Appendix A - JACS NOFO.docx

Appendix A - Application Package SF424, SF424A, SF424B, SF424C, SF424D, SFLLL, Project Narrative, Budget Justification image3.emf

SF424B.pdf

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Assurances for Non-Construction Programs (SF-424B) pward

D:20061106140556- 05'00'

D:20061106140629- 05'00'

1.

OMB Number: 4040-0007 Expiration Date: 02/28/2025

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:

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 cost) to ensure proper planning, management and completion of the project described in this application.

Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee- 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and, (j) the requirements of any other nondiscrimination statute(s) which may apply to the application.

2.

Will give the awarding agency, the Comptroller General of the United States and, if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives.

3.

Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain.

4.

Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.

5.

Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §§4728-4763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in

Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).

6.

Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to:

(a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education

Amendments of 1972, as amended (20 U.S.C.§§1681-

1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation

Previous Edition Usable

Standard Form 424B (Rev. 7-97)Prescribed by OMB Circular A-102

Authorized for Local Reproduction

7.

Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally-assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases.

8.

Will comply, as applicable, with provisions of the Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds.

Standard Form 424B (Rev. 7-97) Back

9.

12.

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 18 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.

Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §§1271 et seq.) related to protecting components or potential components of the national wild and scenic rivers system.

10.

Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more.

11.

Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of Federal actions to State (Clean Air) Implementation Plans under Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. §§7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended (P.L. 93-523); and, (h) protection of endangered species under the Endangered Species Act of 1973, as amended (P.L. 93- 205).

13.

Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. §470), EO 11593(identification and protection of historic properties), and the Archaeological and Historic Preservation Act of

1974 (16 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. §§2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance.

16.

Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. §§4801 et seq.) which prohibits the use of lead-based paint in construction or rehabilitation of residence structures.

17.

Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, "Audits of States, Local Governments, and Non-Profit Organizations."

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

DATE SUBMITTED

APPLICANT ORGANIZATION

Will comply with the requirements of Section 106(g) of the Trafficking Victims Protection Act (TVPA) of 2000, as amended (22 U.S.C. 7104) which prohibits grant award recipients or a sub-recipient from (1) Engaging in severe forms of trafficking in persons during the period of time that the award is in effect (2) Procuring a commercial sex act during the period of time that the award is in effect or (3) Using forced labor in the performance of the award or subawards under the award.

19.

Mandatory:

TextField1:

ViewBurdenStatement:

Signature of the Authorized Certifying Official: Enter the Signature of the Authorized Certifying Official. This field is required.:

Title: Enter the title of the official certifying that the applicant organization will comply with the requirements set forth in this assurance form. This field is required.:

Applicant Organization: Enter the name of the applicant organization. This field is required.:

Date Signed: Enter the date signed. Enter in the format mm/dd/yyyy. This field is required.:

FormVersionIdentifier: 1.1

LastField:

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SF424C.pdf

Adobe Reader.

SF424C_2_0

win2k

D:20061115102127- 05'00'

D:20061115102127- 05'00'

OMB Number: 4040-0008 Expiration Date: 02/28/2025

BUDGET INFORMATION - Construction Programs

NOTE: Certain Federal assistance programs require additional computations to arrive at the Federal share of project costs eligible for participation. If such is the case, you will be notified.

COST CLASSIFICATION

a. Total Cost

FEDERAL FUNDING

b. Costs Not Allowable for Participation

c. Total Allowable Costs (Columns a-b)

1. Administrative and legal expenses

2. Land, structures, rights-of-way, appraisals, etc.

3. Relocation expenses and payments

4. Architectural and engineering fees

5. Other architectural and engineering fees

6. Project inspection fees

7. Site work

8. Demolition and removal

9. Construction

10. Equipment

11. Miscellaneous

12. SUBTOTAL (sum of lines 1-11)

14. SUBTOTAL

15. Project (program) income

17. Federal assistance requested, calculate as follows:

(Consult Federal agency for Federal percentage share.)

Enter the resulting Federal share.

16. TOTAL PROJECT COSTS (subtract #15 from #14)

13. Contingencies

Enter eligible costs from line 16c Multiply X

Mandatory:

ViewBurdenStatement:

TextField1:

1. a: Total Cost of Administrative and legal expenses:

1. b: Costs Not Allowable for Participation in Administrative and legal expenses:

1. c: Total Allowable Costs (Columns a-b) of Administrative and legal expenses. This is a calculated field.:

2. a: Total Cost of Land, structures, rights-of-way, appraisals, etc.:

2. b: Costs Not Allowable for Participation in Land, structures, rights-of-way, appraisals, etc.:

2. c: Total Allowable Costs (Columns a-b) of Land, structures, rights-of-way, appraisals, etc. This is a calculated field.:

3. a: Total Cost of Relocation expenses and payments:

3. b: Costs Not Allowable for Participation in Relocation expenses and payments:

3. c: Total Allowable Costs (Columns a-b) of Relocation expenses and payments. This is a calculated field.:

4. a: Total Cost of Architectural and engineering fees:

4. b: Costs Not Allowable for Participation in Architectural and engineering fees:

4. c: Total Allowable Costs (Columns a-b) of Architectural and engineering fees. This is a calculated field.:

5. a: Total Cost of Other architectural and engineering fees:

5. b: Costs Not Allowable for Participation in Other architectural and engineering fees:

5. c: Total Allowable Costs (Columns a-b) of Other architectural and engineering fees. This is a calculated field.:

6. a: Total Cost of Project inspection fees:

6. b: Costs Not Allowable for Participation in Project inspection fees:

6. c: Total Allowable Costs (Columns a-b) of Project inspection fees. This is a calculated field.:

7. a: Total Cost of Site work:

7. b: Costs Not Allowable for Participation in Site work:

7. c: Total Allowable Costs (Columns a-b) of Site work. This is a calculated field.:

8. a: Total Cost of Demolition and removal:

8. b: Costs Not Allowable for Participation in Demolition and removal:

8. c: Total Allowable Costs (Columns a-b) of Demolition and removal. This is a calculated field.:

9. a: Total Cost of Construction:

9. b: Costs Not Allowable for Participation in Construction:

9. c: Total Allowable Costs (Columns a-b) of Construction. This is a calculated field.:

10. a: Total Cost of Equipment:

10. b: Costs Not Allowable for Participation in Equipment:

10. c: Total Allowable Costs (Columns a-b) of Equipment. This is a calculated field.:

11. a: Total Cost of Miscellaneous:

11. b: Costs Not Allowable for Participation in Miscellaneous:

11. c: Total Allowable Costs (Columns a-b) of Miscellaneous. This is a calculated field.:

12. a: Subtotal (sum of lines 1-11) of Total Cost. This is a calculated field.:

12. b: Subtotal (sum of lines 1-11) of Costs Not Allowable for Participation. This is a calculated field.:

12. c: Subtotal (sum of lines 1-11) of Total Allowable Costs (Columns a-b). This is a calculated field.:

13. a: Total Cost of Contingencies:

13. b: Costs Not Allowable for Participation in Contingencies:

13. c: Total Allowable Costs (Columns a-b) of Contingencies. This is a calculated field.:

14. a: Subtotal of Total Cost. This is a calculated field.:

14. b: Subtotal of Costs Not Allowable for Participation. This is a calculated field.:

14. c: Subtotal of Total Allowable Costs (Columns a-b). This is a calculated field.:

15. a: Total Cost of Project (program) income:

15. b: Costs Not Allowable for Participation in Project (program) income:

15. c: Total Allowable Costs (Columns a-b) of Project (program) income. This is a calculated field.:

16. a: Total Project Costs (subtract #15 from #14) of Total Cost. This is a calculated field.:

16. c: Total Project Costs (subtract #15 from #14) of Total Allowable Costs (Columns a-b). This is a calculated field.:

16. b: Total Project Costs (subtract #15 from #14) of Costs Not Allowable for Participation. This is a calculated field.:

Federal percentage share: Consult Federal agency for Federal percentage share:

17. c: Federal Funding Share. This is a calculated field.:

TextField2:

XDPFirstField:

image5.emf

SF424D.pdf

Adobe Reader.

Assurances for Construction Programs (SF-424D)

D:20061106135954- 05'00'

D:20061106140136- 05'00'

OMB Number: 4040-0009 Expiration Date: 02/28/2025

ASSURANCES - CONSTRUCTION PROGRAMS

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.

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 (0348-0042), Washington, DC 20503.

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 assistance 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:

NOTE:

1.

Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability

(including funds sufficient to pay the non-Federal share of project costs) to ensure proper planning, management and completion of project described in this application.

2.

Will give the awarding agency, the Comptroller General of the United States and, if appropriate, the State, the right to examine all records, books, papers, or documents related to the assistance; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives.

3.

Will not dispose of, modify the use of, or change the terms of the real property title or other interest in the site and facilities without permission and instructions from the awarding agency. Will record the Federal awarding agency directives and will include a covenant in the title of real property acquired in whole or in part with Federal assistance funds to assure non-discrimination during the useful life of the project.

4.

Will comply with the requirements of the assistance awarding agency with regard to the drafting, review and approval of construction plans and specifications.

5.

Will provide and maintain competent and adequate engineering supervision at the construction site to ensure that the complete work conforms with the approved plans and specifications and will furnish progressive reports and such other information as may be required by the assistance awarding agency or State.

6.

Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.

7.

Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain.

8.

Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §§4728-4763) relating to prescribed standards of merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).

9.

Will comply with the Lead-Based Paint Poisoning

Prevention Act (42 U.S.C. §§4801 et seq.) which prohibits the use of lead-based paint in construction or rehabilitation of residence structures.

10.

Will comply with all Federal statutes relating to non-discrimination. These include but are not limited to: (a)

Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681

1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the

Rehabilitation Act of 1973, as amended (29) U.S.C.

§794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse

Office and Treatment Act of 1972 (P.L. 92-255), as amended relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation

Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §§523 and 527 of the Public Health

Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee

3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the

Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statue(s) under which application for Federal assistance is being made; and (j) the requirements of any other nondiscrimination statue(s) which may apply to the application.

Previous Edition Usable

Authorized for Local Reproduction

Standard Form 424D (Rev. 7-97) Prescribed by OMB Circular A-102

11.

Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of

1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal and federally-assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of

Federal participation in purchases.

12.

Will comply with the provisions of the Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds.

13.

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 18 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.

14.

Will comply with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973

(P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more.

15.

Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-

190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of

1972 (16 U.S.C. §§1451 et seq.); (f) conformity of

Federal actions to State (Clean Air) implementation

Plans under Section 176(c) of the Clean Air Act of

1955, as amended (42 U.S.C. §§7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended (P.L. 93-523); and, (h) protection of endangered species under the Endangered Species Act of 1973, as amended (P.L. 93-205).

16.

Will comply with the Wild and Scenic Rivers Act of

1968 (16 U.S.C. §§1271 et seq.) related to protecting components or potential components of the national wild and scenic rivers system.

17.

Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation

Act of 1966, as amended (16 U.S.C. §470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of

1974 (16 U.S.C. §§469a-1 et seq).

18.

Will cause to be performed the required financial and compliance audits in accordance with the Single Audit

Act Amendments of 1996 and OMB Circular No. A-133, "Audits of States, Local Governments, and Non-Profit Organizations."

19.

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

SF-424D (Rev. 7-97) Back

APPLICANT ORGANIZATION

DATE SUBMITTED

20.

Will comply with the requirements of Section 106(g) of the Trafficking Victims Protection Act (TVPA) of 2000, as amended (22 U.S.C. 7104) which prohibits grant award recipients or a sub-recipient from (1) Engaging in severe forms of trafficking in persons during the period of time that the award is in effect (2) Procuring a commercial sex act during the period of time that the award is in effect or (3) Using forced labor in the performance of the award or subawards under the award.

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Title: Enter the title of the Certifying Official. This field is required.:

Applicant Organization: Enter the Applicant Organization. This field is required.:

Signature of the Authorized Certifying Official: Enter the Signature of the Authorized Certifying Official. This field is required.:

Date Signed: Enter the date signed. Enter in the format mm/dd/yyyy. This field is required.:

FormVersionIdentifier: 1.1

LastField:

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SFLLL.pdf

Adobe Reader.

Disclosure of Lobbying Activities (SF-LLL)

D:20061124112418- 05'00'

D:20061124112418- 05'00'

10. a. Name and Address of Lobbying Registrant:

9. Award Amount, if known:$

* Street 1

* City

State

Zip

Street 2

* Last Name

Prefix

* First Name

Middle Name

Suffix

DISCLOSURE OF LOBBYING ACTIVITIES

Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352

OMB Number: 4040-0013

Expiration Date: 02/28/2025

1. * Type of Federal Action:

Type of Federal Action: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. This field is required.

Type of Federal Action is required: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

2. * Status of Federal Action:

Status of Federal Action: Identify the status of the covered Federal action. This field is required.

Status of Federal Action: Identify the status of the covered Federal action. This field is required.

Status of Federal Action is required: Identify the status of the covered Federal action.

3. * Report Type:

Report Type: Identify the appropriate classification of this report. If this is a follow up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the previously submitted report by this reporting entity for this covered Federal action. This field is required.

For Material Change Only:

year quarter date of last report

4. Name and Address of Reporting Entity:

Reporting Entity: Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. This field is required.

Reporting Entity is required: Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

Tier if known:

* Name

* Street 1

Street 2

* City

State

Zip

Congressional District, if known:

Congressional District, if known:

* Name

* City

State

* Street 1

Street 2

Zip

6. * Federal Department/Agency:

7. * Federal Program Name/Description:

CFDA Number, if applicable:

8. Federal Action Number, if known:

b. Individual Performing Services (including address if different from No. 10a)

Prefix

* First Name

Middle Name

* Street 1

* City

State

Zip

Street 2

11.

* Last Name

Suffix

Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when the transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

* Signature:

*Name:

Prefix

* First Name

Middle Name

* Last Name

Suffix

Title:

Telephone No.:

Date:

Federal Use Only:

Authorized for Local Reproduction

Standard Form - LLL (Rev. 7-97)

XDPFirstField:

Mandatory:

Disclosure Statement: Click the button to read the "Review Public Burden Disclosure Statement".:

Type of Federal Action: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. This field is required.

Contract: Click if the Type of Federal Action is a contract.:

Type of Federal Action: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. This field is required.

Grant: Click if the Type of Federal Action is a grant.:

Type of Federal Action: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. This field is required.

Cooperative Agreement: Click if the Type of Federal Action is a cooperative agreement.:

Type of Federal Action: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. This field is required.

Loan: Click if the Type of Federal Action is a loan.:

Type of Federal Action: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. This field is required.

Loan Guarantee: Click if the Type of Federal Action is a loan guarantee.:

Type of Federal Action: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. This field is required.

Loan Insurance: Click if the Type of Federal Action is a loan insurance.:

Status of Federal Action: Identify the status of the covered Federal action. This field is required.

Bid, Offer, Application: Click if the Status of Federal Action is a bid, an offer or an application.:

Status of Federal Action: Identify the status of the covered Federal action. This field is required.

Initial Award: Click if the Status of Federal Action is an initial award.:

Status of Federal Action: Identify the status of the covered Federal action. This field is required.

Post Award: Click if the Status of Federal Action is a post-award.:

Report Type: Identify the appropriate classification of this report. If this is a follow up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the previously submitted report by this reporting entity for this covered Federal action. This field is required.

Initial Filing: Click if the Report Type is a initial filing.:

Report Type: Identify the appropriate classification of this report. If this is a follow up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the previously submitted report by this reporting entity for this covered Federal action. This field is required.

Material Change: Click if the Report Type is a material change.:

Year: If this is a follow up report caused by a material change to the information previously reported, enter the year in which the change occurred.:

Quarter: If this is a follow up report caused by a material change to the information previously reported, enter the quarter in which the change occurred.:

Date of last report: Enter the date of the previously submitted report by this reporting entity for this covered Federal action.:

ReportTypeAttr:

ReportingEntityEntityType:

Reporting Entity: Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. This field is required.

Prime: Click to designate the organization filing the report as the Prime Federal recipient.:

SubAwardee: Click to designate the organization filing the report as the SubAwardee Federal recipient. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.:

ReportEntityType:

Tier: Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. :

Reporting Entity Organization Name: Enter the name of reporting entity. This field is required.:

Street 1: Enter the first line of the street address for the Reporting Entity. This field is required.:

Street 2: Enter the second line of the street address for the Reporting Entity.:

City: Enter the city of the Reporting Entity. This field is required.:

State: Select the state for the Reporting Entity's address from this pull down menu.:

Zip / Postal Code: Zip Code (or ZIP+4) of the Reporting Entity.:

Congressional District: If known, the Congressional District of the reporting entity. Should be numeric characters.:

Section5Text:

Prime Organization Name: If the organization filing the report in item 4, checks "Subawardee", enter the full name of the prime Federal recipient.:

Street 1: If the organization filing the report in item 4, checks "Subawardee", enter the address of the prime Federal recipient.:

Street 2: If the organization filing the report in item 4, checks "Subawardee", enter the address of the prime Federal recipient.:

City: If the organization filing the report in item 4, checks "Subawardee", enter the city of the prime Federal recipient.:

State: If the organization filing the report in item 4, checks "Subawardee", select the appropriate state from this pull down menu.:

Zip / Postal Code: If the organization filing the report in item 4, checks "Subawardee", enter the zip code.:

Congressional District: If the organization filing the report in item 4, checks "Subawardee", enter the Congressional District of the prime Federal recipient, if known. Should be numeric characters.:

EntityType: Prime

Federal Department/Agency: Enter the name of the Federal Department or Agency making the award or loan commitment. This field is required.:

Federal Department/Agency: Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments. :

CFDA Number: Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments.:

Federal Action Number: Enter the most appropriate Federal identifying number available for the Federal action, identified in item 1 (e.g., Request for Proposal (RFP) number, invitation for Bid (IFB) number, grant announcement number, the contract, grant, or loan award number, the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001".:

Award Amount: For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment of the prime entity identified in item 4 or 5.:

Prefix: Enter the prefix (e.g., Mr., Mrs., Miss), if appropriate, for the Lobbying Registrant.:

First Name: Enter the first name of Lobbying Registrant. This field is required.:

Middle Name: Enter the middle name of Lobbying Registrant.:

Last Name: Enter the last name of Lobbying Registrant. This field is required.:

Suffix: Enter the suffix (e.g., Jr. Sr., PhD), if appropriate, for the Lobbying Registrant.:

Street 1: Enter the first line of street address for the Lobbying Registrant.:

Street 2: Enter the second line of street address for the Lobbying Registrant.:

City: Enter the city of the Lobbying Registrant.:

State: Select the appropriate state of the Lobbying Registrant.:

Zip / Postal Code: Enter the Zip Code (or ZIP+4) of the Lobbying Registrant.:

DataEntered1:

Prefix: Enter the prefix (e.g., Mr., Mrs., Miss), if appropriate, for the Individual Performing Services.:

First Name: Enter the first name of the Individual Performing Services. This field is required.:

Middle Name: Enter the middle name of the Individual Performing Services.:

Last Name: Enter the last name of the Individual Performing Services. This field is required.:

Suffix: Enter the suffix (e.g., Jr. Sr., PhD), if appropriate, for the Individual Performing Services.:

Street 2: Enter the second line of street address for the Individual Performing Services.:

City: Enter the city of the Individual Performing Services. :

State: Select the state for the address of the Individual Performing Services from this pull down menu.:

Zip / Postal Code: Enter the Zip Code (or ZIP+4) of the Individual Performing Services.:

Street 1: Enter the first line of street address for the Individual Performing Services.:

DataEntered2:

Prefix: Enter the prefix (e.g., Mr., Mrs., Miss), if appropriate, for the Certifying Official.:

First Name: Enter the first name of Certifying Official. This field is required.:

Middle Name: Enter the middle name of the Certifying Official.:

Last Name: Enter the last name of the Certifying Official. This field is required.:

Suffix: Enter the suffix (e.g., Jr. Sr., PhD), if appropriate, for the Certifying Official.:

Title: Enter the title of the Certifying Official.:

Telephone Number: Enter the telephone number of the certifying official.:

LastField:

Signature: Enter the Signature. This field is required.

Date: Enter the date signed. Enter in the format mm/dd/yyyy. This field is required.:

image7.emf

Example Budget Justification.xlsx Budget Justification

Example Detailed Budget Justification - Not a Required Form

Award Number: (Not Available at Application) Award Recipient:

General Instructions

1. Only fill in light blue cells, white cells contain instructions, headers, or summary calculations and should not be modified.

2. The Summary section at the end will auto-fill when each budget subsection is completed.

3. Budget categories must include both Federal and Non-Federal (cost match) portions. All costs must be directly relevant to the project objectives.

4. All costs incurred by the preparer's sub-recipients and vendors should be entered only in section f. Contractual.

5. All costs must be allowable, allocable, and reasonable in accordance with the administrative requirements and applicable cost principles prescribed in 2 CFR 200.

6. Rows can be added as needed throughout sections a. through j. If rows are added, formulas/calculations may need to be adjusted.

Cost Match Instructions

1. The budget must include at least the minimum Federal to non-Federal required match, if applicable.

2. Cost Match can be either Cash or In-kind. Cash Cost Match - encompasses all contributions to the project incurred and paid for during the project. This includes Cost Match payments for personnel, supplies, equipment, activities and items necessary for the project. In-kind Cost Match - encompasses all contributions to the project that do not involve a payment or reimbursement and represent donated items or services that are necessary to the performance of the project. This includes volunteer personnel hours, donated existing equipment, donated existing supplies, etc. The market value and calculations for all In-kind cost match items must be justified and explained.

3. Funds from other Federal sources MAY NOT be counted as cost match. Non-Federal sources include any source not originally derived from Federal funds.

4. Fee or profit, including foregone fee or profit, are not allowable as project costs (including cost match). The project may only incur those costs that are allowable and allocable to the project (including cost match) as determined in accordance with the administrative requirements and cost principles in 2 CFR 200.

a. Personnel

1. Personnel are staff employed by the lead applicant organization. Personnel costs for subrecipients and vendors must be included under f. Contractual.

2. Identify all personnel by position title. Enter the amount of time (i.e., hours or % of time) and the base pay rate and the total will automatically calculate. Also include the basis of rate (e.g., actual salary, labor distribution report, state civil service rates, etc.). Personnel costs may only include time spent working directly on the project.

3. If a position and hours are attributed to multiple employees (e.g. Technician working 2500 hours) the number of employees for that position title must be identified.

Position Title Time (Hrs or %) Rate (Hr or Salary) Total Cost Federal Share Cost Match Rate Basis

EXAMPLE!!! Sr. Engineer 400 $46.00 $18,400 $14,000 $4,400 Actual Salary

$0 $0

$0 $0

$0 $0

$0 $0

$0 $0

$0 $0

$0 $0

Total 0 $0 $0 $0

b. Fringe Benefits

1. Fill out the table below by position title. If all employees receive the same rate, you may list Total Personnel in the Position column instead of listing out all position titles. If more than one rate is used, list each rate separately. Complex calculations should be provided in the Comments section.

2. Fringe rates may not exceed what is currently provided by the organization. If a federally approved Fringe rate exists, provide the rate agreement with the application.

Position Title Personnel Rate Total Cost Federal Share Cost Match Comments (as needed)

EXAMPLE!!! Sr. Engineer $18,400 20% $3,680 $1,680 $2,000

$0 $0

$0 $0

$0 $0

$0 $0

$0 $0

Total: $0 $0 $0 $0

c. Travel

1. All travel must be necessary for performance of the project objectives.

2. Travel costs should remain consistent with travel costs incurred by an organization during normal business operations as a result of the organizations written travel policy. In absence of a written travel policy, organization's must follow the regulations prescribed by the General Services Administration (GSA): www.gsa.gov.

From To # of Days # of Travelers Lodging per Traveler Flight per Traveler Vehicle per Traveler Per Diem per Traveler Cost per Trip Federal Share Cost Match Basis for Estimate

Denver Washington, D.C. 2 2 $250 $500 $100 $160 $2,020 $1,520 $500 GSA rates

$0 $0

$0 $0

$0 $0

$0 $0

$0 $0

Total $0 $0 $0

d. Equipment

1. Equipment is generally defined as one item with an acquisition cost greater than $5,000 and a useful life of more than one year. Refer to the supplies section for items of lesser value and useful life.

2. List all equipment noting its purpose in the project and the basis of cost (e.g. vendor quotes, catalog prices, prior invoices, etc.). If it is existing equipment, provide a justification for its estimated value.

3. Note that equipment items with a residual value of $5,000 or more at the end of the award will be subject to the equipment disposition regulations in 2 CFR 200.313.

Equipment Item Quantity Unit Cost Total Cost Federal Share Cost Match Basis of Cost Purpose

EXAMPLE!!! Commercial Printer 1 $12,000 $12,000 $8,000 $4,000 Vendor Quote Printing of photographs and brocures

$0 $0

$0 $0

$0 $0

$0 $0

$0 $0

Total $0 $0 $0

e. Supplies

1. Supplies are generally defined as items with an acquisition cost of $5,000 or less and a useful life expectancy of less than one year. Supplies are generally consumed during the project.

2. List all supplies noting their purpose in the project and the basis of cost (e.g. vendor quotes, catalog prices, prior invoices, etc.). Supply items must be direct costs to the project and not duplicative of supply costs covered in the indirect rate.

3. Multiple supply items valued at $5,000 or less used to assemble an equipment item with a value greater than $5,000 and useful life of more than one year should be included in the equipment section.

Supply Item Quantity Unit Cost Total Cost Federal Share Cost Match Basis of Cost Purpose

EXAMPLE!!! Photo Laminate 800 $2.00 $3,600 $3,600 $0 Catalog price Lamination of the printed photographs

$0 $0

$0 $0

$0 $0

$0 $0

$0 $0

$0 $0

$0 $0

Total $0 $0 $0

f. Contractual

1. List all third party costs as either sub-recipients or contractors. A sub-recipient (partner, sub-awardee) is a legal entity to which a subaward is made, who has performance measured against whether the objectives of the grant project are met, is responsible for project-related decision-making, must adhere to the applicable grant program compliance requirements, and uses the Federal funds to carry out a program of the organization. A contractor (vendor): is a legal entity contracted to provide goods and services within normal business operations, provides similar goods or services to many different purchasers, operates in a competitive environment, provides goods or services that are ancillary to the operation of the grant project, and is not subject to compliance requirements of the Federal program. All characteristics may not be present and judgment must be used to determine subrecipient vs. contractor status.

2. For each sub-recipient budget cost that is 35% or more of the total project costs, a separate budget justification form must be submitted with the application. The sub-recipient budget justification may be completed by the lead applicant or the sub-recipient.

3. List all vendors supplying commercial supplies or services used to support the project. For each Vendor budget cost that is 35% or more of the total project costs, a vendor price quote must be submitted with the application. All vendor work must be competitively selected in accordance with the procurement standards in 2 CFR 200.317 - 200.326.

Subrecipient Name Purpose Total Cost Federal Share Cost Match Basis of Cost

EXAMPLE!!! XYZ Corp. Partner to develop training curriculum for teachers $25,000 $10,000 $15,000 Personnel and supplies costs

$0 $0

$0 $0

$0 $0

$0 $0

$0 $0

Subtotal $0 $0 $0

Vendor Name Purpose Total Cost Federal Share Cost Match Basis of Cost

EXAMPLE!!! ABC Corp. Vendor to perform photograph scanning $8,000 $0 $8,000 Cost per 800 photos

$0 $0

$0 $0

$0 $0

$0 $0

$0 $0

Subtotal $0 $0 $0

Total $0 $0 $0

g. Construction

1. Construction is generally defined as construction, alteration, or repair (including dredging, excavating, and painting) of buildings, structures, or other real property.

2. List all proposed construction below, providing a basis of cost such as engineering estimates, prior construction, etc., and purpose as it applies to the Project Objectives.

General Description Purpose Total Cost Federal Share Cost Match Basis of Cost

EXAMPLE!!! Construct Parking Lot To build a parking structure for the museum $22,000 $12,000 $10,000 Engineering estimate

$0

$0

$0

$0

$0

Total $0 $0 $0

h. Other Direct Costs

1. Other direct costs are direct cost items required for the project which do not fit clearly into other categories. Indirect Costs should not be included in this section.

2. Basis of cost are items such as vendor quotes, prior purchases of similar or like items, published price list, established organizational rates, etc.

Cost Item Purpose Total Cost Federal Share Cost Match Basis of Cost

EXAMPLE!!! 4 Grad student tuition Support of graduate students working on project $16,000 $12,000 $4,000 Established University tuition rate

$0

$0

$0

$0

$0

Total $0 $0 $0

i. Indirect Costs

1. Indirect costs are costs an organization incurs for common or joint objectives that cannot be specifically identified with one organizational cost objective or project.

2. Applicants may apply established indirect rates if they have been approved or negotiated with a Federal government agency, and a copy is included with this application.

3. If the applicant does not have a current Federally approved rate agreement they may elect to apply a rate limited to 10% of total direct costs.

Rate Type Federal Rate? Base Description Base Total Rate Total Cost Fed Share Cost Match

EXAMPLE!!! Indirect Rate Yes Total Direct costs excluding equipment, tuition, and subgrants greater than $25,000 $113,020 42.80% $48,373 $28,373 $20,000

EXAMPLE!!! Overhead Rate No Total Direct Costs $141,020 15.00% $21,153 $5,000 $16,153

$0 $0

$0 $0

$0 $0

$0 $0

Total $0 $0 $0

Summary Figures in this summary table are calculated from entries made in subsequent categories, only blank white cells require data entry.

Category Total Cost Federal Share Cost Match Cost Match % Comments (as needed)

a. Personnel $0 $0 $0 ERROR:#DIV/0!

b. Fringe Benefits $0 $0 $0 ERROR:#DIV/0!

c. Travel $0 $0 $0 ERROR:#DIV/0!

d. Equipment $0 $0 $0 ERROR:#DIV/0!

e. Supplies $0 $0 $0 ERROR:#DIV/0!

f. Contractual $0 $0 $0 ERROR:#DIV/0!

g. Construction $0 $0 $0 ERROR:#DIV/0!

h. Other Direct Costs $0 $0 $0 ERROR:#DIV/0!

i. Indirect Charges $0 $0 $0 ERROR:#DIV/0!

Total Costs $0 $0 $0 ERROR:#DIV/0!

SF424A

SF424A Budget Information

The below SF424A Budget is autopopulated from entries made on the Budget Justification Tab. No data entry is required here.

Award Number: (Not Available at Application) Award Recipient: 0 OMB Approval No. 0348-0044

Section A - Budget Summary

Grant Program Function or Activity Catalog of Federal Domestic Assistance Number Estimated Unobligated Funds New or Revised Budget

Federal Non-Federal Federal Non-Federal Total

(a) (b) (c ) (d) (e) (f) (g)

1. $0 $0 $0

2.

3.

4.

5. Totals $0 $0 $0

Section B - Budget Categories

6. Object Class Categories Grant Program, Function or Activity Total (5)

Federal Non-Federal

a. Personnel $0 $0 $0

b. Fringe Benefits $0 $0 $0

c. Travel $0 $0 $0

d. Equipment $0 $0 $0

e. Supplies $0 $0 $0

f. Contractual $0 $0 $0

g. Construction $0 $0 $0

h. Other $0 $0 $0

i. Total Direct Charges (sum of 6a-6h) $0 $0 $0

j. Indirect Charges $0 $0 $0

k. Totals (sum of 6i-6j) $0 $0 $0

7. Program Income $0 $0 $0

SF-424A (Rev. 4-92)

Previous Edition Usable Authorized for Local Reproduction Prescribed by OMB Circular A-102

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Federal Use Only

This tab is for federal use only,…