HomeMy WebLinkAboutC12-212 EHS Expansion Supplemental GrantAPPLICATION FOR 2.DATE SUBMITTED:Applicant Identifier
FEDERAL ASSISTANCE 05/13/2012 08CH0149
I.TYPE OF SUBMISSION 3.DATE RECEIVED BY STATE:State Application Identifier
Application Preapplication
fl Construction Construction 4.DATE RECEIVED BY FEDERAL Federal Identifier
E Non-Construction Non-Construction 05/1412012 08CH0149 -200
5.APPLICANT INFORMATION
Legal Name:Organizational Unit:
EAGLE COUNTY HEALTH AND HUMAN SERVICES Department:HHS:Office of Head Start
Organizational DUNS:084024447 Division:HHS:Office of Head Start
Address:Name and telephone number of the person to be contacted on matters
Street:551 Broadway involving this application (give area code)
P.O.Box 660 Prefix:Middle Name:
City:Eagle First Name:Rosie
County:N/A Last Name:Moreno
State:CO Zip Code:81631 Suffix:
Country:N/A Email:rosie.moreno@eaglecounty.us
6.EMPLOYER IDENTIFICATION NUMBER fEIN)Phone Number (give area code)Fax Number (give area code)
846000762 (970)471 -3443
8.TYPE OF APPLICATION 7.TYPE OF APPLICANT (enter appropriate letter in box)
fl New Continuation Revision Other (specify)
If Revision,enter appropriate letter(s)in boxfes):
Other (specify)9.NAME OF FEDERAL AGENCY:
Supplemental-COLA,HA and Expansion HHS /ACF I OHS
10.CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:11.DESCRIPTION TITLE OF APPLICANTS PROJECT:
Supplemental application for continued operations of expansion services;93.600 COLA and HA for 37 additional low-income children and families in the
TITLE (Name of Program):Early Head Start program.
Head Start /Early Head Start
12.AREAS AFFECTED BY PROJECT (Cities,Counties,States etc.):
Eagle County,Colorado
13.PROPOSED PROJECT:14.CONGRESSIONAL DISTRICTS OF:
Start Date:01/01/2012 Ending Date:12/31/2012 a.Applicant:Third b.Project:Third
16.IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER15.ESTIMATED FUNDING 12372 PROCESS?
a,Federal $124,547 a.YES THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE
O THE
STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ONb.Applicant $31,140
c.State $0 Date:
d.Local $0 b.NO PROGRAM IS NOT COVERED BY E.O.12372
OR PROGRAM HAS NOT BEEN SELECTED BY STATE FORe.Other $0 E REVIEW
f.Program Income $0 17.IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
g.Total $155,687 Yes lf”Yes,”attach an explanation.No
18.TO i n OF MY KNOWLEOG ii’i.iEF,ALL DATA IN THIS APPL CATION ARE TRUE AND rxi..i.THE uIii..UIVIIN i HAS BEEN DULYWTHORIZED
BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE ISWJARDED
a.Authorized Representative
Prefix:First Name:Peter Middle Name:
Last Name:Runyon
.Suffix:
b.Title:Authorizing Official ,,,c.Telephone number:(970)328-2605
d.Signature of Authorized e.Date Signed:I i I
Jtandard 1-orm 424 (Rev.-2UtE3)PFescribed by 0MB Circular
A-102
U.S.DEPARTMENT OF HEALTH AND HUMAN SERVICES
COMPENDIUM OF REQUIRED CERTIFICATIONS AND ASSURANCES
SF424B
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:
7.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.Wiil 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 ail 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.Wiil 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 7964 (P.C.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.7687-
1683,and 1685-1686),which prohibits discrimination on the basis of sex;(c)Section 504 of the
Rehabilitation Act of 7973,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.6707-6707),which prohibits
discrimination on the basis of age;(e)the Drug Abuse Office and Treatment Act of 7972 (P.L.92-255),as
amended relating to non-discrimination on the basis of drug abuse;(I)the Comprehensive Alcohol Abuse
and Alcoholism Prevention,Treatment and Rehabilitation Act of 7970 (P.L.97-676),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 7972 (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 7968 (42 U.S.C.3607 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 6’)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 II and Ill of the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970 (P.C.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.7507-7508 and 7324-7328)which limit the
political activities of employees whose principal employment activities are funded in whole or in part with
Federal funds.
9.Will comply,as applicable,with the provisions of the Davis-Bacon Act (40 U.S.C.276a to 276a-7),the
Copeland Act (40 U.S.C.276c and 78 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.
70.Will comply,if applicable,with flood insurance purchase requirements of Section 702(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 $70,000 or more.
77.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 7969
(P.L.97-790)and Executive Order (EO)77574;(b)notification of violating facilities pursuant to EO 17738;
(c)protection of wetlands pursuant to EO 77990;(d)evaluation of flood hazards in fioodplains in accordance
with EO 17988;(e)assurance of project consistency with the approved State management program
developed under the Coastal Zone Management Act of 1972 (76 U.S.C.7457 et seq.);(f)conformity of
Federal actions to State (Clear Air)Implementation Plans under Section 176(c)of the Clear Air Act of 7955,
as amended (42 U.S.C.7407 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 7973,as amended (P.L.93-205)
72.Will comply with the Wild and Scenic Rivers Act of 7968 (76 U.S.C.1277 et seq.)related to protecting
components or potential components of the national wild and scenic rivers system.
73.Will assist the awarding agency in assuring compliance with Section 706 of the National Historic
Preservation Act of 7966,as amended (76 U.S.C.470),EO 11593 (identification and protection of historic
properties),and the Archaeological and Historic Preservation Act of 7974 (76 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.2737
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.
76.Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C.4807 et seq.)which
prohibits the use of lead based paint in the construction or rehabilitation of residence structures.
77.Will cause to be performed the required financial and compliance audits in accordance with the single
Audit Act of 1984.
78.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/or submitting this application or grant agreement,the grantee is providing the certification set out
below.
This certification is required by regulations implementing the Drug-Free Workplace Act of 1988,45 CFR,Part
76,Subpart F.The regulations published in the January 31,1989 Federal Register,require certification by
grantees that they will maintain a drug-free workplace.The certification set out below is a material
representation of fact upon which reliance will be placed when HHS determines to award the grant.False
certification or violation of the certification shall be grounds for suspension of payments,suspension or
termination of grants,or 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 grantees 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 while in operation,State employees in each local unemployment office,
performers in concert halls or radio studios).
If the workplace identified to HHS changes during the performance of the grant,the grantee shall inform the
agency of the change(s),it previously identified the workplaces in question (see above).
Definitions of terms in the Nonprocurement Suspension and Debarment common rule and Drug-Free Workplace
common rule apply to this certification.Grantees’attention is called,in particular to the following definitions
from these rules:
“Controlled substance”means a controlled substance in Schedules I through V of the Controlled Substances
Act (27 USC 872)and as further defined by regulations (21 CFR,1308.11 through 1308.75).“Conviction”
means a finding of guilt (including a plea of nob 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
‘ndirect 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’á 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 grantees 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 grantees
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;
f)Taking one of the following actions within 30 days of receiving notice under subparagraph
(d)(2),with respect to any employee who is so convicted:
(7)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 Federa4 State,or local health,
law enforcement,or other appropriate agency.
g)Making a good faith effort to continue to maintain a drug-free workplace through
implementation of paragraphs (a)through (f).
CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE
Public Law 7 03-227,also known as the Pro-Children Act of 7994 (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 78,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 childrens
services that are provided in indoor facilities that are constructed,operated,or maintained with such Federal
funds.The law does not apply to childrens 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 $7,000 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.
CERTIFICATION REGARDING DEBARMEN7 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 certifies to the best of his or her knowledge and believe that it and its principals:
(a)are not presently debarred,suspended,proposed for debarment,declared ineligible or voluntarily
excluded from covered transaction by any Federal Department or agency;
(b)have not within a 3year period preceding this proposal been convicted or had a civil judgement
rendered against them for commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain,or performing a public (Federal,State or local)transaction or contract under a
public transaction:violation of Federal or State antitrust statutes or commission of embezzlement,
theft,forgery,bribery,falsification or destruction of records,making false statement,or 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 (7)(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 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
“Certification Regarding Debarment,Suspension,Ineligibility and Voluntary Exclusion -Lower Tier Covered
Transactions,“provided below without modification in all lower tier covered transactions.
CERTIFICATION 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,a 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 beIie/that:
(7)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 suba wards at all tiers (including subcontracts,sub grants,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 7352,title 37,U.S.Code.Any person who fails to file the required certification
shall be subject to a civil penalty or not less than $70,000 and not more than $700,000 for each such failure.
I hereby agree to tl6l3ove cfii io and assurances.
I”I’Signature of Cert g Official Date
(A&4 i2—’Y%f
Title
(I ftU1 fkH)P U’Jt1iTt C)t iA 1 i?5
App’icant Organization
