2005-037-RES AUTHORIZING EXECUTION OF A GRANT APPLICATION TO THROUGH ARK-TEX COUNCIL OF GOV. FOR A VIOLENCE AGAINST WOMENT ACT GRANT

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Supporting Documents Form 1. Equal Employment Opportunity Plan (EEOP) Certification A. eflnltlons Tel Enti - EducationaVmedicaVnon-profit institution/Native American Tribe - certification required (select appropriate ch ice below). EEOP NOT REQUIRED. Tell Enti - All other recipients receiving more than $25,000, but not more than $500,000 - certification required (select th appropriate choice below); organizations must maintain EEOP on file for possible audit if the organization has more th 50 employees. e III Enti - For profit entities and state and local governments receiving $500.000 or more - certifications required (s ect the appropriate choice below); the organization must submit an EEOP to the Office for Civil Rights (OCR) for ap roval. B. anlzation T e SELECT One: Clptiori4 . Option 1: I certify this organization Is a Type I Entity. This entity will comply with the prohibitions against discrimination in any program or activity (28 CFR ~42.203), is not required to maintain an Equal Employment Opportunity Plan, but will comply with equal employment opportunity program guidelines of the Department of Health and Human Services (28 CFR ~2.302). Option 2: I certify this organization Is a Type II Entity that employs less than 50 people. This entity will comply with the prohibitions against discrimination in any program or activity (28 CFR ~42.302). but Is not required to maintain an Equal Employment Opportunity Plan (28 CFR ~2.301 et seq). Option 3: I certify this organization Is a Type II Entity that employs 50 or more people. This entity will comply with prohibitions against discrimination in any program or activity (28 CFR ~2.302), and has formulated an Equal Employment Opportunity Plan (28 CFR ~42.302 et seq). that is on file in the office of: 11 Option 4: I certify this organization Is a Type 111 Entity. This entity will comply with the prohibitions against discrimination in any program or activity (28 CFR ~42.302), and has formuiated an Equal Employment Opportunity Plan (28 CFR ~2.301 et seq), that will be submitted to the Office for Civil Rights, Office of Justice Programs, Department of Justice, for approval upon award of a grant. 1. Debarment Certification A. he applicant certifies that it and its principals: . Are not presently debarred, suspended. proposed for debarment, declared ineligible, sentenced to a denial of Federai enefits by a State or Federal Court. or voluntarily excluded from participation in this transaction by any federal epartment or agency; . Have not within a three-year period preceding this application been convicted of or had a civil judgment rendered gains! them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or erforming a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state ntitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making alse statements, or receiving stolen property; . Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) ith commission of any of the offenses unumerated in section 1.2(a) of this form; and have not within a three-year period receding this application had one or more public transactions (federal, state, or local) terminated for cause or default; or B. If the applicant Is unable to certify to the above statements, SELECT 'Unable to Certify' and provide an explanation blow: Unable III Certify Page of 5 Supporling Documents Fonn