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HomeMy WebLinkAboutC12-311 Early Head Start 2013 Continuation Grant Application 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. .evious Edition Usable Standard Form 424B (Rev. 7 - 97) Authorized for Local Reproduction Prescribed by OMB CircularA - 102 x,,13,' 3f 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 AUTHORIZE CERTIFYING • i∎ ICIAL TITLE ,'� Board of County Commissioners, Chairman APPLICANT ORGANIZATION DATE SUBMITTED Eagle County Health and Human Services September 30, 2012 Standard Form 424B (Rev. 7 -97) Back APPLICATION FOR Version 7/03 FEDERAL ASSISTANCE 2. DATE SUBMITTED Applicant Identifier 08CH0149 1. TYPE OF SUBMISSION: 3. DATE RECEIVED BY STATE State Application Identifier Application Pre - application Construction Construction 4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier V Non - Construction _ Non - Construction 5. APPLICANT INFORMATION Legal Name: Organizational Unit: Eagle County Health and Human Services Deppartment: HHS: Child, Family and Adult Services Organizational DUNS: Division: 08402447 Early Head Start Address: Name and telephone number of person to be contacted on matters Street: involving this application (give area code) 551 Broadway Prefix: First Name: P.O. Box 660 Rosie City: Middle Name Eagle County: Last Name Eagle Moreno State: Zip Code Suffix: CO Country: Email: rosie.moreno@eaglecounty.us 6. EMPLOYER IDENTIFICATION NUMBER (E /N): Phone Number (give area code) Fax Number (give area code) 8 4— 6 0 0 0 7 6 2 970- 328 -2605 855- 848 -8826 8. TYPE OF APPLICATION: 7. TYPE OF APPLICANT: (See back of form for Application Types) 11 New V1 Continuation Revision B. County 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: 1 HHS /ACF /OHS 10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: 9 3 — 6 0 0 Continuation of Early Head Start funding for 2013 TITLE (Name of Program): 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 1/1/13 12/31/13 Third District Third District 15. ESTIMATED FUNDING: 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS? a. Federal $ °U frl THIS PREAPPLICATION /APPLICATION WAS MADE 903,736 . a. Y es. iu AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 b. Applicant $ 225,934 °° PROCESS FOR REVIEW ON c. State $ .ou DATE: d. Local $ .°o b. No. PROGRAM IS NOT COVERED BY E. O. 12372 e. Other $ .ou r OR PROGRAM HAS NOT BEEN SELECTED BY STATE FO R REVIEW f. Program Income $ . 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? g. TOTAL $ 00 1,129,670 . E Yes If "Yes" attach an explanation. 1i 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 Middle Name Pet Last Name n 1 ,, Suffix LB_ n ' ft \1 N( - ,V 1 b. Title 1 S tiv. c. Telephone Number Board of County Commissioners, Chairman P (give area code) II 970- 328 -2604 d. Signature of Authorized Representative ,, p e. Date Signed q { 11 1 Previous Edition Usable Standard Form 424 (Rev.9 -2003) Authorized for Local Reproduction Prescribed by OMB Circular A -102