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Home My WebLink About20062629.tiff RESOLUTION RE: APPROVE STATEMENT OF GRANT AWARD FOR JUVENILE ACCOUNTABILITY BLOCK GRANT 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 Statement of Grant Award for the Juvenile Accountability Block Grant between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Sheriffs Office, and Colorado Division of Criminal Justice, commencing October 1, 2006, and ending September 30, 2007,with further terms and conditions being as stated in said grant award, and WHEREAS,after review,the Board deems it advisable to approve said grant award,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 Statement of Grant Award for the Juvenile Accountability Block Grant between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Sheriffs Office, and the Colorado Division of Criminal Justice be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said grant award. The above and foregoing Resolution was,on motion duly made and seconded,adopted by the following vote on the 20th day of September, A.D., 2006. BOARD OF COUNTY COMMISSIONERS `'it ice WELD COU TY, COLORADO ATTEST: 'rd�s'1_�� -} Q - M. J. ile, Chair Weld County Clerk to the 135apctikir JUN 1 r David . Long, Pro-Tem BY: _ Dep Clerk t he Board 1 -Will H. er C \40,L__ AP ED AS Robert D. Masden unt9v2drfiey EXCUSED g ci/Z-1 Ian Glenn Vaad Date of signature: 2006-2629 SO0027 C /'U y Ds Division of Criminal Justice Carol C.Poole,Acting Director 700 Kipling St. Suite 1000 COLORADO Denver,CO 80215-5865 (303)239-4442 DEPARTMENT FAX(303)239-4491 OF PUBLIC SAFETY September 13, 2006 Commander Kenneth Poncelow Weld County Sheriffs Department 1950 O Street Greeley, CO 80631 Re: Juvenile Accountability Block Grant: Weld County Grant #25-JB-L-19-13 Dear Commander Poncelow: Congratulations on the approval of this grant. Enclosed are two copies of the Statement of Grant Award (SOGA) in the total plan amount of $18,066, which includes $16,259 in federal funds and $1,807 in cash match. Both the blue copy and the white copy (which includes the final approved application) must be signed by your Authorized Official and returned to this office by September 22, 2006 to insure the start date as listed on page one of the SOGA. Failure to return within 45 days of the issuance date may result in cancellation of the grant. Please note the Special Conditions, Instructions and the Standard Conditions listed in the SOGA. Bill Owens GOVERNOR Joe Morales After we receive both signed copies of the Statement of Grant Award and the EXECUTIVE DIRECTOR application from you, they will be signed by the director of the Division of Criminal Crimine Justice Justice and the Controller of the Department of Public Safety. If the Statement of Colorado State Grant Award (SOGA) is not properly signed by the subgrantee's authorized official Patrol and returned to the Division of Criminal Justice prior to the beginning date of the Colorado Bureau of Investigation Grant Period as stated on page one, the Division of Criminal Justice may Division of designate a later start date and reissue the SOGA for signatures. No expenditures Fire Safety of these grant funds will be allowed prior to the final approved start date. The white copy with the attached approved application will be returned to you for your files and will serve as your grant contract. Be sure that both you and your financial officer use only this final approved copy of the application which may r J have revisions, including budget figures, that change from the original application. After thoroughly reading the enclosed DCJ Form 30 "Certification of Compliance Dci with Regulations" regarding Civil Rights Requirements and Equal Employment Opportunity Plans (EEOP), submit it to the Authorized Official for review, completion and signature. Home Page'. www.stale.co.us/gov_dir/cdps/dcl.htm 2006-2629 E-Mail: carolpoole@cdps.slate.co.us Commander Poncelow September 13, 200 Return the original signed form to DCJ with the signed SOGAs. Make a copy for your files and send a copy to the person, in your agency or unit of government, identified on the form as being responsible for reporting civil rights findings of discrimination. A requirement of receipt of this subgrant by your agency or unit of government is certification to comply with civil rights regulations, including the responsibility to notify the Division of Criminal Justice of civil rights findings of discrimination occurring within your agency or unit of government. The Division of Criminal Justice will forward the Certification to the Office for Civil Rights, Office of Justice Programs, U.S. Department of Justice. Also enclosed is a packet of forms needed for quarterly reporting, grant modifications and cash draw downs. If you are a first time grantee, a copy of our "Administrative Guide for Federal Justice Grant Programs Administered by the Colorado Division of Criminal Justice" is also enclosed. Continuation grants will only receive a packet of forms since a Guide was provided the first year of the award. If you or your financial officer have questions after thoroughly reading the Guide, forms and instructions, call and we will be glad to offer further explanation. The Administrative Guide and forms, are also available on our website: http://dcfstate.co.usIoallat I will be working on modifying the data collection form(s) for your selected purpose area(s) and will get these to you before the October 1, project start date. If you have any suggestions on ways to make the data collection form more user friendly please let me know. Quarterly financial and narrative reports are due thirty (30) days after the end of each calendar quarter- January 31, April 30, July 31 and October 31. Cash requests (draw downs of awarded funds) can be submitted initially for anticipated expenses of two months and then monthly afterwards, or submitted monthly or quarterly for reimbursement of expenses. Reference the above grant number on all forms and correspondence. Please reference grant #25-JB-L-19-13 on all forms and correspondence. If you have any questions, please call me at (303) 239-5705 or Deb Ristow at (303)239- 4471. Sincerely, 4/ Anna Lopez Planning/Grants Specialist Office of Adult and Juvenile Justice Assistance Enclosures OF cOi� r�-i 'moo, COLORADO DIVISION OF CRIMINAL JUSTICE \7/876 t v STATEMENT OF GRANT AWARD (SOGA) FEDERAL PROGRAM INFORMATION CFDA Title& Number: #16.523 Federal Agency: Office of Juvenile Justice and Delinquency Prevention, OJP, DOJ Federal Award Name& Number: #2005-JB-FX-0034 Juvenile Accountability Incentive Block Grant Program Award Subgrantee Name: Weld County Project Director: Commander Kenneth Poncelow Project Director Address: Weld County Sheriffs Department • 1950 O Street Greeley, CO 80631 Grant Number: 25-JB-L-19-13 Project Title: Juvenile Accountability Incentive Block Grant: Weld County Grant Period: October 1, 2006 To September 30, 2007 Date Issued: September 13, 2006 In accordance with provisions of the Colorado Revised Statutes §24-33.5-502, the Division of Criminal Justice hereby awards a grant to the above-named subgrantee. The attached grant application (Exhibit A), including Special Provisions and Certified Assurances, is incorporated herein as a part of this document. APPROVED BUDGET BY PURPOSE AREA Purpose Area#/Project Federal Award Cash Match Total * 12a-Collaborative Crisis Assessment 9,033.00 1,807.00 10,840.00 * 15a-Female Offender Program 7,226.00 0.00 7,226.00 TOTAL AWARD AMOUNT I $16,259.00 I $1,807.00 I $18,066.00 ' The detailed budget(s)found in the attached,approved plan provide budget category amounts for each purpose area. Use these approved detailed budget(s)for reporting expenditures by Purpose Area. * Purchase of equipment requires prior completion and approval of DCJ Form 13. * Professional services require prior completion and approval of DCJ Form 16. Special Condition(s): 1. This project was supported by Grant No. 2005-JB-FX-0034 awarded by the Office of Juvenile Justice and Delinquency Prevention through the Division of Criminal Justice, Colorado Department of Public Safety. The Office of Juvenile Justice and Delinquency Prevention is a component of the Office of Justice Programs,which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Bureau of Justice Assistance, and the Office of Victims of Crime. Points of view or opinions in this document are those of the author and do not represent the official position or policies of the United States Department of Justice nor the Division of Criminal Justice, Colorado Department of Public Safety. 2. The Grant Management Form, page 19, needs to be completed and returned to DCJ no later than November 1, 2006.. Version 4-4-05 Page 1 of 3 P:\dcj\OAJJA\JABG\JB SOGAS\25jb-19-13.SOGA.wpd Statement of Grant Award (SOGA) INSTRUCTIONS 1. Grant activities must be based on the approved budget shown on page one of this Statement of Grant Award, and the approved detailed budget(s)within the attached application,which supersedes any earlier budget request submitted, and which may be different from the budget originally submitted in your application. The subgrantee must secure prior written approval from DCJ if there is to be a change in any budget category (see DCJ Form 4-A). 2. The Financial Officer of the project must be provided a copy of this document in order to adequately prepare the necessary financial reports. 3. The Subgrantee Agency affirms that the parties'agreement consists of a two-part document, the Statement of Grant Award (SOGA), and Exhibit A, attached to the SOGA, which contains the Grant Application (including Project Summary, Budget and other Documents), the Certifications, the State Special Provisions, the Grant Requirements, the Federal Certified Assurances, and signatures of persons authorized to sign on behalf of the Subgrantee Agency on each part of the two-part document. 4. Review carefully the"Administrative Guide for Federal Justice Grant Programs Administered by the Colorado Division of Criminal Justice,"which includes procedures regarding this document, draw-down of grant funds, reporting requirements and requesting grant modifications. 5. This grant award shall be effective upon the final approval by the State Controller or designee. No payment shall be made pursuant to the grant prior to State Controller approval. 6. This grant award may be voided in whole without further cause if it is not signed by the subgrantee's Authorized Official and returned to the Division of Criminal Justice within 45 days of the date of issuance. 7. The signature of the Authorized Official below should be the same as the one on the grant application.The subgrantee must promptly notify the Division of Criminal Justice of any changes in the Authorized Official, Project Director, or Financial Officer, by completing and submitting DCJ Form 4-B. (If changes have already occurred, submit completed DCJ Form 4-B with this document). ADDITIONAL DCJ REQUIREMENTS (1) Commencement within 60 Days. If the Division concludes that the project has not commenced within 60 days of the start date of the grant period, the subgrantee must report the following by letter to the Division of Criminal Justice: a. the steps taken to initiate the project; b. the reasons for delay; and, c. the expected starting date. (2) Operational Within 80 Days. If the Division concludes that the project is not operational within 80 days of the original start date of the grant period, the Division of Criminal Justice may begin termination or reduction in grant award proceedings as described in"Special Provisions & Certified Assurances", Section entitled "Termination or Reduction in Grant Award." (3) All subgrants are conditioned on the ability to report to the Division of Criminal Justice all the information contained on the DCJ quarterly narrative and financial reporting forms, which are provided with this SOGA. Technical assistance is available upon request. (4) These funds cannot be guaranteed beyond the end date of the grant period on page 1 of this SOGA. Unexpended funds remaining at the end of the grant period must be returned to the Division of Criminal Justice. RETURN: ALL SETS of the Statement of Grant Award with ORIGINAL SIGNATURES to: Division of Criminal Justice, Office of Juvenile Justice, 700 Kipling Street, Suite 1000, Denver, CO 80215. After other required signatures are obtained, the white SOGA copy with approved application will be returned to your Project Director. Statement of Grant Award (SOGA) Version 4-4-05 Page 2 of 3 P:\dcj\OAJJA\Merge Forms\JAIBG SOGA.pages2-3.apri105.frm THE PARTIES HERETO HAVE EXECUTED THIS BINDING SUBGRANT AWARD SUBGRANTEE: STATE OF COLORADO: Weld County, Colorado The Honorable Bill Owens , GOVERNOR Legal Name of Subgrantee Agency Agency F N(or Social Security)# 84-6000-813 By ��4'�� By LC Sal NATURE of Authorized Official ACTING DIRECTOR Colorado Division of Criminal Justice M. J. Geile, Chair, Board of County Commissio' ers Carol C. Poole, Acting Director Print Name & Title of Authorized Official Print Name & Title /�t Date Signed: SEP 2 0 2006 Date Signed: ,/�[v� Provide below for Corporate/Board Secretary or Equivalent, or Town/City/County Clerk to Certify that person named as Authorized Official above ATTEST BY: has the legal authority to enter into binding legal STATE OF COLORADO LEGAL REVIEW: contracts on behalf of this agency, and is in fact See Contract Routing Waiver# 127 the erson who signed where indicated. (or, if not waived) SEP 2 0 2006 Signature Clerk to the Board Date John Suthers ATTORNEY GENERAL f 7t-i'iL_ 970-356-4000 Tit/e, Dv1_� rk to the Board Phone BY: i E PL:' A / �,..1_ =, Date Signed: til g% Cis ALL ®v �S�& SUBGRANT AWARDS MUST BE APPROVED BY THE STATE CONTROLLER CRS 24-30-202 requires that the State Controller approve all state contracts. This subgrant award is not valid until the State Controller, or such assistant as he may delegate, has signed it. If performance begins prior to the date below, the State of Colorado may not be obligated to pay for the goods and/or services provided. STATE CONTROLLER: ��LES�LIE�M. SHENEF\ELT BY _ "l / 1 (/�J • DATE i 013 I Q 6 • Version 4-4-05 Page 3 of 3 P:1dcj\OAJJA\Merge Forms\JAIBG SOGA.pages2-3.april05.frm DCJ FORM 30 CERTIFICATION OF COMPLIANCE WITH REGULATIONS OFFICE FOR CIVIL RIGHTS, OFFICE OF JUSTICE PROGRAMS FOR SUBGRANTS ISSUED BY THE COLORADO DIVISION OF CRIMINAL JUSTICE INSTRUCTIONS: Complete the ident f ing information, which is found on tie Statement of Grant Award(SOGA), in the table below. Read the form completely,identifying, under "I,"the person responsible for reporting civil rights findings; and checking only the one certification under "II"that applies to your agency Have your Authorized Official sign at the bottom of page 2,forward a copy to the person you identified under "I"and return the original tcthe Colorado Division of Criminal Justice, 700 Kipling, Ste. 1000, Denver, CO 80215, within 45 days of the grant award begnning date. Grant# Grant Project Title: Subgrantee Name(Funded Entity): Address: Duration: Beginning date: End date: Award: $ Project Director's Name& Phone#: AUTHORIZED OFFICIAL'S CERTIFICATION: As the Authorized Official for the above Subgrantee, I certify, by my signature below,that I have read and am fully cognizant of our duties and responsibilities under this Certification. I. REQUIREMENTS OF SUBGRANT RECIPIENTS: All subgrant recipients(regardless ofthe type of entity or the amount awarded)are subject to prohibitions against discrimination in any program or activity, and must take reasonable steps to provide meaningful access for persons with limited English proficiency. ♦I certify that this agency will maintain data(and submit when required)to ensure that: our services are delivered in an equitable manner to all segments of the service population; our employment practices comply with Equal Opportunity Requirements, 28 CFR 42.207 and 42.301 et seq.; our projects and activities provide meaningful access for people with limited English proficiency as required by Title VI of the Civil Rights Act,See also, 2000 Executive Order#13166). ♦1 also certify that the person in this agency or unit of govmment who is responsible for reporting civil rights findings of discrimination will submit these findings, if any, to the Division of Criminal Justice within 45 days of the finding, and/or if the finding occurred prior to the grant award beginning date,within 45 days of the grant award beginning date. A copy of this Certification will be provided to this person, as identified here: Person responsible for reporting civil rights findings of discrimination: (Name, address & phone) II. EQUAL EMPLOYMENT OPPORTUNITY PLAN (EEOP)CERTIFICATIONS: Check the box beforeONLY THE ONE APPROPRIATE CERTIFICATION(A, B, CI or C2 below)that applies to this subgrantee agency during the period of the grant duration noted above. O CERTIFICATION "A" [NO EEOP IS REQUIRED if(1),(2)or(3), below,apply.) This is the Certification that most non-profits and small agencies will use. Check(1), (2) and/or(3)as they apply to your entity. (More than one may apply.) This funded entity has not been awarded more than$1 million cumulatively from all programs administered by the U.S. Department of Justice over an 1&month period that includes the above grant duration periodfnd (1) is an educational, medical or nonprofit institution or an Indian Tribe; and/or (2) has less than 50 employees; and/or (3) was awarded through this grant from the Colorado Division of Criminal Justice less than $25,000 in federal U.S. Department of Justice funds. Therefore, I hereby certify that this funded entity is not requird to maintain an EEOP, pursuant to 28 CFR 42.301,et seq. (CONTINUED ON REVERSE SIDE) Colorado Division of Criminal Justice Page 1 of 2 (Rev 9/13/2006) DCJ FORM 30: CERTIFICATION OF COMPLIANCE WITH REGULATIONS, OFFICE FOR CIVIL RIGHTS, OFFICE OF JUSTICE PROGRAMS (Continued) II. EQUAL EMPLOYMENT OPPORTUNITY PLAN(EEOP) CERTIFICATIONS: (Continued) El CERTIFICATION "B" (EEOP MUST BE ON FILE) This funded entity, as a foFprofit entity or a state or local government having 50 or more employees,was awarded, through this grant from the Colorado Division ofCriminal Justice, more than $25,000, but less than $500,000 in federal U.S. Department of Justice funds. Also, it has not been awarded more than $1 million cumulatively from all programs administered by the U.S. Department of Justice over an 18month period that includes the above grant duration period. Therefore, I hereby certify that the funded entity has formulated an Equal Employment Opportunity Plan in accordance with 28 CFR 42.301,et seq., subpart E, that it has been signed into effect by the poper authority and disseminated to all employees, and that it is on file for review or audit by officials of the Division of Criminal Justice or the Office for Civil Rights, Office of Justice Programs as required by relevant laws and regulations. O CERTIFICATION "Cl" (EEOP MUST BE SUBMITTED) This funded entity, as a fofprofit entity or a state or local government having 50 or more employees, was awarded,through this grant from the Colorado Division of Criminal Justice, more than $500,000 in federal U.S. Department of Justice funds, but, it has not been awarded more than $1 million cumulatively from all programs administered by the U.S. Department of Justice over an 18-month period that includes the above grant duration period. Therefore, I hereby cetify that the funded entity will submit, within 45 days of the award, an EEOP or an EEOP Short Form, that will include a section specifically analyzing the subgrantee(implementing) agency. O CERTIFICATION "C2" (EEOP MUST BE SUBMITTED) This funded entity, having 50 or more employees, has been awarded more than $1 million cumulatively from all programs administered by the U.S. Department of Justice, including this subgrant from the Div. of Criminal Justice, over an 18-month period that includes the above grant duration period. Therefore, I hereby certify that the funded entity will submit, within 45 days of the award, an EEOP or an EEOP Short Form, that will include a section specifically analyzing the subgrantee (implementing) agency. (If you havdraady submitted an EEOP applicable to this time period, send a copy of the letter received from the Office for Civil Rights showing that your EEOP is acceptable.) As the Authorized Official for the above Subgrantee, I certify, by my signature below,fit I have read and am fully cognizant of our duties and responsibilities under this Certification.l,hereby,also certify that the content of this form,other than the data entry required,has not been altered. SEP 2 0 2005 [Au zed dadfa's signature] [Date] M. J. Celle Chair, Board of County Commissioners [Typed Name] [Title] * * * * * * * * * * This original signed form must be returned to the Colorado Division of Criminal Justice, 700 Kipling, Ste. 1000, Denver, CO 80215, within 45 days of the grant award beginning date. You must also forwarda signed copy to the person you /dent f ed under "I"on page 1. DCJ will forward a copy to the Office for Civil Rights, Office of Justice Programs, US. Department of Justice. Colorado Division of Criminal Justice Page 2 of 2 (Reev..911133/2006)' ;1Cee cwI/CG1/ , FORMAT FOR COORDINATED ENFORCEMENT PLAN TO REDUCE JUVENILE CRIME riled' JUVENILE ACCOUNTABILITY BLOCK GRANT PROGRAM Q 1 �J (This page should be completed and submitted as the first page of your plan.) ©�'I, 7 trant# or 5 - 15-1 -)9- /3 (DCJ use only) V Will grant funds be used to conduct research? Yes _X No If yes, please identify the type of research: The project involves research and/or statistical activities but does not involve the collection of information identifiable to private persons The project involves research and/or statistical activities and involves the collection of information identifiable to private persons APPLICANT AGENCY: Legal Title of Applicant Agency: Weld County Address: 1950 O Street City, State, Zip: Greeley. CO 80631 County: Weld Phone: (970) 356-4015 X 2802 Federal Employer ID Number: 8460008130 LOCATION OF AGENCY: U.S. Congressional District: 4 State Judicial District: 19 SERVICE AREA: (This project will service the following areas:) a. U.S. Congressional District#/s: 4 b. Judicial District#/s: 19 c. City(ies): AND/OR County(ies): Weld d. Population size (census) of service area: 225,000 GRANT APPLICATION TYPE:(Check One) X JABG Local Allocation State Program Funds: Statewide Emphasis (Disregard Page 2 and Section I on Page 3) Project Title: Other Project Title: TYPE OF APPLICATION: New _ Continuation If this is a continuation application, provide JABG funding information from the two most current years: Grant Number: Amount: Duration: Grant Number Amount: Duration: PROJECT DIRECTOR: (The Project Director is considered to be the primary contact person, and the person who is directly responsible for ensuring that the plan is implemented. All future correspondence from the Colorado Division of Criminal Justice, regarding this grant, will be sent to this person). Project Director: Kenneth E. Poncelow Agency: Weld County Mailing Address: 1950 O Street,Greeley. CO 80631 Phone: ( 970 ) 356-4015 X2802 Fax: ( 970 ) 304-6467 E-mail: ALLOCATION/REQUESTED AMOUNT: (If this is a joint plan, provide the total from all entities.) JABG Amount $ 16,259 Cash match $ 1,807 (This must be at least 10%of Total Cost. Divide the total cost by 9 to calculate minimum match requirement.) Total Cost $ 18,066 PROJECT DURATION DATES: From: October 1, 2006 To: September 30, 2007 (Revised 3/2006) LOCAL JUVENILE CRIME ENFORCEMENT COALITION This is the coalition you formed to develop the plan. If it has the same membership as the list submitted with your Intent to Accept Funds, "just copy that list. You were encouraged to use existing groups that focus on youth and have or could be enhanced to have the required representation. This is required for all local plans and local programs. (Applicants responding to solicitations from DCJ/OJJ for State Program Funds need not complete this page) Minimum required representation includes categories A-G: (If any category was impracticable, explain on an attached page.) A. Police F. Schools: School district and/or local middle and/or B. Sheriffs High schools (Please include students.) C. Prosecutors: District, County and/or City G. Business D. Probation Services H. Prevention organizations E. Juvenile Court: District and/or municipal I Religious-affiliated, fraternal, nonprofit, and/or social jurisdiction services NAME AGENCY/ORG. &ADDRESS CATEGORY See Attached (You can copy this page if more space is needed.) — (Revised 3/2006) LOCAL JUVENILE CRIME ENFORCEMENT Weld Count You are encouraged to use (Please type or print name e colony h ua ed ncouraged on. existing groups That focus on youth and have or can be enhanced to have he rcrpaltty) Mimimum required representation includes A-I: (Ifarty,category is impracticable, explain on an attached page.) A. Police trict B. Sheriffs F. Schools:School dis C. Prosecutors:District County schools(Please Include and/or local middle and/or high D. Probation Services and/or City G. Business students.) E. Juvenile Court:District and/or munici H. Prevention o jurisdiction P al I Reli Religious-affiliated, services affiliated,fraternal,nonprofit and/or social ,tkgENC:/OF Y S Robert D. Masden � - e Chair, Board of Count - - �" `s ._.: .. P. O. Box 758, Greeley,C�Commissioners Judge Kline8063I-0758 11.1 19th Judicial District Judge Karowsky P.O. Box C, Greeley, CO 80632 a Al Dominguez, Jr. District Attorney, 19th Judicial District 915 10th Street, Greeley, CO. 80631lin Weld County Sheriff's Office 1950.0 Street, Greeley; CO 80631 laiall linallill la Chief Probation Officer 934 9th Avenue, Greeley, Co 80631 INIIIIIIIIIIIII Weld County School District Six al 1025 9th Avenue, Greeley; CO 80631 a A Women's Place 3700 Golden, Greeley, CO 80632 Dan Dailylil North Range Behavioral Health a 1306 11th Avenue, Greeley, CO 80631lea H. J. Dean Island Grove Re 1140 M Street Greeley, ,Treatment Windy � Greeley, CO 80631 Rich-Goldsblaaidt m c/weld County Chief of Police REP Gray Hall, Greeley; CO. 80631 11.1 Greeley Police Department 919 7th Street, Greeley, CO 80631 la iliiiiilia Evans Police Department 1100 37th St MIN !MIIIIIIIMIIMIIIMIIIIIIIIMIIIIMIII ipeonacopid ! a Return to DCJtvith "Iraent to Accept Funds"Form.) rZQ' SECTIONS I-VU:Using the format below,provide a detailed written narrative for each section.Use separate plain white paper to complete this section of your application. Re-write each item title, followed by your response. Do not deviate from the format or exclude any items listed. The format provided for Section VI must be used for each distinct project. _a t_ I. JUVENILE CRIME ENFORCEMENT COALITION(JCEC) (Applicants responding to solicitations from DCJ/OJJ for State Program Funds may disregard this section) Explain how members of the JCEC were recruited;how often the JCEC meets; and how the final decision for the plan was made. How will the JCEC be used during the implementation of the plan and what is its defined role in overseeing these funds? Does this JCEC oversee other plans for juvenile services? If so, please explain how the plans are coordinated. If this is a continuation plan, address the above questions and also describe any changes in the JCEC, including new members. Letters of support and commitment from members are welcome as attachments to the plan. II. COMPLIANCE WITH THE JJDP ACT To be eligible for JABG funds,the Division of Criminal Justice requires that the jurisdictions within the applicant service area be certified by the Juvenile Justice and Delinquency Prevention (JJDP) Council as being in compliance with Sections 223 (a)(11) (Deinstitutionalization of Status Offenders); (a)(12) (Separation); (a)(13) (Jail Removal); and (a)(22) (Disproportionate Minority Contact) of the JJDP Act of 2002. If the service area includes multiple law enforcement jurisdictions,all facilities operated by or under contract to each local unit of government included in the area will be included in this certification. After the compliance monitor from the Division of Criminal Justice completes the certification form and obtains necessary signatures, it will be given to the project director listed on page 1 of the plan format for his/her files, and a copy will be kept at DCJ. Indicate your status of compliance: _X_All jurisdictions have been certified to be in compliance. A plan has been developed and approved by the DCJ compliance monitor to ensure future compliance. We are not in compliance, but are in the process of developing a plan to come into compliance. The plan will be approved prior to the grant start date. III. APPLICANT AGENCY CAPACITY, COMMUNITY COLLABORATION AND SUPPORT Provide the agency's mission, structure, brief history of services,collaboration efforts and how this project relates to them. Describe the cultural competence of the agency. Staff carrying out the project should be trained in the specific model being implemented. Briefly describe qualifications of staff or plans to train staff who are relevant to the proposed project. DCJ puts a high priority on demonstrated coordination, networking,and the establishment of cooperative working relationships with other juvenile justice and/or community agencies. Funds should target identified and documented problems and needs that are not provided for or supported by other federal, state or local government funds. Describe the existing programs, services and personnel currently available to address the problems, including, but not limited to, the SB94 Alternatives to Incarceration Plan for your area, probation offender services funds, Division of Youth Corrections case management and parole services. All projects should demonstrate that partnerships exist or are being developed.Those partnerships may include,but are not limited to, law enforcement, health, social services, alcohol and drug abuse services, recreation,county extension offices,mental health agencies,schools,school districts,alternative schools,job training programs,civic groups,private businesses,churches,foundations and other community-based organizations.Participation in local coordinating/planning groups such as the Juvenile Services(SB94)Planning Committee,family preservation board,community review board, community prevention board,community assessment/evaluation team,managed care planning group,Safe and Drug-Free Schools board or other similar broad-based group should be documented. (Revised 3/2006) 10. BRIEF PROJECT SUMMARY North Range Behavioral Health (NRBH) will deliver needed mental health services to detained youths from Weld County, Colorado at the Platte Valley Youth Services Center. Services to be provided will include risk-mid needs-asscsaaiei €juveni-le offenders crisis interventjonrand - referral to ongoing mental health care as needed. ttr APPLICANT AGENCY CAPACITY, COMMUNITY COLLABORATION, & SUPPORT As its mission, "North Range Behavioral Health provides professional, culturally competent mental health services for Weld County." Known previously as the Weld Mental Health Center, Inc., NRBH has served the mental health needs of the people in this area for more than four decades. From 1995 to 1997, it functioned as the Mental Health Assessment Service Agency (MHASA) for Weld County. In 1998, NRBH joined with the Larimer Center for Mental Health and Centennial Mental Health Center to form Northeast Behavioral Health, which is now the Behavioral Health Organization(BHO) for Weld County, Larimer County, and the 12 counties comprising the northeastern corner of Colorado. NRBH has developed numerous collaborative efforts over the years. Most notably, it currently works with Weld County School District Six (District Six) to provide day treatment, residential treatment, and education services through the Kathleen P. Littler Center in Greeley to children 12 years of age and under facing serious mental health problems. We have also worked with District Six staff to provide mental health services to students attending alternative educational programming at Adelante Middle School, Trademark, and Colorado High. Staff members of NRBH also provide on-site services to the students of Centennial, Dos Rios, and Cameron Elementary Schools and Northridge High School. In the past year, District Six and NRBH worked together to provide educational and treatment services, housed in the NRBH's ICYFS offices, to students who had been expelled from school or who were at imminent risk of expulsion. A positive working relationship between the Family Education Network of Weld county and NRBH enables selected Head Start students to receive mental health care in their schools. Staff of NRBH also worked collaboratively with staff of the Platte Valley Youth Services Center(PVYSC) and with the Juvenile Services Planning Committee (Senate Bill 94 or SB 94) to provide basic mental health services to detained youth. In addition,NRBH was again awarded a JAIBG grant for the current fiscal year that-helped provide services to juveniles while they are detained. NRBH is a regular participant in meetings of the local Juvenile Services (SB94) Planning Committee, local JAIBG, the Greeley-Evans Prevention Council, and the Weld County Community Juvenile Review Board, and the Weld County Child Abuse Team. NRBH is one of the founding members of and a current participant in the Weld County Child Abuse Coalition, participating regularly in the everyday business of the Coalition plus in the reviewing and updating of the Weld County Child Abuse Protocol. An NRBH administrator is a member of the Board of Directors of A Kid's Place, which operates the local children's advocacy center and the Court Appointed Special Advocate(CASA)program. A related collaborative effort, Promises for Children, is now in place as well, necessitated by continuing needs in the community. An ongoing collaborative effort called the Multidisciplinary Youth Assessment Team (MYAT) is now in its third year. Comprised of the Weld County Department of Social Services (WCDSS,) the Weld County Division of Human Services through its Employment Services Program, the IGRTC, and NRBH, this team has planned for and developed a community-wide system to meet various needs of youth and families in conflict or in need of positive youth development. NRBH has also joined in a community collaborative resulting in the formation of the Juvenile Assessment Center(JAC,) a program designed to assess,provide crisis intervention and triage services to appropriate services for juveniles in the community. IV. ANALYSIS OF JUVENILE JUSTICE SYSTEM NEEDS uescrne me prbotew to be addressed, siipptiued by c unenrand letubma data do d heiida,aiid/ui a i uuniiuithy needs assessment. Use data specific to the geographic area and target population the project intends to serve.Provide the age,gender,race and ethnic breakdown of your intended target juvenile population and data that identifies the scope of the existing juvenile problems. Plans must provide a clear and concise statement about the juvenile justice needs or problems this plan will address. V. ADMINISTRATIVE COSTS You are allowed up to 5% of your federal request for administrative costs.This includes any administrative costs incurred by the applicant agency and any contracted services.Provide a separate budget form for the amount to be used by the applicant agency and/or the agency who will be responsible for the overall administration of the JABG program.If any of this 5%will be allowed in contracts to other agencies or organizations,identify that amount in the detailed budget. Use the format of the Budget Form provided below. VI. PROBLEM STATEMENT,LOGIC, AND TARGET POPULATION A. For this project,based on your analysis, provide the following information: Identified Problem/Need and the Program Purpose Area Number (from Purpose Area/Program Type/Performance Indicator Chart). Summary of your focus within the Purpose Area Goals:A broad statement about what the program expects to achieve—logically linked to the problem and its identified causes Objectives: Intermediate effects to be achieved to reach the program goal, should be clearly stated and measurable. What difference will the program make,for whom, and by when Activities: Specific steps by which objectives are achieved and programs implemented. What will the program be doing? Process Measures/Outputs:Directly related to activities, way to assess whether the program activities are implemented according to plan. What information will the program use to document what it is doing? Intended Outcomes: Directly linked to the objective, substantive change or benefit as a result of the program. What and how much of a difference will the program make,for whom, and by when? Outcome Measure: Specific items of data &instruments used to track data to assess a programs status towards reaching its objectives and outcomes. What information will the program use to document the resulting differences/changes? OutpuUShort Term Outcome/Intermediate/Long Term Outcome Indicators. In addition,you MUST collect and report on the indicators from the Purpose Area/Program Type/Performance Indicator Chart. These indicators were identified by the Office of Juvenile Justice and Delinquency Prevention and will be used to create a nation-wide report that will be presented to Congress. You may add other indicators if you feel these don't adequately measure the impact of the project. Explain how the data will be collected to report on these indicators. (Revised 3/2006) B. Number of Juveniles Targeted to be Served including CulturaUGender Competency Plan Please re-create the table below and indicate how many juveniles you plan to serve with these funds,not the total juvenile population in your area.Projects should consider culturally competent and gender-specific services to meet identified needs of the target poputaton.Descrioe how projects will meet the cultural,language and gender-spect11c needs of the target population. A copy of the Guidelines for Female-Specific Programs and information on gender-specific training are available at the Girls ETC (Equitable Treatment Coalition) website www.GirlsETC.org. If the target population includes youth and families with limited English proficiency, explain how you plan to meet their needs. White Hispanic/ African Native American Asian/Pacific Multiracial/ Other Totals Latino American Islander Multiethnic Males Females VII. EVALUATION PLAN Describe the evaluation strategy, reflecting the performance indicators and outcome measures stated in the goals and objectives, that will be used to show project effectiveness, document successful activities and what barriers may be presented, and how these will be used to modify the project plan. An evaluation plan should be designed so that an independent observer can confirm or measure whether or not the objectives have been met and progress was made toward the goals. Quarterly narrative and financial reports and data collection forms will be required from successful applicants to report progress and barriers that may be encountered. Forms will be sent with the award documents. VIII. LONG-TERM SUSTAINABILITY PLAN Describe the long-term plan(3-5 years)for the programmatic development and ongoing financial support of the project(s) included in this plan. Indicate potential funding sources,plans to diversify your funding base,indications of city/county financial support, any anticipated program expansion, etc. How will you document potential cost savings to the community? IX. BUDGET/BUDGET NARRATIVE Budget items must be listed in the proper category of the Budget Form, provided below, and be explained and justified separately in the Budget Narrative. Follow the format and organization of the budget form. DO NOT DEVIATE FROM THIS FORMAT. A separate budget form must be completed for the applicant agency's administrative costs(if any). The budget narrative should include other support for the project beyond the identified 10%cash match, this can include in-kind match information. Cash match must equal 10% of the total project and can be reflected in a lump sum in one line item,or across multiple items or budget categories. Line item by line item cash matching is not required. Cash match can be calculated by taking the federal amount requested and divide by 9, this is your cash match. EXAMPLE: Federal amount requested= $15,000/9=$1,667 (cash match required). X.FINANCIAL MANAGEMENT The Financial Management section must be completed and included in your submitted application.Be sure it is included in the original and the six copies of the application you submit. XI. CERTIFICATION OF APPROPRIATION OF MATCH The Certification of Appropriation of Match form must be completed by all agencies providing cash match to this plan. Copy additional pages of this form as necessary. (Revised 3/2006) 122 PROBLEM STATEMENT, LOGIC, AND TARGET POPULATION A. Problem: Through its work with JAIBG, its member agencies, and other areas of work in the communities of Weld County,North Range Behavioral Health (NRBH) is acutely aware of the .......«e „thy the past few years, progress has been made in the identification of detained juvenile offenders who are in need of mental health services while they are detained and after they are released back into the community. Recidivism rates remain higher than acceptable and are still increasing for those juvenile offenders with identifiable mental health issues who have not received appropriate mental health care. This project, in the past, has helped to improve the communication between the numerous agencies, offices, institutions, and individuals involved with these juveniles but more work remains to be done in terms of holding the youths accountable for their actions, reducing recidivism, and ensuring greater integration of services in working with each juvenile. B. Contributing Factors: Despite ongoing efforts, not enough youths in Weld County are receiving the mental health and related services they need. This is, in part, due to their own reluctance and that of their families to follow through with recommended mental health care after leaving detention. There is an over-representation of Hispanic youth in the population served by PVYSC and the local juvenile justice system. There appears, despite the best efforts of the local juvenile justice system, to be a lack of immediate and meaningful consequences to the illegal behaviors of youth. There is a high level of gang influence in the community for the population targeted by this project. C. Describe the intended long-term change/outcome: Reduce the overall recidivism rate of youths entering the juvenile justice system and the negative impacts of their behavior on their families and the Weld County community. We do not want to see the youth involved to further penetrate the system. We want to see youth experience and report successes in reaching personal goals. D. Proposed project: NRBH will be able to provide services to youths who typically would not have sought services on their own or had them sought for them by their families. Appropriate referrals for continuing mental health care and other types of services can then be made, enabling a way out of the problems they are facing. The youths and their families will be able to receive services directly connected to their needs, services that can be tailored to exactly what is needed to break maladaptive life patterns. Target Population: Number of Persons Proposed to be Served Ethnicity of Persons to be Served Adults Youth Male Female Male Female White 33 8 — Black 4 2 Hispanic 33 8 Asian/Pacific Islander 1 1 Native American 3 2 Other/Unknown 4 1 SUBTOTALS: 78 22 — TOTAL Persons 100 Percent of Total to be Sewed with Limited English Proficiency: <5% 5R- YKOJECI PLAN: GOALS, OBJECTIVES,AND OUTCOMES A. Description of proposed project: Through this proposal, NRBH seeks to be able to continue to quickly and appropriately identify, assess, evaluate, and treat those detained youth at the Platte Valley Youth Services Center(PVYSC) who are in need of mental health services; to communicate effectively with the juvenile court,probation officers, social services workers, detention facility staff, mental health therapists, school personnel, and pertinent others about each referred individual; and to provide timely mental health treatment to those identified in need of such. JAIBG funds have helped accomplish some of these tasks in past years. NRBH again requests continued and increased funding of its efforts. Because of proposed funding cuts this year, 6.80 hours (.17FTE) of a mental health clinician's time will be made available weekly to serve these juveniles through this grant. This will allow up to 20 juveniles to be admitted annually to treatment services. In addition to this, up to three detainees may be seen each day the therapist is on site at their own requests through "Counselor Alerts" or via referrals made by the Court, the staffs of the PVYSC, the Weld County Department of Social Services (WCDSS,) and Weld County Probation Services for crisis intervention. Many juveniles in this latter group, expected to number at least 100, do not need ongoing mental health care but have an emergent or urgent need to speak to a counselor. NRBH proposes to continue to be funded to provide both direct and indirect mental health services to the referred juveniles and to improve its ability to communicate the results of assessments, evaluations, and other interventions to the juvenile court and probation officers so they may have more timely information concerning detained youths involved in this project. It is projected there will be more than 700 detention admissions of Weld County youth to PVYSC this fiscal year. This figure is not equal to the number of juveniles being admitted but to the total number of admissions which is a duplicated count. NRBH proposes to serve at least 100 of those juveniles through this project. Culturally competent services will be provided to all clients served by this project by staff from the Intensive Children, Youth, and Family Services Program (ICYFS) with consultation when needed from the Multi-Cultural Services Program of NRBH, which is housed at the Monfort Children's Clinic. Following up on an initial round of training in cultural competency and sensitivity in May 2002 that has been and will be updated annually, NRBH provides culturally competent care to those seeking its services. Similarly, gender specific services will be available to meet the identified needs of the target population. 4 Goal 1: To rapidly respond to the mental health needs of those detained youth referred to the project Objective 1-1: Time-Line Measurement Responsible Person(s) To evaluate, refer, communicate 10/1/2006 - Track the number of Program about, and treat those youths referred. 9/30/2007. youths referred and Director and served, document clinical staff types of services provided. Objective 1-2: Time-Line Measurement Responsible Person(s) All referred youth opened as NRBH 10/1/2006 - Track the number of Program clients will have a service plan 9/30/2007. youths referred and Director and developed as part of the admission served, document clinical staff process. types of services provided and presence of plan. Objective 1-3: Time-Line Measurement Responsible Person(s) Seventy-five percent of the youth 10/1/2006 - Track the number of Program admitted to mental health treatment 9/30/2007. youths referred and Director and other than crisis services will served, document clinical staff complete their service plan. types of services �-/ ' / / provided. f C� ell 1o2 : GS�Rblt t`u° Q�ld (Pail lYI prC�YGtmis/ 40 ate Putk- CASS�w� Juv2il Q Dy i ter Li S � T erP rek Q.�l �',`,".r� 2vf Pttglve- ie WV Sahli-fa -L`�" oal II-owe0 e` es Fc SUC O.T P 1 d S, 1. What will be measured? The time and date of referral, time and date of evaluation will be tracked, as will be when the evaluation was delivered to the person or office needing it. What services were delivered to whom and the total amount of services delivered to each referral will be tracked as will be the impact of the services. 7 2. How will it be measured? Data will be entered on the form developed in previous years so that the activities can be measured. Provision of mental health services will be documented and measured by written progress and case management notes as well as by entries on a Staff Activity Log, a form already in existence and use at NRBH. Each youth's service plan will be analyzed for compliance and success data. 3. How will the results be analyzed? Progress notes, case management notes, service plans, and Staff Activity Logs will be used to document the delivery of services reflecting quantity, quality, and appropriateness of the services rendered. 14. Evaluation Plan NRBH again seeks to continue its capacity to provide services, albeit at reduced levels, to youths detained at the PVYSC. This project has served, and will continue to serve, as a pilot or model for how initial triage and evaluation, treatment, and case management services can be provided to this target population in a manner best suited to reducing recidivism and the severity of repeat offenses for those who do re-offend. Ideally, a full array of mental health services should be available to detained juveniles and their families. This project, as proposed, when linked with the other services to youths provided by the NRBH ICYFS program will serve as a larger step toward achieving that ideal. The treatment and case management services to be delivered are part of a service plan developed with and for each youth admitted to NRBH services. Some of the youths to be served by this project will not complete their mental health services during the fiscal year, even some of those who are referred early on in the year. NRBH will continue to track them once they do finish and add their data to that of the others. Those who do finish will immediately help prove the value of services such as these and demonstrate the need for continuing this work. Over the time this project has been funded, the benefit of such services to the children and their families has been clearly shown, demonstrating that NRBH does provide cost savings to the community and the state as the mental health treatment costs are much less than those involved in detaining them and immensely less than serving them as committed youth. This project will continue to allow NRBH access to juveniles who otherwise would have nothing to do with mental health care either because they would have refused it or never would have been referred to it. Access is also gained to their siblings and other family members of the referred youths, again expanding NRBH's ability to help others make positive changes in their lives Measurement of the achievement of the goals set forth herein will be ongoing with reports made at required or requested intervals. Both positive and negative results will be used to modify plans as the year progresses to realize maximum goal attainment and to ensure attainment of the desired impact on the needs the therapists are striving to meet. NRBH will continue to regularly evaluate how best to serve the target population over the course of the new grant period. The efficacy of various evaluation and treatment approaches will be studied to show what, if any, V (Copy this form or use this format for each project and the applicant agency's administrative portion of the funds.) PROJECT TITLE: PROGRAM PURPOSE AREA: 12 IMPLEMENTING AGENCY: North ranee Behavioral Health ROUND AU.AMOUNTS TOME NEAREST WHOLE DOLLAR. (1) (2) (3) (4) TOTAL Source 1.PERSONNEL Annual Full-time Annual Fringe Sub-Total %of time for Fed$ Match Salary Benefit Cost This Project N/A + = X % $ + = X % $ + = X % $ + = X % $ + = X % $ '44;Trv II $ J GG $� ..,....�„,,. .. ,.. TOTAL Source 2.SUPPLIES AND OPERATING Fed$ Match N/A $ $ $ $ „ 44. .' ti ,. ,r,,. x ....a. '`i'.'.. ' e ¢eat ',,'n.4t°, r t, rrSc hr': -e1 '{ $ I TOTAL Source 3.TRAVEL(Designate specifically In-state and out-of-state travel.) Fed$ Match $ $ a o.F a- $ TOTAL Source 4. EQUIPMENT Fed$ Match N/A $ $ $ J I i'. < ,_L 1t''wt�4 I-2'i y=t 't $ 5. CONTRACTED CONSULTANT AND PROFESSIONAL SERVICES TOTAL Source Attach a copy of each contract with a detailed budget. Fed$ Match Therapist salary 44,355+10,221 =54,56 X 17% $10,840 9,033 1,807 $ $ $ °� it't , n .s. w }:"... ..`... } $10,840 9,033 1,807 6. TOTAL OF ALL PROJECT COSTS TOTAL Source (1 through 5) Fed$ %of Total Match$ %of Total ; �,» ,Y c: . 9,033 1,807 10% -..',- .I.:'r..”---.. : $10,840 90% BUDGET NARRATIVE FORMAT FOR EACH PURPOSE AREA: (Revised 3/2006) Page? 19TH JUDICIAL PROBATION FEMALE OFFENDER PROGRAM FUNDING REQUEST PROBLEM: In the last five years in Weld County there has been a significant increase of female offenders being served by Juvenile Probation Officers. In 2001 101 juvenile female offenders were served by probation, in 2005 there were 143, a Weld County increase of 42%. Probationers considered at maximum level or"highest risk" are referred to Probation Officer Donna DeLuca, who oversees and coordinates the Juvenile Female Offender Program (JFOP). The term "high risk" as it relates to JFOP is defined as: a female juvenile who is not profiting from standard probation interventions that have been implemented to date and who is continuing to put herself or others at risk through her current behavior. Between 70% and 80% of these young women present with multiple issues such as prior sexual assault, family violence and substance abuse that need to be address in concert with multiple agencies and programs. Without program intervention, maximum level/high risk female offenders are not successful at completing probation. Gender specific issues tied directly to their"high risk" behaviors must be addressed to increase the chance of successful completion of probation. B. Contributing Factors: A key factor is understanding the gender specific relationship between victimization, traumatic and abusive home life, and juvenile female crime. In order to appreciate the complexity of these gender specific issues, it is critical to consider the inter-relationship of all the accompanying behavior variables that play a major role in determining probation outcomes: 1. Youth and Family Issues: Parental disengagement, sexual assault, domestic violence, pregnancy, gang involvement, extensive substance abuse, multiple educational failures and unidentified educational needs and significant losses within the family. 2. Probationer Behaviors: Defiant, disgraceful, aggressive, resistive, belligerent, antagonistic, angry, uncooperative, truant, irresponsible, impulsive, thoughtless. 3. System Issues: Previously failed placements, failure to access or profit from needed services, inappropriate referrals, and program or agency resistance to provide services, lack of gender specific programs, incomplete assessment of needs, lack of access to specific programs or services that might address these needs. Unfortunately, the attention of the families and professionals is often focused on a single, isolated behavior variable. Their reaction to the isolated behavior determines how they relate to these young women, and triggers requests for punitive detention, suspension, expulsion, or even DYC commitment. Rather, their focus must be driven by the dynamic interplay of victimization, the trauma of abusive home life and dysfunctional parental interactions. PROJECT TITLE: Juvenile Female Offender Program @FOP) PURPOSE AREA: Number 12 ��taR hl hing_and raaiat"•^'ngzreuraa to sancluet r' 4 and n f treatment to such uffendeis. - —L // "sit. is. Cs-�abUs d maul' rpre,r�u�,d-. fm ah/r zu o(.4a j , tv2vti(f pra on ofFicers b!? ✓note effec a� PC. ieledrll ih 11,11;2/ juveou'k of�a 7s c�ccounlal afrtd rcducofouuv'e4,�e rec/wA4s'Ar /0 SUMMARY OF FOCUS WITHIN THE PURPOSE AREA: To increase the number of juvenile female offenders that will be served by this program, expedite access to appropriate services and greater accountability and to increase the number of probationers that successfully complete probation. Through providing more intensive supervision, weekly gender specific groups and the development of the Individualized Probation Plan (IPP) a greater number of young women will be served. This grant will continue probation's current services with the professional skills of Hawk II Systems, whose personnel are trained in specialty areas such as family/group dynamics and substance abuse/mental health needs. This collaboration between Probation, Hawk II Systems and other service providers give broader service delivery and greater accountability to this unique population. GOAL 1: For each young woman referred, a collaborative, gender responsive, culturally sensitive process that facilitates timely access to specific community programs, actively involves parents and/or meaningful relations, and incorporates weekly groups, while simultaneously responding to the needs of the probationer and the orders of the court. This rapid and meaningful response, reflected in the creation of an Individualized Probation Plan (IPP), is a critical step in developing a comprehensive assessment, activating appropriate substance abuse services, developing pro-social skills, maintaining accountability, reducing revocations, and increasing the number of positive program completions. Objective 1: To provide greater access to services/accountability to a minimum of 18-22 juvenile female offenders utilizing the Individual Probation Plan (IPP). Responsible Time-Line Measurement _Person Through the use of the multi-disciplinary staffing team, the # of female JFOP IPP will reflect the needs, services and collective inter-agency 10/01/06 to juveniles Probation goals the juvenile female offender will address both short and 9/30/07 assessed Officer long-term. Objective 2: Provide weekly groups and collaborative case management to a minimum of 18-22 juvenile,female offenders facilitated by the contracted services of Hawk II Systems. Responsible Time-Line Measurement Person Once accepted into the JFOP, the parent/youth group will be # of female JFOP required for a period of one month, and then peer education 10/01/06 to juveniles Probation groups will address multiple life-skill subjects. Additionally, 9/30/07 attending & Officer random/collaborative in-home supervision will be provided. completing It GOAL 1 INDICATORS 1. Output indicator: • Caseload of grant funded probation officer. Objective#1, the program will serve a minimum of 18-22 high-risk juvenile female probationers, assessed from 10/1/06 to 9/30/07 and recorded. For each of the probationers, an IPP staffing will be initiated and documented by the grant funded probation officer; the IPP will be present in each probationer's file. Review staffing for each probationer will be formally conducted every 30 days for up to 6 months. Objective #2, the actual number of juvenile female probationers who attended the weekly JFOP group will be counted, the assignment completed will be counted as well as the actual number completing / graduating from the groups. 2. Short-term indicator: • Average number of supervision meetings per month. Objective #1, each female offender accepted into the program will have a minimum of one supervision contact per week, and may have up to five meetings or contacts per week. These supervision events are based on the level of need, how recently the young woman was staffed into the program, the number of supportive services being provided, and her general day to day level of functioning. Objective #2, each group attended by parent and child, each weekly peer group session, each session on parenting held in the family's home, and each collaborative in-home or in-community contact will also be considered a significant part of the overall supervisory structure, and will vary depending on the level of need and/or functioning. • Number and percent of non-compliance events (missed court dates, positive UA's) Objective #1, the percentage of compliance or non-compliance events, based on a behavioral baseline established at the time of referral will be recorded at each of the monthly IPP staffings. Parents, private providers and other supportive agencies will have opportunities to review and report on the progress to date and help in the development of the next month's goals. Objective#2, the percentage of compliance or non-compliance will be recorded by the attendance and assignments completed at each of the groups provided. This information will then be reported at the monthly IPP staffing. /?t. 3. Intermediate Outcome Indicator: • Number and percent of youth to complete their justice requirements successfully. Results of Objective 1, measurements will be analyzed by comparing the total number of juvenile female probationers to those actually served. As part of the analysis, there is an expectation that 100 percent of the FOP girls will have an IPP staffing each month during the time in the program. These staffings will provide a formal method of data collection while giving on going feedback to the youth and her parents. Results of Objective 2 will be analyzed by reviewing the recidivism rate of the JFOP participants to those of the general female offender population. Of the original youth identified, 75% will successfully complete this six-month program. While being in the program for the entire six months is important, completing the IPP goals will be the benchmark for successful program graduation. GOAL 1 COST NEEDS: The cost needs will revolve around direct services and case management, with the goal of conducting immediate assessments on all clients so as to provide early and effective interventions. NUMBER OF JUVENILES TARGETED: 18-22 juvenile (ages 10-18) female probationers will be targeted with an estimated ethnic composition of: 50% Caucasian, 40% Hispanic, and 10% Native American or other heritage. White Hispanic/Latin African Native Asian/Pacifi Multiracia Other Totals o American American c 11 Islander Multi Ethnic Males 0 0 0 0 0 0 0 0 Females 9-11 8-9 0 1-2 0 0 0 18-22 /3 C. Evaluation and Long-Term Sustainability Plan Success will be achieved when 100% (a minimum of 18 annually) of all juvenile female probationers have received greater access to services through the use of the multi-disciplinary staffing and the IPP, and has been provided with weekly groups and collaborative case management. Goals for each individual will be reviewed, renewed and progress acknowledged monthly at the IPP staffing. Supporting measurements of success, weekly supervision meetings, in home collaborative visitations, group attendance, group assignment completion, school attendance, will also be collected on a regular monthly basis. We are confident that the above indicators of success will result in lowered recidivism / revocation rates as compared to the non-Juvenile Female Offender Program participants. The Juvenile Female Offender Program started approximately five years ago. We are dedicated now, more than ever, to the fact that gender specific services are essential in addressing the multifaceted needs of young women in our community. This year we are committed to training other community professionals using our multidisciplinary staffing forum and the Individualized Probation Plan format as a vehicle for learning and sharing. Despite the reduction in funding, we are committed to maintaining the integrity of this program and will provide service to as many young females as possible. This year, the JFOP Probation Officer will receive training from Hawk II Systems, who conducts our parent/youth groups, and the girl gender-specific groups. This training will ensure the future of our program continuity. Additionally, we will be meeting with other collateral agencies at least quarterly to discuss how we can better utilize the time, resources, and services that are currently available to the young women in our program. In an effort to further develop our program, the Probation Officer will attend Girls ETC meetings quarterly, and will attend any related juvenile female offender training, when feasible. We have worked hard at identifying those skills, programs or services that seem to impact our clients in a healthy and positive manner. Continued effort will be made to refine our program, and evaluate "best practice" programs. - RIIXCET/RUDGET M -uRATTVF CONTRACTED CONSULTANT/PROFESSIONAL SERVICES Weld County Probation has contracted with Hawk II Systems L.L.C. continuously for the past several years to work with the Juvenile Female Offender Program (JFOP). In order to continue the program and to maintain current services, the Probation Department is requesting $7,226.00 annually to be allocated towards Hawk II Systems. Hawk II Systems, as well as other providers or agencies working directly with JFOP, will attend monthly staffings where the Individualized Probation Plan (IPP) will be developed, and review and create new goals for the upcoming month outlined. Expenses will cover Hawk II Systems' provision of the required parent/daughter groups that will contain parenting and behavior management information. In addition, weekly, on-going cognitive girls groups will be provided by Hawk II Systems to address issues of personal safety, teen pregnancy, interpersonal relationships, personal decision making and career choices. In order for the girls and their families to receive support and program consistency, regular in-home and/or school visits will be conducted jointly by Hawk II Systems and the probation officer. These visits allow issues that arise to be addressed in a timely and supportive fashion. TOTAL Fed $ Match $ $ TOTAL SUPPLIES AND OPERATING $0 $0 Weekly groups/Coordinate Monthly Staffing, Case management-Hawk II Systems, LLC $7,226.00 $7,226.00 TOTAL CONTRACTED COST $7,226.00 $7,226.00 TOTAL OF ALL PROJECT COSTS TOTAL Source Fed $ % of Total Match % of Total $7,226.00 $7,226.00. ,fll Ii- revamping servicesservicacatz-dThattrade o improve communications wt all others involved in this project and the overall grant. 15. Evaluation of Services and Goal Attainment to Date All goals and objectives for the current fiscal year will be met or exceeded, based on data gathered through 4/18/06. Timely evaluation, case management, and treatment services have been provided to all referred juveniles. The racial balance of those referred was markedly different than predicted with Hispanic/Latino youths comprising about 60%of those referred, down from 70% the previous year. This also reflects the disproportionately high percentage of detained youth who are Hispanic/Latino. Timely responses to both the referred youths and to the agencies/individuals who referred them occurred more than 95% of the time. The expected proportion of the youths seen under this grant needed only crisis intervention services while detained. Ongoing services were offered to the rest and included as part of their release plans. We will work toward meeting the requirements of Colorado KIT. 16. Sustainability Plan: NRBH views this project as a necessary part of its services to the Weld County community and will seek funding to perpetuate and expand it. NRBH will continue to look to JAIBG, Senate Bill 94, federal, state, and other sources for continuing funding. 17. Budget and Budget Narrative Overall Budget The overall budget for this project will be $9,033, broken down as follows: A. Personnel: No personnel expense is planned. B. Supplies and Operating: No support is being requested for costs anticipated for supplies and operating expenses for this project. C. Travel: No funds to cover travel expenses are being sought. D. Equipment: No equipment expense is planned. E. Contracted Consultant/Professional Services: Contract personnel expenses of$9,033 include the salary and fringe benefits for the clinical staff who will be performing the services to be delivered. Fringe benefits account for 23% of gross salary and are prorated based on the full time equivalent. Additional personnel expenses such as the salaries of the Program Director and clinical supervisor are not included here nor is grant support sought for them. Data from Mountain States Employers Council, Inc. of Denver indicates the proposed salary is consistent with what is paid for equivalent positions and employee qualifications in this area. I ' (Copy this form or use this format for each project and the applicant agency's administrative portion of the funds.) PROJECT TITLE: PROGRAM PURPOSE AREA: 12 IMPLEMENTING AGENCY: Weld County Total Budget. ROUND ALLAMOUNTSTOTHE NEAREST WHOLE DOLLAR. (1) (2) (3) (4) TOTAL Source 1.PERSONNEL Annual Full-time Annual Fringe Sub-Total %of time for Fed$ Match Salary Benefit Cost This Project N/A + = X %I$ + = X % $ — + = X % $ + = X % $ + = X % $ qq TOTAL Source 2.SUPPLIES AND OPERATING Fed$ Match f WA $ ill �t� J TOTAL I Source 3.TRAVEL(Designate specifically in-state and out-of-state travel.) Fed$ Match I N/A $$ [4. EQUIPMENT TOTAL Source Fed$ Match N/A $ $ As;lit ....a , .t. .. p .fit IAqi E`::::: 5. CONTRACTED CONSULTANT AND PROFESSIONAL SERVICES TOTAL Source Attach a copy of each contract with a detailed budget. Fed$ Match Therapist salary 44,355+10,221 =54,56 X 17% $10,840 9,033 1,807 Hawk II Systems $7,226 7,226 $ J -4 ° 16,259 >�s d'z z . . ,.. $18,066 ,.4$eG- „ , 41-:',....-- e a� %'''''.'l.—„T:a��, 1.807 6. TOTAL OF ALL PROJECT COSTS TOTAL Source (1 through 5) Fed$ %of Total Match$ %of Total 16,259 1,807 10% .. � 6 . ".� }, $18,066 90% BUDGET NARRATIVE FORMAT FOR EACH PURPOSE AREA: (Revised 3/2006) Page 47 Using the format provided below, provide a detailed written narrative for each project. Use separate plain white paper to complete this section of your application. Provide ajustification and explanation of all budget items in the same format as the Budget Form. Explain your basis for prorating where applicable. The budget narrative should contain the criteria used to compute budget figures. All budget figures should be justified and explained clearly so as to be easily understood.The budget narrative should show the relationship between category amount and proposed project goals. Please be sure that the budget figures in the narrative and those in the Budget Form are the same.Specific information required tor each budget category follows.List sources as either federal funds or cash match.Explain other sources of support(in addition to the 10%match)only in the budget narrative. 1. Personnel: Explain how the salary rate and types of benefits for each position were determined.If using a fringe benefit rate,explain how this percentage is justified or approved.Provide documentation to show that the proposed salary is one which is paid for equivalent positions and employee qualifications in your area.If salaries are expected to increase during the project year,indicate the percentage increases for each position and justify them.Be sure to include scheduled salary increases on the Budget Form. NOTE: Questions regarding the definition of"employee" may be directed to the Internal Revenue Service. Contract employees or independent contractors should be shown under Consultant/Professional Services, not Personnel. 2. Supplies and Operating: Explain how the costs were determined and justify the need for the various line items. Items with a unit cost less than $5,000 are considered supplies and should be listed in this category. Items costing $5,000 or more should be listed under Equipment. If custom development of software is contracted out, it is subject to prior approval and should be shown as a contract under Contracted Services below. All purchases should be made through competitive bid, state or local award, or established purchasing procedures. 3. Travel: Explain the relationship of each cost item to the project,(e.g.,if training or conference expenses are requested, explain the topic of the conference and its relationship to the project).If the applicant agency does not have an approved mileage rate, use the state rate of.28/mile. Out-of-state travel is discouraged and should be thoroughly justified. 4. Equipment: Items that have a unit cost of$5,000 or more (except software) and a useful life of over one year are considered equipment. Explain why the proposed equipment is essential to conducting the project and is not currently available for use of the project within your agency or organization. DCJ must provide prior written approval for the actual purchase of all equipment. All equipment must be purchased through competitive bid, state or local award, or established competitive purchasing procedures. 5. Contracted Consultant/Professional Services Provide a copy of all contracts and explain how they were or will be procured. NOTE: Questions regarding the difference between a contract employee and a regular employee may be directed to the Internal Revenue Service. CASH MATCH:Allowable sources of cash match under the JABG program are as follows: 1. Funds from the state and unit of local government 2. Housing and Community Development Act of 1974 3. Equitable Sharing Program, a federal asset forfeiture distribution program to state and local officials 4. Private funds Funds received from any federal fund sources other than those listed above may not be used as the cash match required for the JABG program. The 10%required cash match may be reflected in a lump sum under one line item if desired.Line by line cash matching is not required. Construction costs. If,under Purpose Area 1,funds are used to construct a permanent juvenile corrections facility,match must be at least 50%of the total cost of the project. Provide the source(s)of your cash match in the Budget Narrative and include a signed"Certification of Matching Funds" form(page 13)from each matching agency.If an agency is waiving funds and the receiving agency is providing the cash match then a form is not required from the waiving agency. (Revised 3/2006) 11 Financial Management Complete the items bPlnv'• A. Please provide the date of the agency's last independent audit or financial review: Has a copy been previously submitted to DCJ? _Yes No If YES, to which program? Enclose with this application one copy of the agency's most recent audit or financial review,including any management report or other auditor comments in the appendix. Also,if there were findings,please attach the audit resolutions and/or correction action plan. B. Does the agency expend over$500,000 from combined federal sources in a year? _Yes No If YES, attach a copy of the A-133 audit,including audit resolutions and/or corrective action plan. C. Please respond to the following questions regarding the agency accounting system's ability to meet the criteria for managing federal grant funds. (These questions cover areas that will be monitored by DCJ staff during site visits or through other reporting mechanisms. They are not intended to be all inclusive and do not substitute for the agency's responsibility to meet all federal and state requirements for these grant funds.)If the answer is "No" to any questions below, provide an explanation on an inserted page. o Yes 0 No Does the agency accounting system separate ALL revenues and expenditures by funding source? ID Yes 0 No Does the system track revenues and expenditures for each grant award separately through a sub-ledger system? ❑ Yes 0 No Does the system allow expenditures to be classified by the broad budget categories listed in the approved grant budget, i.e. Personnel, Supplies and Operating, Travel, Equipment and Professional Services? ❑ Yes 0 No Does the agency reconcile sub-ledgers to its general ledger at least monthly? • Yes 0 No Does the agency mark its invoices with the grant number? o Yes 0 No Does the agency maintain time sheets, signed by the employee and supervisor for each employee paid by DCJ grant funds? ❑ Yes 0 No Does the agency have written financial policies and procedures in place? • Yes 0 No Does the agency have accounting internal controls in place, such as separation of duties, two signatures on certain checks, reconciliations or other reviews? For Continuation Applicants only. o Yes 0 No Does the agency use its accounting system data to prepare the quarterly financial reports for DC7? ❑ Yes 0 No Does the agency reconcile its accounting system data with the quarterly financial reports for DCJ? (Revised 3/2006) �� Federal Fiscal Year 2005 Juvenile Accourttdbtfty Block Grant - • APPENDIX After the Certified Assurance pages and signature page of the original application attach this page and the following applicable items labeled with the appropriate letter: A. Organizational Chart- Highlight any positions included in your budget category. B. Financial Information - Copy of last audit or formal financial review. C. Any other item(s) specifically requested in the plan format and instructions. (Revised 3/2006) JABG Plan Format-Pages XII. CERTIFIED ASSURANCES AND SPECIAL PROVISIONS Print and Review the Certified Assurances and Special Provisions along with the signature page. These need to be 1) signed 2)attached and 3)submitted with your plan.Be sure to include the ongmal signature with the ongmal copy of the plan you submit and copies along with the two copies of the application you submit.Insert the Certified As surances and Special Provisions and signature page immediately after the"Certification of Appropriation of Mach"page. BUDGET FORM (Revised 3/2006) e�� This Certification of Appropriation of Match form should be completed by all agencies providing cash match. If there is more than one source of match, copy this page for all agencies providing a�• . Certification of Appropriation of Match r Date: Colorado Division of Criminal Justice Office of Juvenile Justice 700 Kipling Street Denver, Colorado 80215 To Whom It May Concern: Please be advised that o A/7-3' e o C G has committed support in the form of cash match in the amount of$ .i pi to match the federal funds for the FYO.. Juvenile Accountability Block Grant for (Project Title or Unit of Local Government) Execution of this document represents a certification that said funds have been earmarked within the appropriation of budget process for use as matching funds for this JABG grant application. Sincerely, • 127 08/23/2006 7 Signa we of Person Authorized to Commit to Match Date M. J.CGeile, Chair, Board of ounty C mm" io ers El Typ at.` ATTEST:• � MELD UNTY CLERK TO THE BOARD a t rsm 1 4 + i `tf t 4 •DEPU CLERK THE BOARD (Re ' t 1:'"' , JABG Plan Format-Page 13 d61-. COLORADO DIVISION OF CRIMINAL JUSTICE JUVENILE JUSTICE AND DELINQUENCY PREVENTION(JJDP)ACT APPLICATION FOR JUVENILE ACCOUNTABILITY BLOCK GRANT PROGRAM FUNDS SPECIAL PROVISIONS AND CERTIFIED ASSURANCES Special Provisions&Certified Assurances must remain attached to the application SPCA Page 1 of 10 CHECK BELOW TO INDICATE WHICH CATEGORY BEST DESCRIBES YOUR AGENCY: Inter-Governmental Grant Grant to a Colorado State Agency(Section A does not apply) Grant to a Unit of Local Government,Tribal Government,or Special District. Grant to a Non-Profit, Private Organization(Non-Governmental) The applicant certifies by signing that the project described in this application meets all the requirements of the applicable governing legislation as indicated below; that all information contained in the application is correct;that there has been appropriate coordination with affected agencies; and,that the applicant will read,understand and comply with all provisions of the governing legislation and all other applicable federal and state laws, rules and regulations that have been or may hereafter be established. The applicant further understands and agrees that any subgrant award received as a result of this application shall be subject additionally to the grant conditions set forth in the Statement of Grant Award, and in the current applicable Administrative Guide of the Division of Criminal Justice. GOVERNING LEGISLATION FOR TYIS GRANT PROGRAM. Juvenile Accountability Block Grant Program. From the United States Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention, under federal statutory authority, PLI07-273, November 2002, Making Appropriations for the Departments of Commerce, Justice and State, the Judiciary, and related Agencies and for other Purposes(Appropriations Act) and under applicable program guidelines established by said federal program office. A. STANDARD STATE SPECIAL PROVISIONS Effective August7,2006 1. CONTROLLER'S APPROVAL. CRS§24-30-202(1) This subgrant award shall not be deemed valid until it has been approved by the Controller of the State of Colorado or such assistant as may be designated. 2. FUND AVAILABILITY. CRS §24-30-202(5.5) Financial obligations of the State of Colorado payable after the current fiscal year are contingent upon funds for that purpose being appropriated,budgeted,and otherwise made available. 3. INDEMNIFICATION. FOR NON-INTERGOVERNMENTAL GRANTS ONLY: a. The Subgrantee Agency shall indemnify, save,and hold harmless the State, its employees and agents, against any and all claims,damages, liability and court awards including costs, expenses, and attorney fees incurred as a result of any act or omission by the Subgrantee Agency, or its employees, agents, subcontractors, or assignees pursuant to the terms of this subgrant award. FOR INTERGOVERNMENTAL GRANTS ONLY: b. Indemnity: To the extent authorized by law, the Subgrantee Agency shall indemnify, save, and hold harmless the State, its employees and agents, against any and all claims, damages, liability and court awards including costs, expenses, and attorney fees incurred as a result of any act or omission by the Subgrantee Agency, or its employees, agents, subcontractors, or assignees pursuant to the terms of this subgrant award. c. No term or condition of this subgrant shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protection,or other provisions for the parties, of the Colorado Governmental Immunity Act, C.R.S. Section 24-10-101, et seq. or the Federal Tort Claims Act, 28 U.S.C. 2671, et seq. as applicable, as now or hereafter amended. The Subgrantee Agency, by execution of this grant containing this indemnification clause, does not waive the operation of any law concerning the parties' ability to indemnify. COLORADO DIVISION OF CRIMINAL JUSTICE JUVENILE JUSTICE AND DELINQUENCY PREVENTION(JJDP)ACT APPLICATION FOR JUVENILE ACCOUNTABILITY BLOCK GRANT PROGRAM FUNDS SPECIAL PROVISIONS AND CERTIFIED ASSURANCES Special Provisions& Certified Assurances must remain attached to the application SPCA Page 2 of 10 4. INDEPENDENT CONTRACTOR. 4 CCR 801-2: (THIS PROVISION IS NOT APPLICABLE TO GRANTS TO COLORADO STATE AGENCIES) THE SUBGRANTEE AGENCY SHALL PERFORM THE DUTIES FUNDED UNDER THIS GRANT AS AN INDEPENDENT CONTRACTOR AND NOT AS AN EMPLOYEE OF THE STATE. NEITHER THE SUBGRANTEE AGENCY NOR ANY AGENT, SUB-CONTRACTOR, OR EMPLOYEE OF THE SUBGRANTEE AGENCY SHALL BE OR SHALL BE DEEMED TO BE AN AGENT OR EMPLOYEE OF THE STATE BY VIRTUE OF THIS SUBGRANT. SUBGRANTEE AGENCY SHALL PAY WHEN DUE ALL REQUIRED EMPLOYMENT TAXES AND INCOME TAX AND LOCAL HEAD TAX ON ANY MONIES PAID PURSUANT TO THIS GRANT. SUBGRANTEE AGENCY ACKNOWLEDGES THAT THE SUBGRANTEE AGENCY AND ITS EMPLOYEES ARE NOT ENTITLED TO UNEMPLOYMENT INSURANCE BENEFITS UNLESS THE SUBGRANTEE AGENCY OR THIRD PARTY PROVIDES SUCH COVERAGE AND THAT THE STATE DOES NOT PAY FOR OR OTHERWISE PROVIDE SUCH COVERAGE. SUBGRANTEE AGENCY SHALL NOT HAVE AUTHORIZATION, EXPRESS OR IMPLIED, TO BIND THE STATE TO ANY AGREEMENTS,LIABILITY,OR UNDERSTANDING EXCEPT AS EXPRESSLY SET FORTH HEREIN. IF THIS GRANT PROVIDES FUNDS FOR ANY PERSONAL SERVICES, SUBGRANTEE AGENCY SHALL PROVIDE AND KEEP IN FORCE WORKERS COMPENSATION (AND SHOW PROOF OF SUCH INSURANCE) AND UNEMPLOYMENT COMPENSATION INSURANCE IN THE AMOUNTS REQUIRED BY LAW. SUBGRANTEE AGENCY AGENCY SHALL BE SOLELY RESPONSIBLE FOR THE ACTS OF ITS EMPLOYEES,INDEPENDENT SUB-CONTRACTORS AND AGENTS. 5. NON-DISCRIMINATION. The Subgrantee Agency agrees to comply with the letter and the spirit of all applicable state and federal laws respecting discrimination and unfair employment practices. 6. CHOICE OF LAW. The laws of the State of Colorado and rules and regulations issued pursuant thereto shall be applied in the interpretation, execution, and enforcement of this subgrant. Any provision of this subgrant,whether or not incorporated herein by reference, which provides for arbitration by any extra judicial body or person or which is otherwise in conflict with said laws,rules,and regulations shall be considered null and void. Nothing contained in any provision incorporated herein by reference which purports to negate this or any other special provision in whole or in part shall be valid or enforceable or available in any action at law whether by way of complaint, defense, or otherwise. Any provision rendered null and void by the operation of this provision will not invalidate the remainder of this subgrant to the extent that the subgrant is capable of execution. At all times during the performance of this subgrant,the Subgrantee Agency shall strictly adhere to all applicable federal and State laws, rules,and regulations that have been or may hereafter be established. 7. VENDOR OFFSET.CRS 24-30-202(1)& CRS§24-30-202.4 (THIS PROVISION APPLIES TO NON-INTERGOVERNMENTAL GRANTS ONLY:) Pursuant to CRS 24-30-202.4(as amended), the State Controller may withhold debts owed to State agencies under the vendor offset intercept system for: (a) unpaid child support debt or child support arrearages; (b) unpaid balance of tax,accrued interest,or other charges specified in Article 21,Title 39,CRS; (c) unpaid loans due to the Student Loan Division of the Department of Higher Education; (d) owed amounts required to be paid to the Unemployment Compensation Fund; and (e) other unpaid debts owing to the State or any agency thereof, the amount of which is found to be owing as a result of final agency determination or reduced to judgment as certified by the controller. 8. EMPLOYEE FINANCIAL INTEREST. CRS§24-18-201 &CRS§24-50-507 The signatories aver that to their knowledge, no employee of the State of Colorado has any personal or beneficial interest whatsoever in the service or property described herein. 9. SOFTWARE PIRACY PROHIBITION. (Governor's Executive Order D 002 00) No state or other public funds payable under this subgrant shall be used for the acquisition,operation or maintenance of computer software in violation of United States copyright laws or applicable licensing restrictions. The Subgrantee Agency hereby certifies that,for the term of this subgrant and any extensions,the Subgrantee Agency has in place appropriate systems and controls to prevent such improper use of public funds. If the State determines that the Subgrantee Agency is in violation of this paragraph,the State may exercise any remedy available at law or equity or under this subgrant, including, without limitation, immediate termination of the Subgrant and any remedy consistent with United States copyright laws or applicable licensing restrictions. 10. FEDERAL FUNDING This subgrant is subject to and contingent upon the continuing availability of Federal funds for the purposes hereof. COLORADO DIVISION OF CRIMINAL JUSTICE JUVENILE JUSTICE AND DELINQUENCY PREVENTION (JJDP)ACT APPLICATION FOR JUVENILE ACCOUNTABILITY BLOCK GRANT PROGRAM FUNDS SPECIAL PROVISIONS AND CERTIFIED ASSURANCES Special Provisions& Certified Assurances must remain attached to the application SPCA Page 3 of 10 11. ILLEGAL ALIENS-PUBLIC CONTRACTS FOR SERVICES. CRS 8-17.5-101 and 24-76.5-101 The Subgrantee Agency certifies that the Subgrantee Agency shall comply with the provisions of CRS 8-17.5-101 et seq. The Subgrantee Agency shall not knowingly employ or contract with an illegal alien to perform work under this subgrant or enter into a contract with a subcontractor that fails to certify to the Subgrantee Agency that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this subgrant. The Subgrantee Agency represents, warrants,and agrees that it(i)has verified that it does not employ any illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and(ii)otherwise will comply with the requirements of CRS 8-17.5-102(2)(b). The Subgrantee Agency shall comply with all reasonable requests made in the course of an investigation under CRS 8-17.5-102 by the Colorado Department of Labor and Employment. If the Subgrantee Agency fails to comply with any requirement of this provision or CRS 8-17.5-101 et seq.,the State may terminate this subgrant for breach and the Subgrantee Agency shall be liable for actual and consequential damages to the State. A Subgrantee Agency that operates as a sole proprietor hereby swears or affirms under penalty of perjury that the Subgrantee Agency(i) is a citizen of the United States or otherwise lawfully present in the United States pursuant to federal law, (ii)shall comply with the provisions of CRS 24-76.5-101 et seq, and(iii) shall produce one of the forms of identification required by CRS 24-76.5-103 prior to the effective date of this subgrant. Except where exempted by federal law and except as provided in CRS 24-76.5-103(3), a Subgrantee Agency that receives federal or state funds under this subgrant must confirm that any individual natural person eighteen years of age or older is lawfully present in the United States pursuant to CRS 24-76.5- 103(4)if such individual applies for public benefits provided under this subgrant. B. GRANT REQUIREMENTS 1. FINANCIAL&ADMINISTRATIVE MANAGEMENT a. The Subgrantee Agency assures that fund accounting, auditing,monitoring, evaluation procedures and such records as necessary will be maintained to assure adequate internal fiscal controls, proper financial management, efficient disbursement of funds received, and maintenance of required source documentation for all costs incurred. These principles must be applied for all costs incurred whether charged on a direct or indirect basis. b. All expenditures must be supported by appropriate source documentation. Only actual, approved, allowable expenditures will be permitted. c. The Subgrantee Agency assures that it will comply with the provisions of the current applicable Administrative Guide of the Division of Criminal Justice which is hereby incorporated by reference. However, such a guide cannot cover every foreseeable contingency, and the Subgrantee Agency is ultimately responsible for compliance with applicable state and federal laws,rules and regulations. 2. PAYMENT&REPORTING a. The Division of Criminal Justice will pay the Subgrantee Agency the reasonable and allowable costs of performance, in accordance with current Colorado State Fiscal Rules, not to exceed the amount specified herein as the Total Award Amount,as identified in the Statement of Grant Award. b. The Division's requirements for invoice, advance payments, and cost reporting submissions are contained in the DCJ Form 3 - Cash Request Procedures, and DCJ Form 1-A - Subgrant Financial Report, which are hereby incorporated by reference. c. Advance payments cannot exceed 30-day operating expenses. d. The Subgrantee Agency assures that it shall maintain data and information to provide accurate quarterly program narrative and financial reports to the Division. Said reports shall be provided in such form and contain such data and information as the Division of Criminal Justice reasonably requires to administer the program. e. The Subgrantee Agency assures that quarterly financial and narrative reports shall be submitted within 30 days of the end of each calendar quarter and shall be current and actual. f. The Subgrantee Agency further assures that final financial and narrative reports shall be submitted on the forms provided by the Division of Criminal Justice within 45 days of the end date of the subgrant. g. The Division reserves the right to make and authorize modifications, adjustments, and/or revisions to the Grant Award for the purpose of making changes in budget categories, extensions of grant award dates, changes in goals and objectives, and other modifications which do not change the total amount of the Grant Award. The Division's requirements for such grant adjustments are contained in the procedures for DCJ Forms 4A,4B, 4C, and 4D, which are hereby incorporated by reference. COLORADO DIVISION OF CRIMINAL JUSTICE JUVENILE JUSTICE AND DELINQUENCY PREVENTION(JJDP)ACT APPLICATION FOR JUVENILE ACCOUNTABILITY BLOCK GRANT PROGRAM FUNDS SPECIAL PROVISIONS AND CERTIFIED ASSURANCES Special Provisions&Certified Assurances must remain attached to the application SPCA Page 4 of 10 h. The Division may withhold payment in the event the Subgrantee Agency fails to comply with conditions, including all financial reporting requirements and certifications contained in this grant award. 3. PROCUREMENT AND CONTRACTS a. The Subgrantee Agency assures that open, competitive procurement procedures will be followed for all purchases under the grant. All contracts for professional services,of any amount,and equipment purchases over five thousand dollars (per item, with a useful life of at least one year) must receive prior approval by the Division of Criminal Justice. b. The Subgrantee Agency assures that no contract or agreement will be made for execution of project activities or provisions of services (other than purchase of supplies or standard commercial or maintenance services) that is not incorporated in the approved application or approved in advance by the Division of Criminal Justice. c. The Subgrantee Agency assures that contractors/vendors who assist the Subgrantee Agency to develop specifications, requirements, statements of work and/or Request For Proposal for a proposed procurement shall be excluded from bidding or submitting a proposal to compete for the award of such procurement. d. The Subgrantee Agency assures that where activities supported by this subgrant produce any discovery or invention, original computer programs, writing, sound recordings, pictorial reproductions, drawing or other graphical representation and works of any similar nature,the following requirements apply: i. The Division of Criminal Justice reserves a royalty-free, non-exclusive, and irrevocable license to reproduce, publish, or otherwise use, and authorize others to use, for Federal government purposes: The copyright in any work developed under an award or subaward; and 2) Any rights of copyright to which a recipient or subrecipient purchases ownership with support. ii. If any program produces patentable items, patent rights, processes or inventions, in the course of work sponsored by the Federal award or subaward funds,such facts must be promptly and fully reported to the awarding agency, Division of Criminal Justice. The awarding agency shall determine whether protection on the invention or discovery shall be sought. The awarding agency will also determine how rights in the invention or discovery(including rights under any patents issued thereon)shall be allocated and administered in order to protect the public interest pursuant to published Presidential and government memorandums and guidelines,and the regulations promulgated by the Department of Commerce in 37 CFR Part 401. iii. When issuing statements, press releases, requests for proposals, bid solicitations, and other published documents describing projects or programs funded in whole or in part with these grant funds, all Subgrantee Agencies must clearly: a) State the percentage of the total cost of the program or project, which will be financed with this grant money; b) State the dollar amount of state or federal funds for the project or program; c) Use the phrase-"This project was supported by grant# , issued by the Colorado Division of Criminal Justice." e. The Subgrantee Agency may not assign its rights or duties under this grant without the prior written consent of the Division of Criminal Justice. 4. AUDIT,RECORD-KEEPING,AND MONITORING/INSPECTION a. The Subgrantee Agency assures that it will procure an audit or financial review by a CPA or licensed public accountant incorporating the subgrant. If the agency expends more than $500,000 per year in combined federal funds, an audit must be conducted in accordance with OMB Circular A-133 (Audits of States, Local Governments, and non-profit organizations). i. At such time as the audit or financial review is completed, ONE COPY OF THE REPORT, INCLUDING THE CORRESPONDING MANAGEMENT LETTER, MUST BE FORWARDED TO THE DIVISION OF CRIMINAL JUSTICE for clearance. ii. The Subgrantee Agency accepts responsibility for the costs of a financial program audit to be performed by the Department of Public Safety in the event that the audit report or financial review: a) does not meet the applicable A-133 or DCJ standards; b) is not submitted in a timely manner; or, c) does not provide an audit response plan with corresponding corrections made sufficient to satisfy any audit findings. COLORADO DIVISION OF CRIMINAL JUSTICE JUVENILE JUSTICE AND DELINQUENCY PREVENTION(JJDP)ACT APPLICATION FOR JUVENILE ACCOUNTABILITY BLOCK GRANT PROGRAM FUNDS SPECIAL PROVISIONS AND CERTIFIED ASSURANCES Special Provisions&Certified Assurances must remain attached to the application SPCA Page 5 of 10 b. The Subgrantee Agency assures that: i. It will retain all project records, as will facilitate an effective audit,for seven years after the end of the state fiscal year that includes the end date of the grant. (For example if the grant ended 9/30/91, the state FY would be July 1, 1991-June 30, 1992. The files could be destroyed after 6/30/99);except, ii. If an audit is in progress and/or the findings of a completed audit have not been resolved satisfactorily,then records must be retained beyond the seven-year period until such issues are resolved. c. The Subgrantee Agency assures that it will keep copies of all documents, correspondence, and required receipts related to this subgrant in a separate file bearing the project title and grant number. d. The Division may periodically request submission of supporting financial and programmatic documentation, subcontracts, general and sub-ledgers for the purpose of monitoring compliance with the grant award via desk review, or in preparation for an on-site monitoring visit. Routine or special on-site visits may be conducted at the subgrant agency, and at the location of any collaborating entities, for the same purpose. Subgrantee Agencies will be notified in advance of any on-site monitoring visit. e. The Subgrantee Agency assures that the Division of Criminal Justice, Colorado Department of Public Safety, shall have access for purposes of monitoring, audit and examinations to any bonds, documents, papers and records of the Subgrantee Agency and to relevant books and records of subcontractors of the Subgrantee Agency. It is the responsibility of the Subgrantee Agency to notify any of its project collaborators and subcontractors of these provisions. f The Subgrantee Agency assures that signatories of the application and subgrant award and personnel employed through this subgrant will appear when requested at any administrative hearing, monitoring site visit, conference or meeting conducted by the Division of Criminal Justice. 5. COLORADO VICTIM RIGHTS ACT The Subgrantee Agency assures that the application signatories, all staff and all volunteers assigned to the funded project have read and understand the rights afforded to crime victims pursuant to §24-4.1-302.5 C.R.S., and the services delineated pursuant to §§24-4.1-303 and 24-4.1-304 C.R.S., commonly known as the Victim Rights Act, and enabling legislation. 6. TERMINATION or REDUCTION IN GRANT AWARD The Division will monitor the performance of the Subgrantee Agency against goals and performance standards as found in the application, Section VI required herein. The Division will provide reasonable assistance to the Subgrantee Agency concerning project goals, performance standards and subgrant requirements. Any determination of substandard performance on the part of the Subgrantee Agency shall be within the discretion of the Division, based upon the Division's review of the terms and conditions of the Grant Award, the application and project summary, the grant terms and assurances, and the requirements of applicable law. Substandard performance, as determined by the Division, shall constitute non-compliance, which may result in termination for cause,or reduction of the Grant Award for cause,as follows: a. Reduction In Grant Award Amount for Cause i. The Division may reduce the total Statement of Grant Award amount for cause, without compensation for reduction costs. ii. If the state reduces the grant amount for cause, it will first give ten (10) days written notice to the Subgrantee Agency, stating the reasons for reduction, steps taken to correct the problems, and the date the subgrant award amount will be reduced in the event problems have not been corrected to the satisfaction of the Division. iii. In the event this grant is reduced for cause, the Division will only reimburse the Subgrantee Agency for acceptable work or deliverables received up to the date of reduction. iv. In the event this grant is reduced for cause, final payment to the Subgrantee Agency may be withheld at the discretion of the Division until completion of final Division review. b. Termination for Convenience: i. Either party may terminate the grant with thirty days written notice of intent to cancel or terminate. ii. If the grant is terminated for convenience by either the Subgrantee Agency or the state, the Subgrantee Agency shall be paid the necessary and allowable costs incurred through the date of termination, but not exceeding a prorated amount based on the number of days of project operation prior to the date of termination. c. Termination for Cause: i. The Division may terminate the grant for cause without compensation for termination costs. ii. If the state terminates the grant for cause, it will first give ten (10) days written notice to the Subgrantee Agency, stating the reasons for termination, steps taken to correct the problems, and the date the subgrant will be terminated in the event problems have not been corrected to the satisfaction of the Division. COLORADO DIVISION OF CRIMINAL JUSTICE JUVENILE JUSTICE AND DELINQUENCY PREVENTION(JJDP)ACT APPLICATION FOR JUVENILE ACCOUNTABILITY BLOCK GRANT PROGRAM FUNDS SPECIAL PROVISIONS AND CERTIFIED ASSURANCES Special Provisions&Certified Assurances must remain attached to the application SPCA Page 6 of 10 iii. In the event this grant is terminated for cause,the Division will only reimburse the Subgrantee Agency for acceptable work or deliverables received up to the date of termination. iv. In the event this grant is terminated for cause, final payment to the Subgrantee Agency may be withheld at the discretion of the Division until completion of final Division review. d. Any equipment purchased under this grant would revert, at the option of the Division, to the Division of Criminal Justice upon termination of the grant for any of the above reasons. 7. ORDER OF PRECEDENCE Any inconsistency or conflict in this grant shall be resolved by giving precedence in the following order: (a) Special Provisions and Certified Assurances, (b) Statement of Grant Award; and,(c)the final approved Subgrant Application. 8. DISPUTE RESOLUTION(THIS PROVISION APPLIES ONLY TO INTERAGENCY AGREEMENTS): Any failure of either party to perform in accordance with the terms of this agreement shall constitute a breach of the agreement. Any dispute concerning the performance of this agreement which cannot be resolved at the divisional level shall be referred to superior departmental management staff designated by each department. Failing resolution at that level, disputes shall be presented to the executive directors of each department for resolution. Failing resolution by the executive directors, the dispute shall be submitted in writing by both parties to the State Controller, whose decision on the dispute will be final. C. FEDERAL CERTIFIED ASSURANCES 1. FEDERAL PUBLIC POLICY ASSURANCES a. The Subgrantee Agency hereby agrees that it will comply, and all of its contractors will comply with the applicable provisions of: i. Title I of the Omnibus Crime Control and Safe Streets Act of 1968,as amended; ii. The Juvenile Justice and Delinquency Prevention Act and/or the Victims of Crime Act,as appropriate; iii. All other applicable Federal laws,orders,circulars,regulations or guidelines. b. The Subgrantee Agency hereby agrees that it will comply, and all of its contractors will comply with the provisions of 28 CFR applicable to grants and cooperative agreements including: i. Part 18,Administrative Review Procedure; ii. Part 22,Confidentiality of Identifiable Research and Statistical Information; iii. Part 23,Criminal Intelligence Systems Operating Policies; iv. Part 30 Intergovernmental Review of Department of Justice Programs and Activities; v. Part 35,Nondiscrimination on the Basis of Disability in State and Local Government Services; vi. Part 38,Equal Treatment for Faith Based Organizations; vii. Part 42 Nondiscrimination/Equal Employment Opportunity Policies and Procedure; viii. Part 61 Procedures of Implementing the National Environmental Policy Act; ix. Part 63 Floodplain Management and Wetland Protection Procedures; and, x. Federal Laws or regulations applicable to Federal Assistance Programs. 2. FINANCIAL&ADMINISTRATIVE MANAGEMENT a. Subgrantee Agency assures that it will comply with appropriate federal cost principles and administrative requirements applicable to grants as follows: i. For state, local or Indian tribal government entities; a) OMB Circular A-87, Cost Principles for State, Local&Indian Tribal Governments b) OMB Circular A-102, Common Rule-Uniform Administrative Requirements for Grants and Cooperative Agreements to State and Local Governments c) 28 CFR 66, Uniform Administrative Requirements for Grants and Cooperative Agreements to State and Local Governments ii. For non-profit organizations; a) OMB Circular A-122, Cost Principles for Non-Profit Organizations b) OMB Circular A-110, Uniform Administrative Requirements for Grants and Agreements with Institutions of Higher Education, Hospitals and Other Nonprofit Organizations c) 28 CFR 70, Uniform Administrative Requirements for Grants and Cooperative Agreements with Institutions of Higher Education, Hospitals, and other Non-Profit Organizations iii. For colleges and universities; a) OMB Circular A-21, Cost Principles for Educational Institutions b) OMB Circular A-110, Uniform Administrative Requirements for Grants and Agreements with COLORADO DIVISION OF CRIMINAL JUSTICE JUVENILE JUSTICE AND DELINQUENCY PREVENTION(JJDP)ACT APPLICATION FOR JUVENILE ACCOUNTABILITY BLOCK GRANT PROGRAM FUNDS SPECIAL PROVISIONS AND CERTIFIED ASSURANCES Special Provisions& Certified Assurances must remain attached to the application SPCA Page 7 of 10 Institutions of Higher Education, Hospitals and Other Nonprofit Organizations c) 28 CFR 70, Uniform Administrative Requirements for Grants and Cooperative Agreements with Institutions of Higher Education, Hospitals, and other Non-Profit Organizations iv. For each agency spending more than$500,000 per year in federal funds from all sources; a) OMB Circular A-133,Audits of States, Local Governments and Nonprofit Organizations b. The Subgrantee Agency assures that it will comply with the provisions of the Office of the Comptroller, Office of Justice Programs OC Financial Guide for Grants, current edition. (For practical purposes,the requirements pertinent to the management of these funds have been extracted from the above documents and are contained in the current applicable Administrative Guide of the Division of Criminal Justice, which is hereby incorporated by reference. However, such a guide cannot cover every foreseeable contingency, and the Subgrantee Agency is ultimately responsible for compliance with applicable state and federal laws, rules and regulations.) 3. NON-SUPPLANTING OF FUNDS(Governmental Agencies Only) a. The Subgrantee Agency certifies that any required matching funds used to pay the non-federal portion of the cost of this subgrant are in addition to funds that would have otherwise been made available for the purposes of this project. b. The Subgrantee Agency certifies that federal funds made available under this grant: i. Will not be used to supplant state or local funds; ii. That the Subgrantee Agency's expenditures for the purpose described in this application for the annual period are as great as for the preceding year plus the average annual increment in such expenditures for the past two,three, four or five years;OR iii. Where the certification above(3bii)cannot be made, and there is a reduced or unchanged local investment, then the Subgrantee Agency shall give a written explanation demonstrating that the Subgrantee Agency's reduced or unchanged commitment would have been necessitated even if federal financial support under this federal grant program had not been made available. 4. PROHIBITIONS ON LOBBYING WITH FEDERAL FUNDS(Subgrantee Agencies receiving$100,000 or more in total federal funds per year. See 28 CFR Part 69.) The prospective Subgrantee Agency certifies,by submission of this proposal,that: a. No federal funds received through this subgrant 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 the making of any federal grant, the entering into of any cooperative agreement,and the extension, continuation,renewal,amendment, or modification of any federal grant or cooperative agreement; and, b. If any funds other than funds through this subgrant 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 subgrant, the prospective Subgrantee Agency shall complete and submit Standard Form-LLL,"Disclosure of Lobbying Activities." 5. CERTIFICATION REGARDING DEBARMENT,SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION(Subgrantee Agencies receiving$100,000 or more in total federal funds per year. See, 28 CFR Part 67.) The prospective Subgrantee Agency certifies, by submission of this proposal,that neither it nor its principals,subcontractors or suppliers: a. Are presently debarred, suspended,proposed for debarment,declared ineligible,sentenced to a denial of Federal benefits by a State or Federal court,or voluntarily excluded from participation in this transaction by any Federal department or agency; b. Have not within a three-year period preceding this application been convicted of or had a civil judgment 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 statements,or receiving stolen property; c. Are not 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(5)(b)of this certification; and d. Have not within a three-year period preceding this application had one or more public transactions(Federal, State, or local)terminated for cause or default; and e. Where the prospective Subgrantee Agency is unable to certify to any of the statements in this certification,he or she shall attach an explanation to this application. 6. CERTIFICATION REGARDING DRUG FREE WORKPLACE (See, 28 CFR Part 67, Subpart F.) The orosoective Suberantee Aeencv certifies. by submission of this nr000sal. that it will comply with the Drug Free COLORADO DIVISION OF CRIMINAL JUSTICE JUVENILE JUSTICE AND DELINQUENCY PREVENTION(JJDP)ACT APPLICATION FOR JUVENILE ACCOUNTABILITY BLOCK GRANT PROGRAM FUNDS SPECIAL PROVISIONS AND CERTIFIED ASSURANCES Special Provisions&Certified Assurances must remain attached to the application SPCA Page 8 of I0 Workplace Act of 1988,as implemented at 28 CFR Part 67, Subpart F. 7. CIVIL RIGHTS COMPLIANCE (See, 28 CFR Part 42) a. Upon award, each Subgrantee Agency will be provided DCJ's Form 30, entitled "Certification of Compliance with Regulations Regarding Federal Civil Rights Requirements and Equal Employment Opportunity Plans (EEOP), and will be required to do the following: i. The Project Director must submit the form to the Subgrantee Agency's Authorized Official for this grant; ii. The Authorized Official must review the form in conjunction with subgrant agency personnel responsible for reporting civil rights findings of discrimination; iii. The Authorized Official must accurately complete the required information and provide all information requested; iv. The Authorized Official must provide an original signature on the form as indicated;and, v. The DCJ 30 Form with original signature must be returned to the Division with the Statement of Grant Award(SOGA). b. Any subgrant agency findings of discrimination must be reported to the Division of Criminal Justice within 45 days of receipt of this grant award, and to the Office for Civil Rights, Office of Justice Programs, U.S. Department of Justice. 8. NON-DISCRIMINATION The following federal non-discrimination cites apply in particular: the nondiscrimination requirements of the Omnibus Crime Control and Safe Streets Act of 1968, as amended; Title VI of the Civil Rights Act of 1964; Section 504 of the Rehabilitation Act of 1973,as amended; Subtitle A, Title II of the Americans with Disabilities Act of 1990,42 U.S.C. 12101, et. seq. and Department of Justice Regulations on Disability Discrimination, 28 CFR Part 35 and Part 39;Title IX of the Education Amendments of 1972; the Age Discrimination Act of 1975; the Department of Justice Nondiscrimination Regulations 28 CFR Part 42, Subparts C, D, E, and G; and Executive Order 11246, as amended by Executive Order 11375, and their implementing regulations,41 CFR Part 60.1 et. seq., as applicable to construction contracts. 9. NATIONAL ENVIRONMENTAL POLICY ACT(NEPA)AND NATIONAL HISTORIC PRESERVATION ACT (NHPA)COMPLIANCE (42 USC§§4321-4370 and 16 USC§470) a. The Subgrantee Agency agrees to assist the Division of Criminal Justice and the Office of Justice Programs, U.S. Department of Justice, in complying with the National Environmental Policy Act,the National Historic Preservation Act (NHPA) and other related federal environmental impact analyses requirements in the use of these grant funds either directly by the Subgrantee Agency or by a subcontractor. As long as the activity needs to be undertaken in order to use these grant funds,this NEPA requirement first must be met whether or not the activities listed below are being specifically funded with these grant funds. The activities covered by this special condition are: b. New construction; c. Minor renovation or remodeling of a property either listed on or eligible for listing on the National Register of Historic Places, or located within a 100-year flood plain; d. Renovation, lease or any other proposed use of a building or facility that will either result in a change in its basic prior use, or significantly change its size. e. Implementation of a new program involving the use of chemicals other than chemicals that are either purchased as an incidental component of a funded activity and traditionally used,for example, in office,household,recreational or educational environments. 10. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (This provision applies only to entities that provide medical care and treatment) The Subgrantee Agency acknowledges that it is a covered health care provider under the Health Insurance Portability and Accountability Act,42 U.S.C. 1320d-1320d-8,and its implementing regulations and agrees to comply with the requirements of HIPAA concerning any uses and disclosures of protected health information. 11. Uniform Relocation Assistance and Real Property Acquisitions Act of 1970(Government Entities Only) The prospective Subgrantee Agency certifies,by submission of this proposal,that it will comply with the requirements of the Uniform Relocation Assistance and Real Property Acquisitions Act of 1970,which govern the treatment of persons displaced as a result of federal and federally-assisted programs. 12. Political Activity of Certain State and Local Employees (5 U.S.C. §§ 1501-08 and §§ 7324-28 —applies to Government Entities Only) COLORADO DIVISION OF CRIMINAL JUSTICE JUVENILE JUSTICE AND DELINQUENCY PREVENTION(JJDP)ACT APPLICATION FOR JUVENILE ACCOUNTABILITY BLOCK GRANT PROGRAM FUNDS SPECIAL PROVISIONS AND CERTIFIED ASSURANCES Special Provisions&Certified Assurances must remain attached to the application SPCA Page 9 of 10 The prospective Subgrantee Agency certifies, by submission of this proposal, that it will comply with requirements of 5 U.S.C. §§ 1501-08 and §§ 7324-28, which limit certain political activities of State and local government employees whose principal employment is in connection with an activity financed in whole or part by federal assistance. D. PROGRAM SPECIFIC REQUIREMENTS The following program specific requirements are imposed by the Federal or State sponsoring agency concerning special requirements of law,program requirements,and other administrative requirements which must be passed onto subgrant award recipients. 1. Right if Privacy for Recipients of Service and Sharing of information. The prospective Subgrantee Agency certifies, by submission of this proposal,that: a. Pursuant to Section 223(a)(18)of the Juvenile Justice and Delinquency Prevention Act,procedures have been established to ensure that this program will not disclose program records containing the identity of individual juveniles. Exceptions to this requirement are authorization by law;consent of either the juvenile or his/her legal authorized representative;or justification that otherwise the functions of this title cannot be performed. Under no circumstances may public project reports or£mdings contain names of actual juvenile service recipients. b. Necessary information will be shared appropriately among schools, law enforcement, courts and juvenile- serving agencies pursuant to the Family Educational Rights and Privacy Act(FERPA)(20 U.S.C. §1232g), as amended by Improving America's School Act of 1994(IASA). FERPA allows schools to play a vital role in a community's effort to identify children who are at risk of delinquency and provide services prior to a child's becoming involved in the juvenile justice system. c. Necessary information will be shared in accordance with the"Children's Code Records and Information Act," 19-1-301 et seq., Colorado Revised Statutes,to balance the best interests of children and the privacy interests of children and their families with the need to share information among service agencies and the need to protect the public safety. 2. In addition to the"Termination for Cause" item, F.3 under Grant Requirements above,the subgrant may be suspended or terminated by the Division of Criminal Justice if the Subgrantee Agency fails to comply with the core requirements of the Juvenile Justice and Delinquency Prevention Act, 1974,as amended: Deinstitutionalization of Stats Offenders, Section 223 (a)(12)(A); Separation of Juveniles from Incarcerated Adults, Section 223(a)(13); Removal of Juveniles from Adult Jails and Lockups, Section 223 (a)(14);Disproportionate Minority Confinement, Section(a)(23). DIVISION • ! t JUVENILE ACCOUNTABILITY BLOCK GRANT PROGRAM SPECIAL PROVISIONS AND CERTIFIED ASSURANCES SEp 0 Special Provisions&Certified Assurancel natremain attached to the application (.1. ?COI SIGNATURE PAGE->->->TO BE COMPLETED BY ALL APPLICANTS (ORIGINAL SIGNATURES REQUIRED-Please sign in BLUE ink. See instructions for description of proper signatories.) The Subgrantee Agency and responsible signatories certify by signing that they have read the Application including the Special Provisions and Certified Assurances,and are fully cognizant of their duties and responsibilities for this project.The Subgrantee Agency understands and agrees that any subgrant award received as a result of this application shall incorporate by reference the information contained herein. Responsibility for narrative and fiscal reporting requirements are delegated to the designated Project Director, who will sign all such reports. This delegation is for purposes of reporting to the Division and for operational ease, and in no way limits the authority and responsibility of the Authorized Official. In accordance with the Colorado Revised Statutes 24-72-202.6,information supplied in this application is considered a public record. AUTHORIZED.OFFICIAL Name ;.N TJ. Geile Position `ram ir ''rBn£rd•-of Colinry Commt,c3nMere Agency• Weld County, Colorado Mailing Address P. 0. Box 758 City,State Zip Greeley Colorado 80632 Telephone# (970) 356-4000 X 4200 Fax# (970) 352-4242 .E-mail Address Signature Date „WA t. 08/23/2006 FINANCIAL OFFICER Name AK; f/.T ca E.P.4 Position Oi'/:! c c/ MA.✓R ca Agency I C o Cori.✓ rY a,c-. y a a Mailing Address /7 y-O 0 ,.Si,e,e 6 T City,State,Zip G•ytr'G'C6" : Co ea 3/ Telephone# V zo ) dS6 - 5'o/S 4 .Zeo `/ Fax# (ne) Joy- Gyy? E-mail Address / Signature ( Date PROJECT DIRECTOR Name /C•„/ , .n./C. <0ccj Position C o e".1."- -Agency LJc CO Ca u.✓rr" .r�1r.e.c<,c-.f a r-:C'L a 6: Mailing Address 75' 0 S r4 e 7- City,State,Zip CRdCE CG ,- C a 8a& 3 Telephone# f7a _, ,3SG - yois— .r 280.= Fax# P?o - 3oy - GVC7 E-mail Address 2 @ Co. c✓ %e Co. !mot Oq GP Signature Date• er:7•• dealt( dj at agar COLORADO DIVISION OF CRIMINAL JUSTICE JAIBG FEDERAL AWARD AND CASH MATCH FUNDS DCJ FORM 1-AIJAIBG SUMMARY: QUARTERLY AND FINAL SUBGRANT FINANCIAL REPORT BY PURPOSE AREA COMPLETE THIS FORM FOR EACH DISTINCT PURPOSE AREA BUDGET CONTAINED IN THE APPROVED PLAN ATTACHED TO THE STATEMENT OF GRANT AWARD. ATTACH THE FORM(S)TO THE DCJ FORM 1-A/JAIBG SUMMARY FORM. See the reverse side of this form for detailed instructions for completing this form SUBGRANTEE: GRANT NUMBER: PURPOSE AREA#: PROJECT DURATION - PROJECT TITLE: FROM: TO: PREPARED BY: WHICH CALAENDAR QUARTER OF YEAR DOES THIS DATE: PHONE: REPORT COVER? TYPE OF REPORT: Jan. 1-March 31 0 July 1-Sept. 30 ❑ 1.Quarterly Progress :Quarter# :and/or 2.Final Report_ April 1-June30 0 Oct. 1-Dec.31 0 EXPENDITURES FOR THIS PURPOSE AREA: FEDERAL AWARD AND CASH MATCH .:,„:;,,,r,.4,7, i ?{,+f,l II II - , I X + lUlili 7 � tL �, aJ Y�ICii � it , tfr.s .( vP u _. rr .I..'C'#11.,?_"r•v,F'iiic i ruu Li l t (-7, $0.00 $0.00 $0.00 $ 0.00 gpr ler $0.00 $0.00 $0.00 $ 0.00 + $ 0.00 $ 0.00 $ 0.00 $ 0.00 _._ $0.00 $0.00 $0.00 $ 0.00 $0.00 - ?• $0.00 $0.00 $0.00 $ 0.00 $0.00 +•' $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $0.00 $0.00 $0.00 $ 0.00 $ 0.00 -'+ $0.00 $0.00 $0.00 $ 0.00 $0.00 + $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $0.00 $0.00 $0.00 $ 0.00 $0.00 $0.00 $0.00 $0.00 $ 0.00 $0.00 --� $ 0.00 $ 0.00 $ 0.00 $ 0.00 I $ 0.00 $0.00 $0.00 $0.00 $ 0.00 $0.00 $0.00 $0.00 $0.00 $ 0.00 $ $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 - . $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 .. _.. .... $ 0.00 **REQUIRED SUBGRANTEE SIGNATURES: I certify that, to the best of my knowledge and belief, this report is correct and complete, and that all expenditures and unpaid obligations are for the purposes set forth in the grant award documents. I, hereby,also certify that the content of this form, other than the data entry required,has not been altered. Financial Officer's Signature/Date Project Director's Signature/Date SUBMIT TWO SIGNED FORMS,ONE WITH ORIGINAL SIGNATURES,TO DCJ NO LATER THAN 30 DAYS AFTER THE END OF EACH CALENDER QUARTER; AND THE FINAL REPORT NO LATER THAN 45 DAYS AFTER THE END OF THE GRANT PERIOD. (Rev 9/08/04 dcjflajbvl doc) DETAILED INSTRUCTIONS FOR COMPLETING DCJ FORM 1-AIJAIBG. (HINT: Complete the *1i items below and then make copies of the form for future quarterly and final reporting. This will save some time. However, if you have had a budget revision approved be sure to correct the Approved Budget"column.) Heading *Subgrantee: This is the agency to which the federal grant award was made. *Grant Number: This is the grant number assigned by DCJ. It can be found on the Statement of Grant Award. *Purpose Area # and Title of that Project: This is the Purpose Area Number and name of the project associated with that area, which is identified on the Statement of Grant Award. *Duration: This is the period of the grant award. It can be found on the Statement of Grant Award, and is changed only if the project requests and receives approval for a grant extension. Prepared By: This is the person who actually prepared the report. Date: This is the date this form is completed. Phone: This is the phone number of the person who actually prepared the report. Please include the area code. Type of Report: Check whether this is a quarterly progress report, and indicate which quarter number, or the final report at the end of the project. In those cases where the last quarterly report is combined with the final report, check both Quarterly Progress and Final. The Final Financial Report may be combined with the last Quarterly Financial Report only if 1) the awarded funds and any required match have been fully expended; 2) there are no unpaid obligations remain'ng; and 3) the report is submitted no later than 30 days after the end of the grant award period. Calendar Quarter Which This Report Covers: Fill in the year in which the quarter you are reporting on falls_ Check which calendar quarter this report covers. If you are reporting on less than a full quarter, check the applicable quarter, and write in the exact dates you are reporting on in this section. Expenditures: Federal Award and Cash Match Report all expenditures approved to be charged to this Purpose Area, broken down by category and source - federal award and cash match. If the budget in this Purpose Area does not have a cash match, report only federal award expenditures. *Approved Budget: List the approved budget for this Purpose Area (federal award, cash match, and total dollars) in each budget category. If you have no approved budget in one or more budget categories, leave those lines blank. These figures can be found in the approved plan attached to the SOGA, or your latest approved revised budget. In each column, carry the sum of all "Fund Source" rows to the Budget Category "Total" Row. For example, in Personnel, put the sum of rows 1 and 2 (in each column) in row 3. In "TOTALS" under Budget Category, enter the sum of the Fund Source amounts from the rows above in each column. For example, Award (Row #16) would be the sum of rows 1, 4, 7, 10 and 13. To double check your figures, Row 18, "TOTAL $" should be equal to the sum of rows 16 and 17; and to the sum of rows 3, 6, 9, 12, and 15. Expenditures Beginning of Quarter (column labeled A): If this is the first fiscal report of the grant award, this entire column should be zeros. No expenditures are allowed before the beginning of the grant award period. If this is a subsequent fiscal report, these figures should be the same as the column labeled C on the previous quarter's financial report. This column indicates the total program expenditures prior to the quarter you are now reporting on. Expenditures This Quarter (column labeled B): Enter all federal award and cash match expenditures made during this quarter by budget category. Total Expenditures to Date (column labeled C): Add columns A and B across and enter the total in column C. Unpaid Obligations: An unpaid obligation is a fiscal encumbrance which the subgrantee is legally obligated to pay because it has ordered something, or has entered into a subcontract for some service, but which has not yet been paid for at the end of the quarter. Unpaid obligations may or may not exist at the end of any given quarter in a project. No Unpaid Obligations can remain on the Final Financial Report. The following examples of unpaid obligations are not intended to be all inclusive: 1. Personnel: Future (beyond the end of the quarter) personnel costs are never an unpaid obligation. 2. Supplies and ,Operating: You have signed a purchase order for office supplies, but you have not yet paid the bill. However, future anticipated expenses for which no legal obligation to pay exists are never unpaid obligations. 3. Travel: A staff member submits a travel voucher for travel which occurred during the quarter you are reporting on and you will not have an opportunity to pay the travel before completing the fiscal report. 4. Equipment: You have signed an order or contract to purchase a vehicle, but you have not yet paid the bill. 5. Professional Services/Consultants: You have entered into a contract with a consultant to provide a service. The unexpended amount of the contract at the end of the quarter is an unpaid obligation. Signatures: Both the designated Financial Officer and the Project Director must sign this report and attach it to the DCJ FORM 1-A/JAIBG SUMMARY. Two signed sets of forms, one with original signatures, must be submitted to DCJ. If either the Fiscal Officer or the Project Director has changed since the last quarterly report, also complete and submit a Grant Amendment Form (DCJ Form 4-B). QUARTERLY REPORTS ARE DUE NO LATER THAN 30 DAYS AFTER THE END OF THE QUARTER. FINAL REPORTS ARE DUE NO LATER THAN 45 DAYS AFTER THE END OF THE GRANT PERIOD. COLORADO DIVISION OF CRIMINAL JUSTICE - JAIBG FEDERAL AWARD AND CASH MATCH FUNDS DCJ FORM 1-AIJAIBG SUMMARY: QUARTERLY AND FINAL SUBGRANT FINANCIAL REPORT SUMMARY OF PURPOSE AREAS COMPLETE THIS FORM AS A SUMMARY OF THE TOTAL EXPENDITURES OF THE PURPOSE AREA(S) OF THE GRANT. A DCJ FORM 1- A/JAIBG for each specific Purpose Area should be attached to this summary form. See the reverse side of this form for detailed instructions for completing this form SUBGRANTEE: GRANT NUMBER: PROJECT TITLE PROJECT DURATION FROM: TO: PREPARED BY: WHICH CALAENDAR QUARTER OF YEAR DOES THIS DATE: PHONE: REPORT COVER? TYPE OF REPORT: Jan. 1-March 31 0 July 1-Sept. 30 0 1.Quarterly Progress_:Quarter#_:and/or 2.Final Report_ April 1-June30 0 Oct. 1-Dec.31 0 SUMMARY OF EXPENDITURES: FEDERAL AWARD AND CASH MATCH ".( + s1A Ic}ia lto 1l_�i c b 1. 1 l'1 1 4f i x, /I mrC iRao rm., p ., - $0.00 $0.00 $0.00 $ 0.00 $0.00 $0.00 $0.00 $0.00 $ 0.00 $0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 I $ 0.00 $0.00 $0.00 $0.00 $ 0.00 $0.00 z $0.00 $0.00 $0.00 $ 0.00 ry `j $ 0.00 $ 0.00 $ 0.00 $ 0.00 I $ 0.00 $0.00 $0.00 $0.00 $ 0.00 $0.00 a 1 $0.00 $0.00 $0.00 $ 0.00 $0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 =tl'i $0.00 $0.00 $0.00 $ 0.00 $0.00 $0.00 $0.00 $0.00 $ 0.00 $0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $0.00 $0.00 $0.00 $ 0.00 $0.00 •wl _ $0.00 $0.00 $0.00 $ 0.00 $0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 '!"- $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 **REQUIRED SUBGRANTEE SIGNATURES: I certify that, to the best of my knowledge and belief, this report is correct and complete, and that all expenditures and unpaid obligations are for the purposes set forth in the grant award documents. I, hereby, also certify that the content of this form,other than the data entry required, has not been altered. Financial Officer's Signature/Date Project Director's Signature/Date SUBMIT TWO SIGNED FORMS,ONE WITH ORIGINAL SIGNATURES,TO DCJ NO LATER THAN 30 DAYS AFTER THE END OF EACH CALENDER QUARTER;AND THE FINAL REPORT NO LATER THAN 45 DAYS AFTER THE END OF THE GRANT PERIOD. (Rev.8/08/04 dolt)ajbsumvi.doc) DETAILED INSTRUCTIONS FOR COMPLETING DCJ FORM 1-A/JAIBG SUMMARY. THIS REPORT IS A SUMMARY OF THE TOTAL EXPENDITURES OF ALL PURPOSE AREAS FOR THE QUARTER AND FINAL REPORT. THIS FORM SHOULD BE THE COVER FORM FOR THE MORE DETAILED EXPENDITURE REPORT(S) FOR EACH PURPOSE AREA- DCJ Form 1-A/JAIBG -WHICH IS/ARE ATTACHED TO THIS FORM. (HINT: Complete the *=d items below and then make copies of the form for future quarterly and final reporting. This will save some time. However, if you have had a budget revision approved be sure to correct the "Approved Budget"column.) Heading *Subgrantee: This is the agency to which the federal grant award was made. *Grant Number: This is the grant number assigned by DCJ. It can be found on the Statement of Grant Award. Project Title: This is the name of the project,which is identified on the Statement of Grant Award. *Duration: This is the period of the grant award. It can be found on the Statement of Grant Award, and is changed only if the project requests and receives approval for a grant extension. Prepared By: This is the person who actually prepared the report. Date: This is the date this form is completed. Phone: This is the phone number of the person who actually prepared the report. Please include the area code. Type of Report: Check whether this is a quarterly progress report, and indicate which quarter number, or the final report at the end of the project. In those cases where the last quarterly report is combined with the final report, check both Quarterly Progress and Final. The Final Financial Report may be combined with the last Quarterly Financial Report only if 1) the awarded funds and any required match have been fully expended; 2) there are no unpaid obligations remaining; and 3) the report is submitted no later than 30 days after the end of the grant award period. Calendar Quarter Which This Report Covers: Fill in the year in which the quarter you are reporting on falls. Check which calendar quarter this report covers. If you are reporting on less than a full quarter, check the applicable quarter, and write in the exact dates you are reporting on in this section. Expenditures: Federal Award and Cash Match Report the sum of all expenditures approved to be charged to each Purpose Area, broken down by source - federal award and cash match. The number of Purpose Areas should equal those on page 1 of the Statement of Grant Award. *Approved Budget: List the approved total budget for each Purpose Area (federal award, cash match, and total dollars). Your grant may have one or more Purpose Areas. These figures can be found on page 1 of the SOGA, or your latest approved revised budget. In each column, carry the sum of all "Fund Source" rows to the Purpose Area "Total" Row. For example, in the first Purpose Area, put the sum of rows 1 and 2 (in each column) in row 3. In "TOTALS" enter the sum of the Fund Source amounts from the rows above in each column. For example, Award (Row #16) would be the sum of rows 1, 4, 7, 10 and 13. To double check your figures, Row 18, "TOTAL" $ should be equal to the sum of rows 16 and 17; and to the sum of rows 3, 6, 9, 12, and 15. The total figures must equal the corresponding total figures from the DCJ Form 1-A/JAIBG which will be attached for each Purpose Area. Expenditures Beginning of Quarter (column labeled A): If this is the first fiscal report of the grant award, this entire column should be zeros. No expenditures are allowed before the beginning of the grant award period. If this is a subsequent fiscal report, these figures should be the same as the column labeled C on the previous quarter's summary financial report. This column indicates the total program expenditures prior to the quarter you are now reporting on. Expenditures This Quarter (column labeled B): Enter all federal award and cash match total expenditures made during this quarter by budget category. Total Expenditures to Date (column labeled C): Add columns A and B across and enter the total in column C. Unpaid Obligations: See instructions on the back of DCJ Form 1-A/JAIBG. Signatures: Both the designated Financial Officer and the Project Director must sign this report and attach the DCJ FORM 1- A/JAIBG for each Purpose Area. Two signed sets of forms, one with original signatures, must be submitted to DCJ. If either the Fiscal Officer or the Project Director has changed since the last quarterly report, also complete and submit a Grant Amendment Form (DCJ Form 4-B). QUARTERLY REPORTS ARE DUE NO LATER THAN 30 DAYS AFTER THE END OF THE QUARTER. FINAL REPORTS ARE DUE NO LATER THAN 46 DAYS AFTER THE END OF THE GRANT PERIOD. COLORADO DIVISION OF CRIMINAL JUSTICE(DCJ) Juvenile Accountability Incentive Block Grant(JAIBG)Program DCJ FORM 2JB - SUBGRANT NARRATIVE REPORT -QUARTERLY SUBGRANTEE: GRANT NUMBER: PROJECT TITLE: PROJECT DURATION: PREPARED BY: FROM: T-O: DATE: PHONE:( ) QUARTERLY REPORT. Complete this cover sheet,and then on attached WHICH QUARTER OF YEAR DOES THIS REPORT sheets supply the information requested in Sections I-HI below.Include the COVER?QUARTER# Grant Number,type of report,and date in the heading of each page. See instructions in those sections below and on the back of this form.The Project Oct. 1-Dec.31 April l-June 30 Director must sign this cover sheet. Jan. 1-March 31 July 1-Sept.30 NOTE: Quarterly reports are due 30 days after the end of the quarter;the final report is due 45 days after the end of the grant period. Re nests for funds ma be denied unless the re orts are coin lete and filed on time to the Division of Criminal Justice. Budget Information: Special Conditions: The following special conditions,listed on the Grant Amount: $ Statement of Grant Award(SOGA),have been met to date. Check one: Grant Amount Spent to Date: - $ Grant Funds Remaining: = $ All #s None Ex lain N/A This report should be a cumulative narrative,by quarter,including all activity to date.It is important that you provide any data or information necessary to show the activity and effectiveness of the project. SECTION I. JUVENILE CRIME ENFORCEMENT COALITION(JCEC)ACTIVITY: Report on the membership,oversight and planning activities of your JCEC,by quarter.Include the benefits and obstacles encountered in this collaborative effort. SECTION II.DEMOGRAPHIC INFORMATION:If this project provides services to juveniles,please fill-in or replicate the following table format and report un-duplicated numbers of juveniles served. See back of form for detailed instructions on completing this table. Raee/Ethnieity Quarter I Quarter 2 Quarter3 Quarter 4 best tc Dat e Male Female Male Female Male Female Male Female Male Female — White Hispanic/Latino — African American Native American Asian/Pacific Islander Mixed Race Other TOTALS —_ SECTION III. PROGRESS TOWARD GOALS/OBJECTIVES:Report progress towards the goals using the format below for each Purpose Area of your project.Be sure to use the most recently approved goals and objectives related to each area.This section should be a cumulative narrative,including all activity identified by quarter. PURPOSE AREA#AND NAME OF PROJECT: GOAL 1: Objective 1: a.Activities implemented to date to meet this objective.Are time lines being met? b.Problems encountered;what were they,how did they impact the project,and how were they handled?We are especially concerned with any problems you may be experiencing,please do not think it is a liability to discuss them with us. Goal Outcome Measures a.Provide indicators that show progress toward this goal. b.Are funds being expended as planned to meet this goal? c.Have any significant changes been made within the program since the last reporting period?Please explain. d. What changes are being proposed to improve the program? Re eat or all Goals and Objectives within each Pur ose Area. I,hereby,certify that the content of this form,other than the data entry required,has not been altered. Typed Name and Title of Project Director Signature of Project Director/Date SUBMIT TWO FORMS,ONE WITH ORIGINAL SIGNATURES,TO DCJ (Rev.9/04 2JBQuarter.i-t DETAILED INSTRUCTIONS FOR COMPLETING DCJ FORM 2JB, Subgrant Narrative Report-Quarterly (Quarterly reports must be submitted within 30 days after the closing date of the calendar quarter,the final report is due 45 days after the end of the grant period. Submit 2 copies,one with original signatures. The purpose of this report is to provide DCJ with sufficient information to monitor grant implementation and achievement of objectives.) Suberantee: This is the agency to which the federal grant award was made. Grant Number: This is the grant number assigned to the project by DCJ. It can be found on the Statement of Grant Award. Project Title: This is the name of the project which is identified on the Statement of Grant Award. Project Duration: This is the period of the grant award indicated by the beginning and ending dates found on the Statement of Grant Award. It can be changed only if the project requests and receives a grant extension as explained in the Administrative Guide and submits the request on a DCJ Form 4C. Prepared By: This is the name of the person who actually prepared the report. Date: This is the date the form is completed. Phone: This is the phone number of the person who actually prepared the report. Please include the area code. Which Ouarter of Year...Indicate the calendar year and check which calendar quarter this report covers.The Quarter#refers to the quarters of the grant period.If the grant started October 1",then Oct-Dec is quarter#1.If you are reporting on less than a full quarter,check the applicable quarter,and write in the exact dates covered. NARRATIVE: This report should be a cumulative narrative,including all activity to date,labeled when possible by the quarter in which it took place. With word processing available to most projects,it is hoped this report will build toward the final report as the project progresses. Use as many separate sheets as necessary and include the Grant Number,quarter being reported,and date in the heading of each. SECTION I. JCEC ACTIVITY. Report on activity of the planning coalition including any change in membership,oversight of the various Purpose Area projects,and planning activities for the future.Include the benefits and obstacles encountered in this collaborative effort. SECTION II.DEMOGRAPHIC INFORMATION. If this project is providing services,provide information regarding the juveniles served by each program or activity. At a minimum,information on those served should be provided broken out by gender and race/ethnicity using the table provided as a guideline.Only include the number of juveniles served by these grant funds. "Unduplicated number of juveniles served"means the total number of non-duplicated juveniles that have participated in the program since the start of the grant period(October 1).Count ALL juveniles being served by these grant funds in the first quarter that services begin.If you are serving juveniles that are carry-overs from the previous years grant,include them in the first quarter report.Count a juvenile ONLY ONCE,this means if a juvenile is counted in the first quarter and services continue to this juvenile through other quarters DO NOT count the juvenile again in the subsequent quarter(s). SECTION III. PROGRESS TOWARD GOALS/OBJECTIVES. Using the format provided,report activity related to the implementation of the project by Program Area and Goals. Identify each goal,list all the objectives under that goal and provide a response under each statement as requested.Information must be provided for every goal and subsequent objectives,by Purpose Area. Activities Implemented:Describe the activities which have been implemented to reach the specified objective.Indicate if they are being completed as specified in the grant application time line. Problems: Describe any problems the project has encountered during the current quarter. Indicate the steps you have taken to resolve them,or suggestions for ways DCJ or other agencies might help you to resolve them. It is especially important to discuss all problems frankly so that they can be dealt with and resolved prior to any possible requests for future funding of this project. Progress:Provide indicators that show progress has been made toward the stated goal,and whether this goal will be met within the grant time line.If not,why not? Expenditure of Funds: Report if funds are being expended as planned in the application. Project Changes: Describe any major changes or modifications which that have taken place in the last quarter. Examples are changes in principal staff positions;objectives added,modified or deleted; and location changes. Proposed changes of objectives or budget line items must be submitted for approval on the appropriate forms. Inclusion of changes in the quarterly report is not sufficient for approval. Proposed Changes:Describe any changes that are being proposed to improve the program. SUBMIT TWO FORMS,ONE WITH ORIGINAL SIGNATURES,TO DCJ Quarterly:within 30 days after the closing date of the calendar quarter Final Report: within 45 days after the end of the grant period COLORADO DIVISION OF CRIMINAL JUSTICE(DCJ) Juvenile Accountability Incentive Block Grant(JAIBG)Program DCJ FORM 2JB - SUBGRANT NARRATIVE REPORT-FINAL SUBGRANTEE: GRANT NUMBER: PROJECT TITLE: PROJECT DURATION:FROM: Tao: PREPARED BY: DATE: PHONE:( ) FINAL REPORT. Complete this cover sheet,and then on attached sheets supply the information requested in Questions 1-5 below. Include the Grant Number,type of report,and date in the heading of each page. See instructions in the items below.The Project Director must sign this cover sheet. NOTE: The final report is due 45 days after the end of the grant period. Requests for funds may be denied unless the report i s complete and filed on time to the Division of Criminal Justice. NARRATIVE ITEMS: 1) Project Impact: Include an analysis of each funded project's impact on the problem statement(s)described in the application.Answer the following questions. (1)Was this program effective in addressing the problem(s)as stated in the application?(2)If not,why not? 2) Outcomes: Given how success was defined in your grant application,has this project(s)met with success?In assessing the number and targeted population of youth you intended to serve,did you serve the intended number and population? If not,why not? What changes will you make to your targeted service population if any? 3) Lone-Term Sustainability Plan: If your project has not impacted the intended problem(s)or met with success,do you still plan to continue implementing it? What changes do you plan to make to be more effective? If your project has been successful, what are your plans to diversify your funding base,indications of city/county financial support, anticipated expansions,etc... 4) Publications:List any brochures,pamphlets,fliers,newsletters,etc.that were produced by or for your program using these grant funds. Please attach any that were not previously submitted with quarterly reports. 5) Grants Process: We invite you to provide feedback about improving our application and grant process,including our grant reporting, payments,etc.Please identify any technical assistance we could provide to enhance your program or planning efforts. I,hereby,certify that the content of this form,other than the data entry required,has not been altered. Typed Name and Title of Project Director Signature of Project Director/Date SUBMIT TWO FORMS,ONE WITH ORIGINAL SIGNATURES,TO DCJ (Rev.9/04 2JBFinal.rtf) DETAILED INSTRUCTIONS FOR COMPLETING DCJ FORM 2JB, Subgrant Narrative Report-Final (Final reports must be submitted within 45 days after the end of the grant period. Submit 2 copies, one with original signatures. The purpose of this report is to provide DCJ with sufficient information regarding the overall impact of the project.) Subgrantee: This is the agency to which the federal grant award was made. Grant Number: This is the grant number assigned to the project by DCJ. It can be found on the Statement of Grant Award. Project Title: This is the name of the project which is identified on the Statement of Grant Award. Project Duration: This is the period of the grant award indicated by the beginning and ending dates found on the Statement of Grant Award. It can be changed only if the project requests and receives a grant extension as explained in the Administrative Guide and submits the request on a DCJ Form 4C. Prepared By: This is the name of the person who actually prepared the report. Date: This is the date the form is completed. Phone: This is the phone number of the person who actually prepared the report. Please include the area code. Questions 1-5: Provide the information requested in a narrative format. COLORADO DIVISION OF CRIMINAL JUSTICE DCJ FORM 3, CASH REQUEST (See detailed instructions on the back of this form.) SUBGRANTEE AGENCY: ADDRESS: [State warrant(check)will be sent to address above,noting Grant Number on check stub.] PROJECT TITLE: GRANT NUMBER: PROJECT DURATION: FROM: TO: PREPARED BY: Phone: Fax: SECTION I: CASH NEEDS FOR THIS TIME PERIOD* 1. Projected or Actual Expenditures for* 1. $ (Federal/State funds and Match) (Time Period) 2. Less Cash Match available during this time period 2. $ 3. TOTAL FEDERAL/STATE-AWARDED FUNDS NEEDED DURING THIS TIME PERIOD (Line 1 minus Line 2) 3. $ 0.00 SECTION II: CASH SUMMARY AND REQUEST 4. Total Amount of Federal/State Dollar Award: 4. $ 5. Total Amount of Federal/State Dollars Received to Date: 5. $ 6. Total Amount of Federal/State Dollars Requested, Not Received: 6. $ 7. TOTAL AMOUNT OF THIS REQUEST (#3 above): 7. $ 0.00 8. Totals of Lines 5, 6, &7: 8. $ 0.00 9. Federal/State Award Balance(Line 4 minus Line 8): 9. $ 0.00 I, hereby certify that the content of this form, other than the data entry required, has not been altered. PROJECT DIRECTOR'S SIGNATURE DATE SUBMIT TWO SIGNED FORMS, ONE WITH ORIGINAL SIGNATURE, TO DCJ. I- D-CJ Use Only: [li es; ❑No Required Quarterly Financial and Narrative Reports(DCJ Forms 1-A &2)have been submitted to date. QYes; nNo Reported expenditures justify this cash request amount? Expenses reported through are$ Amount Requested on Line#7 above is nApproved; nApproved as modified to $ ; Q Denied If Request was modified or denied, Reason: Program Specialist, DCJ Date dgf3v1.pdf DCJ Form 3-CASH REQUEST HEADING Subqrantee Agency: This is the agency to which the grant award was made. Address: Enter the agency's address to which the check should be sent. The warrant(State check)for the approved cash request will be sent to the subgrantee agency with the grant number noted on the stub. Project Title: This is the name of the project which is identified on the Statement of Grant Award. Grant Number: This is the grant number assigned to the project by DCJ. It can be found on the Statement of Grant Award. Continuation grants must make sure they enter the current grant number. Duration: This is the period of the grant award, not the time period for which cash is being requested. It can be found on the Statement of Grant Award, and is changed only if the project requests and receives a grant extension. Preparedby: Name of person completing this form. Include this person's phone number. This can be someone other than the project director,but the Project Director must verify the figures by signing at the bottom of the form. SECTION I-Cash Needs for this Time Period: Line 1: Projected or Actual Expenditures: Indicate the time period the cash request covers. For those projects seeking reimbursement of costs already expended, indicate the period (months)for which reimbursement is being sought. For those projects requesting a funding advance, indicate the month for which the advance is being sought. Indicate the actual expenditures(reimbursements)or projected expenditures(advance)of both award and match funds, if applicable,for the time period on line 1. Line 2: Less Cash Match on Hand: Indicate the cash match that the project has currently available for project expenses during the period covered by the cash request. If the project does not require a cash match,this line will be 0. Line 3: Total Cash Needs for Period: Subtract Line 2 from Line 1 and enter the difference on Line 3. SECTION II -Federal/State Award Cash Summary and Request: Line 4: Total Amount of Federal/State Dollar Award: This is the total amount of federal/state dollars awarded to the project. This figure can be found on the Statement of Grant Award. Line 5: Total Amount of Federal/State Dollars Received to Date: Indicate the amount of federal/state dollars the project has actually received to date. Line 6: Total Amount of Federal/State Dollars Requested, not Received: Indicate the amount of federal/state dollars the project has requested from DCJ on a previous cash request but has not yet received. Line 7:Total Amount of this Request: Insert the figure from Line 3 above. Line 8:Totals of Lines 5,6, and 7: Add the amounts on Lines 5,6,and 7 and enter the total on Line 8. Line 9: Federal/State Award Balance: Subtract the amount on Line 8 from the amount on Line 4 and enter the difference on Line 9. This is the amount of federal/state funds remaining for use by the project. REQUIRED SUBGRANTEE SIGNATURE The Project Director must sign and date the original Cash Request. The Financial Officer should review this request to reconcile with actual and anticipated expenditures for the time period indicated in Line 1. The original and one copy must be sent to DCJ. Allow 30 days from the day you mail the request to receive the funds. If the form is not signed by the authorized Project Director, the request will be denied and returned for proper signature. DCJ Use: Quarterly Financial and Narrative Reports are due within 30 days of the end of the calendar quarter. 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V) 6 a U < 0 .7i Z v b 4 = Z o d H c a � � a W > .O e a, € a ;aaa e C4 0 U U.ca Gw a t < 00 'v, a COLORADO DIVISION OF CRIMINAL JUSTICE DCJ Form 4-B: CHANGE IN SIGNING AUTHORITY SUBGRANTEE: GRANT NUMBER: PROJECT TITLE: PROJECT DURATION FROM: TO: PREPARED BY: PHONE: ( ) DATE: A GRANT MODIFICATION IS NOT AUTHORIZED UNTIL IT IS APPROVED IN WRITING BY THE DIVISIQN OF CRIMINAL TUSTICE. For change, submit two forms with original signatures. One approved copy will be returned for your records. See reverse side for full instructions. All other terms and conditions of the original grant with any approved modifications thereto remain in full force and effect. I, hereby certify that the content of this form,other than the data entry required,has not been altered. Change requested by: SUBGRANTEE PROJECT DIRECTOR Signature DATE PROJECT DIRECTOR'S MAILING ADDRESS: THE PURPOSE OF THIS REQUEST IS TO: CHANGE THE PROJECT DIRECTOR _CHANGE THE FINANCIAL OFFICER _CHANGE THE AUTHORIZED OFFICIAL Date Change Effective: From: To: PRINT OR TYPE FULL NAMFJTITLE Agency Name Agency Name Mailing Address Mailing Address I ) I ) Telephone Fax Email Original Signature of new Official(required) Reason for change: "'Division of Criminal Justice Use Only*" THIS REQUEST IS _Approved _Denied,see attached By: PROGRAM SPECIALIST,DCJ DATE Rev.8-04 dcjf4bvl.pdf DETAILED INSTRUCTIONS FOR COMPLETING DCJ Form 4-B-CHANGE TN SIGNING AUTHORITY HEADING Subgrantee: This is the agency to which the grant award was made. Grant Number: This is the grant number assigned to the project by DCJ. It can be found on the Statement of Grant Award. Project Title: This is the name of the project which is identified on the Statement of Grant Award. Duration: This is the period of the grant award. It can be found on the Statement of Grant Award,and is changed only if the project requests and receives a grant extension. Prepared by: Name of person completing this form. Include this person's phone number. Date: This is the date the Change in Signing Authority form is completed. Project Director's Signature and Address: The approved change will be sent to the Project Director at this address. SIGNING AUTHORITY CHANGE Check which signing authority is changing. Submit a separate form for each person changed. Indicate the date the change becomes effective. Supply the name of the person who will no longer hold the position of project director, financial officer,or authorized official. Print or type the name,title,agency,mailing address,telephone and fax number, and email address of the new person. The original signature of the new person is required. Project Director: The project director is the individual who will be in direct charge of the project. This should be a person -who has knowledge and experience in the project area and ability in administration and supervision of personnel. The project director will be expected to devote a major portion of his/her time to the project. Financial Officer: The financial officer is the person who will be responsible for fiscal matters relating to the project and in ultimate charge of accounting,management of funds,verification of expenditures and grant financial reports. This must be an individual other than the project director. Authorized Official: This is the individual authorized to enter into binding commitments on behalf of the applicant agency. This must be an individual other than the Project Director or Financial Officer. In local units of government,this individual will normally be a city manager,district attorney,mayor and/or commissioner. At the state level,this individual will be a department or division head. For private non-profit agencies,this individual will be the Chair of the Board of Directors. Examples of Authorized Officials Follow: If the subgrantee is a: Then the Authorized Official is the:. State Agency Department or Division Director An agency of/or a unit of local govemment: City Mayor or City Manager County Chairperson of the County Commissioners Sheriffs Department Chairperson of the County Commissioners Police Department Mayor or City Manager Courts Chief Judge District Attorney's Office District Attorney or Chair of the County Commissioners Institution of Higher Education President of the institution or chair/dean of the appropriate department Private Non-Profit Agency President/Chairperson of the Board of Directors School District Superintendent/Asst.Superintendent REASON FOR CHANGE: Briefly state why the previous person no longer holds the position with this grant. Send two signed forms,one with original signatures to DCJ. One approved copy will be returned for your records. COLORADO DIVISION OF CRIMINAL JUSTICE DCJ FORM 4-C-CHANGE IN GRANT AWARD PERIOD SUBGRANTEE: GRANT NUMBER: PROJECT TITLE: PROJECT DURATION FROM: TO: PREPARED BY: PHONE: ( ) DATE: A GRANT MODIFICATION IS NOT AUTHORIZED UNTIL IT IS APPROVED IN WRITING BY THE DIVISION OF CRIMINAL JUSTICE. For change,submit two signed forms,one with original signatures. One approved copy will be returned for your records. See reverse side for full instructions. A. Current grant award period: From: To: Requested change of grant award period: From: To: B. Explanation and justification of the need to change: (Continue on plain bond paper as necessary). All other terms and conditions of the original grant with any approved modifications remain in full force and effect. I, hereby, also certify that the content of this form, other than the data entry required,has not been altered. PROJECT DIRECTOR Signature DATE ***Division of Criminal Justice Use Only*** THIS REQUEST IS _Approved _Denied,see attached By: PROGRAM SPECIALIST,DCJ DATE Rev.8/04 DCJ4Cw97.doe DETAILED INSTRUCTIONS FOR COMPLETING DCJ FORM 4-C - CHANGE IN GRANT AWARD PERIOD HEADING Subarantee: This is the agency to which the grant award was made. Grant Number: This is the grant number assigned to the project by DC7. It can be found on the Statement of Grant Award. Proiect Title: This is the name of the project which is identified on the grant application. Duration: This is the period of the grant award. It can be found on the Statement of Grant Award, and is changed only if the project requests and receives a grant extension. Prepared by: Name of person completing this form. Include this person's phone number. Date: This is the date the Modification of Other Grant Agreements form is completed. A. Current Grant Award Period: If this is the first request for a grant period change, indicate the current grant award period which may be found on the Statement of Grant Award. If the subgrantee has previously requested and received a grant period change, indicate the most recently approved grant award period. Requested Chance of Grant Award Period: Indicate your requested grant period change. End dates are usually the end of a calendar quarter. B. Narrative: Include a narrative explaining and justifying the need for a grant period change. *************** Send two signed forms, one with original signatures to DCJ. One approved copy will be returned for your records. Grant extensions are not encouraged or automatic, and are governed by federal and state expiration dates and DCJ discretion. COLORADO DIVISION OF CRIMINAL JUSTICE DCJ FORM 4-D - MODIFICATION OF OTHER GRANT AGREEMENTS SUBGRANTEE: GRANT NUMBER: PROJECT TITLE: PROJECT DURATION: From: To: PREPARED BY: PHONE:( ) DATE: This MODIFICATION OF OTHER GRANT AGREEMENTS form is limited only to addition or deletion ofgoals/ob-jectives or Special Conditions for the above-referenced grant number. Please note that major deviation from the original goals and objectives(scope of work)approved for this project may require issuance of a new Statement of Grant Award. A Grant Modification is not authorized until it is approved in writing by the Division of Criminal Justice. To request approval for change, submit two signed forms, one with original signature. One approved copy will be returned for your records. See reverse side for full instructions. A. The purpose of this request is to: (please mark one selection) ❑ Add,Modify,or Delete Goal(s)and Objective(s) ❑ Add,Modify,or Delete Special Conditions B. Description of modification,including explanation and justification of the need to change: (Continue on plain bond paper as necessary.) All other terms and conditions of the original grant with any approved modifications remain in full force and effect. I, hereby certify that the content of this form,other than the data entry required,has not been altered. PROJECT DIRECTOR Signature DATE ***Division of Criminal Justice Use Only*** This request is: ❑ Approved 0 Denied (see attached) PROGRAM SPECIALIST, DCJ DATE Rev.8/30/2004 DCJ4DW2000.doc DETAILED INSTRUCTIONS FOR COMPLETING DCJ FORM 4-D-MODIFICATION OF OTHER GRANT AGREEMENTS HEADING Suberantee: This is the agency to which the grant award was made. Grant Number: This is the grant number assigned to the project by DCJ. It can be found on the Statement of Grant Award. Project Title: This is the name of the project which is identified on the grant application. Duration: This is the period of the grant award. It can be found on the Statement of Grant Award,and is changed only if the project requests and receives a grant extension. Prepared by: Name of person completing this form. Include this person's phone number. Date: This is the date the Modification of Other Grant Agreements form is completed. A. Requested Modification: Indicate the purpose of the modification by checking the proper line. Normally,subgrantees will only initiate a modification of goals and objectives. DCJ will normally initiate other modifications. B. Modification Description: State whether you are adding,modifying or deleting,and describe fully and justify the modification as specifically as possible. Include the goal and objective number(s) being changed. It is preferred that you write the goaVobjective as it was originally stated and then indicate the change. Attach additional sheets as necessary. Please note that major deviation from the original goals and objectives(scope of work)approved for this project may require issuance of a new Statement of Grant Award(SOGA). Send two signed forms,one with original signature to DCJ. One approved copy will be returned for your records. Rev.8/30/2004 DCJ4DW2000,doc DCJ FORM 16- PROFESSIONAL SERVICES /CONSULTANT CERTIFICATION PROJECT TITLE: PROJECT DURATION: FROM TO PREPARED BY: PHONE: ( ) DATE: This form is used to verify the subgrantee's compliance with federal regulations regarding services provided by outside ve—ndors who are under contract with the project. This form must be completed and forwarded to DCJ prior to subgrantee contract exec-rtion with the proposed vendor. Refer to the DCJ Administrative Guide for Federal Justice Grant Programs for further details. A. Specific services to be contracted are: /Contract Amount$ B. Attach a"Statement of Work"or if a contract is required,please attach a draft. C. Contractor's Name and Address: BY MY SIGNATURE / I CERTIFY THAT(Check all applicable items): PROJECT DIRECTOR Signature / DATE I,hereby,also certify that the content of this form,other than the data entry required, has not been altered. 1. Contractor is not debarred from participation in federal assistance programs to the best of my knowledge. 2. Procurement of services followed an approved method. (Refer to the Administrative Guide, and local procurement policy). Attach a description of the procurement process used to select this contractor. 3. This contract is for the development of software. 4. All expenses for the services will be supported by a valid,signed contract between the project and consultant/service provider and maintained in the project file.A copy must be forwarded to DCJ within 45 days after acceptance of the contractor. The maximum hourly rate of the consultant/service provider does not exceed$450 per 8 hour day($56.23/hr) OR The hourly rate exceeds$56.25/hr and is /hr. Documentation is attached and on file that this compensation rate is reasonable and consistent with that paid for similar services in the marketplace. Documentation must include either prior contract(s)or invoices(2 or 3)between the consultant and other agency(ies)for similar work,if possible,OR comparison with other potential providers of the same or similar work(attach copies). 5. For contracts in excess of$25,000 AND the company has 50 or more employees-The Contractor has an affirmative action plan. If contract is for$500,000 or more,a copy of the company's EEOP must be attached with this request. 6. Dual compensation is not involved(i.e.the consultant is not receiving payment from more than one source for the same work for this project). 7. Contractor/Consultant is not a public employee. 8. Transportation and subsistence costs for travel(if applicable)does not exceed established local travel policies or state travel policy in the absence of local policy. 9. Time and activity records will be maintained in the project file and will be the basis(invoice)for payments to the contractor. *** Division of Criminal Justice Use Only *** Approved Denied,see attached PROGRAM SPECIALIST,DCJ DATE DCJ 16w97.doc(Revised 3/04) DETAILED INSTRUCTIONS FOR COMPLETING DCJ Form 16-PROFESSIONAL SERVICES/CONSULTANT CERTIFICATION HEADING Suberantee: This is the agency to which the grant award was made. Grant Number: This is the grant number assigned to the project by DCJ. It can be found on the Statement of Grant Award. Project Title: This is the name of the project which is identified on the Statement of Grant Award. Duration: This is the period of the grant award. It can be found on the Statement of Grant Award, and is changed only if the project requests and receives a grant extension. Prepared by: Name of person completing this form. Include this person's phone number. Date: This is the date this Professional Services/Consultant Certification form is completed. A. Specific Services to be Contracted: Provide a brief description of the type of service you are contracting and the proposed contract amount. B. Attach a proposed Statement of Work. The Statement of Work must include: 1) Project Objectives, 2) Work Tasks, 3) Work Product/Deliverables,4)Time Line,and 5)Quote/Cost. If your procurement process requires a contract,attach a draft copy. C. Contractor's Name and Address: This is the name and address of the contractor from which the services described in#1 are to be completed. The Project Director should sign this form certifying compliance to the applicable items,based on federal guidelines. Two signed copies, one with original signatures,must be submitted to DCJ. 1-9. Each item that applies to this contract should be marked by an"X". Some items may not apply and should be marked with"N/A".All documentation should be maintained within the subgrantee project file. Please note that some items request additional documentation. A copy of the signed contract,with authorized signatures,should be forwarded to DCJ within 45 days of acceptance of the contractor. DCJ will return a copy of the form, after review,indicating whether the proposed contract is approved. Hello