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HomeMy WebLinkAboutC06-070 AGREEMENT BETWEEN THE COUNTY OF EAGLE, STATE OF COLORADO AND BETHANIE NELSON LINDAL THIS AGREEMENT made this 21st day of February, 2006, by and between the County of Eagle, State of Colorado, a body corporate and politic, by and through its Board of County Commissioners, "County" and, Bethanie Nelson Lindal, hereinafter "Contractor." 1. AGREEMENT: This Agreement shall commence on January 1, 2006 and shall end on December 31,2006. 2. SCOPE: Eagle County hereby contracts with the Contractor for services that stabilize family life and promote family self-sufficiency. Specifically, the agreement is for professional services directed toward family and interpersonal communication skill building; or, intensive family centered services that prevent out of home placement of the children. These services are to be goal- oriented and outcome based. Progress will be monitored by Eagle County. The Contractor will provide one or more of the following services based on the written authorization and request for services by the County: > T ANF service group: Parenting and family communication skill building. > CORE Service group I-MH: individual or group mental health services; family counseling; aftercare; court testimony; crisis intervention services; therapeutic staffing. > CORE Service group 1- Intensive Family Therapy: Individual, family or group therapy, aftercare services; assessment services; therapeutic staffing. > CORE Service group 1 - Home Based: Individual, family counseling, aftercare, therapeutic visitations > Mental health consultation for County HHS programs. The services will be reimbursed at the rate of $ 70 per hour for client family or staff consultation face to face contact from January 1, 2006 through June 30, 2006. From July 1, 2006 through December 31,2006 the aforementioned services will be reimbursed at the rate of$75 per hour. Time spent in travel to and from a client family home for professional service will be reimbursed at the rate of $20Ihour. Mileage in travel from the office to a client family home for professional services will be reimbursed at the rate of .345 cents per mile. Non-reimbursable activities include: > Participation in child protection, community treatment team for staffings. > Travel, except to provide authorized in-home services. > Paperwork and other in-direct administrative time. > Supervision or staff development activities. Clients who do not appear for their scheduled appointment shall be responsible to pay the Contractor full cost of that appointment. . The County is responsible for the determination of family eligibility for services. The County will advise the Contractor in writing of the authorized service plan within ten (10) working days of receipt of the certification and service plan. There shall be no payment for services provided without prior authorization for such services by the County. Such authorization shall include the amount of services to be provided, the scope of services provided and time frames in which these services are to be provided. 3. TERMINATION: The County may terminate this Agreement upon ten (10) days written notice to Contractor if it is deemed by the County in its sole discretion, that the Contractor is not fulfilling the program as specified in this Agreement, or for any other reason. Upon such termination any unexpended funds shall be returned to the County. In addition, any funds not properly expended according to project objectives shall be returned by Contractor to County. In the event the Contractor becomes insolvent, is declared bankrupt or dissolves, the County may declare in writing that this Agreement is terminated, and all rights of the Contractor and obligations of the County shall terminate and cease immediately. 4. CONTRACTOR'S DUTIES: The Contractor shall comply with the following requirements: A. All funds received by Contractor under this Agreement shall be expended solely for the purpose for which granted, and any funds not so expended, including funds lost or diverted for other purposes, shall be returned to County. B. Contractor shall maintain adequate financial and programmatic records for reporting to the County. The Contractor shall maintain all records pertaining to this Agreement for a minimum of three (3) years and may be subjected to an audit by federal, state or county auditors or their designees, as requested. If an auditor discovers misuse of funds, the Contractor shall return said misused funds to the County. The Contractor hereby authorizes the County to perform audits or to make inspections during normal business hours upon 48 hours notice to Contractor, for the purpose of evaluating performance under this Agreement. The Contractor will allow access to and cooperate with authorized Health & Human Services representatives in the observation and evaluation of the program and records. The Contractor shall have the right to dispute any claims of misuse of funds and seek an amicable resolution with the County. C. Customer Service/Termination: In rendering its services, Contractor shall comply with the highest standards of customer service to the public. Contractor shall provide appropriate supervision of its employees to ensure the maintenance of these high standards of customer service and professionalism, the performance of such obligation to be determined at the sole discretion of the County. In the event that the County finds these standards of customer service are not being met by the Contractor, the County may terminate this Contract, in whole or in part, upon providing ten (10) days notice to the Contractor. D. The Contractor shall comply with all applicable rules and laws governing counseling and parenting support services in Colorado. The Contractor shall be solely responsible for ensuring proper licensing and credentialing ofthose providing services under this Agreement. The Contractor shall comply with all applicable rules and laws governing eligibility for services and allowable costs under the Colorado WORKS/T ANF program for those families authorized for services to stabilize family life and promote family self-sufficiency. E. The County requests periodic written reports concerning services under this Agreement. Contractor shall provide the County with an assessment and plan within thirty (30) days of enrollment or participation in services by a family or child. This plan shall include the treatment plan for the child's family, including specific objectives and target dates for accomplishment. The treatment plan shall be subject to review and approval by County. Thereafter, at monthly intervals, the Contractor shall submit reports that include progress and barriers in achieving the goals and provisions of the treatment plan. Reimbursement for services is subject to the timely receipt of written assessment, plan, and reports. F. Contractor shall comply with the requirements ofthe Civil Rights Act of 1964 and Section 504, Rehabilitation Act of 1973 concerning discrimination on the basis of race, color, sex, age, religion, political beliefs, national origin, or handicap. G. Contractor shall assure that the service described herein is provided to the County at cost not greater than that charged to other persons in the same community. H. Contractor shall safeguard information and confidentiality of the child and the child's family in accordance with rules of the Colorado Department of Human Services and Eagle County Health and Human Services, and the Health Information Privacy and Accountability Act. 1. The Contractor will notify Eagle County Health & Human Services immediately of all reports of suspected child abuse or neglect involving the Contractor, including, but not limited to, employees, volunteers and clients. Health & Human Services contractors are considered to be mandatory reporters for suspected child abuse and neglect and are to make those reports directly to Eagle County Health & Human Services - Adult and Family Services Division - (970) 328-8840. J. The Contractor will provide information to all T ANF eligible participants on the following: Food Stamps - Every participant must be informed that they are categorically eligible to receive at least some services and should be referred to Eagle County Health & Human Services for more information on application for benefits. Medicaid - Every participant must be informed they may be eligible and should be referred to Eagle County Health & Human Services for information on application for benefits. Disabilities and other Barriers - The Contractor must inform participants that they can visit the Eagle County Health & Human Services offices to receive an assessment and appropriate services that may better work with their disabilities or other barriers. . Appeal Rights - The Contractor must provide participants with notice of their right to appeal to the Eagle County Department of Human Services. The Contractor will keep a record of all participants served for documentation in case of an appeal. K. The Contractor shall submit monthly billings to the County. Billings will be paid through the County's usual bill paying process. Billings must be submitted by the fifth working day of the subsequent month in order to be eligible for reimbursement, except that billings for services provided through June 30, 2006 must be submitted by July 1, 2006; and billings for services provided through December 31, 2006 must be submitted by January 6, 2007 in order to be eligible for reimbursement. L. Contractors shall participate in an annual training provided by the County regarding program requirements and eligibility; child abuse and neglect reporting; and, financial and program reporting to the County. 5. NOTICE: Any notice required under this Agreement shall be given in writing by registered or certified mail; return receipt requested which shall be addressed as follows: THE COUNTY: THE CONTRACTOR: Eagle County Health & Human Services Bethanie Nelson Lindal Post Office Box 660 P.O. Box 4496 Eagle, CO 81631 Eagle, CO 81631 Notice shall be deemed given three (3) days after the date of deposit in a regular depository of the United States Postal Service. 6. ASSIGNMENT: The Contractor shall not assign any of its rights or duties under this Agreement to a third party without the prior written consent of County. Any assignment without the prior written consent of County shall cause this Agreement to terminate. 7. MODIFICATION: Any revision, amendment or modification to this Agreement, shall only be valid if in writing and signed by all parties. 8. INSURANCE: At all times during the term of this Agreement, Contractor shall maintain in full force and effect the following insurance: Type oflnsurance Coverage Limits Professional Liability Insurance $ 500,000 per occurrence Contractor shall purchase and maintain such insurance as required above and shall provide certificates of insurance in a form acceptable to Eagle County upon execution of the Agreement. . 9. MISCELLANEOUS: A. The parties to this Agreement intend that the relationship of the Contractor to the County is that of independent contractor. No agent, employee or volunteer of the Contractor shall be deemed to be an agent, employee or volunteer of the County. B. This Agreement shall be binding upon and inure to the benefit of the Contractor and the County and their respective heirs, legal representatives, executors, administrators, successors and assigns. Neither party may assign or delegate any of its rights or obligations hereunder without first obtaining the written consent of the other party. C. In the event oflitigation in connection with this Agreement, it is agreed that the prevailing party shall be entitled to recover all reasonable costs incurred, including attorney fees, costs, staff time and other claim related expense. D. The invalidity or unenforceability of any provision ofthis Agreement shall not affect the other provisions hereof, and this Agreement shall be construed as if such invalid or unenforceable provision was omitted. E. Contractor shall indemnify and hold harmless the County, its Board of Commissioners, and the individual members thereof, its agencies, departments, officers, agents, employees, servants and its successors from any and all demands, losses, liabilities, claims or judgments, together with all costs and expenses, including but not limited to attorney fees, incident thereto which may accrue against, be charged to or be recoverable from the County, its Board of Commissioners, and the individual members thereof, its agencies, departments, officers, agents, employees, servants and its successors, as a result of the acts or omissions of Contractor, its employees or agents, in or in part pursuant to this Agreement or arising directly or indirectly out of Contractor's exercise of its privileges or performance of its obligations under this Agreement. F. The Contractor shall comply with all applicable laws, resolutions, and codes. G. Notwithstanding anything to the contrary contained in this Agreement, the County shall have no obligations under this Agreement, nor shall any payments be made to Contractor in respect of any period after December 31 st of each calendar year during the term of this Agreement, without the appropriation therefore by the County in accordance with a budget adopted by the Board of County Commissioners in compliance with the provisions of Article 25, Title 30 of the Colorado Revised Statutes, the Local Government Budget Law (C.R.S. 29-1-101 et.seq.) and the TABOR Amendment (Colorado Constitution, Article X, Sec. 20). H. This Agreement shall be governed by the laws of the State of Colorado. Jurisdiction and venue for any suit, right or cause of action arising under, or in connection with this Agreement shall be exclusive in Eagle County, Colorado. . I. This Agreement supersedes all previous communications, negotiations and/or agreements between the respective parties hereto, either verbal or written, and the same not expressly contained herein are hereby withdrawn and annulled. This is an integrated agreement and there are no representations about any of the subject matter hereof except as expressly set forth in this Agreement. No alterations, amendments, changes or modifications to this Agreement shall be valid unless executed by an instrument in writing signed by both parties. J. This Agreement does not, and shall not be deemed or construed to, confer upon or grant to any third party or parties any right to claim damages or to bring any suit, action or other proceeding against either Contractor or the County because of any breach hereof or because of any ofthe terms, covenants, agreements and conditions herein. K. Contractor hereby certifies that it has read the Agreement, understands each and every term and the requirements set forth herein, and agrees to comply with the same. IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the date first set forth above. The parties hereto have signed this Agreement in triplicate. Two counterparts have been delivered to County and one to the Contractor. COUNTY OF EAGLE, STATE OF COLORADO By and tlrrO~;~~:mSSioners BY:~ -z;. ;7 Peter Runyon, Chairman ,?/ CONTRACTOR: Bethanie Nelson Lindal APPLICATION FOR DATE SUBMITTED: Applicar, dfier 08CH0149 FEDERAL ASSISTANCE 1. TYPE OF SUBMISSION 3. DATE RECEIVED BY STATE: State Application Identifier Application Preapplication o Construction o Construction 4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier o Non-Construction o Non-Construction 5. APPLICANT INFORMATION Legal Name: HHS, Eagle County EHS Organizational Unit: Department: Eagle County Health & Human Services Organizational DUNS: 084-024447 Division: Early Childhood Address: Name and telephone number of the person to be contacted on matters Street: 551 Broadway involving this application (give area code) POB 660 Prefix: I First Name: Kathleen City: Eagle Middle Name: County: Eagle Last Name: Forinash State: CO Zip Code: 81631 Suffix: Country: USA Email: kathleen. forinash@eaglecounty.us 6. EMPLOYER IDENTIFICATION NUMBER (EIN) Phone Number (give area code) Fax Number (give area code) [:TJ -= 970-328-8858 970-328-8829 8. TYPE OF APPLICATION 7. TYPE OF APPLICANT (enter appropriate letter in box) ~ DNew 0 Continuation B Revision Other (specify) If Revision, enter appropriate letter(s) in box(es): D 9. NAME OF FEDERAL AGENCY: Other (specify) ACF 10. CATALOG OF FEDERAL DOMESTIC ~.~ 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: ASSISTANCE NUMBER: Mandatory 1 % reduction TITLE (Name of Program): Early Head Start 12. AREAS AFFECTED BY PROJECT (Cities, Counties, States etc.): Eagle County, Colorado 13. PROPOSED PROJECT: 14. CONGRESSIONAL DISTRICTS OF: Start Date: 1/01/2006 lEnding Date: 12/31/2006 a. Applicant3rd District I b. Project 3rd District 15. ESTIMATED FUNDING 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS? a Federal $ 389,361 .00 a. YES THIS PREAPPLlCA TION/APPLlCA TION WAS MADE AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON b Applicant $ 97,340 .00 eState $ 0.00 Date b. NO 0 PROGRAM IS NOT COVERED BY E.O. 12372 d Local $ 0.00 0 OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW I e Other $ 0.00 I f Program Income $ 0.00 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? I gTotal $ 486,701 .00 DYes If 'Yes," attach an explanation. 0 No i , 118. TOTHE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION ARE TRUE AND CORRECT. THE DOCUMENT HAS BEEN DULY AUTHORIZED I IBY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED I a. Authorized Representative I , Prefix First Name Peter Middle Name Last Name Runyon Suffix b. Title Chair, BOCC c. Telephone number 970-328-8506 d. Signature of Authorized Representative e. Date Signed Standard Form 424 (Rev.9-2003) Prescribed by OMB Circular A-102 BUDGET INFORMATION -Non-Construction Programs OMS Approval No. 0348-0044 )W;ii ;Xii.@<W);; )..)i);';;.;@),;., ;;;;}i SEC'JilIN'I..BUDGE..f;..SUMMl/.i~ ,'l<!;!)!i!); i))!N!i!!!@; ii) )ii;);i)iii!;i!!i! iiX iX!!)i)X!.;}, Grant Program Catalog of Federal Estimated Unobligated Funds New or Revised Budget Function Domestic Assistance or Activity Number Federal Non-Federal Federal Non-Federal Total (a) (b) 1. Program Operation 93.600 $389,361 $97,340 $486,701 2.T&TA 93.600 3. 4. ......... 5. Totals $389,361 $97,340 $486,701 i)W)8f~i)ii;) @~f!l!gJil!;!iii!)) XYX"X))X; ) ix!!i)f!i! .,i}i@, <X!i!!.;!l/;//!!}!!;.xif! !if, XiVi .;iV .;,. ii;i..... SE~'I110N 13 ..I3U~~'l'.OJ\;rEG('i)R1ES..>)i))iiif)i!ii JJ!WJiii!!!iiJi!ii!iiiil!i.@!!) 6. Object Class Categories GRANT PROGRAM, FUNCTION OR ACTIVITY Total (1) Program Operation (2) T&TA (3) (4) a. Personnel $245,601 $245,601 b. Fringe Benefits $115,352 $115,352 c. Travel $516 $516 d. Equipment e. Supplies $10,847 $10,847 f. Contractual $4,000 $4,000 g. Construction ....); h. Other $13,045 $13,045 i Total Direct Charges (sum of 6a - 6h) $389,361 $389,361 j. Indirect Costs k. TOTALS (sum of 6a - 6j) $389,361 $389,361 i j!.i;f\ii i ;i. i!i iii ;; )) ,.y. YF; .).)..i....) 7. Program Income Authorized for Local Reproduction Standard Form 424A (Rev. 7-97) Prescribed by OMS Circular A-1 02 08CH0149 I 0 2006 HHS, Eagle County EHS Supplemental EHS Grant Application 1 % reduction " . ........I!!I~Ula~el"\lIa...e() "" " ". " ~ (a) Grant Program (b) Applicant (c) State (d) Other Sources (e) TOTALS 8. NFS $97,340 $97,340 9. 10. 11. 12. TOTAL (sum of lines 8-11) $97,340 $97,340 " I SECTION D. FORECASTED ~ASH NEEDS. . , Total for 1st Year 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter 13. Federal $389,361 $97,340 $97,340 $97,340 $97,341 14. Non-Federal $97,340 $24,335 $24,335 $24,335 $24,335 15. TOTAL (sum of lines 13 -14) $486,701 $121,675 $121,675 $121,675 $121,676 SECTION E . BUDGe! ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF TH.IS P~O~ECT . FUTURE FUNDING PERIODS (Years) (a) Grant Program (b) First (c) Second (d) Third (e) Fourth 16. 17. 18. 19. 20. TOTAL (sum of lines 16-19) SECTION F . OTHER BUDGET INFORMATION " 21. Direct Charges: I 22. Indirect Charges: 23. Remarks: Authorized for Local Reproduction Standard Form 424A (Rev. 7-97) Page2 08CH0149 I 0 2006 HHS, Eagle County EHS Supplemental EHS Grant Application 1% reduction U.S. DEPARTMENT OF HEAL TH AND HUMAN SERVICES COMPENDIUM OF REQUIRED CERTIFICA TIONS AND ASSURANCES SF 4248 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) Title 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) 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 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 VII 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; (I) 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 It and 11/ 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 al/ 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 US.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 US.c. 276a to 276a-7), the Copeland Act (40 US.C. 276c and 18 US.C. 874), and the Contract Work Hours and Safety Standards Act (40 US.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 US.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 US.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 US.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 US. C. 470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 US. 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 US.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 US.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 al/ 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 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 wilt maintain a drug-free workplace. The certification set out below is a material representation of fact upon which reliance wilt 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 identified on the certification. If known, they may be identified in the grant application. If the grantee does not identify the workplaces at the time of application, or upon award, if there is no application, the grantee must keep the identity of the workplace(s) on file in its office and make the information available for Federal inspection. Failure to identify all known workplaces constitutes a violation of the grantee's drug-free workplace requirements. Workplace identifications must include the actual address of buildings (or parts of 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 white 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 changers), 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 guitt (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) 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 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; 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 (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; t) 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 (t). CERTlFICA TlON 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 governments, 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 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. CERTIFICA 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 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, falsification 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 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 TlON REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION - 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. CERTlFICA TlON REGARDING LOBBYING FOR CONTRACTS, GRANTS, LOANS AND COOPERA TlVE 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 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 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 certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U. S. Code. Any person who fails to file the required certification shall be subject to a civil penalty or not less than $10,000 and not more than $100,000 for each such failure. 0-::1\ -C)Lt Date C~~Q~ Title Applicant Organization Eagle County Early Head Start Mandatory 1% Reduction ($3,933) New PA 25 grant amount is $389,361 Budget Justification _7th year January 1,2006 through December 31, 2006 a. Personnel (object class 6a) No reduction b. Fringe Benefits (Object class 6b) No reduction c. Travel (object class 6c) This item represents out of county travel by the EHS 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 Cost: Meals x 3 w/EI Jebel staff = 150 reduce 50% = 75 Hotel x 4 CHSA meetings = 540 reduce 50% = 270 Meals x 4 CHSA meeting= 342 reduce 50% = 171 1,032 516 d. Equipment (object class 6d) No equipment purchases are planned for this program year. e. Supplies (Object class 6e) Federal Costs: Reduction Office supplies 700 500 Home visit materials (average of 85.64 reduce to $50 per enrolled child) 3,854 2250 Policy Council materials (reduce $150) 400 250 Parent Meeting materials (reduce $150) 200 150 Food for group socialization & parent meetings 5,600 5,600 Food for Health Advisory Committee 160 160 Group Socialization materials (reduce $313) 2,000 1687 Replenishing lending library materials (Eliminate) 1,000 0 Staff references 350 250 Total 14,264 10,847 - 1 - Eagle County Early Head Start l~fandatory 1% Reduction ($3,933) New PA 25 grant amount is $389,361 Budget Justificatiou - ih year January 1,2006 through December 31,2006 f. Contractual (object class 6f) No reduction g. Construction (object class 6g) The program has no plans for construction costs. h. Other (class object 6h) No reduction (T/TA funds (pA 26) 9,582 not included in 1% reduction) Non-Federal Costs: . Personnel and fringe benefits 17,655 . Training and technical assistance 7,200 . Use allowance: for 881 sq. ft. of office & storage space in a 14,500 sq.ft. 19,377 building owned by the applicant. Fair market value is $22/sq.ft. . Rent: Basalt Middle School 36,009 $20/hr x 3 groups/month x 6 hr/ group xl2 months = $4,320 (Reduce 4,320 by $3,379 = 941) 1,594 sq. ft of donated space in the Edwards Annex for group socializations and storage, @ a value of$22/sq.ft. = $35,068 . Utilities & Telephone: Standard telephone service for 8 phone lines 2 1,500 approximately $15.63 per month . Volunteers: 219 hours at an average of $25/hour 5,474 . Parent volunteer services: inkind related to home visits and/or group 10,125 Socialization activities and family plan, includes parents reading to their children. Occurs between home visits or group socialization. 675 hours at an average of$15/hour. Total Non-Federal ($100,719 - 3,379 = $97,340) 97,340 Total Federal Budget original = $393294 $389,361 - 2 -