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HomeMy WebLinkAboutC10-270 Early Headstart Grant Budget Revision of Expansion App APPLICATION FOR Version 7/03 FEDERAL ASSISTANCE 2. DATE SUBMITTED Applicant Identifier 08SA0149/01 1. TYPE OF SUBMISSION: 3. DATE RECEIVED BY STATE State Application Identifier Application Pre - application 08SA0149/01 Construction Construction 4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier Non - Construction E[ Non- Construction 5. APPLICANT INFORMATION Legal Name: Organizational Unit: Eagle County Health and Human Services Department: Ea 9 � Health and Human Services Organizational DUNS: Division: 08402447 Children and Family Services Address: Name and telephone number of person to be contacted on matters Street: involving this application (give area code) 551 Broadway Prefix: First Name: Rosie City: Middle Name Eagle County: Last Name Eagle Moreno State: Zip Suffix: CO Country: Email: rosie.moreno @eaglecounty.us 6. EMPLOYER IDENTIFICATION NUMBER (EIN): Phone Number (give area code) Fax Number (give area code) 8 4_ 6 0 0 0 7 6 2 970- 328 -2604 970 - 328 -2602 8. TYPE OF APPLICATION: 7. TYPE OF APPLICANT: (See back of form for Application Types) r New n Continuation F7 Revision B If Revision, enter appropriate letter(s) in box(es) (See back of form for description of letters.) _ — Other (specify) Other (specify) 9. NAME OF FEDERAL AGENCY: line item change Administration for Children and Families /DHHS 10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: 9 3_ 6 0 0 Budget Revision of Expansion Application, Year 1 TITLE (Name of Program): Early Head Start 12. AREAS AFFECTED BY PROJECT (Cities, Counties, States, etc.): Eagle County 13. PROPOSED PROJECT 14. CONGRESSIONAL DISTRICTS OF: Start Date: Ending Date: a. Applicant b. Project 10/1/2009 9/30/2010 3rd District 3rd District 15. ESTIMATED FUNDING: 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS? a. Federal $ uu a. Yes. THIS PREAPPLICATION /APPLICATION WAS MADE 639,919 AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 b. Applicant $ 00 PROCESS FOR REVIEW ON 159,980 c. State $ 0u DATE: d. Local $ .uu b. No.] PROGRAM IS NOT COVERED BY E. O. 12372 e. Other $ . r OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW f. Program Income $ . 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? g. TOTAL $ 00 799,899 Ct Yes If "Yes' attach an explanation. No 18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION /PREAPPLICATION 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. Authorized Representative Prefix First Name Middle Awe Sara ] Last Name Suffix Fisher b. Title c. Telephone Number (give area code) Board of County Commissioners 970- 328 -8605 d. Signature of Authorized Representative ;C / e. Date Signed ? / /,/ f r 1 Previous Edition Usable V `°/ Standard Form 424 (Rev.9 -2003) Authorized for Local Reproduction Prescribed by OMB Circular A -102 C. (0 -7°0 INSTRUCTIONS FOR THE SF-424 Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for reviewing instructions, searchinc existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, ' o the Office of Management and Budget, Paperwork Reduction Project (0348- 0043), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDE) BY THE SPONSORING AGENCY. This is a standard form used by applicants as a required face sheet for pre - applications and applications submitted for Federal assistance. It will be u3ed by Federal agencies to obtain applicant certification that States which have established a review and comment procedure in response to Executive Order 12372 and have selected the program to be included in their process, have been given an opportunity to review tie applicant's submission. Item: Entry: • Item: Entry: 1. Select Type Of Submission. 11. Enter a brief descriptive title of the project. If more than one program is involved, you should append an explanation on a separate sheet. If appropriate (e.g., construction or real property projects), attach a map showing project location. For preapplications, use a separate sheet to provide a summary description of this project. 2. Date applicat on submitted to Federal agency (or State if applicable) 12. List only the largest political entities affected (e.g., State, and applicanfs control number (if applicable). counties, cities). 3. State use onIN (if applicable). 13 Enter the proposed start date and end date of the project. 4. Enter Date Received by Federal Agency 14. List the applicant's Congressional District and any District(s) • Federal ident fier number: If this application is a continuation or affected by the program or project revision to an existing award, enter the present Federal Identifier number. If for a new project, leave blank. 5. Enter legal nOme of applicant, name of primary organizational unit 15 Amount requested or to be contributed during the first (including division, if applicable), which will undertake the funding /budget period by each contributor. Value of in kind assistance activity, enter the organization's DUNS number contributions should be included on appropriate lines as (received froth Dun and Bradstreet), enter the complete address of applicable. If the action will result in a dollar change to an the applicant (including country), and name, telephone number, e- existing award, indicate only the amount of the change. For mail and fax Of the person to contact on matters related to this decreases, enclose the amounts in parentheses. If both basic application. and supplemental amounts are included, show breakdown on an attached sheet. For multiple program funding, use totals and show breakdown using ame categories item 15. g g as e 6. Enter Employer Identification Number (EIN) as assigned by the 16. Applicants should contact the State Single Point of Contact Internal Revehue Service. (SPOC) for Federal Executive Order 12372 to determine whether the application is subject to the State intergovernmental review process. 7. Select the appropriate letter in 17. This question applies to the applicant organization, not the the space prc}vided. I. State Controlled person who signs as the authorized representative. Categories A. Stake Institution of Higher of debt include delinquent audit disallowances, loans and B. County Learning taxes. C. Muhicipal J. Private University D. To nship K. Indian Tribe E. Int rstate L. Individual F. Int rmunicipal M. Profit Organization G. Sp cial District N. Other (Specify) H. Ind pendent School O. Not for Profit District Organization 8. Select the type from the following list: 18 To be signed by the authorized representative of the applicant. • "New" nleans a new assistance award. A copy of the governing body's authorization for you to sign • "Contintion" means an extension for an additional this application as official representative must be on file in the funding /budget period for a project with a projected completion applicant's office. (Certain Federal agencies may require that date. this authorization be submitted as part of the application.) • "Revisioh" means any change in the Federal Government's financiallobligation or contingent liability from an existing obligatioh. If a revision enter the appropriate letter: • A. Increase Award B. Decrease Award C. Increase Duration D. Decrease Duration 9. Name of Federal agency from which assistance is being requested with this application. 10. Use the Catalpg of Federal Domestic Assistance number and title of the program Under which assistance is requested. SF -424 (Rev. 7 -97) Back OMB Approval No. 0348 -0040 ASSURANCES - NON- CONSTRUCTION PROGRAMS Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348- 0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. 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 Act of 1973, as amended (29 U.S.C. §794), which and the institutional, managerial and financial capability prohibits discrimination on the basis of handicaps; (d) (including funds sufficient to pay the non - Federal share the Age Discrimination Act of 1975, as amended (42 of project cost) to ensure proper planning, management U.S.C. § §6101 - 6107), which prohibits discrimination and completion of the project described in this on the basis of age; (e) the Drug Abuse Office and application. Treatment Act of 1972 (P.L. 92 -255), as amended, relating to nondiscrimination on the basis of drug 2. Will give the awarding agency, the Comptroller General abuse; (f) the Comprehensive Alcohol Abuse and of the United States and, if appropriate, the State, Alcoholism Prevention, Treatment and Rehabilitation through any authorized representative, access to and Act of 1970 (P.L. 91 -616), as amended, relating to the right to examine all records, books, papers, or nondiscrimination on the basis of alcohol abuse or documents related to the award; and will establish a alcoholism; (g) § §523 and 527 of the Public Health proper accounting system in accordance with generally Service Act of 1912 (42 U.S.C. § §290 dd -3 and 290 ee- accepted accounting standards or agency directives. 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the 3. Will establish safeguards to prohibit employees from Civil Rights Act of 1968 (42 U.S.C. § §3601 et seq.), as using their positions for a purpose that constitutes or amended, relating to nondiscrimination in the sale, presents the appearance of personal or organizational rental or financing of housing; (i) any other conflict of interest, or personal gain. nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being 4. Will initiate and complete the work within the applicable made; and, (j) the requirements of any other time frame after receipt of approval of the awarding nondiscrimination statute(s) which may apply to the agency. application. 5. Will comply with the Intergovernmental Personnel Act of 7. Will comply, or has already complied, with the 1970 (42 U.S.C. § §4728 -4763) relating to prescribed requirements of Titles II and III of the Uniform standards for merit systems for programs funded under Relocation Assistance and Real Property Acquisition one of the 19 statutes or regulations specified in Policies Act of 1970 (P.L. 91 -646) which provide for Appendix A of OPM's Standards for a Merit System of fair and equitable treatment of persons displaced or Personnel Administration (5 C.F.R. 900, Subpart F). whose property is acquired as a result of Federal or federally- assisted programs. These requirements apply 6. Will comply with all Federal statutes relating to to all interests in real property acquired for project nondiscrimination. These include but are not limited to: purposes regardless of Federal participation in (a) Title VI of the Civil Rights Act of 1964 (P.L. 88 -352) purchases. which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education 8. Will comply, as applicable, with provisions of the Amendments of 1972, as amended (20 U.S.C. § §1681- Hatch Act (5 U.S.C. § §1501 -1508 and 7324 -7328) 1683, and 1685 - 1686), which prohibits discrimination on which limit the political activities of employees whose the basis of sex; (c) Section 504 of the Rehabilitation principal employment activities are funded in whole or in part with Federal funds. Previous Edition Usable Standard Form 424B (Rev. 7 - 97) Authorized for Local Reproduction Prescribed by OMB Circular A - 102 r i i 9. Will comply, as applicable, with the provisions of the Davis- 12. Will comply with the Wild and Scenic Rivers Act of Bacon Act (40 U.S.C. § §276a to 276a -7), the Copeland Act 1968 (16 U.S.C. § §1271 et seq.) related to protecting (40 U.S.C. §276c and 18 U.S.C. §874), and the Contract components or potential components of the national Work Hours and Safety Standards Act (40 U.S.C. § §327- wild and scenic rivers system. 333), regarding labor standards for federally- assisted construction subagreements. 13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation 10. Will comply, if applicable, with flood insurance purchase Act of 1966, as amended (16 U.S.C. §470), EO 11593 requirements of Section 102(a) of the Flood Disaster (identification and protection of historic properties), and Protection Act of 1973 (P.L. 93 -234) which requires the Archaeological and Historic Preservation Act of recipients in a special flood hazard area to participate in the 1974 (16 U.S.C. § §469a -1 et seq.). program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more. 14. Will comply with P.L. 93 -348 regarding the protection of human subjects involved in research, development, and 11. Will comply with environmental standards which may be related activities supported by this award of assistance. prescribed pursuant to the following: (a) institution of environmental quality control measures under the National 15. Will comply with the Laboratory Animal Welfare Act of Environmental Policy Act of 1969 (P.L. 91 -190) and 1966 (P.L. 89 -544, as amended, 7 U.S.C. § §2131 et Executive Order (EO) 11514; (b) notification of violating seq.) pertaining to the care, handling, and treatment of facilities pursuant to EO 11738; (c) protection of wetlands warm blooded animals held for research, teaching, or pursuant to EO 11990; (d) evaluation of flood hazards in other activities supported by this award of assistance. floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management 16. Will comply with the Lead -Based Paint Poisoning program developed under the Coastal Zone Management Prevention Act (42 U.S.C. § §4801 et seq.) which Act of 1972 (16 U.S.C. § §1451 et seq.); (f) conformity of prohibits the use of lead -based paint in construction or Federal actions to State (Clean Air) Implementation Plans rehabilitation of residence structures. under Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. § §7401 et seq.); (g) protection of 17. Will cause to be performed the required financial and underground sources of drinking water under the Safe compliance audits in accordance with the Single Audit Drinking Water Act of 1974, as amended (P.L. 93 -523); Act Amendments of 1996 and OMB Circular No. A -133, and, (h) protection of endangered species under the "Audits of States, Local Governments, and Non - Profit Endangered Species Act of 1973, as amended (P.L. 93- Organizations." 205). 18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, and policies governing this program. SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE —C1 _ Board of County Commissioners APPLICANT ORGAN ATION DATE SUBMITTED Eagle County Health and Human Services September 10, 2010 Standard Form 424B (Rev. 7 -97) Back • 1