Attachment A - Application Package Checklist.pdf

Attachment A - Application Package Checklist

Careful review of the application notice of funding availability and use of this checklist is strongly encouraged to ensure that a complete application is submitted. Application packages that do not contain all of the required forms and documents will be withdrawn and will not be considered for funding. The table below lists the required documents that must be contained in the application package (if applicable), the document description and its location.

Document Name Document Description & Location Document Included?

Standard Form (SF) 424

Application for Federal

Assistance

(Required Form)

Standard application form for all Federal assistance requests.

This form is available in the Grants.gov application kit.

YES ☐ NO ☐

SF-424A Budget

Information for Non-Construction

Programs

Standard application form for all Federal assistance requests relating to non-construction grant programs.

SF-424B Assurances for

Non-Construction

Programs non-construction grant programs indicating that the applicant organization is in substantial compliance with applicable Federal laws to accept and manage Federal funds.

Grants.Gov Lobbying

Form the limitation on the use of appropriated funds to influence certain

Federal contracting and financial transactions under Title 31 U.S.C.

Section 1352.

SF-LLL Disclosure of

Lobbying Activities

(If Applicable)

Standard application form for all Federal assistance requests to disclose lobbying activities. Only applicable to applicants that have lobbying activities to disclose.

Key Contacts Form

Standard application form for all Federal assistance requests that must contain contact information for the following three roles (annotate in the form if a contact is performing more than one role):

1) Authorized Designated Official (individual for review and acceptance of award);

2) Principal Investigator/Program Director (individual responsible for the technical completion of the proposed work.); and

3) Financial Official (individual authorized to accept payments).

1)YES ☐

2)YES ☐

3)YES ☐

1)NO ☐

2)NO ☐

3)NO ☐

Project Narrative

(Required Document)

See Section C of the notice of funding opportunity for what the project narrative must contain.

Budget Narrative

(Required Document)

Includes a thorough description and clear justification of each project’s cost budget category (object class) and how the cost was derived.

Budget Narrative Guidance is available in Grants.gov under the

“Related Documents” tab.

Indirect Cost Rate

Information

If the applicant includes indirect costs in the budget, the applicant must provide either the fully executed, negotiated agreement from their cognizant Federal agency – or – (if the rate will not be approved by the application due date), the letter of renewal or letter of request that was sent to the cognizant agency.

Standard Title VI/Non-

Discrimination Program

Assurance and Plan

(Required Documents)

Required self-certification assurance ensures that the applicant will comply with Title VI of the Civil Rights Act of 1964 and related

Nondiscrimination authorities (including other related directives, circulars, policy, memoranda, and/or guidance) to ensure that no person in the United States shall, on the grounds of race, color, national origin, sex, age, disability, low-income, or Limited English Proficiency be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination.

A draft Title VI Program Assurance and Plan is available in Grants.gov under the “Related Documents” tab.

PP/TLD or PP/TLD approval letter

(for HP-ITD applications only)

Each HP-ITD applicant shall submit a Program Plan approval letter indicating the Program Plan previously approved includes the projects in which funds are being requested.

Note: The above does not apply if the applicant is requesting funding to develop a Program Plan only.

Attachment B - Program Narrative Guidance

UNITED STATES DEPARTMENT OF TRANSPORTATION

FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION

Fiscal Year 2017 – High Priority Grant Application

Program Narrative Template

High Priority Agency: (enter Agency name):

Optional Field for Applicants other than the MCSAP Lead Agency: We coordinated with the

MCSAP Lead Agency: (enter MCAP Lead Agency’s name): ☐Yes or ☐No

Program Overview

Goal: To ensure that agencies carry out enforcement activities and projects that improves CMV safety and compliance with CMV regulations. Also for projects that are national in scope, increase public awareness and education, demonstrate new technologies and reduce the number and rated of CMV accidents.

Program Strategies

☐Objective 1: As authorized by the FAST Act §5101(c) and 49 U.S.C. §31104(a)(2), FMCSA will reserve up to $20,000,000 of the funds made available under this announcement for HP-

Innovative Technology Deployment (ITD) projects to advance the technological capability and promote the deployment of intelligent transportation system applications for CMV operations, including CMV, commercial driver, and carrier-specific information systems and networks; to support and maintain CMV information systems and networks; to link Federal motor carrier safety systems with State CMV systems; to improve the safety and productivity of CMV’s and drivers; and to reduce the costs associated with CMV operations and Federal and State CMV regulatory requirements.

Brief Introduction:

Include a 1-2 paragraph description of the goal(s) of the application. Include in this introduction specific information about the outputs the application proposes to achieve.

Problem Statement:

Include specific information addressing the specific criteria for this national priority as outlined in the section A of this NOFA.

Performance Objectives:

A description of the quantifiable goals related to the above problem statement. This can be measured in numbers or percentages or other forms that accurately measure the outputs the applicant anticipates will result from implementing the strategies and activities proposed.

The following Summary of Activities (provided below), is provided for your use to summarize the anticipated project activities.

ANTICIPATED SUMMARY OF ACTIVITIES

HP-ITD Projects Number

Core Deployment

Enhancements

Innovative Technologies

Program Activity Plan:

A description of the activities the applicant believes will help mitigate the problem. Specify the strategies that the States will conduct to ensure project is completed on schedule. Description should include details such as number and frequency of project milestone activities. Additional information necessary to support how the applicant will accomplish the above goals.

Performance Measurement Plan:

Specify how the State will monitor and report on the results of these activities. A description of how the applicant will measure progress towards the performance objective goal, such as quantifiable and measurable outputs

(hours, milestones achieved, percentage of electronic credentials realized, etc.) and in terms of performance outcomes. The measure must include specific benchmarks that can be reported on in the quarterly progress report.

Monitoring and Reporting:

activities. A description of how the applicant will measure progress towards the performance objective goal, such as quantifiable and measurable outputs

(hours, percent completed, milestone status, etc.). The measure must include specific benchmarks/milestones that can be reported on in the quarterly progress report.

☐Objective 2: The FMCSA will allocate a minimum of $21,567,000 of the funds made available under this announcement for HP-CMV safety activities and projects to augment motor carrier safety after selections have been made for objective #1 above. The activities and projects are prioritized as follows:

Performance and Registration Information Systems Management (PRISM) projects;

For Agencies that are not currently participating in the PRISM program (required by

October 1, 2020);

For Agencies that have not reached Step 6 or an equivalent (required by October 1, 2020); and

For projects that exceed PRISM routine operations (i.e., beyond Step 6).

Safety Data Improvement projects;

Innovative approaches to resolving Requests for Data Review (RDRs) entered through DataQs provides improved consistency, accountability and removes the review from the originating officer.

Innovative data projects that improve the collection of CMV data during crash investigations and/or roadside inspections.

Targeting unsafe driving of CMVs and non-CMVs in areas identified as high-risk crash corridors;

Improvements for the safe and secure movement of Hazardous Materials;

New technologies to improve CMV safety;

Improvements for the Safe Transportation of Goods and Persons in Foreign

Commerce;

Improve CMV safety and compliance with CMV safety regulations;

Public Awareness and Education; and

For Operations and Maintenance costs associated with PRISM and Safety Data

Improvement projects for an Agency not responsible for submitting a Commercial

Vehicle Safety Plan (CVSP).

COPY AND PASTE THE FOLLOWING NARRATIVE BOXES UNDER EACH

PRIORITY CHECKED IN ABOVE TO PROVIDE THE BRIEF INTRODUCTION,

PROBLEM STATEMENT, AND PERFORMANCE OBJECTIVES FOR EACH

ACTIVITY SELECTED.

Brief Introduction:

Include a 1-2 sentence description of the goal(s) of the application and the applicable program priority(ies) met by the application’s projects (e.g.

Priority 2, Project 3 - Enforcement of traffic laws and safety regulations in high-risk areas such as work zones and on rural roads including prevention of secondary crashes at investigation scenes). Include in this introduction specific information about the outputs the application proposes to achieve.

For each goal identified, the applicant must provide a problem statement, performance objective, program activity plan, and performance measurement plan.

Problem Statement:

A brief, quantitative description of the identified program. Include details on the data use to identified problem. Include details on the data used to identify the problem and to establish the baseline (include data sources, date, and explain how the applicant collects, maintains, and analyzes the data)

Performance Objectives:

A description of the quantifiable goals related to the above problem statement. This can be measured in numbers or percentages that accurately measure the outputs the applicant anticipates will result from implementing the strategies and activities proposed

The Summary of Activities (below), is provided for your use to summarize the anticipated activities and projects. Please complete an individual table for each activity and project.

ANTICIPATED SUMMARY OF ACTIVITIES

# of Traffic Enforcement Contacts (TOTAL) 0

# of Traffic Enforcement Contacts CMV 0

# of Traffic Enforcement Contacts Non-CMV 0

# of Highly Visible Blitzes/Details/Waves TOTAL) 0

# of Inspections (TOTAL) 0

# of Inspections Motorcoach 0

# of Inspections CMV 0

# of Educational Events (TOTAL) 0

# of CMV Educational Events Contacts 0

# of Outreach Events (TOTAL) 0

# of CMV Outreach Events Contacts 0

# of Non-CMV Outreach Events Contacts 0

# of Hours (TOTAL) 0

# of Regular Hours 0

# of Overtime Hours 0

# of Employees (TOTAL) 0

# of Full Time Employees 0

# of Part Time Employees 0

# of Citations (TOTAL) 0

# of Non-CMV Citations 0

# of CMV Citations 0

# of Motorcoach Citations 0

Program Activity Plan:

Additional information necessary to support how the applicant will accomplish the above goals.

A description of the activities the applicant believes will help mitigate the problem. Specify the enforcement strategies that the States will conduct to reduce the crash rate in these corridors. Description should include details such as number and frequency of activities. Additional information necessary to support how the applicant will accomplish the above goals.

Performance Measurement Plan:

Indicate how the State will evaluate the outcome and success of this enforcement activity to demonstrate whether increased vehicle contacts, issuance of traffic citations, and traffic citation convictions and the impact this has on overall crash rates. Indicate how the state will monitor the progress of citations issued under this project through the criminal justice system and State driver licensing agency to ensure that any convictions are recorded on the respective driver history records

Monitoring and Reporting activities. A description of how the applicant will measure progress towards the performance objective goal, such as quantifiable and measurable outputs

(hours, carrier contacts, inspections, number of outreach events, etc.) and in terms of performance outcomes. The measure must include specific benchmarks that can be reported on in the quarterly progress report, if practicable, or as annual outcomes.

Attachment C - Budget Narrative Guidance

What is a Budget Narrative?

The budget narrative explains the “what, “how” and “why” of a line item cost to carry out grant project goals and objectives. A budget narrative is a narrative explanation of each budget component which supports the costs of the proposed work. The budget narrative should focus on how each budget item is required to achieve the proposed project goals and objectives. It should also justify how budget costs were calculated.

The budget narrative should be clear, specific, detailed, and mathematically correct.

The FMCSA reviews the budget narrative to confirm how costs are allowable, allocable, necessary, and reasonable. A well-developed budget narrative is also an effective management tool; a budget that doesn’t represent a project’s needs makes it difficult to recommend for funding and assess financial performance over the life of the project. The budget narrative serves a number of critical functions:

Describes your need for or necessity of an expense;

Documents how reasonable the request is, conveys your judgment as well as the feasibility of the project in context of available and proposed resources.

Helps FMCSA review high-risk cost items to determine funding.

What Different Costs are in a Budget Narrative?

Personnel: Personnel costs are employee salaries working directly on a grant project. Only include costs for personnel employed by your organization. Costs should be consistent with that paid for similar types of work within the organization. Individuals not employed by your organization will be classified as either a subgrant or contractor. See the contractual object class for additional information.

Below is a sample personnel budget narrative. The FMCSA evaluates the personnel budget narrative to determine whether the proposed number of personnel is appropriate and that there is sufficient staffing to meet the project objectives. The proposed effort should be consistent with the effort required by the work plan. The labor mix should be consistent with the caliber of effort – professional/nonprofessional/clerical – required by the grant work plan. The FMCSA also reviews the personnel budget to determine if the salary ranges proposed are reasonable.

Personnel Budget Narrative

Position(s) # of

Staff

% of

Time

Work

Year

Hours

Hourly

Rate Total Cost

Supervisor 1 100 2,080 $21.63 $45,000

Trooper 1 50 2,080 $19.00 $19,760

Sub-Total Salary $64,760.00

Total Personnel 1.5

The ITD Supervisor supervises activities of the project. She/he spends 100% time implementing this project, supervising staff, and conducting activities to meet the objectives of this project.

Activities include: supervising daily operation of projects and staff, providing staff training/technical assistance, coordinating staff work schedule/assignments, ensuring data entry, tracking and following-up on procedures to meet quality assurance, and tracking policy to ensure compliance. There is 1 Trooper (1 PT) assigned to this project to ensure all field operations needs are met, and to coordinate a Field Operational Test. This Trooper is paid an hourly wage of $19 and will average 50% on project activities. The PT Trooper averages 1,040 hours or 50% on activities @ $19,760 per year.

Fringe Benefits: Fringe benefits are allowances and services provided by employers to their employees as compensation in addition to regular salaries and wages. Fringe benefits include, but are not limited to, the costs of leave (vacation, family-related, sick or military), employee insurance, pensions, and unemployment benefit plans. The costs of fringe benefits are allowable provided that the benefits are reasonable and are required by law, non-Federal entity-employee agreement, or an established policy of the non-Federal entity. The FMCSA will only reimburse fringe costs for the personnel and only for the percentage of time they devote to the project.

Some helpful tips:

Include how the fringe benefit amount is calculated (e.g., actual fringe benefits, rate approved by the Health and Human Services State Wide Cost Allocation Plan or cognizant agency).

Explain what is included in the benefit package.

Do not combine the fringe benefit costs with direct salaries and wages in the personnel category.

Below is a sample fringe budget narrative. Note that that the personnel in the personnel budget narrative should be reflected in the fringe benefits budget narrative. The level of personnel participation (full time or part time) must also correspond to the fringe charged. This way, we ensure that the correct fringe is attributed to the correct grant.

Fringe Benefits Budget Narrative

Position(s) Rate Base

Amount Total Cost

ITD Supervisor 16.72 100 $7,524.00

Trooper (Part-Time) 16.72 50 $836.00

Sub-Total Fringe Benefits

Fringe benefits include cost of health insurance, retirement, workers’ compensation and unemployment benefit plans. It is calculated at the average fringe rate of 16.72 as recognized by the cognizant agency. This fringe rate is applied to the average hourly rate of $21.63 for a

Supervisor, and $19 per Trooper with a projected annual hours worked at 2,080 hours. The full-time supervisor would have an annual wage of $45,000 x 16.72% or $7,524 total fringe cost. The

1 part-time Trooper average 50% working on the project or an average of 1,040 hours or $19,760 per year, and an average (per part-time Trooper) fringe cost of $836.00.

Travel: Travel costs include field work activities or for travel to professional meetings. The

FMCSA reviews the travel budget to ensure that amounts are reasonable based on the level of effort described in the project plan. Generally speaking, FMCSA will accept in-State travel costs for routine operations as reasonable unless there is a specific reason to question them. The

FMCSA evaluates out-of-state to ensure the trips planned are necessary to complete the scope of work (usually training or meeting attendance), and that the number of travelers is consistent with the trip purpose. Some helpful tips:

Include estimates for unforeseen travel such as possible FMCSA required meetings, with estimated costs of attendance.

Explain the reason for travel expenses for project personnel (e.g., staff to training, field interviews, advisory group meeting, etc.) and, if known, identify the location/destination of travel.

Do not include payroll, fringe, or other costs listed as part of the travel. For example, payroll/fringe is included in personnel and fuel costs are included in other.

Below is a sample travel budget narrative. Unexpected conferences, such as with FMCSA, can be put into the budget without the need to breakout what the daily cost will be; however, when it is billed to the budget, it will be billed with actuals expenses, which are auditable. Expenses must be auditable (e.g. able to be backed up with actual days on the road, state per diem costs, hotel expenses, and any allowable miscellaneous costs).

Travel Cost Budget Narrative

Purpose # of Staff Days Total Cost

ITD/Prism Workshop 3 5 $6,840

Sub-Total Travel

Costs represent necessary travel funds for 3 personnel to attend the annual ITD/Prism Workshop identified by FMCSA. Reimbursement is based upon the current state per diem rates and rules. The per diem rate for each day is $46.00 meals, and $230 lodging per person for 5 days for a total of

$4,140.

Airfare for training in Arlington, VA for 3 persons with an average airfare cost (per person) of $900 x 3 persons = $2,700.

Equipment: Equipment costs are tangible, nonexpendable, personal property items that have a useful life of more than one year and an acquisition cost of $5,000 or more per unit. The

FMCSA evaluates the need for the equipment (e.g., ratio of employees to equipment) in the budget narrative and how it supports project activities. The FMCSA also evaluates the extent to which the equipment is being used to support more than one FMCSA grant. If it does, FMCSA evaluates if the cost has been prorated accurately. Additionally, the FMCSA reviews past performance information to determine if the same equipment for the project/program was purchased in previous years. A sample equipment budget narrative is below. Some helpful tips:

Indicate in the narrative if your equipment threshold is below $5,000 so FMCSA understands why lower costs items are included in this line. Otherwise, expenses under the threshold of $5,000 per item belong in supplies or other, depending on the item.

Explain the purpose and use of each item of equipment. Prorate the costs, if applicable.

Common purchases like a computer system (when purchased as a package - keyboard, monitor and hard drive, etc.) are considered equipment if the total cost exceeds the threshold. If these same items are purchased individually (and not as a package) and each unit is below the threshold, list them under supplies.

When developing your budget analyze the cost benefits of purchasing versus leasing equipment, particularly high-cost items and those subject to rapid technical advances. List rented or leased equipment costs in the contractual or the other object class, depending upon your procurement method. See the guidance under the other object class for additional information.

Equipment Cost Budget Narrative

Item Name # of

Items

Cost per

Item Total Cost

Bus inspection ramps 2 (sets) $3000 $6000

Sub-Total Equipment

State equipment threshold = $2,500.

2 sets of bus inspection ramps needed to conduct Level 1 inspections throughout the State following established FMCSA policy.

Supplies: Supplies are tangible personal property other than equipment. The FMCSA evaluates supplies costs to ensure a sufficient level of detail that would allow an informed reader to understand that the standard office supplies are reasonable. For example, an applicant need not provide details on the number of paper clips that it will purchase. At the same time, FMCSA cannot accept an amount for office supplies that would equal, say, $8,000 a year per person without further clarification. Some helpful tips:

A good way to document supplies is to indicate the approximate expenditure of the unit as a whole (e.g., office supplies for the unit cost $XX per month).

Do remember to include a quantity and unit cost for larger cost supply items such as computers and printers.

Supplies Cost Budget Narrative

Item Name # of Units/Items Unit of

Measurement

Cost per

Unit Total Cost

General office supplies 12 month $39 $468.00

Laptop computers 2 ea $2,000 $4,000

Sub-Total Supplies

General office supplies include paper, printer ink, etc. for the ITD program. 2 full-time troopers require laptop computers and these computers will be utilized only to fulfill project activities.

Contractual: Contractual object class costs include the cost of any contract or subgrant agreement between the applicant and another organization (for example a vendor or local government organization). Contractual costs can be categorized two ways: contract or subgrant.

The FMCSA reviews the contractual budget narrative to ensure it contains sufficient descriptive information about what specific costs (products and/or services) would be charged to the grant, a rationale for how those costs were derived, and the applicability and necessity of each to the grant.

A helpful tip: Include the name of the vendor/subgrantee, if known. If not, indicate that the selection is pending and an estimated timeframe when the vendor/subgrantee will be selected. In the application, the most important component of the contractual budget narrative is the purpose of the contract/subgrant and how the cost was estimated/derived.

Guidance for Contract Costs: A contract means a legal instrument by which a non-Federal entity purchases services needed to carry out the project or program under a Federal award. A contractor provides the goods and services within normal business operations; provides similar goods or services to many different purchasers; normally operates in a competitive environment;

provides goods or services that are ancillary (but necessary) to the operation of the Federal program. A contractor is not subject to Federal compliance requirements as a result of the grant, though similar requirements may apply for other reasons.

For example, contractual costs could include training, maintenance contracts, or other service contracts except those which belong in different object classes such as equipment or supplies

(depending upon your organization’s policy). The term “procurement” is used to identify the process of acquiring goods and services from sources outside of the grantee organization. When procuring property and services under a Federal award, an organization must follow the same policies and procedures it uses for procurements for its non-Federal funds. Non-competitive procurements should only be used in limited circumstances and should be a last resort.

Guidance for Subgrant Costs: A subgrant means an award provided by the grantee (also known as a pass-through entity) to a subgrantee. A subgrantee has its performance measured in relation to whether objectives of a Federal program were met; has responsibility for programmatic decision making; is responsible for adherence to applicable Federal program requirements specified in the Federal award; and (in accordance with its agreement), uses the

Federal funds to carry out a program for a public purpose specified in authorizing statute, as opposed to providing goods or services for the benefit of the pass-through entity.

A subgrant may be provided through any form of legal agreement, including an agreement that the pass-through entity considers a contract. Federal regulations require that all subgrantees obtain and maintain a Data Universal Numbering System (DUNS) number and continue to maintain an active System for Award Management registration at all times during an active

Federal award.

Below is a sample contractual budget narrative for contractor costs. If you intend to provide funding to another organization as a subaward, provide a new object class budget narrative and line item budget for each subgrantee organization.

Contractual Cost Budget Narrative

Description of Services Total Cost

Contractual Cost for System

Replacement $1,558,000.

Sub-Total Contractual

The contractual costs are for:

- Hiring a consultant to establish System requirements and develop an implementation plan. Estimated cost is $265,000.

- Hiring a vendor to develop the system, including system design and build. Estimated cost is $1,200,000.

- Having the system vendor develop system testing that is consistent with system specifications, and then working with Public Safety to perform tests to verify that the System

Replacement functions as required. Estimated cost is $40,000.

- Having the system vendor perform training at multiple locations for port and mobile officers, Public Safety management and IT staff. Estimated cost is $53,000.

Other: Other costs are costs that do not fit within any of the other object class categories.

Typical costs in this category include rent for buildings used to conduct project activities, utilities, and printing costs. The FMCSA reviews other costs to determine whether these costs are consistent with the proposed work plan and are necessary to complete the approved work plan. The FMCSA also evaluates the costs to ensure that no unallowable costs, such as entertainment expenses, are included. Below is a sample other budget narrative. Some helpful tips:

A lease is considered an Other cost when you are not the prime on the contract; rather, you are partnering with a different agency in your state or using a shared utility, facility or other services purchased through the state for one or more agencies. A lease is considered a contractual cost when you directly engage, and form a contract with, a vendor.

Group other object class costs whenever possible (e.g., space, rental, communication, printing, maintenance) in the budget and explain how they support the grant activities.

Ensure that other costs such as professional services, audit, postage, printing, facilities expenses are not already accounted for in either your indirect cost rate agreement or cost allocation plan.

Other Cost Budget Narrative

Item Name

# of

Unit/

Items

Unit of

Measurement

Cost

Per

Unit

Total Cost

Hand-held transponder reader 1 ea $500 $500.00

Sub-Total Other

This transponder reader is to determine if State issued transponders to CMV operators are in working order before issuance.

Indirect Costs: Indirect costs are costs incurred for common or joint objectives that benefit more than one project. They may be administrative and/or programmatic. The FMCSA reviews indirect cost rates to ensure the rate is valid, calculations are correct in the budget, and that the rate is applied to the appropriate base.

Remember to include your indirect cost rate agreement with your application in Grants.gov. If your rate will not be approved by the application due date, attach the letter of renewal or letter of request that you sent to your cognizant agency. This documentation is used as a placeholder until the rate is approved. Grantees may not receive reimbursement for indirect costs until the rate is approved.

Attachment D - United States Department of Transportation Standard Title

VI/Non-Discrimination Program Assurance and Plan

Attachment D doc. date - June 13, 2016

The United States Department of Transportation

Standard Title VI/Non-Discrimination Assurances

DOT Order No. 1050.2A

The (Title of Recipient) (herein referred to as the “Recipient”), HEREBY AGREES THAT, as a condition to receiving any Federal financial assistance from the United States Department of

Transportation (DOT), through the Federal Motor Carrier Safety Administration (FMCSA), is subject to and will comply with the following:

Statutory/Regulatory Authorities

Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq., 78 Stat. 252), (prohibits discrimination on the basis of race, color, national origin);

Federal-Aid Highway Act of 1973, (23 U.S.C. § 324 et seq.), (prohibits discrimination on the basis of sex);

Title IX of the Education Amendments of 1972, as amended, (20 U.S.C. § 1681 et seq.), (prohibits discrimination on the basis of sex in education programs or activities);

Section 504 of the Rehabilitation Act of 1973, (29 U.S.C. § 794 et seq.), as amended, (prohibits discrimination on the basis of disability);

The Age Discrimination Act of 1975, as amended, (42 U.S.C. § 6101 et seq.), (prohibits discrimination on the basis of age);

Americans with Disabilities Act of 1990, as amended, (42 U.S.C. § 12101 et seq.), (prohibits discrimination on the basis of disability);

49 C.F.R. part 21 (entitled Nondiscrimination In Federally-Assisted Programs Of The

Department Of Transportation—Effectuation Of Title VI Of The Civil Rights Act Of 1964);

49 C.F.R. part 27 (entitled Nondiscrimination On The Basis Of Disability In Programs

Or Activities Receiving Federal Financial Assistance);

49 C.F.R. part 28 (entitled Enforcement Of Nondiscrimination On The Basis Of Handicap

In Programs Or Activities Conducted By The Department Of Transportation);

49 C.F.R. part 37 (entitled Transportation Services For Individuals With Disabilities

(ADA));

49 C.F.R. part 303 (FMCSA’s Title VI/Nondiscrimination Regulation);

28 C.F.R. part 35 (entitled Discrimination On The Basis Of Disability In State And Local

Government Services);

28 C.F.R. section 50.3 (U.S. Department of Justice Guidelines for Enforcement of Title VI of the

Civil Rights Act of 1964);

The preceding statutory and regulatory cites hereinafter are referred to as the “Acts” and “Regulations,” respectively.

Although not applicable to Recipients directly, there are certain Executive Orders and relevant guidance that direct action by Federal agencies regarding their federally assisted programs and activities to which compliance is required by Recipients to ensure Federal agencies carry out their responsibilities. Executive Order 12898 (1995), entitled “Federal Actions to Address

Environmental Justice in Minority Populations and Low-Income Populations” emphasizes that

Federal agencies should use existing laws to achieve Environmental Justice, in particular Title

VI, to ensure nondiscrimination against minority populations. Recipients should be aware that certain Title VI matters raise Environmental Justice concerns and FMCSA intends that all

Recipients evaluate and revise existing procedures (as appropriate) to address and implement

Environmental Justice considerations. See the following FHWA website for more information and facts about Environmental Justice:

http://www.fhwa.dot.gov/environment/environmental_justice/index.cfm

Additionally, Executive Order 13166 (2001) on Limited English Proficiency, according to the

U.S. Department of Justice in its Policy Guidance Document dated August 16, 2000 (65 Fed.

Reg. at 50123), clarifies the responsibilities associated with the “application of Title VI’s prohibition on national origin discrimination when information is provided only in English to persons with limited English proficiency.” When receiving Federal funds Recipients are expected to conduct a Four-Factor Analysis to prevent discrimination based on National Origin.

(See also U.S. DOT’s “Policy Guidance Concerning Recipients’ Responsibilities to Limited

English Proficient (LEP) Persons,” dated December 14, 2005, (70 Fed. Reg. at 74087 to 74100);

the Guidance is a useful resource when performing a Four-Factor Analysis).

General Assurances

In accordance with the Acts, the Regulations, and other pertinent directives, circulars, policy, memoranda, and/or guidance, the Recipient hereby gives assurance that it will promptly take any measures necessary to ensure that:

“No person in the United States shall, on the grounds of race, color, national origin, sex, age, disability, low-income, or LEP be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Recipient receives Federal financial assistance from DOT, including the

FMCSA.”

The Civil Rights Restoration Act of 1987 clarified the original intent of Congress, with respect to Title VI and other Non-discrimination requirements (The Age Discrimination Act of 1975, and Section 504 of the

Rehabilitation Act of 1973) by restoring the broad, institutional-wide scope and coverage of these non-discrimination statutes and requirements to include all programs and activities of the Recipient, so long as any portion of the program is Federally-assisted.

Specific Assurances

More specifically, and without limiting the above general Assurances, the Recipient agrees with and gives the following Assurances with respect to its Federally assisted FMCSA Program:

1. The Recipient agrees that each “activity,” “facility,” or “program,” as defined in 49 C.F.R. §§

21.23 (b) and 21.23 (e) will be (with regard to an “activity”) facilitated, or will be (with regard to a “facility”) operated, or will be (with regard to a “program”) conducted in compliance with all requirements imposed by, or pursuant to the Acts and the Regulations;

2. The Recipient will insert the following notification in all solicitations for bids, Requests For

Proposals for work, or material subject to the Acts and the Regulations made in connection with http://www.fhwa.dot.gov/environment/environmental_justice/index.cfm the FMCSA Program and, in adapted form, in all proposals for negotiated agreements regardless of funding source:

“The (Title of Recipient), in accordance with the provisions of Title VI of the Civil

Rights Act of 1964 (78 Stat. 252, 42 U.S.C. §§ 2000d to 2000d-4) and the Regulations, hereby notifies all bidders that it will affirmatively ensure that any contract entered into pursuant to this advertisement, all contractors will be afforded full opportunity to submit bids in response to this invitation and will not be discriminated against on the grounds of the owner’s race, color, national origin, sex, age, disability, income-level, or LEP in consideration for an award.”;

3. The Recipient will insert the clauses of Appendix A and E of this Assurance in every contract or agreement subject to the Acts and the Regulations;

4. The Recipient will insert the clauses of Appendix B of this Assurance, as a covenant running with the land, in any deed from the United States effecting or recording a transfer of real property, structures, use, or improvements thereon or interest therein to a Recipient;

5. That where the Recipient receives Federal financial assistance to construct a facility, or part of a facility, the Assurance will extend to the entire facility and facilities operated in connection therewith;

6. That where the Recipient receives Federal financial assistance in the form, or for the acquisition of real property or an interest in real property, the Assurance will extend to rights to space on, over, or under such property;

7. That the Recipient will include the clauses set forth in Appendix C and Appendix D of this

Assurance, as a covenant running with the land, in any future deeds, leases, licenses, permits, or similar instruments entered into by the Recipient with other parties:

a. for the subsequent transfer of real property acquired or improved under the applicable activity, project, or program; and

b. for the construction or use of, or access to, space on, over, or under real property acquired or improved under the applicable activity, project, or program.

8. That this Assurance obligates the Recipient for the period during which Federal financial assistance is extended to the program, except where the Federal financial assistance is to provide, or is in the form of, personal property, or real property, or interest therein, or structures or improvements thereon, in which case the Assurance obligates the Recipient, or any transferee for the longer of the following periods:

a. the period during which the property is used for a purpose for which the Federal financial assistance is extended, or for another purpose involving the provision of similar services or benefits; or

b. the period during which the Recipient retains ownership or possession of the property.

9. The Recipient will provide for such methods of administration for the program as are found by the Secretary of Transportation or the official to whom he/she delegates specific authority to give reasonable guarantee that it, other recipients, sub-recipients, sub-grantees, contractors, subcontractors, consultants, transferees, successors in interest, and other participants of Federal financial assistance under such program will comply with all requirements imposed or pursuant to the Acts, the Regulations, and this Assurance.

10. The Recipient agrees that the United States has a right to seek judicial enforcement with regard to any matter arising under the Acts, the Regulations, and this Assurance.

By signing this ASSURANCE, [Name of the recipient] also agrees to comply (and require any sub-recipients, sub-grantees, contractors, successors, transferees, and/or assignees to comply) with all applicable provisions governing the FMCSA access to records, accounts, documents, information, facilities, and staff. You also recognize that you must comply with any program or compliance reviews, and/or complaint investigations conducted by the FMCSA. You must keep records, reports, and submit the material for review upon request to FMCSA, or its designee in a timely, complete, and accurate way.

Additionally, you must comply with all other reporting, data collection, and evaluation requirements, as prescribed by law or detailed in program guidance.

[Name of Recipient] gives this ASSURANCE in consideration of and for obtaining any Federal grants, loans, contracts, agreements, property, and/or discounts, or other Federal-aid and Federal financial assistance extended after the date hereof to the recipients by the Department of Transportation under the

FMCSA Program. This ASSURANCE is binding on [insert State], other recipients, sub-recipients, sub-grantees, contractors, subcontractors and their subcontractors’, transferees, successors in interest, and any other participants in the FMCSA Program. The person (s) signing below is authorized to sign this

ASSURANCE on behalf of the Recipient.

(Name of Recipient) by_____________________________________________________

(Signature of Authorized Official)

DATED_________________________________

APPENDIX A

During the performance of this contract, the contractor, for itself, its assignees, and successors in interest

(hereinafter referred to as the “contractor”) agrees as follows:

1. Compliance with Regulations: The contractor (hereinafter includes consultants) will comply with the Acts and the Regulations relative to Nondiscrimination in Federally-assisted programs of the U.S. Department of Transportation, Federal Motor Carrier Safety Administration (FMCSA), as they may be amended from time to time, which are herein incorporated by reference and made a part of this contract.

2. Nondiscrimination: The contractor, with regard to the work performed by it during the contract, will not discriminate on the grounds of race, color, national origin, sex, age, disability, income-level, or LEP in the selection and retention of subcontractors, including procurements of materials and leases of equipment. The contractor will not participate directly or indirectly in the discrimination prohibited by the Acts and the Regulations as set forth in Appendix E, including employment practices when the contract covers any activity, project, or program set forth in

Appendix B of 49 C.F.R. part 21.

3. Solicitations for Subcontracts, Including Procurements of Materials and Equipment: In all solicitations, either by competitive bidding, or negotiation made by the contractor for work to be performed under a subcontract, including procurements of materials, or leases of equipment, each potential subcontractor or supplier will be notified by the contractor of the contractor’s obligations under this contract and the Acts and the Regulations relative to Non-discrimination on the grounds of race, color, national origin, sex, age, disability, income-level, or LEP.

4. Information and Reports: The contractor will provide all information and reports required by the Acts, the Regulations and directives issued pursuant thereto and will permit access to its books, records, accounts, other sources of information, and its facilities as may be determined by the Recipient or the FMCSA to be pertinent to ascertain compliance with such Acts, Regulations, and instructions. Where any information required of a contractor is in the exclusive possession of another who fails or refuses to furnish the information, the contractor will so certify to the

Recipient or the FMCSA, as appropriate, and will set forth what efforts it has made to obtain the information.

5. Sanctions for Noncompliance: In the event of a contractor’s noncompliance with the Non-discrimination provisions of this contract, the Recipient will impose such contract sanctions as it or the FMCSA may determine to be appropriate, including, but not limited to:

a. withholding payments to the contractor under the contract until the contractor complies;

and/or

b. cancelling, terminating, or suspending a contract, in whole or in part.

6. Incorporation of Provisions: The contractor will include the provisions of paragraphs one through six in every subcontract, including procurements of materials and leases of equipment, unless exempt by the Acts, the Regulations and directives issued pursuant thereto. The contractor will take action with respect to any subcontract or procurement as the Recipient or the FMCSA may direct as a means of enforcing such provisions including sanctions for noncompliance.

Provided, that if the contractor becomes involved in, or is threatened with litigation by a subcontractor, or supplier because of such direction, the contractor may request the Recipient to enter into any litigation to protect the interests of the Recipient. In addition, the contractor may request the United States to enter into the litigation to protect the interests of the United States.

CLAUSES FOR DEEDS TRANSFERING UNITED STATES PROPERTY

APPENDIX B

The following clauses will be included in deeds effecting or recording the transfer of real property, structures, or improvements thereon, or granting interest therein from the United States pursuant to the provisions of Assurance 4:

NOW, THEREFORE, the Department of Transportation as authorized by law and upon the condition that the (Title of Recipient) will accept title to the lands and maintain the project constructed thereon in accordance with (Name of Appropriate Legislative Authority), the

Regulations for the Administration of Federal Motor Carrier Safety Administration (FMCSA)

Program, and the policies and procedures prescribed by the FMCSA of the Department of

Transportation in accordance and in compliance with all requirements imposed by Title 49, Code of

Federal Regulations, Department of Transportation, subtitle A, Office of the Secretary, part 21, Non-discrimination in Federally-assisted programs of the Department of Transportation pertaining to and effectuating the provisions of Title VI of the Civil Rights Act of 1964 (78 Stat. 252; 42 U.S.C. §

2000d to 2000d-4), does hereby remise, release, quitclaim and convey unto the (Title of Recipient) all the right, title and interest of the Department of Transportation in and to said lands described in

Exhibit “A” attached hereto and made a part hereof.

(HABENDUM CLAUSE)

TO HAVE AND TO HOLD said lands and interests therein unto (Title of Recipient) and its successors forever, subject, however, to the covenants, conditions, restrictions and reservations herein contained as follows, which will remain in effect for the period during which the real property or structures are used for a purpose for which Federal financial assistance is extended or for another purpose involving the provision of similar services or benefits and will be binding on the (Title of

Recipient), its successors and assigns.

The (Title of Recipient), in consideration of the conveyance of said lands and interests in lands, does hereby covenant and agree as a covenant running with the land for itself, its successors and assigns, that (1) no person will on the grounds of race, color, national origin, sex, age, disability, income-level, or LEP be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination with regard to any facility located wholly or in part on, over, or under such lands hereby conveyed [,] [and]* (2) that the (Title of Recipient) will use the lands and interests in lands and interests in lands so conveyed, in compliance with all requirements imposed by or pursuant to

Title 49, Code of Federal Regulations, Department of Transportation, subtitle A, Office of the

Secretary, part 21, Non-discrimination in Federally-assisted programs of the Department of

Transportation, Effectuation of Title VI of the Civil Rights Act of 1964, and as said Regulations and

Acts may be amended, and (3) that in the event of breach of any of the above-mentioned non-discrimination conditions, the Department will have a right to enter or re-enter said lands and facilities on said land, and that above described land and facilities will thereon revert to and vest in and become the absolute property of the Department of Transportation and its assigns as such interest existed prior to this instruction.*

(*Reverter clause and related language to be used only when it is determined that such a clause is necessary in order to effectuate the purpose of Title VI.)

CLAUSES FOR TRANSFER OF REAL PROPERTY ACQUIRED OR IMPROVED UNDER

THE ACTIVITY, FACILITY OR PROGRAM

APPENDIX C

The following clauses will be included in deeds, licenses, leases, permits, or similar instruments entered into by the (Title of Recipient) pursuant to the provisions of Assurance 7(a):

A. The (grantee, lessee, permittee, etc. as appropriate) for himself/herself, his/her heirs, personal representatives, successors in interest, and assigns, as a part of the consideration hereof, does hereby covenant and agree [in the case of deeds and leases add “as a covenant running with the land”] that:

1. In the event facilities are constructed, maintained, or otherwise operated on the property described in this (deed, license, lease, permit, etc.) for a purpose for which a Department of Transportation activity, facility, or program is extended or for another purpose involving the provision of similar services or benefits, the (grantee, licensee, lessee, permittee, etc.) will maintain and operate such facilities and services in compliance with all requirements imposed by the Acts and Regulations (as may be amended) such that no person on the grounds of race, color, national origin, sex, age, disability, income-level, or

LEP will be excluded from participation in, denied the benefits of, or be otherwise subjected to discrimination in the use of said facilities.

B. With respect to licenses, leases, permits, etc., in the event of breach of any of the above Non-discrimination covenants, (Title of Recipient) will have the right to terminate the (lease, license, permit, etc.) and to enter, re-enter, and repossess said lands and facilities thereon, and hold the same as if the (lease, license, permit,…