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GRANT APPLICATION CERTIFICATION FORM OFFICE OF THE GOVERNOR CRIMINAL JUSTICE DIVISION P.O. Box 12428 Ausm, TEXAS 78711 512/463 -1919 FAx: 512/475 -2440 WWW.G0VERN0R.STATE.TX.US Applicants must complete and submit this form before they will receive state and /or federal funds. Recipients of state and/or federal funds must read, agree, fully understand and comply with the requirements listed within in each form of this Grant Application Kit as detailed below. PART 1: CERTIFICATIONS The grant applicant must: 1. SELECT 'Certify' or'Unable to Certify for each document that has been certified as true and correct by the Authorized Official. 2. If you SELECTED 'Unable to Certify: a) a brief explanation must be given why the document cannot be certified at the time the grant application kit is submitted to CJD; and b) a date must be ENTERED that notifies CJD when your organization anticipates that the Authorized Official will be able to certify and submit the document to CJD. Description of Document "I Certify" "Unable to Explanation (ex: Incomplete, Not Date Certify" Applicable, etc. Determine Eligibility Form * ® ❑ VAWA Project Narrative & Summary ® ❑ Form Comprehensive Certification and ® ❑ Assurances — Federal Funds Form Cooperative Working Agreement ® ❑ Purpose and Participant Form Financial Capability Questionnaire ❑ ® not applicable Form Coversheet Form ® ❑ Budget Form ED 1 ❑ Match — GPI Form ® 1 ❑ ' Critical: The grant applicant must complete the Determine Eligibility Form in its entirety and submit to CJD with the grant application kit. if any portion of the form is left incomplete and the Authorized Official is unable to certify and /or submit the form, your project will be considered Ineligible and will not be reviewed by CJD. PART II: ATTACH RESOLUTION FORM The Resolution from the governing body must be submitted along with the Grant Application Certification Form to CJD. Please indicate the status of this document below: 1. a Is the Resolution Form attached to the certification form? I ❑ I Yes ® No b) If you selected 'No'. PROVIDE a brief explanation for the delay and the date that your 211212004 Date or anization anticipates submission to CJD: The Grant Coordinator has begun closing various files in his office in preparation of impending retirement, and personnel affected by this grant who were newly assigned responsibility for this year's application were unaware orthe grant deadline in enough time to have a resolution placed on the January City Council agenda. A resolution will be placed on the first agenda in February. PART 111: SIGNATURE The organization's Authorized Official hereby assures and certifies their authorization for the submission of this grant application kit in it's entirety to the Office of the Governor, Criminal Justice Division. City of Paris, Paris, Texas Violent Crimes Against Women Unit _ Applicant's Organization Project Title Michael E. Malone, City Manager ' 1116/2004 Name and Title of the Authorized Official Signature theFAuthafizig Official Effective Date CJD GRANTAPPucAnoN KIT— PAGE 11 VAWA (CFDA- 16.588) ISSUE DATE: NOVEMBER 2003 EV 9t131T A