HomeMy WebLinkAbout20092355.tiffRESOLUTION
RE: APPROVE REVISION TO ONE-TIME FUNDING GRANT APPLICATION FOR MIGRANT/
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 a Revision to the One -Time Funding Grant
Application for the Migrant/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 revision, and
WHEREAS, after review, the Board deems it advisable to approve said revision, 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 Revision to the One -Time Funding Grant Application for the
Migrant/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 revision.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 2nd day of September, A.D., 2009, nunc pro tunc January 1, 2009.
BOARD OF COUNTY COMMISSIONERS
WELD CO)JJNCOLORADO
ATTEST:
Weld County Clerk to th
BY.
Deputy Clerk to the Boa
APPROVE2 AS T•
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Date of signature S
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Sean P. Conway
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2009-2355
H R0080
MEMORANDUM
DATE: August 31, 2009
WIlDTO: William F. Garcia, ChairBoard of County ommissioners
c. FROM: Judy A. Griego, Director, Human Services
COLORADO RE:
Revision to the One -Time Funding Grant Application for
the Weld County Department of Human Services' Migrant
and Seasonal Head Start Program Improvement Request for
2009
Enclosed for Board approval is a Revision to Form 424 of the One-time Funding Grant
Application for the Department's Migrant and Seasonal Head Start Program Improvement
Request for 2009. This Grant Application Revision was presented at the Board's August 31,
2009, Work Session.
This Revision to the original grant application addresses the in -kind match that the school
districts provided to the Program in order to get the funding.
The term of this Grant will be January 1, 2009 through December 31, 2009.
If you have questions, please give me a call at extension 6510.
2009-2355
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: HITS: 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
Continuation
in box(es):
❑ Revision
❑
7. TYPE OF APPLICANT (enter appropriate letter
Other (specify)
in box) B
X New
If Revision, enter appropriate letter(s)
Other (specify)
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:
One -Time Funding Grant Application -Migrant and Seasonal Head Start Program
Improvement Request for 2009
12. AREAS AFFECTED BY PROJECT (Cities, Counties, States etc.):
Weld County, Colorado
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
$74,389
a. YES THIS
STATE EXECUTIVE
b. NO
PREAPPLICATI ON/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
$18,598
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
$92,987
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:/
e. Date Signed: SEP Q 2 2009
Standard Form 424 (Rev.9- 003) Prescribed by OMB Circular A-102
;ADO%- 2S
Family Educational Network of Weld County
One -Time Funding Grant Application
Migrant and Seasonal Head Start
Narrative
Purpose: To improve program quality and safety in the delivery of services through the
renovation and repair of older modular facilities and improvements to outdoor play surfaces;
needs that has been identified in the Community Assessment, the Self -Assessment and
monitoring findings since 2005.
I. Funding Level Requested:
FENWC is requesting Program Improvement funds to renovate and repair 7 older modular
facilities and to add sufficient ground cushion to the play area surrounding 6 playgrounds to
bring them up to the U.S. Consumer Product Safety Commission (CPSC) and State Licensing
requirements for children's outdoor play areas.
II. Purpose:
FENWC intends to use the requested funding to improve program quality and safety in the
delivery of services through the renovation and repair of older modular facilities and upgrading
of children's outdoor play areas.
Internal Health and Safety monitoring and the Program Self Assessment identified a need to
build the health and safety capacity of the modular units.
III. Health and Safety concerns
FENWC is requesting funding for three areas of renovation, repair and improvement: windows,
interior doors and exterior doors. All three areas have significant health and safety issues.
IV. Quality Impact
Since the hoped for replacement of the small, older modular units has been postponed to an
undetermined date in the future, it is imperative that FENWC make significant renovations,
repairs and improvements to areas that impact child health, safety and supervision.
Many of the older modular units have exterior doors that are deteriorating and are constantly
being repaired so that they will either close securely or so that they won't stick and not open at
all. In addition, interior doors with an upper panel of glass for the center director's office would
allow people in the office to see if a child or another adult was standing in front of the door
before opening it; it would also allow the center director greater flexibility in monitoring and
supervising the classrooms. Energy efficient windows would help the classrooms' stay at an
even, comfortable temperature during both the hot summers and the cold winters.
page 1 of 5
V. Need for alternative funding:
The FENWC maintenance and repair schedule for the modular classrooms has been able to
maintain repairs but unable to maintain needed renovations and improvements.
The program has seen no increase to its operating budget in many years while operating costs
continue to increase. Additional funding to complete health and safety renovations and repairs in
the modular units is needed.
VI. Denial of funding
FENWC Head Start had been placed on the Weld County Capital Improvement Plan, to begin
replacement of the modular units; however, because of the economic downturn and budget
constraints, it has become necessary for the County to postpone its commitment to assist with the
purchasing of new modular units.
Therefore, it is imperative that FENWC seek additional funding, such as this Program
Improvement opportunity, to renovate and repair the existing modular units and playgrounds to
bring them up to current standards for health and safety.
VII. Narrative and Budget for Renovation, Repair and Improvement to Modular Facilities
FENWC is requesting funding to install new energy efficient, double -paned slider windows in 7
Migrant Seasonal Head Start modular units. Each modular has 4 double -window units.
FENWC is requesting funding to install new steel exterior doors (front and back) for each
classroom. There are 14 classrooms; located in 7 modular units that require new steel exterior
doors. Each classroom requires 2 doors. The new exterior doors will be steel with an emergency
push bar for exiting.
FENWC is requesting funding to install new interior wood doors with a one-way glass half panel
on top. Each modular unit needs 2 new interior wood doors; there are 7 modular units.
FENWC is requesting funding to install two new pocket doors per modular unit. The tiny 4 ft x
6 ft kitchenette/laundry area in each modular is separated from the classrooms by a pocket door
on each side. Since the area is so very tiny, purchasing and installing a pocket door with a two-
way tempered safe glass upper panel would (a) bring more light into a very tiny, dim space and
(b) allow the people preparing the food to see if children were standing near the doorway when
they attempt to bring the trays of food into the classroom. Each modular unit requires 2 new
pocket doors. There are 7 modular units.
The seven Migrant Seasonal modular units that need new windows, exterior doors and interior
doors are Frederick (2 modular units), Jefferson, Madison, Dos Rios, Centennial and Hudson.
page 2 of 5
Item
Individual
Cost
Extended
In -Kind
Total
Window unit:
energy efficient,
double -paned, sliders
Cost per window unit
$ 458.09
x 4
Cost per modular unit
(includes install)
$1,832.36
$12,826.52
$12,826.52
Exterior Door:
steel door with
emergency push bar
$1,250.00
x 4
Cost per modular unit
(includes install)
$5,000.00
$35,000.00
$35,000.00
Interior Door:
wood doors with half
panel of one-way
glass on top
$ 550.00
x 2
Cost per modular unit
(includes install)
$1,100.00
$7,700.00
$ 7,700.00
Pocket Doors:
Wood door with two-
way tempered safe
glass panel on top
$ 870.00
x 2
Cost per modular unit
(includes install)
$1,740.00
$12,180.00
$12,180.00
Sub Total
$67,706.52
page 3 of 5
VIII. Narrative and Budget for Improvements to Outdoor Play Surface Areas
Many FENWC Migrant Seasonal Head Start classrooms are in elementary schools or sit on
elementary school campuses which do not have adequate playground facilities to meet the health
and safety requirements for preschool age children.
FENWC is requesting funding to add sufficient ground cover to the play area surrounding 5
playgrounds to bring them up to the U.S. Consumer Product Safety Commission (CPSC) and
State Licensing requirements for children's outdoor play areas. This funding would provide the
correct surface area depth for areas not located directly under playground equipment but used by
the children for other outdoor play (dramatic play, sand and water play, etc.)
Sufficient pea gravel to provide a 9" depth is needed at three Migrant Seasonal Head Start
centers: Dos Rios, Centennial and Billie Martinez.
Sufficient wood chip mulch is required to both provide a 9" depth and to cover exposed tree
roots (which are a tripping hazard) is needed at two Migrant Seasonal Head Start centers:
Madison and Frederick.
Item
Individual
Cost
Extended
In -Kind
Total
Pea Gravel:
cover 800 sq ft of
children's play
area at a depth of 9"
$ 1,354.00
$ 4,062.00
$ 4,062.00
Wood Chip Mulch:
Cover 700 sq ft of
children's play area
at a depth of 9"
$ 1,310.00
$ 2,620.00
$ 2,620.00
Sub Total
$ 6,682.00
Renovation, Repair, Improvement to Modular Facilities:
Improvements to Outdoor Play Areas:
Total Grant Dollars Requested:
$ 67,706.52
$ 6,682.00
$ 74,388.52
page 4 of 5
Outcomes: The program's goals for these areas are; (1) to improve the quality of the
classroom environment by upgrading to energy efficient windows, (2) to improve safety and
visibility by installing steel exterior doors and interior doors with upper glass panels and (3) to
insure that center playgrounds meet and exceed Head Start, CPSC and licensing requirements for
child safety and accessibility.
page 5 of 5
For the in-kind/non-federal share on the Program Improvement grant
applications we are using the following:
The 7 school districts will provide land/space to install playground
equipment and sunshades. The in -kind value of the land and space
involved is $4,720 per area. That represents a non-federal/in-kind
match of $33,040.
Dr. Janet Flaugher, Director
Family Educational Network of Weld County
P.O. Box 1805
1555 No. 17th Avenue
Greeley, CO 80632
(970) 353-3800 ext. 3340 (w)
(303) 710-1542 (cell)
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 (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 (ED) 11514; (b) notification of violating facilities pursuant to ED 11738;
(c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance
with ED 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 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)
(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:
(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 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, cr 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:
(I)
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.
bove certifications and assurances.
09/02/2009
Signature of Certifying Official Date
Chair, Board of Weld County Commissioners
Title
Weld County, Colorado
Applicant Organization
oWo 9- 735
GABI - 5F424A Report
01/01/2009 to 12/31/2009
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1 Program Operation 91600 $0 $0 $74,389 $18,598 $92,987
2 93.600 $0 $0 $0 $0 $0
3 $0 $0 $0 $0 $0
4 $0 $0 $0 $0 $0
5 Total (Sum of lines 1-4) $0 $0 $74,389 $18,598 $92,987
SECTION B - FEDERAL RESOURCES
lGRANT PROGRAM, FUNCTION, OR ACTIVITY
6. Object Budget Categories (1) Program Operation (2) (3) (4) Total
a. Personnel $0 $0 $0 $0 $0
b. Fringe Benefits $0 $0 $0 $0 so
c. Travel $0 $0 $0 $0 $0
d. Equipment $6,682 $0 $0 $0 $6,682
e. Supplies $0 $0 $0 $0 $0
f. Contractual $0 $0 $0 $0 $0
g. Construction $0 $0 $0 $0 $0
h. Other $67,707 $0 $0 $ 0 $67,707
i. Total Direct Charges (sum of 6a - 6h) $74,389 $0 $0 $0 $74,389
j. Indirect Costs $0 $0 $0 $0 $0
k. Totals (sum of 6a - 6j) $74,389 $0 $0 $0 $74,389
7. Program Income $0 $0 $0 $0 $0
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01/01/2009 to 12/31/2009
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Total (e)
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9 $0 $0 $0 $0
10 $0 $0 $0 $0
11 $0 $0 $0 $0
12 Total (Sum of lines 8-11) $18,598 $0 $0 $18,598
I SECTION D - FORECASTED CASH NEEDS
4th Quarter
13 Federal $74,389 $0 $0 $74,389 $0
14 Non -Federal $0 $0 $0 $0 $0
15 Total (Sum of lines 13-14) $74,389 $0 $0 $74,389 $0
I SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
FUTURE FUNDING PERIODS (Years)
First (b) Second (c) I Third (d) I Fourth (e)
16 Program Operation $0 $0 $74,389 $0
17 $0 $0 $0 $0
18 $0 $0 $0 $0
19 $0 $0 $0 $0
20 Total (Sum of lines 16-19) $0 $0 $74,389 $0
SECTION F - OTHER BUDGET INFORMATION
21. Direct Charges: 122. Indirect Charges:
23. Remarks:
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