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RE 10-26-99.3
A RESOLUTION OF THE CITY OF COPPELL, TEXAS RESOLUTION NO. 102699.3 A RESOLUTION OF THE CITY OF COPPELL, TEXAS, PROVIDING FOR THE ACCEPTANCE OF FUNDS FROM THE URBAN AND COMMUNITY FORESTRY PROGRAM FOR EXPENDITURES RELATING TO THE HIRING OF AN URBAN FORESTER; AUTHORIZING THE CITY MANAGER AND/OR DIRECTOR OF PARKS AND LISURE SERVICES TO EXECUTION OF THIS RESOLUTON BY THE MAYOR; AND PROVIDING AN EFFECTIVE DATE. ~~ ~ C~ of ~ ~ ~ a ~ ~ ~ T~ F~ ~ ~g ~~ ~ C~ of ~ ~ r~v~ ~o~ by ~ T~ For~ S~ f~ ~d ~ ~ of~~ ~ ~ ($1S,~.~); ~ ~ u~ ~ ~ ~ ~ ~ ~ ~ r~ ~, ~ Ci~ C~ is of~ ~ ~ ~ ~ ~ ~ flora ~ T~ F~ ~ ~d ~ ~~; ~~ ~ ~ ~~ ~ is ~ ~o ~ ~bit "A", ~ fo~ ~ ~ ~ ~ ~ ~~ ~~ by ~ ~~n ~ CiW ~~ ~or ~ ofP~ ~ ~ ~ ~t. NOW ~FO~ BE ~ ~L~D BY ~ ~ CO~ OF ~ ~ CO~PE~,~ ~ ~ S~ON 1. ~ ~ r~ ~ ~~ ~ Ci~ of ~ C~ ~ ~y ~ T~ For~ ~ ~t ~ ~ ~ of~ ~~ ~ ~ ($18,~.~) ~ of~ m U~ F~ ~on ~ ~ of ~ ~ ~ ~ ~n of ~ ~ifion ~ ~ ~ ~ ~ of~ ~ ofCop~ T~. S~ON 2. ~ ~ Ci~ ~~ ~or ~ ~or of P~ md ~ S~ ~t is ~ ~~ to ~te ~ ~ ~~s) ~ ~ ~ ~ ~ ~bit "A", ~ m o~ ~te ~ ~~ of ~ ~t ~ 1 SECTION 3. This Resolution shall become effective immediately from and after its passa~ ~ it is accordingly so resolved. DULY RESOLVED AND ADOPTED by the City Council of the City of Coppell, Texas, on thisthe ~-~y of~ ~999. CANDY SI-I~ ~-IAN, MAYOR ATTEST: ORNEY (REH/cdb 10/21/99y(29124) TE. AS The Texas A&M Clniversity System Urban Forestry Partnership Grant Program 1999 Grant Application Form ProjectTitl¢: City of Coppell Staff Forester For Offi¢ial Use Only Organization: City of Coppell GrnntNo. MailingAddrcss: 732 Deforest stat:,sia::F1 Local: [] City: CO,Dell State: TX ZIP: 75019 Contact Person: Brad Reid [ Daytime Telephone: 972-3..04-3561 E-mail Adclrcss: breid@ci .coppel 1 .tx.us Is your organization tax exempt? Yes Federal Employer ID Numbex: 75-118-3207 A narrative of no more than tba'¢e (3) typed Pages must accompany each grant application. The first part of this narrative should clearly state how the project fits within the mission and goals of the organization by answering the following questions: What is the overall mission of your organization? Who are your members or constituents? What is the role of the organization in promoting urban forestry in the community? How does the project help your group achieve its mission? What problem will it help solve? What will the long- term benefits to your organization and the community be? How will these be measured? The second part of the narrative should address the following areas: I Project Execution: describe all planned activities for the project, the ~imetabie tbr its completion, and the end result or product. 2 Participants: name all the groups that will be involved and what their roles :~il[ be. 3 Use of Federal Funds: state how grant funds will be spent, along with any local cash contribution q in-Kind Contributions: provide the sources and values t'or all in-kind contributions listed in the project budget 5 Project Communication: describe any publicity tbr the project or hv',~ the results or p~,duct v, ill be distributed in the community I hemb~ certJf~ that I ~v~ met with the applt~,m to review tkis propo~ ~d the ptoBr~m reqwrcmcnu. ~nd h&ve recommended euy clmnBes tl~t would help the project eohieve the 8o~e of the Urban For~ry Pa~taenhil~ Cn'~n~ Pro,lin. As a duly Luthodzed rep~samltive of' the orl~tion r~kin8 thi. ~pplic&',ion, I hereby certi~ thlt · lt the ,nformitio~ provided her~n is role ~ represent0 tl~ desir~ ot'thi~ orison. [ fi~rther ceftin/thee I unde,'st~nd ~ ~urpose ~d rules of'the pro~m, es sci ou~ in the .Kppliotio, O~ide Sirs . ~,irector of Parks & Le'.su~e Services 1999 Urban Forestry Partnership Grant Application Part II - Organizational Goals CITY OF COPPELL PARKS AND LEISURE SERVICES MISSION STATEMENT To provide for the health, inspiration and education of the citizens of Coppell by preserving the city's biological diversity, protecting its most valued cultural and natural resources and creating opportunities for high-quality indoor and outdoor recreation. The above statement is the mission of the Parks and Leisure Services Department of the City of Coppell. The statement clearly explains the reasons for requesting funding for a City Forester. Protecting the natural resources of Coppell is something very much on the minds of the public and the city staffand council. A revised tree preservation ordinance was recently adopted in an effort to preserve the remaining trees in the city. This ordinance is having an impact on the proposed development in the city and is deterring developers fi.om removing trees needlessly. As a result of adopting this ordinance the city has taken a leadership role in the preservation of natural resources and in the promotion of urban forestry in Coppell. The City of Coppell has been named as a Tree City USA by the National Ardor Day Foundation for the past four years and, as such, has promoted tree preservation, maintenance and planting, celebrated Arbor Day in the community and maintained a Tree Board to review tree related issues in the city. This Forester position will manage and coordinate the above mentioned actMties, review proposed developments in the city to ensure compliafice with the Tree Preservation Ordinance and generally promote tree preservation and planting throughout Coppell. The long term benefits of the City of Coppell having a staff forester are numerous. We are in need of a planting guide in the city, tree planting and maintenance instruction in the schools, citizen volunteer involvement in the maintenance of existing trees, the creation and management of a city tree farm and a Living Legacy Tree Memorial Program, among other desired projects. The importance of trees to the citizen's of Coppell cannot be overemphasized. The citizens insisted that our tree preservation ordinance be revised ~er witnessing the elimination of several fine stands of trees due to expanding development. A staff forester will be responsible for enforcing all ordinances of the city which pertain to tree maintenance, trimming, elimination, preservation and planting on public lands. The addition of this position will offer the citizens a surety that the existing forest will be preserved as much as possible, a plan is in place for the reforestation of the city and the means are available to carry those plans through. 1999 Urban Forestry Partnership Grant Application Part III - Project Work Plan A City of Coppell staff forester would have many prioritized projects which require immediate attention. City staff has become increasingly responsive to tree protection issues related to proposed developments in the city. A staff forester' s number one goal will be to ensure compliance with the Tree Preservation Ordinance by reviewing development plans, recommending alternative courses of action, determining tree removal reparation and ensuring appropriate protective measures are taken for trees designated for preservation. The revised Tree Preservation Ordinance also creates a Reforestation and Open Areas Fund which will be paid into by developers choosing payment in lieu of tree planting for trees removed due to development. The management of this fund will be done by the Staff Forester. Moneys will be expended on tree plantings and irrigation on parks and municipal grounds, creation and management of a city tree farm and the development of a tree planting guide. All these activities are expected to be complete within the first year of having a forester. Currently, the City of Coppell has, on order, a Living Legacy Tree Memorial Sculpture which will allow the citizens to memorialize a person or event by making a donation to the Living Legacy Memorial Fund. By making this donation, the citizen will receive a plaque, have the honoree's name placed on the sculpture (to be located at Town Center) and have a tree planted in their honor. This program is in the works now and by the time a forester were to be hired would be well underway. Citizen volu.nteer involvement in the maintenance of existing trees, among other desired projects, is something that the Parks and Leisure Services Department has only dreamed of until talk of a forester began. The City of Coppell is blessed with a number of groups constantly in search of volunteer opportunities. A Staff Forester will guide activities with certain of these groups in the planting, care and maintenance of trees on public property. Such events would be advertised in the two local papers and on the local government access channel. As for the past four years the City of Coppell will celebrate Arbor Day each year in all of the elementary schools and then have a tree planting and dignitary celebration of the event at Town Center~ This is a day in which the city attempts to get the entire community involved. The planned events are heavily advertised in the local papers and often volunteer labor is added to the mix to assist with the activities. The importance of trees to the citizen's of Coppell cannot be overemphasized. The citizens insisted that our tree preservation ordinance be revised after witnessing the elimination of several fine stands of trees due to expanding develbpment. A new Staff Forester will ensure to the citizens that existing trees are being looked after, new planting is well thought out and that education of the public and city officials is the best it can be in the City of Coppell. Federal Program Grant Number: 99-04-02 CFDA Number: 10.664 Grant Amount: $18,000 Period: 10-01-99 to 9-30-00 Local Match: $18,000 Urban Forestry Partnership Grant Program A Cooperative Program Between the Texas Forest service And the USDA Forest Service GRANT AGREEMENT This Grant Agreement is hereby entered int© by and between the Texas Forest Service (TFS), a Member of The Texas A&M University System, and the City of Coppell, Texas, hereafter referred to as 'Grantee., Article 1. All funds must be'used for the purposes stated below. Any modification of purpose, final product, grant award, or matching contribution must be requested in writing and approved by the TFS. Grantee must raise the entire balance of funds necessary to complete the budget as proposed, from non-federal sources. Purpose: To support a city forester position, which will be responsible for enforcing ordinances and coordinating all tree planting and maintenance activities on public property. Grant and local matching funds will be used for salary and benefits for the forester. Article 2. The $18,000 grant will be paid on a reimbursement basis upon submission of approved cost records AND a project final report. Interim reports detailing partial project accomplishments and costs will be accepted for partial payment. The amount paid will equal 50% of the approved project costs, not to exceed either the grant amount or the out- of-pocket expenses. The Grantee shall be responsible for a minimum match of $18,000, in eligible cash purchases or in-kind contributions. Article 3. The Grantee shall be responsible for providing proof-of- payment records for all purchases and in-kind contributions. These include source documentation such as invoices, cancelled checks, paid receipts, payroll or time and attendance records, contract documents, and valuation letters for third-party in-kind contributions. Cost records must be retained for three years following conclusion of the project. Article 4. The Grantee must provide the TFS with an official resolution passed by its governing body that authorizes its representative to execute any agreements associated with this grant and commits the organization to the matching contribution as proposed in the grant application and listed above. -2- Article 5. Applicable federal cost principles (attached OMB A-87 for local governments, OMB A-21 for higher education institutions, or OMB A- 122 for nonprofit groups), administrative requirements (attached 7 CFR Part 3016 or 7 CFR Parts 3015/3019), and the Grantee's application will be followed in determining reasonableness, allowability, and allocation of costs. Grantee's procurement procedures must conform to standards defined in these documents and Grantees receiving $300,000 or more in federal funds must comply with federal Single Audit Act requirements, as detailed in circular OMB A-133. Article 6. The Grantee agrees to comply with all applicable federal laws, as specified in the attached Assurances for Non-Construction Programs. Grantee must certify that they have not been debarred from this or any other federal program, must comply with.federal drug-free workplace requirements, and must comply with restrictions on lobbying Congress. Article 7. The Grantee shall submit a final project performance report, a financial summary with supporting documentation, and a copy of any product developed through the grant within 60 days of project completion, or by November 30, 2000, at the latest. (If required, a copy of the Single Audit report covering the grant period must also be submitted.) Article 8. The State Forester and the Comptroller General of the United States, or any of their authorized representatives, shall have the right of access to any pertinent books, documents, papers, or other records of the Grantee which are pertinent to the grant in order to make audits, examinations, excerpts, and transcripts. Article 9. (For tree planting projects only.) The Grantee must provide the TFS with a resolution or letter from the governing body of the entity that owns the property where the trees are to be planted. This document must grant permission to the Grantee to install this planting and commit to providing reasonable protection for the trees. Article 10. (For tree planting projects only.) Exhibit A (Tree Planting Maintenance Specifications), attached hereto and incorporated for all. purposes, must be followed and will be used by the TFS to measure performance by the Grantee. Trees must be maintained for three full years following planting. The Grantee must replace any dead trees within the period of this Agreement if the ~umber of live trees falls below 90% of the original number planted and included in project cost reports. Article 11. If a Grantee materially fails to comply with any term of this award, as stated above, the TFS may temporarily withhold cash payments pending correction of the deficiency by Grantee, disallow all or part of the cost of the activity or action not in compliance, wholly or partly suspend or terminate the current award for the Grantee, withhold further awards for the program, demand repayment of the grant, or take other legally available remedies. -3- Article ~2. The Grantee may terminate this entire Agreement, without cause, prior to the expiration of the grant period, upon thirty (30) days written notice. Upon cancellation of this Agreement and release or return of the unexpended gran~ funds, the Grantee is fully released of all obligations under this Agreement. Article 13. The Grantee agrees to hold the Texas Forest Service (TFS) harmless from any injury to person or property occurring in connection with project operations by Grantee, its agents, or employees, to the extent allowed by law. Article 14. If any part of this Agreement shall be deemed to be or shall, in fact, be invalid, inoperative, or unenforceable as applied, such circumstance shall not have the effect of rendering any other provision of this Agreement invalid, inoperative, or unenforceable to any extent whatever. Acceptance: We accept this grant subject to the terms and provisions stated above. ~rantee: SignatUre Title Organization Date ~rantor: J&mes B. Hull State Forester Texas Forest Service Date OMB Approval No. 0348-0040 ASSURANCES - NON-CONSTRUCTION PROGRAMS ~. pl~hllc reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing '.flons, seamhing existing data sources, gathering and maintaining the data needed, and completing and reviewing the-collection of .ration. 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 N(~T--RETURN YOUR COMPLETED FORM TO THE OFFICE OF'MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. -----J :=--- *-: :*: :~--* *--.*-~-- -- .--. --~*.*-- =- 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 Act of 1973, as amended (29 U.S.C. §794), which and the institutional, managerial and financial capability prohibits discrimination on the basis of handicaps; (d) (including funds sufficient to pay the non-Federal share the Age Discrimination Act of 1975, as amended (42 of project cost) to ensure proper planning, management U.S.C. §§6101-6107), which prohibits discrimination and completion of the project described in this on the basis of age; (e) the Drug Abuse Office and application: Treatment Act of 1972 (P.I_ 92-255), as amended, relating to nondiscrimination on the basis of drug 2. Will give the awarding agency, the Comptroller General abuse; (f) the Comprehensive Alcohol Abuse and of the United States and, if appropriate, the State, Alcoholism Prevention, Treatment and Rehabilitation through any authorized representative, access to and Act of :1970 (P.L. 91-616), as amended, relating to the right to examine all records, books, papers, or nondiSCrimination on the basis of alcohol abuse or documents related to the award; and will establish a alcohol!sm; (g) §§523 and 527 of the Public Health proper accounting system in accordance with generally Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee accepted accounting standards or agency directives. 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the 3. Will establish safeguards to prohibit employees from Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as using their positions for a purpose that constitutes or amended, relating to nondiscrimination in the sale, presents the appearance of personal or organizational rental or financing of housing; (i) any other conflict of interest, or personal gain. nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being 4. Will initiate and complete theworkwithin the applicable made; and, (j) the requirements of any other time frame after receipt of approval of the awarding nondiscrimination statute(s) which may apply to the agency, application. 5. Will comply with the Intergovemmental Personnel Act of 7. Will comply, or has already complied, with the 1970 (42 U.S.C. §§4728-4763) relating to prescribed requirements of Titles II and III of .the Uniform standards for merit systems for programs funded under Relocation Assistance and Real Property Acquisition one of the 19 statutes or regulations specified in Policies ACt of 1970 (P.L. 91-646)which provide for Appendix A of OPM's Standards for a Merit System of fair and equitable treatment of persons displaced or Personnel Administration (5 C.F.R. 900, Subpart F). whose property is acquired as a result of Federal or federally-assisted programs. These requirements apply 6. Will comply with all Federal statutes relating to to all interests in real property acquired for project nondiscrimination. These include but are not limited to: purposes regardless of Federal participation in. (a) Title VI of the Civil Rights Act of 1964 (P.L. 81~-352) purchases. which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education 8. Will comply, as applicable, with provisions of the Amendments of 1972, as amended (20 U.S.C. §§1681- Hatch ACt (5 U.S.C. §§1501-1508 and 7324-7328) 1683, and 1685-1686), which prohibits discrimination on which limit the political activities of emPloyees whose the basis of sex; (c) Section 504 of the Rehabilitation principal employment activities are funded in whole or in part with Federal funds. Previous Edition U~bl~ Standard Form 424B (Rev. 7-97) Authorized for Local Reproduction Prescribed by OMB Circular A-102 9. Will comply, as applicable, with the provisions of the Davis- 12. Will comply with the Wild and Scenic Rivers Act of Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act 1968 (16 U.S.C. ~1271 et seq.) related to protecang (40 U.S.C. §276c and 18 U~S.C. §874), and the Contract components or potential components of the nation~-' Work Hours and Safety Standards Act (40 U.S.C. §§327- wild and scenic rivers system. 333), regarding labor standards-for federally-assisted -- construction subagreements. 13. Will assist the awarding agency in assuring compilance with Section 106 of the National Historic Preservation 10. Will comply, if applicable, with flood insurance pumhase Act of 1966, as amended (16 U.S.C. {470), EO 11593 requirements of Section 102(a) of .the Flood Disaster (identification and protection of historic properties), and Protection Act of 1973 (P.L. 93-234) which requires the Amhaeological and Histodc Preservation Act of recipients in a special flood hazard area to participate in the 1974 (16 U.S.C. ~9a-1 et seq.). program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more. 14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in reseamh, development, and 11. Will comply with environmental standards which may be related activities supported by this award of assistance. prescribed pursuant to the following: (a) institution of environmental quality control measures under the National 15. Will comply with the Laboratory Animal Welfare Act of Environmental Policy Act of 1969 (P.L. 91-190) and 1966 (P.L. 89-544, as amended, 7 U.S.C. ~2131 et Executive Order (EO) 11514; (b) notir=afion of violating seq.) pertaining to the care, handling, and treatment of facilities pursuant to EO 11738; (c) protection of wetlands warm blooded animals held for research, teaching, or pursuant to EO 11990; (d) evaluation of flood hazards in other activities supported by this award of assistance. floodplains in accordance with EO 11968; (e) assurance of project consistency with the approved State management 16. Will comply with the Lead-Based Paint Poisoning program developed under the Coastal Zone Management Prevention Act (42 U.S.C. §§4801 et seq.) which Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of prohibits the use of lead-based paint in construction or · Federal actions to State (Clean Air) Implementation Plans rehabilitation of residence structures. under Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. §§7401 et seq.); (g) protection of 17. Will cause to be performed the required financial and underground sources.- of drinking water under the Safe compliance audits in accordance with the Single Audit Drinking Water Act of 1974, as amended (P.L. 93-523); Act Amendments of 1996 and OMB Circular No. A-133. and, (h) protection of endangered species under the 'Audits of Slates, Local Governments, and Non-Prc Endangered Species Act of 1973, as amended (P.L. 93- Organizations.' 205). 18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, and policies governing this program. SIGNATURE OF AUTHORIZED CERTIFYING OFFICI'AL [TITLE I APPLICANT ORGANIZATION DATE SUBMI~-I'ED Standard Form 424B (Rev. 7-97) Back U.S. DEPARTMENT OF AGRICULTURE CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS STATES AND STATE AGENCIES FEDERAL FISCAL YEAR This certification is required by the regulations implementing Sections 51SI-S160 of the' Drug-Free Workplace Act or 1988 (Pub. L. 100-690, Title -V, Subtitle D;, 41 U.S.C. ?0! et seq.), ? CFR Part ~3017, Subpart F. The regulations, published as Part !1 or the May 2~, 1990 F.~lfl:ll. Bf~iai~ (pages 2t681. 21691), require certification by grantees, prior to award, that they will re·lot·ia · drug*flee workplace. Section 3017.630(c] of the regulation provides that · grantee that is · State my elect to snake one certlflcatioa to the Department or Agriculture in each Federal fiscal yem' in liou of' certificates for each grant durlag the Federal fiscal year covered by the certifleatiou. The certificate set out below Is a material represent·rio· of' fact upon which reliance is placed what the afeney awards the t~*ant. FaiS~ ce~,Jflcation or violation or the certlflcatioa shall be 8rouads for suspension or.payments, suspension or termination of' ~,rants, or Goverumentwfde suspension or debarment (see ? CFR Part 30t?, Sections 30t?.615 and 30t?.620). States and State agencies using this form :hould send it to: U.S. Department of Agri. culture, Office ut' Finance and Management, Federal Ass,'~tance and Fiscal Policy Division, Federal Assist·lice Team, Room 3031 South Building, Wnshlagtoa, D.C. (BEFORE COMP[.gTING CERTIFICATION, READ INSTRUCTIONS ON PAGE :3) A. The grantee certifies that it will e~ will continue to provide a drug-free workplace by: (a) Publishing u statement notif~ing employees that the unlawful manufacture, distribution, dispensing, possessioa, or m or · controlled substance is proMbited ia the p'antee*s workplace and specifying the actions tht wilt be taken against employees for violation of such prohibition; (b) E~tabllshing tn ongoing drug. free awareness program to Inform employees about - (t) The danger3 of' drug abuse in the workplace: (2) The grantee's policy of' maintaining a drag-free workplace; : Any available drug counseling, rehabilitation, and employee assistance · programs; and (4) The penalties that may be imposed upu· employees for drug abuse violations occurring in the workplace; (c) Making it a requirement timt each employee to be engaged 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) th.~t, as a condition of. employment under the grunt, the employee ~ill - (t) Abide by the terms of the statement; and (2) Notify tile employer in 1 criminal drug statute occurring ir. the workplace no later than five calendar dan after such conviction: -. (e) Notifying the ~gency in writing, within ten ~:alendar days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction. Employers ef co6victed employees must provide notice, including position title, to every grant offker on whose grant activity the convicted employee was working. unless the Federal alone7 hal designated a central lmint for the receipt of such notices. Notice shall include the Identification number(s) of each affected grant; (f) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (d)(2}, with r~spect to any employee ~o Ls so convicted -- (1) Takln[ app~priate ~erSennel action against sud~ an employee~ up to and Indudlas teruinafl~ coft.-IsaMnt with the requirements or the Rehabilitation Act of 1913. as amended~ et (2) Requirin~ such emido~l~ to partleipaaM satisfactorily In a ~ abuse assistance or rehabilitation 1~ approved for such purposes by n Federal, State, or Io~! health~ law unrra'cement, m' other apl~eprinte agen~ (g) Maldng a goad faith elfm't to continue to ma,atain a drag-free workplace through Implementation of paragraphs (a), {b), (c), (d), (e) nnd This certification is for n ~ State (All ~'[ Single State Agency (check one) State Agencies} B. The grantee may Insert In the S~,l~ provided belmv the slaM(s) for the performance of wod~ done in connection with the specific g~"ant: Place of Perfor,,unce (Street eddress, icity, county. Sta~ zip code) Check ~ if there are workplaces on file that are not identified above. State/Slate Agency Name Name and T~tle of AuChorized Rep~nlali~e Please append to this form a list of any State agencies the Governor has excluded from this certil~cation. Form AD-10-~2 (REX,. INSTRUCTIONS FOR CERT1 FICATION I. l;y signing and submitting ti,is form, the grantee is providing the certification set out on pag..~.s 1 ............ and 2. 2. The certification set out on pages I and 2 is a material representation of fact upon which reliance is placed when the agency awnrdslthe grant, if it ts later determined that the grantee kno~6g'l'.v-.-.'.-': ......... rendered a false certification, or Otherwise violates the requirements of the Drug-Free Workplace Act. the agency, in addition to any other remedies available to the Federal Government, may take action authorized under the Drug:Free Workplace Act. 3. Workplaces under grants, for grantees other than individuals, J~eed not be identified on the certification. If known, they may be Identified In the grant application. If the grantee does not identify the workplaces at the time of application, or upon award, if there is no application, the grantee must keep the Identity of the workplace(s) on file in Its ofllce and make the Information available for Federal in~pectlon. Failure to identify all known workplaces constitutes a violation of the grantee's drug-free workplace requirements. 4. Workplace Identifications must include the actual address of buildings (or ports of buildings) or uther sites where work under the grant takes place. Categorical descriptions may be used (e.g., all vehicles of n mass transit atlth~rity or '~tate h~o~hway department while in operation, State e..;ployees in each local unemploy~nent office, pc. formers in concert halls or radio studios). 5. if the ~rkplace Identified to the ~gency changes during the performance of the grant, the grantee shall Inform the agency o( the change(s), if it previously Identified the workplaces in question (see paragraph three). 6. Definitions of terms, in the Nonprbcurement Susponsion and Debarment common rule and Drug- Free Workplace common rule apply to this certification. Grantcn."s* attention is called, in particular, to the following definitions from these rules: 'Controlled substance"means; a controlled substance in Schedule~ i through V of the Controlled Substances Act (2! IJ.S.C. $12) and as further defined by regulation (21 CFR 1308.11 through. 1308.15); "Conviction' means a finding of guilt (including a plea of nolo contendere) or imposition of sentence, or both, by any judicial body charged with the responsibility to determine violations of the Federal or State criminal drug statutes; 'Criminal drug statute' means a Federal or non-Federal criminal statute involving the manufacture, distribution, dispensing, use, or possession c,f any controlled substance; 'Employee' means the emplo)~e of a grantee directly engaged in the performance of work under a grant, including: (i) all 'direct charge' employees; (ii) all 'indirect charge' employees unless their impact or involvement is insignificant to the performance of the grant; and, (iii) temporary personnel and consultants who are directly engaged in the performance of work under the grant and who are on the grantee's pa.~n'oll. This definition does not include workers not on the pa)~'oll of the grantee (e.g., volunteers, even if used to meet a matching requirement; consultants or'independent contrnctors not on the grantee's payroll; or employees of subrecipients or subcontractors in covered workplaces). 3 Form AD-I0~2 (REV u.~. u~rRKIM:HI Ur AbKILULIUK~ Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions ~ebeeeent and Susp,~i~, T C~8 Pert 3017, SEcti~ 3017. SI0, Partitives' ~ei~sibi~ictes. .agricuLture i~y of firth1 t~e pe~ covee~ Cr~i~ti~. ~NSTRUCTZON$ F~tI~ CERTZFT. CATZOH Gove~t, tat ~ft~t er el~ ~y te~f~te becM ~he ~mm~l~ ~ the ~1~ ~ ~ ~ late ~11 The ~eKtl~ ~1~ ~rtlel~t f~ the C~tlff~tlm Il ~~. A e~lr~ re, ~ ~ ~t Lilt. ddf~tt. Z Certification For Contracts. Grants. Loans. and Cooperative A~reements The undersigned certifies, to the best of his or her knowledge and belief. that: : (1) No Federal appropriated funds have been pa/d or will be pa/d, by or on behalf of the undersiEned, to any person for tnfluenc/ng or attempt/rig to /nfluence an officer or employee of any aEency, a Member of ConsTess, an officer or employee of ConE~ess, or an employee of a Member of ConEress in connection with ~he award/ng of any Federal contract, the making of any Federa/ E~ant, the making of any Federal loan. the enterinE into of any cooperative aEreement, and the extension, continuation, renewal, amendment, or mod/fication of any Federsl contract, ~rsnt, loan, or cooperative aEreement o (2) If any funds other then Federal appropriated funds have been pa/d or will be ps/d to any person for influenc/ng or attempting to influence an officer or employee of any agency, a Member of CbnEress, an officer or employee of Con&~ess, or an employee of a Member of ConEress in connection with this Federal contract, Erant, loan, or cooperative a~reement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," /n 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 agreements) 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 S10.000 and not more than $100.000 for each such failure. Signature Date Name and Title