HomeMy WebLinkAboutC03-196 Corporation for National and Community Service~ (~~~J~~_~z
aetaT I . t=~!-CE SHEET
APPLICATION FOR FEDERAL ASSISTANCE 1. 'TYPE OF SUBMISSION:
Non-Construction
2a. DATE SUBMITTED TO CORPORATION 3. DATE RECEIVED BY STATE: STATE APPLICATION IDENTIFIER:
FOR NATIONAL AND COMMUNITY ,
SERVICE (CNCS):
2b. APPLICATION ID: 4. DATE RECEIVED: GRANT NUMBER:
04Slt036035 02SRWOD007
8. APPLICATION INFORMATION
NAME AND CONTACT INFORMATION FOR PROJECT DIRECTOR OR OTHER
LEGAL NAME: Eagle Co Govt Hlth&Humao Svcs PERSON TO BE CONTACTED ON MATTERS INVOLVING THIS APPLICATION (give
area codas):
NAME: 7acki M Allen_Benson
ADDRESS (gNe street address, city, state and ~p code): TELEPHONE NUMBER: 9703286818
500 Broadway
Eagle CO 81631 FAX NUMBER: 9703268809
INTERNET E-MAIL ADDRESS: volntrecQeagle•cou~yram
6. EMPLOYER IDENTIFICATION NUMBER (Qi1~: 7. TYPE OF APPLICANT:
7a. Lo®1 Gover~t -County
846000762
7b.
e. TYPE OF APPLICATION:
NEW X^ CONTINUATION
REVISION
It Revision, enter appropriate letter(s) In bmt(es):
A. Increase Award B. Decrease Award C. Increase Duretion
0. Decrease Duretion
9. NAME OF FEDERAL AGENCY:
Corporation for National and Community Service
10a. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 94.002 - 11. DESCRIPTIVE TITLE OF APPLICANTS PROJECT:
10b. TITLE: Retired end Senior Volunteer Progrem Eegla/Summft Co RSVP
12 AREAS AFFECTED BY PROJECT (List CXUes, Counties, States. etc):
Eagle CO: Basalt, Eagle, Gypsum, Mintum, Redcll$ Vail, McCoy Sua®it CO: billion,
Frisco, Breeka~ldga, Silverthome
13. PROROSED PROJECT: START DATE: 09!29/02 END DATE: 09/28/05 14. PERFORMANCE PERIOD: START DATE: END DATE:
18. ESTIMATED FUNDING: ~ 18. IS APPLICATION SUBJECT TO REVIEW BY STATE E)ECUTIVE
ORDER 12372 PROCESST
a. FEDERAL $ 98,741.00
THIS PREAPPLICATIOWAPPLICATION WAS MADE AVAILABLE
YES
,
b. APPLICANT $ 42,118.00 TO THE STATE DECUTIVE ORDER 12372 PROCESS FOR
REVIEW ON:
c. STATE $ 0.00 DATE:
d. LOCAL $ 42,118.00 ,
e. OTHER $ OAO
00
$ 0 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL ^EBT7
f. PROGRAM INCOME . ti
QX NO
l
°
on.
ana
Yes; attach an exp
0 YES iP
g. TOTAL $ 140,859.00
TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICA170NiPRFJ1PPLICATION ARE TRUE AND CORRECT, THE DOCUMENT HAS BEEN
18
.
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: b. TITLE:
Board of Commission
Chairman c. TELEPHONE NUMBER:
rs (970) 328=8605
Michael L. G lagher ,
d. DATE:
_~ -
Run by JALLEN_B i ~ RPf BGT 424
on July 7, 2003 5:08 PM
h
Eagle/Summit Co RSVP
Eagle Co Govt Hlth ~ Human Svcs
Application ID: 04SR036035 Budget Dates:
Total Amt CNCS Share Grantee Share Excess Amount
Sectlbn I. Volunteer Support Expenses
A. Project Personnel Expenses 47,287 47,287 0 0
B. Personnel Fringe BenefRs
FICA 3,607 3,607 0 0
Health trtsurance 12,455 12,455 0 0
Retirement 2,167 2,167 0 0
Lffe Insurance 450 450 0 0
Total $18,679 $18,679 $0 $0
C. Project Staff Travel
Local Travel 2,140 2,140 0 0
Long Distance Travel 2,117 2,117 0 0
Total $4,257 $4,257 $0 $0
D. Equipment
E Supp0es 12,103 765 11,338 0
F. Contractual and Consultant Services 21,130 0 21,130 0
I. Other Volunteer Support Costs 350 350 0 0
J. IndUect Costs
Section I. Subtotal $103,806 $71,338 $32,468 $0
Section II. Volunteer Expenses
A. Other Volunteer Costs
Meals 750 600 150 0
Uniforms 0 0 0 0
Insurance ~ 1,800 1,800 0 0
Recognition 15,310 5,810 9,500 0
Volunteer Travel 19,193 19,193 0 0
Total $37,053 $27,403 $9,650 $0
Section 11. Subtotal $37,053 $27,403 $9,650 $0
BudgetTo~ls $140,859 $98,741 $42,118 $0
Funding Percen~ges 70.1% 29.9%
Form424A Modified 5F-424A (4/88 and 12!97)
Page 1
Budget Narrative for 04SR03603
- Bud et Narrative: Ea Ie/Suit Co RSVP for Ea le Co Govt H~~ Human Svcs
9 9 9
Section I. Volunteer Support Expenses
A. Project Personnel Expenses
Page 1 of 3
Posftion/Tftle -QtyAnnual Salary % Time CNCS Share Share Total Amount ~~ t
Project Director. -1 person(s) at 36109 each x 100 % usage 36,109 0 36,109 0
Summit County Coordinator. -1 person(s) at 28662 each x 39 %
usage 11,178 0 11,178 0
CATEGORY Totals 47,287 0 47,287 0
B. Personnel Fringe Benefits
Item -Description
CNCS Share Grantee
Share
Total Amount Excess
Amount
FICA: 3,607 0 3,607 0
Health Insurance: 12,455 0 12,455 0
Retirement: 2,167 0 2,167 0
Life Insurance: 450 0 450 0
CATEGORY Totals 18,679 0 18,679 0
C. Project Staff Travel
Local Travel
Purpose -Calculation CNCS Share gharea Total Amount ,q mount
site management and volunteer development: 6202@.345 2,140 0 2,140 0
CATEGORY Totals 2,140 0 2,140 0
Long Distance Travel
Purpose -Destination -Trans. Amount-Meals/ Lodging -Other
CNCS Share Grantee
Total Amount F~ccess
Travel Share amount
conference + 2 state meetings:- Meals 1,262 Lodging/Trans 855 2,117 0 2,117 0
Other 0
CATEGORY Totals 2,117 0 2,117 0
D. Equipment
Item/Purpose-Qty -Unft Cost
CNCS Share ~~ Grantee ~~ Total Amount I~ Excess
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Budget Narrative for 04SR03603~
E. Supplies
Page 2 of 3
Item/ Purpose -Calculation CNCS
Share Grantee
Share Total
Amount Excess
Amount
General Office Supplies/ pens/paper/notepads etc.: 600 0 600 600 D
informatioNpromotional mat./memberships etc.: per item estimate 565 750 1,315 0
Computer/fax/networkconnectioNsoftware/maintenance/IT support: 2 0 5,040 5,040 0
Office Space Eagle/Summifi 2 0 4,388 4,368 0
Printer.2 200 200 400 0
Phone:2 0 360 360 0
CATEGORY Totals 765 11,338 12,103 0
F. Contractual and Consultant Services
Purpose -Calculation CNCS Share Share Total Amount ~
Administrative Supervision: Summit Eagle: 125hours@38.00 420 0 21,130 21,130 0
hours @ 39.00
CATEGORY Totals 0 21,130 21,130 0
I.Other Volunteer Support Costs
Item CNCS Share Share Total Amount o
nt
A
u
m
Staff training and Support: 350 0 350 0
CATEGORY Totals 350 0 350 0
J. Indirect Costs
Rate Type -Claimed-Rate CNCS Share ghare Total Amount amount
CATEGORY Totals 0 0 0 0
SECTION Totals 71,338 32,468 103,806 0
Section II. Volunteer F~cpenses
A. Other Volunteer Costs
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Budget Narrative for 04SR03603i - Page 3 of 3
Item -Description
CNCS Share Grantee
Share
Total Amount Excess
Amount
Meals: 125 @ 6.00 600 150 750 0
Uniforms: 0 0 0 0
Insurance: 307@ 5.85 1,800 U 1,800 0
Recognition: 450 @30.00 5,810 9,500 15,310 0
Volunteer Travel: 63977 MILES @ .30 x 450 vol. =aver. 142
miles. most site locations are at least 40 miles from volunteer 19
193 0 19
193 0
homes. Large geographic areas are the largest obstacle to , ,
volunteering in rural Colorado
CATEGORY Totals 27,403 9,650 37,053 0
SECTION Totals 27,403 9,650 37,053 0
BUDGET Totals 98,741 42,118 140,859 0
Source of Funds
Section Description
Section I. Volunteer Support Expenses
Section II. Volunteer Expenses
https://egrants.cns.gov/pls/cns~lsgUcn_bgtnarr.prt_bgtnarr?c_grnt id=04SR036035&p_mode=PLS.. 7/7/2003
r.
Required Documents
.Document Name Status
Articles ofIncorporation Not Applicable
Board ofDirectors Not Applicable
CPA Certification ~ Already on File at CNCS
Organizational Chart Already on File at CNCS
Project Director's Job Description Already on File ax CNCS
Cormunity Advisory Group names and addresses Already on File at CNCS
Negotiated Indirect Cost Agreerr~nt Not Applicable
Statement ofwhether applicant is subject to A133 audit Already on File at CNCS
Staterr~nt ofdate oflast A133 audit Already on File at CNCS
Roster of Volunteer Stations Already on File at CNCS
Aggregate Do1larAimunts offending Not Applicable
List ofthe narr~s ofany Funding Organizations/Sources Already on File at CNCS
Page 11
Narratives
Strengthening Communities
Rural Resort RSVP will develop collaborative approaches with Hurrah Service, Public Safety organizations and
Senior Prograrra to maximize programresources and achieve significant comnnnity impact. These agencies and
RSVP will mitually evaluate community systems and approaches for the use ofvolunteers and develop shared
improvement objectrives. The programdirector and coordinator will work to assure quality commrnity participation
and ownership ofthe RSVP programthrough the RSVP Community Advisory Teamsystem The teamwill have
an annual work plan, will invite participation fiemprivate and public agencies, senior citizens, volunteer stations and
others as appropriate to strengthen the ~,bric ofthe community. Rural Resort RSVP is working with a registered
VIl'S organization, a first responders group and has been granted an EASI charter.
Recruitment and Development
Rural Resort RSVP seeks to recruit volunteers who have the interests, skills and experiences to ensure its
continued success. A maximumspectrumofseniors will be reached via the media and presentations in locations
where seniors gather. To promote the notion ofRSVP volunteers functioning as a teams volunteer assignments will
be clustered by common skills, interests, and shared impact objectives. Assistance will be given to agencies on the
effective recognition ofvolunteers.
Rural Resort RSVP aura to develop volunteer station relationships and ensure high-quality volunteer experiences.
To accomplish this, the programdirector and coordinator will review Mou's and discuss RSVP goals and objectives
with existing agency partners, while actively developing new MOU's with other agencies, particularly those involved
in homeland security functions. Training on RSVP policies, procedures, protocol, general volunteer management
and station responsibilities will be provided forparticipating agency volunteer supervisors.
Program Management
To ensure that all volunteers have the skills, knowledge and confidence to provide quality services, the program
director and coodinator will work with agency partners to provide appropriate training to volunteers. Rural Resort
Region RSVP will meet or exceed RSVP guidelines and requirements through apro-active quality assurance
program Advice and assistance will be obtained through the state office and through mentoring relationships with
Page 2
,.
Narratives
other successful RSVP programs.
To support achievement ofprogramoutcomes,Rural Resort Region RSVP will work with agency partners to
assess the im}~act ofRSVP volunteers. The Comrunity Advisory Teamwill also be utilized in perfornrance
appraisal, along with a yearly evaluation ofvolunteer stations.
To increase public awareness ofRural Resort Region RSVP, the project director and coordinator will disseminate
infomation about RSVP to key audiences and participating agencies. The local media will be utilized via a column
in local newspapers. Local reporters will be invited to special events, including recognition and public n~etings
between agencies and RSVP. A rvegular column will appear in Senior Programpublications and Eagle County
Volunteer publications.
Organizational Capacity
The mussion ofthe sponsoring organization is "to work in partnership with the commnity to prormte healthy
liiistyles, help persons achieve sel€sufficiency, and prevent abuse, neglect and disease." The sponsoring
organization uses approaches ofpro£ssional service, public educaxion and volunteer participation to achieve that
mission. RSVP's mission"ta provide opportunities ~r retired persons to participate mare fully in the life oftheir
community through sigffiificant volunteer service." is compatible in many ways:>with a focus on commrnity life and
community involverrent.>in arecognition ofcommtnity service as a means for achieving a healthy lift' style.>in
identification ofsignific~nt outcomes that come as a result ofservice. RSVP has worked closely with The Eagle
County Volunteer Center, a department located within the sponsoring organization, that acts as the central volunteer
development mechanismin Eagle County.This programwas initiated by Eagle County Health & Human Services in
1996. It is through this programthat Rural Resort RSVP can obtain quality intergenerationaluolunteer opportunities
for its participants.
The sponsoring agencies in Eagle and Summit Counties have significant experience in designing and implementing
programs with the community that involve volunteers - fromfaster parents, to homemuakers, to family mentors and
mediators, to senior nutrition programs. As sponsoring agency, Eagle County Health & Human Services brings
Page 3
Narratives
experience in grants manageir~nt and programimplerr~ntation. As part ofCounty government, the department is
supported by human resources, accounting, infomation technology, legal and other county administrative support
services.
Other
Not applicable.
PIdS Amendment (if applicable)
Not applicable.
Page 4
S
~~
Work PIan/Performance Measures
Service Category : Other Health/Nutrition
Total # Stations : 12 Total # Volunteers : 200
Period of Performance
Community Need Accomplishment: 09-02 through 09-04 Measure:
High cost ofliving in this resort region means that many risidents utilize low-incorm health clinics, imunnization
sites, senior and student nutrition sites, and home health-hospice organizations.
Period of Performance
Service Activity Accomplishment: 09-02 through 09-04 Measure:
Collect & distribute health infortmtion; assist in clinics; congregate meals; provide in-home care; provide
transportation; assist with special events (such as health fairs and blood drives).
Period of Performance
Anticipated Input Accomplishment: 09-02 through 09-04 Measure:
Volunteers will serve at community health events and fairs, blood drives and nutirtion programs for all ages.
Training and teamsupport will be provided by designated stations.
Period of Performance
Anticipated Accomplishments/Outputs Accomplishment: 09-02 through 09-04 Measure•
Volunteers will provide health & nutrition education & support services to 400 families and 200 seniors. Health
and nutrition plans will improve. Individuals and families with critical health needs will be supported within the
community.
Period of Performance
Anticipated Intermediate Impact/Outcome Accomplishment: 09-03 through 09-04 Measure:
Intem:ediate Outcome: Participation in Nutrition Programs will increase.
Indicator. Numbers ofpersons attending congregate meal sites.
Target: At least one new feeding programwill be established.
How Measured: Participate reports fromvolunteer sites.
Antici ated End ImpactlOutcome Period of 09-03 throu h 09-04 Performance
P Accomplishment: g Measure• 0
Outcome: Nutritional level ofpersons attending congregate sites or using a mils on wheels service will be
improved.
Indicator. Increased numbers of people will be attending congregate meal sites assuring an increased level of
wee 5
•
L
v
•
Work Plan/Performance Measures
Service Category : Other Health/Nutrition Total # Stations : 12
adquate nutrition.
Target: A 5%increase in client participation in £eding programs
Total # Volunteers : 200
How Measured:, Menu's ofMeal sites, indicating a proper nutiritional balance and the participation records of
these programs.
Service Category : Other Human Needs
Total # Stations : 12 Total # Volunteers
Period of Pertormance
Community Need Accomplishment: 09-01-02 through 08- Measure:
32-03
Small mining and agricultural comrunities have experienced explosiv (nearly double fromcensus 1990) growth.
Lack ofa~rdable housing healthcare and child care and the stresses compounded by multiple jobs and long
commtes, require RSVP volunteeers to serve as, mcntors, and assist in a myriad ofsocial assistance progrars.
Service Activ Period of 09-02 throu h 09-03 Pertormance
fry Accomplishment: g Measure:
RSVP volunteers will serve as youth rr~ntors; assistants for seniors/disabled persons; builders ofadequate
housing; information/reierral/reassurance network volunteers;coaches at summer day camps, plan and implement
activities for comaunity organizations.
Period of Pertormance
Anticipated Input Accomplishment: 09-02 through 09-03 Measure: ~
Volunteers will provide over 2000 hours ofservices this year. Teams will be trained by and located with The
Buddies Program; CSU Extension; ECDHHS; Prevention Alliance; Red Cross; Shaping our Sumrrit, Americorps
and Habitat for Humanity.
Period of Pertormance
Anticipated Accomplishments/Outputs Accomplishment• 09-02 through 09-03 Measure:
Provide mantoring services to 5-1-youth; homerrgker/chore service to 20 seniors; re£rraUreassurance services to
40 seniors; 4 volunteers trained to educate the commxnity in 'The 40 developmental assets program 20
volunteers to assist in the building ofhomes for 5 families. 4 volunteers will provide tax-preparation assistance to
Page 6
4
Work PIanlPerformance Measures
Service Category : Other Human Needs
12 seniors/low incomes farrrilies.
Service Category : Other Education
Total # Stations : 12 Total # Volunteers
Total # Stations : 12 Total # Volunteers : 76
Period of Pertormance
Community Need Accomplishment- 09-01-03 through 08- Measure-
31-2004
#1 Eagle County is the second highest county in Colorado for stress factors associated with child abuse and
neglect. #2 It is necessary to preserve and teach local history to give strength and roots to the increasing numbers
ofnew residents.
Period of Pertormance
Service Activity Accomplishment- 09-03 through 09-04 Measure: ~
RSVP volunteers will be utilized to assist as family r~ntors, classroomassistants, daycare assistants, and Library
assistants. A teamwill work with local seniors and the Historical Societies to complete an oral history project
(captured on video)
Period of Pertormance
Anticipated Input ~ Accomplishment- 09-02 through 09-04 Measure:
50-70 RSVP volunteers will contribute 4 hours a rmnth in community literacy and cultural heritage programs. 15-
25 volunteers will work 4 hours a month with Head Start, Early Head Strait and other comirunity pre-elementary
programs. l RSVP volunteer will work with local childcare programs and school districts to locate and place pre-
school assitant volunteers ofany age.
Period of Pertormance
Anticipated Accomplishments/Outputs Accomplishment: 09-02 through 09-04 Measure:
It is estimated that 150 children will be involved in literacy programs. 20 children will be engaged in Individual
Reading Plans, 50-75 children families involved in pre-school programs. 5 volunteer assistants will provide a
calming presence for local daycare centers.
Period of Pertormance
Anticipated Intermediate Impact/Outcome Accomplishment: Measure:
Intermediate Outcome: Numbers ofchildren involved in literacy programs will increase. #2. At least two
historical programs will be assisted with RSVP volunteers.
Page 7
a
w
{
Work Plan/Performance Measures
Service Category : Other Education
Indicator. Numbers ofchildren enrolled in literacy programs. Numbers ofpersons attending history programs.
Target: At least 10 new children will be enrolled in Eagle and Suxmit County literacy program At least 10 people
will attend each ofthese two programs.
How Measured: Enrollment reports fromthe volunteer sites involved in Literacy or English as a second
Language. Attendance sheet fromprogram
Period of Pertormance
Anticipated End Impact/Outcome Accomplishment• Measure:
End Outcorro: Literacy Skills will increase armng those participating in these literacy projects. # ofpeople familiar
with local history will improve.
Indicator. Test scores in reading will increase by one grade level. #2Numbers ofpeople attending programs will
increase
Target: At least 25%ofstudents attending will be able to document improvement.
How Measured: Reports fromLiteracy programs. Attendance Records fromprogramevents
Service Category : Other Cormunity and Economic Total # Stations : 21 Total # Volunteers : 155
Development
Period of Performance
Community Need Accomplishment• 09-01-03 through OS- Measure:
• 31-04
The Population in Eagle County has nearly doubled since the 1990 census. Although housing costs are
consistently armng the highest in the state, wages remain at 19%below the state average. This makes
community services critical in developing supports for working families.
Period of Pertormance
Service Activity Accomplishment: 09-03 through 09-04 Measure:
RSVP volunteers will help comirunity non profits provide tangible goods and services to working families. Assist
a variety ofhuman service agencies in fundraising efforts. Assist both local chambers ofcomYrerce in visitor
Total # Stations : 12 Total # Volunteers : 76
assistance services.
Anticipated Input
Period of
Accomplishment• 09-03 through 09-04
Performance
Measure:
Page 8
Certifications • ~ Page 1 of 2
CERT/F/CATIONS
Certification -Debarment, Suspension, and Other Responsibility Matters
This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 34 CFR Part 85, Section
85.510, Participants'responstbilities.
A. As the duly authorized representative of the applicant, I certify, to the best of my knowledge and belief, that neither the applicant nor
its principals:
• Is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions
by any federal department or agency.
• Has, within athree-year period preceding this application, been convicted of, or had an adverse civil judgment entered in
connection with, fraud or other 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 or records, making false statements, or
receiving stolen property.
• Is presently indicted for of otherwise criminally or civilly charged by a governmental entity (federal, state or local) with
commission of any of the offenses enumerated in paragraph (1) (b) of this certification, and
• Has not, within athree-year period preceding this application, had one or more public transactions (federal, state or local)
terminated for cause or default;
B. If you are unable to certify to any of the statements in this certification, you must attach an explanation to this application.
Certification -Drug-Free Workplace
This certification is required by the regulations implementing the Dru~Free Workplace Act of 1988, 34 CFR Part 85, Subpart F. The
regulations require certification by grantees, prior to award, that they will maintain a drugfree workplace. The certification set out below is
a material representation of fact upon which reliance will be placed when the agency determines to award the grant. False certification or
violation of the certification may be grounds for suspension of payments, suspension or termination of grants, or governmentwide
suspension or debarment (see 34 CFR Part 85, Section 85.615 and 85.620).
As the duly authorized representative of the grantee, I certify, to the best of my knowledge and belief, that the grantee will 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 adrug-free awareness program to inform employees about-
• the dangers of drug abuse in the workplace,
• the grantee's policy of maintaining a drug-free workplace.
• any available drug counseling, rehabilitation, and employee assistance programs, and
• 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 requved
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:
• abide by the terms of the statement, and
• notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days
after such conviction.
E. Notifying us within ten days after receiving notice under subparagraph (D) from an employee or otherwise receiving actual notice of
such conviction;
Taking one of the following actions, within 30 days of receiving notice under subparagraph (D), with respect to any employee who is
so convicted-
• Taking appropriate personnel action against such an employee, up to and including termination; or
• Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such
https://egrants.cns.gov/cnsmisc/ECERTS.HTM 6/24/2003
Certifications ~ ~ Page 2 of 2
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 -Lobbying Activities
As required by Section 1352, Title 31 of the U.S. Code, as the duly authorized representative of the applicant, I certify, to the best of my
knowledge and belief, that:
No federal appropriated funds have been paid or will be paid, by or on behalf of the applicant, to any person for influencing
or attempting to influence an officer or employee of any agency, a member of Congress, an officer of Congress in
connection with the awarding of any federal contract, the making of any federal loan, the entering into of any cooperative
agreement, or modification of any federal contract, grant, loan, or cooperative agreement;
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
applicant will submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions;
The applicant will require that the language of this certification be included in the award documents for all subcontracts at
all tiers (including subcontrmts, subgrants, and contracts under grants, loans and cooperative agreeme~s) and that all
subrecipients will certify and disclose accordingly.
Certification -Grant Review Process (State Commissions Only)
I certify that in conducting ow review process, we have ensured compliance with the National and Community Service Act of 1990 as
amended, the Corporation's peer review requirements, and all state laws and conflict of interest cafes.
https://egrants.cns.gov/cnsmisc/ECERTS.HTM 6/24/2003
Assurances ~ • Page 1 of 2
ASSURANCES
As the duly authorized representative of the applicant, I certify, to the best of my knowledge and belief, that the applicant:
Has the legal authority to apply for federal assistance, and the institutional, managerial, and fuuu-cial 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.
Will 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.
Will establish safeguards to prohibit employees from using their position for a purpose that constitutes or presents the
appearance of personal or organizational conflict of interest, or personal gain.
Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728-0763) 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 )~.
Will comply with all federal statutes relating to nondiscrimination. These include but are not limited to: Title VI of the Civil
Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color, or national origin; (b) Title 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 disability (d) The Age Discrimination Act of 1975, as amended (42 U.S.C. 6101! 107), 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 nondiscrimination on the basis of drug abuse; (f) The Comprehensive Alcohol Abuse and Alcoholism
Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis
of alcohol abuse or alcoholism; (g) sections 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. 290dd•3 and
290ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights
Act of 1968 (42 U.S.C. 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing;
(i) any other nondiscrimination provisions in the National and Community Service Act of 1990, as amended; and (j) the
requirements of any other nondiscrimination statute(s) which may apply to the application.
Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance and
Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fav 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.
Will 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.
Will comply, as applicable, with the provisions of the Davis$acon Act (40 U.S.C 276a and 276a-77), 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 sub-agreements.
Will 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 the 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.
Will comply with environmental standards which may be 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) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO
11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency
with the approved state management progrun developed under the Coastal Zone Management Act of 1972 (16 U.S.C 1451
et seq.); (f) conformity of federal actions to State (Clean Air) Implementation Plans under Section 176(c) of the Clean 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).
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 the national wild and scenic rivers system.
Will 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 (identification and protection of historic properties),'and the Archaeological and
Historic Preservation Act of 1974 (16U.S.C. 469a-1 et seq.).
Will 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.
hops://egrants.cns.gov/cnsmisc/EASSUR.HTM 6/24/2003
~ - Assurances • ~ Page 2 of 2
~ Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89.544, as amended, 7 U.S.C. 2131 et seq.) pertaining
to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by
this award of assistance.
Will comply with the Lead Based Paint Poisoning Prevention Act (42 U.S.C. §§ 4801 et seq.) which prohibits the use of
lead based paint in construction or rehabilitation of residence structures.
Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act of 1984,
as amended, and OMB Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations.
Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, application guidelines,
and policies governing this program.
https://egrants.cns.gov/cnsmisc/EASSUR.HTM 6/24/2U03
rr -
Y
Work Plan/Performance Measures
Service Category : Other Community and Economic Total # Stations : 21 Total # Volunteers : 155
Developrr~nt
65 volunteers will serve 10 hours a week to extend the service ofcorrminitynon-profits. 90 volunteers will
contribute 1500 hours peryearto help comnunitynnn-profits rmet avariety ofhurran service, cultural and
recreational needs in the comirunity.
Period of Pertormance
Anticipated Accomplishments/Outputs Accomplishment: 09-03 through 09-04 Measure:
155 RSVP volunteers collecting and distributing food, clothing and other necessities and working to raise funds
through 21 area non-profit agencies whose missions are to support the needs ofthe underemployed fannlies in the
region. will increase comcrunity understanding ofthe needs ofworking families and promote neighbor to neighbor
response to meeting basic fanaly and community needs.
Period of Pertormance
Anticipated Intermediate Impact/Outcome Accomplishment; Measure:
Intern~diate Outcome: Community understanding ofneedy firnilies will increace.
Indicator. Number ofvolunteers participating in the progratrs involved with this
service will increase.
Target: Essential items collected will increase by 5%each year ofthe grant.
How Measured: Statistical Report fibmRSVP programand 1 collection record and 1 distribution record from
volunteer sites performing this service.
Anticipated End Impact/Outcome
Period of
Accomplishment:
Pertormance
Measure:
Programs involved in this service will reach families who were not previously served.
Indicator. number offamnlies served will increase by 5°/a
Target: At least two sites involved in this activity will show a 5%increase in the numbers ofclients served.
How measured: client reports fromtwo randomly choosen sites
Rage 9
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~.
• •
Work Plan/Performance Measures
Service Category : Other Public Safety Total # Stations : 15 Total # Volunteers
Period of Pertormance
Community Need Accomplishment: 09-01-2002 through 08- Measur®: ~
31-03
Public Safety/Homeland Securtiy, volunteers are needed to assist victimes ofdomestic violence, acidents and
criminal activity with comfort, shelter or day to day needs. Volunteers are needed to act as the extra eyes and
hands ofall public sa£ty agencies. Experienced pro£ssional volunteers are especially needed to operate base
emergency operations.
Period of Pertormance
Service Activity Accomplishment: 09-02 through 08-03 Measure:
RSVP volunteers, will be trained by sponsoring sites in crisis intervention, mountain rescue activities, emergency
preparedness and neighborhood watch groups. They will teamwith law enfi~rcerrent, health care pro£ssional and
fire departments.
Period of Pertormance
Anticipated Input Accomplishment: 09-02 through 09-03 Measure:
Teams of5-20 volunteers will provide service according to the needs presented by the individual sites in the
comminity each month.
Period of Pertormance
Anticipated Accomplishments/Outputs Accomplishment• 09-02 through 09-03 Measure:
Volunteers will be trained and ready to respond in the case ofany sudden tragedy emoting this region.
Volunteers will provide at least 100 hours ofservice per month to ongoing public sa£ty programs such as
neighborhood watch.
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