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HomeMy WebLinkAboutC03-320 Department of Health and Human Services APPLICATION FOR FEDERAL ASSISTANCE 1. TYPE OF SUBMISSION Appncation Preappncation o Construction 0 Co~ctIon Non-Constructlon 0 Non-Constructlon 5. APPLICANT INFORMATION 2. DATE SUBMITTED: 1012012003 3. DATE RECEIVED BY STATE: AppRca ntlller 08YC0023 <! 0 ~ -..3 ZO-Z- State AppRcatIon Identifier 4. DATE RECEIVED BY FEDERAL AGENCY Federalldentlfler Organizational Unit HHS, Eagle County EHS Legal Name: HHS, Eagle County EHS Address (give city, county, state, and zip code) POB 660 500 Broadway Eagle, CO 81631 Eagle 6. EMPLOYER IDENTIFICATION NUMBER (EIN) [!E] - ~ 8. TYPE OF APPUCATION o New 0 Continuation 0 Revision If Revision, enter appropriate letter(s) In box(es): A. Increase Award B. Decrease Award D. Decrease Duration Other (specify): 10. CATAlOG OF FEDERAl DOMESTIC ASSISTANCE NUMBER: TITLE: Early Haad Start 12. AREAS AFFECTED BY PROJECT Eagle County 13. PROPOSED PROJECT: Start Date 8/01/2004 Ending Date 7/3112005 15. ESTIMATED FUNDING a Federal $ b Applicant $ eState $ d Local $ eOther $ f Program Income $ g Total $ 383,267 .00 479,084 .00 o D C. Increase Duration Name and telephone number of the pEllson to be contacted on mattelS InvoMng this appRcation (give area code) Kathleen Forinash 970-328-8858 Executive Director 7. TYPE OF APPUCANT (enter appropriate letter In box) [!] A. State H. Independent School DIsI. B. County I. State Controlled Insli1u1Ion of Higher Laamlng C. Municipal J. Private UnlvelSlty D. Township K. Indian Tribe E. IntelState L IndMduai F. Intermunlclpal M. Profit Organization G. Special Dislrict N. Other (specify) 9. NAME OF FEDERAL AGENCY HHs-Admlnlstratlon forChDdran and FamIRes [!E]. ~ 11. DESCRIPTIVE mLE OF APPUCANrS PROJECT: Eagle County EHS Recompetition AppRcation 14. CONGRESSIONAl DISTRICTS OF: a Applicant b. Project 3rd Dislrict 16. IS APPUCATlON SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS? a. YES THIS PREAPPLlCATlONlAPPUCATiON WAS MADE AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON 95,817 .00 DATE 0.00 o PROGRAM IS NOT COVERED BY E.O. 12372 D OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW b NO 0.00 0.00 17. IS THE APPUCANT DELINQUENT ON ANY FEDERAL DEBT? 0.00 D Yes If "Yes,' attach an explanation. o No 18. TO THE BEST OF MY KNOWLEDGE AND BEUEF, 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 Rep entatlve b Title c Telephone number Michael Gallagher BoCC Chair 970-328-8600 tative e Date Signed / / - 7" e;(' ~Q-3 .... N C't) ...,. 0 ..... .... .... C'I ~ ~o ~ C't) Il) ClO ..... 0 ClO CO ~ ,... .... 0 CO ~ .... 0 ClO N ,,< i .... ...: ai ~ ~ cD ('f) ('f) "':lil m .... 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N N U.S. DEPARTMENT OF HEAL TH AND HUMAN SERVICES COMPENDIUM OF REQUIRED CERTIFICA TIONS AND ASSURAN.CES 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 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. 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. 3. Will 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. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5. Will 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. Will comply with all Federal statutes relating to non-discrimination. These include but are not limited to: (a) Tdle Vlofthe Civil Rights Act of 1964 (PL 88-352) which prohibits discrimination on the bases of race, color or national origin; (b) Tdle 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 (PL 92-255), as amended, relating to non-discrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and AlcohoHsm Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating _ fl? flQIJ'1i.i~qjf!!llJ.a...ti(;m. Cln t(1J!.J~~~f}.s.. 9Ulg~hQ/fJ.tm~ gr a!gQtJ.Q!i~!JKfgJ.Q23. and..527 oftb.I!Pu.bJic. HBBIlb 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 V/1 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; (/) any other non-discrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and (j) the requirements of any other non-discrimination statute(s) which may apply to the application. 7. Will comply, or has already complies, with the requirements of Titles /1 and III 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. 20 8. Will comply with the provisions ofthe 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. Will 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. 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 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. 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 program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. 1451 et seq.); (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. 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. 13. 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 (16 U.S.C. 469a-1 et seq.). 14. 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. 15. 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. 16. 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 the construction or rehabilitation of residence structures. 17. Will cause to be performed the required financial and compliance audits in accordance with the single Audit Act of 1984. 18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies goveming this program. 21 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 January 31, 1989 Federal Register, require certification by grantees that they will maintain a drug-free workplace. The certification set out below is a material representation of fact upon which reliance will be placed when HHS determines to award the grant. False certification or violation of the certification shall be grounds for suspension of payments, suspension or termination of grants, or govemment-wide suspension or debarment. Workplaces under grants, for grantees other than individuals, need not be identifif1Cl 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 Jor parts of building) or other sites where work under the grant takes place. Categorical descriptions may be used (e.g. all vehicles of a mass transit authority of 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), 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 regulations (21 CFR, 1308.11 through 1308.15). "Conviction" means a finding of guilt (including a plea of nolo contendere) or imposition of sentence, or both, by any judicial body charged with the responsibility to determine violations of the Federal of 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) aU "indirect charge" employees unless their impact of involvement is insignificant to the performance of the grant; and (iil1 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 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; 22 b) Establishing a 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, 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 terms of the statement; and (2) 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 the agency in writing within ten days after receiving notice under subparagraph (c/)(2), from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to eveI}' 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 identification nurriber(s) of each affected grant; f) 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 a drug-free workplace through implementation of paragraphs (a) through (f). 23 CERTIFICA TION 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 entity 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 local govemments, by Federal grant, contract, loan, or loan guarantee. The law also 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 applicanVgrantee (for grants) certifies that the submitting organization will comply with the requirements of the Act and will not aHow 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 certification be included In. any subawards which subreciplents shall certify accordingly. 24 CERTlFICA TION REGARDING DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MA TTERS - PRIMARY COVERED TRANSACTIONS By signing and submitting this proposal, the applicant, defined as the primary participant in accordance with 45 CFR Part 76 certifies 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 3year 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, falsification or destruction of records, making false statement, or receMng stolen property; (c) are not presently indicted or otherwise criminally or civl7/y 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 . (d) have not within a 3-year period preceding this application/proposal had one or more 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 prospective participant shall submit an explanation of why it cannot provide the certification. The Department of Health and Human Services' (HHS) determination whether to enter into this transaction. However, failure of the prospective primary participant to fumish 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 Transactions, " provided below without modification in all lower tier covered transactions. CERTIFICA TION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION - LOWER TIER COVERED TRANSACTIONS (TO BE SUPPLIED TO LOWER TIER PARTICIPANTS) By signing. am;/. submitting IJis.Joww tier proposal, the prospeGtive I9weFIieT participant, as defined iR 46 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. 25 . . CERTlFICA TlON REGARDING LOBBYING FOR CONTRACTS, GRANTS, LOANS AND COOPERA TIVE AGREEMENTS The undersigned certifies 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 inffuencing or attempting to inffuence 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 inffuencing or attempting to inffuencean officer or employee or an agency, a member of congress, an officer or employee of congress, or an employee o( 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 ret1uire 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 Vlhen 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 me the required certification shall be subject to a civil penalty or not less than $10,000 and not more than $100,000 for each such failure. 26