
Date:
9 PROGRAM IS NOT
WAS MADE AVAILABLE TO THE
PROCESS FOR REVIEW ON
COVERED BY E.O. 12372
HAS NOT BEEN SELECTED BY STATE FOR REVIEW
b. Applicant
$6,751
c. State
$0
d. Local
$0
e. Other
$0
X OR PROGRAM
f. Program Income
$0
17. IS THE APPLICANT DELINQUENT ON ANY
Yes If "Yes," attach an explanation.
FEDERAL DEBT?
g. Total
$33,752
X No
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF. ALL DATA IN THIS APPLICATION ME TRUE AND CORRECT. THE DOCUMENT HAS BEEN DULY AUTHORIZED
BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED
a. Authorized Representative
Prefix: Mr. I First Name: William
Middle Name:
Last Name: Garcia
Suffix:
b. Title: Authorizing Official y/ , q
c. Telephone number: (970)353-3800
d. Signature of Authorized Representative: ///1//�/J
e. Date Signed: 05/08/2009 APR 2 9 2009
Standard Form 424 (Rev.9-2003) Prescribed by OMB Circular A-102
Applicant delinquent explanation of federal debt for line 17:
N/A
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
COMPENDIUM OF REQUIRED CERTIFICATIONS AND ASSURANCES
SF 4248
ASSURANCES - NON -CONSTRUCTION PROGRAMS
Note: Certain of these assurances may not be applicable to your project or program. If you have
questions, please contact the awarding agency. Further, certain Federal awarding agencies may require
applicants to certify to additional assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial
capability (including funds sufficient to pay the non -Federal share of project costs) to ensure proper
planning, management and completion of the project described in this application.
2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the
State, through any authorized representative, access to and the right to examine all records, books, papers,
or documents related to the award; and will establish a proper accounting system in accordance with
generally accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes
or presents the appearance of personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the
awarding agency.
5. Will comply with the intergovernmental Personnel Act of 1970 (42 U.S.C. 4278-4763) relating to
prescribed standards for merit systems for programs funded under one of the nineteen statutes or
regulations specified in Appendix A of OPM=s Standards for a Merit System of Personnel Administration (5
CFR 900, Subpart F).
6. Will comply with all Federal statutes relating to non-discrimination. These include but are not limited to:
(a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the bases of race,
color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. 1681-
1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the
Rehabilitation Act of 1973, as amended (29 U.S.C. 794), which prohibits discrimination on the basis of
handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. 6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as
amended, relating to non-discrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse
and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to
non-discrimination on the bases of alcohol abuse or alcoholism; (g) 523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee-3), as amended, relating to confidentiality of the
alcohol and drug abuse patient records; (h) Title VII of the Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.),
as amended, relating to non-discrimination in the sale, rental or financing of housing; (I) any other non-
discrimination provisions in the specific statute(s) under which application for Federal assistance is being
made; and Q) the requirements of any other non-discrimination statute(s) which may apply to the application.
7. Will comply, or has already complies, with the requirements of Titles II and III of the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and
equitable treatment of persons displaced or whose property is acquired as a result of Federal or Federally
assisted programs. These requirements apply to all interests in real property acquired for project purposes
regardless of Federal participation in purchases.
8. Will comply with the provisions of the Hatch Act (5 U.S.C. 1501-1508 and 7324-7328) which limit the
political activities of employees whose principal employment activities are funded in whole or in part with
Federal funds.
9. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C. 276a to 276a-7), the
Copeland Act (40 U.S.C. 276c and 18 U.S.C. 874), and the Contract Work Hours and Safety Standards Act
(40 U.S.C. 327-333), regarding labor standards for Federally assisted construction subagreements.
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood
Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to
participate in the program and to purchase flood insurance if the total cost of insurable construction and
acquisition is $10,000 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the following: (a)
institution of environmental quality control measures under the National Environmental Policy Act of 1969
(P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738;
(c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance
with EO 11988; (e) assurance of project consistency with the approved State management program
developed under the Coastal Zone Management Act of 1972 (16 U.S.C. 1451 et seq.); (t) conformity of
Federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955,
as amended (42 U.S.C. 7401 et seq.); (g) protection of underground sources of drinking water under the
Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of endangered species
under the Endangered Species Act of 1973, as amended, (P.L. 93-205)
12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 1271 et seq.) related to protecting
components or potential components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic
Preservation Act of 1966, as amended (16 U.S.C. 470), EO 11593 (identification and protection of historic
properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research,
development, and related activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (Pl. 89-544, as amended, 7 U.S.C. 2131
et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching,
or other activities supported by this award of assistance.
16. Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.) which
prohibits the use of lead based paint in the construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the single
Audit Act of 1984.
18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and
policies governing this program.
DRUG -FREE WORKPLACE REQUIREMENTS
GRANTEES OTHER THAN INDIVIDUALS
By signing and/or submitting this application or grant agreement, the grantee is providing the certification set out
below.
This certification is required by regulations implementing the Drug -Free Workplace Act of 1988, 45 CFR, Part
76, Subpart F. The regulations published in the January 31, 1989 Federal Register, require certification by
grantees that they will maintain a drug -free workplace. The certification set out below is a material
representation of fact upon which reliance will be placed when HHS determines to award the grant. False
certification or violation of the certification shall be grounds for suspension of payments, suspension or
termination of grants, or government -wide suspension or debarment.
Workplaces under grants, for grantees other than individuals, need not be identified on the certification. If
known, they may be identified in the grant application. If the grantee does not identify the workplaces at the
time of application, or upon award, if there is no application, the grantee must keep the identity of the
workplace(s) on file in its office and make the information available for Federal inspection. Failure to identify all
known workplaces constitutes a violation of the grantee's drug -free workplace requirements.
Workplace identifications must include the actual address of buildings (or parts of building) or other sites where
work under the grant takes place. Categorical descriptions may be used (e.g. all vehicles of a mass transit
authority of State highway department while in operation, State employees in each local unemployment office,
performers in concert halls or radio studios).
If the workplace identified to HHS changes during the performance of the grant, the grantee shall inform the
agency of the change(s), it previously identified the workplaces in question (see above).
Definitions of terms in the Nonprocurement Suspension and Debarment common rule and Drug -Free Workplace
common rule apply to this certification. Grantees' attention is called, in particular, to the following definitions
from these rules:
"Controlled substance" means a controlled substance in Schedules I through V of the Controlled Substances
Act (21 USC 812) and as further defined by regulations (21 CFR, 1308.11 through 1308.15). "Conviction"
means a finding of guilt (including a plea of nolo contendere) or imposition of sentence, or both, by any judicial
body charged with the responsibility to determine violations of the Federal of State criminal drug statutes;
"Criminal drug statute" means a Federal or non -Federal criminal statute involving the manufacture, distribution,
dispensing use, or possession of any controlled substance; "Employee" means the employee of a grantee
directly engaged in the performance of work under a grant including: (i) All "direct charge" employees; (ii) all
"indirect charge" employees unless their impact of involvement is insignificant to the performance of the grant;
and (iii) temporary personnel and consultants who are directly engaged in the performance of work under the
grant and who are on the grantee's payroll. This definition does not include workers not on the payroll of the
grantee (e.g., volunteers, even if used to meet a matching requirement; consultants or independent contractors
not on the grantee's payroll; or employees of subrecipients or subcontractors in covered workplaces).
The grantee certifies that it will provide a drug -free workplace by:
a) Publishing a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession or use of a controlled substance is prohibited in the grantee's
workplace and specifying the actions that will be taken against employees for violation of such
prohibition;
b) Establishing a drug -free awareness program to inform employees about:
(1) The dangers of drug abuse in the workplace;
(2) The grantee's policy of maintaining a drug -free workplace;
(3) Any available drug counseling, rehabilitation, employee assistance programs; and
(4) The penalties that may be imposed upon employees for drug abuse violations
occurring in the workplace;
c) Making it a requirement that each employee to be engaged in the performance of the grant be
given a copy of be statement required by paragraph (a);
d) Notifying the employee in the statement required by paragraph (a) that as a condition of
employment under the grant, the employee will:
(1) Abide by the terms of the statement; and
(2) Notify the employer of any criminal drug statute conviction for a violation occurring in
the workplace no later than five days after such conviction;
e) Notifying the agency in writing within ten days after receiving notice under subparagraph (d)(2),
from an employee or otherwise receiving actual notice of such conviction. Employers of
convicted employees must provide notice, including position title, to every grant officer or other
designee on whose grant the convicted employee was working, unless the Federal agency has
designated a central point for the receipt of such notices. Notice shall include the
identification number(s) of each affected grant;
f) Taking one of the following actions within 30 days of receiving notice under subparagraph
(d)(2), with respect to any employee who is so convicted:
(1) Taking appropriate personnel action against such an employee, up to and including
termination, consistent with the requirements of the Rehabilitation Act of 1973, as
amended; or
(2) Requiring such employee to participate satisfactorily in a drug abuse assistance or
rehabilitation program approved for such purposes by a Federal, State, or local health,
law enforcement, or other appropriate agency.
g)
Making a good faith effort to continue to maintain a drug -free workplace through
implementation of paragraphs (a) through (f).
CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE
Public Law 103-227, also known as the Pm -Children Act of 1994 (Act), requires that smoking not be permitted
in any portion of any indoor facility owned or leased or contracted for by an entity and used routinely or regularly
for the provision of health, day care, early childhood development services, education or library services to
children under the age of 18, if the services are funded by Federal program either directly or through State or
local governments, by Federal grant, contract, loan, or loan guarantee. The law also applies to children's
services that are provided in indoor facilities that are constructed, operated, or maintained with such Federal
funds. The law does not apply to children's services provided in private residences; portions of facilities used for
inpatient drug or alcohol treatment; service providers whose sole source of applicable Federal funds in medicare
of medicaid; or facilities where WIC coupons are redeemed. Failure to comply with the provisions of the law
may result in the imposition of a civil monetary penalty of up to $1,000 for each violation and/or the imposition of
an administrative compliance order on the responsible entity.
By signing this certification, the offeror/contractor (for acquisitions) or applicant/grantee (for grants) certifies that
the submitting organization will comply with the requirements of the Act and will not allow smoking within any
portion of any indoor facility used for the provision of services for children as defined by the Act.
The submitting organization agrees that it will require that the language of this certification be included in any
subawards which subrecipients shall certify accordingly.
CERTIFICATION REGARDING DEBARMENT, SUSPENSION AND OTHER
RESPONSIBILITY MATTERS - PRIMARY COVERED TRANSACTIONS
By signing and submitting this proposal, the applicant, defined as the primary participant in accordance with 45
CFR Part 76 certifies to the best of his or her knowledge and believe that it and its principals:
(a) are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily
excluded from covered transaction by any Federal Department or agency;
(b) have not within a 3year period preceding this proposal been convicted or had a civil judgement
rendered against them for commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a
public transaction: violation of Federal or State antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false statement, or receiving stolen
property;
(c) are not presently indicted or otherwise criminally or civilly charged by a governmental entity (Federal,
State or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this
certification; and
(d) have not within a 3 -year period preceding this application/proposal had one or more public transaction
(Federal, State or local) terminated for cause or default.
The inability of a person to provide the certification required above will not necessarily result in denial of
participation in this covered transaction. If necessary, the prospective participant shall submit an explanation of
why it cannot provide the certification. The Department of Health and Human Services' (HHS) determination
whether to enter into this transaction. However, failure of the prospective primary participant to furnish a
certification or an explanation shall disqualify such person from participation in this transaction.
The prospective primary participant agrees that by submitting this proposal, it will include the clause entitled
"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered
Transactions," provided below without modification in all lower tier covered transactions.
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARY EXCLUSION - LOWER TIER COVERED TRANSACTIONS
(TO BE SUPPLIED TO LOWER TIER PARTICIPANTS)
By signing and submitting this lower tier proposal, the prospective lower tier participant, as defined in 45 CFR,
Part 76, certifies to the best of its knowledge and belief that it and its principals:
(a) are not presently debarred, suspended, proposed for debarment, declared ineligible, a voluntarily
excluded from participation in this transaction by any Federal department or agency.
(b) where the prospective lower tier participant is unable to certify to any of the above, such prospective
participant shall attach an explanation to this proposal.
The prospective lower tier participant further agrees by submitting this proposal that it will include this clause
entitled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier
Covered Transactions," without modification in all lower tier covered transactions and in all solicitations for lower
tier covered transactions.
CERTIFICATION REGARDING LOBBYING
FOR CONTRACTS, GRANTS, LOANS
AND COOPERATIVE AGREEMENTS
The undersigned certifies to the best of his or her knowledge and belief, that:
(1)
No Federal appropriate funds have been paid or will be paid, by or on behalf of the undersigned, to any
person for influencing or attempting to influence an officer or employee of any agency, a member of
congress, an officer or employee of congress, or an employee of a member of congress in connection
with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal
loan, the entering into of any cooperative agreement, and the extension, continuation, renewal,
amendment or modification of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person
influencing or attempting to influence an officer or employee or an agency, a member of congress, an
officer or employee of congress, or an employee of a member of congress in connection with this
Federal contract, grant, loan or cooperative agreement, the undersigned shall complete and submit
Standard Form LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3)
The undersigned shall require that the language of this certification be included in the award documents
for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was
made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification
shall be subject to a civil penalty or not less than $10,000 and not more than $100,000 for each such failure.
I hereby actreethe above certifications and assurances.
Signature of Certifying Official
William F. Garcia, Chair
Title
Weld County Board of Commissioners
Applicant Organization
APR 2 9 2009
Date
1OO9-/d/ 7
APPLICATION FOR
FEDERAL ASSISTANCE
2. DATE SUBMITTED:
Applicant Identifier
90CM0136
1. TYPE OF SUBMISSION
Application
Construction
Preapplication
❑ Construction
� Non -Construction
3. DATE RECEIVED BY STATE:
State Application Identifier
4. DATE RECEIVED BY FEDERAL AGENCY:
Federal Identifier
90CM0136 - 000
X Non -Construction
5. APPLICANT INFORMATION
Legal Name:
WELD COUNTY RESOURCES DEPARTMENT
Organizational Unit
Department HHS: Office of Head Start
Organizational DUNS: 139136811
Division: HHS: Office of Head Start
Address:
Name and telephone number of the person to be contacted on matters
involving this application (give area code)
Street: 1551 North 17th Avenue
P.O. Box 1805
Prefix: Dr. I Middle Name:
City: Greeley
First Name: Janet
County: N/A
Last Name: Flaugher
State: CO Zip Code: 80632
Suffix:
Country: N/A
Email: jflaugher@co.weld.co.us
6. EMPLOYER IDENTIFICATION NUMBER (EIN)
846000813
Phone Number (give area code)
(970)353-3800
Fax Number (give area code)
(970)304-6453
8. TYPE OF APPLICATION
❑ New � Continuation
If Revision, enter appropriate letter(s) in
Other (specify)
7. TYPE OF APPLICANT (enter appropriate
Other (specify)
etter in box) B
X
Revision
box(es): A
❑
9. NAME OF FEDERAL AGENCY:
HHS / ACE / OHS
10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:
93.600
TITLE (Name of Program):
Head Start / Early Head Start
11. DESCRIPTION TITLE OF APPLICANT'S PROJECT:
Refer to Uploaded Document under "Additional SF424 Document".
12. AREAS AFFECTED BY PROJECT (Cities, Counties. States etc.):
Weld County
13. PROPOSED PROJECT:
14. CONGRESSIONAL DISTRICTS OF:
Start Date: 01/01/2009 Ending Date: 12/31/2009
a. Applicant: 4 b. Project:
15. ESTIMATED FUNDING
16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS:
a. Federal
$81,112
a. YES THIS
STATE EXECUTIVE
b. NO
PREAPPLICATION/APPLICATION
ORDER 12372
Date:
� PROGRAM IS NOT
WAS MADE AVAILABLE TO THE
PROCESS FOR REVIEW ON
COVERED BY E.O. 12372
HAS NOT BEEN SELECTED BY STATE FOR REVIEW
b. Applicant
$20,278
c. State
$0
d. Local
$0
e. Other
$0
X OR PROGRAM
f. Program Income
$0
17. IS THE APPLICANT DELINQUENT ON ANY
❑ Yes If "Yes," attach an explanation.
FEDERAL DEBT?
g. Total
$101,390
X No
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF. ALL DATA IN THIS APPLICATION ARE TRUE AND CORRECT. THE DOCUMENT HAS BEEN DULY AUTHORIZED
BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED
a. Authorized Representative
Prefix: Mr. I First Name: William
Middle Name:
Last Name: Garcia
Suffix:
b. Title: Authorizing Official _
c. Telephone number: (970)353-3800
d. Signature of Authorized Representative: GI A J
e. Date Signed: 05/08/2009 APR 2 9 2009
Standard Form 424 (Rev.9-2003) Prescribed by OMB Circular A-102
oloc'9—/o/ 7
Applicant delinquent explanation of federal debt for line 17:
N/A
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
COMPENDIUM OF REQUIRED CERTIFICATIONS AND ASSURANCES
SF 424B
ASSURANCES - NON -CONSTRUCTION PROGRAMS
Note: Certain of these assurances may not be applicable to your project or program. If you have
questions, please contact the awarding agency. Further, certain Federal awarding agencies may require
applicants to certify to additional assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial
capability (including funds sufficient to pay the non -Federal share of project costs) to ensure proper
planning, management and completion of the project described in this application.
2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the
State, through any authorized representative, access to and the right to examine all records, books, papers,
or documents related to the award; and will establish a proper accounting system in accordance with
generally accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes
or presents the appearance of personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the
awarding agency.
5. Will comply with the intergovernmental Personnel Act of 1970 (42 U.S.C. 4278-4763) relating to
prescribed standards for merit systems for programs funded under one of the nineteen statutes or
regulations specified in Appendix A of OPM=s Standards for a Merit System of Personnel Administration (5
CFR 900, Subpart F).
6. Will comply with all Federal statutes relating to non-discrimination. These include but are not limited to:
(a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the bases of race,
color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. 1681-
1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the
Rehabilitation Act of 1973, as amended (29 U.S.C. 794), which prohibits discrimination on the basis of
handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. 6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as
amended, relating to non-discrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse
and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to
non-discrimination on the bases of alcohol abuse or alcoholism; (g) 523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee-3), as amended, relating to confidentiality of the
alcohol and drug abuse patient records; (h) Title VII of the Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.),
as amended, relating to non-discrimination in the sale, rental or financing of housing; (I) any other non-
discrimination provisions in the specific statute(s) under which application for Federal assistance is being
made; and (j) the requirements of any other non-discrimination statute(s) which may apply to the application.
7. Will comply, or has already complies, with the requirements of Titles II and III of the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and
equitable treatment of persons displaced or whose property is acquired as a result of Federal or Federally
assisted programs. These requirements apply to all interests in real property acquired for project purposes
regardless of Federal participation in purchases.
8. Will comply with the provisions of the Hatch Act (5 U.S.C. 1501-1508 and 7324-7328) which limit the
political activities of employees whose principal employment activities are funded in whole or in part with
Federal funds.
9. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C. 276a to 276a-7), the
Copeland Act (40 U.S.C. 276c and 18 U.S.C. 874), and the Contract Work Hours and Safety Standards Act
(40 U.S.C. 327-333), regarding labor standards for Federally assisted construction subagreements.
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood
Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to
participate in the program and to purchase flood insurance if the total cost of insurable construction and
acquisition is $10,000 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the following: (a)
institution of environmental quality control measures under the National Environmental Policy Act of 1969
(P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738;
(c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance
with EO 11988; (e) assurance of project consistency with the approved State management program
developed under the Coastal Zone Management Act of 1972 (16 U.S.C. 1451 et seq.); (f) conformity of
Federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955,
as amended (42 U.S.C. 7401 et seq.); (g) protection of underground sources of drinking water under the
Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of endangered species
under the Endangered Species Act of 1973, as amended, (P.L. 93-205)
12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 1271 et seq.) related to protecting
components or potential components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic
Preservation Act of 1966, as amended (16 U.S.C. 470), EO 11593 (identification and protection of historic
properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research,
development, and related activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. 2131
et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching,
or other activities supported by this award of assistance.
16. Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.) which
prohibits the use of lead based paint in the construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the single
Audit Act of 1984.
18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and
policies governing this program.
DRUG -FREE WORKPLACE REQUIREMENTS
GRANTEES OTHER THAN INDIVIDUALS
By signing and/or submitting this application or grant agreement, the grantee is providing the certification set out
below.
This certification is required by regulations implementing the Drug -Free Workplace Act of 1988, 45 CFR, Part
76, Subpart F. The regulations published in the January 31, 1989 Federal Register, require certification by
grantees that they will maintain a drug -free workplace. The certification set out below is a material
representation of fact upon which reliance will be placed when NHS determines to award the grant. False
certification or violation of the certification shall be grounds for suspension of payments, suspension or
termination of grants, or government -wide suspension or debarment.
Workplaces under grants, for grantees other than individuals, need not be identified on the certification. If
known, they may be identified in the grant application. If the grantee does not identify the workplaces at the
time of application, or upon award, if there is no application, the grantee must keep the identity of the
workplace(s) on file in its office and make the information available for Federal inspection. Failure to identify all
known workplaces constitutes a violation of the grantee's drug -free workplace requirements.
Workplace identifications must include the actual address of buildings (or parts of building) or other sites where
Kork under the grant takes place. Categorical descriptions may be used (e.g. all vehicles of a mass transit
authority of State highway department while in operation, State employees in each local unemployment office,
performers in concert halls or radio studios).
If the workplace identified to NHS changes during the performance of the grant, the grantee shall inform the
agency of the change(s), it previously identified the workplaces in question (see above).
Definitions of terms in the Nonprocurement Suspension and Debarment common rule and Drug -Free Workplace
common rule apply to this certification. Grantees' attention is called, in particular, to the following definitions
from these rules:
"Controlled substance" means a controlled substance in Schedules I through V of the Controlled Substances
Act (21 USC 812) and as further defined by regulations (21 CFR, 1308.11 through 1308.15). "Conviction"
means a finding of guilt (including a plea of nob contendere) or imposition of sentence, or both, by any judicial
body charged with the responsibility to determine violations of the Federal of State criminal drug statutes;
"Criminal drug statute" means a Federal or non -Federal criminal statute involving the manufacture, distribution,
dispensing use, or possession of any controlled substance; "Employee" means the employee of a grantee
directly engaged in the performance of work under a grant including: (0 All "direct charge" employees; (ii) all
"indirect charge" employees unless their impact of involvement is insignificant to the performance of the grant;
and (iii) temporary personnel and consultants who are directly engaged in the performance of work under the
grant and who are on the grantee's payroll. This definition does not include workers not on the payroll of the
grantee (e.g., volunteers, even if used to meet a matching requirement; consultants or independent contractors
not on the grantee's payroll; or employees of subrecipients or subcontractors in covered workplaces).
The grantee certifies that it will provide a drug -free workplace by:
a) Publishing a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession or use of a controlled substance is prohibited in the grantee's
workplace and specifying the actions that will be taken against employees for violation of such
prohibition;
b) Establishing a drug -free awareness program to inform employees about
(1) The dangers of drug abuse in the workplace;
(2) The grantee's policy of maintaining a drug -free workplace;
(3) Any available drug counseling, rehabilitation, employee assistance programs; and
(4) The penalties that may be imposed upon employees for drug abuse violations
occurring in the workplace;
c) Making it a requirement that each employee to be engaged in the performance of the grant be
given a copy of be statement required by paragraph (a);
d) Notifying the employee in the statement required by paragraph (a) that as a condition of
employment under the grant, the employee will:
(1)
(2)
Abide by the terms of the statement; and
Notify the employer of any criminal drug statute conviction for a violation occurring in
the workplace no later than five days after such conviction;
e) Notifying the agency in writing within ten days after receiving notice under subparagraph (d)(2),
from an employee or otherwise receiving actual notice of such conviction. Employers of
convicted employees must provide notice, including position title, to every grant officer or other
designee on whose grant the convicted employee was working, unless the Federal agency has
designated a central point for the receipt of such notices. Notice shall include the
identification number(s) of each affected grant;
f) Taking one of the following actions within 30 days of receiving notice under subparagraph
(d)(2), with respect to any employee who is so convicted:
g)
(1) Taking appropriate personnel action against such an employee, up to and including
termination, consistent with the requirements of the Rehabilitation Act of 1973, as
amended; or
(2) Requiring such employee to participate satisfactorily in a drug abuse assistance or
rehabilitation program approved for such purposes by a Federal, State, or local health,
law enforcement, or other appropriate agency.
Making a good faith effort to continue to maintain a drug -free workplace through
implementation of paragraphs (a) through (f).
CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE
Public Law 103-227, also known as the Pro -Children Act of 1994 (Act), requires that smoking not be permitted
in any portion of any indoor facility owned or leased or contracted for by an entity and used routinely or regularly
for the provision of health, day care, early childhood development services, education or library services to
children under the age of 18, if the services are funded by Federal program either directly or through State or
local governments, by Federal grant, contract, loan, or loan guarantee. The law also applies to children's
services that are provided in indoor facilities that are constructed, operated, or maintained with such Federal
funds. The law does not apply to children's services provided in private residences; portions of facilities used for
inpatient drug or alcohol treatment; service providers whose sole source of applicable Federal funds in medicare
of medicaid; or facilities where WIC coupons are redeemed. Failure to comply with the provisions of the law
may result in the imposition of a civil monetary penalty of up to $1,000 for each violation and/or the imposition of
an administrative compliance order on the responsible entity.
By signing this certification, the offeror/contractor (for acquisitions) or applicant/grantee (for grants) certifies that
the submitting organization will comply with the requirements of the Act and will not allow smoking within any
portion of any indoor facility used for the provision of services for children as defined by the Act.
The submitting organization agrees that it will require that the language of this certification be included in any
subawards which subrecipients shall certify accordingly.
CERTIFICATION REGARDING DEBARMENT, SUSPENSION AND OTHER
RESPONSIBILITY MATTERS - PRIMARY COVERED TRANSACTIONS
By signing and submitting this proposal, the applicant, defined as the primary participant in accordance with 45
CFR Part 76 certifies to the best of his or her knowledge and believe that it and its principals:
(a)
are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily
excluded from covered transaction by any Federal Department or agency;
(b) have not within a 3year period preceding this proposal been convicted or had a civil judgement
rendered against them for commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a
public transaction: violation of Federal or State antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false statement, or receiving stolen
property;
(c) are not presently indicted or otherwise criminally or civilly charged by a governmental entity (Federal,
State or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this
certification; and
(d) have not within a 3 -year period preceding this application/proposal had one or more public transaction
(Federal, State or local) terminated for cause or default.
The inability of a person to provide the certification required above will not necessarily result in denial of
participation in this covered transaction. If necessary, the prospective participant shall submit an explanation of
why it cannot provide the certification. The Department of Health and Human Services' (HHS) determination
whether to enter into this transaction. However, failure of the prospective primary participant to furnish a
certification or an explanation shall disqualify such person from participation in this transaction.
The prospective primary participant agrees that by submitting this proposal, it will include the clause entitled
"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered
Transactions," provided below without modification in all lower tier covered transactions.
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARY EXCLUSION - LOWER TIER COVERED TRANSACTIONS
(TO BE SUPPLIED TO LOWER TIER PARTICIPANTS)
By signing and submitting this lower tier proposal, the prospective lower tier participant, as defined in 45 CFR,
Part 76, certifies to the best of its knowledge and belief that it and its principals:
(a) are not presently debarred, suspended, proposed for debarment, declared ineligible, a voluntarily
excluded from participation in this transaction by any Federal department or agency.
(b) where the prospective lower tier participant is unable to certify to any of the above, such prospective
participant shall attach an explanation to this proposal.
The prospective lower tier participant further agrees by submitting this proposal that it will include this clause
entitled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier
Covered Transactions," without modification in all lower tier covered transactions and in all solicitations for lower
tier covered transactions.
CERTIFICATION REGARDING LOBBYING
FOR CONTRACTS, GRANTS, LOANS
AND COOPERATIVE AGREEMENTS
The undersigned certifies to the best of his or her knowledge and belief, that:
(1) No Federal appropriate funds have been paid or will be paid, by or on behalf of the undersigned, to any
person for influencing or attempting to influence an officer or employee of any agency, a member of
congress, an officer or employee of congress, or an employee of a member of congress in connection
with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal
loan, the entering into of any cooperative agreement, and the extension, continuation, renewal,
amendment or modification of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person
influencing or attempting to influence an officer or employee or an agency, a member of congress, an
officer or employee of congress, or an employee of a member of congress in connection with this
Federal contract, grant, loan or cooperative agreement, the undersigned shall complete and submit
Standard Form LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3)
The undersigned shall require that the language of this certification be included in the award documents
for all subawards at all tiers (including subcontracts, sub grants, and contracts under grants, loans, and
cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was
made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction imposed by section 1352, title 31, U.S. Code. Any person who falls to file the required certification
shall be subject to a civil penalty or not less than $10,000 and not more than $100,000 for each such failure.
I hereby J1gr p thabove certifications and assurances.
/
APR 2 9 2009
Signature of Certifying Official Date
William F. Garcia, Chair
Title
Weld County Board of Commissioners
Applicant Organization
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