HomeMy WebLinkAbout20081795.tiff RESOLUTION
RE: APPROVE MODIFICATION TO WELD COUNTY YOUTH CONSERVATION
CORPS CONTRACT AND AUTHORIZE ELECTRONIC SUBMITTAL - GOVERNOR'S
COMMISSION ON COMMUNITY SERVICE, COLORADO AMERICORPS PROGRAM
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 Modification to the Weld County Youth
Conservation Corps Contract between 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,
Employment Services of Weld County, and the Governor's Commission on Community Service,
Colorado AmeriCorps Program,commencing September 10,2007,and ending September9,2008,
with further terms and conditions being as stated in said modification, and
WHEREAS,after review,the Board deems it advisable to approve said modification,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 Modification to Weld County Youth Conservation Corps Contract
between 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, Employment
Services of Weld County, and the Governor's Commission on Community Service, Colorado
AmeriCorps Program be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Deputy Clerk be, and hereby is,
authorized to submit said modification electronically.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 25th day of June, A.D., 2008, nunc pro tunc September 10, 2007.
BOARD OF COUNTY COMMISSIONERS
L WELD COUNTY, COLORADO
ATTEST: L U
iasi "t^--`---\) VV.W. 'am H. Jerke, Chair
Weld County Clerk to t Bo ', l_
�� Robert'D. Masden, Pro-Tem
BY:
Deputy CI to the Board
Wil a F. G rcia
AP V ORM: Gu
David E. Long
my Attorney
•
Douglas demache
Date of signature: 77A�/6/
2008-1795
Cl , F-IS HR0079
e?�is o .�
Kit a
MEMORANDUM
'11 TO: J , Date: June 25, 2008
C• Board
am ofH Countyerke ComChairmissioners
FR: Judy A. Griego, Director, Human Services a
COLORADO
RE: Modification to the AmeriCorps Grant with t Gove or's
Commission on Community Services
Enclosed for Board approval is a Modification to the AmeriCorps Grant with the Governor's Commission
on Community Services. The Governor's Commission will not be implementing the evaluation project
that included in our original grant for a total of$12,638.00. Rather,the commission is allowing us to use
half the funds or$6,282.00 for the program. This Modification was reviewed by the Board on June 16,
2008.
The major provisions of the modification are as follows:
1. The term of performance for these funds is September 10, 2007 through September 9, 2008.
2. Funds will be used as follows: One Thousand Dollars($1,000.00)for staff Mileage; One
Thousand Dollars ($1,000.00)for Team Building; Two Thousand and Two Hundred and Eighty
Four Dollars($2,284.00)for Supplies (tools and safety equipment); and Two Thousand Dollars
($2,000.00) for attendance at the national conference. The national conference was a grant
requirement and occurred in late May. These funds would be used instead of the cash match.
If you have any questions, please telephone me at extension 6510.
2008-1795
RP!_BGT_424
June 24,2008 4:12 PM
Weld County Youth Conservation Corps (WCYCC)
Board of Weld County Commissioners,Weld County Division of Human
Application ID:07AC090252 Services Budget Dates:
Total Amt CNCS Share Grantee Share
Section I.Program Operating Costs
A.Personnel Expenses 50,717 25,083 25,634
B.Personnel Fringe Benefits 18,269 9,035 9,234
C.Travel
Staff Travel 1,000 1,000 0
Member Travel 16,000 4,321 11,679
Total $17,000 $5,321 $11,679
D.Equipment 0 0 0
E Supplies 5,751 4,077 1,674
F.Contractual and Consultant Services 0 0 0
G.Training
Staff Training 0 0 0
Mentor Training 8,620 1,000 7,620
Total $8,620 $1,000 $7,620
H.Evaluation 400 0 400
I.Other Rogram Operating Costs
Travel to CNCS-Sponsored Meetings 2,000 2,000 0 _
Total $2,000 $2,000 $0
Section I.Subtotal $102,757 $46,516 $56,241
Section I Percentage 45% 55% — —
Section II.Member Costs
A.Living Allowance
Full Tme(1700 hrs) 88,800 62,160 26,640
1-Year Half Time(900 hours) 44,400 31,080 13,320
Reduced Half Time(675 hrs) 0 0 0
Quarter Tme(450 hrs) 0 0 0
Ivfnimum Time(300 hrs) 0 0 0
2-Year Half Time(2nd Year) 0 0 0
2-Year Half Tme(1st Year) 0 0 _ 0
Total $133,200 $93,240 $39,960
B.Member Support Costs
FICA for Members 10,190 7,133 3,057
Worker's Compensation 0 0 0
Health Care 15,804 11,062 4,742
Total $25,994 $18,195 $7,799
Section II.Subtotal $159,194 $111,435 $47,759
Section II.Percentages 70% 30%
Section III.Administrative/Indirect Costs
A.Corporation Fixed Percentage
Corporation Fixed Amount 7,560 0 7,560
Commission Fixed Amount 0 0 0
Total $7,560 $0 $7,560
B.Federally Approved Indirect Cost Rate
Section III.Subtotal $7,560 $0 $7,560
Section III Percentage 0% 100%
Section I+Ill.Funding Percentages 42% 58%
Budget Totals $269,511 $157,951 $111,560
Budget Total Percentage 59% 41%
Required Match 30%
#of years Receiving CNCS Funds 5
Form 424A Modified SF-424A(4/88 and 12/97)
Page 1
RPT_BGT_424
June 24,2008 4:12 FM
Weld County Youth Conservation Corps (WCYCC)
Board of Weld County Commissioners,Weld County Division of Human
Services
Total MSYs 12.00
Cost/MSY $13,163
Form 424A Modified SF-424A(4/88 and 12/97)
Page 2
S
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Applicant Info •
Application info
• ie• • 2
Narratives
Performance Measures
Docwnents . Budget Section I. Program Operating Costs Enter Source of matching...... A
Ei Budget Section 1 Please enter the necessary budget information for your project.
Budget Section 2
Budget Section 3
Review
Authorize.and S!rbn,;t Personnel Expenses:add a new budget item
Annu?ii % .iota. CNCS Grantee
Pusition'TiLle Qty Salar edit del
' y . Time Amount Share Share
Grant Application ID: 07AC09025i Director 1 $53,157 10% $5,316 $0 $5,316 Uhl del
Grant*: 06AFI•+CG001O004
de j
TeaiT
I $39,852 30% S11,956 $0 $11,956 it
Prime Application Info:07AC090051 Leader
(Colorado Governor's Commission on'
Community Service) Crew Leader 1 $33,445 100% $33,445 $25,063 $8,362gtift del
NOfA;Commission AmeriColps State Subtotal ? S126,454 $50,717 $25,083 $25,634
FY 2007
Type:Amendment
Status:Subapplicant Initial Entry
Personnel Fringe Benefits: add a new budget item
f'4t 3 - -•l•.
•w :r.n:..:;_. -._.::,: ;.:-.... Total CNCS Grantee edif del
Board of Weld County Purpose CalculationAmount Share Share .
Commissioners,Weld Cn,:nty
Division of Human Services 36.02%of
dej
PO Box 1805 Director- Salary
51,915 $0 $1,915 ega
1551 N. 17th Ave Fringe Total
Greeley,CO 80637 Amount
c
. W of
. . sajarYer $4,307 $0 $4,307
Tealn
lead Total 4 31
Fringe
Amount
:.---_. mou
36.02%of
Crew
Leader Salary $1'1.,047 $9,0:35 $3,012 a del
r;. ;s ._.;`• Fringe
Amount
Subtotal $18,269 59,035 $9,234
Staff Travel add a new budget item
•
4:.:::r: s'>' • • ' Total CNCS Grantee
it
:....
r:::. Purpose. Celeuiati rn
. Amount Share mare
For
reimbursement
• del
., ..,.., of staff travel. ,
N/A �1,00D 41,000 SO edtt
e
Calc:,lated at
•
•
49.5 cnets per
mile
Subtotal 63,000 $1,000 $0
' ''.. Member Travel:add a new budget item
Total CNCS :•Grantee
Purpose Calcination Amount Share Share edit del
51.10 per
Transportation
mile(cost of
to project van' $16,000 $4.321 $11 79eda S
maintenance)
_... training,
all t day
sites16 06
corps a
x 14,546
etc
miles
Subtotal 6 $4 321 $1
51 ,679
r100 t
. Equipment:ada a new budget item
Unit Total CNCS Grantee
edit del
Ttem`Purpae Oty
Cost 4r-lount Share Share .
. . N/A 0 $5,000 $0 $0 $0 edit osj
.. Subtotal 0 55,000 $0 $0 $0
..
Supplies:add a new budget item i
Total CNCS Grantee •edit. del
Item Calculation
Amount Share Share
Member 12
uniforms/member members
$3,467 51,7$3 $1,674 edit del
equipment/safety x 5250 per
equipment member
- purchase
of shovels,
. . rakes,
' Assorted tools for picks,
$2.234 $2,234 SO tat del
projects drills,
gloves,
saftey
iteins,etc.
Subtotal $5,751 $4,077 $1,674
`•' Contractual and Consultant Services add a ne v budget item
'•,!...!'•:......'i' Total CNCS •Grant t I Daily TO a edit del.
l an
I • •se 1 SI S
Rat* Antou tt tare
� bare
e t
N/A Aso $0 $0 $0 edit del
Subtotal so $0 $0 5t?
:;..! il
Staff Training : ado a new 1 udget item '
Daily Total CNCS Grantee
.. Purpesa C alcuiat.or erilt del
. Rate Amount Share Share
State
.
Corn+nl5slUn
.. .... ,..• Training, NO cost to
$4 50 $0 $0 edit del
CYCA Lou., program
prulecl site
tnq.
.. Subtotal sa si, $0 $0
Member Training :add a new budget item rli
;)aily Total CNCS Grantee edit del
+rpas_ alw olio^
Rate Amount Share Share
•
•
• Basic
. members
Skills/GED $10 $7,200 $0 $7,200 OA del
$1,800
preparation ea
.t
1st Aid,
conflict 1st Aid
resolution, tog. 12
•
leadership, members
team building, C.3.1 535 per
HIV member.
. awareness, Team $0 $1,420 $1,000 $420 elk
dei
Aids Building
awareness, activity
.
Environmental 51.000 or
Education, all
. Citizenship, members
etc.
Subtotal $10 $£3,620 $1,000 $7,620
Evaluation :add a new budget item .:
.
Daily Total CNCS Grantee
Purpose Calculation..::s :,`�:. :°:::;....:.'. ' • t anon• edit • del
• '::.' '... : ::'.': •....'.... vpA5c: Amount Share Share • ...
:,
Based on
° ',....::::.' •..:,'_::.:.. :,.:: Internal staff time
Evaluation to compile $0 $400 S0 $400 gat lfel
by Board reports
and data
Subtotal SO 5400 "' $400
•
•
. Other Program Operating Costs :add a new budget item'..:.
Rota ra ntee
Purpose Calculationulation h Sh edit del
Amount S are are
Travel to Travel to
CNCS-
National $2,000 $2,000 $0 gat
Sponsored CollPrence
• Meetings
Subtotal $2,000 $2,000 $G
_.. . . .
.:. . . _: _. ._ ..: Subtotal:
Grantee Amount CNCS Share Share
$102,757 $46,516 $56,241
.. 45% 55%
ASSURANCES Page 1 of 3
(1. � ASSURANCES
As the duly authorized representative of the applicant,I certify,to the best of my knowledge and belief,that the applicant:
• 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.
• 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.
• Will establish safeguards to prohibit employees from using their position for a purpose that constitutes or presents the
appearance of personal or organizational conflict of interest,or personal gain.
• Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
• Will comply with the Intergovernmental Personnel Act of 1970(42 U.S.C.4728-4763)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).
• Will comply with all federal statutes relating to nondiscrimination.These include but are not limited to:Title VI of the Civil
Rights Act of 1964(P.L.88-352)which prohibits discrimination on the basis 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 disability(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
nondiscrimination 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 nondiscrimination on the basis of alcohol abuse or alcoholism;
(g)sections 523 and 527 of the Public Health Service Act of 1912(42 U.S.C.290dd-3 and 290ee-3),as amended,relating to
confidentiality of alcohol and drug abuse patient records;(h)Title VIII of the Civil Rights Act of 1968(42 U.S.C.3601 et seq.),
as amended,relating to nondiscrimination in the sale,rental or financing of housing;(i)any other nondiscrimination provisions in
the National and Community Service Act of 1990,as amended;and(j)the requirements of any other nondiscrimination statute(s)
which may apply to the application.
• Will comply,or has already complied,with the requirements of Titles II and 11I 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.
• 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.
• Will comply,as applicable,with the provisions of the Davis-Bacon Act(40 U.S.C 276a and 276a-77),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 sub-agreements.
• 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 the 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.
• 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 HO 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.);(I)conformity of
federal actions to State(Clean Air)Implementation Plans under Section 176(e)of the Clean 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).
• 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.
• 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(16U.S.C.469a-1 et seq.).
• 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.
https://egrants.cns.gov/cnsmisc/eAssur.htm 6/24/2008
ASSURANCES Page 2 of 3
• 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.
• 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 construction or rehabilitation of residence structures.
• Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act of 1984,as
amended,and OMB Circular A-133,Audits of States,Local Governments,and Non-Profit Organizations.
• Will comply with all applicable requirements of all other Federal laws,executive orders,regulations,application guidelines,and
policies governing this program.
For AmeriCorps*State and National Direct Applicants ONLY
If you are not applying for a grant through AmeriCorps*State and National,you may ignore this section.
• Will comply with all rules regarding prohibited activities,including those stated in applicable Notice,grant provisions,and
program regulations,and will ensure that no assistance made available by the Corporation will be used to support any such
prohibited activities.
• Will comply with the nondiscrimination provisions in the national service laws,which provide that an individual with
responsibility for the operation of a project or program that receives assistance under the national service laws shall not
discriminate against a participant in,or member of the staff of,such project or program on the basis of race,color,national
origin,sex,age,political affiliation,disability,or on the basis of religion(except that the prohibition on religious discrimination
does not apply to the employment of any staff member paid with non-Corporation funds or paid with Corporation funds but
employed with the organization operating the project on the date the grant was awarded.
• Will comply with all other federal statutes relating to nondiscrimination,including any self-evaluation requirements. 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
basis 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 nondiscrimination 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
nondiscrimination on the basis of alcohol abuse or alcoholism;(g)sections 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 alcohol and drug abuse patient records;(h)Title
VIII of the Civil Rights Act of 1968(42 U.S.C.3601 et seq.),as amended,relating to nondiscrimination in the sale,rental or
financing of housing;and(i)the requirements of any other nondiscrimination statute(s)which may apply to the application.
• Will provide,in the design,recruitment,and operation of any AmeriCorps program,for broad-based input from—(1)the
community served and potential participants in the program;and(2)community-based agencies with a demonstrated record of
experience in providing services and local labor organizations representing employees of service sponsors,if these entities exist
in the area to be served by the program;
• Will,prior to the placement of participants,consult with the appropriate local labor organization,if any,representing employees
in the area who are engaged in the same or similar work as that proposed to be carried out by an AmeriCorps program,to ensure
compliance with the nondisplacement requirements specified in section 177 of the NCSA;
• Will,in the case of an AmeriCorps program that is not funded through a State,consult with and coordinate activities with the
state commission for the state in which the program operates.
• Will ensure that any national service program carried out by the applicant using assistance provided under section 121 of the
National and Community Service Act of 1990 and any national service program supported by a grant made by the applicant using
such assistance will address unmet human,educational,environmental,or public safety needs through services that provide a
direct benefit to the community in which the service is performed;
• Will comply with the nonduplication and nondisplacement requirements set out in section 177 of the National and Community
Service Act of 1990,and in the Corporation's regulations at§2540.100;
• Will comply with the grievance procedure requirements as set out in section 176(1)of the National and Community Service Act
of 1990 and in the Corporation's regulations at 45 CFR§2540.230;
• Will provide participants in the national service program with the training,skills,and knowledge necessary for the projects that
participants are called upon to perform;
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ASSURANCES Page 3 of 3
• Will provide support services to participants,such as information regarding G.E.D.attainment and post-service employment,
and,if appropriate,opportunities for participants to reflect on their service experiences;
• Will arrange for an independent evaluation of any national service program carried out using assistance provided to the applicant
under section 121 of the National and Community Service Act of 1990 or,with the approval of the Corporation,conduct an
internal evaluation of the program;
• Will apply measurable performance goals and evaluation methods,which are to be used as part of such evaluation to determine
the program's impact on communities and persons served by the program,on participants who take part in the projects,and in
other such areas as required by the Corporation;
• Will ensure the provision of a living allowance and other benefits to participants as required by the Corporation;
• If a state applicant,will ensure that the State sub-grants will be used to support national service programs that were selected by
the State on a competitive basis;
• If a state applicant,will seek to ensure an equitable allocation within the State of assistance and approved national service
positions,taking into consideration such factors as the locations of the programs,population density,and economic distress;
• If a state applicant,will ensure that not less than 60%of the assistance will be used to make grants to support national service
programs other than those carried out by a State agency,unless the Corporation approves otherwise.
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CERTIFICATIONS ,;it,Q _� � /5 6,
67.2e/%2 XP Page 1 of 3
CERTIFICATIONS
Certification-Debarment,Suspension,and Other Responsibility Matters
This certification is required by the regulations implementing Executive Order 12549,Debarment and Suspension,34 CFR Part 85,Section
85.510,Participants'responsibilities.
A. As the duly authorized representative of the applicant,1 certify,to the best of my knowledge and belief,that neither the applicant
nor its principals:
• Is presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered
transactions by any federal department or agency.
• Has,within a three-year period preceding this application,been convicted of,or had an adverse civil judgment entered in
connection with,fraud or other criminal offense in connection with obtaining,attempting to obtain,or performing a public
(federal,state or local)transaction or contract undcr a public transaction;violation of federal or state antitrust statutes or
commission of embezzlement,theft,forgery,bribery,falsification or destruction or records,making false statements,or
receiving stolen property.
• Is presently indicted for 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
• Has not,within a three-year period preceding this application,had one or more public transactions(federal,state or local)
terminated for cause or default;
B. If you are unable to certify to any of the statements in this certification,you must attach an explanation to this application.
Certification-Drug-Free Workplace
This certification is required by the regulations implementing the Drug-Free Workplace Act of 1988,34 CFR Part 85,Subpart F.The
regulations require certification by grantees,prior to award,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 the agency determines to award the grant.False certification or
violation of the certification may be grounds for suspension of payments,suspension or termination of grants,or government-wide
suspension or debarment(see 34 CFR Part 85,Section 85.615 and 85.620).
As the duly authorized representative of the grantee,I certify,to the best of my knowledge and belief,that the grantee 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-
• the dangers of drug abuse in the workplace,
• the grantee's policy of maintaining a drug-free workplace.
• any available drug counseling,rehabilitation,and employee assistance programs,and
• 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 the 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:
• 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 us within ten days after receiving notice under subparagraph(D)from an employee or otherwise receiving actual notice
of such conviction;
F. Taking one of the following actions,within 30 days of receiving notice under subparagraph(D),with respect to any employee who
is so convicted-
• Taking appropriate personnel action against such an employee,up to and including termination;or
• 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;
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CERTIFICATIONS Page 2 of 3
G. Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs(A)through(F).
Certification-Lobbying Activities
As required by Section 1352,Title 31 of the U.S.Code,as the duly authorized representative of the applicant,I certify,to the best of my
knowledge and belief,that:
• No federal appropriated funds have been paid or will be paid,by or on behalf of the applicant,to any person for influencing
or attempting to influence an officer or employee of any agency,a member of Congress,an officer of Congress in
connection with the awarding of any federal contract,the making of any federal loan,the entering into of any cooperative
agreement,or modification of any federal contract,grant,loan,or cooperative agreement;
• If any funds other than federal appropriated funds have been paid or will be paid 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 this federal contract,grant,loan,or cooperative agreement,the
applicant will submit Standard Form-LLL,"Disclosure Form to Report Lobbying,"in accordance with its instructions;
• The applicant will require that the language of this certification be included in the award documents for all subcontracts at
all tiers(including subcontracts,subgrants,and contracts under grants,loans and cooperative agreements)and that all
subrecipients will certify and disclose accordingly.
Certification-Grant Review Process(State Commissions Only)
I certify that in conducting our review process,we have ensured compliance with the National and Community Service Act of 1990 as
amended,the Corporation's peer review requirements,and all state laws and conflict of interest rules.
For AmeriCorps*State and National Direct Applicants ONLY
If you are not applying for a grant through AmeriCorps*State and National,you may ignore this section.
Erroneous certification or assurance
The assurances and certifications are material representations of fact upon which we rely in determining whether to enter into this
transaction. If we later determine that you knowingly submitted an erroneous certification or assurance,in addition to other remedies
available to the federal government,we may terminate this transaction for cause or default.
Notice of error in certification or assurance
You must provide immediate written notice to us if at any time you learn that a certification or assurance was erroneous when submitted or
has become erroneous because of changed circumstances.
Definitions
The terms"covered transaction","debarred","suspended","ineligible","lower tier covered transaction","participant","person","primary
covered transaction","principal","proposal",and"voluntarily excluded"as used in this clause,have the meanings set out in the
Definitions and Coverage sections of the rules implementing Executive Order 12549. An applicant shall be considered a"prospective
primary participant in a covered transaction"as defined in the rules implementing Executive Order 12549. You may contact us for
assistance in obtaining a copy of those regulations.
Assurance requirement for subgrant agreements
You agree by submitting this proposal that if we approve your application you shall not knowingly enter into any lower tier covered
transaction with a person who is debarred,suspended,declared ineligible,or voluntarily excluded from participation in this covered
transaction,unless authorized by us.
Assurance inclusion in subgrant agreements
You agree by submitting this proposal that you will obtain an assurance from prospective participants in all lower tier covered transactions
and in all solicitations for lower tier covered transactions that the participants are not debarred,suspended,ineligible,or voluntarily
excluded from the covered transaction.
Assurance of subgrant principals
You may rely upon an assurance of a prospective participant in a lower-tier covered transaction that is not debarred,suspended,ineligible,
or voluntarily excluded from the covered transaction,unless you know that the assurance is erroneous. You may decide the method and
frequency by which you determine the eligibility of your principals. You may,but are not required to,check the List of Parties Excluded
from Federal Procurement and Nonprocurement Programs.
Non-assurance in subgrant agreements
If you knowingly enter into a lower tier covered transaction with a person who is suspended,debarred,ineligible,or voluntarily excluded
from participation in this transaction,in addition to other remedies available to the federal government,we may terminate this transaction
for cause or default.
Prudent person standard
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CERTIFICATIONS Page 3 of 3
Nothing contained in the aforementioned may be construed to require establishment of a system of records in order to render in good faith
the assurances and certifications required. Your knowledge and information is not required to exceed that which is normally possessed by
a prudent person in the ordinary course of business dealings.
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Page 1 of 1
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