HomeMy WebLinkAbout920755.tiff RESOLUTION
RE: APPROVE GRANT APPLICATION FOR FEDERAL ASSISTANCE BETWEEN EMPLOYMENT
SERVICES OF WELD COUNTY AND NATIONAL INSTITUTE FOR LITERACY AND AUTHORIZE
CHAIRMAN TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado,
pursuant to Colorado statute and the Weld County Home Rule Charter, is vested
with the authority of administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Grant Application for Federal
Assistance between Employment Services of Weld County and National Institute for
Literacy, commencing January 1, 1993, and ending December 31, 1993, with the
further 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 the Grant Application for Federal Assistance between
Employment Services of Weld County and National Institute for Literacy be, and
hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chairman 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 12th day of August, A.D. , 1992.
BOARD OF COUNTY COMMISSIONERS
ATTEST: ffl7d®p WELD COUNTY, COLORADO
Weld County Clerk to the Board EXCUSED
Geor e Kennedy,
ChhaairmaaJn1 ,
BY: \J� JIl�, . �vaa5i -62Ij�-tr�Y QYf�f
Deputy Cldik to the Board Constance L. Harbert, Pro-Tem
APPROVED AS 0 FORM: EXCUSED
C. W. Kirb
County Attorney Gordo c
4,1
W. H. Webster
920755
.gin I I 'IL_
APPENDIX C OMB Approval No.0348-0043
APPLICATION FUR 2 DATE SUBMITTED App cant Identifier
FEDERAL ASSISTANCE August 10, 1992
I. TYPE OF SUBMISSION. 3 DATE RECEIVED SY STATE State Application Identifier
Application Preapplrca non
❑ Construction 0 Construction
y-y 4 DATE RECEIVED BY FEDERAL AGENCY Federal Identifier
AQ Non-Construction O Non-Construction
S. APPLICANT INFORMATION
Legal Name Organizational Unit
Weld County Division of Human Resources Employment Services of Weld County
Address (gore city. county. state and zip Code) Name and telephone number of the person to 6e contacted on matters involnng
this application (give area code)
1551 N. 17th Ave.
P.O. Box 1805 Walter J. Speckman, Executive Director
Greeley, Colorado 80632 Weld County Division of Human Resources
(303)-353-3816
s EMPLOYER IDENTIFICATION NUMBER MIN) T. TYPE OF APPLICANT:(enter aporopnere letter in box) Lal
4 6 D D D B 1 3 A State N Independent School Dist
• B County I State Controlled Institution of Higher Learning
C Municipal J Private University
S. TYPE OF APPLICATION: D Township K. Indian Tribe
XJ(New O Continuation O Revision E. Interstate L Individual
F Intermunicipal M Profit Organization
If Revision enter appropriate Whirls)in boxiest. O El G Special District N. Other(Speedy)
A Increase Award B. Decrease Award C Increase Duration
0 Decrease Duration Other(specify) s. NAME OF FEDERAL AGENCY:
National Institute for Literacy
t0. CATALOG OF FEDERAL DOMESTIC 8 4 • 2 5 7 11. DESCRIPTIVE TITLE OF APPLICANTS PROJECT:
ASSISTANCE NUMBER:
TITLE National Institute for Literacy Weld County Literacy Program
Grants Program
12. AREAS AFFECTED Sr PROJECT(cities.Counties. stales.PIC.)
Weld County, Colorado
i7. PROPOSED PROJECT 14. CONGRESSIONAL DISTRICTS OF.
Start Dale Ending Date a Applicant b Protect
1/1/93 12/31/93 4
IS.ESTIMATED FUNDING IS.IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12377 PROCESS?
a Federal S .W XX a YES THIS PREAPPLICATIOWAPPLIOATION WAS MADE AVAILABLE TO THE
67,156 STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON
O Applicant E 36,396 .00 DATE
c State S .00
D NO O PROGRAM IS NOT COVERED BY E O. 12372
d Local S OD
0 OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW
e Other S oo
t Program Income S 00 IT. IS THE APPLICANT DELINOUENT ON ANY FEDERAL DEBT?
— 0 Yes If 'Yes.'attach an explanation. O( NO
g TOTAL S 103,552 .00
Ia. TO THE BEST OF MY KNOWLEDGE AND BELIEF.ALL DATA IN THIS APPLICATIONAREAPPLICATION ARE TRUE AND CORRECT.THE DOCUMENT HAS BEEN DULY
AUTHORIZED By THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED
a Typed Name or Authorized Representative b Lore CHAIRMAN PRO-TEM c Telephone number
CONSTANCE L. HARBERT Weld County Boarc of County Commissioners (303) 356-4000
_
d //lure of Author,zed Repiesentativ e Dare Signed
-1 08/17/92 08/12/92
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Weld County Literacy Program
A. Executive Summary
The Weld County Board of Commissioners administers all employment and
training programs through the Weld County Division of Human Resources.
The employment and training programs are delivered through the Employment
Services of Weld County, a major department of the Weld County Division of
Human Resources.
The Weld County Private Industry Council shares oversight and planning
responsibilities for the delivery of services through Employment Services.
In this capacity, the Weld County Private Industry Council joins with the
Board of Weld County Commissioners in the development of goals and
objectives, and system design; and the monitoring and evaluation of
program activities.
B. Overall Goals and Objectives
To establish a mobile computerized learning and assessment center which
focuses on family literacy and workplace literacy. The center will be
utilized by adults, youth and their families who reside in rural Weld
County, Colorado.
The project will utilize standardized tests coupled with the Jostens
Invest Adult Learning Program to assess and educate individuals in need of
a literacy program.
The Weld County Private Industry Council and the Board of County
Commissioners have established four overall and continuing goals as
follows:
1. Develop innovative approaches in the coordination and the
delivery of literacy services between agencies and schools.
2. Develop and evaluate state of the art teaching methods
utilizing computer technology in the delivery of literacy
services.
3. Deliver literacy services to economically disadvantaged and
other individuals that need literacy training in rural Weld
County.
4. Assist the welfare applicant and recipient households in rural
Weld County in the achievement of self-sufficiency.
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C. Extent of Need
Weld County will be the geographical area served under this project. Weld
County, Colorado is approximately 4,004 square miles and is located in
north central Colorado.
There are 28 incorporated towns in Weld County. The county seat and
principle city, Greeley, is located in the west central part of the county
and contains approximately 43% of the county's population. Generally,
most of the remaining population resides within a 20 to 30 mile radius of
Greeley; the northeastern part of the county is sparsely populated.
A review of the history and future projections of the population growth in
Weld County reveals a steady increase in the total population. Of
significance is the county's population growth rate of approximately 25%
per decade which is more than triple the national average of 8%. The
population density for this area is approximately 149 people per square
mile. Among the 63 counties in Colorado, Weld County ranks 9th in total
population and population density.
Although Weld County is 9th in the State for total population, labor
market studies done by the University of Northern Colorado, Weld County is
a labor surplus area. The average wage in Weld County is 17% lower than
the State's average wage. Based on information provided by Colorado
Departments of Labor and Employment and Social Services, 15.2% of Weld
County's population are in poverty and 4% are recipients of AFDC (Aid to
Families with Dependant Children) . For the area that this project would
serve there are 271 recipients of AFDC.
Statistics from the Colorado Employment and Training Division indicate
that of the individuals who registered with Weld County Employment
Services between July 1990 and June 1991, 38.4% had less than a 12th grade
education.
The above information indicates that there is a large population in the
rural areas in need of basic literacy services who do not have the means
or the ability to access those services outside their own community. This
project is proposing to deliver quality literacy services to the
individuals in their own communities and making those services available
to the entire family.
D. Plan of Operation/Adequacy of Resources
The intent of the project is to create a mobile computerized learning
center, utilizing ten stand-alone computer stations and the Jostens Invest
Adult Learning system which will serve individuals with restricted
mobility in rural Weld County and who are in need of literacy services.
Coordination agreements have been entered into with two rural school
districts and Right to Read. Right to Read is a community based program
that offers volunteer tutors to assist with adult literacy and English as
a Second Language (ESL) services. The two school districts will provide
classroom space and teaching personnel. Right to Read will refer
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individuals, who are utilizing their services, to the computerized
learning center to enhance the learning process.
Since the focus of small communities is in their schools, the computer
learning center will be placed within the schools to aid in the
accessibility to individuals in the target population located in rural
Weld County communities.
Current services provided through the Stationary Computer Center have
increased the success rate of GED attainment by over 100%. We anticipate,
through utilization of the mobile computerized learning center, a
comparable success rate. By providing mobile learning services, a greater
emphasis will be placed on resolving family and workplace literacy.
E. Quality of Key Personnel
Weld County assures that they will comply with the Title VI of the Civil
Rights Act of 1986, and that no person shall, on the grounds of race,
creed, color, sex, or national origin, be excluded from participation in,
be denied the benefits of, or be otherwise subjected to discrimination.
The project will be supervised, and staff trained, by Charles Dalpra,
Vocational/Education Supervisor, Weld County Division of Human Resources.
Daily support will be provided by Melvin Langshaw, Computer Laboratory
Assistant, Weld County Division of Human Resources. Other Weld County
staff involved in the project will be Ted Long, Special Programs
Coordinator, Donna Cornelius, Youth Technician and Marilyn Carlino, Fiscal
Officer. Other key individuals involved in the project will be Christine
Ingram, Case Manager and Career Counselor, School District RE-5J,
Administrators and other staff as assigned from School District RE-1 and
RE-5J, Judy Knapp, Executive Director, Right to Read of Weld County and
tutors as assigned.
The time that each person will spend on the project is as follows:
Charlie Dalpra, 15%; Melvin Langshaw, 15%; Ted Long, 5%; Donna Cornelius,
15%; and Fiscal Office, 5%.
Charles Dalpra, the Project Supervisor, has 20 years experience in
education, 12 years direct management experience including development,
implementation and supervision of educational programs. He has a Masters .
Degree in Education and Counseling and possesses a teaching and Vocational
certificate from the State of Colorado.
Melvin Langshaw has 26 years vocational/adult education experience and has
20 years as a director of computing services in higher education. He has
a Bachelors Degree in Business Education and a Masters Degree in
Educational Administration and Supervision. Mr. Langshaw also possesses
a life-time teaching certificate from the State of Colorado.
Christine Ingram has 5 years case management and counseling experience
with youth and adults. She has a Bachelors Degree in Community Health
Education with a minor in Psychology.
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F. Budget and Cost-Effectiveness
See Attached
G. Evaluation Plan
The project will be evaluated quarterly by the Project Coordinator, the
Director of the Right to Read Program and the Administrators from the two
participating school districts. Monitoring activities will be primarily
based on increased family involvement in literacy training, adult GED
attainment, and academic improvement in youth participants.
H. Adequacy of Resources
Refer to Section D.
I. Significance
Refer to Section C and D.
J. Technical Soundness
The project will utilize the Jostens Invest Learning System which is based
on the most current research available regarding successful adult learning
methods. The comprehensive INVEST curriculum is built upon the foundation
characteristics of relevancy, privacy, control and success. Learning to
learn is an major adult need, and is one of the central, integrated skills
of the program.
The Jostens Invest Learning System curriculums consist of:
* Literacy * Reading Level 1 to 3
* Adult Basic Education * Reading Level 4 to 8
* GED * Reading Level 9 to GED
The uniqueness of the project is the coupling of the Jostens Invest
Learning System and four community agencies interfacing to maximize
resources and participant success. The characteristics incorporated into
the Jostens Invest Learning System which will increase the success rate of
the participants are:
* Nontraditional learning methods and environments
* Immediate feedback during learning activities
* Relevant, adult content in learning materials
* Skill development specific to individual needs
* Practical applications of literacy skills
* Small sequential learning increments
* Integrated learning activities reflecting adult life experiences
* Flexible time frames and locations to meet the need of rural
individuals
* Self-paced programs
* Open-entry/open-exit programs 920755
Adults seeking literacy skills have not, for various reasons, been
successful in the traditional learning environments. This lack of success
has often resulted in low self esteem and expectations of failure. This
project and its innovative approach to family literacy will increase the
participants success and enhance their ability to become self-sufficient.
920755
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BREAKDOWN OF LINE ITEM COSTS i
A. PERSONNEL&
B. FRINGE BENEFITS
ANNUAL SALARY PERCENTAGE SALARY X FRINGE
OF TIME TIME @21%
DIRECTOR OF VOCATIONAL SERVICES $21,767.40 15.00% $3,265.11 $685.67
DIRECTOR OF ADULT/YOUTH SERVICES $21,115.32 5.00% $1,055.77 $221.71
YOUTH SERVICES TECHNICIAN $17,837.64 15.00% $2,675.65 $561.89
COMPUTER LAB SPECIALIST $8,580.00 15.00% $1,287.00 $270.27
ACCOUNTANT $21,226.56 5.00% $1,061.33 $222.88
TOTAL PERSONNEL $9,344.85 $1,962.42
E. EQUIPMENT
THE FOLLOWING FIGURES FROM PROPOSAL
FROM JOSTENS LEARNING CORP.
INCLUDES JOSTENS ADD ON LICENSE;
STAND ALONE INVEST STATION
SOFTWARE INSTALLATION
INSTRUCTIONAL SOFTWARE
MANAGEMENT SOFTWARE $1,500.00
ADD ON SUPPORT SERVICES;
SOFTWARE ENHANCEMENTS/REPLACEMENTS
REMOTE DIAGNOSTICS/TA
DOCUMENTATION AND SUPPLIES $450.00
HARDWARE;
JOSTENS LEARNING 386SX, 25 MHz, 1MB
RAM, 1.44 DISK DRIVE, DOS 5.0, MOUSE
KEYBOARD, VGA COLAR MONITOR, 120 MB
IDE HARD DRIVE, INTERNAL CD-ROM D $1,950.00
DIGISPEECH ADAPTOR $153.00
LEXMARK PRINTER W/CABLE $347.00
CD ROM DRIVE CLEANING KIT $32.00
HEADSET $10.00
MULTI OUTLET BOX W/SURGE SUP. $12.00
TOTAL PER STATION $4,454.00
X 10 STATIONS=
TOTAL EQUIPMENT $44,640.00
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E. SUPPLIES
STATION SUPPLIES
@$325/STATION $3,250.00
F. OTHER
OVERHEAD @ 11% STAFF COSTS $1,258.81
STAFF TRAVEL TO SITES
@$500 X 3 $1,500.00
OUTREACH STAFF TRAINING
4 @$200 $800.00
HARDWARE/SOFTWARE MAINTENANCE $4,500.00
TOTAL OTHER $8,058.81
........................... .
G!'#AND TOTAL $87t158.08
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NON-FEDERAL RESOURCES
BREAKDOWN
RIGHT TO READ TUTORS VOLUNTEER TIME;
@$10/HR FOR A TOTAL OF 144 $1,440.00
WELD SCHOOL DISTRICT RE-1;
ESTIMATES OF INKIND INSTRUCTOR CO $15,000.00
ESTIMATES OF INKIND FACILITY COSTS $2,000.00
WELD SCHOOL DISTRICT RE-5J;
ESTIMATES OF INKIND INSTRUCTIONAL $17,956.00
TOTAL NON-FEDERAL $36,396.00
920755
Certification Regarding Lobbying
Certification for Contracts , Grants . Loans ,
and Cooperative Agreements
The undersigned certifies , to the best of his or her knowledge
and belief, that:
• (1) No Federal appropriated funds have been paid or will be
paid , by or on behalf of the undersigned, 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 awarding of any Federal contract, the making of any
Federal grant, the making of any Federal loan, the entering
into of any cooperative agreement, and the extension ,
continuation, renewal , amendment, or modification of any
Federal contract, grant , loan, or cooperative agreement.
(2 ) If any funds other than Federal appropriated funds have
been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any agency, a
Member of Congress , an officer or employee of Congress , or an
employee of a Member of Congress in connection with this
Federal contract, grant, loan or cooperative agreement , the
undersigned shall complete and submit Standard Form-LLL,
"Disclosure Form to Report Lobbying, " in accordance with its
instructions.
(3 ) The undersigned shall require that the language of this
certification be included in the award documents for all
subawards at all tiers (including subcontracts , subgrants , and
contracts under grants , loans , and cooperative agreements) and
that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon
which reliance was placed when this transaction was made or
entered into. Submission of this certification is a
prerequisite for making or. entering into this transaction
imposed by section 1352 , title 31, U.S . Code. Any person who
fails to file the required certification shall be subject to a
civil penalty of not less than $10, 000 and not more than
$100, 000 for each such failure.
WELD COUNTY BOARD OF COMMISSIONERS
Organization
_ CHAIRMAN
./ —zee CEO-TEM 08/12/92
Authorized Signature Title Date
08/17/92
NOTE: If Disclosure Forms are required, please contact: Mr.
William Sexton, Deputy Director, Grants and Contracts
Management Division, Room 341F, HHH Building, 200 Independence
Avenue , SW, Washington, D. C. 20201-000155
Appendix D - Executive Order 12372-State Single Points of
Contact
Alabama
Mrs . Moncell Thornell, State Single Point of Contact, Alabama
Department of Economic and Community Affairs , 3465 Norman
Bridge Road, Post Office Box 250347, Montgomery, Alabama
36125-0347 , Telephone (205) 280-1315
Arkansas
Mr. Joseph Gillespie, Manager, State Clearinghouse, Office of
Intergovernmental Services , Department of Finance and
Administration, P.O. Box 3278 , Little Rock, Arkansas 72203 ,
Telephone (501) 371-1074
California
State Single Point of Contact, State Clearinghouse, Division
of Local Government, 1313 Sherman Street, Room 520, Denver,
Colorado 80203 , Telephone (303) 866-2156
Connecticut
Under Secretary
ATTN: Intergovernmental Review Coordinator, Comprehensive
Planning Division, Office of Policy and Management,
80Washington Street, Hartford, Connecticut 06106-4459 ,
Telephone (203) 566-3410
Delaware
Francine Booth, State Single Point of Contact, Executive
Department, Thomas Collins Building, Dover, Delaware 19903 ,
Telephone (302) 736-3326
District of Columbia
Lovetta Davis, State Single Point of Contact, Executive OFfice
of the Mayor, Office of Intergovernmental Relations, Room 416,
District Building, 1350 Pennsylvania Avenue, NW, Washington,
DC 20004 , Telephone (202) 727-9111
Florida
Karen McFarland, Director, Florida State Clearinghouse,
Executive Office of the Governor, Office of Planning and
Budgeting, The Capitol, Tallahassee, Florida 32399-0001,
Telephone (904) 488-8114
92075s
U.S. Department of Health and Human Services
Certification Regarding Drug-Free Workplace Requirements
Grantees Other Than Individuals
By signing and/or submitting this application or grant agreement, the grantee is providing the certification
set out below.
This certification is required by regulations implementing the Drug-Free Workplace Act of 1988,45 CFR Part 76,Subpart
F. The regulations,published in the May 25,1990 Federal Register,require certification by grantees that they will maintain
a thug-free workplace. The certification set out below is a material representation of fact upon which reliance will be placed
when the Department of Health and Human Services (HHS) determines to award the grant. If it is later determined that
the grantee knowingly rendered a false certification, or otherwise violates the requirements of the Drug-Free Workplace
Act,HHS,in addition to any other remedies available to the Federal Government,may taken action authorized under the
Drug-Free Workplace Act. False certification or violation of the certification shall be grounds for suspension of payments,
suspension or termination of grants,or governmentwide suspension or debarment.
Workplaces under grants,for grantees other than individuals,need not be identified on the certification. If known,they
may be identified in the grant application. If the grantee does not identify the workplaces at the time of application,or upon
award, if there is no application, the grantee must keep the identity of the workplace(s) on file in its office and make the
information available for Federal inspection. Failure to identify all known workplaces constitutes a violation of the grantee's
drug-free workplace requirements.
Workplace identifications must include the actual address of buildings(or parts of buildings) or other sites where work
under the grant takes place. Categorical descriptions may be used (e.g., all vehicles of a mass transit authority or State
highway department while in operation,State employees in each local unemployment office,performers in concert halls or
radio studios.)
If the workplace identified to HHS changes during the performance of the grant,the grantee shall inform the agency of
the change(s), if it previously identified the workplaces in question (see above).
Definitions of terms in the Nonprocurement Suspension and Debarment common rule and Drug-Free Workplace
common rule apply to this certification. Grantees' attention is called, in particular,to the following definitions from these
rules:
"Controlled substance" means a controlled substance in Schedules I through V of the Controlled Substances Act (21
USC 812) and as further defined by regulation (21 CFR 1308.11 through 1308.15).
"Conviction" means a finding of guilt (including a plea of nob contendere) or imposition of sentence, or both, by any
judicial body charged with the responsibility to determine violations of the Federal or State criminal drug statutes;
"Criminal drug statute" means a Federal or non-Federal criminal statute involving the manufacture, distribution,
dispensing,use,or possession of any controlled substance;
"Employee' means the employee of a grantee directly engaged in the performance of work under a grant,including: (i)
All"direct charge" employees; (ii) all"indirect charge- employees unless their impact or involvement is insignificant to the
performance of the grant; and, (iii) temporary personnel and consultants who are directly engaged in the performance of
work under the grant and who are on the grantee's payroll. This definition does not include workers not on the payroll of
the grantee (e.g.,volunteers, even if used to meet a matching requirement; consultants or independent contractors not on
the grantee's payroll; or employees of subrecipients or subcontractors in covered workplaces).
The grantee certifies that it will or will continue to provide a drug-free workplace by:
(a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or
use of a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be taken against
employees for violation of such prohibition;
(b) Establishing an ongoing drug-free awareness program to inform employees about:
(1)The dangers of drug abuse in the workplace; (2)The grantee's policy of maintaining a drug-free workplace; (3) Any
available drug counseling,rehabilitation,and employee assistance programs; and, (4) The penalties that may be imposed
upon employees for drug abuse violations occurring in the workplace;
(c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the
statement required by paragraph (a);
(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the
grant, the employee will:
(1)Abide by the terms of the statement;and, (2)Notify the employer in writing of his or her conviction for a violation
of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction;
(e) Notifying the agency in writing,within ten calendar days after receiving notice under subparagraph (d)(2) from an
employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice,
including position title,to every grant officer or other designee on whose grant activity the convicted employee was working,
unless the Federal agency has designated a central point for the receipt of such notices. Notice shall include the
identification number(s) of each affected grant;
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(f) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (d)(2), with
respect to any employee who is so convicted:
(1)Taking appropriate personnel action against such an employee,up to and including termination,consistent with the
requirements of the Rehabilitation Act of 1973, as amended; or, (2) Requiring such employee to participate satisfactorily
in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law
enforcement, or other appropriate agency;
(g)Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a),
(b), (c), (d), (e) and (f).
The grantee may insert in the space provided below the site(s) for the performance of work done in
connection with the specific grant (use attachments, if needed):
Place of Performance (Street address,City,County,State,ZIP Code)
Check_if there are workplaces on file that are not identified here.
Sections 76.630(c) and (d)(2) and 76.635(a)(1) and (b) provide that a Federal agency may designate a central receipt
point for STATE-WIDE AND STATE AGENCY-WIDE certifications,and for notification of criminal drug convictions.
For the Department of Health and Human Services, the central receipt point is: Division of Grants Management and
Oversight, Office of Management and Acquisition, Department of Health and Human Services, Room 517-D, 200
Independence Avenue,S.W.,Washington,D.C.20201.
DGMO Form+12 Revised May 1990
Certification Regardinc Debarment , Suspension , and Other
gesoonsibility Matters - Primary Covered Transactions
By signing and submitting this proposal , the applicant, defined as
the primary participant in accordance with 45 Cl?. Part 76 ,
certifies to the best of its knowledge and believe that it and its
principals :
(a) are not presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from
covered transactions by any Federal Department or agency;
(b) have not within a 3-year period preceding this
proposal been convicted of or had a civil judgment rendered against
them for commission of fraud or a criminal offense in connection
with obtaining, attempting to obtain, or performing a public
(Federal , State, or local) transaction or contract under a public
transaction; violation of Federal or State antitrust statutes or
commission of embezzlement, theft, forgery, bribery, falsification
or destruction of records, making false statements, or receiving
stolen property;
(c) are not presently indicted or otherwise criminally or
civilly charged by a governmental entity (Federal , State of local)
with commission of any of the offenses enumerated in paragraph ( 1)
(b) of this certification; and
(d) have not within a 3-year period preceding this
application/proposal had one or more public transactions (Federal ,
State , cr local) terminated for cause or default.
The inability of a person to provide the certification required
above will not necessarily result in denial of participation in
this covered transaction. If' necessary, the prospective
participant shall submit an explanation of why it cannot provide
the certification. The certification or explanation will be
considered in connection with the Department of Health and Human
Services (HHS) determination whether to enter into this
transaction. However, failure of the prospective primary
participant to furnish a certification or an explanation shall
disqualify such person from participation in this transaction.
' The prospective primary participant agrees that by submitting this
proposal , it will include the clause entitled "Certification
Regarding Debarment, Suspension, Ineligibility, and Voluntary
Exclusion - Lower Tier Covered Transaction. " provided below
without modification in all lower tier covered transactions and in
all solicitations for lower tier covered transactions.
92J755
ca ion Regarding Debarment Suscension Ineligibility and
Voluntary Exclusion - Lower Tier Covered Transactions
(To Be Supplied to Lower Tire Participants)
By signing and submitting this lower tier proposal , the prospective
lower tier participant, as defined in 45 CFR Part 76 , certifies to
the best of its knowledge and belief that it and its principals:
(a) are not presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any federal department or
agency.
(b) where the prospective lower tier participant is
unable to certify to any of the above, such prospective participant
shall attach an explanation to this proposal.
The prospective lower tier participant further agrees by submitting
this proposal that it will include this clause entitled
"certification Regarding Debarment, Suspension, Ineligibility, and
Voluntary Exclusion - Lower Tier Covered Transactions. "without
modification in all lower tier covered transactions and in all
solicitations for lower tier covered transactions.
9
OW Approval No.0348-OC40
ASSURANCES - NON-CONSTRUCTION PROGRAMS
Note: Certain of these assurances may not be applicable to your project or program. If you have questions.
please contact the awarding agency. Further, certain Federal awarding agencies may require applicants
to certify to additional assurances. If such is the case,you will be notified.
As the duly authorized representative of the applicant I certify that the applicant:
• 1. Has the legal authority to apply for Federal (e) the Drug Abuse Office and Treatment Act of
assistance, and the institutional, managerial and 1972 (P.L. 92.255), as amended, relating to
financial capability (including funds sufficient to nondiscrimination on the basis of drug abuse: (1)
pay the non-Federal share of project costs) to the Comprehensive Alcohol Abuse and Alcoholism
ensure proper planning, management and com- Prevention, Treatment and Rehabilitation Act of
pletion of the project described in this application. 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
2. Will give the awarding agency, the Comptroller alcoholism;(g) §§ 523 and 527 of the Public Health
General of the United States, and if appropriate, Service Act of 1912(42 U.S.C. 290 dd-3 and 290 ee-
the State, through any authorized representative, 3), as amended, relating to confidentiality of
access to and the right to examine all records, alcohol and drug abuse patient records: (h) Title
books, papers, or documents related to the award; VIII of the Civil Rights Act of 1968 (42 U.S C. §
and will establish a proper accounting system in 3601 et seq.), as amended, relating to non-
accordance with generally accepted accounting discrimination in the sale, rental or financing of
standards or agency directives. housing; (i) any other nondiscrimination
3. Will establish safeguards to prohibit employees provisions in the specific statute(s) under which
from using their positions for a purpose that application for Federal assistance is being made:
constitutes or presents the appearance of personal and (j) the requirements of any other
or organizational conflict of interest, or personal nondiscrimination statute(s) which may apply to
gain. the application.
4. Will initiate and complete the work within the 7. Will comply, or has already complied, with the
applicable time frame after receipt of approval of requirements of Titles II and III of the Uniform
the awarding agency. Relocation Assistance and Real Property
Acquisition Policies Act of 1970 (P.L. 91-646)
5. Will comply with the Intergovernmental which provide for fair and equitable treatment of
Personnel Act of 1970 (42 U.S.C. §§ 4728-4763) persons displaced or whose property is acquired as
relating to prescribed standards for merit systems a result of Federal or federally assisted programs.
for programs funded under one of the nineteen These requirements apply to all interests in real
statutes or regulations specified in Appendix A of property acquired for project purposes regardless
OPM's Standards for a Merit System of Personnel of Federal participation in purchases.
Administration(5 C.F.R. 900, Subpart F). -
- 8. Will comply with the provisions of the Hatch Act
6. Will comply with all Federal statutes relating to (5 U.S.C. §§ 1501-1508 and 7324-7328) which limit
nondiscrimination. These include but are not the political activities of employees whose
limited to: (a) Title VI of the Civil Rights Act of principal employment activities are funded in
1964 (P.L. 88-352) which prohibits discrimination whole or in part with Federal funds.
on the basis of race, color or national origin; (b)
Title IX of the Education Amendments of 1972, as 9. Will comply, as applicable, with the provisions of
amended(20 C.S.C. §§ 1681.1683, and 1685-1686), the Davis-Bacon Act (40 U.S C. §§ 276a to 276a-
which prohibits discrimination on the basis of sex; 7), the Copeland Act (40 U.S.C. § 276c and 18
(c) Section 504 of the Rehabilitation Act of 1973, as U.S.C. §§ 874), and the Contract Work Hours and
amended (29 C.S.C. § 794), which prohibits dis- Safety Standards Act (40 U.S.C. §§ 327-333),
crimination on the basis of handicaps; (d) the Age regarding labor standards for federally assisted
Discrimination Act of 1975, as amended (42 construction subagreernents.
C S C.§§ 6101-6107), which prohibits discrim-
ination on the basis of age;
Standard Form 4240 (4.88)
Prescr,oed ay GUS Circular A•r02
Authorized for Local Reproduction 920755
10. Will comply, if applicable, with flood insurance 13. Will assist the awarding agency in assuring
purchase requirements of Section 102(a) of the compliance with Section 106 of the National
Flood Disaster Protection Act of 1973 (P.L. 93-234) Historic Preservation Act of 1966, as amended (16
which requires recipients in a special flood hazard U.S.C. 470), ED 11593 (identification and
area to participate in the program andto purchase protection of historic properties), and the
flood insurance if the total cost of insurable Archaeological and Historic Preservation Act of
construction and acquisition is $10,000 or more. 1974 (16 U.S.C. 469a-1 et seq.).
11. Will comply with environmental standards which 14. Will comply with P.L. 93-348 regarding the
may be prescribed pursuant to the following: (a) protection of human subjects involved in research,
institution of environmental quality control development, and related activities supported by
measures under the National Environmental this award of assistance.
Policy Act of 1969 (P.L. 91-190) and Executive 15. Will comply with the Laboratory Animal Wtifare
Order (ED) 11514; (b) notification of violating Act of 1966 (P.L. 89-544, as amended, 7 U.S.C.
facilities pursuant to EO 11738; (c) protection of 2131 et seq.) pertaining to the care, handling, and
wetlands pursuant to EO 11990; (d) evaluation of treatment of warm blooded animals held for
flood hazards in floodplains in accordance with EO research,teaching,or other activities supported by
11988, (e) assurance of project consistency with this award of assistance.
the approved State management program
developed under the Coastal Zone Management 16. Will comply with the Lead-Based Paint Poisoning
Act of 1972 (16 U.S.C. §§ 1451 et seq.); (O Prevention Act (42 U.S.C. §§ 4801 et seq.) which
conformity of Federal actions to State (Clear Air) prohibits the use of lead based paint in
Implementation Plans under Section 176(c) of the construction or rehabilitation of residence
Clear Air Act of 1955, as amended (42 U.S.C. § structures.
7401 et seq.): (g)protection of underground sources 17. Will cause to be performed the required financial
of drinking water under the Safe Drinking Water and compliance audits in accordance with tne
Act of 1974, as amended, (P.L. 93-523); and (h) Single Audit Act of 1984.
protection of endangered species under the
Endangered Species Act of 1973, as amended,(P.L. 18. Will comply with all applicable requirements of all
93-205). other Federal laws, executive orders, regulations
and policies governing this program.
12. Will comply with the Wild and Scenic Rivers Act
of 1968 (16 U.S.C. §§ 1271 et seq.) related to
protecting components or potential components of
tne national wild and scenic rivers system.
E SNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE
1, CONSTANCE L. HARBERT
![-� --G., / / ( CHAIRMAN PRO-TEM
e-�-� � � �/G� /17/92
APPLICANT ORGANIZATION DATE SUBMITTED
WELD COUNTY BOARD OF COMMISSIONERS 08/12/92
,\I I-LIST") / /7/Let
R/oi4Livl /(7'v(/
-;,r, I Tr, 3CARD
LL. 'UTY CLER TO THE BOARD
SF9Vl04
MEMORAnDU
wokTo George Kennedy, Chairman Date August 10, 1992 ++ //
COLORADO From Walter J. Speckman, Executive Director of Human Resourced/1,ij
Subject Application for National Literacy Grant
Enclosed for Board approval is the Weld County application for the
National Literacy Grant.
The application requests funds in the amount of $75,000.00 to
purchase and operate family literacy programs in rural Weld County.
The funds will be utilized to purchase a mobile computer lab which
will consist of ten computer learning stations. The systems will be
placed in two rural schools for access by the community. The
application coordinates services between Right to Read, Weld County
School District RE-1 and RE-5J.
If you have any questions, please telephone me at 353-3816.
920755
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