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HomeMy WebLinkAboutC04-102 Colorado Department of Public Health and Environment – Early Head Start~° U ~-lO~.r~~ APPLICATION FOR ATE SUBMITTED: Applicant er 08YC0023 ` FEDERAL ASSISTANCE 1. TYPE OF SUBMISSION 3. DATE RECENED BY STATE: State Application Identifier AppliraUon Preapplication Construction ~ Construction 4. DATE RECENED BY FEDERAL AGENCY Federal Identifier Non-Consbucfaon ~ Non-Constructlon 5. APPLICANT INFORMATION Legal Name: HHS, Eagle County Early Head Start Organizational Unit Health 8 Human Services Eagle County EHS Address (give city, county, state, and zip code) Name and telephone number of the person to be contacted on matters involving this POB 660 appliption (give area code) 551 Broadway Kathleen Forinash 970-328-8858 Eagle, CO 81631 Eagle Executive Director 6. EMPLOYER IDENTIFICATION NUMBER (EIN) 7. TYPE OF APPLICANT (enter appropriate letter M box) ^g 8 4 ~ 6 0 0 0 7 6 2 A. State H. Independent School Dist B. County I. State Controlled Institution of Higher Learning 8. TYPE OF APPLICATION C. Municipal 'J. Private University New ~ Contfiuation ~ Revision D. Township K. Indian Tribe E. Interstate L. Individual F. Intermuniapal M. Profit Organization If Revision, enter appropriate letter(s) in box(es): ~ ~ G. Special District N. Other (specfy) A. Increase Award B. Decrease Award C. Increase Duration 9. NAME OF FEDERAL AGENCY D. Decrease Duration Other (specify): 10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 9 3, 6 0 0 11. DESCRIPTIVE TRLE OF APPLICANTS PROJECT: Supplementalfor T/TA Instifitte on Father Invo(vemerd 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 10/01/2003 7131/2004 15. ESTIMATED FUNDING 16. IS APPLICATION SUBJECT TO RE1lIEW BY STATE EXECUTVE ORDER 12372 PROCESS? d l F $ 2 000 00 a YES THIS PREAPPLICATIONIAPPUCATION WAS MADE AVAILABLE TO THE STATE era a e , . EXECUTIVE ORDER 12372 PROCESS FOR Rf~/IEW ON b Applipnt $ 0 •~ DATE c State $ 0.00 b NO ~ PROGRAM IS NOT COVERED BY E.0.12372 d Laval $ 500.00 ~ OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW e Other $ 0 •~ 17 IS THE APPLICANT DELIN UENT ON ANY FED . Q ERAL DEBT? f Program Income $ 0 .00 ° ° Yes If Yes, attach an explanation. ~ No g Tonal $ 2,500.00 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 Authorised Representative b Title c Telephone number Tom Stone Chair, BoCC 970-328-8605 b Signature of Authored Represerdative a Da te S~jned ~Z , `-~ ~ t0 V chi 0 c Z O H d7 O C. 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O O W ° L N c~ = a • • 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 notfied. As fhe duly authorized representative of the applicant, 1 certify that the applicant: 1. Has the legal autho-rty to apply for Federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay fhe non-Federal share of project costs) to ensure proper planning, management and completion of the project described in this application. 2. Will gnie 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. 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) Tide 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) Tide 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 ofthe 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; (f) the Comprehensive Alcohol Abuse and Alcoholism 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 Acf 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 specific 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. Will comply, or has already complies, with the requirements of Titles 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. Will comply with the provisions of the Hatch Act (5 U.S.C. 1501-1508 and 73247328) 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 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) 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.); (fl 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 of seq.); (g) protection of underground sources of drinking wafer 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 fo 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 governing this program. • DRUG-FREE WORKPLACE REQUIREMENTS GRANTEES OTHER THAN INDIVIDUALS By signing and/orsubmitting this application orgrant agreement, the grantee is providing the cert~cation set out below. This certification is required by regulations implementing fhe 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 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 government-wide suspension or debarment. Workplaces under grants, for grantees other than individuals, need not be ident~ed 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 fo 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 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, 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 fhe 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 a Federal 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 performance of work under a grant including: (i) All °din:ct charge° employees; (ir) all "indirect charge ° employees unless their impact of involvement is insignificant to the performance of the grant- and (iii) temporary personnel and consultants who are directly engaged in the performance of work underthe 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 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 6e 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 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 (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 identification 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-flee workplace through implementation of paragraphs (a) through (t). 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 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 orlocal governments, by Federal grant, contract, loan, orloan 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 facilit%es 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 certfication, the offeror/contractor (for acquisitions) or applicant/grantee (for grants) certifies 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 certification 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 with 45 CFR Part 76 cert~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 voluntaNy 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 fo obtain, or performing a public (Federal, State or focal) 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 receiving stolen properly; (c) are not presently indicted or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (7) (b) of this certfication; and (d) have not within a 3-year period preceding this applicatioNproposal had one ormore public transaction (Federal, State or local) terminated for cause or default. The inability of a person to provide the certfication 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 cert~cation. The Department of Health and Human Services' (HHS) determination whether to enter into this transaction. However, failure of the prospective primary pancipant 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 "Cert~cafion Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transactions, "provided below without modification in all lower her 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, 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. CERTIFICATION REGARDING LOBBYING • FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE 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 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 info 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 influencing or attempting to influence an officer or employee or an 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 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 subject to a civil penalty or not less than $10, 000 and not more than $100, 000 for each such failure. 1 hereby agree to the ve certifications and assurances. 3 1~ o Signature of Ce ing Official Date ~ ~.~;uLt~rk~ ~ ~~GG Title Applicant Organization J HEALTH & HUMAN SERVICES (970)328-8840 FAX: (970) 328-8829 TDD: (970) 328-8797 www.eaglecountyus f.~GL~ COUNTY March 2, 2004 Adult & Family Services Child Support Enforcement Early Childhood Services Public Assistance Public Health Nursing Volunteer Services My signature certifies that Eagle County Early Head Start Policy Council has reviewed and approved the supplemental funding grant request for the National Head Start Institute on Father Involvement. Simon Perez, President Eagle County Early Head Start Policy Council Old Courthouse Building, 551 Broadway, P.O. Box 660, Eagle, Colorado 81631-0660 Ea le County Early Head Start g Supplemental funds: Father Involvement Budget and Budget Justification: Item Federal Funds Non-Federal Funds National HS Institute on Father Involvement Lodging for 1 parent leader and 1 staff 2,000 Parent Volunteer: 3 x $138/night x 6 nights = 2,484 1 parents x 40 hours of training time x $15/hour = $600 Program will use $500 of this value TOTAL $2,000 $500 Budget Narrative Supplemental funds will assist in covering the costs for two persons to attend the National HS Institute on Father Involvement. The program is planning to send 2 fathers (one from the El JebelBasalt who is the President of Policy Council and one from the Eagle River Valley who is a parent leader) and the program director or family services coordinator. The third person's costs will be covered by existing T/TA funds. Total projected costs are $5,150. Enhancing participation of fathers as primary nurturers is a goal of the program for both staff and parents. Steps identified to achieve this goal include: 1) implementing a fatherhood parenting curriculum; 2) implementing evening and weekend group socialization activities; 3) providing group mental wellness services for fathers. The program has had many successes in involving fathers and in meeting some of identified steps to achieving this goal. This funding and training opportunity will allow the program to continue improvement in developing and sustaining a high quality father involvement program. -1-