02/14/2002 Agreement
Cleltl oIl11e
Circul coun
Danny L. Kolhage
Phone: 292-3550 Fax: 295-3663
Memnrandum
To:
Tim McGarry, Director
Growth Management Division
Isabel C. DeSantis, , . L
Deputy Clerk ~
From:
Date:
Monday, March 18, 2002
At the BOCC meeting of February 14, 2002, the Board granted approval and
authorized execution of a Coastal Impact Assistance Program Award between Monroe
County and the United States Department of Commerce, National Oceanic and
Atmospheric Administration (NOAA), to complete a Mooring Field Implementation
Plan and a Habitat Restoration Plan.
Attached hereto are two duplicate originals of the above for your handling.
Should you have any questions concerning the above, please do not hesitate to contact
this office.
cc: County Attorney
Finance, w/FADS & Attachment B
~le
i.t4'O'C'q,.._
..~.,. ,
..'" ~...
.. :1it <'
: ~: UNITED STATES DEPARTMENT OF COMMERCE
\. "National Ocaanic and AtlT10spheric AdlT1inistration
#. i~
....'.".0..... OFFICE OF FINANCE AND ADMINISTRATION
Coastal 1m act Assistance Program
Award Notification
RECIPIENT:
Monroe County
NOAA Award No. NA 170Z2123
Accounting Code:
2ND3000/3A5BAF12/4113
Award Amount: $296,387
Award Period: 12/01/2001 - 11/30/2004
State ClAP Dated: August 1, 2001 "
C) C':'1
CFDA: 11.419 ~:: ?< _
Access Code: 99013 ~;;2::~ ~~..
...-, ...
2798 Overseas Hwy, Suite 420
Marathon, FL 33050
fC~~::..- '1
~~?02 -D
This is a Coastal Impact Assistance award. It represents an obligation of th~~raP:
Government to provide financial assistance pursuant to 43 U.S.C. 1356a. ~ ~~ ~
The Secretary of Commerce has reviewed and approved the State's Coastal Impact
Assistance Plan (ClAP), which is incorporated by reference into this award. Amounts
received by Producing Coastal States and coastal political subdivisions may be used
only for the purposes specified in the Producing Coastal State's Coastal Impact
Assistance Plan.
Payment under this award will be sent by electronic funds transfer after receipt of the
attached Vendor Profile form which can also be accessed at the following website
httD:/Iwww.rdc.noaa.aov/-acod/eftform.htm. The Vendor Profile Form must be
completed and returned to the NOAA Finance Division before any transfer of funds can
be made. This form can be faxed to that office at 301-427-3242 or 301-427-2035.
In addition, we require the following enclosed documents to be completed and returned,
if you have not already done so with this countersigned award document. Please
complete the SF424B - Assurances or the SF424D - Construction Assurances, and the
CD511, Certifications Regarding Debarment, Suspension and Other Responsibility
Matters; Drug Free Workplace Requirement and Lobbying. These documents as well
as two copies of the Award Document (Grants and Finance Copy) must be returned to
the NOAA Grants Management Division within 30 days.
By signing this award notification letter, you agree to comply with the following provisions
which are incorporated by reference: Department of Commerce Financial Assistance
Standard Terms and Conditions; NOAA Special Award Conditions; OMB Circular A-87,
Cost Principles for State, Local, and Indian Tribal Government; 15 CFR Part 24, Uniform
Administrative Requirements for Grants and Cooperative Agreements to State, and
Local Governments, and OMB Circular A-133, Audits of States, Local Government,
and non-Profit Organizations.
*
Printed on Recycled Paper
-"
r
f'l
o
-"
o
;0
;;0
rrl
(')
C;)
;;0
o
.~"MO~':'>o
i ." \,
(~)
<~ ~
,,~ ~<.t;
~>91".\fENT Of cd1'
An annual progress report and Financial Status Report (SF-269) will be due 90 days
after the anniversary date of your award, for the life of the award period (see attachments).
Failure to submit any report may result in the suspension of the payments under this award.
Please be advised that you must keep this award document on file in accordance with 15
CFR Part 24.42. If the Government determines at any time that your application includes
a false statement, the Government has the right to pursue any remedies allowed by law to
recover the disbursed Federal Funds. The making of false statements may be subject
to criminal penalties, including fine and/or imprisonment, under 18 U.S.C. 1001 and
42 U.S.C. 3220.
If you have any questions, please contact the NOAA Program manager for the technical
issues or the NOAA Grants Management Specialist for administrative issues.
NOAA Program Manager:
Joshua Lott
301-713-3155
Josh.Lott@NOAA.GOV
NOAA Grants Management Specialist:
Alan Conway/Christine Brown
301-713-0922
1325 East-West Highway, 9th Floor
Silver Spring, MD 20910
To the best of my knowledge and belief, all data in the ClAP are true and correct. The document has
been duly authorized by the government body of the applicant and the applicant will comply with the
attached assur nces if the assistance is awarded.
I M&tfor"
C ha./'/1.s · roM" " .;11/< Cz J/I'f/OJ-
Recipient I ate I
Rimas T. Liogys
NOAA Grants Officer
Date
Enclosed
NOAA Special Award Conditions
DoC Standard Terms and Conditions
Vendor Profile Form
Assurances
CD511
SF269
NOAA
SPECIAL AWARD CONDITION
1 . Award payment shall be made through the NOAA Financial Assistance
Disbursement System (FADS). In accordance with 31 CFR 205 (Treasury Circular
1075 "1977"), the Recipient shall: (1) maintain procedures for fund control to
ensure that drawndowns are made only when actually needed for its immediate
disbursement needs; (2) comply with timely reporting of cash disbursements and
balances as required. If the Recipient does not adhere to these provisions, NOAA
may revoke the unobligated portion of the federal award funds. Instructions for
use of the FADS are attached.
FADS is an automated system that allow Recipients to request funds using a
touch-tone telephone. FADS will record Recipients' requests and process them
automatically, subject to review by NOAA officials. Once approved, funds will be
directly deposited in the Recipient organization's bank account.
See award letter for the access code.
2. NOAA has issued a Programmatic Environmental Assessment (EA) detailing
the environmental impacts of NOAA's approval of the state Coastal Impact
Assistance Program (ClAP) plans in 66 FR 57038. This EA is incorporated
by reference. No funding, other than up-front planning and administrative costs,
may be expended on any specific project identified in the EA as needing "further
review" or consult under the Endangered Species Act, Magnuson-Stevens Act,
or National Historic Preservation Act, until NOAA has completed the review of
the specific project and informed the recipient in writing or electronic
communication that the project may proceed.
3. This award supports the work described in the State's ClAP plan as referenced
in the award notification letter and pursuant to guidance promulgated in 66 FR
51396 (10/09/01), and 66 FR 17151 (3/29/01). All of these are incorporated by
reference.
4. An annual Progress Report must be submitted to the Program manager within
90 days of the anniversary date of each grant year throughout the duration of
the award. This report will be used to keep the program up to date on the recipient's
progress. The report should address the following:
(1) the status of each project, including accomplishments to date, estimated time
for completion, and expiration for any anticipated delays.
(2) any approved amendments and/or extensions to the ClAP plans; and
(3) for completion projects, submittal of relevant work products (e.g. report data
sets, links to on-line photographs, etc.).
If some or all the funds have been deposited in a trust fund, the trust fund must report
annually on the uses of those funds. The Annual Progress Report submitted after the
award has expired will be considered the final report and is due 90 days after the
expiration date.
Jlnp:JI \'\'"\.\.\.'v. r u~.noaa.goVl-acod! cttlorm. h tm
This form is printable. When completed, please fax this form to 301-427-3242 or 301-427-2025,
VENDOR PROFILE FORM
~,:.....\...;........~.,.
,- .
...... T.
f~'.. '\
~ ~
e ;:
~ fj
'-:....~.... "..~:"
ow.~('~'
The purpose of this form is to provide mandatory award and payment information for NOAA. This information
is required as set forth in FAR 52.232-33, Mandatory lnfonnationfor Electronic Funds transfer Payment, the Debt Collection
Improvement Act of] 9%, and the Taxpayer Relief Act of] 997. NOAA will use the information only for the purposes stated in
the references cited above and will restrict access to the data to authorized personnel who will use it only for the specified
purposes. Until this information is received, our payment office will not make any payments. You, the vendor, are required to
inform us of any banking changes that occur to ensure prompt payment of your invoices. Your payments may be delayed if the
information you provide is not accurate.
Please select one: ~ New Vendor _ Change (complete bold areas, along wi changes)
Name: Legal Name Monroe County Board of County Commissioners
Acronym or shortened name MCBOCC
(8 characters long or less)
What type of Vendor are you (select one):
:r,.;';';;';;.;."'"!';.;;;;';;;;;.;;;.;.;;;';.;;:;';;';;';;;;;;;';';;;';;';';;;';;';;';;;;;;;':;:::."'-;:;'''';-;-;;-;:;.;;::r':,;;.;;;;:;.:;::-;:;:::;;:::-",.;;;;.:::-;,;;;;,;;;;,;;;,;,;;.;;;-;.;;;.;;;;;;.;;';;;';;';;':;';';-;;';;-;;;';';';';;;.;';'.r-:;:::-:;;';;::r.:;;;;:;';;;';;';;:.;;;;';;;:::;.;';:;':;';;;.;;';';;;';;;.;;.;.;;,;;,;.;.;.:.;.;;::;;:;.;.;;.;;;;.;,;;.;.;;.:..
::~Small Disadvantaged Business i :jIndividual . : Other Small Business
UI......~~..~~.~.j~.~~~:~~01lr::iJr~s~~=J==IC~~'Jr'~~~.~~~,~~,~~~~~~~~~..~~~~~~~.,~~~~~~~~~~~~~~~~~~.,.;.,~~~~~~
:! .. jJ\V()I?J::lon-Pr()~t ,l\~~~y....,.. ..,.. . .J ......:j~~~~i~.~oIltr.a.~t()r o~c:ol}lor~tion: : Non-Profit Organization
.: r'...........,~......,.,...,........,............:..~.,......'-.....,..''-..''.~.~...I..';....... ",.........,',...........,..,.........,...,~......,....~.,.....,.:.......,.1'..~~.:..'..I~~~'.~.~~~...~.".~"..,.,.""'....:... ... ". .. .. ....... .
:: jDomestic Contractor Performing: :~T 'b I G t : : HBCIU Mi ......,.........,.................,...,..
) iOutside US : :1 n a ovemmen :: or
'.::r......... ;,........".................................................,...........;r......,;~.,..,-'_..,....,..__.........................,.......,.'-.'....'r........;~........._....,.........,................,..,............,.".....,....
::: ~Private University ! :~Non-Profit Hospital ': Federal Government
<i r' ",.,," ~"""""'''''''.,;''''.'''';'''''=''''''''''.,='''=''='r'''''''';'..............,.............,...... ............ ............ ................ 'r-"'''''f .....-....................,....... ....... .. ........ .. ......... ....
:~~StatelLocal Gov't - Education : i :
.:. .. . .. ; .
Minority Owned and Operated Business Yes_No ~
Woman Owned and Operated Business Yes_ No ~
What is your Individua1/BusinesslOrganization's mailing address and point of contact?
Name
Monroe County Board of County Commissioners
Address line 1 P.O. Box 1980
Address line 2 500 Whitehead Street
City Key West,
State
Florida
ZIP
33041-1980
Country U. S .A.
Phone 305-294-4641
N/A
Fax
305-295-3660
Internet E-mail address
11
"Ut' ."."... .......~.uV4o.l.lSu..' -........'-"-1J4.:.I.U.Urnl.nlnl
If payment remit address is different than the mailing address, please provide it below:
Name
Address line 1
Address line 2
City
State
Zip
Country
Phone
Fax
Taxpayer Identification Number (TIN)""
;~ EIN (Corporation/partnership/sole
:ii p,r.~P.r.~~t~~h.iP.~I~.~I"~o.r.~.e~pl.~Y~~L '.' .....
11~~.r.~.~~.<:;()~p~,IlYN~~~.~~~..~..l'l~~~~r.. ,. '..
I j~
I I.>.i~~~i()Il.()r...~.u~lIl1it..~~~,e,~I1.cJ...!Il'l.~lJ~~er... ...... ,.. ...... ...
:iil~~~..~(c:.~~~~..c~~lvel1cJ.~,....~,I1IYL ...... .. ....... .......... ~l A.., .,. .... ....,
NIA.
.. .....
~NIA.
.......... .....
m 59-6000749
* The taxpayer Identification number is required by law, If you fail to provide us with this information,
your payments may be subject to income tax withholding,
Type of Entity/ Account applicable to the TIN (SeeFonn W-9 Request for Taxpayer Identification Nwnber &
Certification. Specific Instructions Section). Select One:
.. "F';;;;;;;~.'I:';;=';';';';';. .;.;=.;.;. ';';';';'--. . "';;';';';';';';';';';';';';';;;';';;;;;;';';';;;;;;;;;;;;';;;';';';'; .;.;.;;;...;.;.;.;.;;;.;.;....' '.; .;;;;;.;.;.;;;;.;.;.;.;;;.;.;.;=;;;;.;.;.;;;;;;;=;;;;;.;.;.;;;;.;.;.;.;;;.;.;.;.;.;.;;; 'f'';';';';;;. ;;f";;';';';';';; .;.;.;;.;.;;;;.;.;.;;;;.;.;;;;;;.;.;;;;;;;.;.;.;.;.;;;;;;;;;.;.;;;.;.;;;.;;;.;.;.;.;...;.;;;;...,
: i As~., Club, Reli~ous,1 : Account w/ Dept of :: . . .. "1
, : Chantable, EducatIonal, or other i A' It . th f;: 10mt Account (Two/more ;
: , (S eILoc I : gncu ure m e name 0 a ; ; ;
. : tax exempt arg. tat a 1 , ~,. : :1 : Persons) :
: : Govt., School, etc.) 1 pl!tJhc entIty '! : :
T.........'. [,....'.'.........'............. ...........'.'...'........'..................,... :.......... r-'......................'..............................'..................,.....,.....'T. ..........' r...'......,............................................................,......:
I .. : ~eY?~h.I~ Saying~ TIllstj ... : <:u~~o~iCill ~C?~..~J:lli.n<>.r,. ........ I.JY~I.i~ ~lUst/Estate :
.. r......-[:....'.....'......'......'................"........................... ,......'..r..........,................,..._...............,......_.........,..... r"""'~"''''''''',;,;--;;,;,;;'';';';'';';;';';;;;;';';';;;';';';';';';';';';';'' ...;'....... ..
: i Partnership ~ . Sole Proprietorship :j ~ Federal Government ..... ,.............':
LI;;~~:~::::::::=J-]E=~:::=~="=-=~Il="_,="="===,=_'"=
Do you require payment in foreign currency? Yes_No XX Currency type? u. S. Dollar
Please indicate the type of products you provide to NOAA,
Services Only xx Goods Only_Goods/Services
11 A
EFI r:OI<.M
hnp://www.rdc.noaa.govl-acodleftfonn.htm
The Debt Collection Improvement Act of 1996 mandates the use of Electronic Funds Transfer (EFT) for
all Federal payments to recipients who become eligible to receive such payments 90 days after enactment,
which is July 26, 1996. Federal agencies must grant waivers for this mandate to recipients who certify in
writing that they do not have an account with a financial institution. Please select one of the following
payment methods:
xx EFT (Automated Clearing House Payments (ACH))
_ Check (must submit w~vier in writing to the Finance Office, along with this form)
If EFT was checked, please provide the following financial information for EFT payments.
(The ACH Coordinator at your financial institution can supply you with this information)
Financial Institution Name First State Bank of the Florida Keys
Address 1201 Simonton Street
City Key West,
State
Florida
Zip 33040
ACH Coordinator Name
Daisy Naseiro
Phone
305-296.,-8535
Nine Digit RoutinglTransit Number (ABA#)
067000438
Type of Account: (select one):
.~fr""'....".'.'Ifch;~ki~;"A~~~~~~'.'N~;;;b;;'''''..'..'.'.'f.'."",....,.,.,""',.,.,"''''..,.,.,...,...,.,.,.,,,.,,,.,,,..',,,...',.,'.'..,.,.,,,.,.,...,..,,,,.,.,.,..... . ....'....'. . .......'..... .... ,.'. .. .,..,..'. ',.'.., .'.., ", ,....,...
i:II~......',','..ii~,~.0~&~.',.~.~~,~~..~~.~~.~~.,.............,'..,'..:...i.,:..'.::'...............?X?,~,~-~.~.~~'.l...,......,.,..,...,..,.."..,.,.......,..,....".....'."...,...............,..........,......,...."."."..".....,......,..'.,...,..........-...,........,..,
I certify that the information which I have provided on this form is correct.
Name (type or print) Danny L. Kolhage
305-294-4641
Date: March 28, 2002
11 B
r ~IJ';;;) IJI~UU' ::.iC::U.C::'1l neyut::~&.
~scr Authorization
~I Oceanac ana
Atmospheric Admfnlstnrtton
Financial Assistance Disbursement System (FADS)
This tonn IS 10 be c:ompteted by the recipient's chief
executive officer or designated repl'8:J&.ative ancI
rewmed 10:
U .S. Depanment of CommercelNOAA
Finance Services Division OAlll2Xl
20020 Century Blvd.
Caller Service No. 7025
Germantown, MD 20874
Prtncy Act Sbd.-nent: Public law 87-255 FinanaalInIegn(y Aa. 31 usc. 3S 12.
audlorizes the l)epeall....nt of Commetce. NOM to COUect aU the informanon
(except the Social Security Number (SSN)) which Wilt be used by NOAA 10 protect
distxnement data frcm trauduIenIBCtions. The JlUIpQse of 1he CSaIa is 10 saf8guato
1he FADS Disbursement ReqU8$IS from unauIhorized access.. The daIa ant useo
10 ensure thai individuaJs ant not able to Obtain multiple access UMra and for
~ 1hat 1tlOI9I!I RiMduaIs who hav81eft 1he Oepa, u._.. no longer have IICCeSS
10 FADS. Failure to provide the information reQuesled on 1he form may delay the
pcocessing of your IIppI'OV8l for acc:ess to FADS. While the provision of the SSN
is voluntary. NOAA uses It as a unique identifier tor safeQuarding the FADS from
unauthorized acx:ess. this information will not be 0Cherwise d~ or rete&sed
ouISide of NOM. except as pernWed or required by law.
u.r 10: cr- _ ...... ....,
1. T~ 01 FunaaI:
16 New User 3D T ermina1e User
20 AddIChange Authority
3. A&Ilhanmd u.r-a ....... ... IIlIl
Albury, Lisa
"'- Ha.: finc*.da .. CIllOaJ
( 305. )z92-3528
0Ib Allclr-.: --. cay. s.a & ZiP)
500 Whitehead Street, Key West, Florida, 33040
.. ...... Orge._. tar ..... ,.",.., II IIeng ____
Ta 10: Ol~~. tiIaIM:
59-6000749 Monroe County Board of County Commissioners
5. Authorized to request funds for:
a All awards for this organization
o Only awards listed below:
I authorize the person identified
7, ~L~~1fa~, Clerk of the Circuit fltawHa.:
Court and Chief Financial Officer to th ( 305) 292-3550
ommissioners
Ollica ~--. 0Iy. s.a.. ZlO alOel
500 Whitehead Street, Key West, Florida, 33040
~. ~~ ~-~-~~
Tho_oI...,....~_oI__oI..._oI__.,.....~~___;n__
sana.ons under FedetW LAw,
9
NOU flOAW
r ,",LJ~ IJ'~UUI :>>t:II.t:11l "e"lUC::~L
User Authorization
I'IaUOrUlI OoeanIc ana
Atmospheric: Admfnlstmton
Financial Assistance Disbursement System (FADS)
This tonn IS to be completed by the rec:ipjent'$ chief
executive officer or designated represe..4WiV'8 and
returned to:
U.S. Department of CommercelNOAA
Finance Services Division OAlll2Xl
20020 Century Blvd.
Caller Service No. 7025
~nnantown,~ 20874
Prtv.cy Ad SbIt.MWIt: Public Law 87~ FinanaalIrdegnry Aa. 31 U.8.C,3512.
aUIhorizes the [)epe.1l.nrilt of Commerce. NOM to COllect all the informanon
(except the Soc:iaf Security Number (SSN)) which wilt be used by NOAA to pl'Dlect
distxnemenr daIa frtxn buduIent 8aicns. The purpose at Ihe da%a is to aIeguaro
the FADS Disbursement RequesIS from unauthocized access. The da!a are useo
10 ensure that individuais are not able to Obtain muttipIe access user~ and for
ensuring 1hat1ho:ge individuals who haYe left Ihe ~ no longer hava 8CIOeSS
10 FADS. Failure to provide the infonna1ion hlQUested on Ihe form may delay the
Plooessillg at your epprovaJ for access to FADS. While !he PfOVision of the SSN
is wIuntary, NOAA uses It as a unique identifier lor safeguaraing the FADS from
unauIhorized access. This infamaIian wilt not be DChefwise ~ or released
0UISide of NOAA. except as permitted or RIQUired by law.
u.r ID: .... - ..... IIIMIlI
1, Tn- or Funaaan:
, m New User 30 T enninate User
20 AddIChange Authority
3. ~ u.r-a NlwM~'" IIIiI
Carlile, Sandra
"'- No.: (inca.IlIe .. a:JOeI
.
(305 ) 292-3560
Oll\ae ~ .... CIly. s.. ... IiDI
500 Whitehead Street, Key West, Florida, 33040
c. ~ Org.I-.., Iar WIIIidIIWIIDIrtr II ~ ---=
Tax ID: OI9-Iiil.-wo, ......
59-6000749 Monroe .County Board of County Commissioners
5. Authorized to request funds for:
m All awards for this organization
o Only awards listed below:
6. 5~... 0..:
x~~
I authorize the person identified above to access FADS via the Voice Response System.
7, ~~~~~~, Clerk of the Circuit "'-No.:
Court and Chief Financial Officer to th b05 ) 292-3550
. ioners
Ollie. ~--. CIly. s... ZIP _I
500 Whitehead Street, Key West, Florida, 33040
s.gr,... .. 0..:
X"\G~h"'~ lf~7--0'l-
The rnaIang 01 My taIse auement. ~ 01 hudulenc clOcuments. or 1ransmcSSOoI. 01 huduIena informaDan by eleal..._ IM8nS InIIy __ in __ cnninaI
satlCllOns Under Federal Law,
9
NOAA"""'""
. ...--.............. ......-......,W.-=-c:".c:I.' nc;:L.t'"'~V"
Cscr Authorization
....uonal OoeaNc ano
Atmospheric Admtnlatrwtton
FinanciaJ Assistance Disbursement System (FADS)
This form 1$ 10 be completed by Ihe recipient's chief
executive officer or deSignated repl BSe.4Wive an<I
rewmed 10:
U.S. Department of CommerceJNOAA
Finance Services Division OAll12Xl
20020 Century Blvd.
Caller Service No. 7025
Gennantown,~ 20874
PrtwKy Act StJdenwIt: Public Law 97-255 Mnanaaf Integmy Aa. 31 u.s.c. 3S 12.
auU10rizes 1he [)epeIu....nt of Commerce. NOM 10 caIIect aIl1he information
(acept 1he Social Security Number (SSN)) which will be used by NOM 10 protect
distxnement da:Ia from trauduIenl Baions. The purpose of the aara is 10 saIeguaro
the FADS Disbursement Reqc I8SlS from unauIhOrized -=cess.. The data are usea
to ensure that individuBJs are not able 10 Obtain rnuttipIe ac:cess user~ and tor
ensLW'ing that 1hose individuals who hawlllft the [)epanm,..1l no longer have 8CCeSS
10 FADS. FaiIunt 10 provide the information nlquesutd on 1he bm may delay the
pcocessiug of your approval for access 10 FADS. While the Pl'OVision of It1e SSN
is vaIuntaIy, NOM uses It as a unique identifier for safeguanfing the FADS from
unauIhOriz8d access. This lntarmaIion will not be 0Iherwise tticelosed or reteaseCl
0UIIide of NOM. except lIS penniR$d or required by law.
u..r lD: ew- _ .... IMNq
1. Type 01 Funaoan:
1 ~ New User 30 Terminate User
20 AddIChange Authority
3. h.IhanDG UMr'. ~ .... 11111
DeLoach-Hartle, Laura
PtDw Ha.: /induoa __ _I
Olb ~..... cay. s.. ... ZiOI
500 Whitehead Street, Key West, Florida, 33040
(305 ) 292-3534
., ~ erg.,_. tar WhiCII ,..,...., II .... ____
Ta D: o._~......
59-6000749
Monroe Gounty Board of County Commissioners
5. Authorized to request funds for:
m All awards for this organization
o Only awards listed below:
~~l~-~~ rIL~i2Jm
I authorIZe the person identified above to access FADS via the Voice Response System.
7. tfg~ ~~~~, Clerk of the Circuit PtDw No.:
Court and Ehief Financial Officer to the (305) 292-3550
tloard of ounty Comm1ss1oners
Olb ~ cay. SIal. ~_I
500 Whitehead Street, Key West, Florida, 33040
~ ~~ if~1---o7-
The Il1alang cc My IaIse ~ ~ of fra.uauIenr dOcumenIs. or ~ cc huduIenI infonnaDon by ~..._ mNtIS may..... in __ cnninaI
sana.ons under Federal Law.
9
NOM f'OMl
rl"\u';;) .....,.:>>uu.::tt::...e.1l ne~Ut::':>>L
l!scr Authorization
NatlcNwI Ooeanfc ana
Atmospheric: Admtnlatmlon
Financiaf Assistance Disbursement System (FADS)
This form IS to be completed by the recipient.s chief
executive officer or designaled repre:se..wi\1'8 ~
returned to:
U.S. Department of CommcrcelNOAA
Finance Services Division OAlll2Xl
20020 Century Blvd.
Caller Service No. 7025
Germantown, MD 20874
Prtncy Act Sbd.emwat: Public law 97~ FinanaaJ Inlegnry Ad. 31 use. 35t2,
auIhorizes 1he Depaau.nn1t of Commerce. NOM to COllect aU 1he infonnanon
(excepl1he Social Security Number (SSN)) which MIl be USed by NOM to prot8Cl
distxnement dara tram fr3UduIenI.aions. The puqJQse of 1he daZa is to saf8guaro
the FADS Disbursement R8qU8SIS from unauthorized access. The daZa are useo
10 ensure 1hat individuals are naI able to Obtain muttipIe IICICeSs user.c and tor
ensuring that Ihose individuals who have left the 0epa,...1IllIr1t no longer haw 8CCIeSS
to FADS. Failure 10 provide the information ~ on 1he tonn may delay 1tIe
PI ooessing of )OUr appnJV8J for IlOC8SS to FADS. WhItt the Pr'OVision of the SSN
is WlIuntary. NOM uses It as a unique identifier tor safeguarojng 1he FADS from
unauIhorized access.. ThIs intormatian will not be 0CheI wise ~~ or rwteaseo
outside of NOM. except as pem..a.t or ntQUired by law.
u.r ID: er- _ .... ...,
,. T WIle 01 Funa.an:
1 gj: New User 30 T enninaIe User
20 AddIChange Authority
3. """- u-'. ......~ ... 1ft}
........ No.: ~ .. _I
Boan, Tina
~ Mar-.: .... DIy. s... & zipl
500 Whitehead Street, Key West, Florida, 33040
(305 ) 29i':3539
4, ...... Org.l~. b WfticfI ".,..., II .... ......
Tu I); Ol~ ' . .....
59-6000749 Monroe County Board of County Commissioners
5. Authorized to request funds for:
IJl All awards for this organization
o Only awards listed below:
6. $~ &0..:
x ---r:~----- ~/z/Ov
I authorize the person identified above to access FADS via the Voice Response System.
7, ~roved by".J!wM & ..., . . fIho!te No.:
Danny L. Kolhage, Clerk of the C1rcu1t
Court and Chief Financial Officer to th ( 305) 292-3550
Board ot County Comm1ss1oners
~ ~i~:J' ~r?e~1 Key West, Florida 33040
~~
X' t.(: -J.,..---- 0 L--
The maJang any taIse ~ 01 trauauIenc or IranSm&s$jgn 01 huduIena informabon by eIeal"'''''....... nwy -* in __ amin8I
sanctions under FedenlllAw.
9
HOMI'Ol'IIoI
FADS
Financial
. Assistance
Disbursement
System
Grantee Instructions
Revised July 31, 2001
TABLE OF- CONTENTS
What is FADS? . .
. . . .
. . . .
Benefits
. . . .
.........
How
to use FADS . . .. .
Access code ~..
Requesting fund~ (option 1)
Checking the balance (option 2) .. .
Checking your last transaction (option 3.)
. . . . .
. . . .
How to request a user 1D
security
.......
....................
.......
Vendor Express
.......
Addendum record .
. . . . .
. . .
Cash management
. . . .
. . . .
What if I have a problem? .
. . . .
. . . .
2
.......
.. .
. . . . .
. . .
. . . .
. . . . .
. . .
. . . .
. . .
'" '
3
3
4
5
5
7
7
8
8
10
12
13
13
What is FADS?
Financial Assistance Disbursement System (FADS) is the system
used by National Oceanic and Atmospheric Administration (NOAA) to
disburse Federal funds to recipient organizations.
FADS enables you to request funds using any touch-tone telephone.
An automated system will process your request, telling whether it
is within the available balance for that financial assistance
award. .
FADS makes payments through the Department of Treasury's Vendor
Express program. The funds you request will be transferred
through the Automated Clearing House network. The funds will be
deposited directly into your organization's bank account--
normally within four working days of your request.
Benefits
+ Prompt availability of funds.
+ An easy-to-use method to request funds via any touch-tone
phone.
+ Instant access to the available balance of your grant.
+ Funds deposited directly in your organization's bank account.
+ Ability to inquire as to the date and time of your last
transaction.
3
How to use FADS
FADS is easy to use. Begin by calling our toll-free number from
any touch-tone-phone:
1-800-437-8328
If you are in the washington, D.C. metropolitan area or you can't
use our toll-free number, then dial our local number:
301-763-4424
If you are on the Federal Telephone System (FTS), please use our
FTS number:
763-4424
Once you're on-line, the system will ask you for your five-digit
user IO, followed by a "I" sign:
D
D
D
D
D
o
Each person authorized to use FADS has a unique user ID. (See
the "How. to request a user ID" section for more information.)
Once you've entered your valid user IO, you will be asked to
choose from the following primary options:
o to request funds
~ to check the balance on a grant
~ to check the last transaction
~ when you are finished
4
More information on each of these options follows. Please note
that after you complete one of these functions, FADS will return
to this main menu and give the chance to exercise another option.
por faster response: Once you gain familiarity
need not wait for instructions. You may enter
at any time, even while a message is playing.
immediately to the choice you enter.
with FADS, you
the correct codes
FADS will respond
Access code
Each financial assistance award in FADS has a numeric access code
associated with it. You must use this access code whenever you
obtain information about or request funds for that award. The
access code information will be sent to you at the time of the
grant award. (See Exhibit 1.)
Requesting funds (option 1)
Once you indicate that you wish to request funds, FADS will
prompt you for the access code associated with that grant:
D
.0
o
o
o
o
After you've entered a valid access code, FADS will ask you for
how much money you are requesting. Enter that amount in whole
dollars. (Don't enter dollars signs, commas, or decimal points--
just the numbers.)
The system will check the amount you enter against the available
balance.for that award. If the amount is more than the balance,
FADS will ask you to try again. If not, FADS will read the
amount to you and ask you to confirm it by pressing "1". FADS
will then ask you to confirm that the request is for immediate
needs by pressing "1".
Your request is subject to review by NOAA officials. Under
normal circumstances, you may expect federal funds to be
deposited in your organization's account within four working
days.
5
EXHIBIT 1
ACCESS CODE NOTICE
Department of commerce
National Oceanic and Atmospheric Administration
Grant Award Access Code Identification Form
Date: 02/01/91
Address:
123456789
Sample grantee
1234 Main st.
Grantee No:
Grantee Name:
State: MD
Anytown
Zip Code: 12345
City:
Award Number: (award number)
Project Title:
------------------------------------------------------------
Access Code: 12345
------------------------------------------------------------
NOTE 1: The Access Code identified above is to be used to
gain access to the Financial Assistance
Disbursement System (FADS) for the purpose of
requesting an advance of grant funds. Refer to the
FADS Grantee Instructions for additional
information on the use of the code.
NOTE 2: If information on this form is incorrect, please
notify the Department of commerce, NOAA, Grants
Management Division.
6
Checking the balance (option 2)
Once you indicate that you wish to check the balance on a grant,
FADS will p~ompt you for the access code associated with that
grant:
D
D
D
D
D
o
After you've entered a valid access code, FADS will tell you the
current bala~ce for that grant.
Checking your last transaction (option 3)
If you indicate that you wish to check the last transaction for a
grant, FADS will prompt you for the access code associated with
that grant:
D
D
D
D
D
o
After you've entered a valid access code, FADS'will tell you the
status of your last funds request for that grant. If the request
has not yet been processed by NOAA, FADS will give you the
opportunity to cancel the request.
Please note that your opportunity to cancel transactions is
limited. We normally review all fund requests at 9 a.m. each
work day. After reviewing those requests, we start processing
them at 1 p.m. that day for payment. You have only up until that
time to cancel the request. .
7
How to request a user 10
Each person must be assigned a user ID before he or she can use
FADS. Use the FADS Disbursement Request User Authorization form
to request user IDs. (See Exhibit 2.) Fill out a separate form
for each person. You may photocoPY the form, if necessary.
However, signature~ must be original. The form should be signed
by the authorizing official for your organization.
Security
The security of the funds available to your organization is
dependent upon the proper use of the access code for the grant
and the user ID for the person requesting funds. Safeauard these
two Dieces of information accordinalv to Drevent anv unauthorized
transfers of funds.
Treat the user ID as a sensitive piece of information. Request
user IDs for only those persons that need access to FADS. In
normal circumstances, no more than two or three persons would
need access to the funds for a particular grant. Each person's
user ID should only be known to that person. Use block 5 on the
user authorization form to restrict people to onl~ the grants for
which they are responsible. Submit a user authorization form to
revoke the user IDs of any employees who leave your organization.
Take similar precautions with the access codes for your grants.
Reveal an access code only to people who will be using FADS in
connection with that grant. Don't post the access codes on a
bulletin board or any other public place.
8
t-AU:::i ulSDursemenl tiequesl
User Authorization
NatIonal Oceanic and
A~hertc Administration
Financial Assistance Disbursement System (FADS)
This fonn is to be completed by the recipient's chief
executive officer or designaled ntpIese..Wive and
returned to:
U.S. Department of CommercelNOAA
Finance Services Division OAll12Xl
20020 Century Blvd.
Caller Service No. 7025
Germantown, MD 20874
PItney Act Statement: Public Law 97-255 Financ:iallnlegnty Aa. 31 U.S.c. 3512.
authorizes the Oepanment of Commerce. NOAA to collect all the informanon
(except the Social Security Number (SSN)) which will be used by NOAA to protect
distxnement data from fraudulent IICtians. The purpose of the clara is to safeguaro
the FADS Disbursement RequestS from unauthorized access. The data are useo
to ensure that individuals are not 8ble to obtain mulliple IICCltSS user~ and lor
enuing that 1hoge individuals who have left the [)epanment no longer have access
to FADS. Failure to provide the information reqlHlSled on the lonn may delay the
processing of your epprovaI for access to FADS, While the provision of the SSN
is Wlluntaly, NOM uses it as a unique identifier lor aafeguaramg the FADS from
unaulhoriz8d aal8SS. ThIs infannation will not be othet wise o"=clos8d or released
0UlSide of NOAA. except as pennitl8cI or required by law.
u.. 10; c- - -- bIMIc)
, . Type of Func:uon:
10 New User 30 Terminate User
20 AddIChange Authority
3. Aulhclnmd u.r'a ......... .... 11'1)
"'- No.: (inc:lude .. ClIXltl
( )
Ofta ~ .... City. s.. & ZiPI
.. F\ec:ipIerc ~_. tDr "'*" AI6III1Iflt . being -...
Td I a..-_._
5. Authorized to request funds for:
o All awards for this organization
o Only awards listed below:
6. SigI-.. & 0.:
x
I authorize the person identified above to access FADS via the Voice Response System.
, Approved br.-... I '( No')
ona AdcII__.-t. City. Slue. ZlIJ ClIXltl
SigI-.. & 0.:
x
The maJUng of eny llIIse 1Wln'nen1, IUbmilIIIion of traudulenI doc:umenls. or hnSmissian 01 tnwduIent informlmon by eleal.....c means may...,. in ___ c:nminaI
sancllons under FedtnI Law.
9
NOM ...,...
Vendor Express
Vendor Express js Department of the Treasury's Direct Deposit
program for organizations receiving payment from the Federal
Government. Payments are made electronically through the
Automated Clearing House (ACH) network for deposit directly into
your organization's bank account.
Before we can transfer funds to you via Vendor Express, we must
have a completed Vendor Profile Form on file. The purpose of the
form is to provide mandatory award and payment information for
NOAA. Return the completed form to us. Both you and your bank
should keep a copy of the form.
If your bank information changes, notify the Finance Services
Division immediately at 301-427-2034. Then complete a new
Payment Information Form and return it to us.
Vendor Express provides
identifies the payment.
"electronic check stub"
work out with your bank
your bank with information which
This information is contained in an
called the addendum record. You need to
how you will receive this information.
Payments are transmitted to your bank in the Cash Concentration
or Disbursement Plus (CCD+) format.
10
http://www,rdc.noaa,gov/-acod/eftform.hlm
This form is printable. When completed, please fax this form to 301-427-3242 or 301-427-2025.
VENDOR PROFILE FORM
,,;;,~,,,"_(;"l<""~<\,_
.r.... .'.
;r.. . ~
c ):
i ~
"... .",..
'.~" r><>'
""""T(< cO'
The purpose of this form is to provide mandatory award and payment information for NOAA. This information
is required as set forth in FAR 52.232-33, Mandatory Informationfor Electronic Funds transfer Payment, the Debt Collection
Improvement Act of 19%. and the Taxpayer Relief Act of 1997. NOAA will use the information only for the purposes stated in
the references cited above and will restrict access to the data to authorized personnel who will use it only for the specified
purposes. Until this information is received, our payment office will not make any payments. You. the vendor. are required to
inform us of any banking changes that occur to ensure prompt payment of your invoices. Your payments may be delayed if the
information you provide is not accurate.
Please select one: _ New Vendor _ Change (complete bold areas, along wi changes)
Name: Legal Name
Acronym or shortened name
(8 characters long or less)
What type of Vendor are you (select one):
rl";";';';~';';;:.:;;';~~';~';:;';;;;;';~';;~~~;;;';'~~;';.;~~;;,~;,.;.;,;;.;~.:.;~~,:~;.;~~.:~~;~~;;~~.:.;~~.;.;':-'r':~';~~~';';~'~';~;~'~;':':':';';';';':;';;~';;';':;.;.;.;;.;.;~;:;.:.;,:,:.;~.:,:-;,:-;.;.:-;,;.;,;~:.;~~:;;,:.:-;,;':-;';~';';';';';~':-;':"l~~';:-;~';~:-:/':~';':~';':-;';';;;;;:-;.;;-:-;,:.;;:.;;;.:;;.;.;~;:-;.:~,:.:.;~.;.;~~.;;:-;,;,.;.:-:.;';;';";:;';';';':;';':-;';':;';';',':'
l1Small Disadvantaged Business ~ !jIndividual ! i Other Small Business
::'r..'.'.'..:"""',.",,..,,".'.'.,,'.""''''''''.....,''''''''.''."".".""'"''''''.'~l.'.'''''':;;".'''''''''.'''''''''.'''''''...'''''".""."'.'''''.'''''.''.'.''''.'''.'''.'.''''.'/'''''''':1'''''''''''...''''.'".",."''''',."''".,,''''.''.,..,'',.,.,,'',,.,,.,,'.''...
:~lState/Local Government - Hospital i ijOther State/L<>cal Government . i Large Business .
E.~E~~iJlr:~JE~===r/:JE~~.:=_~::=_:
Hfrivate U~versity ~ ilNon-Profit Ho~ita.l i 11Federal Government .
'Ir';;";f~~~~~t~~~~'~'~;;ti~~;;";"'~'1r";"'!H""'",......... . .".,.. ...... ',....,................,.......,.... C'''']. .,.,.,..,...,..',......."."........"..............,..............,.......
Minority Owned and Operated Business Yes_ No_
Woman Owned and Operated Business Yes_No_
What is your Individua1/BusinesslOrganization's mailing address and point of contact?
Name
Address line 1
Address line 2
City
State
ZIP
Country
Phone
Fax
Internet E-mail address
11
n ttP:liwww.rdc.noaa.gov/-acod/cftform.htm
If payment remit address is different than the mailing address, please provide it below:
Name
Address line 1
Address line 2
City
State
Zip
Country
Phone
Fax
Taxpayer Identification Number (TIN)*
:.:..........................~....................................................................................................................................................................,.....,.......................................................................,.............................................................,...................................................................................................,.......................................,.....................
:::ISSN (individual/sole proprietorship) :j ..... ...................... ...................................
,1: EiN..(C.~.~~~~~.ii'~~;~~.~~.~~.hi~;~'~.i~................... .. .. ...... .. .., ....... ............................
:~ p..r.CJ.P.~~~tCJ.~ b.,ip. ViJ.1., ,CJ. r. .~().r.~..~~p~,()y~~~), ...... .....u... ............... . ..... ........ ... ........ ...... ............................-...-. .. ... ..... .............. :
11.f:l~r.~~~,<:.().~.p.~~y..~ ~~,e..~Il~..!~~~~~~r. .......... ... .. .... ............................ ...........--.......... ......... . . . . . . . . . - . . . .
:II:I>..iy'~~iCJ.~. .()r. .~.Il~IlIl~t. .~~~e. .~Il,<J. .'J:'~.~ ~~ ~~~ ....it.. ,
........... ......... ........... .................... ........ ........... .. ... ........... ...........-. ,
:U~ P~~.. #! (c:.()~~ ~..~i.~l. y.e.~,<J.()r.C).Il~Y).. ,
....... ............... ........ ........ ... ..... ........ ......... ....... ........ ......... ..........
* The taxpayer Identification number is required by law. If you fail to provide us with this information,
your payments may be subject to income tax withholding.
Type of Entity/ Account applicable to the TIN (SeeFonn W-9 Request for Taxpayer Identification Nwnber &
Certification, Specific Instructions SectiOn). Select One: .
,.. "'''''~'' ''''''''''''''''''''''''''''',' ''''''''''''''''''''''''''''''''''''''''..... :""""." "''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''['' "''''''f'' """"""""''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''~,
: i As~" Club, Reli~ous':i : Account w/ Dept of : i . :
: ~ Chantable, EducatIOnal, or other; : A . It . th f:: Jomt Account (Two/more :
: :; : gncu ure m e name 0 a : : :
: : tax exempt org. (StatelLocal1 : bl" . : ~ Persons) !
: : Govt., School, etc.), : pu IC entIty : : :
If,j~rf~~~~~-!==:..BI'r~~~t:.-=3rB~~1!~:-=::-
: : roker or Registered! : C t' : :
, :N " : orpora Ion : ,
L""""L""~~~~~"""""""""""""""""""""""".L"",L""",,,,;;;;,,;;"";;"""""""",,,,,,,,,,,;;,,,,,,,,,,,,,,,,,,,,,,,L,,,,,,),,,,,;;,,,,,,,,;;,,,,,,,,;;,,,,,,,,,,,,,",..;"",."".",,,.,,,,,,,,,,,,,,,.
Do you require payment in foreign currency? Yes_No _ Currency type?
Please indicate the type of products you provide to NOAA.
Services Only
Goods Only _ Goods/Services_
11 A
EfT ~ORM
http://www.rdc.noaa.gov/-acodleftfonn.htm
The Debt Collection Improvement Act of 1996 mandates the use of Electronic Funds Transfer (EFT) for
all Federal payments to recipients who become eligible to receive such payments 90 days after enactment,
which is July 26~ 1996. Federal agencies must grant waivers for this mandate to recipients who certify in
writing that they do not have an account with a financial institution. Please select one of the following
payment methods:
_ EFT (Automated Clearing House Payments (ACH))
_ Check (must submit wavier in writing to the Finance Office~ along with this form)
If EFT was checked~ please provide the following financial information for EFT payments.
(The ACH Coordinator at your financial institution can supply you with this information)
Financial Institution Name
Address
City
State
Zip
ACH Coordinator Name
Phone
Nine Digit RoutinglTransit Number (ABA#)
Type of Account: (select one):
;: ...............,.......... .................................................................................................... .................... ................................................. . ................................. ......
~~I,....,.,',.,.:~~.~.~~~~,~.~~~~.~~~~~~.,..,...,.'.:,.~.......,.....,.,..,..,",..,.......,.......,..,....,..................................,...............................,....,...,.............,....l
I certify that the information which I have provided on this form is correct.
Name (type or print)
Title
Phone #
Signature
Date:
~
11 B
Cash management
FADS is designed to make Federal funds available to your
organization within four working days of receiving a request.
Therefore, your organization should request funds b~sed on
immediate disbursement requirements and promptly disburse funds
to minimize the Federal cash on hand in accordance with policies
established in Treasury Circular 1075.
NOAA will monitor drawdowns to ensure that recipient
organizations are maintaining minimal balances of Federal funds.
Each request for funds will receive a post audit review by NOAA
to determine that payments are in compliance with Federal
guidelines.
What if I have a problem?
Your primary points of contact with NOAA are the Finance services
Division and the Grants Management Division.
If you are having trouble connecting with FADS, if you have a
problem with your user ID, or if you are concerned about the
status of a payment you should have received, call the NOAA'
Finance Services Division at 301-427-2034. When the system is
'down, the Finance Services Division has the capability to take
your requests over the phone.
If you haven't received the ac~ess code or if your grant has been
suspended, call the Grants Management Division at 301-713-0922 or
301-713-0942.
13
..
Addendum. record
Each payment transmitted to your bank is accompanied by an
addendum record which contains identifying information. How each
bank communicates this information to its clients varies. This
information might appear on your bank statement.
The addendum record from FADS tells the grant from which the
funds were transferred, plus the date and time of.the request.
ACH addenda records can be up to 94 characters long. The format
of the record is governed by the American National Standards
Institue (ANSI) X12.4 syntax. The first three positions are
always "705". Tbe.next 80 positions are available to provide
information about the payment. FADS puts the grant number, the
date requested, and time requested here. The last 11 positions
are reserved for the special addendum sequence number (4
positions) and the entry detail sequence number (7 positions).
Here is a sample of what your bank receives:
70SREF*ca*HA16PS0001\DTH*O'7*'1061S*142S\0001'S76S43
where,
.
"705" always occupies the first 3 positions,
"REF" is ANSI Segment Identifier Code for
Reference Numbers,
"CR" is ANSI Reference Number Qualifier code for
customer Reference Number,
"NA16FS0001" is the grant number,
"\" terminates the segment,
"OTH" is ANSI segment Identifier Code for
Date/Time Reference,
"097" is ANSI Date/Time Qualifier code for'
Transaction creation,
"910615" is the date of the funds request (June
15, 1991),
"1425" is the time (2:25 p.m.) of the funds
request,
"\" terminates the segment,
"0001" represents the special addendum sequence
number,
"9876543" represents the entry detail sequence
number
12
ATTACHMENT B
NOAA ADMINISTRATIVE STANDARD AWARD CONDITIONS
A. The Recipient shall submit all refund checks to the Department of Commerce (DoC)
accounting office identified below. All checks must contain the name of the DoC funding
agency, award number, and no more than a two-word description to identify reason for
refund. For example - Interest Earned, Program Income, Credit, Excessive Drawdown,
etc.
U.S, Department of Commerce/NOAA
Finance Division, OFA232
20020 Century Boulevard
Caller Service #7025
Germantown, MD 20874
301-427 -2034
B. Program income earned during the award period shall be retained by the Recipient and
shall be added to funds committed to the award and used for the purposes and under the
conditions applicable to the use of the award funds.
C. If applicable, the Recipient must request prior approval from NOAA to purchase
equipment costing in excess of $5,000 per unit and having a useful life of more than one
year, This condition applies to equipment not specifically identified and justIfied in the
Recipient's proposal and approved budget.
0, If applicable, cost sharing is to be calculated on the basis of the total financial award to
the Recipient. The Government does not recognize funds made in overmatch
subsequent to making an award.
E. Notwithstanding Department of Commerce Financial Assistance Standard Terms and
Conditions, Section L.02d., when a recipient uses foreign flagged air carrier(s) for travel,
the recipient must submit the certification required by the regulations implementing the
Fly America Act (41 CFR Part 301-10) to the Grants Officer in the same frequency as the
Financial Status Report (SF-269). This certification may be in any format and may even
be the internal travel form used by the recipient which highlights and justifies the use of a
foreign flagged air carrier (see 41 CFR 301-10.142),
The certification must include:
(a) Traveler's name;
(b) Dates traveled;
(c) The origin and the destination of the travel;
(d) A detailed itinerary of the travel, name of the air carrier, and flight number
for each leg of the trip; and
(e) A statement explaining why one of the exceptions in ~ 301-10,135, ~
301-10,136, or ~ 301-10.137 was met, or a copy of your agency's written
approval that foreign air carrier service was deemed a matter of necessity
in accordance with ~ 301-10,138.
DEPARTMENT OF COMMERCE
FINANCIAL ASSISTANCE
STANDARD TERMS AND CONDITIONS
~€.~,. OF Co
~ ~%
9."Y: ~~
~ ~ %
* I~/ *
i~ =<
~ I u
~ ~
~<> ~<<;
&7'ArES or ~
October 2001
DEPARTMENT OF COMMERCE
FINANCIAL ASSISTANCE STANDARD TERMS AND CONDITIONS
Page
PREFACE ..................,..,...,........................................ 1
A. FINANCIAL REQUIREMENTS .,.,.........,...."...........,..........1
.01 Financial Reports. . . . . , . . . . . . , . . . . . , . . . . . . . . . . . . . . . , . . . . . . . . . . . , . . . 1
.02 Award Payments ..,...,........................................... 1
.03 Federal and Non-Federal Sharing ........,.....,..........,.,..,...... 2
.04 Budget Changes and Transfer of Funds Among Categories, . . . .. .. . . . .. . . . . 2
.05 Indirect Costs. . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
.06 Incurring Costs or Obligating Federal Funds Beyond
the Expiration Date .........................,...................... 4
.07 Tax Refunds ..........................,.......................,.. 4
B. PROGRAMMATIC REQUIREMENTS..............................,..... 5
.01 Performance (Technical) Reports .....................................5
.02 Unsatisfactory Performance. . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . , , 5
.03 Programmatic Changes ..,............................,........"... 5
,04 Other Federal Awards with Similar Programmatic Activities. . . . . , . . . . . . . , . , 5
.05 Non-Compliance with Award Provisions ...............................6
.06 Prohibition Against Assignment by Recipient. , . . . . , . . . . . . . . , , . . . , . . . . , , . 6
.07 Disclaimer Provisions ...............,....,....,....................6
C. NON-DISCRIMINATION REQUIREMENTS ..,...........................6
.01 Statutory Provisions. , . . . . . . . . . . . . . . . . . . . , . . , . . , . . . . . . . . . . . . . . . . . . . . 6
.02 Other Provisions. . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . 7
D. AUDITS. . . . . . , , . . . . . , . . . . , , . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . , . . . 7
.01 Organization-Wide, Program-Specific, and Project Audits. . . . . . . . . . . . . . . . . . 8
.02 Audit Resolution Process. . , , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , . . . , . , , 8
E. DEBTS, . . . , . . . . . . , . . , . . . . . , . . . . . . . . . . . . . . , . . . . . . . . , . . . . . . . . . , . . , . , , . . 9
.01 Payment of Debts Owed the Federal Government. , .. .. . . . ,. . . . . , . .. .. . . . .9
.02 Late Payment Charges . , , , . . . , . , . . . , . , . , , , . . . . , , . . . , . . . . . . . , , , , . . . , 10
i
F. NAME CHECK ...................,.........................,.,.,..... 10
.01 Results of Name Check. . . . . . , . . . . . . . . . . . . . . . . . .. . . . , . . . .. . . , . . . . , . 10
,02 Action(s) Taken as a Result of Name Check Review .............,....... 11
G. GOVERNMENTWIDE DEBARMENT AND SUSPENSION
(NONPROCUREMENT) ............................................... 11
H. DRUG-FREE WORKPLACE ........................................... 11
I. LOBBYING RESTRICTIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
.01 Statutory Provisions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
.02 Disclosure of Lobbying Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
J. CODES OF CONDUCT AND SUBA WARD, CONTRACT,
AND SUBCONTRACT PROVISIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
.01 Code of Conduct for Recipients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
.02 Applicability of Award Provisions to Subrecipients ..... . . . . . . . . . . . . . . . . . 12
.03 Competition and Codes of Conduct for Subawards .. .... . . . .. . .. . . .. . . . . . 12
.04 Applicability of Provisions to Subawards, Contracts,
and Subcontracts .........................................,....... 13
.05 Minority and Women-Owned Business Enterprise. . . . . . . . . .... .. . . . . . . . . 14
.06 Sub award and/or Contract to a Federal Agency. . . . . . . . . . . . . . . . . . . . . . . . . . 14
K. PROPERTY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 14
.01 Standards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
.02 Real Property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . , , . . . . . . . . . . 14
L. MISCELLANEOUS REQUIREMENTS.................................. 15
.01 Criminal and Prohibited Activities .........,......................... 15
.02 Foreign Travel .............................,.........,........... 15
.03 American-Made Equipment and Products ............................. 16
.04 Intellectual Property Rights . . . . . . . . . . , . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . 16
.05 Increasing Seat Belt Use in the United States ........................... 19
,06 Research Involving Human Subjects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
.07 Federal Employee Expenses ....,...................,...,........,.,20
.08 Preservation of Open Competition and Government Neutrality Towards
Government Contractors' Labor Relations on Federal and Federally Funded
Construction Projects . . . . . . . . . . . . , , . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . 20
,09 Minority Serving Institutions Initiative . . . . . . . . . . . . , . . . . . . . , . . , . . . . . . . . 20
ii
PREFACE
The recipient and any subrecipients must, in addition to the assurances made as part of the
application, comply and require each of its contractors and subcontractors employed in the
completion of the project to comply with all applicable statutes, regulations, executive orders
(EOs), Office of Management and Budget (OMB) circulars, terms and conditions, and approved
applications.
This award is subject to the laws and regulations of the United States. Any inconsistency or
conflict in terms and conditions specified in the award will be resolved according to the
following order of precedence: public laws, regulations, applicable notices published in the
Federal Register, EOs, OMB circulars, Department of Commerce (DoC) Financial Assistance
Standard Terms and Conditions, agency standard award conditions (if any), and special award
conditions, Special award conditions may take precedence over DoC standard terms and
conditions, on a case-by-case basis, when allowed by the DoC standard term and condition.
Some of the DoC terms and conditions herein contain, by reference or substance, a summary of
the pertinent statutes, or regulations published in the Federal Register or Code of Federal
Regulations (CFR), EOs, OMB circulars or the assurances (Forms SF-424B,424D). To the extent
that it is a summary, such provision is not in derogation of, or an amendment to, any such statute,
regulation, EO, or OMB circular.
A. FINANCIAL REQUIREMENTS
.01 Financial Reports
a. The recipient shall submit a "Financial Status Report" (SF-269) on a semi-annual
basis for the periods ending March 31 and September 30, or any portion thereof,
unless otherwise specified in a special award condition. Reports are due no later
than 30 days following the end of each reporting period. A final SF-269 shall be
submitted within 90 days after the expiration date of the award.
b. Unless otherwise authorized by a special award condition, all financial reports
shall be submitted in triplicate (one original and two copies) to the Grants
Officer.
.02 A ward Payments
a, The advance method of payment shall be authorized unless otherwise specified in
a special award condition. The Grants Officer determines the appropriate method
of payment. Payments will be made through electronic funds transfers directly to
the recipient's bank account and in accordance with the requirements of the Debt
Collection Improvement Act of 1996, The DoC A ward Number must be
included on all payment-related correspondence, information, and forms.
1
10/01
b. When the "Request for Advance or Reimbursement" (SF-270) is used to request
payment, the recipient shall submit the request no more frequently than monthly,
and advances shall be approved for periods to cover only expenses anticipated
over the next 30 days. When the SF-270 is used, the recipient must complete the
SF-3881, "ACH Vendor Miscellaneous Payment Enrollment Form," and return it
to the Grants Officer.
c. Advances shall be limited to the minimum amounts necessary to meet immediate
disbursement needs. Advanced funds not disbursed in a timely manner must be
promptly returned to DoC. If a recipient demonstrates an unwillingness or
inability to establish procedures which will minimize the time elapsing between
the transfer of funds and disbursement or if the recipient otherwise fails to
continue to qualifY for the advance method of payment, the Grants Officer may
change the method of payment to reimbursement only.
.03 Federal and Non-Federal Sharing
a. Awards which include Federal and non-Federal sharing incorporate an estimated
budget consisting of shared allowable costs. If actual allowable costs are less
than the total approved estimated budget, the Federal and non-Federal cost share
ratio shall be calculated as a percentage of Federal and non-Federal approved
amounts. If actual allowable costs are greater than the total approved estimated
budget, the Federal share shall not exceed the total Federal dollar amount as
reflected in the Financial Assistance Award (CD-450) and Amendment(s) to
Financial Assistance Award (CD-451).
b. The non-Federal share, whether in cash or in-kind, is expected to be paid out at
the same general rate as the Federal share. Exceptions to this requirement may be
granted by the Grants Officer based on sufficient documentation demonstrating
previously determined plans for or later commitment of cash or in-kind
contributions. In any case, the recipient must meet its cost share commitment
over the life of the award.
.04 Budget Changes and Transfer of Funds Among Categories
a. Requests for budget changes to the approved estimated budget in accordance with
the provision noted below must be submitted to the Grants Officer who shall
make the final determination on such requests and notifY the recipient in writing.
b. Transfers of funds by the recipient among direct cost categories are permitted for
awards in which the Federal share of the project is $100,000 or less. For awards in
which the Federal share of the project exceeds $100,000, transfers of funds must be
approved in writing by the Grants Officer when the cumulative amount of such
transfers exceed 10 percent of the current total Federal and non-Federal funds
authorized by the Grants Officer. The 10 percent threshold applies to the total
Federal and non-Federal funds authorized by the Grants Officer at the time of the
2
10/01
transfer request. This is the accumulated amount of Federal funding obligated to
date by the Grants Officer along with any non-Federal share. The same criteria
applies to the cumulative amount of transfer of funds among projects, functions,
joint ventures, consortia, activities, and annual costs when budgeted separately
within an award. Transfers will not be permitted if such transfers would cause any
Federal appropriation, or part thereof, to be used for purposes other than those
intended. This transfer authority does not authorize the recipient to create new
budget categories within an approved budget unless the Grants Officer has provided
prior approval.
c, The recipient is not authorized at any time to transfer amounts budgeted for direct
costs to the indirect costs line item or vice versa, without written prior approval
of the Grants Officer.
.05 Indirect Costs
a. Indirect costs will not be allowable charges against the award unless specifically
included as a line item in the approved budget incorporated into the award. (The
term "indirect cost" has been replaced with the term "facilities and administrative
costs" under OMB Circular A-21, "Cost Principles for Educational Institutions.")
b. Excess indirect costs may not be used to offset unallowable direct costs.
c. If the recipient has not previously established an indirect cost rate with a Federal
agency, the negotiation and approval of a rate is subject to the procedures in the
applicable cost principles and the following subparagraphs:
1. The OIG is authorized to review cost allocation procedures and negotiate
indirect cost rates on behalf of DoC for those organizations for which DoC is
cognizant or has oversight. The OIG either will negotiate a fixed rate for the
recipient or, in some instances, will limit its review to evaluating the
procedures described in the recipient's cost allocation methodology plan. The
recipient shall submit to the OIG within 90 days of the award start date,
documentation (indirect cost proposal, cost allocation plan, etc.) necessary for
the OIG to perform its review. The recipient shall provide the Grants Officer
with a copy of the transmittal letter to the OIG.
2. When an oversight or cognizant Federal agency other than DoC has
responsibility for establishing an indirect cost rate, the recipient shall submit
to that oversight or cognizant Federal agency within 90 days of the award
start date the documentation (indirect cost proposal, cost allocation plan, etc.)
necessary to establish such rates. The recipient shall provide the Grants
Officer with a copy of the transmittal letter to the cognizant Federal agency,
3
10/01
3. If the recipient fails to submit the required documentation to the OIG or other
oversight or cognizant Federal agency within 90 days of the award start date,
the Grants Officer may amend the award to preclude the recovery of any
indirect costs under the award. If the DoC OIG, oversight, or cognizant
Federal agency determines there is a finding of good and sufficient cause to
excuse the recipient's delay in submitting the documentation, an extension of
the 90-day due date may be approved by the Grants Officer.
4. Regardless of any approved indirect cost rate applicable to the award, the
maximum dollar amount of allocable indirect costs for which DoC will
reimburse the recipient shall be the lesser of:
(a) The line item amount for the Federal share of indirect costs contained in
the approved budget of the award; or
(b) The Federal share of the total allocable indirect costs of the award based
on the indirect cost rate approved by a cognizant or oversight Federal
agency and current at the time the cost was incurred, provided the rate is
approved on or before the award end date.
.06 Incurring Costs or Obligating Federal Funds Beyond the Expiration Date
a. The recipient shall not incur costs or obligate funds for any purpose pertaining to
the operation of the project, program, or activities beyond the expiration date
stipulated in the award. The only costs which are authorized for a period of up to
90 days following the award expiration date are those strictly associated with
closeout activities. Closeout activities are normally limited to the preparation of
final progress, financial, and required project audit reports unless otherwise
approved in writing by the Grants Officer.
b. Unless otherwise authorized in 15 CFR ~ 14.25(e)(4) or a special award
condition, any extension of the award period can only be authorized by the Grants
Officer in writing. Verbal or written assurances of funding from other than the
Grants Officer shall not constitute authority to obligate funds for programmatic
activities beyond the expiration date.
c. The DoC has no obligation to provide any additional prospective funding. Any
amendment of the award to increase funding and to extend the period of
performance is at the sole discretion of DoC.
.07 Tax Refunds
Refunds ofFICNFUTA taxes received by the recipient during or after the award
period must be refunded or credited to DoC where the benefits were financed with
Federal funds under the award. The recipient agrees to contact the Grants Officer
immediately upon receipt of these refunds, The recipient further agrees to refund
4
10101
portions ofFICAlFUTA taxes determined to belong to the Federal Government,
including refunds received after the award end date.
B. PROGRAMMATIC REQUIREMENTS
.01 Performance (Technical) Reports
a. The recipient shall submit performance (technical) reports in triplicate (one
original and two copies) to the Federal Program Officer in the same frequency as
the Financial Status Report (SF-269) unless otherwise authorized by the Grants
Officer.
b. Unless otherwise specified in the award provisions, performance (technical)
reports shall contain brief information as prescribed in the applicable uniform
administrative requirements incorporated into the award.
.02 Unsatisfactory Performance
Failure to perform the work in accordance with the terms of the award and maintain at
least a satisfactory performance rating or equivalent evaluation may result in
designation of the recipient as high risk and assignment of special award conditions
or other further action as specified in the standard term and condition entitled "Non-
Compliance With Award Provisions."
.03 Programmatic Changes
a. The recipient shall not make any programmatic changes to the award without
prior written approval by the Grants Officer.
b. Any requests by the recipient for programmatic changes must be submitted to the
Grants Officer who shall make the final determination and notify the recipient in
writing.
.04 Other Federal Awards with Similar Programmatic Activities
The recipient shall immediately provide written notification to the Federal Program
Officer and the Grants Officer in the event that, subsequent to receipt of the DoC
award, other financial assistance is received to support or fund any portion of the
scope of work incorporated into the DoC award. DoC will not pay for costs that are
funded by other sources.
5
10/01
.05 Non-Compliance With Award Provisions
Failure to comply with any or all ofthe provisions of the award may have a negative
impact on future funding by DoC and may be considered grounds for any or all of the
following actions: establishment of an account receivable, withholding payments
under any DoC awards to the recipient, changing the method of payment from
advance to reimbursement only, or the imposition of other special award conditions,
suspension of any DoC active awards, and termination of any DoC active awards.
.06 Prohibition Against Assignment by the Recipient
Notwithstanding any other provision of the award, the recipient shall not transfer,
pledge, mortgage, or otherwise assign the award, or any interest therein, or any claim
arising thereunder, to any party or parties, banks, trust companies, or other financing
or financial institutions.
.07 Disclaimer Provisions
a. The United States expressly disclaims any and all responsibility or liability to the
recipient or third persons for the actions of the recipient or third persons resulting
in death, bodily injury, property damages, or any other losses resulting in any way
from the performance of this award or any other losses resulting in any way from
the performance of this award or any subaward or subcontract under this award.
b. The acceptance of this award by the recipient does not in any way constitute an
agency relationship between the United States and the recipient.
C. NON-DISCRIMINATION REQUIREMENTS
No person in the United States shall, on the ground of race, color, national origin, handicap,
age, religion, or sex, be excluded from participation in, be denied the benefits of, or be
subject to discrimination under any program or activity receiving Federal financial
assistance. The recipient agrees to comply with the non-discrimination requirements below:
.01 Statutory Provisions
a. Title VI of the Civil Rights Act of 1964 (42 USC ~~ 2000d et seq.) and DoC
implementing regulations published at 15 CFR Part 8 which prohibit
discrimination on the grounds of race, color, or national origin under programs or
activities receiving Federal financial assistance;
b. Title IX of the Education Amendments of 1972 (20 USC ~~ 1681 et seq.)
prohibiting discrimination on the basis of sex under Federally assisted education
programs or activities;
6
10/01
c. Section 504 of the Rehabilitation Act of 1973, as amended (29 USC S 794) and
DoC implementing regulations published at 15 CFR Part 8b prohibiting
discrimination on the basis of handicap under any program or activity receiving
or benefitting from Federal assistance;
d. The Age Discrimination Act of 1975, as amended (42 USC SS 6101 et seq.) and
DoC implementing regulations published at 15 CFR Part 20 prohibiting
discrimination on the basis of age in programs or activities receiving Federal
financial assistance;
e. The Americans with Disabilities Act of 1990 (42 USC SS 12101 et seq.)
prohibiting discrimination on the basis of disability under programs, activities,
and services provided or made available by state and local governments or
instrumentalities or agencies thereto, as well as public or private entities that
provide public transportation;
f. Any other applicable non-discrimination law(s).
.02 Other Provisions
Parts II and III ofE011246 (30 FR 12319, 1965) as amended by EO 11375 (32 FR
14303, 1967) and 12086 (43 FR 46501, 1978) require Federally assisted construction
contracts to include the nondiscrimination provisions of SS 202 and 203 of that EO
and Department of Labor regulations implementing EO 11246 (41 CFR S 60-1.4(b),
1991 ),
D. AUDITS
Under the Inspector General Act of 1978, as amended, 5 USC App. 3,S 1 et seq., an audit of
the award may be conducted at any time, The Inspector General of the DoC, or any of his
or her duly authorized representatives, shall have access to any pertinent books, documents,
papers and records of the recipient, whether written, printed, recorded, produced or
reproduced by any electronic, mechanical, magnetic or other process or medium, in order to
make audits, inspections, excerpts, transcripts or other examinations as authorized by law,
When the OIG requires a program audit on a DoC award, the OIG will usually make the
arrangements to audit the award, whether the audit is performed by OIG personnel, an
independent accountant under contract with DoC, or any other Federal, state or local audit
entity,
7
10/01
.01 Organization-Wide, Program-Specific, and ProjectAudits
a. Organization-wide or program-specific audits shall be performed in accordance
with the Single Audit Act Amendments of 1996, as implemented by OMB
Circular A-B3, "Audits of States, Local Governments, and Non-Profit
Organizations." Recipients that are subject to the provisions of OMB Circular
A-133 and that expend $300,000 or more in a year in Federal awards shall have
an audit conducted for that year in accordance with the requirements contained in
OMB Circular A-B3.
b. Pursuant to 15 CFR g 14.26 (c) and (d), DoC requires for-profit recipients of
awards that exceed $100,000 in Federal funding to have a program-specific audit
performed. If DoC does not have a program-specific audit guide available for the
program, the auditor should follow Generally Accepted Government Auditing
Standards and the requirements for a program-specific audit as described in OMB
Circular A-B3 g .235. A copy ofthe program-specific audit shall be submitted
to the OIG at the following address with a copy of the transmittal letter to the
Grants Officer:
Office of Inspector General
U.S. Department of Commerce
Atlanta Regional Office of Audits
401 West Peachtree Street, N.W., Suite 2742
Atlanta, GA 30308
c. Recipients expending Federal awards over $300,000 a year and having audits
conducted in accordance with OMB Circular A-133 shall submit a copy of
organization-wide or program-specific audits to the Bureau of the Census, which
has been designated by OMB as a central clearinghouse. The address is:
Federal Audit Clearinghouse
Bureau of the Census
1201 E. 10th Street
Jeffersonville, IN 47132
.02 Audit Resolution Process
a. An audit of the award may result in the disallowance of costs incurred by the
recipient and the establishment of a debt (account receivable) due DoC. For this
reason, the recipient should take seriously its responsibility to respond to all audit
findings and recommendations with adequate explanations and supporting
evidence whenever audit results are disputed.
8
10/01
b. In accordance with the Federal Register notice dated January 27, 1989 (54 FR
4053), a recipient whose award is audited has the following opportunities to
dispute the proposed disallowance of costs and the establishment of a debt:
1. Unless the Inspector General determines otherwise, the recipient has 30 days
from the date of the transmittal of the draft audit report to submit written
comments and documentary evidence.
2. The recipient has 30 days from the date of the transmittal of the final audit
report to submit written comments and documentary evidence. There will be
no extension of this deadline,
3. The DoC shall review the documentary evidence submitted by the recipient
and shall notify the recipient of the results in an Audit Resolution
Determination Letter. The recipient has 30 days from the date of receipt of
the Audit Resolution Determination Letter to submit a written appeal. There
will be no extension of this deadline. The appeal is the last opportunity for
the recipient to submit written comments and documentary evidence that
dispute the validity of the audit resolution determination. In addition, an
appeal does not preclude the recipient's obligation to pay a debt that may be
established, nor does the appeal preclude the accrual of interest on a debt.
4. The DoC shall review the recipient's appeal and notify the recipient of the
results in an Appeal Determination Letter, After the opportunity to appeal
has expired or after the appeal determination has been rendered, DoC will not
accept any further documentary evidence from the recipient. No other
administrative appeals are available in DoC,
5. An appeal of the Audit Resolution Determination does not prevent the
establishment ofthe audit-related debt nor does it prevent the accrual of
interest on the debt. If the Audit Resolution Determination is overruled or
modified on appeal, appropriate corrective action will be taken retroactively.
An appeal will stay the offset of funds owed by the auditee against funds due
to the auditee.
E. DEBTS
.01 Payment of Debts Owed the Federal Government
Any debts determined to be owed the Federal Government shall be paid promptly by
the recipient. In accordance with 15 CFR ~ 21.4, a debt will be considered delinquent
if it is not paid within 15 days of the due date, or if there is no due date, within 30
days of the billing date. Failure to pay a debt by the due date, or ifthere is no due
date, within 30 days of the billing date, shall result in the imposition of late payment
charges as noted below. In addition, failure to pay the debt or establish a repayment
agreement by the due date, or if there is no due date, within 30 days of the billing
9
10/01
date, will also result in the referral of the debt for collection action and may result in
DoC taking further action as specified in the standard term and condition entitled
"Non-Compliance With A ward Provisions." Funds for payment of a debt must not
come from other Federally sponsored programs. Verification that other Federal funds
have not been used will be made, e.g., during on-site visits and audits.
.02 Late Payment Charges
a. An interest charge shall be assessed on the delinquent debt as established by the
Debt Collection Act (31 U.S.C. 3701 ~.), as amended. The minimum annual
interest rate to be assessed is the Department of the Treasury's Current Value of
Funds Rate. This rate is published in the Federal Register by the Department of
the Treasury. The assessed rate shall remain fixed for the duration of the
indebtedness.
b. A penalty charge shall be assessed on any portion of a debt that is delinquent for
more than 90 days, although the charge will accrue and be assessed from the date
the debt became delinquent.
c. An administrative charge shall be assessed to cover processing and handling the
amount due.
d. State and local governments are not subject to penalty and administrative charges.
F. NAME CHECK
A name check review shall be performed by the OIG on key individuals associated with
non-profit and for-profit organizations, unless an exemption has been authorized by the
Inspector General, such as the exemption authorized for Economic Development Districts
designated by the Economic Development Administration.
.01 Results of Name Check
DoC reserves the right to take any of the actions described in section F.02 if any of
the following occurs as a result of the name check review:
a. A key individual fails to submit the required Form CD-346, "Applicant for
Funding Assistance;"
b. A key individual made an incorrect statement or omitted a material fact on the
Form CD-346; or
c, The name check reveals significant adverse findings that reflect on the business
integrity or responsibility of the recipient and/or key individual.
10
10/01
.02 Action(s) Taken as a Result of Name Check Review
If any situation noted in F.O 1 occurs, DoC, at its discretion, may take one or more of
the following actions:
a. Consider suspension/termination of the award;
b. Require the removal of any key individual from association with the management
of and/or implementation of the award; and/or
c. Make appropriate provisions or revisions with respect to the method of payment
and/or financial reporting requirements.
G. GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT)
The recipient shall comply with the provisions of EO 12549, "Debarment and Suspension"
and DoC's implementing regulations published at 15 CFR Part 26, Subparts A through E,
"Govemmentwide Debarment and Suspension (Nonprocurement)," which generally prohibit
entities that have been debarred, suspended, or voluntarily excluded from participating in
Federal nonprocurement transactions either through primary or lower tier covered
transactions,
H. DRUG-FREE WORKPLACE
The recipient shall comply with the provisions of Public Law 100-690, Title V, Subtitle D,
"Drug-Free Workplace Act of 1988," and DoC implementing regulations published at 15
CFR Part 26, Subpart F, "Govemmentwide Requirements for Drug-Free Workplace
(Grants)," which require that the recipient take steps to provide a drug-free workplace.
I. LOBBYING RESTRICTIONS
.01 Statutory Provisions
The recipient shall comply with the provisions of Section 319 of Public Law 1 0 1-121,
which added Section 1352 to Chapter 13 of Title 31 ofthe United States Code, and
DoC implementing regulations published at 15 CFR Part 28, "New Restrictions on
Lobbying." These provisions generally prohibit the use of Federal funds for lobbying
the Executive or Legislative Branches of the Federal government in connection with
the award, and require the disclosure of the use of non-Federal funds for lobbying.
.02 Disclosure of Lobbying Activities
The recipient receiving in excess of $ 100,000 in Federal funding shall submit a
completed Form SF-LLL, "Disclosure of Lobbying Activities," regarding the use of
non-Federal funds for lobbying. The Form SF-LLL shall be submitted within 30 days
following the end of the calendar quarter in which there occurs any event that requires
11
10/01
disclosure or that materially affects the accuracy of the information contained in any
disclosure form previously filed. The recipient must submit the Forms SF-LLL,
including those received from subrecipients, contractors, and subcontractors, to the
Grants Officer.
J. CODES OF CONDUCT AND SUBA WARD, CONTRACT, AND SUBCONTRACT
PROVISIONS
.01 Code of Conduct for Recipients
Pursuant to the certification in SF-424B, paragraph 3, the recipient must maintain
written standards of conduct to 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 in the administration of this award.
.02 Applicability of Award Provisions to Subrecipients
The recipient shall require all subrecipients, including lower tier subrecipients, under
the award to comply with the provisions of the award including applicable cost
principles, administrative, and audit requirements.
.03 Competition and Codes of Conduct for Sub awards
a. All subawards will be made in a manner to provide, to the maximum extent
practicable, open and free competition. The recipient must be alert to
organizational conflicts of interest as well as other practices among subrecipients
that may restrict or eliminate competition. In order to ensure objective
subrecipient performance and eliminate unfair competitive advantage,
subrecipients that develop or draft work requirements, statements of work, or
requests for proposals shall be excluded from competing for such subawards.
b. The recipient shall maintain written standards of conduct governing the
performance of its employees engaged in the award and administration of
subawards. No employee, officer, or agent shall participate in the selection,
award, or administration of a sub award supported by Federal funds if a real or
apparent conflict of interest would be involved. Such a conflict would arise when
the employee, officer, or agent, any member of his or her immediate family, his or
her partner, or an organization in which he/she serves as an officer or which
employs or is about to employ any of the parties mentioned in this section, has a
financial interest or other interest in the organization selected or to be selected for
a subaward. The officers, employees, and agents of the recipient shall neither
solicit nor accept anything of monetary value from subrecipients. However, the
recipient may set standards for situations in which the financial interest is not
substantial or the gift is an unsolicited item of nominal value, The standards of
conduct shall provide for disciplinary actions to be applied for violations of such
standards by officers, employees, or agents of the recipient.
12
10/01
c. A financial interest may include employment, stock ownership, a creditor or
debtor relationship, or prospective employment with the organization selected or
to be selected for a subaward. An appearance of impairment of objectivity could
result from an organizational conflict where, because of other activities or
relationships with other persons or entities, a person is unable or potentially
unable to render impartial assistance or advice. It could also result from non-
financial gain to the individual, such as benefit to reputation or prestige in a
professional field.
.04 Applicability of Provisions to Subawards, Contracts, and Subcontracts
a. The recipient shall include the following notice in each request for applications or
bids:
Applicantslbidders for a lower tier covered transaction (except for goods and
services under the $100,000 simplified acquisition threshold and where the
lower tier recipient will have no critical influence on or substantive control
over the award) are subject to 15 CFR Part 26, Subparts A through E,
"Govemmentwide Debarment and Suspension (Nonprocurement). In
addition, applicantslbidders for a lower tier covered transaction for a
subaward, contract, or subcontract greater than $100,000 of Federal funds at
any tier are subject to 15 CFR Part 28, "New Restrictions on Lobbying."
Applicantslbidders should familiarize themselves with these provisions,
including the certification requirements. Therefore, applications for a lower
tier covered transaction must include a Form CD-512, "Certifications
Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion--
Lower Tier Covered Transactions and Lobbying," completed without
modification.
b. The recipient shall include a statement in all lower tier covered transactions
(subawards, contracts, and subcontracts), that the award is subject to EO 12549,
"Debarment and Suspension" and DoC implementing regulations published at
15 CFR Part 26, Subparts A through E, "Govemmentwide Debarment and
Suspension (Nonprocurement)."
c. The recipient shall include a statement in all lower tier covered transactions
(subawards, contracts, and subcontracts) exceeding $100,000 in Federal funds,
that the sub award, contract, or subcontract is subject to Section 319 of Public
Law 101-121, which added Section 1352, regarding lobbying restrictions, to
Chapter 13 of Title 31 of the United States Code as implemented at 15 CFR Part
28, "New Restrictions on Lobbying." The recipient shall further require the
subrecipient, contractor, or subcontractor to submit a completed "Disclosure of
Lobbying Activities" (Form SF-LLL) regarding the use of non-Federal funds for
lobbying. The Form SF-LLL shall be submitted within 15 days following the end
of the calendar quarter in which there occurs any event that requires disclosure or
that materially affects the accuracy of the information contained in any disclosure
13
10/01
form previously filed. The Form SF-LLL shall be submitted from tier to tier until
received by the recipient. The recipient must submit all disclosure forms
received, including those that report lobbying activity on its own behalf, to the
Grants Officer within 30 days following the end of the calendar quarter.
.05 Minority Owned Business Enterprise
DoC encourages recipients to utilize minority and women-owned firms and
enterprises in contracts under financial assistance awards. The Minority Business
Development Agency will assist recipients in matching qualified minority owned
enterprises with contract opportunities. For further information contact:
U.S. Department of Commerce
Minority Business Development Agency
Herbert C. Hoover Building
14th Street and Constitution Avenue, N.W.
Washington, D.C. 20230
.06 Sub award and/or Contract to a Federal Agency
a. The recipient, subrecipient, contractor, and/or subcontractor shall not sub-grant or
sub-contract any part ofthe approved project to any agency or employee of DoC
and/or other Federal department, agency or instrumentality, without the prior
written approval of the Grants Officer.
b. Requests for approval of such action must be submitted to the Federal Program
Officer who shall review and make a recommendation to the Grants Officer, The
Grants Officer shall make the final determination and will notify the recipient in
writing of the final determination.
K. PROPERTY
.01 Standards
The recipient shall comply with the property management standards as stipulated in
the applicable uniform administrative requirements.
.02 Real Property
The recipient shall record liens or other appropriate notices of record to indicate that
real property has been acquired or improved with Federal funds and that disposition
conditions apply to the property.
14
10/01
L. . MISCELLANEOUS REQUIREMENTS
.01 Criminal and Prohibited Activities.
a. The Program Fraud Civil Remedies Act (31 U,S.c. SS 3801-3812), provides for
the imposition of civil penalties against persons who make false, fictitious, or
fraudulent claims to the Federal government for money (including money
representing grants, loans or other benefits).
b. False statements (18 U,S.C. SS 287 and 1001), provides that whoever makes or
presents any false, fictitious, or fraudulent statements, representations, or claims
against the United States shall be subject to imprisonment of not more than five
years and shall be subject to a fine in the amount provided by 18 U.S.C. S 287.
c, False Claims Act (31 U.S.c. 3729 ~,), provides that suits under this act can
be brought by the government, or a person on behalf of the government, for false
claims under Federal assistance programs.
d. Copeland "Anti-Kickback" Act (18 U.S.C. S 874 and 40 U.S.C. S 276c),
prohibits a person or organization engaged in a Federally supported project from
enticing an employee working on the project from giving up a part of his
compensation under an employment contract.
.02 Foreign Travel
a. The recipient shall comply with the provisions ofthe Fly America Act (49 USC S
40118), The implementing regulations of the Fly America Act are found at 41
CFR SS 301-10,131 through 301-10.143,
b. The Fly America Act requires that Federal travelers and others performing U.S.
Government-financed foreign air travel must use U.S, flag air carriers, to the
extent that service by such carriers is available. Foreign air carriers may be used
only in specific instances, such as when a U.S. flag air carrier is unavailable, or
use of U.S. flag air carrier service will not accomplish the agency's mission,
c. Use of foreign air carriers may also be used only ifbilateral agreements permit
such travel pursuant to 49 USC S 40 118(b). DoC is not aware of any bilateral
agreements which meet these requirements. Therefore, it is the responsibility of
the recipient to provide the Grants Officer with a copy of the applicable bilateral
agreement ifuse of a foreign carrier under a bilateral agreement is anticipated.
d. If a foreign air carrier is anticipated to be used for any part of foreign travel, the
recipient must receive prior approval from the Grants Officer, When requesting
such approval, the recipient must provide a justification in accordance with
guidance provided by 41 CFR S 301-10,142, which requires the recipient to
provide the Grants Officer with the following: name; dates of travel; origin and
15
10/01
destination of travel; detailed itinerary of travel, name of the air carrier and flight
number for each leg of the trip; and a statement explaining why the recipient
meets one of the exceptions to the regulations. If the use of a foreign air carrier is
pursuant to a bilateral agreement, the recipient must provide the Grants Officer
with a copy of the agreement. The Grants Officer shall make the final
determination and notifY the recipient in writing. Failure to adhere to the
provisions of the Fly America Act will result in the recipient not being
reimbursed for any transportation costs for which the recipient improperly used a
foreign air carrier.
.03 American-Made Equipment and Products.
Recipients are hereby notified that they are encouraged, to the greatest extent
practicable, to purchase American-made equipment and products with funding
provided under this award.
.04 Intellectual Property Rights
a. Inventions.
The rights to any invention made by a recipient under a DoC financial assistance
award are determined by the Bayh-Dole Act, Pub. L. 96-517, as amended, and
codified in 35 U.S.C. ~ 200 et seq, except as otherwise required by law. The
specific rights and responsibilities are described in more detail in 37 CFR Part
401 and in particular, in the standard patent rights clause in 37 CFR ~ 401.14.
1. ()wnership.
(a) Recipient. The recipient has the right to own any invention it makes
(conceived or first reduced to practice) or made by its employees. The
recipient may not assign its rights to a third party without the permission
of DoC unless it is to a patent management organization (i.e., a
university's Research Foundation.) The recipient's ownership rights are
subject to the Government's nonexclusive paid-up license.
(b) Department. If the recipient elects not to own or does not elect rights or
file a patent application within the time limits set forth in the standard
patent rights clause, DoC may request an assignment of all rights, which
is normally subject to a limited royalty free nonexclusive license for the
recipient. DoC owns any invention made solely by its employees but
may license the recipient in accordance with the procedures in 37 CFR
Part 404.
(c) Inventor/Employee. Ifneither the recipient nor the Department is
interested in owning an invention by a recipient employee, the recipient,
with the written concurrence of DoC Patent Counsel, may allow the
16
10/01
inventor/employee to own the invention subject to certain restrictions as
described in 37 CFR ~ 401.9.
(d) Joint inventions. Inventions made jointly by a recipient and a DoC
employee will be owned jointly by the recipient and DoC. However,
DoC may transfer its rights to the recipient as authorized by 35 U,S.C. ~
202( e) and 37 CFR ~ 401.10 if the recipient is willing to patent and
license the invention in exchange for a share of "net" royalties based on
the number of inventors (e.g., 50-50 if there is one recipient and DoC
employee). The agreement will be prepared by DoC Patent Counsel and
may include other provisions, such as a royalty free license to the
Government and certain other entities.
2. Responsibilities.
The recipient has responsibilities and duties set forth in the standard patent
rights clause, which are not described below. The recipient is expected to
comply with all the requirements ofthe standard patent rights clause and 37
CFR Part 401.
(a) Reporting. Within two months of when the recipient reports the
invention, the recipient will send the invention disclosure to DoC Patent
Counsel (HCHB Room 4613, Washington, DC 20230, telephone: 202-
482-8097) and the appropriate DoC program office.
(b) Electing. Within two years of reporting the invention to DoC, the
recipient will notify DoC Patent Counsel of its decision whether or not it
wishes to own the invention.
(c) Filing. Within one year of notifying DoC that it wishes to own the
invention, the recipient will file a patent application (either a provisional
or non-provisional) and promptly send a copy of the application to DoC
Patent Counsel. Any foreign or international application must usually be
filed within 10 months of the first filed application in the United States.
The recipient will ensure that any U.S. application contains the required
statement of Government support. The recipient will also promptly send
the required confirmatory Government license to DoC Patent Counsel
who shall record that license in the Patent and Trademark Office. If the
recipient decides to discontinue the prosecution of any patent application
or not pay a maintenance fee or defend a reexamination, it shall notify
DoC Patent Counsel of that fact in sufficient time (but not less than 30
days) for the Government to respond to any outstanding requirement or
letter from a patent office. However, if the recipient is filing a
continuing application, it needs only to notify DoC Patent Counsel of
this and provide a copy of the continuing application with the
appropriate confirmatory license. Upon issuance of any application, the
17
10/01
recipient will promptly provide a copy of the patent to DoC Patent
Counsel.
(d) The recipient should send any request for an extension of time to DoC
Patent Counsel in advance of the expiration of the time period.
b. Patent Notification Procedures.
Pursuant to EO 12889, DoC is required to notify the owner of any valid patent
covering technology whenever the DoC or its financial assistance recipients,
without making a patent search, knows (or has demonstrable reasonable grounds
to know) that technology covered by a valid United States patent has been or will
be used without a license from the owner. To ensure proper notification, ifthe
recipient uses or has used patented technology under this award without a license
or permission from the owner, the recipient must notify the DoC Patent Counsel
at the following address, with a copy to the Grants Officer:
Department of Commerce
Office of Chief Counsel for Technology, Patent Counsel
14th Street and Constitution Avenue, N.W. Room H-4613
Washington, D.C. 20230
c. Data, Databases, and Software.
The rights to any work produced or purchased under a DoC Federal financial
assistance award are determined by 15 CFR ~ 24.34 and 15 CFR ~ 14.36. Such
works may include data, databases or software. The recipient owns any work
produced or purchased under a DoC Federal financial assistance award subject to
DoC's right to obtain, reproduce, publish or otherwise use the work or authorize
others to receive, reproduce, publish or otherwise use the data for Government
purposes.
d. Copyright.
The recipient may copyright any work produced under a DoC Federal financial
assistance award subject to DoC's royalty-free nonexclusive and irrevocable right
to reproduce, publish or otherwise use the work or authorize others to do so for
Government purposes. Works jointly authored by DoC and recipient employees
may be copyrighted but only the part authored by the recipient is protected
because, under 17 U.S,C, ~ 105, works produced by Government employees are
not copyrightable in the United States. If the contributions of the authors cannot
be separated, the copyright status of the joint work is questionable. On occasion,
DoC may ask the recipient to transfer to DoC its copyright in a particular work
when DoC is undertaking the primary dissemination of the work. Ownership of
copyright by the Government through assignment is permitted by 17 U.S.C. ~
105.
18
10/01
.05 Increasing Seat Belt Use in the United States.
Pursuant to EO 13043, recipients should encourage employees and contractors to
enforce on-the-job seat belt policies and programs when operating company-owned,
rented or personally-owned vehicles.
.06 Research Involving Human Subjects.
a. All proposed research involving human subjects must be conducted in accordance
with 15 CFR Part 27, "Protection of Human Subjects." No research involving
human subjects is permitted under any DoC financial assistance award unless
expressly authorized by the Grants Officer.
b, No research involving human subjects is permitted under this award unless
expressly authorized by Special A ward Condition, or otherwise in writing by the
Grants Officer.
c. Federal policy defines a human subject as a living individual about whom an
investigator conducting research obtains (1) data through intervention or
interaction with the individual, or (2) identifiable private information. Research
means a systematic investigation, including research development, testing and
evaluation, designed to develop or contribute to generalizable knowledge,
d. DoC regulations, 15 CFR Part 27, require that recipients maintain appropriate
policies and procedures for the protection of human subjects. In the event it
becomes evident that human subjects may be involved in this project, the
recipient shall submit appropriate documentation to the Federal Program Officer
for approval by the appropriate DoC officials. This documentation may include:
1. Documentation establishing approval of the project by an institutional review
board (IRB) approved for Federal-wide use under Department of Health and
Human Services guidelines, see 15 CFR ~ 27.103;
2, Documentation to support an exemption for the project under 15 CFR ~
27.101(b);
3, Documentation to support deferral for an exemption or IRB review under 15
CFR ~ 27.118;
4. Documentation of IRB approval of any modification to a prior approved
protocol or to an informed consent form.
e. No work involving human subjects may be undertaken, conducted, or costs
incurred and/or charged for human subjects research, until the appropriate
19
10/01
documentation is approved in writing by the Grants Officer. Notwithstanding
this prohibition, work may be initiated or costs incurred and/or charged to the
project for protocol or instrument development related to human subjects
research.
.07 Federal Employee Expenses.
Federal agencies are generally barred from accepting funds from a recipient to pay
transportation, travel, or other expenses for any Federal employee unless specifically
approved in the terms of the award. Use of award funds (Federal or non-Federal) or
the recipient's provision of in-kind goods or services, for the purposes of
transportation, travel, or any other expenses for any Federal employee may raise
appropriation augmentation issues. In addition, DoC policy prohibits the acceptance
of gifts, including travel payments for Federal employees, from recipients or
applicants regardless of the source.
.08 Preservation of Open Competition and Government Neutrality Towards
Government Contractors' Labor Relations on Federal and Federally Funded
Construction Projects.
Pursuant to EO 13202, "Preservation of Open Competition and Government
Neutrality Towards Government Contractors' Labor Relations on Federal and
Federally Funded Construction Projects," unless the project is exempted under
section 5(c) of the order, bid specifications, project agreements, or other controlling
documents for construction contracts awarded by recipients of grants or cooperative
agreements, or those of any construction manager acting on their behalf, shall not:
a) include any requirement or prohibition on bidders, offerors, contractors, or
subcontractors about entering into or adhering to agreements with one or more labor
organizations on the same or related construction project(s); or b) otherwise
discriminate against bidders, offerors, contractors, or subcontractors for becoming or
refusing to become or remain signatories or otherwise to adhere to agreements with
one or more labor organizations, on the same or other related construction project(s).
.09 Minority Serving Institutions (MSIs) Initiative.
Pursuant to EOs 12876, 12900, and 13021, DoC is strongly committed to broadening
the participation ofMSIs in its financial assistance programs. DoC's goals include
achieving full participation ofMSIs in order to advance the development of human
potential, strengthen the Nation's capacity to provide high-quality education, and
increase opportunities for MSIs to participate in and benefit from Federal financial
assistance programs. DoC encourages all applicants and recipients to include
meaningful participation ofMSIs. Institutions eligible to be considered MSIs are
listed on the Department of Education website,
20
10/01
This form is printable. When completed, please fax this form to 301-427-3242 or 301-427-2025.
VENDOR PROFILE FORM
..;:~.;,...~" ';McSro~....,.'t
.~~~ ... \
". 11
~ j
'{f"4 .fi.7
'~~"'~^IE:-,'c~oT""'"
The purpose of this form is to provide mandatory award and payment information for NOAA. This
information is required as set forth in FAR 52.232-33, Mandatory Informationfor Electronic Funds transfer Payment. the Debt
Collection Improvement Act of 1996, and the Taxpayer Relief Act of 1997. NOAA will use the information only for the
purposes stated in the references cited above and will restrict access to the data to authorized personnel who will use it only for
the specified purposes. Until this information is received, our payment office will not make any payments. You, the vendor, are
required to inform us of any banking changes that occur to ensure prompt payment of your invoices. Your payments may be
delayed if the information you provide is not accurate.
Please select one: _ New Vendor _ Change (complete bold areas, along w/ changes)
Name: Legal Name
Acronym or shortened name
(8 characters long or less)
What type of Vendor are you (select one):
',- " ' '.' ....:v"'...'..'..-.."' ,- ,.. ~,. ,,' "",,,,,<,,,,,,_,~).,','A:,~;'::<:"I>,'" -, .'". %'\,,",.,-:,,\"";<-~':,'", ,-.;.-,~,..,,^,,' ":','_!"~'::,",'"-,""'".+'\)::~'i<2;::"""'C':<..-1,,n:;::>,.,':.~.:.,;~'b".':";':<~_~:~ ,>'C-":":':"'_'" b'.:...'.':'::_'\":"':;C"'~'" ", ""':;":U~~'":,,,.,:>,<,< ,-, ,;,,....;,,,' ,"",,~':~':~d"".::"""")C:;' .,' '.
r.!I~~!I~i,sa~~a,nta~~d B~~~n.:.~s]~lIn~i~id~a.l no."'.' ,..... ;1.JOt~~!~~all ~~siness "..... .'
<r-..--:r..-.--..-...-.....--'-- ----'-....'..----: '__m.......___________._______ -----, h-'----.--.---........--.- '---'--"-'-'---
'I ., ,'ISt~~e/~~:~I.~?_ve~:n.t :.ff?~I>i!a.~.:L ... ",.I?t~,~~~!~te/~<>.:a~~<>.v:~en!...__.. ..'I___'L~arg~!3~siI1~~~... ......., ,
r---riWOD Non-Pr~fit Ag;ncy .'. ..... ....r.---.IForeignContractor or Corpor;tion l[---'!Non..Profitgrganjz~'tion-"--'---'----
.. c-,,-- r""""::,~~~'--'------=--";:~'~"'-"--; r--,..:..:,---::_-"_.., ....... ....:..:.c""--""-'--'--"--_."...::, r-'~---' ,__..-"-:"..~...,--,~..-'--'.c.,-_...c.._....c.,,__.....
il........ ,Ig~;~;~y~o~~ac~:r~erfo~n.g... ..1/... .IITr_i~a~~ove~~nt__ .....__., ,.il... ..ii~,~~~.~~~i._... ."
"L-HPrivatelJniversit)' -- .. ... ... . .-__r']N~~=Pr?~~'H?;ital,-=--__. .!r___]I~e~,~;al(J()~~~:nt . "__..----__01
T__"HSt~te/L~calGo~'t~~ducation-=J["~ n ......... ... ............ ...... .'. .......1
.__.____~.._~~b~_*__~'""".....,,""_,~.___ , . ~..~__....o-.....!!J
Minority Owned and Operated Business Yes_ No_
Woman Owned and Operated Business Yes_ No_
What is your Individual/Business/Organization's mailing address and point of contact?
Name
Address line 1
Address line 2
City
State
ZIP
Country
Phone
Fax
Internet E-mail address
Ifp".yment remit address is different than the mailing address, please provide it below:
of3
11/27/2001 10:33 AM
Name
Address line 1
Address line 2
City
State
Zip
Country
Phone
Fax
Taxpayer Identification Number (TIN)*
, ""'-',,-,'''-''-'-'. ;.'x... ,_ .. ~ "_..,,. ",..~.., iF -v:.;....,..". .. t"" .., ""::"',:SS.."b?i-,i'-_':',,,::',,,_"'>" . " ,',,"';"~"':'i"~""i?,.--."~'."..~n .. "....., .,"~-:.::l)','>':,':"'."". ':.<;i'X..i \;.-.....,..;:,.'f.'.:>."..y ;':-.::,,{,...~.>, ::;..".;.;.'."..},.-.\;,....., ",", T-V".. 'C'-. ,.
~iSSN (individual/sole proprietor;hip) ----l!.-.---~__'_.
J... _.. ,.... ,.._ _,_...,.". ,. ........ .'pp 0..'."_. ". ' ....._... .,......, .._...... ..., .,..... ,'" _. .._ ............... ...." ".._.. ,. ..., m__..
.IEIN(C~~porati~:;;jpa~tne~sbip/;o-I;---'-- ".- ..- -"-'I~. - ...-------.....------"'---.--- --. '-..-----.1.
dproprietorship w/t or mor~ ~mployees) ._ _... _ I
;;I~~i~~!~~~p~~Y]~..!!l~~Il.~.!~.~.-~~!ll!>e~p_JL . .,.___p - ._______. .. ,._" ;
~fDi~isio~~~~.~~~l1it~ameanf.l'fI~l~u!ll!>er ..... f._....... .,... ....,..... .... .... .,.... ... .....
,{nUNS # (commer~j;l~;ndor ~;iy)-------.-r------.---_.--------------:,
;",,~~~'- :..;.'~-~'" ..:.--~.~-_._--'-'''-'''.. ..- .-.~';;~~~,~;;;;~;;;;;.:..~-'- ..:;".,~-~;,.;;.;.;.;...~;~~:;;;;..;;;,;;;;._;.;;.;..;.""__,;~";~.;;l;;...;;;;;------,~--'-..--n..__."m..~~'.__-~"':;,,;;;.;;.:-~;.;.::~;.;~~:~~~~
* The taxpayer Identification number is required by law. If you fail to provide us with this information,
your payments may be subject to income tax withholding.
Type of Entity/Account applicable to the TIN (See Form W -9 Request for Taxpayer Identification Number &
Certification, Specific Instructions Section). Select One:
r-: !~~:~~~b~~~~~~~~it7~:~t or other
i lltax exempt org. (State/Local
I . i(}()vt:, S~h()()l, ~t~)..
I 1.R~vo~ab1e Sa~ing~ ':!'rt.I,st.
J-i~rtnership-"
'r:....:.:.::.~===.::,....,...-......-
'I :IBrok~r or Registered
~"-.J~orn:l~:~~=,.,c:=_=_, ... ..
:Il~~:!~~~~i~:~e:-a- [I :1~~~~S)count;;:~~::e1
.'1. I '....,.....,..., -.. .,.. .1.........,....___ .._,.........,.,. _ .... .'..1
., ..!I,.':J~~!~~~,an~~c.t~~~_=~=![.,..:fY~!~~.I~s!l~~t~!~__ ,.. ,.--._-1'
f;ISole Proprie~iP---.. ,e]Federal Government I'J
r--:c-------. --
;1 : I Corporation :,
I.. .. , ... ... . ' ,
Do you require payment in foreign currency? Yes_No _ Currency type?
Please indicate the type of products you provide to NOAA.
Services Only
Goods Only_Goods/Services_
The Debt Collection Improvement Act of 1996 mandates the use of Electronic Funds Transfer (EFT) for
of3
11127/2001 10:33 AM
all Federal payments to recipients who become eligible to receive such payments 90 days after enactment,
which is July 26, 1996, Federal agencies must grant waivers for this mandate to recipients who certify in
writing that they do not have an account with a financial institution. Please select one of the following
payment methods:
_ EFT (Automated Clearing House Payments (ACH))
_ Check (must submit wavier in writing to the Finance Office, along with this form)
If EFT was checked, please provide the following financial information for EFT payments.
(The ACH Coordinator at your financial institution can supply you with this information)
Financial Institution Name
Address
City
State
Zip
ACH Coordinator Name
Phone
Nine Digit Routing/Transit Number (ABA#)
Type of Account: (select one):
Account Number
Account Number
I certify that the information which I have provided on this form is correct.
Name (type or print)
Title
Phone #
Signature
Date:
~
of3
11127/2001 10:33 AM
FINANCIAL STATUS REPORT
(Long Form)
Public reporting burden for this collection or information is estimated to average 30 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 01 information, including suggestions for reducing this burden, to the Offoce of
Management and Budget, Paperwork Reduction Project (0348-0039), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND
BUDGET.
Please type or print legibly. The following general instructions explain how to use the form itself. You may need additional
information to complete certain items correctly, or to decide whether a specific item is applicable to this award. Usually,
such information will be found i1 the Federal agency's grant regulations or in the terms and conditions of the award (e.g..
how to calculate the Federal share, the permissible uses of program income, the value of in-kind contributions, etc.), You
may also contact the Federal agency directly.
~
Entry
1, 2 and 3. Self-explanatory.
4. Enter the Employer Identification Number (EIN)
assigned by the U.S. Internal Revenue Service,
5. Space reserved for an account number or other
identifying number assigned by the recipient.
6. Check yes only if this is the last report for the
period shown in item 8.
7. Self-explanatory.
8. Unless you have received other instructions from
the awarding agency, enter the beginning and
ending dates of the current funding period. If this is
a multi-year program, the Federal agency might
require cumulative reporting through consecutive
funding periods. In that case, enter the beginning
and ending dates of the grant period, and in the rest
of these instructions, substitute the tenn "grant
period" for "funding period."
9. Self-explanatory.
1 O. The purpose of columns, I, II, and III is to show the
effect of this reporting period's transactions on
cumulative financial status. The amounts entered in
column I will normally be the same as those in
column III of the previous report in the same
funding period. If this is the first or only report of
the funding period, leave columns I and I blank. If
you need to adjust amounts entered on previous
reports, footnote the column I entry on this report
and attach an explanation,
lOa, Enter total gross program outlays. Include
disbursements of cash realized as program income
if that income will also be shown on lines 10c or
109. Do not include program income that will be
shown on lines lOr or 10s.
For reports prepared on a cash basis, outlays are
the sum of actual cash disbursements for direct
costs for goods and services, the amount of indirect
expense charged, the value of in-kind contributions
applied, and the amount of cash advances and
payments made to subrecipients, For reports
prepared on an accrual basis, outlays are the sum
of actual cash disbursements for direct charges for
goods and services, the amount of indirect expense
incurred, the value of in-kind contributions applied,
and the net increase or decrease in the amounts
owed by the recipient for goods and other property
received, for services performed by employees,
contractors, subgrantees and other payees, and
other amounts becoming owed under programs for
which no current services or perfonnances are
required, such as annuities, insurance claims, and
other benefit payments.
Item
Entry
lOb. Enter any receipts related to outlays reported on the
form that are being treated as a reduction of expenditure
rather than income, and were not already netted out of
the amount shown as outlays on line lOa.
10c. Enter the amount of program income that was used in
accordance with the deduction allernative.
Note: Program income used in accordance with other
alternatives is entered on lines q, r, and s, Recipients
reporting on a cash basis should enter the amount of
cash income received; on an accrual basis, enter the
program income earned. Program income mayor may
not have been included in an application budget and/or
a budget on the award document. If actual income is
from a different source or is significantly different in
amount, attach an explanation or use the remarks
section,
10d, e, f, g, h, i and j. Self-explanatory.
10k. Enter the total amount of unliquidated obligations,
including unliquidated obligations to subgrantees and
contractors.
Unliquidated obligations on a cash basis are obligations
incurred, but not yet paid. On an accrual basis, they are
obligations incurred, but for which an outlay has not yet
been recorded.
Do not include any amounts on line 10k that have been
included on lines lOa and 10j.
On the final report, line 10k must be zero.
101. Self-explanatory.
10m. On the final report, line 10m must also be zero.
lOn, 0, p, q, r, sand t. Self-explanatory.
lla. Self-explanatory,
11 b. Enter the indirect cost rate in effect during the reporting
period.
11 c. Enter the amount of the base against which lhe rate
was applied.
lld. Enter the tolal amount of indirect costs charged during
the report period,
lle, Enter the Federal share of the amount in lld.
Note: If more than one rate was in effect during the period
shown in item 8, attach a schedule showing the bases
against which the different rales were applied, the
respective rates, the calendar periods they were in
effect, amounts of indirect expense charged to the
project, and the Federal share of indirect expense
charged to the project (J dale.
SF-269 Back (Rev. 7-97)
1. Federal Agency and Organizational Element
to Which Report is Submitted
FINANCIAL STATUS REPORT
(Long Form)
(Follow instructions on the back)
2. Federal Grant or Other Ident~ing Number Assigned
By Federal Agency
OMB Approval Page d
No,
0348-0039
pages
3. Recipient Organization (Name and complete address, including ZIP code)
4. Employer Identification Number
5. Recipient Account Number or Identifying Number 6. Final Report
D Ves D No
7. Basis
D Cash D Accrual
8. FundinglGrant Penod (See instlUctions)
From: (Month, Day, Vear)
To: (Month, Day, Vear)
9. Period Covered by this Report
From: (Month, Day, Vear)
To: (Month, Day, Vear)
10. Transactions:
Previousl Re rted
This Period
III
Cumulative
a. Total outlays
b. Refunds, rebates, etc.
c. Program income used in accordance with the deduction alternative
d, Net outlays (Une a, less the sum of lines b and c)
Recipient's sha,e of net outlays. consisting of:
e. Third party (in-kind) contributions
f. Other Federal awards authorized to be used to match this award
g. Program income used in accordance with the matching or cost
sharing atternative
h. All other recipient outlays not shown on lines e, f or g
Total recipient share of net outlays (Sum of lines e, f. g and h)
Federal share of net outlays (line d less line i)
Recipient's share of unliquidated obligations
k. T oIal unliqUld,ated obligations
m. Federal share of unliquidated obligations
n. Total Federal share (sum of/ines j and m)
o. Total Federal funds authorized for this funding period
p Unobligated balance of Federal funds (Une 0 minus line n)
Program Income, consisting of:
q. Disbursed program income shown on lines c andlor g above
r. Disbursed program income using the addition alternative
s. Undisbursed program income
Total program income realized (Sum of/ines q, rand s)
a.
Type of Rate (Place 'X'in appropriate box)
D Provisional
11. Indirect
Expense
b.
Rate
c. Base
D Predetermined
d. Total Amount
D Final
e.
D Fixed
Federal Share
12. Remarks.' Attach any explanations deemed necessary or ,"formation required by Federal sponsoring agency in compliance with
governing legis/ation.
13. Certification:
Telephone (Area code, number and extension)
Signature of Authorized Cert~ing Official
Date Report Submitted
Previous Edition Usable
269-104
Standard Fonn 269 (Rev. 7,97)
Prescribed by OMB CircularsA-l02 and A-ll0
NSN 7540-01-012-4285
200-498 P,O. 139 (Face)
ASSURANCES - NON-CONSTRUCTION PROGRAMS
OMS Approval No, 0348-0040
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:
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 cost) to ensure proper planning, management
and completion of the project described in this
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. 9947284763) 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. 991681-
1683, and 1685-1686), which prohibits discrimination on
the basis of sex; (c) Section 504 of the Rehabilitation
Previous Edition Usable
Act of 1973, as amended (29 U.S.C. 9794), which
prohibits discrimination on the basis of handicaps; (d)
the Age Discrimination Act of 1975, as amended (42
U.S.C. 996101-6107), 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) 99523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. 99290 dd-3 and 290 ee-
3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title V!" of the
Civil Rights Act of 1968 (42 U.S,C. 993601 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, m 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 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, 991501-1508 and 7324-7328)
which limit the political activities of employees whose
principal employment activities are funded in whole or
in part with Federal funds.
Authorized for Local Reproduction
Standard Form 4248 (Rev. 7-97)
Prescribed by OMS Circular A-102
9. Will comply, as applicable, with the provisions of the Davis-
Bacon Act (40 U.S.C. 99276a to 276a-7), the Copeland Act
(40 U.S.C. 9276c and 18 U.S,C. 9874), and the Contract
Work Hours and Safety Standards Act (40 U.S.C. 99327-
333), regarding labor standards for federally-assisted
construction subagreements.
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. 991451 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. 997401 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).
12. Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. 991271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.
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. 9470), EO 11593
(identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of
1974 (16 U.S.C. 99469a-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. 992131 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. 994801 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 OM B 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
APPLICANT ORGANIZATION DATE SUBMITTED
Standard Form 4248 (Rev. 7-97) Back
FORM CO-511
(7,91)
UNITED STATES DEPARTMENT OF COMMERCE
CERTIFICATIONS REGARDING DEBARMENT, SUSPENSION AND
OTHER RESPONSIBILITY MATTERS; DRUG-FREE WORKPLACE REQUIREMENTS
AND LOBBYING
Applicants sho,;Iid refer. to the ~egulations ~ited ~el~w to det~rmine the cer:ification to which t~ey a~e required, to attest. Applicants
should also review the instructIOns for certification Included In the regulatIOns before completing thiS form. Signature on this form
provides for compliance with certification requirements under 15 CFR Part 26, "Govemmentwide Debarment and Suspension
(Nonprocurement)" and "Govemmentwide Requirements for Drug-Free Workplace" and 15 CFR Part 28, "New Restrictions on
Lobbying." The certifications shall be treated as a material representation of fact upon which reliance will be placed when the
Department of Commerce determines to award the covered transaction, grant or cooperative agreement.
1. DEBARMENT, SUSPENSION AND OTHER
RESPONSIBILITY MATTERS
As requested by Executive Order 12549, Debarment and
Suspension, and implemented at 15 CFR Part 26, for
prospective participants in primary covered transactions, as
defined at 15 CFR Part 26, Sections 26.105 and 26,110 -
(1) The prospective primary participant certifies to the best
of its knowledge and belief, that it and its principals:
(a) Are not presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from
covered transactions by any Federal department or agency;
(b) Have not within a three-year period preceding this
proposal been convicted of or had a civil judgment
rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or
performing a public (Federal, State or local) transaction or
contract under a public transaction; violation of Federal or
State antitrust statutes or commission of embezzlement,
theft forgery, bribery, falsification or destruction of records,
making false statements, or receiving stolen property:
(c) Are not presently indicted for or otherwise criminally or
civilly charged by a governmental entity (Federal, State or
local) with commission of any of the offenses enumerated
in paragraph (1) (b) of this certification; and
(d) Have not within a three-year period preceding this ap-
plication/proposal had one or more public transactions
(Federal, State, or local) terminated for cause or default.
(2) Where the prospective primary participant is unable to
certify to any of the statements in this certification, such
prospective participant shall attach an explanation to this
proposal.
2. DRUG-FREE WORKPLACE REQUIREMENTS
Alternate I. Grantees Other Than Individuals
As required by the Drug-Free Workplace Act of 1988, and
implemented at 15 CFR Part 26, Subpart F, for grantees, as
defined at 15 CFR Part 26, Sections 26.605 and 26.610-
A. The grantee certifies that it will or will continue to provide
a drug-free workplace by:
(a) Publishing a statement notifying employees that the un-
lawful manufacture, distribution, dispensing, possession, or
use of a controlled substance is prohibited in the grantee's
workplace and specifying the actions that will be taken
against employees for violation of such prohibition;
(b) Establishing an ongoing drug-free awareness program
to inform employees about--
(1) The dangers of drug abuse in the workplace;
(2) The grantee's policy of maintaining a drug-free
workplace;
(3) Any available drug counseling, rehabilitation, and em-
ployee assistance programs; and
(4) The penalties that may be imposed upon employees for
drug abuse violations occurring in the workplace;
(c) Making it a requirement that each employee to be en-
gaged in the performance of the grant be given a copy of
the statement required by paragraph (a);
(d) Notifying the employee in the statement required by
paragraph (a) that as a condition of employment under the
grant, the employee will --
(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or her conviction for
a violation of a criminal drug statute occurring in the
workplace no later than five calendar days after such
conviction;
(e) Notifying the agency in writing, within ten calendar days
after receiving notice under subparagraph (d)(2) from an
employee or otherwise receiving actual notice of such
conviction. Employers of convicted employees must
provide notice, including position title, to the Director, Office
of Federal Assistance, Office of Federal Assistance and
Management Support, HCHB Room 6054, U.S. Department
of Commerce, Washington, DC 20230. Notice shall include
the identification numbers(s) of each affected grant;
(f) Taking one of the following actions, within 30 calendar
days of receiving notice under subparagraph (d) (2), with
respect to any employee who is so convicted-
(1) Taking appropriate personnel action against such an
employee, up to and including termination, consistent with
the requirements of the Rehabilitation Act of 1973, as
amended; or
(2) Requiring such employee to participate satisfactorily in a
drug abuse assistance or rehabilitation program approved
for such purposes by a Federal, State, or local health, law
enforcement, or other appropriate agency;
USCOMM.DC 91-7115
(g) Making a good faith effort to continue to maintain a
drug-free workplace through implementation of paragraphs
(a), (b), (c), (d), (e), and (f).
B. The grantee shall insert in the space provided below the
site(s) for the performance of work done in connection with
the specific grant:
Place of Performance: (Street address, city, county, state,
ZIP code):
Check 0 if there are workplaces on file that are not iden-
tified here.
Alternate II. Grantees Who Are Individuals
As required by the Drug-Free Workplace Act of 1988, and
implemented at 15 CFR 26, Subpart F, for grantees, as
defined at 15 CFR Part 26, Sections 26,605 and 26.610-
(A) The grantee certifies that, as a condition of the grant, he
or she will not engage in the unlawful manufacture, distribu-
tion, dispensing, possession, or use of a controlled
substance in conducting any activity within the grant;
(B) If convicted of a criminal drug offense resulting from a
violation occurring during the conduct of any grant activity,
he or she will report the conviction, in writing, within 10
calendar days of the conviction, to the Director, Office of
Federal Assistance, Office of Federal Assistance and
Management Support, HCHB Room 6054, U.S. Department
of Commerce, Washington, DC 20230. When notice is
made to such a central point, it shall include the
identification number(s) of each affected grant.
3. LOBBYING
As required by Section 1352, Title 31 of the U.S. Code, and
implemented at 15 CFR Part 28, for persons entering into a
grant, cooperative agreement or contract over $100,000, or
loan or loan guarantee over $150,000, as defined at 15 CFR
Part 28, Sections 28.105 and 28.110, the applicant certifies
that 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 an agency, a Member of Congress, an officer or
employee of Congress, or an employee of a Member of
Congress in connection with the awarding of any Federal
contract, the making of any Federal grant, the making of
any Federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal,
amendment, or modification of any Federal contract, grant
loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have
been paid or will be paid to any person 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 Form to Report
Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this
certification be included in the award documents for all
subawards at all tiers (including subcontracts, subgrants,
and contracts under grants, loans and cooperative agree-
ments) and that all subrecipients shall certify and disclose
accordingly.
This certification is a material representation of fact upon
which reliance was placed when this transaction was made
or entered into. Submission of this certification is a
prerequisite for making or entering into this transaction
imposed by section 1352, title 31, U ,S. 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.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge
and belief, that:
If any 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 em-
ployee of Congress, or an employee of a Member of
Congress in connection with this commitment providing for
the United States to insure or guarantee a loan, the
undersigned shall complete and submit Standard Form
-LLL, "Disclosure Form to Report Lobbying," in accordance
with its instructions.
Submission of this statement is a prerequisite for making or
entering into this transaction imposed by section 1352, title
31, U.S. Code. Any person who fails to file the required
statement shall be subject to a civil penalty of not less than
$10,000 and not more than $100,000 for each such failure.
As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with
the above applicable certification(s).
NAME OF APPLICANT AWARD NUMBER AND/OR PROJECT NAME
PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE
SIGNATURE
DATE
ASSURANCES - CONSTRUCTION PROGRAMS
OMS Approval No. 0348-0042
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.
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 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:
1. Has the legal authority to apply for Federal assistance, 8. Will comply with the Intergovernmental Personnel Act
and the institutional, managerial and financial capability of 1970 (42 U,S.C. ~~4728-4763) relating to prescribed
(including funds sufficient to pay the non-Federal share standards for merit systems for programs funded
of project costs) to ensure proper planning, under one of the 19 statutes or regulations specified in
management and completion of the project described in Appendix A of OPM's Standards for a Merit System of
this application. Personnel Administration (5 C.F.R. 900, Subpart F).
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 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
interest in the title of real property in accordance with
awarding agency directives and will include a covenant
in the title of real property aquired 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
progress 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.
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. ~91681-
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.
9794), which prohibits discrimination on the basis of
handicaps; (d) the Age Discrimination Act of 1975, as
amended (42 U.S.C. 996101-6107), 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. 9~3601 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, 0) the requirements of any other
nondiscrimination statute(s) which may apply to the
application.
Previous Edition Usable
Authorized for Local Reproduction
Standard Form 4240 (Rev. 7-97)
Prescribed by OMB Circular A-1 02
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. 99327-
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. 991451 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. 9~7401 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. 991271 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. 9470), EO 11593
(identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of
1974 (16 U.S,C. ~9469a-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
APPLICANT ORGANIZATION DATE SUBMITTED
SF-424D (Rev, 7-97) Back