HomeMy WebLinkAbout20051118.tiff RESOLUTION
RE: APPROVE APPLICATION FOR VICTIM/WITNESS PROGRAM,DOMESTIC VIOLENCE
AND SPECIAL POPULATIONS PROJECT AND AUTHORIZE CHAIR TO SIGN
WHEREAS,the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS,the Board has been presented with an Application for Victim/Witness Program,
Domestic Violence and Special Populations Project from the County of Weld,State of Colorado, by
and through the Board of County Commissioners of Weld County, on behalf of the 19th Judicial
District Attorney's Office, to the Division of Criminal Justice, with terms and conditions being as
stated in said application, and
WHEREAS,after review,the Board deems it advisable to approve said application,a copy
of which is attached hereto and incorporated herein by reference.
NOW,THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County,Colorado,that an Application for Victim/Witness Program,Domestic Violence and Special
Populations Project from the County of Weld,State of Colorado,by and through the Board of County
Commissioners of Weld County, on behalf of the 19th Judicial District Attorney's Office, to the
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 application.
The above and foregoing Resolution was,on motion duly made and seconded,adopted by
the following vote on the 4th day of April, A.D., 2005.
BOARD OF COUNTY COMMISSIONERS
, �� WELD COUNTY, COLORADO
G" ,
,1861 f.-3 EXCUSED
William H. J e, Chair
C.
' • n�� lerk to the Board(DUNI ' f �
M. J. Geile, Pro-Tem
Deputy Clerk to the Board EXCUSED
D 'd E. Lon
OV AS TO
Robert . Mas e
oun y Attorney
Glenn Vaad
Date of signature: #:�`/6�3-
2005-1118
DA0020
(0 ,' all d3f-,.a8-nom
OFFICE FOR VICTIMS PROGRAMS
2005 VOCA ASSISTANCE FUNDS
APPLICATION
Grant Period (January 1 , 2006 — December 31 , 2007)
VOCA Applications must be received at DCJ
700 Kipling Street, Suite 1000, Denver, CO 80215
no later than 3:00 pm on April 8, 2005
Late Applications will not be accepted.
Please read the Announcement of Funds &
Instructions before completing this document.
Colorado Department of Public Safety
(DY I.C9Zn Division of Criminal Justice
9, � OFFICE FOR VICTIMS PROGRAMS
en c=c) C}
4.10 %/ For Information and Questions Contact:
Pat Glick, VOCA Administrative Assistant
/876 Office: (303) 239-5719
Fax: (303) 239-5743
Email: pat.glick@cdps.state.co.us
Toll Free (outside Denver/Metro area):
1-888-282-1080
Website: http://dcj.state.co.us/ovp
aov5-//1P
A complete application includes all of the following items. Please use this form to double check that you have
provided a complete application to DCJ. Send 4 copies of the application, at least two of which have
original signatures in BLUE ink.
)( SECTION A: Agency Information(Questions 1,2,3,4)
SECTION B: Project Narrative
5. Brief Project Title
6. Brief Project Summary
7. Description of Project for Which Funds are being Requested
u( SECTION C: Goals and Objectives
X" 8. Common Goal and Objectives for this Project
-.C 9. Project Specific Goals and Objectives
X SECTION D: Budget Information
10. Project Funds Requested Budget
11. Matching Funds Budget
12. Grant Budget Summary
13. Budget Detail and Justification
14. Total Agency Victim Services Funding That Your Program is Currently
Receiving
15. Diversification of Funding
k SECTION E: Continuation Applicants Progress History
16. Summary of Progress
SECTION F: Support,Coordination and Networking
17. Community Support,Coordination and Networking
SECTION G: Victim Information and Assistance
18. Cultural Competency Plan
19. Victims Rights Act
rr11�� 20. Victim Compensation
SECTION H: Evaluation
21. Evaluation
x SECTION I: Financial Management
22. Financial Management
SECTION.1: Supplemental Pages for New Applicants Only
23. Agency Information and Statement of Need
24. Workplan for Achieving Goals and Objectives
APPLICATION ATTACHMENTS
Certifications and Signatures
Special Provisions and Certified Assurances
Signature Page(Blue Ink)
Certification of Match
Appendices
Letters of Support
Victims Rights Act brochure,if applicable
Organisational Chart,with requested personnel highlighted
Direct Services Job Descriptions, including qualifications, education,
experience training and responsibilities
Direct Services Volunteer Job Descriptions
Board Members(private non-profits)
Proof of non-profit status(501 (c)3)(new applicants only)
Audit or Financial Review(one copy only)
Required Memoranda of Understanding(MOU), if applicable
Subgrant Award Report/Application Information(pink sheet)
Please remember to send one copy of your completed application to your Local.VALE Board by April 8,2005.
SECTION A: AGENCY INFORMATION
Please do NOT change Ponta of table or applieaoion
1. APPLICANT AGENCY: District Attorney's Office, 19th Judicial District DCJ USE ONLY
Program Name: Victim Witness Assistant Unit App# 25-VA- - (CY 2006)
Mailing Address: PO Box 1167 Grant#
Street Address: 915 Tenth Street Award $
City/Town: Greeley Zip Code: 80632
County: Weld Judicial District: 19th New Applicant Agency
Phone#: (970)356-4010 I Fax#: (970)352-8023 Continuation Applicant Agency
E-Mail Address: jholden@co.weld.co.us
Federal Employer Identification Number(FEIN): 84-6000813
2. CONTACT PERSON: Jo Ann Holden Position: Community Programs Administrator
Phone#: (970)356-4010 Fax# : (970)352-8023 E-Mail: jholden@co.weld.co.us
3. FUNDS REQUESTED: $32,924
4. APPLYING FOR: ® VOCA
SECTION B: PROJECT NARRATIVE
5. BRIEF PROJECT TITLE: Domestic Violence & Special Populations Project
6. BRIEF PROJECT SUMMARY:
The Victim Witness Assistance Program is a prosecution-based project, serving all of Weld County providing direct services to adult
and child victims of domestic violence,victims of child sexual abuse, adult sexual assault victims, and underseved victim populations
including elderly victims, Spanish-speaking victims,and at-risk adult victims.
The Domestic Violence Fast Track Program in the District Attorney's Office provides next day contact with victims, referrals,
Victims' Rights and Criminal Justice System information. This type of contact is crucial when working with domestic violence
victims to effectively address their needs and to achieve ultimate success in prosecuting.
7. DESCRIPTION OF PROJECT FOR WHICH FUNDS ARE BEING REQUESTED:
The Victim Witness Assistance Program in the l9'h Judicial District Attorney's Office, is the only prosecution-based program serving
victims and witnesses of crime in Weld County. The VOCA project enables the Program to provide enhanced services to cime
victims of domestic violence and victims in other special propulations such as elderly victims, Spanish-speaking victims, and at-risk
adult victims. VOCA partially funds the salaries and benefits for three Victim Witness Assistance Unit Staff who provide direct and
ongoing services to victims.
Victim Witness Staff work with domestic violence victims from initial contact for"meaningful consulation" to court support at
hearings and trials. Victims are kept well-informed and supported regarding their rights under the Victim Rights Amendment,Victim
Compensation, as well as being given appropriate referrals and resources. Victim Witness Staff is also available to facilitate
communication with Spanish-speaking victims with prosecutors or the court. The Program insures prompt assistance and service
referrals to victims,as well as enables prosecutors to quickly and efficiently assess a case to potentially attain a swift resolution.
Training will be available to law enforcement training with emphasis on primary aggressor, investigative techniques and victim
dynamics.
The comprehensive services provided by the Victim Witness Assistance Program are: crisis counseling, follow-up contacts,criminal
justice education and advocacy,personal support, information and referral, emergency financial assistance, Crime Victim
Compensation information,HIV notices and education,Victim Rights Amendment notices,helping victims with Victim Impact
Statements and Restitution Information and supporting victims when they come to court to invoke their rights or when subpoenaed.
2005 VOCA Application
Page 1 of 16
SECTION C: GOALS AND OBJECTIVES
Please do NOT change format of table or a r r/ication.
8. COMMON GOAL AND OBJECTIVES FOR THIS PROJECT: (Important: See instructions first)
Record the percent of victims served by VOCA funds plus matching dollars: (select one option only)
❑ Option 1: I am reporting the number of victims and services provided served with only VOCA funds and matching funds.
OR
® Option 2: I am reporting the total number of victims served by the a ency's entire victims assistance program. The VOCA
grant plus matching funds represent approximately I 9 % of the agency's total victim assistance budget.
COMMON GOAL 1: This project will provide direct services that assist crime victims with emotional and physical needs to
stabilize their lives,provide for a measure of safety and security and/or enhance victims'experience with the criminal justice
system.
♦ Common Objective 1: Provide services to the following unduplicated number of crime victims during the firstl2-month
grant period.
Count each victim ONLY ONCE,by predominant type of crime.Please see definition of victim and unduplicated count in the instructions.
VICTIMS TYPE OF CRIME VICTIMS TYPE OF CRIME(continued)
200 Child Physical Abuse 800 Assault
300 Child Sexual Abuse 0 Adults Molested as Children
1,400 Domestic Violence 50 Elder Abuse(including Economic exploitation
and fraud crimes)
50 Adult Sexual Assault 80 Robbery
1,000 Other violent crimes such as hate and bias
530 Victims of vehicular assault or homicide, DUI/DWI crime, gang violence, crimes against seniors
crashes,or careless driving resulting in death. (Be specific): burglary,menacing,theft
100 Survivors of Homicide Victims
TOTAL UNDUPLICATED VICTIMS ESTIMATED TO BE SERVED DURING THE 12-MONTH PERIOD: 4,510
• Common Obiective 2: Provide the following types of services to the following estimated number of victims:
Count each victim ONLY ONCE for each applicable service,regardless of the number of times a type of service is provided to the victim.
No number listed in any category of`Common Objective 2'should be greater than the total number of victims reported in`Common
Objective 1'.
VICTIMS SERVICES VICTIMS SERVICES(continued)
900 Crisis Counseling(in person) 40 Emergency Financial Assistance
3,000 Follow-up 0 Emergency Legal Advocacy
0 Therapy 3,000 Victim Compensation Assistance(required)
0 Group Treatment/Support 200 Personal Advocacy
0 Shelter/Safehouse 3,000 Telephone Contact
900 Info/Referral(in person) 1,500 Other(Be Specific):
additional letters
2,500 Criminal Justice Support/Advocacy
2005 VOCA Application
Page 2 of 16
9. PROJECT SPECIFIC GOALS AND OBJECTIVES: Please do not include more than three additional goals with
objectives. All goals and objectives must fit on this page. See instructions for more information.
PROJECT SPECIFIC GOAL 2: To provide direct assistance to victims of domestic violence(in cases where the defendants
are prosecuted by the 19th JD District Attorney's Office)by reinforcing safety planning,offering information on counseling,
Victim's Compensation,community referrals,Victims' Rights and Criminal Justice System information
Objective 2 A: By December 31,2007,the Victim Witness Assistance Program will provide services to 1400 primary victims
of domestic violence.
Objective 2 B: By December 31,2007,the Misdeameanor Domestic Violence Fast Track Program will provide intial
"meaningful consultation" to 90% of victims within 24 hours of the criminal episode which will result in a 50%disposition
rate at the defendant's initial hearing.
Goal 3: Review domestic violence co-defendant and female statistics to determine if training would be beneficial to law
enforcement and deputy district attorneys.
Objective 3 A. Quarterly,compile statistics of co-defendant and female defendant domestic violence cases.
Objective 3 B. By December 31,2007,create a DA Office review process of these cases to enhance prosecution knowledge.
Objecctive 3 C: By December 31, 2007,provide training,if requested,to law enforcement officers on predominant
aggressor,domestic violence investigations,and victim dynamics.
Goal 4:—To provide services to victims and their families in criminal cases of child abuse,child sexual abuse,adult sexual
assault,elderly victims,at-risk adult victims and Spanish-speaking victims with information and support regarding the
Victim Rights Amendment,Criminal Justice System,Victim Compensation,Victim Impact and Restitution Statements and
court support.
Objective 4 A. By December 31,2007,the Victim Witness Assistance Program will provide 10,000 Victim Rights Letters to
these victims which will include information regarding the Criminal Justice System and Victim Compensation.
Objective 4 B. By December 31,2007,the Victim Witness Assistance Program will provide Victim Impact and Restitution
Statements to 4510 victims.
Objective 4 C. By December 31,2007,the Victim Witness Assistance Program will provide court support to 1000 victims
including domestic violence victims.
Objective 4 D. By December 31,2007,the Victim Witness Assistance Program provide Goal 4 services to 350 Spanish-
speaking victims including domestic violence victims.
2005 VOCA Application
Page 3 of 16
SECTION I): BUDGET INFORMATION
Please do NOT change formal of table or a licalion.
10. PROJECT FUNDS REQUESTED BUDGET:
Continuation Applicants fill out Columns 1,2 and 3. DCJ Use Only: Application# -VA- -
New Applicants fill out Column 2 only. PP
Continuation
Continuation Applicants ALL APPLICANTS
Applicants
(Column 1) (Column 2) (Column 3)
Current Grant Award REQUESTED BUDGET Increase or
Decrease
PERSONNEL PERSONNEL (+ / -)
Employee/Job Position (FTE) Employee/Job Position (Full Time Equivalent)
Patch Comm Sery Coun II .19 $7,001 Patch, Com Sery Coun II .21 FTE $7,354 $353
Blakely,Com Sery Tech .39 $10,628 Owens, Corn. Sery Tech .43 FTE $11,160 $532
Soltes, Corn Sery Tech .37 $4,831 Lopez,Com Sery Tech .40 FTE $9,844 $459
Gailitis, Corn Sery Tech .35 $4,554 $0 $
$0 $0 $0
$0 $0 $0
$0 $0 $0
$0 $0 $0
$0 $0 $0
Fringe Benefits $4,348 Fringe Benefits $4,566_ $218
Subtotal I $31,362 Subtotal $ I $32,924 $1,562
SUPPLIES AND OPERATING SUPPLIES AND OPERATING EXPENSES(copying, rent, (+/ )
EXPENSES phone,tuition, registration fees and other items under$5,000)
$0 $0 $0
$0 $0 $0
$0 $0 $0
$0 $0 $0
$0 $0 $0
Subtotal I $0 Subtotal I $0 $0
IN-STATE TRAVEL IN-STATE TRAVEL(itemize transportation/per diem,etc.) (+/ -)
$0 $0 $0
$0 $0 $0
$0 $0 $0
Subtotal I $0 Subtotal $0 $0
EQUIPMENT EQUIPMENT(items that cost over$5,000 each) (+/ -)
$0 $0 $0
Subtotal I $0 Subtotal I $0 $0
PROFESSIONAL SERVICES PROFESSIONAL SERVICES (+/ -)
$0 $0 $0
$0 $0 $0
Subtotal I $0 Subtotal I $0 $0
TOTAL FUNDS: $31,362 TOTAL FUNDS REQUESTED: $32,924 $1,562
2005 VOCA Application
Page 4 of 16
11. MATCHING FUNDS BUDGET: List the total matching funds. ALL VOCA PROJECTS MUST PROVIDE MATCH. See
instructions for more details.
PERSONNEL(Employees/Volunteers of the applicant agency)
EmployeeNolunteer/Job Position(Full Time Equivalent)
Patch $2,134
Owens $3,240
Lopez $2,857
Fringe Benefits $0
Subtotal $8,231
SUPPLIES AND OPERATING EXPENSES(copying,rent,phone,tuition,registration fees and other items under$5,000)
$0
$0
Subtotal $0
OTHER: In-State Travel,Equipment and/or Professional Services(specify)
$0
$0
Subtotal $0
TOTAL MATCHING FUNDS: $0
SOURCE OF MATCH: non-federal governmental funds I IN-KIND: $0 I CASH: $8,231
12. GRANT BUDGET SUMMARY: This chart summarizes all dollars by category. All applicants should fill out pertinent
sections. If your project does not have matching funds, leave match columns blank.
BUDGET CATEGORIES Funding Request In-Kind Match Cash Match TOTALS
Personnel $32,924 $0 $8,231 $41,155
Supplies& Operating $0 $0 $0 $0
Travel $0 $0 $0 $0
Equipment $0 $0 $0 $0
Professional Services $0 $0 $0 $0
TOTALS $32,924 $0 $8,231 $41,1550
Funds Requested Match Total Total Project Cost
(In-Kind Match+Cash Match)
$32,924 $8,231 $41,155
2005 VOCA Application
Page 5 of 16
13. BUDGET DETAIL AND JUSTIFICATION: (Do not exceed the two pages allowed for this budget narrative.) Please
provide the following information for each budget category:
A. PERSONNEL REQUEST AND MATCH:
1) Please explain how you arrived at the cost of the salaries and benefits you are requesting.
As recommended by Weld County's Personnel Services, the salary and benefit costs for all positions are established by the Board
of County Commissioners. The County Commmissioners award a cost-of-livng raises and step-increases. These increases are
estimated at 5%. The VOCA Grant request reflects a 5%funding increase for salaries and benefits for a total increase of$1,562.
2) Please provide the following ADDITIONAL information on the positions for which you are requesting funding.
Employee/Job Position Requested #of hours #of hours FTE If THIS grant funding If THIS grant funding
per week per week will not pay for the will not pay for the entire
requested this entire position, what is position,what is the
for THIS position the SOURCE of other AMOUNT of other funds
grant works in funds that will be used that will be used to pay
period(12 total. to pay for the rest of for the rest of this
months) this position? position?
Patch 8.40 40.00 1.00 grants,admin,gov 42,722
Owens 17.20 40.00 1.00 grants, admin, gov 24,878
Lopez 16.00 40.00 1.00 grants, admin, gov 24,193
0.00 0.00 0.00 0
0.00 0.00 0.00 0
0.00 0.00 0.00 0
3) Using concrete data,fully explain and justify any increase in dollars for each position(s)requested. See instructions
for more detail.
These positions are based on Weld County's Personnel Departments salary and fringe benefits scale. The increase in salary and
fringe for 2006 of$1,562 is an estimated projection of 5%based on previous years increases in salary and fringes.The Victim
Witness Unit is currently relying on excess VALE and Victim Compensation Administrative Funds accured in previous years, to
meet current costs in running the Victim Witness Assistance Program.
Karol Patch has been with the Victim Witness Assistance Unit for over 6 years bringing knowledge and expertise to this project.
Owns brings extensive knowledge regarding the Criminal Justice System and Victims'Rights Amendment. Lopez brings her
abilities as a bilingual Victim Witness Assistant with extensive knowledge in Victim's Compensation and Restitution.
2005 VOCA Application
Page 6 of 16
13. BUDGET DETAIL AND JUSTIFICATION(CONTINUED)
B. SUPPLIES AND OPERATING REQUEST AND MATCH: Please see instructions,and fully explain and justify the need
for the current request and for any increase over last year. Include and identify any supplies and operating used as
cash or in-kind match.
N/A
•
C. IN-STATE TRAVEL REQUEST AND MATCH: Please see instructions,and fully explain and justify the need for the
current request and for any increase over last year. Include and identify any travel items used as cash or in-kind match.
N/A
D. EQUIPMENT REQUEST AND MATCH: Please see instructions, and fully explain and justify the need for the current
request. Generally,funding of equipment is minimal. Include any equipment used as cash or in-kind match,.
N/A
E. PROFESSIONAL SERVICES REQUEST AND MATCH: Please see instructions,and fully explain and justify the need
for the current request. Include and identify any professional services used as cash or in-kind match. Please note that
professional services expenditures require prior approval by DCJ(Form 16).
N/A
F. DIFFERENCES FROM LAST YEAR'S REQUEST(Continuation Subgrantees only): Please briefly summarize the
reasons for the differences between this request and your current grant award.
The only difference between 2005 VOCA Grant Request and 2006 VOCA Grant Request is a 5%increase for salary and benefits for
staff involved in the project. Although the 2006 Goals and Objectives have been revised to emphasize the Domestic Violence and
Special Population Project rather than the overall services provided by the entire VW Unit as were indicated in the 2005 grant. The
services provided contain no tremendous differences from the VOCA Grant Project currently being funded.
2005 VOCA Application
Page 7 of 16
14. TOTAL AGENCY VICTIM SERVICES FUNDING THAT YOUR PROGRAM IS CURRENTLY
RECEIVING:
FUNDING START DATE END DATE
AMOUNT
FEDERAL FUNDS: Month / Day / Year Month / Day / Year
VAWA funds: MI $9,000
'!'E 4 / 1 / 05 , 3 / 31 / 06
rdp
VOCA funds: " $31,352 _`_i' 1 / 12 / 05 "( 12 / 31 / 05
FVPSA(ACT)funds: $0 '" / / / /
:p is I Pall
'PM gi
tillii
Other US Dept. of Justice funds such as Byrne
Yei $0 / / / /
(DCSIP),Juvenile Justice,COPS,etc. �{� IF 'ii
'ol Ti
Sex Assault Prevention funds: illii $0 ii;
/ / / /
11 h
Other Federal funds: ; $0 .i,. / / ii Ei / /
STATE FUNDS:
State VALE funds: r?!, $0 j
nt
State DAAP funds: f4P21 $0 / / IliPl / /
Other State funds(e.g. general fund) i) $0 011 / / fig / /
LOCAL GOVERNMENT FUNDS:
Local VALE funds: Judicial District 19 3, $72135 7 / 1 / 04 ii 6 / 30 / 05
Judicial District: �,r) $0 r / /05 / /
Judicial District i $0 paP / / IIRliD / /
Judicial District: ;;ri; $0 qi; / / .'e / /
Local Government funds: $97693 '° 1 / 1 / 05 Fi 12 / 31 / 5
v v( $0 / / all / /
PRIVATE OR OTHER FUNDS:
Private funds: fEi $0 Milli,,: / / oli / /
jul
Other funds:
15. DIVERSIFICATION OF FUNDING: Address diversity of funding. See instructions.
The Victim Witness Assistance Program in the Weld County District Attorney's Office utilizes grant funding from Local VALE,
VOCA and VAWA,Administrative Funds from VALE and Victim Compensation and County funding. The VW Unit has increased
its efforts in obtaining volunteer school interns to add more working hours to the many duties the Unit is responsible for completing.
Additional funding sources continue to be sought.
2005 VOCA Application
Page 8 of 16
SECTION E: CONTINLArION APPLICANTS PROGRESS HISTORI"
• Continuation A licants Only •
16. SUMMARY OF PROGRESS: In the grid below,briefly document the progress made in meeting projected goals and
objectives for the previous grant project. Note specific services that were provided. Space below the grid has been provided for
explanations of unmet goals and to record outcomes that were not measurable in a way that fits the reporting grid. (Ideally all
goals and objective would fit in the grid.)
A. Common Goal 1: ,Objective 1)
Est.# Actual# TYPE OF CRIME Est.# Actual# TYPE OF CRIME
Victims Victims Victims Victims
150 333 Child Physical Abuse 750 887 Assault
450 336 Child Sexual Abuse 0 0 Adults Molested as Children
2250 1697 Domestic Violence 2 7 Elder Abuse
75 85 Adult Sexual Assault 100 80 Robbery
Victims of vehicular assault or homicide, Other violent crimes(specify):
1000 386 DUI/DWI or careless driving resulting in 1000 2188
injury/death.
50 142 Survivors of Homicide Victims 5827 6141 TOTAL CRIME VICTIMS
B. Common Goal 1: (Objective 2)
Est.# Actual# SERVICES Est.# Actual# SERVICES
Victims Victims Victims Victims
900 911 Crisis Counseling(in person) 20 36 Emergency Financial Assistance
3000 3408 Follow-up 0 0 Emergency Legal Advocacy
0 0 Therapy 5000 4457 Victim Compensation Assistance
0 0 Group Treatment/Support 20 191 Personal Advocacy
0 0 Shelter/Safehouse 2250 3583 Telephone Contact
900 908 Info/Referral(in person) 1500 2990 Other(Be Specific):
2500 2533 Criminal Justice Support/Advocacy 16,090 19,017 TOTAL SERVICES
C. Project Specific Objectives:
Estimated#for Service Provided* Actual#Achieved
each Objective (Outcome)
20,000 staffed waiting area,trial coordination, case-satus info, court support 35,276
400 help victims apply for Victim Compensation 426
20 help victims receive emergency financial assistance 36
15 provide HIV education and notification 2
65 contact 65 elderly victims providing comprehensive services 67
13,000 provide Victim Rights Amendment notices to victms 18,630
D. Unmet Outcomes: If outcomes did not meet projections, explain here: * The Objective regarding providing HIV education
and notification to 15 victims was not met because the original number indicated was based on incorrect information as to which
defendants would be ordered to undergo HIV testing, the consequence being less victims who needed to be notified.
E. Objectives Not Fitting Grid Format: For objectives that do not fit in the grid above,report their progress here. Ideally, all
objectives should be measurable in a manner that fit the grid format in item B. * Additional grid objectives:
15 trainings to law enforcement and victim services agencies 24 completed
2000 provide information to Victim Rights Victims and Careless Driving with Injuries 3126 victims
Other: Provide staff support&participate in coordinating groups-Done outlines on-going coordination efforts.
*Additional pages may be attached to your APPENDIX if needed.
2005 VOCA Application
Page 9 of 16
SECTION F: SUPPORT,COORDINATION AND NETWORKING
Please do NOT change pinta(of table or application.
17. COMMUNITY SUPPORT,COORDINATION AND NETWORKING:
A. LETTERS OF SUPPORT: List the agency names and persons that provided the three letters of support in your appendix.
AGENCY PERSON/POSITION DCJ USE ONLY
Sexual Assault Survisor's Inc Anpeytu Raben\Director
South Weld Victim Services Patti Vissat\Director
A Woman's Place Ellen Szabo\Director
B. MEMORANDUMS OF UNDERSTANDING OR AGREEMENT: List the agencies with which you have active
memorandums of understanding(MOUs)or agreement regarding coordination and provision of services. Attach the MOUs in
the appendix.
A Kid's Place/CARE Child Advocacy Resource Center Weld County Legal Services/Envision
A Women's Place/Adult Sexual Assault Program UNC
Partners/South Weld Victim Services/Catholic Charities
Greeley Police Department/Colorado Legal Services THE AGENCIES LISTED AS WELL AS THE DISTRICT
Sexual Assault Survivor's Inc/Area on Aging ATTORNEY'S OFFICE VICTIM WITNESS UNIT HAS
19th JD Probation Victim Services/Weld County Sheriffs Office A COODINATION AGREEMENT (SEE ATTACHED)
C. REFERRALS MADE TO YOUR PROGRAM.
1. South Weld County Victim Services Program
2. Greeley Police Department,Victim Services Program
3. A Woman's Place, Inc.
4. Sexual Assault Survivor's Inc.
5. A Kid's Place/CASA of Weld County
6. North Colorado Medical Center
7. Weld County Department of Social Services
8. 19`s Judicial District Courts
9. 19`h Judicial Districe Probation Deaprtment Victim Services
10. Envision
D. REFERRALS YOU MAKE TO OTHER PROGRAMS.
1. A Woman's Place, Inc.
2. Catholic Charities,Northen
3. Child Advocacy Resource &Education(CARE)
4. Colorado Legal Services
5. 19`"Judicial District Probation Department,Victim Services Program
6. Sexual Assault Survivors,Inc.
7. Weld County Department of Social Services
8. North Range Behavioral Health Center
9. Greeley Police Department
10. South Weld Victim Services Program
•
2005 VOCA Application
Page 10 of 16
SECTION C: VICTIM INFORMATION AND ASSISTANCE
('lease do NOT change forma'of fable or application.
18. CULTURAL COMPETENCY PLAN: See instructions for additional information.
Latinos/Hispanics are a statistically significant minority in the 19th Judicial District at 27%of the population. To assure
sensitivity and relevancy in addressing the needs of Spanish speaking victims,the Victim Witness Unit has a fulltime Spanish
bilingual Victim Witness Assistant. Victim Witness Unit Staff are encouraged to take conversational Spanish classes offered by
Weld County so all staff can at least communicate minimally until the Spanish bilingual Victim Witness Assistant is available.
Positions open in the Unit give a hiring preference to Spanish bilingual applicants. The Victim Rights Amendment Brochure,
Victim Compensation information and other key letters have been translated into Spanish. The Victim Witness Unit seeks to
maintain cultural competency by actively participating in various community groups,education that is relevant to cultural
sensitivity and to proactively be involved in community efforts to assess and address issues and needs related to cultural
competency.
19. VICTIMS RIGHTS ACT: (See instructions for additional information.)
A. Training: What training does your agency provide to direct services staff and volunteers about giving information to
victims on their rights under the Colorado Constitution?
The previous supervisor of the Victim Witness Assistance Unit provided Victim Rights Act training to all new staff and volunteers
including requiring them to read copies of the Victim Rights Brochure and VRA statutes. New staff members received VRA-
specific training from a knowledgeable staff person and were strongly encourage to attend relevant state training when it is offered.
Jo Ann Holden,Victim Witness Coordinator, will be conducting specific Victim Rights Training to the Victim Witness Assistance
Staff in May 2005.
B. Date of the last training: continual Provided by: Gary Rathke
C. Does your agency have a statutory mandate to notify victims of their rights under the Victim ® Yes ❑ No
Rights Act?
D. If applicable,how do you notify victims of their rights under the Victims Rights Act?
The Victim Witness Unit provides written or phone notifications to all victims designated in the Victim Rights Amendment prior to
each of the critical stages of the court system. Initial notices include VRA Brochures, Victim Compensation information and
community resource information.
E. If you answered 'yes' above,how do you document that such notification has been given?
Documentation of all VRA notifications is maintained on the outside of the DA case file and in the database of DA's Office
including a screen for tracking BRA notices.
F. List the approximate number of Victims Rights Act notifications made by 2O000
your agency each year:
G. Does your agency have a Victims Rights brochure that is distributed to victims? ® Yes * ❑ No
*If yes,please attach one copy in the appendix of the grant application.
H. In what languages are your Victims Rights Act brochures available?
English and Spanish
2005 VOCA Application
Page I I of 16
20. VICTIM COMPENSATION: (See instructions for more information.)
A. How does your agency regularly inform victims about the Victim Compensation program and assist them in applying
when appropriate?
The Victim Witness Assistance Program provides information to victims concerning Crime Victim Compensation by distributing
Victim Compensation Brochures(English and Spanish)and application forms,referring to Victim Compensation in VRA
Brochures,providing Victim Compensation Training at law enforcement departments, victim service agencies and other local
groups,and explaining and helping victims to complete application forms.
B. Are there any major issues that hinder your victim assistance program in helping crime victims apply for Victim
Compensation benefits and understanding eligibility requirements?
None
C. Are any of the services provided by your agency eligible for Victim Compensation ❑ Yes ® No
reimbursement? List services:
N/A
IX Please describe how your agency tracks funds and services to ensure that it is not using VOCA funds to provide services
which could be or have been paid for by Victim Compensation.
N/A
E. Does your agency regularly conduct/receive Victim Compensation training for direct services staff or volunteers?
Z Yes ❑ No Date of last training: continual Training provided by: Gary Rathke,Karol Patch
2005 VOCA Application
Page 12 of 16
SECTION H: EVALUATION
Please do NOT change formal of table or a dicalivnl.
21. EVALUATION: Describe how you will evaluate the efficiency and effectiveness of this project.(Please see
instructions.)
A. Efficiency:
The Victim Witness Assistance Program will utilize both efficiency and effectiveness measures in
evaluation by gathering and compiling statistical data for grant reporting on a quarterly basis.
During 2006,did the Victim Witness Assistance Program provide:
1. services to 1400 primary victims of domestic violence?
2. intial "meaningful consultation"to 90%of misdemeanor domestic violence victims within 24 hours of the criminal episode
which should result in a 50%disposition rate at the defendant's initial hearing?
3. statistics of co-defendant and female defendant domestic violence cases?
4. 10,000 Victim Rights Letters to victims of domestic violence, child abuse, child sexual abuse,adult sexual assault, elderly
victims, at-risk adult victims and Spanish-speaking victims?
5. Victim Impact and Restitution Statements to 4510 victims?
6. court support to 1000 victims including domestic violence victims?
B. Effectiveness:
1. Did training with Law Enforcement Agenices on predominate aggressor, domestic violence investigations and victim dynamics
coorespond with reduction of co-defendant cases and female defendant cases?
2. Were victim surveys reviewed for feedback in the following areas:
a. Did victims feel their contact with the court system was positive under the circumstances?What could have been done better?
b. Did victims feel that Victim Witness Unit Staff was accessible by phone?
c. Did victims feel that what would happen at court hearings was explained adequately to them?
2005 VOCA Application
Page 13 of 16
SECTION I: FINANCIAL. MANAGEMENT
Please du NUT change lorumt()liable or application.
22. FINANCIAL MANAGEMENT: Please answer the following questions.
A. Please provide the date of your last independent audit or financial review: 12-31-03
Include one copy of your most recent audit or financial review,including any management report or other auditor
comments,in the appendix.
B. Does your agency expend over$500,000 from combined federal sources in a year? ❑ Yes Z No
C. Please respond to the following questions about whether your accounting system meets the criteria for managing
federal/state 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 are not a substitute for the agency's
responsibility to meet all federal and state requirements for these grant funds.)
® Yes ❑ No Does your accounting system separate ALL revenues and expenditures by funding source?
Z Yes ❑ No Does your system track revenues and expenditures for each grant award separately through a
sub-ledger system?
® Yes 0 No Does your system allow expenditures to be classified by the broad budget categories listed in the
approved budget in your grant, i.e.Personnel, Supplies and Operating,Travel, Equipment and
Professional Services?
® Yes ❑ No Do you reconcile sub-ledgers to your general ledger at least monthly?
® Yes ❑ No Do you mark your invoices that are paid with grant funds and indicate the grant number?
® Yes 0 No Do you maintain time sheets, signed by the employee and supervisor for each employee paid by
DCJ grant funds?
® Yes 0 No ❑ N/A If your grant requires a match,does your accounting system clearly identify the funds and
amount used as cash match?
❑ Yes ❑ No ® N/A If your grant requires a match and you are using in-kind match such as volunteer hours,have you
clearly documented how you are keeping track of the match that you are reporting on your
quarterly financial I-A report?
O Yes ❑ No Do you have written financial policies and procedures in place?
® Yes ❑ No Do you have internal accounting controls in place, such as separation of duties,two signatures on
certain checks,reconciliations or other reviews?
For Continuation Applicants only.
® Yes 0 No Do you use your accounting system data to prepare your quarterly financial reports for DCJ?
® Yes ❑ No Do you reconcile your accounting system data with your quarterly financial reports for DCJ?
D. If you answered NO to any of the questions above,please provide an explanation.
2005 VOCA Application
Page 14 of 16
SECTION J: StPPI.ENIEN IAL PACES FOR NEW APPLICANTS ONLY
Pleuse do NOT change lormut o/table or application.
23. AGENCY INFORMATION AND STATEMENT OF NEED:
A. TYPE OF PROJECT(choose one):
❑ Start a new victim services project.
❑ Expand or enhance an existing project not funded by VOCA funds in a previous year.
B. AGENCY DESCRIPTION AND HISTORY:
C. STATEMENT OF NEED FOR THE PROPOSED PROJECT:
2005 VOCA Application
Page 15 of 16
SECTION J - Continued +
NEW APPLICANTS ONLY
Please do NOT c'lunge loirInat al tab/c or application
24. WORKPLAN FOR ACHIEVING GOALS AND OBJECTIVES: (See instructions.)
2005 VOCA Application
Page 16 of 16
SPECIAL PROVISIONS AND CERTIFIED ASSURANCES SPCA PAGE 1 of 11
Special Provisions&Codified Assurances must remain attached to the application
CHECK BELOW TO INDICATE WHICH CATEGORY BEST DESCRIBES YOUR AGENCY:
fg Inter-Governmental Grant
f l Grant to a Colorado State Agency
Grant to a Unit of Local Government,Tribal Government,or Special District.
n 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 THIS GRANT PROGRAM•
Victims Of Crime Act Assistance Funds (VOCA). From the United States Department of Justice, Office of
Justice Programs, under federal statutory authority Victims of Crime Act of 1984(VOCA), as amended, Public
Law 98473, Chapter XIV, 42 U.S.C. 10601,et seq., Section 1402, Section 1404, and under applicable program
rules and regulations established by the federal program office.
A. STANDARD STATE SPECIAL PROVISIONS
(Revised 4/1/04)
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 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, or its employees,
agents,subcontractors,or assignees pursuant to the terms of this subgrant award.
FOR INTERGOVERNMENTAL GRANTS ONLY:
b. Indemnity: To the extent required by law, the Subgrantee shall indemnify, save, and hold harmless
the State 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, or its employees,
agents,subcontractors,or assignees pursuant to the terms of this subgrant award.
c. No term or condition of this grant 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, Section 24-10-101 et seq., C.R.S. or the Federal Tort Claims Act, 28
U.S.C.2671 et seq.as applicable, as now or hereafter amended.
Waiver 2005.doc
SPECIAL PROVISIONS AND CERTIFIED ASSURANCES SPCA PAGE 2 of 11
Special Provisions&Certified Assurances must remain attached to the application
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 nor any agent,subcontractor,or employee of the Subgrantee shall be
or shall be deemed to be an agent or employee of the state by virtue of this Subgrant. Subgrantee shall pay when
due all required employment taxes and income tax and local head tax on any monies paid pursuant to this grant.
Subgrantee acknowledges that the subgrantee and its employees are not entitled to unemployment insurance
benefits unless the subgrantee or third party provides such coverage and that the state does not pay for or otherwise
provide such coverage. Subgrantee 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 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 shall be
solely responsible for the acts of its employees, independent sub-contractors and agents.
5. NON-DISCRIMINATION
The Subgrantee 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 subgraM is capable of execution.
At all times during the performance of this subgrant,the Subgrantee 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
hereby certifies that, for the term of this subgrant and any extensions, the Subgrantee has in place appropriate
systems and controls to prevent such improper use of public funds. If the State determines that the Subgrantee 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.
B. GRANT REQUIREMENTS
1. FINANCIAL&ADMINISTRATIVE MANAGEMENT
a. The Subgrantee 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
Waiver 2005.doc
SPECIAL PROVISIONS AND CERTIFIED ASSURANCES SPCA PAGE 3 of 11
Special Provisions&Certified Assurances must remain attached to the application
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 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 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 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.
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 assures that it shall maintain data and information to provide accurate quarterly
program and financial reports to the Division. Said reports shall be provided in such form, at such
times, and containing such data and information as the Division of Criminal Justice reasonably
requires to administer the program.
e. The SubgraMee 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 SubgraMee 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.
h. The Division may withhold payment in the event the Subgrantee fails to comply with conditions and
certifications contained in this grant award.
3. PROCUREMENT AND CONTRACTS
a. The Subgrantee 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 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 assures that contractors/vendors who assist the Subgrantee 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 SubgraMee 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:
The Division of Criminal Justice has the right to use, duplicate and disclose, the above
material in whole or in part in any manner for any purpose whatsoever and authorize
others to do so.
ii. If the material or invention is copyrightable, the Subgrantee may copyright such, but the
Division of Criminal Justice reserves a perpetual, royalty-free, non-exclusive and
irreversible license to practice, reproduce, publish and use such materials in whole or in
part, and authorize others to do so.
Hi. 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 Subgrantees must dearly:
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;
Waiver 2005.doc
SPECIAL PROVISIONS AND CERTIFIED ASSURANCES SPCA PAGE 4 of 11
Special Provisions 8 Certified Assurances must remain attached to the application
c) Use the phrase-'This project was supported by grant # , issued by the
Colorado Division of Criminal Justice.'
e. The Subgrantee 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 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).
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 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.
b. The Subgrantee assures that:
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 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. Subgrantees will be notified in advance of any on-site
monitoring visit.
e. The Subgrantee 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 and to relevant books and records of
subcontractors of the Subgrantee. It is the responsibility of the Subgrantee to notify any of its
project collaborators and subcontractors of these provisions.
f. The Subgrantee 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 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 against goals and performance standards
required herein. The Division will provide reasonable technical assistance to the Subgrantee concerning
project goals, performance standards and subgrant requirements; however, substandard performance as
determined by the Division will constitute noncompliance with this grant award. Substandard performance
may result in termination or reduction of grant award as follows:
a. Reduction In Grant Award Amount for Cause
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, stating the reasons for reduction, steps taken to correct the problems,
Waiver 2005.doc
SPECIAL PROVISIONS AND CERTIFIED ASSURANCES SPCA PAGE 5 of 11
Special Provisions&Certified Assurances must remain attached to the application
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 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 may be
withheld at the discretion of the Division until completion of final Division review.
b. Termination for Convenience:
Either party may terminate the grant with thirty days written notice of intent to cancel or
terminate.
ii. The grant may be terminated by the Division if it is in the best interest of the state of
' Colorado to terminate the grant.
iii. If the grant is terminated for convenience by either the Subgrantee or the state, the
Subgrantee 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:
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, 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.
iii. In the event this grant is terminated for cause, the Division will only reimburse the
Subgrantee 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 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 hereby agrees that it will comply, and all of its contractors will comply with the
applicable provisions of
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:
Part 18,Administrative Review Procedure;
ii. Part 20, Criminal Justice Information Systems;
iii. Part 22, Confidentiality of Identifiable Research and Statistical Information;
iv. Part 23, Criminal Intelligence Systems Operating Policies;
v. Part 30, Intergovernmental Review of Department of Justice Programs and Activities;
vi. Part 42, NondiscriminatioriEqual Employment Opportunity Policies and Procedure;
vii. Part 61, Procedures of Implementing the National Environmental Policy Act;
viii. Part 63, Floodplain Management and Wetland Protection Procedures; and,
ix. Federal Laws or regulations applicable to Federal Assistance Programs.
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SPECIAL PROVISIONS AND CERTIFIED ASSURANCES SPCA PAGE 6 of 11
Special Provisions&Certified Assurances must remain attached to the application
2. FINANCIAL&ADMINISTRATIVE MANAGEMENT
a. Subgrantee assures that it will comply with appropriate federal cost principles and administrative
requirements applicable to grants as follows:
For state, local or Indian tribal government entities;
a) OMB Circular A-87, Cost Principles for State, Local&Indian Tnbal Governments
b) OMB Circular A-102, Common Rub-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
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 Institutions of Higher Education, Hospitals and Other Nonprofit
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 Govemments and Nonprofit
Organizations
b. The Subgrantee 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 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 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 certifies that federal funds made available under this grant:
Will not be used to supplant state or local funds;
ii. That the Subgrantee'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(3b.ii)cannot be made, and there is a reduced or
unchanged local investment,then the Subgrantee shall give a written explanation
demonstrating that the Subgrantee'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. CERTIFICATION REGARDING LOBBYING(Subgrantees receiving$100,000 or more in total federal funds
per year. See 28 CFR Part 69.)
The prospective Subgrantee 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 shall complete and submit Standard Form-LLL, 'Disclosure of
Lobbying Activities."
5. CERTIFICATION REGARDING DEBARMENT,SUSPENSION, INELIGIBILITY AND VOLUNTARY
EXCLUSION(Subgrantees receiving$100,000 or more in total federal funds per year.See, 28 CFR Part 6.)
The prospective Subgrantee certifies, by submission of this proposal, that neither it nor its principals,
subcontractors or suppliers are presently debarred, suspended, proposed for debarment,declared ineligible,
or voluntarily excluded from participation in this transaction by any Federal department or agency.
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SPECIAL PROVISIONS AND CERTIFIED ASSURANCES SPCA PAGE 7 of 11
Special Provisions&Certified Assurances must remain attached to the application
6. CERTIFICATION REGARDING DRUG FREE WORKPLACE (See, 28 CFR Part 67, Subpart F.)
The prospective Subgrantee certifies, by submission of this proposal, that it will comply with the Drug Free
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 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:
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 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 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:
New construction;
ii. 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;
iii. 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.
iv. 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 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.
D. SUBRECIPIENT ORGANIZATION ELIGIBILITY REQUIREMENTS
VOCA establishes eligibility criteria that must be met by all organizations that receive VOCA funds. These funds are
to be awarded to subrecipients only for providing services to victims of crime through their staff. Each subrecipient
organization shall meet the following requirements.
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SPECIAL PROVISIONS AND CERTIFIED ASSURANCES SPCA PAGE 8 of 11
Special Provisions 8 Certified Assurances must remain attached to the application
1. PUBLIC OR NONPROFIT ORGANIZATION
To be eligible to receive VOCA funds, organizations must be operated by a public or nonprofit organization,
or a combination of such organizations, and provide services to crime victims.
2. RECORD OF EFFECTIVE SERVICES
Demonstrate a record of providing effective services to crime victims. This includes having the support and
approval of its services by the community, a history of providing direct services in a cost-effective manner,
and financial support from other sources.
3. NEW PROGRAMS
Those programs that have not yet demonstrated a record of providing services may be eligible to receive
VOCA funding, if they can demonstrate that 25-50 percent of their financial support comes from non-federal
sources. It is important that organizations have a variety of funding sources besides federal funding in order
to ensure their financial stability. States are responsible for establishing the base level of non-federal
support required within the 25-50 percent range.
4. PROGRAM MATCH REQUIREMENTS
The purpose of matching contributions is to increase the amount of resources available to the projects
supported by grant funds. Matching contributions of 20% (cash or in-kind) of the total cost of each VOCA
project(VOCA grant plus match)are required for each VOCA-funded project and must be derived from non-
federal sources, except as provided in the OJP Financial Guide, effective edition (Part Ill. Post Award
Requirements, Chapter 3. Matching or Cost Sharing). All funds designated as match are restricted to the
same uses as the VOCA victim assistance funds and must be expended within the grant period. Match
must be provided on a project-by-project basis. Any deviation from this policy must be approved by OVC.
For the purposes of this program, in-kind match may include donations of expendable equipment, office
supplies, workshop or classroom materials, work space, or the monetary value of time contributed by
professionals and technical personnel and other skilled and unskilled labor, if the services they provide are
an integral and necessary part of a funded project. The value placed on donated services must be
consistent with the rate of compensation paid for similar work in the subrecipient's organization. If the
required skills are not found in the subrecipient's organization,the rate of compensation must be consistent
with the labor market. In either case, fringe benefits may be included in the valuation. The value placed on
loaned or donated equipment may not exceed its fair market value. The value of donated space may not
exceed the fair rental value of comparable space as established by an independent appraisal of comparable
space and facilities in privately owned buildings in the same locality.
a. Record Keeping. VOCA recipients and their subrecipients must maintain records that dearly show
the source, the amount, and the period during which the match was allocated. The basis for
determining the value of personal services, materials,equipment, and space must be documented.
Volunteer services must be documented, and to the extent feasible, supported by the same
methods used by the subrecipient for its own paid employees. The state has primary responsibility
for subrecipient compliance with the requirements. State grantees are encouraged not to require
excessive amounts of match.
b. Exceptions to the 20% match: OVC sets lower match requirements for:
Native American Tribes/Organizations Located on Reservations. The match for new or
existing VOCA subrecipients that are Native American tribes/organizations located on
reservations is 5% (cash or in-kind) of the total VOCA project. For the purpose of this
grant, a Native American tribe/organization is defined as any tribe, band, nation, or other
organized group or community which is recognized as eligible for the special programs
and services provided by the U.S. to Native Americans because of their status as Native
Americans. A reservation is defined as a tract of land set aside for use of,and occupancy
by, Native Americans.
ii. The U.S. Virgin Islands, and all other territories and possessions of the U.S., except
Puerto Rico, are not required to match VOCA funds. See 48 U.S.C. 1469a(d).
OVC may waive the match requirement if extraordinary need is documented by State
VOCA administrators.
5. VOLUNTEERS
Subrecipient organizations must use volunteers unless the state grantee determines there is a compelling
reason to waive this requirement. A °compelling reason' may be a statutory or contractual provision
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SPECIAL PROVISIONS AND CERTIFIED ASSURANCES SPCA PAGE 9 of 11
Special Provisions& Certified Assurances must remain attached to the application
concerning liability or confidentiality of counselorNictim information,which bars using volunteers for certain
positions, or the inability to recruit and maintain volunteers after a sustained and aggressive effort.
6. PROMOTE COMMUNITY EFFORTS TO AID CRIME VICTIMS
Promote, within the community, coordinated public and private efforts to aid crime victims. Coordination
may include, but is not limited to, serving on state, federal, local, or Native American task forces,
commissions, working groups, coalitions, and/or multi-disciplinary teams. Coordination efforts also include
developing written agreements that contribute to better and more comprehensive services to crime victims.
Coordination efforts qualify an organization to receive VOCA victim assistance funds, but are not activities
that can be supported with VOCA funds.
7. HELP VICTIMS APPLY FOR COMPENSATION BENEFITS
Such assistance may include identifying and notifying crime victims of the availability of compensation,
assisting them with application forms and procedures, obtaining necessary documentation, and/or checking
on claim status.
8. COMPLY WITH FEDERAL RULES REGULATING GRANTS
Subrecipients must comply with the applicable provisions of VOCA, the Program Guidelines, and the
requirements of the OJP Financial Guide, effective edition, which includes maintaining appropriate
programmatic and financial records that fully disclose the amount and disposition of VOCA funds received.
This includes:financial documentation for disbursements; daily time and attendance records specifying time
devoted to allowable VOCA victim services; client files; the portion of the project supplied by other sources
of revenue;job descriptions; contracts for services; and other records which facilitate an effective audit.
9. MAINTAIN CIVIL RIGHTS INFORMATION
Maintain statutorily required civil rights statistics on victims served by race, national origin, sex, age, and
disability, within the timetable established by the state grantee; and permit reasonable access to its books,
documents, papers, and records to determine whether the subrecipient is complying with applicable civil
rights laws. This requirement is waived when providing a service, such as telephone counseling, where
soliciting the information may be in appropriate or offensive to the crime victim.
10. COMPLY WITH STATE CRITERIA
Subrecipients must abide by any additional eligibility or service criteria as established by the state grantee
including submitting statistical and programmatic information on the use and impact of VOCA funds, as
requested by the grantee.
11. SERVICES TO VICTIMS OF FEDERAL CRIMES
Subrecipients must provide services to victims of federal crimes on the same basis as victims of state/local
crimes.
12. NO CHARGE TO VICTIMS FOR VOCA-FUNDED SERVICES
Subrecipients must provide services to crime victims, at no charge, through the VOCA-funded project. Any
deviation from this provision requires prior approval by the state grantee. Prior to authorizing subrecipients
to generate income, OVC strongly encourages administrators to carefully weigh the following considerations
regarding federal funds generating income for subrecipient organizations.
a. The purpose of the VOCA victim assistance grant program is to provide services to all crime victims
regardless of their ability to pay for services rendered or availability of insurance or other third-party
payment resources. Crime victims suffer tremendous emotional, physical, and financial losses. It
was never the intent of VOCA to exacerbate the impact of the crime by asking the victim to pay for
services.
b. State grantees must ensure that they and their subrecipients have the capability to track program
income in accordance with federal financial accounting requirements. All VOCA-funded program
and match income, no matter how large or small, is restricted to the same uses as the VOCA grant.
Program income can be problematic because of the required tracking systems needed to monitor
VOCA-funded income and ensure that it is used only to make additional services available to crime
victims. For example: VOCA often funds only a portion of a counselor's time. Accounting for
VOCA program income generated by this counselor is complicated, involving careful record
keeping by the counselor, the subrecipient program, and the state.
13. CLIENT—COUNSELOR CONFIDENTIALITY
Maintain confidentiality of client-counselor information, as required by state and federal law.
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SPECIAL PROVISIONS AND CERTIFIED ASSURANCES SPCA PAGE 10 of 11
Special Provisions& Certified Assurances must remain attached to the application
14. CONFIDENTIALITY OF RESEARCH INFORMATION
Except as otherwise provided by federal law, no recipient of monies under VOCA shall use or reveal any
research or statistical information furnished under this program by any person and identifiable to any specific
private person for any purpose other than the purpose for which such information was obtained in
accordance with VOCA. Such information, and any copy of such information, shall be immune from legal
process and shall not, without the consent of the person furnishing such information, be admitted as
evidence or used for any purpose in any action, suit, or other judicial, legislative, or administrative
proceeding. See Section 1407(d) of VOCA codified at 42 U.S.C. 10604.
These provisions are intended, among other things, to ensure the confidentiality of information provided by crime
victims to counselors working for victim services programs receiving VOCA funds. Whatever the scope of application
given this provision, it is clear that there is nothing in VOCA or its legislative history to indicate that Congress
intended to override or repeal, in effect, a state's existing law governing the disclosure of information which is
supportive of VOCA's fundamental goal of helping crime victims. For example, this provision would not act to
override or repeal, in effect, a state's existing law pertaining to the mandatory reporting of suspected child abuse.
(See Pennhurst School and Hospital v. Halderman et al., 451 U.S. 1 (1981).) Furthermore, this confidentiality
provision should not be interpreted to thwart the legitimate informational needs of public agencies. For example,this
provision does not prohibit a domestic violence shelter from acknowledging, in response to an inquiry by a law
enforcement agency conducting a missing person investigation, that the person is safe in the shelter. Similarly,this
provision does not prohibit access to a victim service project by a federal or state agency seeking to determine
whether federal and state funds are being utilized in accordance with funding agreements.
E. PROGRAM SPECIFIC REQUIREMENTS
The following program specific requirements are imposed by the State sponsoring agency concerning special
requirements of law, program requirements, and other administrative requirements which must be passed on to
subgrant award recipients. These requirements are more likely to change from year to year than the special
provisions and federal certified assurances shown above, and usually vary across offices within the Division.
1. FUTURE FUNDING
The capacity for VOCA funds to provide future continuation dollars for projects is undetermined at this time.
Subgrantees are advised to seek other funding sources, especially for personnel dollars.
2. STATE CONFIDENTIALITY OF VICTIMS INFORMATION
The Subgrantee certifies that the signing authorities, all staff and volunteers assigned to the VOCA-funded
project have read and understood, state laws and applicable rules of professional conduct related to issues
of confidentiality and privilege, particularly with respect to releasing identifying information about victims of
crime, including, but not limited to,those found in C.R.S. §13-90-107.
Waiver 2005.doc
CERTIFICATION OF MATCHING FUNDS - (All Applicants)
If no match is required,you may disregard this page.
PLEASE BE ADVISED that Weld County Government has appropriated
(unit of government,forfeiture fund,non-profit agency,or corporation)
funds in the amount of$ 8,231 to match federal funds for the Domestic Violence and Special Populations
Project (project title)
The source(s)of these funds is non-federal governmental funds
These funds are made available as X_ CASH or IN-
_
KIND match
Execution of this document represents a certification that said funds have been earmarked within the
appropriation of budget process, which by state or local government law or practice, binds and
obligates the state/local unit of government or the implementing agency to use such funds for purposes
of this grant funded project, or permits such uses. The funds are, or will be (within the project
duration), actually provided for such purposes.
Signature must be by the individual
authorized to commit these funds on behalf
of the unit of government, forfeiture fund,
non-profit agency or corporation. This
Sincerely, individual is either the Authorized Official
on this grant or appropriate financial
7 controller of matching funds.
2 ' j
APR 0 4 2005
Signature Date
M. J. Geile
Typed Name
Pro—Tem Chair. Board of County Commissioners, Weld County,Colorado
Title
al0OS-///9
SPECIAL PROVISIONS AND CERTIFIED ASSURANCES SPCA PAGE 11 of 11
Special Provisions& Certified Assurances must remain attached to the application
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 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 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 M. J. Geile
Position Board Chair pro—Tern
Agency Board of County Commissioners,Weld County
Mailing Address PO Box 758
City,State,Zip Greeley, CO 80632
Telephone# (970)336-7204 ext.4200
Fax# (970)352-0242
E-mail Address mgeile@ .weld.co.us
Signature , Date
APR 0 4 2005
FINANCIAL OFFICER
Name Donald D.Warden
Position Director of Finance and Administration
Agency Weld County Government
Mailing Address PO Box 758
City,State,Zip Greeley, CO 80632
Telephone# (970)356-4000 ext.4218
Fax# (970)352-0242
E-mail Address DW en@co.weld.co.ps
Signature n ji, Date
/j % `' � ��-- APR 0 4 2005
P OJEaT DIRECTOR
Name Jo Ann Holden
Position Community Programs Administrator\Victim Witness Coordinator
Agency 19TH Judicial District Attorney's Office,Victim Witness Assistance Unit
Mailing Address PO Box 1167
City,State,Zip Greeley, CO 80632
Telephone# (970)356-4010 ext 4747
Fax# (970)352-8023
E-mail Address jholden@co.weld.co.us
Signature Date(Lk\Waiver 2005.doc
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