ESBD_424523_1748905694422_458-E250462 Exhibit D - Federal Assurances and Certification.pdf

458-E250462 Exhibit D 5 Pages

0MB Number: 4040-0007

Expiration Date: mm/dd/my

ASSURANCES - NON-CONSTRUCTION PROGRAMS

Public reporting burden for this collection of information is estimated :o 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. PapetWOrk Reduction Project (0348-0040), Washington. DC 20503.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND

IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.

NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances.

If such is the case. you will be notified.

As the duly authorized representative of the applicant, I certify that the applicant:

1. Has the legal authority to apply for Federal assistance and the institutional. managerial and financial capability (induding 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.

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

5. W�I comply with the Intergovernmental Personnel Ad 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 indude 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 b asis 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.

7. Will comply. or has already complied, with the requirements of Titles II and Ill 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.

AcXonttn.g to tbe � R.e<tocDon Act or 1995, no persons .m lt!QlllIM 10 msponO 10 a ooJJecOon ot tnl'Olmanon unJ.QM n dlSplays a vane,. OMS oontrol numl>er. 1be valli1 OMB control nun:1>er ta: tblS 1n:ronnanm collea:J.m ts 4040-0007

1be ame requnc:t to compklote ltllS ll1!0mlaDOn oollQCQonts esamate<t to average 05 bOUr$ per msponse, 1TIC100Lng a» tJIDe to review tnslIUCOOf'LS, SNrCb QXLSUn.g c1ata resources. ganw: aie <t.ata 1'1QQC1ro, ano OOlllplQle aru1 revtew tbe tnl'Olmattm C0ileCIIOI\. II you lla\'e OOl!llDelUS eooe,rning 1lle aooncy ot Ille llll1e ..uma!O(S) °' $11W'SOOl1S tor llllp[0\1l1g 1lllS torm. pi.as. WIiie to U s. Departme111 ot H..mi & HUm.m SeMCO&, OSKlCIO/PRA, 200 llV:leperuleTICe A, .... s.w .. Slllll! 336- B. WllSllJnglOOD C. 20201, At!Ql'OOI\ PRA Repo:tS = OlIICeI

9. Will comply. as applicable. wilh the provisions of Iha Davis Bacon Act {40 U.S.C. §§276a to 276a•7). 1ho Copoland Act (40 U.S.C. §276c and 18 U.S.C. §874), and tile Contract Work Hours and Safely Standards Act (40 U.S.C. §§327· 333), regarding labor standards for federally-assisted construction subagreemenls.

10. wm comply. ii appicsblo, with flood insurance pUtchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.l. 93-234) which requiros recipients in a special flood ha7.ard aroa lo participate in the p rogram and to purchase llood insU(anco if tho total cost of insurable construcllon and acquisition is $10,000o, more.

11. Will comply with environmontal standards which may be prescribed pursuant to Iha following: (a) inslitulion of environmental quality control measuros under the National Environmental Policy Act of 1969 (P.L. 91·190) and EKecutive 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 accorda'\ce wilh EO 11988: ( e) assurance of proJect consisten cy wlh Iha approveo Stato management prog,am developed under tho Coastal Zone Managemont Act of 1972 {16 U.S.C. §§1451 ot soq.): (f) conformily of Federal actions to Slate (Clean Air) Implementation Plans ondet Section 176(c) of the Clean Air Act of 1955. as amen0acl (42 u.s.c. §§7401 01 seq.); (g) protection or unde<gr01.1nd sources of drinking wator undor Iha Safe Drinking Water Act of 1974. as amondod (P.l. 93-523);

and, (h) protection of endangorod spocios under the Endangered Species Act of 1973, as amondcel (P.L. 93.

205).

12. Will comply with tho Wild and Soonic Rivers Acl of 1968 (16 U.S.C. §§1271 01 soq.) rolatod to protecting oomponents or potontial components of tho national wild and scenic rivers system.

SIGNATIJRE OF AUTHORIZEO CERTIFYING OFFICIAL

APPLICANT ORGANIZATION

I

13. Will ossist lho awarding a9oncy in assuring compliance wilh Section 106 or the National Historic Preservation Act or 1966. as amended {16 u.s.c. §470). EO 11593 (identijication and pcoteclion of historic properties). and the Archaeological and Historic Praservalion Act of 1974 (16 U.S.C. §§469a-1 Ot SOQ,).

14. Will comply with P.l. 93•348 regarding the protection ot human subjocts involved in research, development, and related actlvitlos supportod by this award of assistance.

1s. Will comply with the Laboratory Animal Welfare Act of 1966 (P.l. 69·544, as amended, 7 u.s.c. §§2131 et seq.) pertaining to the care. handling. and t,ealment of warm blooded ariimals hold for research. leaching. or other activities suppor1ed by this award of assistance.

16. Will comply with tho Lood-Besod Paint Poisoning Prevonlion Act (42 U.S.C. §§4601 et seq.) which prohibits tho uso of lead-based paint in construction or rohabililafon of resicfenco structures.

17. Wil cause lo be performed the required financial and complianco audits in accordanco with the Single Audit Act Amandmanti; of 1996 and 0MB Circular No. A· 133.

• Audits or States. Local G011E1mmen1s. ano Non-Prom Otganizalions. •

18. WiD comply with all applicable roquiremenls of all other Foelorel lews. cxoculivo ordors. regulations. end policies go11ornin9 this program.

19. Will C(lmply with the requirements of Section 106(g) of the Trafficking Victims Protection Act (TVPA) of 2000. as amanded {22 U.S.C. 7104) which prohibits graril award reeipionh, or o sub•recipient from (1) Engaging in severe forms of trafficking in porsons during lhe period of lime that tho award is in o ffccl (2) Procuring a commercial sex act during the poriod of time that the award is in etfect or (3) Using forced labor in the performance of the award or subawards un(lor the award.

TITLE

I II

0A TE SUBMITTED II

i I 11 Stondard to,.,. 4248 (Rev. 7-97) Back

458-E250462 Exhibit D

CERTIFICATION REGARDING LOBBYING

The undersigned certifies, to the best of his or her knowledge and belief, that:

(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment or modification of any Federal contract, grant, loan, or cooperative agreement.

(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award documents of all sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all sub-recipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, United States Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

Organization:

Street address:

City, State, Zip:

CERTIFIED BY:

(type or print)

TITLE:

(signature) (date)

Approved by OMB

0348-0046

Disclosure of Lobbying Activities

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

(See reverse for public burden disclosure)

1. Type of Federal Action:

a. contract

____ b. grant

c. cooperative agreement

d. loan

e. loan guarantee

f. loan insurance

2. Status of Federal Action:

a. bid/offer/application

_____ b. initial award

c. post-award

3. Report Type:

a. initial filing

_____ b. material change

For material change only:

Year _______ quarter _______

Date of last report___________

4. Name and Address of Reporting Entity:

____ Prime _____ Subawardee

Tier______, if Known:

Congressional District, if known:

5. If Reporting Entity in No. 4 is Subawardee, Enter

Name and Address of Prime:

Congressional District, if known:

6. Federal Department/Agency: 7. Federal Program Name/Description:

CFDA Number, if applicable: __________________

8. Federal Action Number, if known: 9. Award Amount, if known:

10. a. Name and Address of Lobbying Registrant

(if individual, last name, first name, MI):

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

(last name, first name, MI):

11. 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 this 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: __________________________________

Print Name:_________________________________

Title:______________________________________

Telephone No.: ________________ Date: _______

Federal Use Only Authorized for Local Reproduction

Standard Form - LLL (Rev. 7-97)

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.

1. 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. Identify the status of the covered Federal action.

3. Identify the appropriate classification of this report. If this is a followup 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 last previously submitted report by this reporting entity for this covered Federal action.

4. 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 or 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.

5. If the organization filing the report in item 4 checks “Subawardee,” then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known.

6. Enter the name of the federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard.

7. 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.

8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number;

the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Included prefixes, e.g., “RFP-DE-90-001.”

9. 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 for the prime entity identified in item 4 or 5.

10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action.

(b) Enter the full names of the individual(s) performing services, and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI).

11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.

According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is estimated to average 10 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 (0348-0046), Washington, DC 20503