Item C09
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: September 16. 2009 Division: Deputv County Administrator
Bulk Item: Yes ..x.. No - Department: Library
Staff Contact Person/Phone #: Norma Kula J x7349
AGENDA ITEM WORDING:
Approval to accept and execute Library Services and Technology Act FY2009-2010 grant
agreement for "Southernmost Literacy Book Club" between Monroe County and the Florida
Department of State, Division of Library and Information Services.
ITEM BACKGROUND:
The Library Services and Technology Act (LST A) is the major federal grant program for
libraries. Administered by the Institute of Museum and Library Services, it is a state-based program
with a broad mandate to reach out in innovative and effective ways to persons having difficulty using
libraries to assure that Library service is accessible for all.
PREVIOUS RELEVANT BOCC ACTION:
Board has approved a history of prior LST A grant applications, agreements, and resolutions for
Library services.
CONTRACT/AGREEMENT CHANGES:
NJA
ST AFF RECOMMENDATIONS:
Approval
TOTAL COST:--OO-- INDIRECT COST: N/A BUDGETED: Yes LNo -
DIFFERENTIAL OF LOCAL PREFERENCE: N/A
COST TO COUNTY: --00-- SOURCE OF FUNDS: N/A
REVENUE PRODUCING: Yes x.. No AMOUNT PER Year $ 9.999.00
APPROVED BY: County Atty _ ~urchasing _ Risk Management _
DOCUMENTATION: Included ~ Not Required_
DISPOSITION: AGENDA ITEM #
Revised 7/09
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACTSU~ARY
Contract with: FL Dept. of State, DLIS Contract #09- LSTA-E-04
- --, -
Effective Date: Upon execution
Expiration Date: September 30, 2010
Contract Purpose/Description:
Library grant agreement supporting literacy and providing a learning program in
bookclub format.
Contract Manager: Norma Kula 7349 Library / #23
(Name) (Ext. ) (Department/Stop #)
for BOCC meeting on Sept. 16, 2009 Agenda Deadline: Sept. 1, 2009
CONTRACT COSTS
Total Dollar Value of Contract: $ 9,999.00 Current Year Portion: $ 9,999.00
Budgeted? YeslXl NoD Account Codes: - - - -
-----
Grant: $ 9,999.00 - - - -
--- -
County Match: $ -00- - - - -
--_--.~
- - - -
-----
ADDITIONAL COSTS
Estimated Ongoing Costs: $-OO-/yr For:
(Not included in dollar value above) (eg. maintenance. utilities. ianitorial, salaries. etc.)
CONTRACT REVIEW
Changes Date Out
~ Needed
Division Director q 09 YesD Nd'
Risk Mana~ment ~ (1...'6 J!1 YesO N
O.~.IP~~tg ~ YesD No
County Attorney ct~Q..
Comments:
OMB Form Revised 2/27/01 MCP #2
Memornndwn
To: Monroe County Board of commission~
From: Norma Kula, Director of Libraries ~ YJJ
Date: 8/2612009
Re: soee Agenda Item-Approval of LSTA Grant Acceptance and Execution
The above-referenced item is a program to be offered in partnership with the Literacy
Volunteers of America, with whom the Library has a long and effective relationship of mutual
support and cooperation. A previous joint grant project in 2002 was honored as one of the
State Library's Exemplary Programs. In the current program, the Library will primarily provide
space and oversight; LVA will implement the training, the program, and the publicity. Our goal
is to reach new potential Library users, adding to our base of non-traditional customers, and
enabling them to communicate effectively through increased literacy skills through reading
and discussion.
1
PROJECT NUMBER 09-LST A-E-04
Florida Department of State, Division of Library Rnd Information Services
LIBRARY SERVICES AND TECHNOLOGY ACT
GRANT AGREEMENT
AGREEMENT executed and entered into
BETWEEN the State of Florida, Department of State, Division of Library and Information Services, hereinafter
referred to as the DIVISION, and the
SUBGRANTEE: Monroe County Board of County Commissioners for and on behalf of Monroe
County Public Library System
the PROJECT: Southernmost Literacy Book Club
the GRANT AMOUNT: Nine thousand nine hundred ninety-nine dollars ($9,999)
released in four equal advance payments as determined by the Division after consultation with the
SUBGRANTEE.
The funds shall be expended on or before September 30,2010.
Unless there is a change of address, any notice required by this agreement shall be delivered to the DIVISION,
500 South Bronough Street, Tallahassee, Florida 32399-0250, for the State, and to 700 Fleming Street, Key
West, FL 33040, for the SUBGRANTEE. In the event of a change of address it is the obligation of the moving
party to notify the other party in writing of the change of address.
The DIVISION, as administrator of federal funds authorized under Section 257.12, Florida Statutes, wishes to
provide a grant of federal funds. Federal funds are provided through the Library Services and Technology Act
of 1996 under Florida's long range plan approved by the Institute of Museum and Library Services. The
SUBGRANTEE agrees to meet all state requirements and requirements of the Library Services and Technology
Act, hereinafter referred to as LST A.
The parties agree as follows:
I. The SUB GRANTEE agrees to:
a. Administer all funds granted to it by the DIVISION to carry out the project as described in the project
proposal and revisions submitted to and approved by the DIVISION. The project proposal and revisions
are incorporated by reference.
b. Provide the DIVISION with statistical, narrative, financial and other evaluative reports as requested.
c. Retain and make available to the DIVISION, upon request, all financial and programmatic records,
supporting documents, statistical records, and other records for the project.
d. Retain all records for a period of 5 years from the date of submission of the final project report. If any
litigation, claim, negotiation, audit or other action involving the records has been started before the
expiration of the 5 year period, the records shall be retained until completion of the action and resolution
of all issues which arise from it, or until the end of the regular 5 year period, whichever is later.
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e. Payout all project funds on or before the project ending date. Use and maintain adequate fiscal
authority, control, and accounting procedures that will assure proper disbursement of, and accounting
for federal project funds.
f. Perform all acts in connection with this agreement in strict conformity with all applicable State and
Federal laws and regulations.
g. Expend all grant funds received under this Agreement solely for the purposes ofthe project. Repay to
the DIVISION any and all funds not expended for the purposes of the project.
h. That to the best of the SUBGRANTEE'S knowledge and belief that the SUBGRANTEE, and its
principals:
1. Are not presently excluded or disqualified (debarment, suspension and other responsibility matters);
2. Have not been convicted within the preceding three years of any of the offenses listed in 45 CFR
] 1 85.800(a) or had a civil judgment rendered against the applicant or its principals for one of those
offenses within that time period;
3. 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 listed in 45 CFR ] 185.800(a); and
4. Have not had one or more public transactions (Federal, State, or local) terminated within the
preceding three years for cause or default.
That the SUB GRANTEE, and its principals will comply with 45 CFR Part 1185 Subpart C
(Responsibilities of Participants Regarding Transactions) and will require similar compliance with
Subpart C by persons at the next lower tier with whom the primary tier participant enters into covered
transactions.
1. Provide or continue to provide a drug-free workplace by complying with the requirements in Subpart B
of 45 CFR Part 1186.
This includes: making a good faith effort, on a continuing basis, to maintain a drug-free workplace;
publishing a drug-free workplace statement; establishing a drug-free awareness program for its
employees; taking actions concerning employees who are convicted of violating drug statutes in the
workplace; and identifying (either with this application, upon award, or in documents kept on file in the
SUBGRANTEE'S office) all known workplaces under the award.
J. Not use any grant funds for lobbying the legislature, the judicial branch, or any state agency.
k. As required by Section 1352, Title 31 of the United States Code, and implemented for persons entering
into a grant or cooperative agreement over $100,000, the SUBGRANTEE certifies to the best of his or
her knowledge and belief that
1. No Federal appropriated fWlds have been paid or will be paid, by or on behalf of the undersigned, to
any person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress
in connection with the awarding of a Federal contract, the making of a Federal grant, the making of
a Federal loan, the entering into of a cooperative agreement, or the extension, continuation, renewal,
amendment, or modification of a Federal contract, grant, loan, or cooperative agreement.
2. If any funds other than appropriated Federal funds have been paid or will be paid to any person
(other than a regularly employed officer or employee of the applicant) 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 request, complete, and submit Standard Form
LLL, "Disclosure of Lobbying Activities," in accordance with its instructions.
3. The SUBGRANTEE shall include the language of this certification in Part k in the award
documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under
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grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose
accordingly.
1. That to the best of the SUBGRANTEE'S knowledge and belief that the SUBGRANTEE is not
delinquent in the repayment of any Federal debt.
m. As required by the Civil Rights Act of 1964, the Rehabilitation Act of 1973, the Education Amendments
of 1972, and the Age Discrimination in Employment Act of 1975, as implemented at 45 CFR Part
1180.44, the SUBGRANTEE certifies that the SUBGRANTEE will comply with the foIlowing
nondiscrimination statutes and their implementing regulations:
1. Title VI of the Civil Rights Act of 1964, as amended (42 USC ~ 2000 et seq.), which provides that
no person in the United States shall, on the grounds of race, color, or national origin, be excluded
from participation in, be denied the benefits of, or otherwise be subject to discrimination under any
program or activity receiving Federal financial assistance;
2. Section 504 of the Rehabilitation Act of 1973, as amended (29 USC S 701 et seq.), which prohibits
discrimination on the basis of disability in Federally-assisted programs;
3. Title IX ofthe Education Amendments of 1972, as amended (20 USC ~~ 1681-83, 1685-86), which
prohibits discrimination on the basis of sex in education programs and activities receiving Federal
financial assistance;
4. The Age Discrimination in Employment Act of 1975, as amended (42 USC ~ 6101 et seq.), which
prohibits discrimination on the basis of age in Federally-assisted programs;
The SUB GRANTEE shall insert similar provisions listed in Part m in all subcontracts for services
required by this agreement.
n. In the event that the SUB GRANTEE expends $500,000 or more in Federal awards in its fiscal year, the
SUBGRANTEE must have a single or program-specific audit conducted in accordance with the
provisions ofOMB Circular A-133, as revised. In determining the Federal awards expended in its fiscal
year, the SUB GRANTEE shall consider all sources of Federal awards, including Federal resources
received from the Department of State. The determination of amounts of Federal awards expended
should be in accordance with the guidelines established by OMB Circular A-B3, as revised. An audit
of the SUBGRANTEE conducted by the Auditor General in accordance with the provisions OMB
Circular A-133, as revised, will meet the requirements of this part.
In connection with the audit requirements addressed in Part n., paragraph 1, the SUB GRANTEE shall
fulfill the requirements relative to auditee responsibilities as provided in Subpart C ofOMB Circular A-
133, as revised.
If the SUBGRANTEE expends less than $500,000 in Federal awards in its fiscal year, an audit
conducted in accordance with the provisions ofOMB Circular A-B3, as revised, is not required. In the
event that the SUB GRANTEE expends less than $500,000 in Federal awards in its fiscal year and elects
to have an audit conducted in accordance with the provisions ofOMB Circular A-133, as revised, the
cost of the audit must be paid from non-Federal resources (i.e., the cost of such an audit must be paid
from SUB GRANTEE resources obtained from other than Federal entities).
Copies of reporting packages for audits conducted in accordance with OMB Circular A-133, as revised,
and required by this agreement shall be submitted, when required by Section .320 (d), OMB Circular A-
133, as revised, by or on behalf of the SUB GRANTEE directly to each of the following:
1. The Department of State at the following address:
Office of Inspector General
Florida Department of State
Clifton Building, Suite 320
2661 Executive Center Circle
Tallahassee, FL 32301
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2. The Federal Audit Clearinghouse designated in OMB Circular A-133, as revised (the number of
copies required by Sections 320 (d)(l) and (2), OMB Circular A-133, as revised, should be
submitted to the Federal Audit Clearinghouse), at the following address:
Federal Audit Clearinghouse
Bureau ofthe Census
1201 East 10th Street
Jeffersonville, IN 47132
3. Other Federal agencies and pass-through entities in accordance with Sections 320 (e) and (t), OMB
Circular A-l33, as revised.
n. The DNISION agrees to:
a. Provide a grant in accordance with the tenns of this agreement in the amount and frequency as stated
above in consideration for the SUB GRANTEE's perfonnance hereinunder, and contingent upon funding
by the Institute of Museum and Library Services. The State of Florida's perfonnance and obligation to
pay under this agreement is contingent upon an annual appropriation by the Legislature. In the event
that the state or federal funds on which this agreement is dependent are withdrawn, this agreement is
terminated and the state has no further liability to the SUB GRANTEE beyond that already incurred by
the termination date. In the event of a state revenue shortfall, the total grant may be reduced
accordingly.
b. Provide professional advice and assistance to the SUBGRANTEE as needed, in implementing and
evaluating the project.
c. Review the project during the grant period to assure that adequate progress is being made toward
achieving the project objectives.
III. The SUB GRANTEE and the DNISION mutually agree that:
a. This instrument embodies the entire agreement of the parties. There are no provisions, terms,
conditions, or obligations other than those contained herein; and this agreement shall supersede all
previous communications, representations, or agreements, either verbal or written, between the parties.
No amendment shall be effective unless reduced in writing and signed by the parties.
b. This agreement is executed and entered into in the State of Florida, and shall be construed, performed,
and enforced in all respects in accordance with the laws and rules of the State of Florida. Each party
shall perform its obligations hereunder in accordance with the terms and conditions of this agreement.
c. Ifany term or provision of the agreement is found to be illegal and unenforceable, the remainder of the
agreement shall remain in full force and effect and such term or provision shall be deemed stricken.
d. No delay or omission to exercise any right, power or remedy accruing to either party upon breach or
default by either party under this Agreement shall impair any such right, power or remedy of either
party; nor shall such delay or omission be construed as a waiver of any such breach or default, or any
similar breach or default.
e. This agreement shall be terminated by the DNISION because of failure of the SUB GRANTEE to fulfill
its obligations under the agreement in a timely and satisfactory manner unless the SUBGRANTEE
demonstrates good cause as to why it cannot fulfill its obligations. Satisfaction of obligations by the
SUBGRANTEE shall be determined by the DIVISION based on the terms and conditions imposed on
the SUB GRANTEE in this agreement and compliance with the program guidelines. The DIVISION
shall provide SUBGRANTEE a written notice of default letter. SUBGRANTEE shall have 15 calendar
days to cure the default. If the default is not cured by the SUB GRANTEE within the stated period, the
DNISION shall terminate this agreement, unless the SUB GRANTEE demonstrates good cause as to
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why it cannot cure the default within the prescribed time period. For purposes of this agreement, "good
cause" is defined as circumstances beyond the SUBGRANTEE's control. In the event of termination of
this agreement, the SUBGRANTEE will be compensated for any work satisfactorily completed prior to
the notification of termination, if equitable.
f. The DIVISION shall unilaterally cancel this agreement if the SUBGRANTEE refuses to allow public
access to all documents or other materials subject to the provisions of Chapter 119, Florida Statutes.
g. Surplus funds must be temporarily invested and the interest earned on such investments shall be
returned to the State quarterly.
h. Bills for services or expenses shall be maintained in detail sufficient for proper preaudit and postaudit.
1. Any travel expenses must be maintained according to the provisions of Section 112.061, Florida
Statutes.
J. The DIVISION shall not be liable to pay attorney fees, interest, late charges and service fees, or costs
related to collection of grant funds.
k. The DIVISION shall not assume any liability for the acts, omissions to act or negligence of the
SUBGRANTEE, its agents, servants or employees; nor shall the SUB GRANTEE exclude liability for
its own acts, omissions to act or negligence to the DIVISION. In addition, the SUB GRANTEE hereby
agrees to be responsible for any injury or property damage resulting from any activities conducted by
the SUBGRANTEE.
1. The SUB GRANTEE, other than a SUB GRANTEE which is the State or agency or subdivision of the
State, agrees to indemnify and hold the DIVISION hannless from and against any and all claims or
demands for damages of any nature, including but not limited to personal injury, death, or damage to
property, arising out of any activities performed under this agreement and shall investigate all claims at
its own expense.
m. The SUB GRANTEE shall be responsible for all work performed and all expenses incurred in
connection with the Project. The SUBGRANTEE may subcontract as necessary to perform the services
set forth in this agreement, including entering into subcontracts with vendors for services and
commodities, PROVIDED THAT such subcontract has been approved by the DIVISION prior to its
execution, and PROVIDED THAT it is understood by the SUBGRANTEE that the DIVISION shall not
be liable to the subcontractor for any expenses or liabilities incurred under the subcontract and that the
SUB GRANTEE shall be solely liable to the subcontractor for all expenses and liabilities incurred under
the subcontract.
n. N either the State nor any agency or subdivision of the State waives any defense of sovereign immunity,
or increases the limits of its liability, by entering into this contractual relationship.
o. The SUB GRANTEE, its officers, agents, and employees, in perfonnance ofthis agreement, shall act in
the capacity of an independent contractor and not as an officer, employee or agent ofthe DIVISION.
Under this agreement, SUB GRANTEE is not entitled to accrue any benefits of state employment,
including retirement benefits and any other rights or privileges connected with employment in the State
Career Service. SUBGRANTEE agrees to take such steps as may be necessary to ensure that each
subcontractor of the SUBGRANTEE will be deemed to be an independent contractor and will not be
considered or pennitted to be an agent, servant,joint venturer, or partner of the DIVISION.
p. The SUBGRANTEE shall not assign, sublicense or otherwise transfer its rights, duties, or obligations
under this agreement without prior written consent of the DIVISION, which consent shall not be
unreasonably withheld. The agreement transferee must demonstrate compliance with the requirements
of the program. If the Department approves a transfer of the SUBGRANTEE's obligations, the
SUBGRANTEE remains responsible for all work performed and all expenses incurred in connection
with the agreement. In the event the Legislature transfers the rights, duties, and obligations of the
DIVISION to another government entity pursuant to section 20.06, Florida Statutes, or otherwise, the
Page 5 of6
rights, duties, and obligations under this agreement shall also be transferred to the successor government
entity as if it were an original party to this agreement.
q. This agreement shall bind the successors, assigns and legal representatives of the SUBGRANTEE and
of any legal entity that succeeds to the obligations of the DNISION.
r. When publications, films or similar materials are developed, directly or indirectly, from a program,
project, or activity supported with grant funds, any copyright resulting therefrom shall be held by the
Department of State. The author may arrange for copyright of such materials only after approval from
the DIVISION. Any copyright arranged for by the author shall include acknowledgment of grant
assistance. As a condition of grant assistance, the SUB GRANTEE agrees to, and awards to the
Department and to its officers, agents, and employees acting within the scope of their official duties, and
if applicable, the Federal Government, a royalty-free, nonexclusive, and irrevocable license throughout
the world for official purposes, to publish, translate, reproduce, and use all subject data or copyrightable
material based on such data covered by the copyright.
s. No costs incurred before the date of this agreement shall be eligible as project expenditures. No costs
incurred after the completion date or other termination of the Agreement shall be eligible as project
expenditures unless specifically authorized by the DNISION.
IV. The term of this agreement will commence on the date of execution of the agreement.
THE SUB GRANTEE THE DIVISION
Signature of Authorized Official Judith A. Ring, Director
Division of Library and Information Services
Department of State, State of Florida
Typed Name and Title of Authorized Official
Witness Witness
Witness Witness
06/1 0/2009
(
.
. .
-.. ~: State:
...):: INSTITUTE of .
...... MuseumwLlbraty
..:>:; SERVICES
.- ..
. .
-
CERTIFICATIONS REGARDING DEBARMENT, SUSPENSION AND OTHER
RESPONSIBILITY MATTERS; DRUG-FREE WORKPLACE REQUIREMENTS;
LOBBYING; FEDERAL DEBT STATUS; AND NONDISCRIMINATION
Signature of this form provides for compliance with the statutes and regulations cited below. The
certifications shall be treated as material representations of fact upon which reliance will be placed when
the Institute of Museum and Library Services determines to award Federal funds to State Library
Administrative Agencies.
1. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS
As required by Executive Order 12549 and implemented at 45 C.F.R. Part 1185, the undersigned,
on behalf of the applicant, certifies to the best of his or her knowledge and belief that neither the
applicant, nor its principals:
(a) are presently debarred, suspended, proposed for debannent, declared ineligible, or voluntarily
excluded from covered transactions by any Federal department or agency;
(b) have within a three-year period preceding this proposal been convicted of or had a civil
judgment rendered against them for commission offraud 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, or in connection with a 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 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 (b)
of this certification;
(d) have within a three-year period preceding this application/proposal had one or more public
transactions (Federal, state or local) terminated for cause or default.
Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach
an explanation to this application.
2. DRUG-FREE WORKPLACE REQUIREMENTS
As required by the Drug-Free Workplace Act of 1988 and implemented at 45 C.F.R. Part 1185, the
undersigned, on behalf of the applicant, certifies that the applicant will or will continue to provide a drug-
free workplace by:
(a) publishing a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession or use of a controlled substance is prohibited in the grantee's
workplace and specifying the action that will be taken against employees for violation of
such prohibition;
(b) establishing an ongoing drug-free awareness program to infonn 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 employee assistance programs; and
1
(4) the penalties that may be imposed on employees for drug abuse violations occurring in
the workplace;
(c) making it a requirement that each employee to be engaged in the perfonuance ofthe 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 tenus 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 not later than five calendar days after such conviction;
(e) notifying the agency in writing within ten (10) 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 every grant officer on whose grant activity the convicted employee was working, unless
the Federal agency has designated a central point for the receipt of such notices. Notices
shall include the identification number(s) of each affected grant;
(f) taking one ofthe following actions within thirty (30) 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 (29 U.S.C. S 701 et seq.); 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
or other appropriate agency;
(g) making a good faith effort to continue to maintain a drug-free workplace through
implementation of paragraphs (a), (b), (c), (d), (e), and (t).
The applicant either shall identiJy the site(s) for the performance of work done in connection with the
project in the application material or shall keep this information on file in its office so that it is available
for Federal inspection. The street address, city, county, state, and zip code should be provided whenever
possible.
3. LOBBYING
As required by Section 1352, Title 31 ofthe United States Code, and implemented for persons entering
into a grant or cooperative agreement over $100,000, the applicant certifies to the best of his or her
knowledge and belief that:
(a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or employee
of any agency, a Member of Congress, an officer or employee of Congress, or an employee
of a Member of Congress in connection with the awarding of a Federal contract, the making
of a Federal grant, the making of a Federal loan, the entering into of a cooperative agreement,
or the extension, continuation, renewal, amendment, or modification of a Federal contract,
grant, loan, or cooperative agreement.
(b) If any funds other than appropriated Federal funds have been paid or will be paid to any
person (other than a regularly employed officer or employee of the applicant) 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
request, complete, and submit Standard Form LLL, "Disclosure of Lobbying Activities," in
accordance with its instructions.
2
(c) 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 agreements) and that all subrecipients shall certify and
disclose accordingly.
4. FEDERAL DEBT STATUS
The undersigned, on behalf of the applicant, certifies to the best of his or her knowledge and beliefthat
the applicant is not delinquent in the repayment of any Federal debt.
S. NONDISCRIMINATION
As required by the Civil Rights Act of 1964, the Rehabilitation Act of 1973, the Education Amendments
of 1972, and the Age Discrimination in Employment Act of 1975, as implemented at 45 C.F.R. Part
1180.44, the undersigned, on behalf of the applicant, certifies that the applicant will comply with the
following nondiscrimination statutes and their implementing regulations:
(a) Title VI of the Civil Rights Act of 1964, as amended (42 U.S.C. 92000 et seq.), which
provides that no person in the Vni1ed States shall, on the grounds of race, color, or
national origin, be excluded from participation in, be denied the benefits of, or otherwise
be subject to discrimination under any program or activity receiving Federal financial
assistance;
(b) Section 504 of the Rehabilitation Act of 1973, as amended (29 V.S.C. 9 701 et seq.), which
prohibits discrimination on the basis of disability in Federally-assisted programs;
(c) Title IX of the Education Amendments of 1972, as amended (20 V.S.C. 99 1681-83, 1685-
86), which prohibits discrimination on the basis of sex in education programs and
activities receiving Federal financial assistance;
(d) The Age Discrimination in Employment Act of 1975. as amended (42 U.S.C. 96101 et seq.),
which prohibits discrimination on the basis of age in Federally-assisted programs;
The undersigned further provides assurance that it will include the language of these certifications in all
subawards and that all sub recipients shall certify and disclose accordingly.
As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with
the above certifications.
I
Signature of Authorized Certifying Official
Print Name and Title of Authorized Certifying Official
Date
State Programs 3 Issued 2/9/2006
Approved by OMS
0348-0046
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this fonn to disclose lobbying activities pursuant to 31 U.S.C. 1352
(See reverse for public burden disclosure.)
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
0 a. contract D a. bid/offer/application D a. initial filing
b. grant b. initial award b. material change
c. cooperative agreement c. post-award
d. loan For Material Change Only:
e. loan guarantee
f loan insurance year quarter
date oflast report
4. Name and Address of Reporting Entity: 5. If Reporting Entity in No.4 is Subawardee, Enter Name
o Sub awardee and Address of Prime:
o Prime
Tier . ifknown:
Congressional District, ifknown- Congressional District, if known:
6, Federal Department/Agency: 7. Federal Program NamelDeseription:
CFDA Number. if applrcable:
8. Federal Action Number, ifknown: 9. Award Amount, ifknown.
$
10. a. Name and Address of Lobbying Entity b, Individuals Performing Services (mcludmg address if
(ifindrVldual. last name. first name, MI)" dlfferentfrom No. lOa)
(last name, first name, Ml)'
attach Continuation Sheet s
II. Infornsation requested Ihrough Ihis form is aulhorized by title 31 V.S.C. Signature:
section 1352. This disclosure of lobbyiag acllvilles is a material Print Name:
representatioa of fact upon which reiillOce was placed by the tier above
wben Ihis IraasaclloD was made or entered inlo. This disclosure is required Title:
pursullDI 10 31 U.S.c. 1352. This iaformalion wiD be nporled 10 CODgress
semi-IIDDulllly and will be available for public iaspeclloD. Aay penOD who
fails to tile Ihe nquired disclosure shall be subjed to a civil penally Df not Ttltphone No.: Date:
less than SlO,OOO and not more 1han 5100,000 lor each such failure.
Authonzed for Local Reproduction
Slandard Fonn - LLL (Rev 7 - 97)
Page 1 of 2
DEP 55-221 (03/2002)
. STATE OF FLORIDA
Department of Financial Services - Chief Financial Officer
Bureau of Accounting, 200 East Gaines Street, Tallahassee, FL 32399-0354
Telephone (850) 413-5519 Fax (850) 413-5550
Substitute Form W-9
In order to comply with IRS regulations, we are requesting Taxpayer Identification information that will be used to
determine whether you will receive a F onn 1099 for payment(s) made to you by an agency of the State of Florida.
For questions regarding this form, please use the address or telephone number provided above. In order to comply
with the IRS rules, please provide us with your social security (SSN) or federal employer identification number
(FEIN). This is not a request for state sales tax exemption.
In the event this infOlmation is not provided, or should the IRS notify us that the provided information is incorrect,
all payments made to you may become subject to a Backup Withholding Tax Rate that is different each year but
could be up to 31 % or more. Please print clearly or type.
PART 1 - Please provide the correct Tax Identification Number (TIN), be it FEIN -or- SSN,
and the applicable name and address. The TIN is (check one) _SSN_FEIN
Federal Employer Identification Number (FEIN) - or-
Example 9 9 -- 9 9 9 9 9 9 9
Social Security Number (SSN)
Example 9 9 9 -- 9 9 -- 9 9 9 9
NAME
Business name if sole proprietor
ADDRESS
CITY, STATE, ZIP
PART 2 - Below, circle one number that accuratelYldescribes the business or the individual.
1 - CORPORATlONt PROFESSIONAL ASSOCIATION OR PROFESSIONAL CORPORATION
(A corporation formed under the laws of any state within the United Slates.)
2 - NOT FOR PROFIT CORPORATION (Section 501 (c)(3) Internal Revenue Code)
3 - PARTNERSHIP, JOINT VENTURE, ESTATE, TRUST OR MULTIPLE MEMBER LLC
4 - INDIVIDUAL, SOLE PROPRIETOR, SELF EMPLOYED OR SINGLE MEMBER LLC
5-NONCORPORATERENTALAGENT
6 - GOVERNMENTAL ENTITY (City, County, State or U.S. Government)
7 - FOREIGN CORPORATION OR ENTITY (A foreign entity formed under the laws of a country other than
the United States.) If YES is marked below, complete and attach Form 4224.
Is income effectively connected with business in the United Stales? _YES NO
8 - NONRESIDENT ALIEN (An individual temporarily in the U. S. who is not a U.S. citizen or resident.)
Under the penalties of perJury, I certify that I have examined this request and to the best of my knowledge and belief, It 15 true, correct and
complete.
SIgnature Date Telephone Number
TItle emall (optional)
INTERNET SAFETY CERTIFICATION FOR APPLICANT
PUBLIC LIBRARIES
PUBLIC ELEMENTARY AND SECONDARY SCHOOL LffiRARIES, and
CONSORTIA WITH PUBLIC AND/OR PUBLIC SCHOOL LIBRARIES
As the duly authorized representative of the applicant library, I hereby certify that the
library is (check only one of the following boxes)
A. 0 CIP A Compliant
(The applicant library has complied with the requirements of
Section 9134(/)(1) of the Library Services and Technology Act.)
OR
B. 0 The CIP A requirements do not apply because no funds made available
under the LST A program are being used to purchase computers to access
the Internet, or to pay for direct costs associated with accessing the
Internet.
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