HomeMy WebLinkAboutC03-098 Early Head Start GrantAPPLICATION FOR DATE SUBMITTED: Applicant I er 08YC0023 ~`~ ~ ~
"FEDERAL ASSISTANCE
1. TYPE OF SUBMISSION 3. DATE RECEIVED BY STATE: State Application Identifier
Applicatlon Preappl/catlon
Construction ~ Construction 4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier
X Non-Construction ~ Non-Construction
5. APPLICANT INFORMATION
Leal Name: Health & Human Services Eagle County EHS Organizational Un(t Health & Human Services Eagle County EHS
Address (give dry, county, state, and zip code) Name and telephone number of the person to be contacts on matters involving
POB 660
500 Broadway titis
Kathleen Forinash 970-328-8858
Eagle, CO 81631 Eagle Executive Director
6. EMPLOYER IDENTIFICATION NUMBER (EIN) 7. TYPE OF APPLICANT (enter appropriate latter In box) ~g
8 4 ~ 6 0 0 0 7 6 2 A. State H. Independent School Dist
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8. TYPE OF APPLICATION C. Munidpal J. Private University
New ~ Continuation ~ Revision D. Township K. Indian Tribe
E. Interstate L. Ind>vidual
F. Intermunidpal M. Prof(t Organization
If Revision, enter appropriate letter(s) in box(es): ~ ^ G. Spedal District N. Otirer (specfy)
A. Increase Award B. Decrease Award C. Increase Durstion 9. NAME OF FEDERAL AGENCY
D. Decrease Duration Other (specify):
10. CATALOG OF FEDERAL DOMESTIC 9 3 ^ - 6 0
CE NUMBER 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
:
ASSISTAN Eagle County Early Head Start
TITLE: Early Head Start
12. AREAS AFFECTED BY PROJECT
Eagle County, Colorado
13. PROPOSED PROJECT: 14. CONGRESSIONAL DISTRICTS O F:
Start Date Ending Date a Applicant 3rd District ~ b. Protect 3rd District
8/01!2003 7131/2004 ~
15. ESTIMATED FUNDING 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS?
a. YES THIS PREAPPLICATIONIAPPLICATION WAS MADE AVAILABLE TO THE STATE
a Federal $ 379,390.00 EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON
b Applicant $ 94,848.00 DATE
c Site $ .00 b NO ~ PROGRAM IS NOT COVERED BY E.0.12372
d Local $ .00 ® OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW
e Other $ .00
IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
17
.
f Program Income $ .00
~ No
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g Total $ 474,238.00
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION 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 of Authorized Representative ~~
Michael Gallagher p~ ~ b Titre
le County Board of County Commissioners, C c Telephone number
970-328605
b Signature o Rep e ~ a e Date Signed
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U,S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
COMPENDIUM OF REQUIRED CERTIFICATIONS AND ASSURANCES
SF 4246
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 noted.
As the duly authorized representative of the applicant, 1 certify that the applicant:
1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial
capability (including funds sufficient to pay the non-Federal share of project costs) to ensure proper
planning, management and completion of the project described in this application.
2. X11 give the awarding agency, the Comptroller General of the United States, and if appropriate, the
State, through any authorized representative, access to and the right to examine all records, books,
papers, or documents related to the award; and will establish a proper accounting system in accordance
with generally accepted accounting standards or agency directives.
3. ill establish safeguards to prohibit employees from using their positions for a purpose that constitutes
or presents the appearance of personal or organizational conflict of interest, or personal gain.
4. X11 initiate and complete the work within the applicable time frame after receipt of approval of the
awarding agency.
5. ill comply with the intergovernmental Personnel Act of 1970 (42 U.S.C. 4278-4763) relating to
prescribed standards for merit systems for programs funded under one of the nineteen statutes or
regulations specified in Appendix A of OPM=s Standards for a Merit System of Personnel Administration
(5 CFR 900, Subpart F).
6. ill comply with all Federal statutes relating to non-discrimination. These include but are not limited to:
(a) Tale VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the bases of
race, color or national origin; (b) Tale IX of the Education Amendments of 1972, as amended (20 U.S.C.
1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the
Rehabilitation Act of 1973, as amended (29 U.S.C. 794), which prohibits discrimination on the basis of
handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U. S. C. 6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as
amended, relating to non-discrimination on the basis of drug abuse; (t) the Comprehensive Alcohol Abuse
and Afcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating
to non-discrimination on the bases of alcohol abuse or alcoholism; (g) 523 and 527 of the Public Health
Service Act of 1912 (42 U. S. C. 290 dd-3 and 290 ee-3), as amended, relating to confidentiality of the
alcohol and drug abuse patient records; (h) Title Vll of the Civil Rights Act of 1968 (42 U.S.C. 3601 et
seq.), as amended, relating to non-discrimination in the sale, rental or financing of housing; (1) any other
non-discrimination provisions in the speck statute(s) under which application for Federal assistance is
being made; and Q) the requirements of any other non-discrimination statute(s) which may apply to the
application.
7. X11 comply, or has already complies, with the requirements of TrtJes 11 and 111 of the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970 (P. L. 91-646) which provide for fair and
equitable treatment of persons displaced or whose property is acquired as a result of Federal or Federally
assisted programs. These requirements apply to all interests in real property acquired for project
purposes regardless of Federal participation in purchases.
8. Wll comply with the provisions of the Hatch Act (5 U.S.C. 1501-1508 and 7324-7328) which limit the
political activities of employees whose principal employment activities are funded in whole or in part with
Federal funds.
9. ill comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C. 276a to 276a-7), the
Copeland Act (40 U.S.C. 276c and 18 U.S.C. 874), and the Contract Work Hours and Safety Standards
Act (40 U.S.C. 327-333), regarding labor standards for Federally assisted construction subagreements.
10. ill comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood
Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to
participate in the program and to purchase flood insurance if the total cost of insurable construction and
acquisition is $10, 000 or more.
11. ill comply with environmental standards which maybe prescribed pursuant to the following: (a)
institution of environmental quality control measures under the National Environmental Policy Act of 1969
(P. L. 91-190) and Executive Order (EO) 11514; (b) not cation of violating facilities pursuant to EO 11738;
(c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodp/ains in
accordance with EO 11988; (e) assurance of project consistency with the approved State management
program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. 1451 et seg.); (f)
conformity of Federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear
Air Act of 1955, as amended (42 U.S.C. 7401 et seq.); (g) protection of underground sources of drinking
water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of
endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205)
12. ill comply with the ~Id and Scenic Rivers Act of 1968 (16 U. S. C. 1271 et seq.) related to protecting
components or potential components of the national wild and scenic rivers system.
13. Wll assist the awarding agency in assuring compliance with Section 106 of the National Historic
Preservation Act of 1966, as amended (16 U.S.C. 470), EO 11593 (ident~cation and protection of historic
properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. 469a-1 et seg.).
14. X11 comply with P.L. 93-348 regarding the protection of human subjects involved in research,
development, and related activities supported by this award of assistance.
15. ill comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. 2131
et seg.) pertaining to the care, handling, and treatment of want blooded animals held for research,
teaching, or other activities supported by this award of assistance.
16. X11 comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4801 of seq.) which
prohibits the use of lead based paint in the construction or rehabilitation of residence structures.
17. ill cause to be pertormed the required financial and compliance audits in accordance with the single
Audit Act of 1984.
18. X11 comply with all applicable requirements of all other Federal laws, executive orders, regulations and
policies governing this program.
• •
DRUG-FREE WORKPLACE REQUIREMENTS
GRANTEES OTHER THAN INDIVIDUALS
By signing and/or submitting this application or grant agreement, the grantee is providing the cert~cation set
out below.
This cert~cation is required by regulations implementing the Drug-Free Workplace Act of 1988, 45 CFR, Part
76, Subpart F. The regulations published in the January 31, 1989 Federal Register, require cert~cation by
grantees that they will maintain adrug-free workplace. The cert~cation set out below is a material
representation of fact upon which reliance will be placed when HHS determines to award the grant. False
cert~cation or violation of the cert~cation shall be grounds for suspension of payments, suspension or
termination of grants, or government wide suspension or debarment.
Workplaces under grants, for grantees other than individuals, need not be identified on the cert~cation. If
known, they maybe 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 ident~cations must include the actual address of buildings (or parts of building) or other sites
where work under the grant takes place. Categorical descriptions maybe used (e.g. all vehicles of a mass
transit authority of State highway department while in operation, State employees in each local unemployment
office, pen`ormers in concert halls or radio studios).
If the workplace ident~ed to HHS changes during the pertormance of the grant, the grantee shall inform the
agency of the change(s), 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 1 through V of the Controlled Substances
Act (21 USC 812) and as further defined by regulations (21 CFR, 1308.11 through 1308.15). "Conviction"
means a finding of guilt (including a plea of polo contendere) or imposition of sentence, orboth, by any judicial
body charged with the responsibility to determine violations of the Federal of State criminal drug statutes;
"Criminal drug statute"means aFederal ornon-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 pertormance of work under a grant including: (i) All "direct charge" employees; (ii) all
"indirect charge"employees unless their impact of involvement is insignificant to the pertormance of the grant;
and (iii) temporary personnel and consultants who are directly engaged in the pertormance 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 cert~es that it will provide adrug-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 adrug-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, 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 be 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 teens of the statement; and
(2) Notify the employer of any criminal drug statute conviction fora violation occurring in
fhe workplace no later Phan five days after such conviction;
e) Notifying the agency in writing within ten 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 the convicted employee was working, unless the Federal
agency has designated a central point for the receipt of such notices. Notice shall include the
ident~cation number(s) of each affected grant;
fl Taking one of the following actions within 30 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 adrug-free workplace through
implementation of paragraphs (a) through (f).
CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE
Public Law 103-227, also known as the Pro-Children Act of 1994 (Act), requires that smoking not be permitted
in any portion of any indoor facility owned or leased or contracted for by an entii and used routinely or
regularly for the provision of health, day care, early childhood development services, education or library
services to children under the age of 18, if the services are funded by Federal program either directly or
through State or/oca/ governments, byFedera/ grant, contract, loan, orloan guarantee. The lawalso applies
to children's services that are provided in indoor facilities that are constructed, operated, or maintained with
such Federal funds. The law does not apply to children's services provided in private residences; portions of
facilities used for inpatient drug or alcohol treatment; service providers whose sole source of applicable
Federal funds in medicare of medicaid; or facilities where WIC coupons are redeemed. Failure to comply with
the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000 for each
violation and/or the imposition of an administrative compliance order on the responsible entity.
By signing this certification, the offeror/contractor (for acquisitions) or applicant/grantee (for grants) cert~es
that the submitting organization will comply with the requirements of the Act and will not allow smoking within
any portion of any indoor facility used for the provision of services for children as defined by the Act.
The submitting organization agrees that it will require that the language of this cert~cation be included in any
subawards which subrecipients shall certify accordingly.
• •
CERTIFICATION REGARDING DEBARMENT, SUSPENSION AND OTHER
RESPONSIBILITY MATTERS -PRIMARY COVERED TRANSACTIONS
By signing and submitting this proposal, the applicant, defined as the primary participant in accordance whh 45
CFR Part 76 cerf~es to the best of his or her knowledge and believe that it and its principals:
(a) are not presently debarred, suspended, proposed for.debarment, declared ineligible or voluntarily
excluded from covered transaction by any Federal Department or agency;
(b) have not within a 3-year period preceding this proposal been convicted or had a civil judgement
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, falsecation or destruction of records, making false statement, or receiving
stolen property;
(c) are not presently indicted or otherwise criminally or civilly charged by a governmental enfity (Federal,
State or local) with commission of any of the offenses enumerated in paragraph (7) (b) of this
cert~cation; and
(d) have not within a 3-year period preceding this applicatioMproposal had one ormore public transaction
(Federal, State or 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 prospecYrve participant shall submit an explanation
of why it cannot provide the cert~cation. 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 Phis transaction.
The prospective primary participant agrees that by submitting this proposal, it will include the clause entitled
"Cert~cation Regarding Debarment, Suspension, Ineligibility and Voluntary. Exclusion -Lower Tier Covered
Transactions, "provided below without mod cation in all lower tier covered transactions.
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARYEXCLUSION -LOWER TIER COVERED TRANSACTIONS
(TO BE SUPPLIED TO LOWER TIER PARTICIPANTS)
By signing and submitting this lower tier proposal, the prospective lower tier participant, as defined in 45 CFR,
Part 76, cert~es 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 "Cert~cation 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.
•
•
CERTIFICATION REGARDING LOBBYING
FOR CONTRACTS, GRANTS, LOANS
AND COOPERATIVE AGREEMENTS
The undersigned certffies to the best of his or her knowledge and belief, that:
(1) No Federal appropriate 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 ormodffication 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
influencing or attempting to influence an officer or employee or an agency, a memberof 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
Sfandard Form LLL, "Disclosure Form to Report Lobbying,"in accordance with its instructions.
(3) The undersigned shall require that the language of this certffication 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 certffication is a material representation of fact upon which reliance was placed when this transaction was
made or entered into. Submission of this certffication 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 subjecf to a civil penalty or not less than $10, 000 and not more than $100, 000 for each such failure.
1 here to th a certfficati and assurances.
~-~~ Cz ~
Signature of rtifying Offici Date
y ~ ~~'~ ~°
Tale -'
~ '~
Applicant O anization c°cosP9®
• •
Eagle County Early Head Start
Budget Justification -continuing application 5th year
August 1, 2003 through July 31, 2004
a. PERSONNEL (object class 6a)
Position -total fte Federal non-federal
Early Head Start Director .9 fte .9fte -0-
(Health Coordinator/Family & Community Partnerships)
Family Services Coordinator .75 fte .55 fte .20 fte
(Disabilities Coordinator/Education Coordinator/home visitor supervisor)
Home Visitors** 4.5 fte 4.5 fte -0-
Fiscal Tech .OS fte*
Executive Director (Administrative) -0- .1 Ofte*
Accountant -0- .OS fte'
Group Socialization Assistance (5 hours per GS) 0.24 fte
Child care provider for Policy CounciVParent Meetings 0.06 fte
TOTAL 6.25fte 0.4 fte
* as documented by time sheets.
b. FRINGE BENEFITS (object class 6b)
In addition to mandatory benefits, EHS provides health care coverage and life insurance for
individuals and families. The average cost of coverage is $ 12,089. Retirement benefits begin after
one full year of employment. EHS's contribution is 6 % of gross salary. Fringe benefit costs are
prorated according to the federaVnon-federal allocation of fte.
c. TRAVEL (object class 6 c)
This item represents out of county travel by the Early Head Start Director and Family Services
Coordinator to participate in regional meetings and for program coordination with the Roaring Fork
portion of Eagle County which is separated from the Eagle River Valley by 55 miles and which must
be reached by travel through another county.
Federal Costs:
5015 miles @ .345/mile = 1,731
24 meals @ 10.50/meal = 252
1,983
d. EQUIPMENT (object class 6d) No equipment purchases are planned for this program year.
e. SUPPLIES (object class 6e) Consumable and non-capital durable supplies.
Federal Costs:
Office supplies _ $1,150
Home visitation materials ~ 3,700
Playground Package 3,000
Parent Policy Council materials 800
Food for parent meetings and group socializations 7,000
Food for Health Advisory Committee 160
Socialization materials 2,000
Family & Staff reference materials 757
18,567
•
Eagle County Early Head Start
Budget Justification -continuing application 5th year
August 1, 2003through July 31, 2004
f. CONTRACTUAL (object class 6~
Program evaluator
Staff Mental Wellness
2,500
1,500
4,000
g. CONSTRUCTION (object class 6g) The program has no plans for construction costs.
b. Other (Object Class 6h)
Federal Costs:
Utilities
Telephone : 7 cell phones @ $50/month,
Local Travel
Client related -home visits
Client related- home visits
and group socialization
Client related -home visits
and group socialization
Sub-TOTAL
4,200
6,108 miles @ .345 2,107
Personal car
40,000 miles @ .23 9,200
EHS vehicles
5,000 miles @ .46
applicant fleet vehicles 2,300
51,108 miles 13,607
Training: materials and presenters for training workshops for staff, parents and/or community
partners including child care providers. 14,022
TOTAL Federal 56,380
Non-Federal Costs:
Depreciation allowance: for 300 sq ft of office space in a 14,500 sq ft building owned by the
applicant. This building was remodeled in 1997 at a cost of $2.7 million. Depreciation is
based on a 20-year schedule. 1,315
Rent: Community space for parent meetings & group socialization activities
165 meetings @ $60/meeting use 20,400
Utilities: Standard telephone service for five phone lines is @ $18.75/month 1,500
Nutrition Services: Provided through CSU Extension as in-kind. 400
Volunteers: 360 hours at an average of $30/hour 9,000
Parent Services: Contributions by parents @ an average of $15/hour
(4hr, 20min. per child per month) 34,087
Donations by the community to training activities. 720
Personnel and fringe benefits 27,426
TOTAL Non- Federal 94,848
J:\EARLY HEAD START\Budget\2003-04\bubget jus 03-04.wpd
