HomeMy WebLinkAbout860762.tiff 44,/tioarMEMORAf1DUf`
1119 Jackie Johnson, Chairman
To Board of County_ Commi_ssionersoa,p_Jul_y 29, 1986
COLORADO Fran Walter J_ SQeckman,_Executive Director , ;
subject Amendment to the 1986 PA 22 Basic
Enclosed for Board approval is an amended grant application to the 1986
PA 22 Basic.
The Weld County Head Start Program is requesting funds in the amount of
$16,000 from the Department of Health and Human Services to replace one
of its vehicles utilized to provide transportation for Head Start children.
The funds will be utilized to replace a 1972 Ford Mini-Van with capacity
for eleven (11) passengers. The vehicle has 250,689 miles. The motor
has been replaced twice, due to malfunction, and the transmission was
replaced once. The vehicle' s unsafe condition puts the lives of the
children being transported in danger.
If you have any questions, please call me.
J 67[1,())2( 800762
OMB Approval No.0348-0008
FEDERAL ASSIS'TANC 2 c;.S a NUMBER E a.NUMBER
APPL`- 08CH0019/13 CATION
1. TYPE CATION I CENT-
OF O NOIT. OF INTENT(TONAL) ' NTH b.DATE F ER b. DATE
P
SUBMISSION FIER ear i tip-?.TOBB
(Mark op- ❑ PREAPPUCATON 7, AWCNED ASSIGNED Year month day
Prapriate ❑ APp iCArioN 19 86-07-30 i 3Y FATE 19
box)
Lean
Blank '
4. LEGAL APPLICANT/REG NT 15. EMPLOYER IDENTIFICATION NUMBER(E114)a Applicant Name Weld County Division of Human Resources 34-6000813
b.oa„o UM Weld County Head Start —
P.0.Streit/P.O.Box PRO— a NUMBER 1 13 I ' I6 IID I '
d.City Greeley ac«xxy Weld GRAM
I.State Colorado (Fran CFDA)
Mr. Walter J. SpecKman 8O631 MULTIPLE CI
h.Contact Person(Nam b. TITLE Child Development
&Td.phone Nat - (303)353-0540 Ext. 2360 Head Start
7. TIME OF APPLICANTS PROJECT (Use section IV of the form to provide a summery davipbon of re a TYPE OF APPLICANT/RECIPIENT
V0}0,70 sa-+r r I4 Comm.+r~esrawo�
z O_& F-We Esrr Wa.
E. 1986 PA 22 Basic Purchase of Equipment D-Ccurft x ^
w Alma
o
w E-q
C F-3a*d IWOM
I.- ESN regrgnea Les D
g
9.AREA OF PROJECT gWPCT Clams c,/cress meatiel seas<a) 10.ESTIMATED NUMBER 11.TYPE OF ASSISTANCE
I
Weld County, Colorado �� sBEN 3Rs� nG .. o-""� �,,Y,.
0.-.'"On Y CatF-01�
,,a Al
a
n 12. PROPOSED RACING 13. CONGRESSIONAL DISTRICTS OF: 14.TYPE OF APPLICATION
a.r,.. E-a.PleSts
a FEDERAL $ 16.000 .co' a- APPLICANT b. PROJECT `'"wawa a--Cona.rr.w Eider e ,W rm. lA
•
b.APPLICANT 3,200 .co 4 County-Wide t7_TYPE OFCHANCi€(Fee Nt sf4r)
.-,fa..oar-. F.-COWOMV*
c STATE .00 15. PRO-T-0T START 16. PROJECT s-C.e,..mp Cleves
d.LOLL -- - - - — DATE Year mar* Lay DURATION «
) _ .LO 19 Morrto
e.OTHER -COI Eno'saws
-. —OB. DATE WE TO Year month day I Pin Mtan IA I
t Total s 19,200 _col FED&IALAGENCY► 1986-07-30 I
119. FEDERAL AGENCY TORECc1VEREDUEST Administration for Children Youth & Families 29.,EXISDNG FEDERAL GRANT
�_e IDENTIFICATION NUMBER
a. ORGANIZATIONAL LiptAS i_ r O ADMINISTRATIVE CONTACT OF KNOWN)
L4N 5s?��ICES 08CH0019/13
ADDRESS z.L ' 21.X REMARKS AWED
C. -.•-r.J.: C�;-lt U:':t;;it1 E)�b- _�'. .,._ �JI SiRv�Ct5
REGION 8, EEDE?.ZL E U 1:?=G
1961 scour STREET, DENVER CO 80994 ❑ Yes ❑ N,
✓ 22. To the beet d my krefeedge and bezel. a. YES.THS NOTCE OF INTENT/PREAPPLICATICN/.APPLICATION WAS MADE AVAILABLE TO THE STATE
4 THE data in ;U A.preap c&appa noon EXECUTIVE ORDER N:12372 PROCESS FOR REVEW O
< APPLICANT are true and correct.7!e cbcxxnent Fm
CERTIFIES been Gfl 'n
au:rad lb.by 9
ovemn'9 DATE
THAT► _body of the wok: and the appeal/en .-
will carq y r ial„e attactted assurances b. NO.PROGRAM IS NOT COVERED BY E.O.12372 O -
Sa if the asses ce o aPpro+sd. OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW 1n '
z 23. a I TPtU NAME AND TITLE b. SIGNATURE ,1
RERrFYING Jacqueline Johnson Chairman \ \
REPRE- , I
SENTATIVE Weld County Board of Commissioners -\()-1)3S4.-. \(.(.,'L �_
24. APPLICA- Year r ..th '7 '25. FEDERAL APPLCATION IDEN'I CATI N NUa3F" ?125. FEDE AL RANT IDENTIFICATION
TION
RECEIVED 19
27. ACTION TAKEN 23- F-1,:,NG Year month day 30. Year month dote '
STARTING
• C a. AWARDED i 29. ACTION DATE).- 19 DATE 19
-- .S 0 b. REJECTED a FEDERAL S .00 31. CONTACT FOR ACOCONAL INFORMA- 32. Year month date
0 a RETURNED FOR I TION(Nome and te!crr-e.,amber) ENDING
AMENDMENT I b. APPLICANT .00 DATE 19
0 d. RETURNED FOR a SALE I .00 33. REMARKS ADDED
E.O. 12372 SUBMSSION 0
BY APPLICANT TO i d. LOCAL .W
STATE
❑e. DEFERRED 1 a. OTHER I .00 I
O f. WITHDRAWN I t. TOTAL S .00
Yes ❑ No
.3N 7540-01-008-8162 424-103 STANDARD FORM 424 PAGE 1 (Rev.4-84)
-EVIOUS EDITION y11.r;:',1-1,77 fl Procrib.d by OMB Cieeular A-)02
NOT USABLE .... n ,
OM3 NO 0348.0005
• PART II
PROJECT APPROVAL INFORMATION
Item 1.
Does this asssa.-ce request rte.•e Nacre of Governing Body
State, local rectonal, or other cr r rating? Priory Ra:ing
Y X No
Item 2.
Does this aSs=s'a•'ce request " _.re State. or icca: Name of Agency or
advisory, ecvca-onat or healtt'az7rces? Boars
Yes_ X •
No (Attach Documentation)
Item 3.
Does this assstance request rec,.:re State. local, Name 'Appro n .A
regional or ether planning appra. s? Date �dret7L Y0 1 C Council
X Yes No
Item 4.
Is the proposed project covered rY an approved compre- Check one: State ❑
hensive plan? Local 0
Regional 0
Yes No Location of Plan
Item 5.
Will the askance requested serve a Federal Name of Federal Installation
installation? Yes X No Federal Population benefiting from Project
Item 6.
Will the assistance requested be cn Federal land or Name of Federal Installation
installation? Location of Federal Land
Yes X _No Percent of Project
Item 7.
Will the assistance requested have an impact or effect See instructions for additional information to be
on the environment • X provided.
Yes No
Item 6. Num,er of:
Will the asssance requested the displacement Individuals
of individuals, families, businesses or farms? Families
Businesses_
Yes_ X No Farms
Item 9.
Is there other related assistarce:n this pro;act previous, See instructions for additional information to be
pending, or anticipated provided.
Y Y No
OMB NO.03430 Os
PART III - BUDGET INFORMATION
SECTION A- BUDGET SUMMARY
Grant Program, Federal ! Estimated Unobligated Funds New or Revised Budget
Function —
or Activity Catalog No. Federal Non-Federal Federal Non-Federal Total
(a) (b) ! (c) (d) (e) (f) (g)
1. PA 22 13,600 $ $ $ 16,000 $ 3,200 $ 19,200
2.
3 -- ..
4.
5. TOTALS S S $ 16,000 $ 3,200 $ 19,200
SECTION B-BUDGET CATEGORIES
-Grant Program, Function or Activity
6. Object Class Categories } —J Total
(o) PA 22 I(2) (3) (4) — (5)
a. Personnel $ $ $ $ S
ti
b. Fringe Benefits I
c. Travel
d. Equipment 16,000 16,000
e. Supplies
f. Contractual
g. Construction
h. Other
i. Total Direct Charges 16,000 16,000
j. Indirect Charges
k. TOTALS $ 16,0011 �� $ $ $ 16,000
7. Program Income S S $ $ $
a
04,81.10.034.3-WA
SECTION C - NON-FEDERAL RESOURCES
(a)Grant Program APPLICANT (c) STATE (d)OTHER SOURCES (e)TOTALS
8.
PA 22 s 3,200 is S $ 3,ZUQ
9.10.
11.
12. TOTALS s 3,200 S $ s 3,200
SECTION D- FORECASTED CASH NEEDS
ITotal for 1st Years 1st Quarter 2nd Quarter I 3rd Quarter 4th Quarter
13. Federal IS IS S S 16,000 $
14. Non-Federal 1 3,200
15. TOTAL is IS IS s 19,200 _ $
SECTION E-BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
(a)Grant Progrun FUTURE FUNDING PERIODS (YEARS)
16 (a) FIRST I (c)SECOND (d)THIRD _ (e) FOURTH
IS IS
17.
18.
19.
•
20. TOTALS IS is S $
SECTION F-OTHER BUDGET INFORMATION
(Attach Additional Sheets if Necessary)
21. Direct Charges:
L
22. Indirect Charges:
23. Remarks:
_ I
PART IV PROGRAM NARRATIVE (Attach per instruction)
IV. Narrative.
1. Need
The Weld County Head Start is requesting funds to replace one of it's
vehicles utilized to provide transportation for head start children.
The funds will be utilized to replace a 1972 Ford Mini-Van, with
capacity for eleven (11) passengers. The vehicle has 250,689 miles.
The motor has been replaced twice, due to malfunction, and the trans-
mission was replaced once.
The vehicle' s unsafe condition puts the lives of the children being
transported in danger.
Hello