HomeMy WebLinkAbout850921.tiff ‘e1(
D To... Jackie Johnson, Chairman Date August 13, 1985
Board of County commissioners.
COLORADO From Walter J. Speckman, Executive Director, Human Resource
Subject: Monies for Migrant Head Start
Enclosed for Board approval is the formal incorporation of the
additional $25,945 that were received for the Migrant Head Start
Program.
As you recall , we were notified of the availability of the additional
monies via telegram communique. The monies are to be utilized for
supplies and equipment for the Migrant Head Start Program.
If you have any questions, please contact me.
/// �y 850921
/
OMB Approval No.C348-0006
___T—... ,r) er.).
'2_ P'J-AP a.NUMBER 1 STATE •a.NUMBER
FEDERAL ASSISTANCE c,A.N S A.ALI •
-
APPL- CATION •
1. TYPE CCTON F"eJTI- 911- 01 4
OF O No; of iNrx(C T' AL) b.DATE TO BE b. DATE
SUBMISSION rcr ASSIGNED Year mc�s.h
(u O xiEAPP I AT,ON .ten day
mate Les APPL.CAT)0H 19 85 08 14 =-'r" 19
8larkz
A. LEGAL APPLIC.Ah7/P OPT :. 5. EMPLOYER IDENTIFICATION NUMBER(EIN)
a_A.olieantNan* - Weld County Division of Human Resources
b.Organization Ui t - Head Start Program . •
c.Streat/P.O.Box • P.O. Box 1805 :PRO- a. NUMBER I 1 1 31 . 1 61010 1
GRA.M
d uty - Greeley 0.00%01Y Weld Tram CFDA) rNULT Le O
1.Szata • Colorado 9-1 P`tee• 80632
IL Contact Person(Name Walter J. Speckman, Executive Director ! b. TITLE
A Telephone N+.) - (303) 353-0540 rtigraat_H1ead Start/Day Car;
i 7. TITLE OF APPLICANTS PROJECT(the secdorm IV of therm form b provide a sumrary ..ie *i 3. TYPE OF APPLICANT/RECIPIENT
c Drbiect) a-sesesea- r �,Ai et om,
3 Weld County, Colorado J. ,Tab• 'r`"°"
Migrant Head Start/Day Care K-0°"`
Equipment & Supplies { `'s..... ..0 appropriateEeur ,
z E
a 9. AREA OF PROJECT IMPACT n eer of eirie ear.flares acl 10.EST MATS`+�v3 I it.TYPE OF ASSISTANCE
I OF PEA f�'.c--I---rhG `i'e Grv'' D-LrrAvs
5 Weld and Adams County . 200 17.--,..... G.» E.-011*. n■
APPLICATION
TYPE OF 14.
4.
4 12 PROPOSED r'.PC* G 113- CONGRESSsONAL DISTRICTS or: 1• w.
FEDERAL s 25,945 .co' a APPLICANT b. PROJECT p}'4-"""" D-Goneane"a. 'Aargn,.q.,eer:cur
b.APPLICANT 5,189 m i 17.TYPE OF CHANGE(For lee or 14k.)
:--a' +Do..n s-Saw 1 3-45,00‘ss•Cobra ,4l.):
C.STATE 1 t5. PROJECT START 16. PROJECT
DURATON
d.LOCAL
.00 DATE a Tear mar:./: dal'
e OTHER .pp.. 13 85 06 01 S .4.4-,..z-51 en*other,. ■ii13 OATS DUE TO Year rrc .ti prateiefterre)
,f. Total ,s 31,134 .00 i rE ,RAl.AGENCY r 19
119. FEDERAL AGENCY TO R_✓r R_=OUS 20.DUSTING FEDERAL GRANT
I Administration for Chi 1 dran Yriuth and Families IDENTIFICATION NUMBER .
a_ ORGANIZATIONAL UNIT(F APPROPRIAt&I ab.ADMINISTRA c:,ih: 7 CI:C+."7:e+vN)
!!!!
a ADDRESS 21. REMARKS ADDED
[21 yesEl No
To Ma bas CI r-.y icQ.6.69D ar4 b1;.ef.' YES.THIS NO OF INTEINTENT/PcE PP 'C- ..2. JCATION WAS MAD=AVAILABLE TO THE STATE
2I THE data in bin preacraa ^/+9p'c'a NOTICE c EXEOFT/E.ORDER 12372 P°OrSS_R 4--h ON:
.7APPLCANT are Lo ea a and r` r'»dco. rt tas!
2jCERT,FIES been at.- xodDyrm' 9cY9rY+;! DATE
1 THATa- body e t+e axcar:ar4 Eta am+•carz. ^ r -_
win o:r mpry.r1=ee 4-=e-,40 ass•.r%t S.b. NO.PRCGP&.0 IS NOT C O EPE 5'_ "22 .- '
if the-- a"s woraroil OR PROGRAM HAS NOT BEEN .......-EC.:.Z - 71-72 FOR REVIEW O
Z f 23- a TY?F�7 NA.k.472 t_A tiO TITLE b S-'� -x
;I REPRE-CERTIFYING Jacqueline Johnson, Chairman_+�RcPRc-
`ISENTATIVE Board of nissioners �'
24. APPLICA- Yea' �xa.li =7 25. FEDERAL APPLICATION I -c ^=.=i 25. FE ERAL GRANT IDENTIFICATION
TION
RECEIVED 19 !
27. ACTION TAKEN 2r. `.:~DING Year month day 30• Year nrrrh date
F. STARTING
0 a. AWARDED 1 29. ACT's:::•A 7B-11.- 13 DATE 19
:_ j;CJ D_ REJECTED 00 31. C! AC P:L t�J+D AL INFORMA- Year trr.uh dote
a. FEDERAL S ENDING
_ <1 O AMENDMENT :b- APPLICANT:A`rT { 00 RETURNED FORTomN 'ti2� �rnber) DATE 19
'i D d. RETURNED FOR , Q0 33.REMARKS ADDED
I E.O. 12372 SU9MISSCN ' STATE
BY APPLICANT TO r d. LOCAL. .00
STATE
O e. DEFERRED 'a. OTHER 1 000
o 1. WITHDRAWN I. TOTAL 'S .001 D Yes O No
I
I 424-103 (Rev.STANDARD FORM 424 PAGE 1 (R .4-84)
75401-003.8162 )
EV1OUS EDITION Preocribed by OW Circular A-1CL'
PART ff OMB NO.0348-0008
PROJECT APPROVAL INFORMATION
Item 1.
Does this assistance request require Name of Governing Body
State. local regional, or other priority rating? Priority Rating
Yes No
Item 2.
Does this assistance request require State, or local Name of Agency or
advisory, educational or health clearances? Board
-Yes No (Attach Documentation)
Item 3.
Does this ass-stance request require State, local, Name of Approving Agency.x nS��^�` • ( .
regional or other planning approval? Date
-Yes No
Item 4.
Is the proposed project covered by an approved compre- Check one: State 0
hensive plan? Local
Regional 0 •
• Yes No Location of Plan
Item 5. •
Will the assistance requested serve a Federal Name of Federal Installation
installation? Yes No Federal Population benefiting from Project
Item 6.
Will the assistance requested be on Federal land or Name of Federal Installation
installation? Location of Federal Land
Yes 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 provided.
Yes _No •
Item 8. Number of:
Will the assistance requested cause the displacement Individuals
•
of individuals,families, businesses, or farms? Families
Businesses
Yes No Farms
Item 9.
Is there other related assistance on this project previous, See instructions for additional information to be
pending, or anticipated provided.
Yes No
0Q3!A.c343-0ppg
PART III - BUDGET INFORMATION
SECTION A - BUDGET SUMMARY
Grant Program,
Function Federal I Estimates Unobiigated Funds 1 New or Revised Budget
or Activity 1 Catalog No. Federal I
allon Federal FJ�'2J NorrFed,ral(c) d ' Tota�
t
13.600 ;S s Is 25.945 !S 5 189 Is 31 134
2. !
3.
I 1 I
4. ' f '
I I
5. TOTALS iS r is
25,945 �s 5 189 is 31 134
SECTION B - BUDGET CATEGORIES
-Grant Program, Function o-Activity
6. Object Class Categories
1
PA 23 ' ( Total
f 2 1(3 1(4
a. Personnel S 5
;s S I s S
b. Fringe Benefits i
c. Travel I k
d. EquipmentI
; l
e. Supplies i
I
f. Contractual •
g. Construction I
h. Other I E!
i. Total Direct Charges ' I
j. Indirect Charges
k. TOTALS $ 25,945 fS is
'S $ 25,945
7. Program Income IS iS is IS
S
w
!I-1
OMB NO.C1=24004
SECTION C- NON-FEDERAL RESOURCES
(a)Grant Procram (b)APPLICANT (c) STATE . t�.r OTHER SOURCES tej OTALS
8. PA 23 S 5,188 S s s 5,189
. 9.
10.
11. s 5,189
12. TOTALS S s,18,9 S
SECTION D- FORECASTED CASH NEEDS
Total for 1st Year 1st Quarter , 2nd Q a-ar , 3rd Quarter 4th Quarter
13. Federal is J.:�4,844 $ -0- $ 1-11,616. -s 223,229 S 334,844
14. Non-Federal I 66,968 -0- 22 323 i 44,6.45 65,968
15. TOTAL IS 401,812 S -0- s 131,(132 i5 267,,$24 S an.I ,812
SECTION E- BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
FUTURE FU' DING PERIODS (YEARS)
(a)Grant Program (b) FIRST (c) SECOND ' (d)THIRD (e)FOURTH
16. PA 23 _ s 296.018 $ 310,819 's 3?n,36n .S 110,678
i17. PA 26 28.326 29.762 ( 3i A" 37,790
18.
19. I -
1 20. TOTALS s 324.344 Is 34n, 61 IS 3 L7,r18Q $ 375,468
SECTION F-OTHER BUDGET INFORMATION
(Attach Additional Sheets if Necessary) _
21. Direct Charges:
22. Indirect Charges:
23. Remarks:
j
PART IV PROGRAM NARRATIVE (Attach per instruction)
CERI11FICATION OF HEAD START
ADMINISTRATIVE COSTS
We Weld County Commssioners Reesd 7TC,ounty .Division of Human have reviewed
astern of Grantee)
45 LH_( Part 1301.32 and certify that the development and administrative costs to administer the
Niarant -
Weld County Divison of Human Resources ' Head Start Program for the program year
Cw wOrmua.I
June 17, 1985 through October 25, 198jll not exceed 15 percent of $ 25,945. 00
(total Federal and non-Federal costs for program accounts 22 through 26).
Documents substantiating administrative costs are available in our files for review by auditor and
Officdof Human Development Services/Health and Human Services Personnel.
•
•
August 14 . 1985
Signs Cy-Vying Official Date
acqueline Johnson, Chairman
Weld County Board of Commissioners
HDS GRANTS MANAGEMENT
DEPA.RTMENF HEALTH AND HUMANlRVICES
ASSURANCE OF COMPLIANCE WITH SECTION 5114 OF THE
REHABILITATION ACT OF 1973, AS AMENDED
The undersigned (hereinafter called the "recipient") HEREBY AGREES THAT it will comply with
section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), all requirements im-
posed by the applicable HHS regulation (45 C.F.R. Part 84), and all guidelines and interpretations
issued pursuant thereto.
Pursuant to § 84.5(a) of the regulation [45 C.F.R. 84.5(a)], the recipient gives this Assurance in
consideration of and for the purpose of obtaining any and all federal grants, loans, contracts (ex-
cept procurement contracts and contracts of insurance or guaranty), property, discounts, or other
federal financial assistance extended by the Department of Health and Human Services after the
date of this Assurance, including payments or other assistance made after such date on applica-
tions for federal financial assistance that were approved before such date. The recipient recognizes
and agrees that such federal financial assistance will be extended in reliance on the representations
and agreements made in this Assurance and that the United States will have the right to enforce
this Assurance through lawful means. This Assurance is binding on the recipient, its successors,
transferees, and assignees, and the person or persons whose signatures appear below are author-
ized to sign this Assurance on behalf of the recipient.
This Assurance obligates the recipient for the period during which federal financial assistance is
extended to it by the Department of Health and Human Services or, where the assistance is in the
form of real or personal property, for the period provided for in § 84.5(b) of the regulation [45
C.F.R. 84.5(b)].
The recipient: [Check (a) or (b)] •
a. ( ) employs fewer than fifteen persons;
b. ( ) employs fifteen or more persons and, pursuant to § 84.7(a) of the regulation
[45 C.F.R. 84.7(a)], has designated the following person(s) to coordinate its
efforts to comply with the HHS regulation:
Weld County Commissioners/
Weld County Division of Human Resources
Name of Designee(s) — Type or Print
Weld County Division of Human 1516 Hospital Road - P.O. Box 1805
N ob'F teeapient — Type or Print Street Address
84-6000813 Greeley, Colorado 80632
(IRS) Employer Identification Number City
(303) 353-0540 Colorado 80632
Area Code — Telephone Number State Zip
I certify that the above information is complete and correct to the best of my knowledge.
•
08/14/85 Date S gnat�
and e of Aut razed Official
acque ine o nson, Chaq.rman
Board of County Commissioenrs
If there has been a change in name or ownership within the last year, please PRINT the former
name below:
PLEASE RETURN ORIGINAL TO: Office for Civil Rights, Room 5627/B North Building,
330 Independence Avenue, N.W., Washington, D.C.
20201.
RETURN COPY TO: Grants Management Office
HHS-641 (7/84) REV
GPO 908.714
HDS GRANTS NIA NAG E>IE,T
• ASSURANCE OF CGPLIANCE WITH THE DEPrtTMENT OF
HEALTH AND HUMAN SERVICES REGULATION UNDER
TITLE VI OF THE CIVIL RIGHTS ACT OF 1964
-Weld County Co. issioners and the
Weld County Division of Human Resourc reinafter called the "Applicant") HEREBY
. AGREES THAT .: :: comply with Title VI of the Civil Rights Act of 1964 (P.L. 88-352) and
all requirements :rH_.`slid b or pursuant to the Regulation of the Department of Health and Human
Services (4: CFR Par: :SO) issued pursuant to that title. to the end that, in accordance with Title
VI of that Act and :he Regulation, no person in the United States shall, on the ground of race,
color, or national or_ i-t, be excluded from participation in, be denied the benefits of, or be other •
-
wise subjected to discrimination under any program or activity for which the Applicant receives
Federal financial assistance from the Department; and HEREBY GIVES ASSURANCE THAT
it will immediately take any measures necessary to effectuate this agreement.
If any real property structure thereon is provided or improved with the aid of Federal financial
assistance extended to the Applicant by the Department, this assurance shall obligate the Appli-
cant, or in the case of any transfer of such property, any transferee, for the period during which
the real property or structure is used for a purpose for which the Federal financial assistance is
extended or for anc:der purpose involving the provision of sirni_a.r services or benefits. If any per-
sonal property is s o ?: o• ded, this assurance shall obligate the Applicant for the period during
which it retains ov n ership or possession of the property. In all other cases, this assurance shall
obligate the Applicant for the period during which the Federal financial assistance is extended to
it by the Depa<s.rrnen-:.
THIS ASSURANCE is given in consideration of and for the purpose of obtaining any and all Federal
grants, loans, contracts, property, discounts or other Federal financial assistance extended after
the date hereof to the Applicant by the Department, including installment payments after such •
date on account of applications for Federal financial assistance which were approved before such
date. The Applicant recognizes and agrees that such Federal financial assistance will be extended
in reliance on the re_reseritations and agreements made in this assurance, and that the United States
shall have the nigh: to seek judicial enforcement of this assurance. This assurance is binding on
the Applicant, its successors. transferees, and assignees. and the person or persons whose signatures
appear below are au:horized to sign this assurance on behalf of the Applicant.
Date 08/14/85 •
acqu ine sq_- y .. rrtIe Cfbei.VrBsarOfficial
oard of County Commissioners
—(303) 3:3 0540.
\7:a Code — T_._--.- `_—
Weld Ccun=_ Co:zi ssioners/ •
Weld County sion of Human Resources
1516 Hosz)i Lal Rcad
_ P. O.. �0x_ 2E;.5
-
v_i
•
Greeley, Clc:_adc 80632
_:ate Z:-
PLEASE RETURN ORIGINAL TO: Office of Civil Rights
Room 562- B North Buildi-_
?.0 Independence Ave.. N.W.
Washington. DC 20201
•
RETURN COPY TO: GRANTS MANAGEMENT OFFICE •
N4•:GRANT,:"I\\.\GEMEtT
HHS-=:l ! -) IQr GPO 90e-7,5
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