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<br />GRANT ApPLICATION <br />CERTIFICATION FORM <br /> <br />OFFICE OF THE GOVERNOR <br />CRIMINAL JUSTICE DIVISION <br />P.O. Box 12428 <br />AUSTIN, TEXAS 78711 <br />512/463-1919 <br />FAX: 512/475-2440 <br />WWW.GOVERNOR.STATE.TX.US <br /> <br />Applicants must complete and submit this form before they will receive state andlor federal funds. <br />Recipients of state andlor federal funds must read, agree, fully understand and comply with the <br />requirements listed within in each form of this Grant Application Kit as detailed below. <br /> <br />PART I: CERTIFICATIONS <br /> <br />The grant applicant must: <br />1. SELECT 'Certify' or 'Unable to Certify' for each document that has been certified as true and correct by the <br />Authorized Official. <br />2. If you SELECTED 'Unable to Certify': <br />a) a brief explanation must be given why the document cannot be certified at the time the grant application kit <br />is submitted to CJD; and <br />b) a date must be ENTERED that notifies CJD when your organization anticipates that the Authorized Official <br />will be able to certify and submit the document to CJD. <br /> <br />Description of Document "I Certify" "Unable to Explanation (ex: Incomplete, Not Date <br /> Certify" Applicable, etc.) <br />Determine Eligibility Form * ~ D <br />VAWA Project Narrative & Summary 181 0 <br />Form <br />Comprehensive Certification and 181 0 <br />Assurances - Federal Funds Form <br />Cooperative Working Agreement 181 0 <br />Puroose and Particioant Form <br />Financial Capability Questionnaire 0 181 not applicable <br />Form <br />Coversheet Form 181 0 <br />Budaet Form 181 0 <br />Match - GPI Form 181 0 <br /> <br />* Critical: The grant applicant must complete the Determine Eligibility Form in its entirety and submit to CJD with <br />the grant application kit. If any portion of the form is left incomplete and the Authorized Official is unable to certify <br />and/or submit the form, your project will be considered Ineligible and will not be reviewed by CJD. <br /> <br />PART II: ATTACH RESOLUTION FORM <br /> <br />The Resolution from the governing body must be submitted along with the Grant Application Certification Form to <br />CJD. Please indicate the status of this document below: <br /> <br />1. a Is the Resolution Form attached to the certification form? No <br />b) If you selected 'No'. PROVIDE a brief explanation for the delay and the date that your <br />or anization antici ates submission to CJD: <br />The Grant Coordinator has begun closing various files in his office in preparation of impending retirement, and personnel affected by this <br />grant who were newly assigned responsibility for this year's application were unaware of the grant deadline in enough time to have a <br />resolution laced on the Janua Ci Council a enda. A resolution will be laced on the first a enda in Februa . <br /> <br /> <br />PART III: SIGNATURE <br /> <br />The organization's Authorized Official hereby assures and certifies their authorization for the submission of <br />this grant application kit in it's entirety to the Office of the Governor, Criminal Justice Division. <br /> <br />City of Paris, Paris, Texas <br />Applicant's Organization <br /> <br />Violent Crimes A~ainst Women Unit <br />Project Title <br /> <br />Michael E. Malone, City Manager <br />Name and Title of the Authorized Official <br /> <br /> <br />1/16/2004 <br />Effective Date <br /> <br />CJD GRANT ApPLICATION KIT - PAGE 11 <br /> <br />VAWA (CFDA-16.588) <br /> <br />ISSUE DA TE: NOVEMBER 2003 <br /> <br />~H\BlT A <br />