HomeMy WebLinkAboutR25-025 Authorizing the Submisison of the Block Grant Application for the Northwest Loan Fund Docusign Envelope ID: 141 B7009-21AC-4614-8565-B50D431 FDC86 Commissioner scherr moved adoption of the following Resolution: BOARD OF EAGLE COUNTY COMMISSIONERS COUNTY OF EAGLE, STATE OF COLORADO RESOLUTION NO. 2025- 02 5 RESOLUTION AUTHORIZING THE APPLICATION AND SUBMISSION OF THE COMMUNITY DEVELOPMENT BLOCK GRANT APPLICATION FOR THE NORTHWEST LOAN FUND AND AUTHORIZING THE EAGLE COUNTY MANAGER TO SIGN ALL CORRESPONDING CONTRACTS AND DOCUMENTS WHEREAS, Eagle County Government("ECG") desires to apply for a 2025 Community Development Block Grant("CDBG")through the State of Colorado, Department of Local Affairs for the provision of funds to be used for the purpose of recapitalization the Northwest Business Loan Fund for small business job creation, retention and/or expansion(the"Application"); and WHEREAS, the Board of County Commissioners for Eagle County has reviewed the Application, attached hereto as Exhibit"A", and finds good cause to approve the same. NOW, THEREFORE,BE IT RESOLVED BY THE COMMISSIONERS OF THE EAGLE COUNTY: THAT,ECG approves the CDBG application, along with Exhibits thereto, attached hereto as Exhibit "A," for submittal to DOLA and authorizes the Chair of the Board of County Commissioners to sign the same. THAT, ECG assigns full signatory authority to the Eagle County Manager, Jeff Shroll, with regard to all contracts and corresponding documents associated with agreements entered into with the State as related to the CDBG grant for . THAT,ECG finds,determines and declares that this Resolution is necessary for the public health, safety and welfare of its citizens of Eagle County, State of Colorado. //Remainder of Page Intentionally Left Blank// Docusign Envelope ID: 141B7009-21AC-4614-8565-B50D431FDC86 MOVED, READ AND ADOPTED by the Eagle County Board of Commissioners at its regular meeting held this 1 1th day of March, 2025. Signed by: COUNTY OF EAGLE, STATE OF �� COLORADO, By and Through Its BOARD OF COUNTY COMMISSIONERS ATTEST: Sig/need by: /,t. DocuSignneyd by: EBSDC 83BCBA4C8... CA4AC128F8AA47A... Clerk to the Board Jeanne McQueeney Chair Signed by: nv, 15,4 C:119995F4RF5F4411 Tom Boyd Commissioner nASiwgnneed by: . Ami ,n Jl'', II1„^ Al F7R21171 AF0473 Matt Scherr Commissioner Commissioner Boyd seconded adoption of the foregoing resolution. The roll having been called, the vote was as follows: Commissioner McQueeney Aye Commissioner Boyd Aye Commissioner Scherr Aye This resolution passed by 3/0 vote of the Board of County Commissioners of the County of Eagle, State of Colorado. Docusign Envelope ID: 141B7009-21AC-4614-8565-B50D431FDC86 EXHIBIT A Docusign Envelope ID: 141B7009-21AC-4614-8565-B50D431FDC86 Application Response CCOLORADO A Department of Local Affairs DOL Division of Local Government 2025 CDBG Business Loan Fund (BLF)Application Local Government/Organization: Status:? Filed On: Filed By: Reviewed On: Reviewed By: Reviewer Notes: Application Overview The project is to provide Community Development Block Grants for the purpose of the recapitalization of an existing Business Loan Fund for small business job creation,retention,and/or expansion.The project is eligible under HUD section 105(a)(15)economic development. Applicant Eligibility Rural Colorado Counties either individually or jointly with a lead county designated.HUD entitlement areas are not eligible.Colorado Counties may sub-grant to approve small business loan funds in their region. Applications will be considered on an on-going basis if funds are available.For multi jurisdictional applications,a copy of the application must be available for public review in each participating jurisdiction as required by HUD. PLEASE NOTE:In Section A The Principal Representative MUST be a different person than the Responsible Administrator and they MUST have different email addresses in order for the application to be accepted. A.APPLICANT/CONTACT INFORMATION 1.Local Government/Organization:Eagle County In the case of a multi-jurisdictional application,select the other participating eligible organizations: Garfield, Grand,Jackson, Moffat, Pitkin, Rio Blanco, Routt and Summit Counties 2.Principal Representative: (In the case of a multi-jurisdictional application,principal representative of the lead organization.) Jill Klosterman,Eagle County Chief Financial Officer Honorific: First Name: Jill Middle Name: Last Name: Klosterman Suffix: Role: Eagle County Chief Financial Officer Mailing Address: P 0 Box 850/500 Broadway Address 2: 1/7 Docusign Envelope ID: 141 B7009-21AC-4614-8565-B50D431 FDC86 Application Response City: Eagle State: CO Zip Code: 81631 Phone#: 970-328-8600 Email Address: jill.klosterman@eaglecounty.us 3.Responsible Administrator(will receive all mailings)for the Application: Honorific: First Name: Anita Middle Name: Last Name: Cameron Suffix: Role: Northwest Loan Fund Director Mailing Address: P 0 Box 2308 Address 2: City: Silverthorne State: CO Zip Code: 80498 Phone#: 970-406-0025 Email Address: anita@NorthwestLoanFund.org B.RECENT PERFORMANCE/FINANCIAL INFORMATION 2/7 Docusign Envelope ID:141B7009-21AC-4614-8565-B50D431FDC86 Application Response Please provide the requested information based on your most recent contract period(typically 4 years) 1.Total Amount of recent CDBG Contract $5,159,898.00 a)Total amount of loan funds drawn. $3,514,166.00 b)Total amount of administrative funds drawn $487,554.20 c)De-obligation Amount(if applicable) To Be Determined at 3-31-2025 2.Number of loans made 24 3.Number of jobs created/retained Please provide number of jobs created vs.retained 87 4.Number of LMI jobscreated/retained Please provide number of jobs created vs.retained 45 5.Unrestricted funds available 6.Number of loan defaults If there were any loans defaulted,please provide information on the borrower,the amount of the default the the circumstances contributing to the default. If loans defaulted proceed in answering a-c below. If no defaults, proceed to question 7. Zero a)Amount of CDBG Funds Lost $0.00 b)Loss as a%of Total Assistance c)Loss as a%of$Value of Loans Made 7.Ratio of leveraged funds to CDBG funds Amount of Leveraged Funds $7,871,113.00 Ratio of Leveraged Funds 2.6 x Loans C.PAST PERFORMANCE 3/7 Docusign Envelope ID: 141B7009-21AC-4614-8565-B50D431FDC86 Application Response Please provide BLF"historical"performance/financial information(since first DOLA/CDBG contract) 1.Total amount of CDBG business assistance dollars previously received. (50 character limit) 2016-602. $2,014,000.00 2013-589. $. 893,140.00 2.Total amount of CDBG administration dollars previously received. (50 character limit) 2016-602. $310,640.00 2013-589. $142,891.00 3.Historical number of loans made during previous CDBG contracts (50 character limit) (50 character limit) 4.Historical number of jobs created/retained through past CDBG program contracts. 2016-602. 124 jobs 2013-589. 32 5.Historical number of LMI jobs created/retained through past CDBG program contracts. 2016-602. 108 LMI 2013-589 22 LMI 6.Historical number of loans defaulted through past CDBG program contracts. (50 character limit) 2016-602.Two loans 2013-589 One loan a)Historical total amount of loans defaulted through past CDBG program contracts. (50 character limit 2016-602 $51,980.00 2013-589 $17,692.00 7.Historical ratio of leveraged funds to CDBG funds through past CDBG program contracts. Minimum leveraging is 2:1 (other funds:CDBG) (50 character limit) 2013-589 and 16-602. $6,745,400.00 D.PROGRAM AND BUDGET 4n Docusign Envelope ID: 141B7009-21AC-4614-8565-B50D431FDC86 Application Response 1.Total amount of CDBG grant funds requested including admin Please use numbers only.No dollar signs,commas or periods.Do not use cents. 580000 2.Project Description The Northwest Loan Fund provides Business Assistance loans in nine counties (Eagle, Garfield, Grand, Jackson, Moffat, Pitkin, Rio Blanco, Routt and Summit). Loan proceeds can be used for: Equipment Furniture & Fixtures Inventory Raw materials Working Capital Business occupied building purchase of existing building Other fixed assets Equity participation in exchange for business shares or royalty payments Construction of new facilities and renovation of interiors and exteriors (discouraged due to David-Bacon Wage and other Federal Requirements) Collateral Coverage is required. In all cases will take a security agreement on all business assets. When possible, the NLF will pay directly for equipment being purchased to create a priority Purchase Money Lien. When possible, NLF will take the next available lien position on equipment, buildings, and real estate financed with NLF funds. If the borrower owns property in the local area, NLF will generally take the next available deed of trust position on the real estate along with the above mentioned business assets, unless other collateral is agreed upon. Personal guaranties of all principals with 20% ownership will be required on all loans. Co-signers will be required when requested by the loan committee. All security interests will be perfected to adequately protect the NLF security interest. 3.Upload your CDBG project budget. Budget must include CDBG business assistance requested,other leveraged business assistance funds,CDBG administration requested,other leveraged administration funds. Download the CDBG budget template here-https://dlg.colorado.gov/CDBG-ED ,the document can be found in the application documents drop done. Upload the completed budget document in the box below. Gowrilcod 4.Jobs that will be created/retained through this CDBG project. 25 5.Unique Entity Identifier(UEI)number: GDB1 EPFH8JR9 5/7 Docusign Envelope ID:141 B7009-21AC-4614-8565-B50D431 FDC86 Application Response FM-Pan/11.1 Lcu\vn1\7 rt-rws pP 1.Geographic area served by County. (500 character limit) Eagle, Garfield, Grand, Jackson, Moffat, Pitkin, Rio Blanco, Routt and Summit Counties 2.Eligible Business types. List all business types that will be eligible to receive these funds.(1000 character limit) For Profit and Not for Profit businesses are eligible List the minimum loan amounts for this project.(250 character limit) $5,000.00 List the maximum loan amounts for this project.(250 character limit) 3.Minimum loan amounts $5,000.00 4.Maximum loan amounts $1,000,000.00 5.Rate,Term&Loan fee Prime plus 2 and 2%Origination Fee(additional fees may be charged when they are passed through to a third party) List the maximum interest rate,term limit and loan fee that will be applied to loans for this program.(500 character limit) Prime plus 2 and 2%Origination Fee(additional fees may be charged when they are passed through to a third party) Maximum term ten years 6.Use of loan proceeds Describe eligible uses of loan funds.(1000 character limit) Loan proceeds can be used for: Equipment Furniture & Fixtures Inventory Raw materials Working Capital Business occupied building purchase of existing building Other fixed assets Equity participation in exchange for business shares or royalty payments Construction of new facilities and renovation of interiors and exteriors (discouraged due to David-Bacon Wage and other Federal Requirements) 7.Upload a copy of your loan policy Do,:{:nls,ad l bn Docusign Envelope ID:141B7009-21AC-4614-8565-B50D431FDC86 Application Response 1.Proposed Administrative Structure. Specify who is responsible for completed defined tasks.Include name,title and responsibilities.(1500 character limit) Anita Cameron, Director is responsible for all tasks except: Payroll-NWCCOG Finance Director CDBG Reports-NWCCOG Accountant Financial Analysis-FOS Consulting(Contractor)and Chris Lind(Contractor) Payment Posting-Becky Walter(Contractor)and Greg Ociepka (Contractor) List your current loan committee members and their organizations.Please include the loan committee's relationship to the loan fund's governing board. (2500 character limit) 2.Proposed Loan Committee Structure. Jill Klosterman, Eagle County Government Nicole Christianson, B:Side Capital Mark Krieg, Krieg Accounting and Tax Melanie Leaverton,Timberline Builders Supply(sold business in 2024) Catherine Blevins,Yampa Valley Bank Bill Johnson,Aspen Public House Owner Tawny Halandras, Mountain Valley Bank Willis Wodnik, Colorado Event Rentals and CER Linen Owner Peter Ammons,Alpine Bank The Loan Committee has no relationship to the Board.The Board mirrors the NWCCOG Council. Describe the relationship between the BLF and the unit of local government which is sponsoring this application. (2500 character limit) Eagle County, as the lead county is the NWCCOG's largest member.The Northwest Loan Fund is a 501c6 that offices with and utilizes services(accounting and payroll)of the NWCCOG.The NWCCOG is the sub-grantee on the CDBG Grant Application. 3.BLF and Local Government Relationship. The NLF makes presentations to the Commissioners in the nine counties upon request and at least every five years. 717 Docusign Envelope ID: 141B7009-21AC-4614-8565-B50D431FDC86 Application Response G.PROGRAM MARKETING PLAN 1.Describe how your organization intends to obtain new loans for this program (4000 character limit) Having managed the NLF for 11 years,Anita Cameron has established strategic relationships in each of the counties.Those provide referrals.The website is attractive and provides most of the leads.The NLF is on the OEDIT website. 2.Upload loan pipeline Include the type of project,loan amount and status. Download the CDBG loan pipeline template here https://dlg.colorado.gov/CDBG-ED,the document can be found in the application documents drop down. Upload the completed pipeline document in the box below. H.REQUIRED DOCUMENTATION 1.Upload Statement of Assurances and Certifications In the case of a multi-jurisdictional application,all directly participating jurisdictions are required to sign this form. fatw,r11 i ac.i 1 2.Upload Citizen Participation Plan One signed original copy by the chief elected official. In the case of a multi-jurisdictional application,all directly participating jurisdictions are required to have a Citizen Participation Plan submitted here. 3.Upload Public Hearing affidavit Upload original publisher's affidavit with an attached copy of the public notice.At least one public hearing must be held prior to the submission of this application. Download 4.Upload Residential Anti-displacement and Relocation Assistance Plan In the case of a multi-jurisdictional application,all directly participating jurisdictions are required to have a Residential Anti- displacement and relocation assistance plan submitted here. Download 5.Upload Intergovernmental Agreement Required only in the case of a multi-jurisdictional application. Download 6.Upload Acknowledgement and chief elected official certification document Required to ensure that participating jurisdictions are in agreement that all information submitted in this application is accurate and a true representation of the intended program. Download 7.Upload CENST Environmental Review for Activity form 8/7 Docusign Envelope ID: 141B7009-21AC-4614-8565-B50D431FDC86 Application Response Download the CDBG environmental review for activity form here https://dlg.colorado.gov/CDBG-ED,the form can be found in the application documents dropdown.Upload the completed form in the document below. 9/7 Docusign Envelope ID: 141B7009-21AC-4614-8565-B50D431FDC86 ACKNOWLEDGEMENT AND CHIEF ELECTED OFFICIAL CERTIFICATION DOCUMENT for the Community Development Block Grant (CDBG) Program To the best of my knowledge and belief, statements and data in this application are true and correct and their submission has been duly authorized by the governing body of all participating jurisdictions. ,-DocuSigned by: Sig ciatarmAcakisi4Elected Official Signature, Chief Elected Official** Chair, Eagle County BOCC Chair, Garfield County BOCC Title and Jurisdiction (Typed or Printed) Title and Jurisdiction (Typed or Printed) 3/11/2025 Date Date Signature, Chief Elected Official** Signature, Chief Elected Official** Chair, Grand County BOCC Chair, Jackson County BOCC Title and Jurisdiction (Typed or Printed) Title and Jurisdiction (Typed or Printed) Date Date Signature, Chief Elected Official** Signature, Chief Elected Official** Chair, Moffat County BOCC Chair, Pitkin County BOCC Title and Jurisdiction (Typed or Printed) Title and Jurisdiction (Typed or Printed) Date Date Signature, Chief Elected Official** Signature, Chief Elected Official** Chair, Rio Blanco County BOCC Chair, Routt County BOCC Title and Jurisdiction (Typed or Printed) Title and Jurisdiction (Typed or Printed) Date Date 1 Docusign Envelope ID: 141 B7009-21AC-4614-8565-B50D431 FDC86 Signature, Chief Elected Official** Chair, Summit County BOCC Title and Jurisdiction (Typed or Printed) Date ** Additional signatures are required only in the case of"multi jurisdictional" applications. If this is a multi-jurisdictional application, the Chief Elected Official of each municipality and/or county participating in the application must sign. 2 Docusign Envelope ID: 141 B7009-21AC-4614-8565-B50D431 FDC86 EXHIBIT I-B Community Development Block Grant Program APPLICANT STATEMENT OF ASSURANCES AND CERTIFICATIONS The applicant hereby assures and certifies that: (a) It possesses: (1) Legal authority to apply for the grant and to execute the proposed project, and its governing body has duly adopted or passed as an official act a resolution, motion or similar action authorizing the filing of the application, including all understandings and assurances contained therein, and directing and authorizing the applicant's chief executive officer and/or other designated official representatives to act in connection with the application and to provide such additional information as may be required; and (2) Has developed its application, including its projected use of funds, so as to give maximum feasible priority to activities that will benefit low and moderate income persons or aid in the prevention or elimination of slums or blight. (The requirement for this certification will not preclude the State from approving an application where the applicant certifies and the State determines, that all or part of the proposed project activities are designed to meet other community development needs that have arisen during the preceding twelve-month period and have particular urgency because existing conditions pose a serious and immediate threat to the health or welfare of the community and where other financial resources are not available to meet such needs.) Furthermore: (A) With respect to activities it claims benefit low and moderate income persons, it has determined and documented that not less than fifty-one percent (51%) of the beneficiaries of the activity are low and moderate income persons; and (B) With respect to activities it claims aid in the elimination of slums or blight, it has determined and documented: (i) For activities to address slums or blight on an area basis: (I) The area meets a definition of a slum, blighted, deteriorated or deteriorating area under State or local law; (II) Throughout the area, at least twenty-five percent (25%) of the buildings are in a state of deterioration or two or more types of public improvements are in a state of deterioration; (III) Documentation is being maintained on the boundaries of the area and the condition which qualified the area at the time of its designation; and 1 DOLA revised 7/2024 Docusign Envelope ID: 141 B7009-21 AC-4614-8565-B50D431 FDC86 (IV) The assisted activity addresses one or more of the conditions which contributed to the deterioration of the area. (V) Rehabilitation will only be undertaken on residential structures which are not occupied by low and moderate income persons if such structures are substandard under local definition, and provided that all deficiencies making such structure substandard must be corrected before less critical work on the structure may be undertaken; (ii) For activities to address slum or blight on a spot basis, the activities must be designed to eliminate specific conditions of blight or physical decay and must be limited to acquisition, clearance, relocation, historic preservation and rehabilitation of buildings, but only to the extent necessary to eliminate specific conditions detrimental to public health and safety. (b) It is following a detailed citizen participation plan which: (1) Provides for and encourages citizen participation with particular emphasis on participation by persons of low and moderate income who are residents of slum and blight areas and of areas in which Community Development Block Grant (CDBG)funds are proposed to be used; (2) Provides citizens with reasonable and timely access to local meetings, information, and records relating to its proposed and actual use of CDBG funds; (3) Provides for technical assistance to groups representative of persons of low and moderate income that request such assistance in developing proposals with the level and type of assistance to be determined by the applicant; (4) Provides for public hearings to obtain citizen views and to respond to proposals and questions at all stages of the community development program, including at least the development of needs, the review of proposed activities, and review of program performance, which hearings shall be held after adequate notice at times and locations convenient to potential or actual beneficiaries, and with accommodation for the handicapped; (5) Provides for a timely written answer to written complaints and grievances, within 15 working days where practicable; and (6) Identifies how the needs of non-English speaking residents will be met in the case of public hearings where a significant number of non-English speaking residents can be reasonably expected to participate. (c) It has provided for and encouraged citizen participation, with particular emphasis on participation by persons of low and moderate income who are residents of slum and blight areas and of areas in which CDBG funds are proposed to be used, by: 2 DOLA revised 7/2024 Docusign Envelope ID:141 B7009-21AC-4614-8565-B50D431 FDC86 (1) Furnishing citizens information concerning the amount of funds available for proposed community development and housing activities and the range of activities that may be undertaken, including the estimated amount proposed to be used for activities that will benefit persons of low and moderate income and its plans for minimizing displacement of persons as a result of activities assisted with CDBG funds and to assist persons actually displaced as a result of such activities; (2) Publishing a proposed project plan/application in such a manner to afford citizens an opportunity to examine its content and to submit comments on the proposed project plan/application and on the community development performance of the jurisdiction(s); (3) Holding two or more public hearings, as indicated below, to obtain citizen views and to respond to proposals and questions related to community development and housing needs, proposed activities and past CDBG performance. All hearings were held no sooner than five days after notice, at times and locations convenient to potential or actual beneficiaries, and with accommodation for the handicapped and for the needs of non-English speaking residents where a significant number of such residents could have been reasonably expected to participate. Applicant/Participant* Date Time Location Eagle County 3/11/2025 10:30 AM 500 Broadway, Eagle Co 81631 Garfield County Grand County Jackson County Moffat County Pitkin County Rio Blanco County Routt County Summit County * In the case of a "multi jurisdictional" application, each participating municipality and county must hold at least one public hearing. (4) As applicable, providing citizens with reasonable and timely access to local meetings, information and records regarding its proposed and past use of CDBG funds; (5) In preparing its project plan/application, considering any such comments and views and, if deemed appropriate, modifying the proposed project plan/application; 3 DOLA revised 7/2024 Docusign Envelope ID: 141B7009-21AC-4614-8565-B50D431FDC86 (6) Making the final project plan/application available to the public; (7) Identifying its community development and housing needs, including the needs of low and moderate income persons, and the activities to be undertaken to meet such needs. (d) In the event it is awarded CDBG funds by the State it will: (1) Follow a residential anti-displacement and relocation assistance plan which shall: (A) In the event of such displacement, provide that: (i) Governmental agencies or private developers shall provide within the same community comparable replacement dwellings for the same number of occupants as could have been housed in the occupied and vacant occupiable low and moderate income dwelling units demolished or converted to use other than for housing for low and moderate income persons, and provide that such replacement housing may include existing housing assisted with project based assistance provided under Section 8 of the United States Housing Act of 1937; (ii) Such comparable replacement dwellings shall be designed to remain affordable to persons of low and moderate income for 10 years from the time of initial occupancy; (iii) Relocation benefits shall be provided for all low or moderate income persons who occupied housing demolished or converted to a use other than for low or moderate income housing, including reimbursement for actual and reasonable moving expenses, security deposits, credit checks, and other moving-related expenses, including any interim living costs; and, in the case of displaced persons of low and moderate income, provide either: (I) compensation sufficient to ensure that, for a 5-year period, the displaced families shall not bear, after relocation, a ratio of shelter costs to income that exceeds 30 percent; or, (II) if elected by a family, a lump-sum payment equal to the capitalized value of the benefits available under sub clause (I)to permit the household to secure participation in a housing cooperative or mutual housing association. (iv) Persons displaced shall be relocated into comparable replacement housing that is: (I) decent, safe, and sanitary; (II) adequate in size to accommodate the occupants; 4 DOLA revised 7/2024 Docusign Envelope ID: 141 B7009-21AC-4614-8565-B50D431 FDC86 (Ill) functionally equivalent; and, (IV) in an area not subject to unreasonably adverse environmental conditions; (B) persons displaced shall have the right to elect, as an alternative to the benefits under this subsection to receive benefits under the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 if such persons determine that it is in their best interest to do so; and, (C) where a claim for assistance under subparagraph (A)(iv) is denied by grantee, the claimant may appeal to the State, and that the decision of the State shall be final unless a court determines the decision was arbitrary and capricious. (2) Comply with the provisions of the above paragraph (1) except that paragraphs (A)(i) and (A)(ii) shall not apply in any case in which the Secretary of the U.S. Department of Housing and Urban Development finds, on the basis of objective data, that there is available in the area an adequate supply of habitable affordable housing for low and moderate income persons. A determination under this paragraph is final and not reviewable. (3) Provide citizens with reasonable notice of, and opportunity to comment on, any substantial change proposed to be made in the use of CDBG funds from one eligible activity to another by following the same procedures required in paragraph (c)for the preparation and submission of the final project plan/application. (e) It will: (1) Minimize displacement of persons as a result of activities assisted with CDBG funds and provide for reasonable benefits to any person involuntarily and permanently displaced as a result of the use of CDBG funds to acquire or substantially rehabilitate property; (2) Affirmatively further fair housing in addition to conducting and administering its project in conformity with Public Law 88-352 and Public Law 90-284 as certified in paragraph (h) hereinafter; (3) Not attempt to recover any capital costs of public improvements assisted in whole or part with CDBG funds by assessing any amount against properties owned and occupied by persons of low and moderate income, including any fee charged or assessment made as a condition of obtaining access to such public improvements, unless: (A) CDBG funds are used to pay the proportion of such fee or assessment that relates to the capital costs of such public improvements that are financed from revenue sources other than the CDBG program, or 5 DOLA revised 7/2024 Docusign Envelope ID:141 B7009-21 AC-4614-8565-B50D431 FDC86 (B) for purposes of assessing any amount against properties owned and occupied by persons of moderate income who are not persons of low income, it certifies that it lacks sufficient CDBG funds to comply with the requirements of subparagraph (A); (f) Its chief executive officer or other officer of the applicant approved by the State: (1) Consents to assume the status of responsible Federal official under the National Environmental Policy Act of 1969 (NEPA) and other provisions of Federal law, as specified in 24 CFR Part 58, which further the purposes of NEPA, insofar as the provisions of such Federal law apply to the Colorado Community Development Block Grant (CDBG) Program; (2) Is authorized and consents on behalf of the applicant and himself/herself to accept the jurisdiction of the Federal courts for the purpose of enforcement of his/her responsibilities as such an official. (g) It will comply with the financial management regulations, policies, guidelines and requirements set forth in the CDBG Public Facilities and/or Housing Guidebook. (h) It will comply with: (1) Section 110 of the Housing and Community Development Act of 1974, as amended, and any State regulations regarding the administration and enforcement of labor standards; (2) Davis-Bacon Fair Labor Standards Act (40 USC 276a -276a-5) requiring that, on all prime contracts which exceed $2,000 for federally-assisted construction, alteration or rehabilitation, laborers and mechanics employed by contractors or subcontractors shall be paid wages at rates not less than those prevailing on similar construction in the locality as determined by the Secretary of Labor. (This requirement applies to the rehabilitation of residential property only if such property is designed for use of eight or more families.) (3) Contract Work Hours and Safety Standards Act of 1962 (40 USC 327 et seq.) requiring that mechanics and laborers employed on federally-assisted contracts which exceed $2,000 be paid wages of not less than one and one-half times their basic wage rates for all hours worked in excess of forty in a work week. (4) Copeland "Anti-Kickback" Act of 1934 (40 USC 276 (c)) prohibiting and prescribing penalties for"kickbacks" of wages in federally-financed or assisted construction activities. (i) It will comply with: (1) Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352; 42 USC 2000 (d)) prohibiting discrimination on the basis of race, color, religion or religious affiliation, or national origin in any program or activity receiving federal financial assistance. 6 DOLA revised 7/2024 Docusign Envelope ID: 14187009-21AC-4614-8565-B50D431FDC86 (2) The Fair Housing Act (42 USC 3601-20 and 24 CFR 100-115), as amended, prohibiting housing discrimination on the basis of race, color, religion, sex, national origin, handicap, and familial status. (3) Section 109 of the Housing and Community Development Act of 1974 (42 USC 5309), as amended, providing that no person shall be excluded from participation (including employment), denied program benefits or subjected to discrimination on the basis of race, color, national origin or sex under any program or activity funded in whole or in part under Title I (Community Development) of the Housing and Community Development Act. (4) Executive Order 11063 (1962), as amended by Executive Order 12259 and 12892, requiring equal opportunity in housing by prohibiting discrimination on the basis of race, color, religion, sex or national origin in the sale or rental of housing built with federal assistance. (5) Executive Order 11246 (1965), as amended by Executive Orders 11375, prohibiting discrimination on the basis of race, color, religion, sex or national origin in any phase of employment during the performance of federal or federally-assisted contracts in excess of$2,000. (6) Section 3 of the Housing and Community Development Act of 1968 (12 USC 1701 (u), 24 CFR 570.487, and 24 CFR Part 75), as amended, providing that, to the greatest extent feasible, opportunities for training and employment that arise through HUD-financed projects, will be given to lower-income persons in the unit of the project area, and that contracts be awarded to businesses located in the project area or to businesses owned, in substantial part, by residents of the project area. (7) Section 504 of the Rehabilitation Act of 1973 (29 USC 793), as amended, providing that no otherwise qualified individual shall, solely by reason of a handicap, be excluded from participation (including employment), denied program benefits or subjected to discrimination under any program or activity receiving federal funds. Effective communication with persons of all types of disabilities must be ensured. (8) Age Discrimination Acts of 1968 and 1975, (42 USC 6101-6107), as amended, providing that no person shall be excluded from participation, denied program benefits or subjected to discrimination on the basis of age under any program or activity receiving federal funds. (9) The Architectural Barriers Act (ABA) of 1968 (42 USC § 4151 et seq.), as amended, stipulates that all buildings which are (1)financed with Federal funds, and (2) intended for use by the public, or which may result in employment or residence therein of physically handicapped persons, be designed and constructed in accordance with standards prescribed by the ABA to ensure that such buildings are fully accessible to and usable by handicapped individuals. (j) It will comply with: (1) Section 104(d) of the Housing and Community Development Act of 1974, as amended (42 USC 5301), known as the "Barney Frank Amendment," and the HUD implementing regulations at 29 CRF Part 570, requiring that 7 DOLA revised 7/2024 Docusign Envelope ID: 141B7009-21AC-4614-8565-B50D431FDC86 local grantees follow a residential anti-displacement and relocation assistance plan which provides for the replacement of all low/moderate-income dwelling units that are demolished or converted to another use as a direct result of the use of CDBG funds, and which provides for relocation assistance for all low/moderate-income households so displaced. (2) Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as amended --Title Ill, Real Property Acquisition (Pub. L. 91-646 and HUD implementing regulations at 49 CFR Part 24 and 24 CFR Part 42), providing for uniform and equitable treatment of persons displaced from their homes, businesses, or farms by Federal or Federally- assisted programs and establishing uniform and equitable land acquisition policies for federal assisted programs. Requirements include bona fide land appraisals as a basis for land acquisition, specific procedures for selecting contract appraisers and contract negotiations, furnishing to owners of property to be acquired a written summary statement of the acquisition price offer based on the fair market price, and specified procedures connected with condemnation. (3) Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as amended --Title II, Uniform Relocation Assistance (Pub. L. 91-646 and HUD implementing regulations at 49 CFR Part 24), providing for fair and equitable treatment of all persons displaced as a result of any federal or federally-assisted program. Relocation payments and assistance, last-resort housing replacement by displacing agency, and grievance procedures are covered under the Act. Payments and assistance will be made pursuant to state or local law, or the grant recipient must adopt a written policy available to the public describing the relocation payments and assistance that will be provided. Moving expenses and up to $22,500 or more for each qualified homeowner or up to $5,250 or more for each tenant are potential costs. (k) It will comply with: (1) National Environmental Policy Act of 1969 (42 USC 4321 et seq.), as amended, and the implementing regulations of HUD (24 CFR Part 58) and of the Council on Environmental Quality (40 CFR Parts 1500 - 1508) providing for establishment of national policy, goals, and procedures for protecting, restoring and enhancing environmental quality. (2) National Historic Preservation Act of 1966 (16 USC 470 et seq.), as amended, requiring consideration of the effect of a project on any district, site, building, structure or object that is included in or eligible for inclusion in the National Register of Historic Places. (3) Executive Order 11593, Protection and Enhancement of the Cultural Environment, May 13, 1971 (36 FR 8921 et seq.) requiring that federally-funded projects contribute to the preservation and enhancement of sites, structures and objects of historical, architectural or archaeological significance. (4) The Archaeological and Historical Data Preservation Act of 1974, amending the Reservoir Salvage Act of 1960 (16 USC 469 et seq.), 8 DOLA revised 7/2024 Docusign Envelope ID: 141B7009-21AC-4614-8565-B50D431FDC86 providing for the preservation of historic and archaeological data that would be lost due to federally-funded development and construction activities. (5) Executive Order 11988, Floodplain Management, May 24, 1977 (42 FR 26951 et seq.) prohibits undertaking certain activities in flood plains unless it has been determined that there is no practical alternative, in which case notice of the action must be provided and the action must be designed or modified to minimize potential damage. (6) Executive Order 11990, Protection of Wetlands, May 24, 1977 (42 FR 26961 et seq.) requiring review of all actions proposed to be located in or appreciably affecting a wetland. Undertaking or assisting new construction located in wetlands must be avoided unless it is determined that there is no practical alternative to such construction and that the proposed action includes all practical measures to minimize potential damage. (7) Safe Drinking Water Act of 1974 (42 USC 201, 300 f et seq., 7401 et seq.), as amended, prohibiting the commitment of federal financial assistance for any project which the Environmental Protection Agency determines may contaminate an aquifer which is the sole or principal drinking water source for an area. (8) The Endangered Species Act of 1973 (16 USC 1531 et seq.), as amended, requiring that actions authorized, funded, or carried out by the federal government do not jeopardize the continued existence of endangered and threatened species or result in the destruction or modification of the habitat of such species which is determined by the Department of the Interior, after consultation with the State, to be critical. (9) The Wild and Scenic Rivers Act of 1968 (16 USC 1271 et seq.), as amended, prohibiting federal assistance in the construction of any water resources project that would have a direct and adverse affect on any river included in or designated for study or inclusion in the National Wild and Scenic Rivers System. (10) The Clean Air Act of 1970 (42 USC 1857 et seq.), as amended, requiring that federal assistance will not be given and that license or permit will not be issued to any activity not conforming to the State implementation plan for national primary and secondary ambient air quality standards. (11) HUD Environmental Criteria and Standards (24 CFR Part 51) providing national standards for noise abatement and control, acceptable separation distances from explosive or fire prone substances, and suitable land uses for airport runway clear zones. (I) It will: (1) Comply with The Lead-Based Paint Poisoning Prevention Act --Title IV (42 USC 4831) prohibiting the use of lead-based paint in residential structures constructed or rehabilitated with federal assistance, and requiring notification to purchasers and tenants of such housing of the hazards of lead-based paint and of the symptoms and treatment of lead-based paint poisoning. 9 DOLA revised 7/2024 Docusign Envelope ID: 141B7009-21AC-4614-8565-B50D431FDC86 (2) Comply with the Armstrong/Walker"Excessive Force" Amendment, (P.L. 101-144) &Section 906 of Cranston-Gonzalez Affordable Housing Act of 1990, which requires that a recipient of HUD funds must certify that they have adopted or will adopt and enforce a policy prohibiting the use of excessive force by law enforcement agencies within their jurisdiction against individuals engaged in nonviolent civil rights demonstrations; or fails to adopt and enforce a policy of enforcing applicable state and local laws against physically barring entrance to or exit from a facility or location which is the subject of such non- violent civil rights demonstration within its jurisdiction. (3) Comply with the "Government-wide Restriction on Lobbying, (P.L. 101- 121), which prohibits spending CDBG funds to influence or attempt to influence federal officials; which requires the filing of a disclosure form when non-CDBG funds are used for such purposes; which requires certification of compliance by the state; and which requires the state to include the certification language in grant awards it makes to units of general local government at all tiers and that all subrecipients shall certify accordingly as imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to civil penalty of not less than $10,000 and not more than $100,000 for each failure. (4) Comply with the Department of Housing and Urban Development Reform Act of 1989 (24 CFR part 12) requiring applicants for assistance for a specific project or activity from HUD, to make a number of disclosures if the applicant meets a dollar threshold for the receipt of covered assistance during the fiscal year in which an application is submitted. An applicant must also make the disclosures if it is requesting assistance from HUD for a specific housing project that involves assistance from other governmental sources. (5) Give the State, the U.S. Department of Housing and Urban Development (HUD), and any authorized representatives access to and the rights to examine all records, books, papers or documents related to the application and grant; and (m) It will comply with all parts of Title 1 of the Housing and Community Development Act of 1974, as amended, which have not been cited previously as well as with other applicable laws and regulations. EAGLE COUNTY GARFIELD COUNTY (Lead Party) By DocuSigned by: By 17 CA4AC128F8AA47A.. Chair, Eagle County BOCC Chair, Garfield County BOCC 10 DOLA revised 7/2024 Docusign Envelope ID: 141B7009-21AC-4614-8565-B50D431FDC86 GRAND COUNTY JACKSON COUNTY By By Chair, Grand County BOCC Chair, Jackson County BOCC MOFFAT COUNTY PITKIN COUNTY By By Chair, Moffat County BOCC Chair, Pitkin County BOCC RIO BLANCO ROUTT COUNTY By By Chair, Rio Blanco County BOCC Chair, Routt County BOCC SUMMIT COUNTY By Chair, Summit County BOCC **Additional signatures are required only in the case of"multi jurisdictional" applications. If this is a multi-jurisdictional application, the Chief Elected Official of each municipality and/or county participating in the application must sign. 11 DOLA revised 7/2024 Docusign Envelope ID: 141 B7009-21AC-4614-8565-B50D431 FDC86 Exhibit I-C (SUGGESTED FORMAT) CITIZEN PARTICIPATION PLAN for the Community Development Block Grant (CDBG) Program Pursuant to Section 104(a)(3)of the Housing and Community Development Act of 1974, as amended, this Citizen Participation Plan is hereby adopted to ensure that the citizens of EAGLE County , particularly persons of low and moderate income residing in slum and blight areas and in areas in which CDBG funds are proposed to be used, are provided the opportunity and encouraged to participate in the planning and implementation of CDBG- funded activities. PUBLIC HEARING Public hearings will be the primary means of obtaining citizen views and responding to proposals and questions related to community development and housing needs, proposed CDBG activities and past CDBG performance. Prior to submitting a CDBG application to the State, EAGLE County_will conduct at least one public hearing to identify community development and housing needs, including the needs of low and moderate income persons, as well as other needs in the community that might be addressed through the CDBG program, and to review proposed CDBG activities and the past performance of EAGLE County_in carrying out its CDBG responsibilities. In the event CDBG funds are granted by the State, EAGLE County will conduct at least one additional public hearing to allow citizens to review and comment on its performance in carrying out its CDBG program. A formal public notice will be published in a newspaper of general circulation in the area at least five(5)days prior to such public hearings. A public notice will also be posted in the EAGLE Coiunty building_and in other places frequented by the public, especially low and moderate income persons and persons benefiting from or affected by proposed CDBG activities. As circumstances warrant and as EAGLE County_determines necessary or appropriate, participation may additionally be specifically solicited from persons of low and moderate income, those benefiting from or affected by CDBG activities and/or representatives of such persons. Hearings will be held at times and locations convenient to potential and actual beneficiaries, and with accommodation for the handicapped. In the case of public hearings where a significant number of non-English speaking residents can be reasonably expected to participate, arrangements will be made to have an interpreter present. PUBLIC INFORMATION AND RECORDS Information and records regarding the proposed and past use of CDBG funds will be available at Northwest Colorado Council of governments, 249 Warren Ave., Silverthorne, CO 80498 during regular office hours. The public will be so informed by public notice. Special communication aids can be made available to persons upon request. TECHNICAL ASSISTANCE EAGLE County_will provide technical assistance to groups representative of persons of low and moderate income that request assistance in developing CDBG proposals. The level and type of assistance appropriate will be determined by EAGLE County_based on its ability to provide or arrange for such assistance, the cost of providing such assistance and other relevant factors. WRITTEN COMMENTS AND RESPONSES EAGLE County_will respond to written complaints and grievances in writing in a timely manner. When practicable, such written responses shall be made within fifteen (15)working days. EDocuSigned by: •• 14-9"?-"Ta 3/11/2025 c Ac 20 a a'A Signature o thief Elected Official Date NOTE 1: EACH MUNICIPALITY AND COUNTY DIRECTLY PARTICIPATING IN A MULTI-JURISDICTIONAL APPLICATION IS REQUIRED TO HAVE A CITIZEN PARTICIPATION (CP) PLAN. NOTE 2: CITIZEN ADVISORY COMMITTEES ARE NOT REQUIRED. IF ONE IS PROPOSED, HOWEVER, ITS ROLE AND COMPOSITION SHOULD BE INCLUDED IN THIS CP PLAN. DOLA revised 05/2013 Docusign Envelope ID:141 B7009-21 AC-4614-8565-B50D431 FDC86 EXHIBIT I-E (for initial public hearing) PUBLIC NOTICE AND NOTICE OF PUBLIC HEARING Eagle County plans to submit a Community Development Block Grant(CDBG)application to the State of Colorado, Department of Local Affairs. CDBG funds are intended to provide decent housing, suitable living environments and economic opportunities, principally for low and moderate-income persons through rehabilitation and preservation, economic/job development and public facilities improvements. The application being considered would request$580,000.00 *for Business Assistance and Administration*. It is estimated that approximately 60 *% of the funds would benefit low and moderate-income persons. Permanent involuntary displacement of neighborhood persons or businesses is not anticipated. Should it later become necessary to consider such displacement, alternatives will be examined to minimize the displacement. If no feasible alternatives exist, required/reasonable benefits will be provided to those displaced to mitigate adverse effects and hardships. Any low and moderate income housing which is demolished or converted will be replaced. In compliance with the Americans with Disabilities Act, individuals needing special accommodations (including auxiliary communicative aids and services)during these hearings should notify Anita Cameron at Northwest Loan Fund, P 0 Box 2308, Silverthorne, CO 80401 a minimum of 3 days in advance so that appropriate aids can be made available. A public hearing will be held at 10:30 a.m. on Tuesday , March 11, 2025 at EAGLE COUNTY, 500 Broadway, Eagle, CO 81631 to obtain citizen views and to respond to proposals and questions related to: • The proposed CDBG application for this project; and • Community development and housing needs, including the needs or low and moderate income persons, as well as other needs in the community that might be addressed through the CDBG program; and • The performance of the EAGLE COUNTY in carrying out its community development responsibilities. • Potential historical effects. A copy of the application(s) as submitted to the State will be available for public review at NWCCOG, 249 Warren Ave., Silverthorne, CO 80498 Written comments are also welcome and must be received by March 15, 2025 at NWCCOG, 249 Warren Ave., Silverthorne, CO 80498 anita(a,NorthwestLoanFund.orq Oral and written comments will be considered in deciding whether to submit an application for the proposed project. Written summary information will be available at NWCCOG, 249 Warren Ave., Silverthorne, CO 80498 ** on April 5, 2025 until April 30, 2025 on any CDBG application(s)the EAGLE COUNTY intends to submit to the State. Information and records regarding the EAGLE COUNTY proposed and past use of CDBG funds are available at NWCCOG, 249 Warren Ave., Silverthorne, CO 80498 during regular office hours. Meeting link:www.ecgtv.com NOTE 1: THIS NOTICE MUST BE PUBLISHED IN A NEWSPAPER OF GENERAL CIRCULATION IN THE AREA AT LEAST FIVE (5) DAYS PRIOR TO THE PUBLIC HEARING. It should also be posted in the city/town hall or county courthouse and in other places frequented by the public, ESPECIALLY LOW AND MODERATE INCOME PERSONS BENEFITING FROM OR AFFECTED BY PROPOSED CDBG ACTIVITIES. NOTE 2: EACH MUNICIPALITY AND COUNTY PARTICIPATING DIRECTLY IN A MULTI- JURISDICTIONAL PROJECT IS REQUIRED TO CONDUCT A PRE-APPLICATION PUBLIC HEARING AND TO PROVIDE PUBLIC NOTICES. AS APPROPRIATE, THE NOTICES MAY BE COMBINED AND THE HEARINGS MAY BE HELD JOINTLY. * For projects with more than one activity, provide estimated amount for each activity and estimated percentages by which each activity will benefit low and moderate income persons. DOLA revised 05/2013 Docusign Envelope ID: 141 B7009-21AC-4614-8565-B50D431 FDC86 ** For multi-jurisdictional applications, written summary information and a copy of the application must be available for public review in each participating jurisdiction, as required by HUD. DOLA revised 05/2013 Docusign Envelope ID:141 B7009-21AC-4614-8565-B50D431 FDC86 EXHIBIT I-F SUGGESTEi FG .f rT RESIDENTIAL ANTIDISPLACEMENT AND RELOCATION ASSISTANCE PLAN for the Community Development Block Grant (CDBG) Program Eagle County will replace all occupied and vacant occupiable low/moderate income dwelling units demolished or converted to a use other than as low/moderate income housing as a direct result of activities assisted with CDBG funds, as required by Section 104(d) of the Housing and Community Development Act of 1974, as amended (the Act), and implementing regulations at 24 CFR 570, 24 CFR Part 42, 49 CFR Part 24, and 42 U.S.C. Ch. 61. All replacement housing will be provided within three years of the commencement of the demolition or rehabilitation relating to conversion. Before obligating or expending funds that will directly result in such demolition or conversion, the Eagle County will make public and submit to the State the following information in writing: 1. Description of the proposed assisted activity; 2. The general location on a map and approximate number of dwelling units by size (number of bedrooms) that will be demolished or converted to a use other than as low/moderate dwelling units as a direct result of the assisted activity; 3. A time schedule for the commencement and completion of the demolition or conversion; 4. The general location on a map and approximate number of dwelling units by size (number of bedrooms) that will be provided as replacement dwelling units; 5. The source of funding and a time schedule for the provision of replacement dwelling units; and, 6. The basis for concluding that each replacement dwelling unit will remain a low/moderate income dwelling unit for at least 10 years from the date of initial occupancy. Eagle County will provide relocation assistance, as described in 570.496a(b)(2), to each low/moderate income household displaced by the demolition of housing or by the conversion of a low/moderate income dwelling to another use as a direct result of assisted activities. Consistent with the goals and objectives of activities assisted under the Act, Eagle County will take the steps indicated below to minimize the displacement of persons from their homes:* The following are examples of steps to minimize displacement. The first two are required. The others are optional. Only check those which are appropriate for the project and local circumstances. Add other steps as necessary or appropriate. X Consider all practical alternatives to any proposed project that may result in residential displacement. Alternatives to be considered include other sites for the proposed DOLA revised 7/2024 Docusign Envelope ID: 141 B7009-21 AC-4614-8565-B50D431 FDC86 facilities/project. Also to be considered are the costs and benefits, both financial and nonfinancial, of each alternative. X Provide counseling and referral services to assist displacees find alternative housing in the community. X Work with area landlords and real estate brokers to locate vacancies for households facing displacement. Stage rehabilitation of assisted housing to allow tenants to remain during and after rehabilitation, working with empty buildings or groups of empty units first so they can be rehabilitated first and tenants moved in before rehab on occupied units or buildings is begun. Establish temporary relocation facilities in order to house families whose displacement will be of short duration, so they can move back to their neighborhoods after rehabilitation or new construction. Evaluate housing codes and rehabilitation standards in reinvestment areas to prevent their placing undue financial burden on long-established owners or on tenants of multi- family buildings. Develop displacement watch systems in cooperation with neighborhood organizations to continuously review neighborhood development trends, identify displacement problems, and identify individuals facing displacement who need assistance. Eagle County Signature of Chief Elected Official °ocuSigned b � Date 3/11/2025 """off CA4AC128F8AA47A.. NOTE: EACH MUNICIPALITY AND COUNTY DIRECTLY PARTICIPATING IN A MULTI- JURISDICTIONAL APPLICATION IS REQUIRED TO HAVE A RESIDENTIAL ANTIDISPLACEMENT AND RELOCATION ASSISTANCE PLAN. DOLA revised 7/2024 1Docusign Envelope ID: 141B7009-21AC-4614-8565-B50D431FDC86 `` Exhibit IV-F.1: CDBG Economic Development Business Loans—Exempt/CENST Environmental Review for Activities Exempt or Categorically Excluded Not Subject to 24 C.F.R.Part 58.5, Pursuant to 24 C.F.R.Part 58.35(b), 1 Proiect/Activity Information: Contract Name&Number: Eagle County Contract#TBD Business Name: Business Owner: Business Address: Detail of business loan activities(including project location/address): 2 Classification of Activity: (Check All that Apply) ❑ 24 CFR Part 58.34(a): Exempt activities include: • Administration • Engineering and design costs • Management • Technical assistance and training • Purchase of tools ❑ 24 CFR Part 58.35(b)(3): Operating costs, including: • Maintenance • Equipment • Security • Supplies • Operation • Staff training/recruitment • Utilities • Other incidental costs • Furnishings ▪ 24 CFR Part 58.35(b)(4): Economic development activities including but not limited to: • Inventory Financing • Operating Expenses • Equipment Purchase • Supplies Is your project within 15,000 feet of a military airport or 2,500 feet of a civilian airport? ❑ Yes If checked, please contact DOLA's Environmental Compliance Officer prior to submission • No If checked,the activity is exempt or converts to exempt Business Loan Fund Regional Contact-printed or typed: Environmental Preparer's Name: Anita Cameron Title: Director, Northwest Loan Fund Environmental Preparer's signature: Date: DOLA Representative's Information-Responsible Entity,-printed or typed: Name: Title: Phone: Representative's signature: Page 1 of 1 Revised 9/30/2024