06-D GREAT Grant AwardDRAFT
J:Wttorney~isa~esolntionsACiJRRENTVGREAT Grant Awtl Res 2002.wptl
March 6, 2002
RESOLUTION NO.
A RESOLUTION OF THE CITY OF PARIS, PARIS, TEXAS, ACCEPTING
THE GANG RESISTANCE EDUCATION AND TRAINING (G.R.E.A.T.)
PROGRAM GRANT; AUTHORIZING THE EXECUTION OF
COOPERATIVE AGREEMENT NO. ATC020223; MAHING OTHER
FINDINGS AND PROVISIONS RELATED TO THE SUBJECT; AND
DECLARING AN EFFECTIVE DATE.
WHEREAS, the City of Paris Police Deparhnent has been involved in the Gang Resistance
Education and Training (G.R.E.A.T.) Program since 1996; and,
WHEREAS, the Deparhnent of the Treasury, Bureau of Alcohol, Tobacco, and Firearms,
has issued its Grant Award entitled "G.R.E.A.T. Program" grantfor the period beginning January 16,
2002, and ending January 15, 2003, in the total amount of $48,282.50, which requires no matching
funds from the City of Paris; and,
WHEREAS, acceptance of the same requires the execution of Cooperative Agreement No.
ATC020223 by and between the City of Paris and the Bureau of Alcohol, Tobacco, and Firearms,
and it is deemed to be in the best interests of the citizens of Paris that the City of Paris accept said
Grant Award and continue to improve the G.R.E.A.T. Program in the City of Paris; and,
WHEREAS, the form ofCooperative AgreementNo. ATC020223, attached hereto as Exhibit
A, should, in all things, be approved, and the City Manager should be authorized to execute the same;
NOW, THEREFORE,
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF PARIS, PARIS,
TEXAS:
Section 1. That the findings set out in the preamble to this resolution are hereby in all things
approved.
Section 2. Thatthe "Gang Resistance Education and Training (G.R.E.A.T.) Program" grant
for the period beginning January 16, 2002, and ending January 15, 2003, in the total amount of
$48,282.50, requiring no matching funds from the City ofParis, be, and the same is hereby, accepted.
Section 3. That the form of Cooperative Agreement No. ATC020223, attached hereto as
Exhibit A, be, and the same is hereby, approved.
Section 4. That the City Manager be, and he is hereby, authorized and directed to execute,
on behalf of the City of Paris, Cooperative Agreement No. ATC020223, under the terms and
conditions and in the form shown in Exhibit A, attached hereto.
Section 5. That this resolution shall become effective from and after its date of passage.
PASSED AND APPROVED this l lth day of March, 2002.
Michael J. Pfiester, Mayor
ATTEST:
Thomas E. Haynes, Assistant City Clerk
APPROVED AS TO FORM:
Larry W. Schenk, City Attorney
.,a
COOPERATIVE AGREEMENT NO. ATC020223
BETWEEN
The City of Parie, Texas
AND
BUREAU OF ALCOHOL, TOBACCO AND FIREARMS
PURPOSE
The purpose of this Cooperative Agreement (agreement) is to
establish a legal relationship between the Bureau of
Alcohol, Tobacco and Firearms (ATF) and the Paris Police
Department, Paris, Texas(LOCAL GOVERNMENT). This agreement
sets forth the responsibilities for the operation of the
gang prevention program known as Gang Resistance Education
and Training (G.R.E.A.T.) in the City of Paris, Texas. All
terms and conditions herein are binding upon execution of
the agreement by both parties.
2. PERIOD OF PERFORMANCE
This agreement is limited to the operation of the G.R.E.A.T.
Program. The period of performance begins January 16, 2002
and ends January 15, 2003. However, ATF intends to continue
the legal relationship in the future, subject to continuing
congressional appropriations. In future years, no legal
liability on the part of ATF or the Federal Government shall
accrue unless funds are made available to the CAO and the
LOCAL GOVERNMENT receives written notification of the amount
of funds available. The continuation of the agreement in
future years will be subject to a reapplication process by
the LOCAL GOVERNMENT.
3. SCOPE OF WORK
In the Treasury, Postal Service and General Government
Appropriation Bill for the Fiscal Year ending
September 30, 2001, ATF was directed to continue operation
of the G.R.E.A.T. Program, which was originally started as
PROJECT OUTREACH in the Fiacal Year 1992 appropriation.
G.R.E.A.T. is a project which uses the skills of ATF, State
and local law enforcement personnel, as well as individuals
from community and civic groups, to develop a program that
educates youth about the dangers associated with joining
E3CHIBIT A i
COOPERATIVE AGREEMENT NO. ATC020223
street gangs. G.R.E.A.T. consists of three major phases:
Phase I School-Based Education
Phase II Summer Education/Recreation
Phase III Parent Involvement Program
4. COOPERATIVE AGREEMENT PLAN
During the period of performance the G.R.E.A.T. Program will
be implemented and continued as follows:
A. RESPONSIBILITIES OF the City of Paris., Texas
The City of Paris, Texas, through the Paris Police
Department, will participate in the G.R.E.A.T. Program as
specified below:
(1) Phase I- The LOCAL GOVERNMENT shall arrange with
local area middle/junior high schools, to schedule 13 one
period classes,(for those agencies whose officers have
been re-certified in the new G.R.E.A.T. Curriculum. All
others will continue to teach the nine class curriculum
until they have been re-certified) in a sufficient number
of instructional blocks so as to instruct a minimum of
576 students per year on the dangers of gangs in
accordance with the G.R.E.A.T. Program lesson plans.
Classes will be taught in an appropriate education time
slot as determined by local school officials. These
classroom lessons are to be presented during the school
year of the performance period of the agreement as
specified in Section 2 of this agreement. The lessons
will be taught to middle/junior high school students
within the City of Paris school system or approved after-
school settings.
The LOCAL GOVERNMENT is required to order graduation
certificates from the G.R.E.A.T. Program Office for
student participants of the program. Certificates are
provided free of charge and should be ordered at least 8
weeks prior to graduation. Requests for certificates
should be mailed to the address listed in Section 15.C.
The number of certificates ordered shall reflect the
actual number of students enrolled in the program, as
this information will be used as a factor in determining
future funding.
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COOPERATIVE AGREEMENT NO. ATC020223
PHASES II and 22I OF G.R.E.A.T.
The LOCAL GOVERNMENT shall submit an implementation plan
for phases II and III by May 1, 2002. Implementation of
Phases II and III must support Phase I of this agreement
and be in accordance with the following guidelines:
Phase II
The LOCAL GOVERNMENT will be required to coordinate summer
education/recreation activities at sites selected by the
cognizant police department.
Additionally, the LOCAL GOVERNMENT will attempt to match
available existing community programs and resources with
G.R.E.A.T. students and graduates.
These summer components must be in accordance with the
G.R.E.A.T. programs guidelines for this section. Copies
of approved activities and educational components can be
obtained from the G.R.E.A.T. program Branch.
Phase 222
The LOCAL GOVERNMENT will institute an education program
for parents of youth involved in gangs and/or at risk of
joining gangs, and for parents of other Phase I
participants.
These family components must be in accordance with the
G.R.E.A.T. programs guidelines for this section. Copies
of approved activities and educational components can be
obtained from the G.R.E.A.T. program Branch.
Under the terms of this agreement, ATF will not
reimburse the LOCAL GOVERNMENT for any expenses
incurred after the end of the period of performance
specified in Section 2.
(3) The LOCAL GOVERNMENT agrees to provide an officer(s)
part-time, to assist the G.R.E.A.T. Program as a Team
Leader(s). The LOCAL GOVERNMENT agrees to allow an
officer(s) to complete G.R.E.A.T. Officer Training,
teach the G.R.E.A.T. curriculum, complete G.R.E.A.T.
4
COOPERATIVE AGREEMENT NO. ATC020223
I
Management Leader training, and assist the National
Training Team as a Team Leader. The LOCAL GOVERNMENT
agrees to provide the services of said Team Leader(s) for
G.R.E.A.T. training sessions during the period of
performance of this agreement at the rate of 2 weeks per
$50,000 dollars of award.
Amount of Award Reauired Weeks
$50,000
2
$100,000
4
$150,000
6
$200,000
8
$250,000
10
$300,000
12
$350,000
14
$400,000
16
Local governments that are in their first year of federal
funding are excluded from the above requirement. However,
it is suggested that the LOCAL GOVERNMENT designate an
officer to complete team leader training. In the event
funding becomes available for the following year, the
LOCAL GOVERNMENT will be required to provide an
officer(s) in accordance with paragraph 4 above.
(4) It is the responsibility of the LOCAL GOVERNMENT to
plan, initiate and oversee the completion of the
G.R.E.A.T. Program; to prepare quarterly progress
reports and quarterly requests for payments; to certify
the accuracy of contractor and vendor billings; to
ensure the cost efficient and timely completion of the
project; and to immediately notify ATF, in writing, of
any issues or problems, real or anticipated, which might
affect the successful completion of the project within
the time frame and funding established in the agreement. (5) It ie the responsibility of the LOCAL GOVERNMENT to
enaure that Officer's regular and overtime salariea shall
not exceed 70% of the total amount obligated under this
agreement. It is also tha reaponaibility of the LOCAL
GOVERNMENT to ensure that any funds requested for regular
or overtime salaries muat be G.R.E.A.T. related and the
funds must be for certified G.R.E.A.T. officere or
exceptions approved by the Branch.
5
COOPERATIVE AGREEMENT NO. ATC020223
(6) Expenditures for equipment, furniture or other
capital assets may be reimbursed, but only if prior
written approval for the purchase is obtained from the
Government Technical Representative (GTR). " Equipment
means an article of non-expendable, tangible personal
property having a useful life of more than one year.
" Other Capital Assets " means buildings, land, and
improvement to buildings or land that materially increase
their value or useful life.
Expenditure requests must be submitted in writing to the
GTR. The request shall include the item(s) to be purchased, quantity, per item cost, extended cost, useful
life and a justification as to why such an expenditure is
required and how it benefits the G.R.E.A.T. program. The
request must also include any previous purchases of the
same or similar item. Total of expenditures for
equipment, furniture or other capital assets shall not
exceed 20°s of the total amount obligated under this
agreement. Upon receiving written approval from the GTR
and once this equipment is purchased, the LOCAL
GOVERNMNET must submit a list of this equipment and any
applicable serial numbers to the GTR for accountability
purposes.
(7) The LOCAL GOVERNMENT must submit to the GTR a
semi-annual report within 45 days of the close of each
calendar quarter. This report shall describe the
programmatic and financial status of the project. The
GTR shall be advised of any significant programmatic or
financial adjustments/modifications. A progress report
format is provided in Attachment V. Failure to submit the
first 2 quarterly reports will result in a non-compliance
judgment with the agreement and any further expenditures
will not be reimbursed. ,
A final agreement report must be submitted by the LOCAL
GOVERNMENT within 45 days after the completion of the
project. This final report will contain the date of
completion, final costs, and a statement that the
agreement is completed.
Failure to submit semi-annual progress reports or the
final agreement report may be interpreted as
non-compliance with this agreement and will be utilized
in any further requests for funding.
6
.
COOPERATIVE AGREEMENT NO. ATC020223
B
RESPONSIBILITIES OF ATF FOR REIMBURSEMENT
(1)(a) ATF has obligated, to the City of Paris, Texas,
$48,282.50 for the school-based education phase of the
G.R.E.A.T. Program. Funds are provided to reimburse the
LOCAL GOVERNMENT's cost incurred as follows:
* Officers' time , regular and overtime, must be
G.R.E.A.T. related and documented with a
signature from an authorizing official;
* G.R.E.A.T. training expenses, such as
instructional materials, workbooks, instructor
fees, and guest speakers' fees;
* Expenses incurred in connection with officers
receiving G.R.E.A.T. officer training. This
includes transportation, lodging and per diem in
accordance with Federal Travel Regulation.
Officer's time (regular and overtime) will be
paid during training. Overtime shall not exceed
10 hours per week during training;
* Printed materials such as student handbooks,
and awards;
* Administrative expenses, directly supporting
G.R.E.A.T. activities, such as general office
supplies, office space leases, and clerical
support directly supporting G.R.E.A.T.
activities, during the term of this agreement;
and
* Expenses for G.R.E.A.T. promotional materials
such as pamphlets, bumper stickers, hats,
T-shirts, buttons, pens and pencils.
* Any items bearing the
must be purchased from
authorized vendors:
G.R.E.A.T. name or logo
one of the following
Best Expression
21606 N. 3rd Ave.
Phoenix, AZ 85027
800-932-8931
www.bestexpression.com
7
Creative Impression
5305 E. 18`h Street
Vancouver, WA 98661
800-654-0724
COOPERATIVE AGREEMENT NO. ATC020223
Treadway Graphics
Sav-on Printing
1401 Cannon Circle
4520 N. 19`" Ave.
Fairbault, MN 55021
Phoenix, AZ 85015
800-653-7063
602-242-2308
www.treadwavaraphics.com
Industries for the Blind,
Inc.
3220 West. Vilet Street
Milwaukee, WI 53208
414-933-4319
www.ibmilw.com
Any expenditure in excess of $1,000, for other than
equipment, furniture or other capital assets and excluding
those made from the authorized G.R.E.A.T. vendors above, must
be pre-approved, in writing, by the GTR. In addition, any
expenditures for guest speakers, training, (other than
G.R.E.A.T. Officer training), or ceremonies must be pre-
approved in writing with the GTR.
Any expenditure in excess of $5,000 made from the G.R.E.A.T.
vendors above, must be pre-approved, in writing, by the GTR.
(b) Reimbursements will be made only when a completed
SF-270, Request for Advance or Reimbursement form,
attachment I, is provided by the Local Government in
accordance with the terms of this agreement.
(2) It is the responsibility of the GTR or designee to
monitor the project status, to review and certify interim
and final payment requests submitted by the LOCAL
GOVERNMENT and; to ensure that the funding limitations in
paragraphs 4.A.5, 4.A.6, 4.B.1.A and 4.B.1.D have not
been exceeded.
C. THIRD/FOURTH GRADE SCHOOL-BASED EDUCATION PROGRAM
In addition to the G.R.E.A.T. middle/junior high school
component, the LOCAL GOVERNMENT may elect to teach a
third/fourth grade G.R.E.A.T. component.
The LOCAL GOVERNMENT shall arrange with local area
elementary schools, to schedule four one-period sessions
to instruct third and fourth grade students on the
dangers of gangs, in accordance with the G.R.E.A.T.
Program lesson plans. Classes will be taught in an
8
COOPERATIVE AGREEMENT NO. ATC020223
I I
appropriate education time slot, as determined by local
school officials. These classroom lessons are to be
presented during the school year of the performance
period of the agreement as specified in Section 2 of
this agreement. The lessons will be taught to third and
fourth grade students within the City of Paris school
system.
Under the terms of this agreement, ATF will not
reimburse the LOCAL GOVERNMENT for any expenses
incurred after the end of the period of performance.
D. Limitations - Other than the administrative costs
expressly set out in paragraph B(1)(a), above, no
administrative expenses or costs, whether direct or
indirect, shall be reimbursed under this agreement.
5. FUNDING, PAYMENT AND SUBMISSION OF INVOICES
A. ATF will obligate $48,282.50 for reimbursement under this
agreement. Requests for reimbursement for work completed
will be made by the LOCAL GOVERNMENT on a SF-270, Request
for Advance or Reimbursement, attachment I, to the GTR for
review and certification. Payments will only be issued to
the LOCAL GOVERNMENT, and not vendors or contractors.
ATF will not provide funding in excess of the amount
specified for each year the agreement is in effect. The
LOCAL GOVERNMENT accepts responsibility for all costs
associated with the G.R.E.A.T. Program which exceed the
level of funding provided by ATF.
B. Requests for Reimbursements shall be submitted by the
LOCAL GOVERNMENT on a quarterly basis as follows:
(1) Original SF-270, Request for Advance or Reimbursement
form, along with receipts/invoices supporting
reimbursement request to the GTR. Requests for travel
reimbursements must include the TRAVEL REIMBURSEMENT
9
COOPERATIVE AGREEMENT NO. ATC020223
SHEET Attachment II). The GTR's address is as follows:
Bureau of Alcohol, Tobacco and Firearms
ATTN: Cooperative Reimbursement Section
P.O. Box 50418
Washington, DC 20091-0418
The LOCAL GOVERNMENT will provide ATF with whatever
payment information is necessary to transfer funds
(electronic payment information, bank account numbers,
etc.) to the LOCAL GOVERNMENT. .
C. Title 31 of'the Code of Federal Regulations, Part 208,
effective July 01, 1997, mandates that Federal payments
under cooperative agreements be made via electronic
funds transfer (Waiver: Department of the Treasury
check(s) will be issued ONLY when the LOCAL GOVERNMENT
certifies in writing that the recipient does not have an
account at a financial institution or authorized payment
agent).
(1) The following applies only to Direct Deposit
payments:
The LOCAL GOVERNMENT shall forward a completed SF-
3881, ACH Vendor/Miscellaneous Payment Enrollment
Form, attachment III with this signed agreement.
(a) The Agency Information is preprinted to issue
payment from ATF.
(b) The Payee/Company Information is to be
completed by the Payee. The Taxpayer
Identification Number (TIN) must be provided.
The TIN is the Employer ldentification Number.
Notice of each Direct Deposit will be
forwarded to the address listed.
(c) The Financial Institution Information should be
completed by the Payee's Financial Institution.
(d) All payments will be made to checking or
savings accounts, not lockboxes.
11
(e) Financial Institutions must list their nine
digit American Bankers Association (ABA)
10
COOPERATIVE AGREEMENT NO. ATC020223
identifying number. This number is used for the
routing of direct deposited funds. (Provide this
number only if the receiving financial institution
has access to the Federal Reserve Communications
System).
(f) If the receiving financial institution does not
have access to the Federal Reserve Communications
System, provide the name of the correspondent
financial institution through which the receiving
financial institution receives electronic funds
transfer messages. '
(2) Any changes to funding and payment information
shall be furnished to ATF at the address in
paragraph 15.B, in writing, at least 30 days before
the effective date of the change. It is the LOCAL
GOVERNMENT'S responsibility to furnish these
changes promptly to avoid payments to erroneous
addresses or bank accounts.
(3) All documents furnishing payee information from the
agreement recipient must be dated and contain the
signature, title, and telephone number of the
agreement recipient official authorized to provide
it, as well as the agreement recipient's name.
D. The LOCAL GOVERNMENT certifies, by signing the SF-270
form, attachment I, that all requests for reimbursement
submitted shall be supported by valid receipts/invoices
which are in accordance with the project authorized in
this agreement. Copies of paid invoices shall be clearly
marked with the appropriate agreement number to which
they are charged and maintained in the agreement project
file by the LOCAL GOVERNMENT. All such documentation ,
shall be made available for review upon the request of
ATF or any Federal audit agency.
Funds specified and approved for G.R.E.A.T. shall not be
transferred to another project or be used for any other
purpose, unless authorized by a written modification to
this agreement signed by the LOCAL GOVERNMENT and the
CAO or his designee.
E. The LOCAL GOVERNMENT certifies that no request for
payment will be submitted for work, materials or
11
COOPERATIVE AGREEMENT NO. ATC020223
services which have been previously funded by any other
source.
F. The LOCAL GOVERNMENT will maintain such books, records,
documents and other records that will accurately
document all costs relating to this agreement in
accordance with State laws and procedures for expending
and accounting for its own funds. This documentation
must be kept for a period of at least three years
following the end of the agreement's period of
performance and final payment. All such documents will
be subject to.periodic on-site review as deemed .
necessary by ATF and any Federal audit ageneies
including any Contractor hired by the Federal Government
to perform audit services.
6. INSPECTION/ACCEPTANCE
Inspection and acceptance of all supplies and services under
this agreement shall be accomplished by ATF's GTR or someone
otherwise designated by the CAO.
7. MODIFICATIONS
A. The CAO may at any time, by written order, make changes
within the general scope of this agreement in any one or
more of the following:
(1) Description of services to be performed.
(2) Period of Performance
B. Modifications that change any part of the agreement or
the responsibilities of the LOCAL GOVERNMENT must be made
by mutual agreement of both parties. Failure to agree to "
any modification shall be a dispute under the DISPUTES
clause (Section 11) of this agreement. However, nothing
in this clause shall excuse the LOCAL GOVERNMENT from
proceeding with the agreement as changed.
C. Notwithstanding the terms and conditions of paragraphs A
and B above, the estimated cost of this cooperative
agreement shall not be increased or considered increased
except by specific written modification of the agreement
12
COOPERATIVE AGREEMENT NO. ATC020223
indicating the new agreement total. Until this
modification is made, the LOCAL GOVERNMENT is not
authorized to incur costs beyond those specified under
Section 5.A of this agreement.
8. ASSURANCES
This agreement provides for Federal participation in an
education and public awareness program to warn youth about
the dangers of gangs. A local government receiving Federal
funds under this agreement is required to assure and certify
that it will, as a condition of receiving the funds, comply
with applicable Federal laws and regulations governing
cooperative agreements. By acceptance of this agreement the
LOCAL GOVERNMENT assures and certifies that it will comply
with the regulations in Attachment IV of this agreement, as
well as other listed regulations, policies, guidelines, and
requirements listed in the agreement, including OMB Circular
A-87-Cost Principles for State, Local and Indian Tribal
Governments, A-102-Uniform Administrative Requirements for
Grants and Cooperative Agreements to State and Local
Governments, and A-133-Audits of State and Local
Governments, as they relate to participation in the
G.R.E.A.T. Program.
In this agreement, the term "Contractor" used in Attachment
IV Clauses and Provisions refers to the "LOCAL GOVERNMENT."
9. PUBLICATIONS AND NEWS RELEASES
A. Definition. For the purpose of this clause,
"publication" includes:
(1) Any document containing information for public
consumption; or,
(2) The act of, or any act which may result in,
disclosing information to the public.
B. The results of this program are planned to be made
available to the public through such means as the Director
of ATF shall determine.
C. Federal Government Ownership of Official Products of
Work.
All interim and final reports and information, data
analyses, special methodology, findings, and their related
13
COOPERATIVE AGREEMENT NO. ATC020223
documents and work products, including reports, work sheets,
survey instruments, computer tapes, and any other physical
materials and products produced directly under this
agreement are considered Official Products of Work, owned by
the Federal Government and held for the benefit of the
public. Further, the LOCAL GOVERNMENT acknowledges that it
will not acquire any rights in data or goodwill for any of
the materials or products produced under this agreement.
D. Independent and Special Products
During the term of this agreement, works authored,
composed, or developed by the LOCAL GOVERNMENT and approved
by the G.R.E.A.T. National Policy Board, including but not
limited to brochures, curriculum, student handbooks,
instructor manuals, newsletters, pamphlets, and other
products developed to enhance the G.R.E.A.T. Program are
considered to be Independent and Special Products.
E. Publication of Official Products of Work
Official Products of Work, quotations therefrom,
paraphrasing, or disclosures of interim findings may not be
published without the written approval of the GTR for a
period of 60 days after acceptance of the product by the
GTR. Thereafter, the LOCAL GOVERNMENT shall be free to
publish without ATF approval.
F. Acknowledgement and Disclaimer
(1) All Official Products of Work, or any part
thereof, developed through the use of funds provided
for under this instrument, when published by the
LOCAL GOVERNMENT or other participants in the work,
shall contain the following acknowledgement and
disclaimer: ,
"The work that provided the basis for this
publication was supported by funding under a
Cooperative Agreement with the Bureau of Alcohol,
Tobacco and Firearms. The substance and findings
of the work are dedicated to the public. The
author and publisher are solely responsible for
the accuracy of the statements and interpretations
contained in this publication. Such
interpretations do not necessarily reflect the
views of the Federal Government."
14
COOPERATIVE AGREEMENT NO. ATC020223
(2) All Independent and Special Products, or any parts
thereof, developed through the use of funds provided for
under this instrument, when published by the Local
Government or other participants in the work, shall
contain the following acknowledgement and disclaimer:
"The work that provided the basis for this
publication was supported in part by funding under
a cooperative agreement with the Bureau of
Alcohol, Tobacco and Firearms, which maintains its
rights in this publication as set forth in 41
C.F.R. 3105-71.134. The author and publisher are
solely responsible for the accuracy of the
statements and interpretations contained in this
publication. Such interpretations do not
necessarily reflect the views of the Federal
Government."
G. Notice of News Release and Public Announcements
Two copies of all press releases, formal announcements, and
other planned, written issuance's containing news or
information concerning this agreement that may be made by
the LOCAL GOVERNMENT or its staff, or any subcontractor or
other person or organization participating in the work of
this agreement shall be provided to the GTR at the earliest
possible time. News releases and other public announcements
may not disclose any interim finding or quote or paraphrase
any part of any Official Product of Work without complying
with paragraphs (E) and (F) above.
10. COLLECTION'OF DATA
Collection of information from ten or more persons and
sponsored by ATF, shall be subject to S CFR 1320. A `
collection of information undertaken by a recipient of a
Federal cooperative agreement is considered to be sponsored
by ATF only under the following conditions:
A. The recipient of a cooperative agreement is collecting
information at the specific request of the agency; or
The terms and conditions of the cooperative agreement
require specific approval by the agency of the
collection of information or the collection procedures.
15
COOPERATIVE AGREEMENT NO. ATC020223
11. DISPUTES
A
B
It is hereby agreed upon that this agreement is subject
to the Contract Disputes Act of 1987, as amended (41
U.S.C. 601-613).
Except as provided in the Act, all disputes arising
under or relating to this agreement shall be resolved
under this clause.
C. "Claim," as used in this clause, mearis a written demand
or written assertion by one of the agreement parties
seeking, as matter of right, the payment of money in a
sum certain, the adjustment or interpretation of
agreement terms, or other relief arising under or
relating to this agreement. A claim arising under a
cooperative agreement, unlike a claim relating to that
agreement, is a claim that can be resolved under a
cooperative agreement clause that provides for the
relief sought by the claimant. However, a written
demand or written assertion by the LOCAL GOVERNMENT
seeking the payment of money exceeding $100,000 is not a
claim under the Act until certified as required by
subparagraph D(2) of this clause. A voucher, invoice,
or other routine request for payment that is not in
dispute when submitted is not a claim under the Act.
The submission may be converted to a claim under the
Act, by complying with the submission and certification
requirements of this clause, if it is disputed either
as to liability or amount or is not acted upon in a
reasonable time.
D. (1). A claim by the LOCAL GOVERNMENT shall be made in
writing and, unless otherwise stated in this cooperative
agreement, submitted within 3 years after accrual of the
claim to the CAO for a written decision. A claim by the
Government against the LOCAL GOVERNMENT shall be subject
to a written decision by the CAO.
(2). The LOCAL GOVERNMENT shall provide the
certification specified in subparagraph D(4) of this
clause, in writing, when submitting any claim.
16
COOPERATIVE AGREEMENT NO. ATC020223
(a) Exceeding $100,000; or
(b) Regardless of the amount claimed, when using.
1. Arbitration conducted pursuant to 5 U.S.C.
575-580; or
2. Any other alternative means of dispute
resolution (ADR) technique that the agency
elects to handle in accordance with the
Administrative Dispute Resolution Act '
(ADRA).
(3). The certification requirement does not apply to
issues in controversy that have not been submitted
as part of a claim.
(4). The certification shall state as follows: "I
certify that the claim is made in good faith; that the
supporting data are accurate and complete to the best of
my knowledge and belief; that the amount requested
accurately reflects the agreement adjustment for which
the LOCAL GOVERNMENT believes the Government is
liable; and that I am duly authorized to certify the
claim on behalf of the LOCAL GOVERNMENT."
(5). The certification may be executed by any person
duly authorized to bind the LOCAL GOVERNMENT with
respect to the claim.
E. For LOCAL GOVERNMENT claims of $100,000 or less, the CAO
must, if requested in writing by the LOCAL GOVERNMENT,
render a decision within 60.days of the request. For
LOCAL GOVERNMENT-certified claims over $100,000, the CAO
must, within 60 days, decide the claim or notify the
LOCAL GOVERNMENT of the date by which the decision will
be made.
F. The CAO's decision shall be final unless the LOCAL
GOVERNMENT appeals or files a suit as provided in the
Act.
17
COOPERATIVE AGREEMENT NO. ATC020223
G. If the claim by the LOCAL GOVERNMENT is submitted to the
CAO or a claim by the Government is presented to the
LOCAL GOVERNMENT, the parties, by mutual consent, may
agree to use ADR. If the LOCAL GOVERNMENT refuses an
offer for alternative disputes resolution, the LOCAL
GOVERNMENT shall inform the CAO, in writing, of the
LOCAL GOVERNMENT's specific reasons for rejecting the
request. When using arbitration conducted pursuant to
5 U.S.C. 575-580, or when using any other ADR technique
that the agency elects to handle in accordance with the
ADRA, any claim, regardless of amount, shall be
accompanied by the certification described in subparagraph D(4) of this clause, and executed in
accordance with subparagraph D(5) of this clause.
H. The Government shall pay interest on the amount
found due and unpaid from (1) the date that the CAO
receives the claim (certified, if required); or (2) the
date that payment otherwise would be due, if that date
is later, until the date of payment. With reqard to
claims having defective certifications, as defined in
(FAR) 98 CFR 33.201, interest shall be paid from the
date that the CAO initially receives the claim. Simple
interest on claims shall be paid at the rate, fixed by
the Secretary of the Treasury as provided in the Act,
which is applicable to the period during which the CAO
receives the claim and then at the rate applicable for
each 6-month period as fixed by the Treasury Secretary
during the pendency of the claim.
I. The LOCAL GOVERNMENT shall proceed diligently with
performance of this agreement, pending final resolution
of any request for relief, claim appeal, or action
arising under the contract, and comply with any decision of the CAO.
12. STOP WORK
A. The CAO or his designee may issue, and the LOCAL
GOVERNMENT will accept, a written order to hold or Stop
Work on the G.R.E.A.T. Program funded under this
agreement for a period of up to 30 days. Such orders
will be issued only for sufficient cause, such as reason
to believe work is being performed outside of the terms
18
COOPERATIVE AGREEMENT NO. ATC020223
of the agreement, for financial improprieties found
during a monitoring inspection or voucher and records
review, or a change in relevant laws or regulations.
B. A Stop Work Order may be continued, cancelled or
reissued as termination.
C. The LOCAL GOVERNMENT is responsible for any Costs
incurred after the issuance of a Stop Work Order
unless such work, material, equipment or services
were purchased prior to the issuance of the Stop
Work Order and delivery cannot be cancelled.
13. TERMINATION
A. The Government may terminate performance of work
under this agreement in whole, or in part, if the CAO
determines that a termination is in the Government's
interest. The CAO shall terminate by delivering to the
LOCAL GOVERNMENT a Notice of Termination specifying the
extent of termination and the effective date.
(1) After receipt of a Notice of Termination and except
as directed by the CAO, the LOCAL GOVERNMENT shall
immediately proceed with the following obligations:
(a) Stop work as specified in the notice.
(b) Place no further orders, except as necessary to
complete the continued portion of the
agreement.
(c) Terminate all applicable subcontracts and cancel
or divert applicable commitments covering
personal services that extend beyond the '
effective date of termination.
(d) Take any action that may be necessary for the
protection and preservation of the property
related to this agreement that is in the
possession of the LOCAL GOVERNMENT and in
which the Government has or may acquire an
interest.
19
COOPERATIVE AGREEMENT NO. ATC020223
t
(e) Within 60 days after the date of termination,
the LOCAL GOVERNMENT shall submit a final report
along with a final SF-270, Request for Advance
or Reimbursement (ATTACHMENT I), to the GTR.
B. This Agreement may be terminated in-full or in-part by
the LOCAL GOVERNMENT at anytime prior to the completion
of the Program listed in the Agreement. The LOCAL
GOVERNMENT shall notify the CAO, in writing, prior to
the proposed date of termination.
14. REPORTS
A. The LOCAL GOVERNMENT shall submit to the GTR a semi-
annual report within 45 days of the close of each
six month period. This report shall describe the
programmatic and financial status of the project.
The GTR shall be advised of any significant
programmatic or financial adjustments/modifications. A
progress report format is provided in Attachment V.
B. A final agreement report shall be submitted by the LOCAL
GOVERNMENT within 45 days after the completion of the
project. This final report will contain the date of
completion, final costs, and a statement that the
agreement is completed.
C. Failure to submit semi-annual progress reports or the
final agreement report may be interpreted as
non-compliance with this agreement.
15. GOVERNMENT REPRESENTATIVES
A. The Cooperative Agreement Officer (CAO) is the Chief or
Deputy Chief, Acquisition and,'Property Management .
Division, located at 650 Massachusetts Avenue, NW, Room
3290, Washington, DC 20226, phone number (202) 927-8820.
B. The Cooperative Agreement Administrator (CAA) is
Kevin R. Merriweather, located at 650 Massachusetts
Avenue, NW, Room 3290, Washington, DC 20226, phone number
(202) 927-7716.
20
COOPERATIVE AGREEMENT NO. ATC020223
C. The Government Technical Representative (GTR) is
Juanita Wright, located at P.O. Box 50418, Washington,
DC 20091-0418, phone number (202) 927-2160.
16. LIMITATION OF TECHNICAL DIRECTION FROM THE GTR
A. Performance of work under this agreement shall be
subject to the technical direction of the GTR identified
in paragraph 15.C. of this agreement, or a designated
representative. The term "technical direction" is
defined to include, without limitation, direction to the
LOCAL GOVERNMENT which directs or redirects the labor
effort, shifts the work between work areas or locations,
further defines tasks and otherwise serves to ensure
that the tasks outlined in the agreement are
accomplished in a satisfactory manner.
B. Technical direction must be within the scope of the
agreement. The GTR does not have the authority to, and
may not, issue any technical direction which:
(1) Constitutes a change of assignment or additional
work outside the scope of work of the agreement;
(2) Constitutes a change in the agreement that
requires a modification as specified in Section 7
"MOdifications."
(3) In any manner cause an increase or decrease in the
agreement price, or the time required for agreement
performance.
(4) Changes any of the terms, conditions or scope of
work of the agreement; or
(5) Interferes with the LOCAL GOVERNMENT's right to
perform under the terms and conditions of the
agreement.
C. Technical directions may be oral or in writing, by GTR
or a designee with written delegated authority from the
CAO. Oral directions shall be confirmed in writing
within two working days of issuance.
D. The LOCAL GOVERNMENT shall proceed promptly with the
21
COOPERATZVE AGREEMENT NO. ATC020223
performance resulting from technical directions issued
by the GTR, or his designee. If in the opinion of the
LOCAL GOVERNMENT, any instruction or direction of the
GTR, or his designee, falls within the purview defined
in paragraph b.l. through S. above, the LOCAL GOVERNMENT
shall immediately notify the CAO no later than the
beginning of the next Government workday.
E. Failure of the LOCAL GOVERNMENT and the CAO to agree
that the technical directions are within the scope of
the agreement shall be subject to the terms of the
clause entitled Disputes in Section 11.
17. COOPERATIVE AGREEMENT OFFICER'S AUTHORITY
The CAO is the only person authorized to approve
modifications to this agreement. This authority remains
solely with the CAO. In the event the LOCAL GOVERNMENT
affects any modifications at the direction of any person
other than the CAO, the modifications will be considered to
have been made without authority and no adjustment will be
made to the agreement. The CAO shall be the only individual
authorized to accept non-conforming work, waive any
requirement of the agreement, and/or modify any term or
condition of the agreement. The CAO is the only individual
who can legally obligate the Government to expend public
funds.
18. Attachments I(SF-270 REQUEST FOR ADVANCE OR REIMBURSEMENT),
II (Travel Reimbursement Sheet), III (ACH
VENDOR/MISCELLANEOUS PAYMENT ENROLLMENT FORM), IV (Additional
Clauses and Provisions) and V(QUARTERLY COOPERATIVE
AGREEMENT PROGRESS REPORT) are hereby incorporated to form an
integral part of this Agreement.
19. FORMS
The following standard forms, provided, must be
completed and submitted with the agreement:
SF-LLL Disclosure of Lobbying Activities;
SF-3881 ACH Vendor/Miscellaneous Payment
Enrollment Form (ATTACHMENT III);
* SF-424A Budget Information - Non-Construction
22
COOPERATIVE AGREEMENT NO. ATC020223
I
Programs (with instructions);
* SF-424B Assurances - Non-Construction Programs;
The following reimbursement forms, provided, must be
completed and submitted with each request for
reimbursement:
* SF-270 Request for Advance or Reimbursement
(ATTACHMENT I) (make copies as needed)
Travel Reimbursement Sheet (ATTACHMENT
II)(make copies as needed) :
Also complete and submit quarterly, the form provided
as attachment V- QUARTERLY PROGRESS REPORT (make
copies as needed).
t
23
COOPERATIVE AGREEMENT NO. ATC020223
LOCAL GOVERNMENT's signature Date
PRINTED NAME AND TITLE
ATF COOPERATIVE AGREEMENT OFFICER'S signature Date
24
COOPERATIVE AGREEMENT NO. ATC020223
ATTACHMENT IV
Additional Clauses and Provisions
a. The LOCAL GOVERNMENT possesses legal authority to apply for
the cooperative agreement, that a resolution, motion or
similar action has been duly adopted or passed as an
official act of the applicant's governing body authorizing
the filing of the application, including all understandings
and assurances contained therein, and directing and
authorizing the person identified as the official
representative of the applicant to act in connection with
the application and to provide such additional information
as may be required (SF-424 attached).
b. The LOCAL GOVERNMENT will comply with Title VI of the Civil
Rights Act of 1964 (P.L. 88-352) and in accordance with
Title VI of that Act, no person in the United States shall,
on the ground of race, color, or national origin, be
excluded from participation in, be denied the benefits of,
or be otherwise subjected to discrimination under any
program or activity for which the applicant receives Federal
financial assistance and will immediately take any measures
necessary to execute this agreement.
c. The LOCAL GOVERNMENT will comply with the provisions of the
Hatch Act, which limits the political activity of employees.
d. The LOCAL GOVERNMENT will establish safeguards to prohibit
employees from using their positions for a purpose that is
or gives the appearance of being motivated by a desire for
private gain for themselves or others, particularly those
that have family, businesses or 'other ties.
e. The LOCAL GOVERNMENT will give the ATF or the Comptroller
General through any authorized representative access to and
the right to examine all records, books, papers, or
documents related to the cooperative agreement.
The LOCAL GOVERNMENT will comply with 28 C.F.R., Part 66,
Administrative Requirement for Grants and Cooperative
agreements to state and local Governments concerning
requirements of law, program requirements, and other
administrative requirements. The regulations were publiahed
25
COOPERATIVE AGREEMENT NO. ATC020223
in Federal Register of March 11, 1988 (pages 8034-8069).
g. The LOCAL GOVERNMENT will ensure that the facilities under
its ownership, lease or supervision which shall be utilized
in the accomplishment of G.R.E.A.T. are not listed on the
Environmental Protection Agency's (EPA) list of Violating
Facilities and that it will notify ATF of the receipt of any
communication from the Director of the EPA Office of Federal
Activities indicating that a facility to be used in the
Program is under consideration for listing by the EPA.
h. The LOCAL GOVERNMENT will comply with the minimum wage and
maximum hours provisions of the Federal Fair Labor Standards
Act, as they apply to law enforcement employees of srate and
local governments.
i. LIMITATION ON PAYMENTS TO INFLUENCE CERTAIN FEDERAL
TRANSACTIONS (DEVIATION - DEPARTMENT OF THE TREASURY, NOV
1990) (JUN 1997)
(a) Definitians.
'Agency,' as uscd in this clause, means cxew[ive agrncy as defined in 2.101.
'Covered Federal action,' as us<d in Nis claus<, mwns any of 1he following Fcderal actiortr.
(a) The awuding af any Fcdenl cantnct.
(b) 7T< making af any Fcderal grant.
^ 'Ihe making of any Federalloan.
(d) The emcring into of any coopentive
agmement.
(e) 7Le uiension, coatinuuioq rcnewal, amendmrnt, or modification of any Fcderal contrazt, gnnt, loan, or coopetative agreemeN.
'Indian tribe' and "tribal arganizaiion," as usN in Ihis clausq M1ave lhe meaning proridM in scction 4 of Ihe Indian Sdf-Deiermiwiion and Education Assistance
Act (25 U.S.C. 450B) anJ include Alaskan Natives. '
'InOuencing or auempting m inlluence,' as used in this clause, means making, wiih Ihe intrnt w iniluence, any communication to or appeannce before an officer
or employee of any ageMy, a Member of Congress, an offittr or employee of Cong¢ss, or an employee of a blemb<r af Congress in connection with any covercd
Federal action.
'Local government,' az used in Ihis clause, meons a unit o( government in a SuI<and, if charmred, esmblished, or otherwise recognizcd by a Sum for 1h<
perfortnana of a yoverrvn<ntal duty, including a lacal public authoriry, a spttial district, an intrasum district, a cauncil or eovernm<nu, a sponsor graup rcpresmtative
organization, aM any other imtrvmm(ality af a loal Yavernment.
'Officer or employee of an ayeMy,' as uscd in lhis clause, iMludes the followine irdividuals who are employed by an agency:
(a) An individual wha is appointcd to a position in Ihe Governmrnt under tiHe 5, Unitcd States Code, including a posilion under a temporary
appoinNient.
(b) A member of N<uniformed serviees, u defincd in subsection 10I(3), ti11e 37, United Stams Coda ~
0 A special Government cmployee, as defincd in stttion 202, litle 18, Unitcd Stams Code.
(d) An i,Wividual who is a m<mber of a Fed<ral advisory comminee, as defincd by Ihe Federal Advisory Committee Act, litle S, United Sula Code.
app<ndix 2. .
'Person,' as used in Uiis clause, means an individual coryontion, <ompany, assaiation, awhoriry, firtn, parmership, sociery, Snte. aM local Qovernmrnt,
reyaMless or whether such rntity is opentcd for pmfit, or not for profrt. This tertn eacludes an InWian tribe, Iribal oryaninlion, or any other Indian orgonivtion
wiN rupmt lo expeMitures specifically permilted by ather Federai law.
'Reasowble compensation,' at usM in ihis clause means, with respecc to a regularly employcd officer or employee of any person, compentation tlwt is consistent
with nomal campensa[ion for such aff¢er or employee for work Ihu is not turnishcd m, not fuMed by, or mt PomisheJ in cooperation wilh fhe Fedenl
Government. '
'Reuonable paymmt,' as uscd in this clause, means, with rupttt ro profusional and alher IecMical servicu, a payment in an amaunt Ihat is <onsistent with
vnount nwmwlly paid for such servicu in ihe privatc sector.
'Recipient,' u used in Ihis clause, inciudes Ne Contnclor and all subconttaclars. This lerm excludes an Indian Iribe, tribal oreanixation, or any olher IMian
organizmion with respect to cxpendimrts spccifically permiued by othu Fed<ni law.
'ReyWady employcd,' as uscd in this claus<, meam, with mp<ct ro an offittr or employtt or a person requnting or raeivine a Fedenl wntract, an officer or
employtt who is empioycd by euch person for at 1<ast 130 workin; days within 1 year immcdiamiy preccdinE the date of Ne submissian Ihat Iniliatts agrncy
consideration of such person far rec<ipt of such <omnct. An offi«r or employee wlw u employcd by such person tor iess ihan I30 workine days within i yar
immedimety preceding the dam or the mbmission Uhm initiatu agency eomideration of such perwn shali be eonsidered to be regulaAy employed as aoon u he or
26
COOPERATZVE AGREEMENT NO. ATC020223
she is employed by such person for 130 working days.
'Scate,' as uscd in ihis clause, means a Snm af the Unittd Sums, the Disvia of Columbia, the Commonwealth of Puerto Rico, aicrritary or possession of the
Uniccd Scates, an agency or instrumrntaliry of a State, and multiState, regianai, or imers(ate emiry having governmrntal ducies and pawers.
(b) Pmhibitians. (q Sation 1352 of title 3I, Unitvd States Code, among olher things, pmhibits a mcipimt of a Fedeml contrace, gnn[, loan, or coopentive atrecmrnt from using
appmpriazed Nnds w pay any person tor inFluencing or anempting co influmce an offittr or <mpioyce of any agrncy, a Mcmber of Congrcss, an officer ar
nnploy<e af Congrcss, or an <mployc<of a Member of Congress in connmion with any of the following <overcd Federal actiona: the awarding of any Fedenl
conuact; the making of any Fedenl granr, the making of any Fcderal loan; ihe entering inro of any cooperuivc ayre<ment; or the modiFlcation of any F<denl
conuact, grant, loan, or coaperative agrcement.
(2) The Act olso rcquires Comnctors to fumish a disclosure if any fuMs other than FNeral appmpriamd Nm1s (including pmGt or ke received under a cavered
FNenl tnnsaction) have been paid, or will be paid, m any person for inlluencing or auempting lo in0ucnce an o(ficer or employee of any a6rncy, a Member of
Congras, an off¢er or employet of Congress, or an employee of a Mem6er af Congress in wnn<ction a Fedenl conlract, gran[, loan, or coapentive agreemrn[.
(3) The prohibitiorts of the AG do not apply under the fullawing conditionc
(I) Agency and legislative liaison by own employees.
(A) The pmhibition on the use of appropriaad PorMs, in subparagraph (b)(p of (his dause, does mt apply in ihe case of a payment of reasonable
compensuion madr to an offiner or employee of a pvson requesting or mceiviny a covered Fcderal aaion i( the payment is for ayency and legislative liaison
activi[ies not directly rNazed [o a cavered Federal action.
(B) For puryoses of subdivision (b)(7HI)(A) of Nis clause, providing my informazion specifically requestcd by an agenry or Congress is p<rmii[cd at
any tima
a. The follawing agency aM legislative liaison aaivities are permi¢ed m any time wherc thcy are not rela¢d la a specific solicitation for any covered
Federal oction:
(I) Discussing with an agency the qualities and characmrinics (including individual d<mons[ruions) of the person's products or services, coMitions
or terms of sale, and servi<e capa6ili[ies.
(2) Techniwl discussions and other auivicies regarding Ihe application or adaptmion of the person'S produ<IS or s<rvices for an agmcy's use.
(D) The (ollowing agcncy and legisluive liaison activiti<s arc permiued wherc they are prior lo formal soliciulion of any covered Federal attion-
(I) Providing any in(ormaiion nu[ specifically requesrcd but nmessary fot an agency lo make an infnrmed decision about initiation of covered Federal
action;
(2) Technical discussionv «garJing ihe prepantion of an unsolicited pmposal prior to its official submission; and
(J) CaPabiliq prcsrntuions by persons sttking awards fwm an aSrnq pursuant to the provisimis of the Small Busincss Act, as amended by Pub. L.
95-507, anJ subscquent amendments.
(E) Only those services enpressly authorized by subdivision (b)(3)(I)(A) of this clause are pcrmitted wMer lhis clause.
(ii) Pro@ssional and Ic<hniwl services.
(A) The prohibition on the use of appropriamd Ponds, in subparagraph (b)(p of this dausc, does wt apply in the wse o4-
(q A paym<nt of ¢uonable compensalion made ta an officer or employee o( a perwn requesting or rtteivinC a covered Federal action or an
ezmiuion, continuatioq ren<wal, amendment, or modification of a covered Fedenl anion, if paymrnt is Por profcesional ar mchnical servitts rendered dirtttly in
the prcpuation, submission, ar negotiation of any bid, propusal, or appliation (or Lhat Federal aclion ot for meeting reyuiremrn(s imposeJ by or pursuanl to law
as a conWition (or receiving that Fed<ral aclion.
(2) Any reasonable DaYment to a person, odier ehan an officer or emplayec of a persan requuting or recciving a covered Federal actian or an
eatmsion, wNinuazion, mntwal, amendment, or modiFlcation of a covercd Federal action if ihe paymrnt is for professiowl or [echnical tervica rendered
directly in (he preparation, submission, or ncgotiation of any bid. proposal, or application for ihu Federal action or for mecting reyuiremems imposed by or
pursuano lo law as a condition (or rmeiving Ihat Federal aaion. Persons other than offimrs or employees o( a person requesting or rcceiving a covered Federal
action include corttullanB arM trade associations.
(B) For purposes of su6division (b)(3)(ii)(A) of this clause,'professionul anM tecMical services' shall b< limited to advice and anaiysis directly
applying any professional or technical diuipline. The (ollawing e.camples are not immnded to be all inclusive, to limit the application of the professional or
mchnicai exemption providcd in the law, or to limit the exemption to liceaud professiomis. For esample, dnfting of a Iegal document accompmying a bid ar proposal by a lawyer is allowabie. Similatly, lechnical advice provided by an engineer on the p<rformance or operational capabilily of a piece of equipment
rendered dirtttly in the negotiation of a contnce is ailowable. However, mmmunications wiih ihe intrnt to influence made by a pmkuional (such as a licenmd
' Iawyer) or a ttthnical person (such as a IicensM accountant) are noe allowable und<r Ihis stttion unless they provide advice ani awlysis directly applying Iheir professional or lechnical upertise and unless the advi<e or onalysis is rendered dirmtly and salely in the prepantion, submission or negotiation of a covered
Federai action. Thus, for example, comnrvnicalions wiih the intent lo inliuence made by a Iawyer that do not provide legal advitt or analysis dircctly and soiely
relaud to the leyal aspecta of his or h<r client's pmpasal, but yenenlly advocate one proposal over alwther are mt allowable under this section because the lawyer
is mt providine profusional Iegai services. Similuly, communi<ations with the intmt to inlluence made by an engineer proviCing an engineering awlysia prior to
the pre0antion or submission of a bid or proposal are not allowable under lhis section since the eneineer is providing technical services but not direclly in the
preparation, submission or nega[ialion of a cavered Federal a<tion.
^ Requiremenes imposcd by or pursuant lo Iaw as a condition far receiving a covered Fedenl award iMlude Ihos< required by law or rcgulation and
any oNer requiremeno in the acwal award docum<nls.
(D) Only those servias exprcssly auehorizcd by subdivisions (b)(3)(ii)(A)(I) and (2) of Uiis clause are pertnined urMer this clause.
(E) The reporting r<quiamenu of FAR 3.803(a) shail not apply with rcspect to paymenu of rtasonable compensation made to regulaAy employcd
officers or employtts of a person.
(iii) Selling a«ivities bY iidependrn[ salu repres<Natives.
The prohibition on the us<of appropriucd tunds, in subpangraph (b)(I) of Ihis clause, daes nol apply W the followinr selling aclivities bePore an
agencY bY iMepadent
sala represrntatives, Providcd such activities are prior to formai solicitaiion by an agercy anW are apecif¢ally limiud m the merils o(Ihe matmr:
(A) Discussing with an agmry (inctuding individml demonstretions) N<qualities afd chancteristics of the person's producu or urvices, eonditions or terms
of sale, and service capabilitin; a (8) T<chnical discussions and oNer aclivities rtQaNine the applialion or adaptation o( the person's praductt ot aervica Por an aeency's use.
27
COOPERATIVE AGREEMENT NO. ATC020223
° Disclosure.
(I) The Contncmr who rcquesu or racivu from an agency a Fcderal contract shall file with that agency a disciosum form, OMB standard fortn
LLL, Disclosure of Lobbying Activities, if such permn has made or has agrced to make any payment using nonappropriated fumis (m irrclude pmfils (mm any
covercd Federal action). which would be pmhibitcd under subpangnph (b)(1) of Uiis clause, if paid for with appropriated fuWS.
(2) The Canuactor shall file a disclosurc form at the end of each caleiWar quaner in which there occurs any event that mamriaily afkcu the accuracy
of the infonnazion contain<d in any discloturt form prcviously filed by such person urNer subparagraph (c)(q of ihis claus<. An event thu mamrially affects the
accuracy of the information reponed inciudes-
(q A cumuiativc increasc of 525,000 or morc in the amount paid or expccted m 6e paid for influencing or attempting m inlluence a covered Fedeni
action; or
(ii) A change in the person(s) or individual(s) influencing or anemptine ro in0uence a covered FeJeral or action; ar
(iii) A change in the offi<er(s), emDloyee(t), or hlemhers(s) contactcd m in0uence or anempt to influence a covercd Federal action. .
(3) The Conuactor shail require the submiaal of a ttrtification, and if required, a diulosurc (orm by any pcrson who requesu or receives any
su6contract excecding $100,000 uMer the Fedcral wncnct.
(4) All sub<onlracmr disclasurc fomu (but not certiGcations) shall he forwarded (rom tiv m tier uNil received by the prime Convacmc The prime
Contnctor shall submi[ all disclosures m ihe Convazting Officer at the eM of the caleMar quaner in which the disclosure fortn is suhmi¢ed by the subcomncror.
Each subcontracmr crtification shall be rctained in the subcomrect file ot the awuding Comracror.
(d) ayrcemenL The Conltacwr agrees m[ m make any paymrnt prohibittd by this clause.
(e) Prnalties.
(I) Any person who makes an expendimre pmhibitcd under paragnph (a) of this clause or who fails lo file or amend the disclosum fartn m be filcd or
amendM by paraeraph (b) of Ihis clause shall be subjttt w civil penalties as provided for by 31 U.S.C.1352. An imposition of a civil penaity does not prevrnt the
Governmart from seeking any othcr rcmedy iha[ may be applicable.
(2) Cantracrors may rely without liabiliry on 1h< reprcsrntazion made by their subconlractoro in the c<rtification aitd dis<losurc Portn.
(D Cost allowability. Nothing in this clause makes allowable or rcasonabte any costs which would athcrwise be unallowable or unreuonabla Convers<ly, coets
made specifcally unallowable by the requimmenis in this clause wiil not be made allowa6le uMer any other pmvision.
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS (MAR
1996)
Instmctions Por Certifimtian
1. By signing and submirting this proposal, Ihe pmspcctivc Drimary
paticipmt is providing the certificuion set out below.
2. The inability of a p<rson to provide the certification required below will
not ne<essarily rcsult in denial af participuion in the coverN trensasian.
7Te prospm(ive puticipant shall submit an explanation of why it cannot
pmviJe the certificalion set out below. The ttnification ar ezplanation
will b< considered in connection with Ihe deputnxm or agency's
determiweion whelher to enter inlo Ihis tnntaction. However, hilure o(
the prospcctive primary panicipant to Pomish a cenification or an
explawtian shall disqualify such person from participa(ion in this
Iransaclion.
3. Th<ttrtifialion in this Nause is a mamrial representation of (act upon
which reliance was pla<M when the deparlmeN or aEency detertnined m
enler inm this transaclion. If it is la¢r determined Ihat the pmsptttiv<
primary participant knowingly reMered an ermneous ttrtifiwtion, in
addition to other remedies available to the Federai Gavernnwnt, the
deparunrnt or a¢ercy may terminale Ihis tnnsaction Por ause of defaWt.
4. The prospective primary participant shall pmvide immedim< written
nolice to the deparun<nt or ag<ncy ro whom Ihis proposal is submitied if at
any time the prospwtive primary participant learfu Nat its certification was
erronmus when submitted or has becom< etronmus by rcason af chmgeJ
circumsnntts.
5. 'Ihe lerms 'eovered Innsa<tion,' 'debarrcd," *suspeM<d,'
'inelieible,* "lower ti<r cov<rcd ttansaction,* "participan[,' 'p<rson,'
'primary covercd Iransaction,' "principal: 'praposal,' anW'voluntarily
eacluded,' as used in this clause, hav< the meanings set out in the
D<finiliont and Coverage stttione of the rvles implem<ming Enttutive
Ord<r 12549. You may conlatt N< deparunem or apercy lo which this
praposal is being aubmi[tcd for assisWnce in obtainin¢ a copy of ihose
regulations.
6. The pmspectivc primary panicipant agrees by submi¢ing this proposal
that, shauld the proposeJ covcred Imnsaction be emered into, it shall no[
knowingly rnter into any law<r lier covercd tnnsaction wiih a person who
is debarred, suspcMed, declued in<ligible, or volunurily excluded (rom
participaiion in this covered Ransazoion, unlus authorized by the
depanmrn[ or agrncy entering into lhis tnmaction.
7. Th<prospective primary parlicipant Porther ayrecs by submit[ing this
propasal thu it will include the Amse litled'Certifiwtion Regardiny
Debumrnt, $uspension, Ineligibiliry ofd Volunury Ezclusion-Lower Tier
Cov<red Tnnsaction,' providcd by the depanment ar agency inb Ihis
covercd Iransaction, without modification, in all iower lier covercd
transactions and in all solicitatiortt for lower tier covercd trentactions.
8. A puticipant in a covercd tnmaclion may rely upon a certifintion of a
prospeaive panicipant in a lower lier cavered Innsaclion thal il is trot
deborred, suspended, ineligibl<, or volunurily ezcluded from the covered
trantactian, unless it knows Ihaz the cenification is ermnmus. A
puti<ipant may dc<ide the method aM frequrncy by which it dctermines
the eligibiliry of ios prin<ipais. Each participant may, bW is not required
m, check the Nanprocurement List (202-063J278).
9. Nolhing connincd in the foregoing shail be eonsuued to require
esWblishment af a system of rccords in order m r<Mer in good failh the
artification required by Ihis clause. The knawl<dee and informa[ion of a
participam is not required m en<eed Ihal which is normally poxussed by a
prudenl person in the ordinary course of business deaiings. 10. En<ept for tnnsaction authorized under pangraph 6 of [hese
inswctions, i( a Oarti<ipant in a covercd transaction knowingly rnmrs into
a iow<r tier cavered Iransaaion wiih a permn who is auspended, debarred,
ineliyible, or volunurily exciuded trom participation in this tnmaction, in
addition to oth<r remedies availabie m the FMenl Goverrvnene, the
deparunent or agnrcy mry termimte ihis Innuction for nuse or default.
28
COOPERATIVE AGREEMENT NO. ATC020223
C<rtificuion Regarding Debafmmt, Suspension, arid Other
Responsibiliry Maners-Primary Covered Tranaactioas
(q The pwspective primary participmt rertifes m the best of ics
knowlcdge and belicf, Ihat it and its principals:
(a) Are not prcsmtly debarred, suspended, propostd fot
dc6armem, Aeclarcd incliSible, or volun(arily excluded (rom coverM
« muactians by any Federal depanment or agency:
(b) Have not wilhin a Ihree-year period prcttAing lhis
proposal b<en convicteC or had a civil judgmenl r<ndemd against them for
commission of fnud or a<riminal offmse in connation wilh obWining,
anempiing m obtain, or performing a public (Federal. State. or locap
transaaion or canvacl uMer a pu6lic onnaaction; vioiation of Federal or
Swte antitmst stawms or eommission of emb<zzlement, fheft, Porgery,
bribery, (al:ifica(ion or datru<[ion af rcmrds, making false suttments, or
receiving stolen pmpeny;
° Are wt presently iMicted for or otherwise criminally or
civilly charged by a governmental entiry (Fcderal, Sute ar lo<ap with
commission of any of the offenses enumen[ed in paragraph (q(b) of this
certificalion: arM
(d) Have mt within a Ihreeytar period praeding this
applicatioNproposal had one or more public uansaziion (F<dernl, State or
Iwal) terminated for cause or default.
(2) Where the prospective primary pmicipam is uwble lo eertify to any of
the stattmerns in this certifintion, such pmspective panicipmt shall atuch
an ezplanation to Ihis proposal.
k. CERTIFICATION REGARDING DRUG-FREE WORKPLACE
REQUIREMENTS
Instmctions for Certification
1. By signing and/or submining this applicalion or grant agreemeN, the granttt is providing th<c<rtification set out below.
2. The certifiwtian xl ow below is a mamrial representazion of fan upon which reliance is placed when the agmcy awards the grant. If it is Imer determined that
the grantce knowinSlY rcnde¢d a false ttrtification, or otherwise violams the rcquimments o(the Drug-Free Workplace An, the a6enry, in addition to any other
remcdies available l0 the Pederal Govenunrnt, nmy uke action authorized under the Drug-Free Wurkplxe Act.
3. For gramecs other tWn individuals, Alternat< 1 applies.
4. For grantees who are individuais, AI¢rnate 11 applies.
5. Workplaces uMer grants, far granttes other than individuals, n<cd mt be identified on the « rti(ication. If known, they may be identified in the grant
application. If the granme does not identify the workplaces at Ih<time of application, or upon award, it there is no applicazion, ihe Erantee must keep the idenlity
af the workplace(s) onlile in its office and make ihe information available for Fcderai inspection. PoiNm lo identify all knawn workplaces constilutes a violation
of the grantec's drvg-free workplace rcquircments.
6. Workplace identi0cadons must include the acwal addrcss o( building (or puu of buildings) or aiher sites where work wWer the grant takes plaze. Cattgorical
descripiions may be usM (e.g., all vehicies of mass transit authoriry or Sute highway deparunent while in operatian, SWte employees in each local unemploymrnt
offce, perfarmers im mnccrl halls or radio studias).
7. If the workplace iJentified to the agcnry changes during the pcrformance of 1h<grant, the graNec shall infomi the agency of the <hmge(s), if the previously
idmtified the wurkplaces in question (see paragraph five). S. Dcfinitions of Icrms in tlie Nonpmwrement Suspnuion and Debalmmt common rule and Drug-Free Workplace comman mle apply to this cenifin(ion.
Gnnttes' attrntion is nlled, in panicWaq lo the following definitions from these rules:
Com Itcd substance means a contmlled subswnce in Schcdul<s 1 thrnugh V of the Commlled Subseances Act (21 U.S.C. 812) and as furLher defined
by reguia(ion (21 CFR 1308.11 through 1308.15):
Convictio means a finding o( ¢uilt (inciuding a plea o( noio conlnWere) or impasition of sentence, or bolh, by any judicial body char¢cd with the
respansibility lo decermine violmions of the Fedenl or Su1e <riminal dmg aumus;
Cr'minai drue statum mmns a Fcderai or nomFcderai cr'uniml sumte involviny the manufaaure, distribution, dispensing, use, or possession of any
controlled subslance;
Emolavice mwns the employee of a grem<e directly <nga¢ed in the performan<e of work uMer a grant, including: (p All dirmt charge employees;
(ii) AII indirect <haree empioy<es unless Iheit impact or involvement is irttignificam m th<peiPotmame of the granl; anW, (iii) Temponry personnel afd
comulwms who are directly engaECd in the performance of work under the gnnt aM who are an the ynntee's paymil. This definition does not include workers
not on the payroll of the grant<e (e.g., volunmers, even If used ta meet a matching requiremem; consuilanu or iMeperdrnt contnaors not on the gnntee's
payroll; or employtes of subrttipienu or subcontracmrs in covercd wortplacuJ
Ccnificaiion Regardiny Drug-Pree
Workplace Requiremenls
Alternale 1. (Gnmees Oiher Than Individuals)
A. The granme certifies Ihat it will or will concinu< co pmvide a drug-tree <mployees abom-
warkpiace by: (I) 7Ta dangers of drvy abuse in the workpiace;
(a) Pu6lishing a stalement iwtifying emploYees lhat the unlawPol (2) The granme's policy of mainuininY a drvg-free
manufac[ure, distribution, Aispensing, possession, or use of a contmlied workplace;
subsnn<e is prohibited in the erant<e's warkplace and specifyiny the (J) Any availabie druY counuiiny, rehabililalion, end
actiofu Ihat will be uken against employees for violatian af such employee assislance proyrarns; and
prohibitian; (4) The penaleia that may be imposcd upon employ<es Por
(b) EsWbiishing an ongoing druy-trec awaren<ss prognm to intortn drug abuse violatians occurring in the workplacc;
29
COOPERATIVE AGREEMENT NO. ATC020223
° making it a requirement iha[ each employee to be enga8cd in the
perfomiance of the grant be given a copY of the stammcm requircd by
puagraph (a):
(d) Noli(ying the rniploy<e in the stammrnt requircd by paragraph (a) Nat,
as a cofMition of cmployment under the granl, the employee will-
( q Abide by the Iemu o( the statcmenr, and
(2) Notify the employ<r in writing of his or h<r conviclian for
a violation of a criminal dmg sutute occurring in the warkplace no later
than five calerWar days afmr such <onviaion; (e) Notifying the agarcy in writing, withim mn calendar days aRer
receiving natice uMcr pua&mPh (2) from an employee or otherwise
rcceiving actuai noiice of such eonviction. Employcrs of convicted
employees must provide mtice, including posilion title, lo every gram
activity the mnvic[ed employee wu working, unless the Federal agrncy
has designatN a central point for the receipt of such notices. Notice shall
incluAe the identification number(s) of each af(eaeA grm[;
(Q Taking an af the follawing actions within 30 calendu days of receiving
notitt under paragraph (d)(2), with respect lo any employee who is so
canvicttd-- (1) Taking aDPropriatt perzonncl action against such an
employee, up to and including temiimeian, consismnt with the
r<quiremrnts of the Rehabilitation Aa of 1973, as ameiMed; or
(2) Requiring such employre to participate satisfazlorily in a
dm& abusc assismncc or rehabiliution pmgram approvM for such purposes
by a Fcdenl, Smie, or iocal health, law rnforcement, ar aiher appmprime
agency:
(g) Making a good faith effortm continue m mainmin a dmg-free
workplace thmugh implemen[ation of paragraphs (a), (b), (c), (d), (e) and
m.
B. Thc grantee may inscr[ in the space provided 6elow the site(s) for the
pcr(ortnance of work done in connection with the specific grant: Place a(
PerPormance (SVea address, ciry, counry, sm(e, zip code)
Chcck if thue are workplaces on fde that a¢ not identified here.
Alt<rtute 11. (Granmes Who Are Individmis)
(a) The gnnme <ertifies thaz, as a coiWition of the grant, he or she will mt
<ngage in the uNawNi manufauurc, disaribution, dispensine, posaeuion,
or use af a comrollcd substance in conducting any aetivity with the gnm;
(b) If conviacd of a<riminal drug ofknse resulting from a violation
accurring during th<conduci of any yram aceiviry, he or she will report the
conviction, in writing, within 10 calendar days of the conviction, lo every
grant officer or aiher designee, unless the Federal agrncy desigmtes a
centnl point for the receipt of such notices. W hen notice is made lo such a
centnl point, it shall include Lhe iden[ification numbv(s) of ach aH<eted
grent.
1. CERTIFICATION FOR CONTRACTS, GRANTS, LOANS, AND
COOPERATIVE AGREEMENTS
The unJersigned certifies, w the best oFhis or her knowledge and b<lief, thac
(q No Federal appmpriatN Ponds have bcen paid or will be paid, by or on behal( of the undersigned, to any person for intluencing or attempling ro iniluena
an offcer or cmployee of an agency, a hlember of Congrtss, an offset or employee of Congress, or un employee of a Member of Congrcss in connection wilh the
awaNing of any Federal contract, the making of any Federal Ioan, the rntering into any coopermive agrcemrnt, and the exiension, continuation, renewai,
amendmern, or malificuion of any Fcderal contnct, gnnt, loan, or coopeneive agreement.
(2) If any fu`Ms o(her than Federal appropriated furMs have been paid or will be paid m any person for in0uencing or avempling to influence an officer or
empluyee of any agency, a Member of Cong¢ss, an offittr of employ<e of Congrcss, or an employ<e of a Member of Congress in <onnection with this Fcdenl
<onvazt, granq loan, or coopcn(ive agreemmt, the undcrsign shall complete afM submit Standud Form-LLL, 'Disclosure Form io Report Lobbying,' in
accordance wiih its ins[mctions.
(7) The undenigned shall require [hu the language of this certification be included in the award docum<nts Por all subawuds a1 all tiers (induding
submntnerors, subgrants, and mntnct under grants, loans, aM cooperativt agreements) and Ihat all subrccipiems shall certity and disclose accordingiy. This cenificatian is a material represrnution of faa upon which rcliarce was placed wh<n Ihis tronsaaian was made or entered into. Submission o( this
certifwtion is a pmrequisite (or makine or entering into this Iransaztion imposed by sttlion 1352, litle 3 1, U.S. Code. Any person who fails ta file Ili< requirM
mrtifmaiion shall be subject lo a civil penahy of noUess than $10.000 aM not mort thon $ 100,000 for ea<h such failure.
Summent for Loan Gmrontees anl Loan Imunnce
The undersignnl states, lo the best of his or her knowleAge and belief, Ihat
If any Ponds have been paid or will be paid ro any person Por in0uencing or aUempting lo inllurnce an o(ficer or employtt of an agarcy, a Member of
Cangress, an off¢er ar employee of Congr<ss, or an employee of a Member of Congmss in connection with Ihis <ommionrnt providiny (or the United Sutes to
irtsure or gvaranme a loan, the undenigned shall <ampkte and submit Slandard Farm-LLL,'Disclosure Fortn to Repart Lobbying,' in accordance with ilc
inslmctions.
Submission of lhif statement is a prerequisim for making or entering into Ihis lransaction impostd by seclian 1352, title 31, U.S. Code. Any person who (ails
to file the required swmment shail be subjmt to a civil penaity af not I<ss Nan SI0,000 and not more Ihan $100,000 for each such failure.
30
I
I
ATTACHMENT II
TRAVEL REIMBURSEMENT SHEET
This form must be completed and submitted along with the SF-270,
Request for Advance or Reimbursement for travel reimbursements.
Travel expenses will be.reimbursed in accordance with current
Federal Government Travel Regulations.
TRAVEL TRANSPORTATION MODE LODGING PER
DATE(s) EXPENSE TRANSPORTATION EXPENSE DIEM
OTHER TRAVEL EXPENSES:
WHAT AMOUNT
TOTAL TRAVEL REIMBURSEMENT REQUESTED: $
Reason for travel:
SUBMITTED BY:
LOCAL Government's signature '
APPROVED:
GTR's signature
31
ATTACHMENT V
QUARTERLY COOPERATIVE AGREEMENT PROGRESS REPORT
INSTRUCTIONS: It is the responsibility of the LOCAL GOVERNMENT
to prepare a progress report quarterly for the G.R.E.A.T.
program, which have.been authorized in the agreement. The LOCAL
GOVERNMENT should copy additional copies of the report for future
quarterly submission. If additional space is needed, this report
can be continued on plain white bond paper. The complete report
should be forwarded to:
Bureau of Alcohol, Tobacco and Firearms
ATTN: Juanita Wright
P.O. Box 50418
Washington, DC 20091-0148
If you have any questions or need additional guidance, please
contact Juanita Wright, Government Technical Representative, on
202-927-2160.
1. Local Government Name:
2
3
4
5
6
Cooperative Agreement No.: _
Program: G.R.E.A.T. Pro4ram
Quarterly Start Date:
Quarterly Completion Date:
Funding Status:
Funds Approved Funds Obliqated to Date Balance Remainina
$ $
7. Progress to Date:
# of students attending Phase I:
# of students attending Phase II:
# of students attending Phase III:
# of students graduated this quarter:
$
8. Describe G.R.E.A.T. activities taking place this quarter: to
include number of officers teaching, grade levels, conferences
attended, summer program, events, etc.
32
9. Problems Noted (need for modifications, delays anticipated,
etc.) State NONE if applicable.
PREPARED BY:
Name of LOCAL GOVERNMENT Official and Title
SIGNATURE:
REVIEWED BY:
Government Technical Representative
DATE:
DATE:
33
G.R.E.A.T.Program
OMBMPROVALNO.
PME . OF
~
0348-0004
PAcES
REQUEST FOR ADVANCE
,x•~a,ab,,,,,
2eAM oF nE«,ESr
OR REIMBURSEMENT
1•
❑ADVANCE ❑ REIMBURSE-
ttaeov
MEM
❑CASH
nAveeern
e.xen..ca~r~a.m.
. (Sae InsWctlons on bad)
REWESfED
El FINAL ❑ PARTIAL
❑ ACCRUAL
3. FEDERAL SPONSORING AGENCY AND ORGAM7ATONAI EIEMENT TO
1. FEDERAL GRA61T OR OTHER
5. PMML PAYMQJf REpJEST
WHICHTHISREPORTISSUBMffTEO
pENfIFltN('ryUM8ERA55I0NED
NUMBERFORiM5RE0UESf
-BYFEDERALAOENGY... .
.
6. EMPLOYQi IDETIfIFlCATION
7. RKIPIEM'S ACCIX1Nf NUMBER
S. PERIOD COVERED BY THIS REQUEST
NUMBER
OR IDEMIFYING NUMBER
FROM (ma+N, Gy, year) TO (monM, Lq, ye0
9. REGPIEM ORGRNVATON
70. PAYEE (lMMchecN is ro be sent ll mRerenf fhan ttem 9)
Name:
Nama:
Num6er
Num6er . '
and Streeh
and SYreet: -
Cify, Stata
dty, State
and ZIP Code:
and ZIP Code:
11, COMPUTATION OF AMOUNT OF REIMBURSE M ENTS/ADVANCES REQUESTED
(e)
(b)
PROGRAMS/FUNCTIONSIACTIVITIES ►
TOTAL
a. Total program (a+wdele)
outla to date
$
$
$
$
b. Less: CumuWtNe r ram Income
c. Net program oWays (Une a minus
Bne 6
d. EsUmated net cash outlays tor advance
rbd
e. Total Sum olOnes c 8
f. Nan-Federai sharc of amount on Ilne e
. Federai share of amount on Ilne e
.
h. Fede21 payments prevlousty veshd
1. Federal share now requested (IJne g
minuslns h
1. Advances MOW ~
uesled
when re
b
tstmonth
q
mon
,
Dy Federal 9ranta
ki
I
Znd month
n ma
ng
egenq la use
.
presdieduled edvances
3rd monlh
12.- ALTERNATE COMPUTATION FOR Aovqrvces orvLT
a Estimated Fede21 eash outlays that wili be made during perlod covered by the advarke
b. Lsss: Estlmated batarKe ot Federal wsh on hand as ol beginning of advexe perbd
PreseriDed by OMB Clrctdam A-702 and A-170
13. CERTIFICATION
I cerGy that to lhe best of my
ImovAedge and Delief the data on the
reverse ere correct and that ail ouUays
were made in eccordance with the
grant condttlons or other agreement
and that payment Is due and has not
been prevlousyrequested.
agency use
NUMBER,
Pubiic reporting burden for thls collection o( Intormation Is estimated to average 60 minutes per
response, Including tlme for reviewing Instructlons, searching edsting data sources, gatheAng and
maintaining the data needed, and wmpletlng and reNewing Ne wllection of Infortnation. Send
commenls regarding the burden estlmate or any other aspect of lhis wllectlon of Infortnation,
including suggestions for reducing thfs burden, to the Office of Management end Budget, Papervrork
Reductlon ProJect (0348-0004), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT
AND BUDGET. SEND 1T TO THE AODRESS PROVIDED BY THE SPONSORING AGENCY.
INSTRUCTIONS
Please type or print legibly. Items 1, 3,5, 9, 10, 11e, 11f, 11g, 11i, 12 and 13 are self-explanatory; specific
instructions for other items are as followr. 2 Indicate whether request is prepared on cash or accrued
expenditure basis. AII requests for advances shall be
prepared on a cash basis.
Enter the Federal grant number, or other identifying
number assigned by the Federai sponsoring agency. If
the advance or reimbursement is for more than one grent
or other agreement, Insert N/A; then, show the aggregate
amounts. On a separete sheet, list each grant or
agreement number and the Federal share of outlays
made against the grant or agreement.
6 Enter the employer identifcation number assigned by the
U.S. Internal Revenue Service, or the FICE (institution)
code if requested by the Federel agency.
7 This space is reserved for an account number or other
identifying number that may be assigned by the recipient.
8 Enter the month, day, and year for the Deginning and
ending of the period covered In this request. If the request
Is for an advance or tor both an advance and
reimbursement, show the period that the advance will
cover. If the request Is for reimbursement, show the lly
period for which the reimbursement Is requested.
Note: The Federal sponsoring agencies have the option of
requiring recipients to complete items 11 or 12, but not
both. Item 12 should be used when only a minimum
amount of Information Is needed to make an advance and
outlay Information contalned In Item 11 can be obtafned In
a timely manner from other reports.
11 The purpose of the vertical columns (a), (b), and (c) is to
provide space for separate cost breakdowns when a
project has been planned and budgeted by program,
tunction, or
activity. If additional columns are needed, use as many
additionai forms as needed and Indicate page number In
space provided in upper right; however, the summary
totals of all programs, functions, or activities should be
shown in the "total" column on the first page.
Enter in "as of date," the month, day, and year of the
ending of the accounting pertod to which this amount
appiies. Enter progrem outlays to date (net of refunds,
rebates, and discounts), in the appropriate coiumns. For
requests prepared on a cash basis, outlays are the sum
of actual cash disbursements for goods and services,
the amount of indirect expenses charged, the value of in-
kind contributions applied, and the amount of cash
advances and payments made to subcontrectors end
subrecipients. For requests prepared on an accrued
expenditure basis, outlays are the sum of the actual
cash disbursements, the amount o1 Indirect expenses
incurred, and the net increase (or decrease) in the
amounts owed by the recipient tor goods and other
property recefved and for services performed by
employees, contracts, subgrantees and other payees.
11a
Enter the cumulative cash income received to date, If
requests are prepared on a cash basis. For requests
prepared on an accrued expenditure basls, enter the
cumulative Income earned to date. Under either basis,
enter only the amount applicable to pragram income that
was required to be used for the projed or program by
the terms of the grant or other agreement.
11d Only when makfng requests for advance payments,
enter the total estfmated amount of cash outlays that wili
be made during the period covered by the advanca.
13 Compietetha certification before submitting this request.
STANOMD FORM 270 (Iw.7•07) Bxk
BUDGET INFORMATION - Non-Constructien Prnarams
OMB Approval No. 03484OO44
SECTION A- BUDGET SUMMARY
Grant Program
Function
Cataiog of Federal
Domestic Assistance
Estimated Unobligated Funds
New or Revised Budget
orActivity
a
Number
b
Federal
c
Non-Federal
d
Federal
e
Non-Federai
Total
1.
$
$
$
$
$
2.
3.
4.
5. Totals
'
$
$
$
$
$
`SECTIONB:BUDGET~CATEGORIES
6. ObJBd CI855 C8t@90I18S
GRANT PROGRAM, FUNCTION OR ACTIVITY
Total
I~) (z) (3)
(5)
a. Personnel
$
$
$
$
$
b. Fringe Benefits
a Travei
d. Equipment ,
e. Supplies ,
f. Contractual ,
g. ConsWctlon
h. Other
f. Total Direct Charges (sum o(6a-6h)
'
j. Indirect Charges
k. TOTALS (sum of 6i and 6j)
$
$
$
$
$
_ ,
. . . - ~I : : . 4..'..... . . . . . - ~ .
7. Program Income
$
g
$
$
$
iaucnonzea ror Locai rceproduction Standard Form 424A (Rev. 7-97)
Previous EdlUon Uuble
. PrescriDed by OMB Clrwlar A-102
SECTION C - NON-FEDERALRESOURCES
(a) Grant Program
(b) Applicant (c) State (d) Other Sources (e) TOTALS
8
.
$
$
$
$
9
.
10
.
11
.
12. TOTAL (sum o(lines 8-11) . $ $ $ $
" ^ ~ ^ ~ •:SECT T
I,ON D,•;FORECASTED CASH NEEDS
•••f.. . .
y
ToWI tor tst Year
1st p
13
Federal
uarter
2nd Quarter
3rd Quarter
4th Quartar
.
$
$
$
$
$
14. Non-Federal
15. TOTAL (sum oflines 13 and 14) $ $ $ $ $
SECTION'E; BUDGET'ESTIMAT~SOFFEDERAL'FUNDS NEEDED FOR:BACANCE OFT E:?RQJECi
(a) Grant Program FUTURE FUNDING PERIODS Years
b First c Second d Third e Fourth
16. $ $ $ $
17.
18.
19.
20. TOTAL (sum oflines 16-19) $ $ $ $
SEC'CION F- OTHER BUDGET INFORMATION 7T77 ,
21. Direct Charges: 227Indirect Charges:
23. Remarks:
Aumonzea tor Local Reproduction SWndard Form 424A (Rav.7-97) Page 2
INSTRUCTIONS FOR THE SF-424A
Pubiic reporting burden for thfs collection of information Is estimated to average 180 minutes per response, including time for review
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewtng the coltection
intortnatfon. Send comments regarding the burden eslimate or any other aspeGt of this collection of Informatton, including suggastions
reducing thfs burden, to the Office ot Management and Budget, Paperwork Reduction ProJect (0348-0044), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
This fortn is designed so that applicalion can be made for funds
from one or more grant programs. In preparing the budget,
adhere to any existing Federai grantor agency guidelines which
prescribe how and whether budgeted amounts should be
separately shown for different functions or activities within the
program. For some programs, grantor agencies may require
budgets to be separateiy shown by function or activity. For other
programs, grantor agencies may require a breakdown by function
or activity. Sections A, B. C, and D should include budget
estimates for lhe whole project except when applying for
assistance which requires Federal authorization in annual or
other funding period increments. In the tatter case, Sections A, B.
C, and D should,provide the budgel for the first budget period
(usually a year) and Section E should present the need for
Federal assistance in the subsequent budget periods. All
applicatlons should conlain a breakdown by lhe object class
categories shown in Lines a-k of Section B.
Section A. Budget Summary Lines 1-4 Columns (a) and (b)
For applications pertaining to a singie Federal grant program
(Federal Domestic Assistance Catalog number) and not requiring
a functional or acliviry breakdown, enter on Line 1 under Column
(a) the Catalog program title and the Catalog number in Column
(b).
For applications pertaining to a single program requiring budget
amounts by multiple functions or activities, enter the name of
each activity or funclion on each line in Column (a), and enter the
Catalog number in Column (b). For applications pertainfng to
multiple programs where none of the programs require a
breakdown by function or activity, enter the Catalog program title
on each line in Column (a) and the respective Cataiog number on
each line in Column (b).
For appiirations pertaining to multipla programs where one or
more programs require a breakdown by function or activity,
prepare a separate sheet for each program requiring the
breakdown. Additional sheets should be used when one form
does not provide adequate space for ail breakdown of data
required. However, when more than one sheet is used, the first
page should provide the summary totais by programs.
Lines 1-4, Columns (c) through (g)
For new applications, leave Column (c) and (d) blank. For each
line entry In Columns (a) and (b), enter in Columns (e), (0, and
(g) lhe appropriale amounts o( funds needed to support the
project for lhe first funding period (usually a year).
For continuing grant program applications, submit these fortns
before the end of each funding period as required by the grantor
agency. Enler in Coiumns (c) and (d) the estimated amounts of
funds which wlll remain unobligated at the end of the grant
funding period only if the Federal grantor agency instruqions
provide for this. Otherwise, leave these columns blank. Enler In
columns (e) and (0 the amounts of funds needed for ihe
upcoming period. The amount(s) in Column (g) should be the
sum of amounls in Columns (e) and (Q.
For supplementalgrants and changes to existing grenls, do not
use Columns (c) and (d). Enter in Column (e) the amount of the
increase or decrease of Federal funds and enter in Coiumn (o the
amount of the increase or decrease of non-Federal funds. In
Column (g) enter lhe new total budgeted amount (Federal and
non-Federal) which includes the lotal previous authorized
budgeted amounts plus or minus, as appropriate, the amounts
shown in Columns (e) and (Q. The amount(s) in Column (g)
should not equal the sum of amounts in Columns (e) and (Q.
Line 5- Show the totals for all columns used.
Section B Budget Categories
In the column headings (1) through (4), enter lhe litles of the
same programs, funclions, and activities shown on Lines 131,
Column (a), Section A. When additional sheets are prepared for
Seclion A, provide similar coiumn headings on each sheet. For
each program, function or activity, fill in the total requirements for
funds (bolh Federal and non-Federai) by objecl ciass categories.
Line 6a-i - Show the totals of Lines 6a to 6h in each column.
Line 6J - Show the amount of indirect cost.
Line 6k - Enter lhe total of amounts on Lines 61 and 6j. For ail
applications for new grents and continuation grants the total
amount in column (5), Line 6k, shouid be the same as the total
amount shown in Section A, Column (g), line 5. For
supplemental grants and changes to grants, the total amount of
the increase or decrease as shown in Columns (1)-(4), Line 6k
shouid be the same as the sum of the amounts in Section A,
Columns (e) and (Q on Line 5.
Line 7- Enter the estimated amount of Income, if any, expected
to be generated from this project. Do not add or subtract this
amount from the total project amount, Show under the program
SF424A (Rev. 7-97) Page 3
INSTRUCTIONS FOR THE SF424A (continued)
nartative statement the nature and source of income. The Ltne 15 - Enter the totals of amounts on Lines 13 and 14.
eslimated amount of program fncome may be considered by the
Federel grantor agency In determining the total amount of the Section E. Budget Estimates of Federel Funds Needad for
grant. Balance of the ProJed
Section C. Non-Federal Rasources
Lines 8-11 Enter amounts of non-Federal resources that will be
used on the grant. If In-kind contributions are inciuded, provide a
brief explanation on a separate sheet.
Column (a) - Enter the program titles identical to
Column (a), Section A. A breakdown by fundion or
activiry is not necessary.
Column (b) - Enter the contribution to be made by fhe
appiicant.
Column (c) - Enter the amount of the State's cash and
in-kindcontribution if the appiicant fs not a State or
State agency. Appiicants which are a State or State
agencies should leave this column blank.
Column (d) - Enter the amount of cash and In-kind
contributions to be made from all other sources.
Column (e) - Enter totals of Columns (b), (c), and (d).
Line 12 - Enter the total for each of Columns (b)-(e). The amount
In Coiumn (e) should be equal to the amount on Line 5,Column
(0, Section A.
Section D. Forecasted Cash Needs
Line 13 - Enter the amount of cash needed by quarter from the
grantor agency during the firsl year.
Line 14 - Enter the amount of cash from ail other sources needed
by quarter during the first year.
Lines 16-19 - Enter In Coiumn (a) the same grant program titles
shown In Column (a), Section A. A breakdown by function ar
activity Is not necessary. For new applications and continuation
grant appiications, enter in the proper columns amounts of Federal
funds which will ba needed to complete lhe program or project over
the succeeding funding periods (usuaily In years). This section
need not be completed for revisions (amendments, changes, or
supplements) to funds for lhe current year of existing grants.
If more than four lines are needed to Iist the program titles, submit
additional schedules as nacessary.
Line 20 - Enter the total for each of the Coiumns (b)-(e). When
additional schedules are prepared for this Sedion, annotate
accordingiy and show the overail totais on this line.
Section F. Other Budget Informatlon
Line 21 - Use this space to explain amounts tor individual direct
object class cost categories that may appear to be out of the
ordinary or to expiain the details as required by the Federal grentor
agency.
Line 22 - Enter the type of indirect rete (provisional, predetermined,
finai or fixed) that will be in effect during the funding period, the
estimated amount of the base to which the rate is applied, and the
total indirect expense.
Line 23 - Provide any other explanations or comments deemed
necessary.
SF-424A (Rev. 7-97) Page 4
OMB Approval No. 034&Opq6`
ASSURANCES - NON•CONSTRUCTION PROGRAMS
reporting burden for this collection of information is estimated to average 15 minutes par response, including lime for review
;ions, searching existing data sources, gathering and maintainfng the data needed, and completing and reviewing the collection
ition. Send comments regarding the burden estimate or any other aspecl of this coilection of information, Including suggestions
ig this burden, to the Office of Management and Budgel, Papenvork Reduction Project (0348-0040), Washington, DC 20503.
DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, piease contact the
awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such
is lhe case, you will be notified.
As the duly authorized representative of the applicant, i certity that the applicant:
1. Has the legal authority to apply for Federel assistance
and the institutional, managerial and financial capability
(including funds sufficient to pay the non-Federal share
of project cost) to ensure proper planning, management
and completion of lhe project described in this
application.
2. Will give the awarding agency, lhe Comptroller Generai
of the United States and, if appropriate, the State,
through any authorized representative, access to and
the right to examine aIl records, books, papers, or
documents reiated to the award; and will establish a
proper accounting system in accordance with generally
accepted accounting standards or agency directives.
3. Will establish safeguards •to prohibit employees from
using their positions for a purpose that constitutes or
presenls the appearance of personal or organizationai
conflict of interest, or personal gain.
4. Will initiate and complele lhe work within the applicable
time frame after receipt of approval of the awarding
agency.
Act of 1973, as amended (29 U.S.C. §794), whlch
prohibits discrimination on the basis of hahdicaps; (d)
the Age Discrimination Act of 1975, as amended (42
U.S.C. §§6101-6107), which prohibits discrimination
on the basis of age; (e) the Drug Abuse Office and
Treatment Act of 1972 (P.L. 92-255), as amended,
relating to nondiscrimination on the basis of drug
abuse; (o the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcohoiism; (g) §§523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§290 dd3 and 290 ee
3), as amended, relating to confidentiality of alcohol
and drug abuse patienl records; (h) Title VIII of the
Civil Rights Acl of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in lhe sale,
rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s)
underwhich application tor Federei assistance fs being
made; and, (j) the requiremenls ot any other
nondiscrimination statute(s) which may apply to the
application.
5. Will comply with lhe Intergovernmental Personnel Ad of
1970 (42 U.S.C. §§4728-4763) reiating to prescribed
standards for merit systems for programs tunded under
one of the 19 statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of
Personnel Admfnistretion (5 C.F.R. 900, Subpart F).
6. Will comply with ail Federal statules relating to
nondiscrimination. These fnclude but are not limited to:
(a) Title VI of the Civil Rights Ad of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color
or national origin; (b) Title IX of the EducaUon
Amendments of 1972, as amended (20 U.S.C. §§1681-
1683, and 1685-1686), which prohibits discrimination on
the basis of sex; (c) Sedion 504 of the Rehabilitation
Will compiy, or has already complied, with the
requirements of Titles II and III ot the Unifortn
Relocation Asststance and Real Property Acquisition
Poiicies Act of 1970 (P.L. 91-646) which provide for
fafr and equitable treatment of persons displaced or
whose property is acqufred as a result of Federal or
federally-assisted programs. These requirements apply
to all interests in real property acquired for proJect
purposes regardless of Federal participation In
purchases.
8. Will comply, as applicabie, with provisions of lhe
Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328)
which limit the political activities of amployees whose
principal employment activities are tunded in whote or
In part with Federai funds.
Prevloua Edltian Usable Standard Form 4248 (Rav.7-97)
Authorized for Locai Reproduction Preseribed by OMB ClrcuiarA-102
9. Will comply, as applicabie, with the provistons of the Davis-
Bacon lkct (40 U.S.C. §§276a to 276a-7), the Copeland Act
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract
Work Hours and Safety Standards Act (40 U.S.C. §§327-
333), regarding labor standarcls for federallyassisted
conslrudion subagreements.
10. Will comply, if appiicable, with flood insurance purchase
requirements of Section 102(a) of the Fiood Disaster
Protection . Act of 197,3,._(P L._.93234) _which : requires~
recipients in a special flood hazard area to participate In the
program and to purchase Oood insurance if the total cost of
insurable construction and acquisition is $10,000 or more.
11. Will comply with environmental standards which may be
prescribed pursuant to the tollowing: (a) Institution of
• environmental quality control measures under the National
Environmenlal Policy Act of 1969 (P.L. 91-190) and
Executive Order (EO) 11514; (b) notification of vioiating
facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards !n
Ooodplains In accordance with EO 11988; (e) assurence of
project consistency with the approved State management
progrem developed under the Coastal Zone Management
Act of 1972 (16 U.S.C. §§1451 et seq.); (o conformity of
Fetleral actions to State (Clean Air) Implementation Plans
under Section 176(c) of the Clean Air Act of 1955, as
amended (42 U.S.C. §§7401 et seq.); (g) protection of
underground sources oF drinking water under the Safe
Drinking Waler Act of 1974, as amended (P.L. 93-523);
and, (h) protection of endangered species under the
Endangered Species Act of 1973, as amended (P.L. 93-
205).
12. Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. §§1271 et seq.) related to protecttng
components or potential componentslot the national
wild and scenic rivers system.
13. Will assist the awarding agency In assurfng comptiance
with Section 106 of the National Hisloric Preservation
Act of 1966, as amended (16 U.S.C. §470), EO 11593
(identification and protection of historic properties), and
the ArchaeologicaL.and -Historic_Preservation Act of
isia (is U.S.C. ggassa-t et seq.).
14. Will comply with P.L. 93-348 regarding the protection of
human subjects involved In research, devalopment, and
related activitias suppoRed by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of
1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et
seq.) peRaining to the care, handling, and trealment of
warm blooded animals held for research, teaching, or
other activities supported by this award of assistance.
16. Will comply with the Lead-Based Paint Poisoning
Preven8on Act (42 U.S.C. §§4801 et seq.) which
prohibits the use of lead•based paint In conslruction or
rehabilitation of residence structures.
17. Will cause to be performed the required financial and
compliance audits In accordance with lhe Single Audit
Act Amendments of 1996 and OMB Circular No. A-133,
"Audits of States, Local Govemments, and Non-Profd
Organizations"
18. Will comply with ali applicable requirements of all other
Federal laws, executive orders, regulations, and policfes
governing this program.
Na..Ae..1 C...... A9An lDsv O_OT
ACH VENDOR/MISCEI.LANEOUS PAYMENT OMBNO.1510.0058
Exqredon Data 01131I2000
ENROLLMENTFORM
This form is used for Automated Clearing House (ACH) payments with an addendum record that contains
payment-related information processed through the Vendor Express Program. R6cipients of these
payments should bring this information to the attention of their financial institution when presenting this
fnrm fnr r.nm[flBtlOfl.
PRIVACY ACT STATEMENT
The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All
information collected on this form is required under the provisions of 31 U.S.C. 3322 and 31 CFR
210. This information will be used by the Treasury Department to transmit payment data, by
electronic means to vendor's financial institution. Failure to provide the requested information may
delay or prevent the receipt of payments through the Automated Clearing House Payment System.
AGENCY INFORMATION
FEDERAL PflOGHAM AGENCY BUREAU OF ALCOHOL, TOBACCO AND FIREAflMS
AGENCY IDENTIFIEfl: 303
AGENCV LOCATION CODE (ALCI: 20-10.0001
F-I
ACH FORMAT:
CCD LTX CTP
ADDRE55: PO BOX 61071. WASHINGTON, DC 20091-1071
CONTACT PERSON NAME: WILLJAM T. WHIGHT
T.
T
(202)927-7726
ADDITIONAL INFOflMATION:
.
FINANCIAL INSTITUTION INFORMATION
NAME:
ADDflESS:
'
TELEPHONE NUMBER:
ACH COOPOINATOfl NAME:
( I
NINE-DIGIT ftOUTING TflANS1T NUMBER:
DEPOSITOR ACCOUNT TITLE:
LOCKBOX NUMBER:
DEPOSITOR ACCOUNT NUMBER:
TYPE OF ACCOUM:
CHECKING SAVINGS LOCKBOX
TELEPHONENUMBEN:
StGNATUPE AND 71TLE OF AU7HOflIZEO OFFICIAL:
lCoWd bs Nw sune aa ACH Caordinetorl
av
_r r....rv
NSN 7640-01•274-9925 AGENCY COPY Fla~W-.,
31 U S C 3322: 31 CFfl 210
instructions for Completing SF 3881 Form
1. Agency Information Section - Federal agency prints or types the name and address of
the Federal program agency originating the vendor/miscellaneous payment, agency
identifier, agency location code, contact person name and telephone number of the
agency. Also, the appropriate box for ACH format is checked.
2. Payee/Company Information Section - Payee prints or types the name of the
payee/company and address that will receive ACH vendor/miscellaneous payments,
social security or taxpayer ID number, and contact person name and telephone number
of the payee/company. Payee also verifies depositor account number, account title,
and type of account entered by your financial institution in the Financial InstiEution
Information Section.
3. Financial Institution Information Section - Financial institution prints or types the name
and address of ihe payee/company's financial institution who wili receive the ACH payment, ACH coordinator name and telephone number, nine-digit routing transit
number, depositor (payee/company) account title and account number. Also, the box
for type of account is checked, and the signature, titie, and telephone number of the
appropriate financial institution official are included.
Burden Estimate Statement
The estimated average burden associated with this collection of information is 15 minutes
per respondent or recordkeeper, depending on individual circumstances. Comments
concerning the accuracy of this burden estimate and suggestions for reducing this burden
should be directed to the Financial Management Service, Facilities Management Division,
Property and Supply Branch, Room B-101, 3700 East West Highway, Hyattsville, MD
20782 and the Office of Management and Budget, Paperwork Reduction Project
(1510-0056), Washington, DC 20503.
DISCLOSURE OF LOBBYING_ACTIVITIES ApprovedbyOMB
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 osaaooas
(See reverse for pubiic burden disclosure.)
1. Type of Federal Action:
2. Status of Federal Action:
3. Report Type: t
❑ a. contract
F-I a. bid/offer/application
~ a. initial filing
b. grant
b. Initial award
b. material change
c. cooperative agreement
c. post-award
For Materiai Change Only:
d.loan
year quarter
e. loan guarantee '
date of last report
f. loan insurance
4. Name and Address of Reporting Entity:
S. If Reporting Entity In No. 4 Is a Subawardee, Enter Name
❑ Prime ❑ Subawardee
and Address of Prime:
Tier , Ifknown:
Con resslonal District, ifknown:
Con ressional District, ifknown:
6. Federal DepartmenUAgency:
7. Federal Progrem NamelDescriptlon:
CFDANumber, ifapplicable:-
8. Federal Action Number, i(known:
9. Award Amount, ifknown:
$
10. a. Name and Address of Lobbying Entity
b. Individuals Performing Services (including address if
(ifindividual, last name, first name, MI):
different irom No. 10a)
(last name, firstname, MI):
(attach ContinuaUOn Shee
t(s) SFLLLA, if necessary)
11. Amount of Payment (check all that apply):
13. Type of Payment (check all that apply):
$ ❑ actual ❑ planned
❑ a. retainer -
❑ b. one-tima tea
12. Form of Payment (check all that apply):
❑ e. commisston
❑ a. eash
❑ d. contingent fea
~ b. In-kind; spaeity: f18tUf0
❑ e. deferrad .
V81UB
❑ t. other, speclfy:
14. Brief Descrlptipn of Servlces Pertormed or to be Performed and Date(s) of Service, including offlcer(s),
employee(s), or Mem6er(s) contacted, for Payment Indicated In Item 11:
(attach ConPnuaNon Sheef s SFLLUI, flnecessa )
15. Contlnuatlon Sheet s SF-LLLA attached: ❑ Yea ❑ No
'"~m"'.a"°"° °.ow"'"' a""".""°"`°° er au. a, ua.e...cSon
16
Slgnature:
.
1352. fi4 Ebtlaun N bb0y1^Y MMUea ba mleAY rapra+onUtlm M hc4
'w°"`"'uc""""'""0'°°bi"""".°°"°""'°"'"'°'""`"°'"'°°'"'°°
PrintName:
«.wf.a Nm n+i m.ao... ro~.aww w~•~•m m ai us.a 1uz mi.
infamutlon M M nporlM b IM Caqnss Smii•rmuetly rk wM M MBo6N br
ww a.awW. .na w
ro aw a m. u,. r
Tltle:
pAft wpeaw. Nn n«sw
w
wel.u e. a+ wrMr afa w. nn $+o.ooo w mt ~ em $+oo.ooo ror
tl
m
w
Telephone No.: Date:
, „
,
-
Authorized for lacal Reproduction
F6defdl U38 Ot11J/: . . ~ .
Standard Form LLL Rev.7•97
INSTRUCtIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disGosure fortn shatl be eompleted by the reporting endty, whethar aubawardeear prime Federal reciplent, at the initlatlon or recoipt of e wvared Federal
action, or a material change W a prevlous fitlag, pursuant W tlUe 31 U.S.C. seetlog 1352. The fi0ng of a lortn b required for each peymenlor egreementto make
payment to any Iobbying entiry far Inlluendng or ettempting to Influenee en oflker or employeeof any epenq, a Member ot Congress, an o(flcar ar employee oi
Congress, a en employeeaf a Memberof Congreu In conneUtonwttA a coveredFederalactlon. Use the SF-LLLA ContinuationSheet (or additional InfortnaUon H
the apace on the form is Inadaquate. Canplete all items that epply tor boN the Inttial filing end malerial ehange report Reter to the Implementing guidance
published by the Office of Management and Budget tor addiUonal informatlon.
1. Identify the rype of covered Federal acUon for which Iobbying actlviry Is andlor has been secured ta influenee the outcome ol a eovered Faderel actian.
2. Identify the status ot the covered Federel acGon. .
3. Identi(y the appropriateclassificaNon of this repoR. If this Is a folbwup reportcaused by a materialchange lo the infortnatlon previouslyreported, enter
the year and quarter in which the change oecurred. Enter the dale of the lasl previouslysubmitted report by this repoRing entity for this covered Federel
acUOn.
4. Enterthe lull name, address, city, State end zip codeof the repwting entity.lndude CongressionalDisVict, H known. Check the approprlateclassmcation
of the reporting enGry that designales if It is, or expeets to be, e prime or subaward recfpient IdenUfy the Uer of the subawardee,e.g., the firet subawardee
of the prime Is the t st tier. Subawards Include but are not limited to subcontracb, subgrents and eonVact awards under granLS.
5. It the organlzatfonfiling the repoA in Item 4 checks'Subawardee; then enter the tull name, address, Gly, State and zip wde of the prime Federel
reGplent. InclWe Cangressionai Distdcl, lf known.
6. EnlerNenameoftheFederalagencymakingtheawardorloanwmmitment.Includeatleastoneorganizatbnallevelbebwagencyneme,Hknown.For
example, Departmenl of TrensportaNan, UNled SWtes Coast GuaM. 7. Enter the Federelprogram name or descApllon for the covered Fede21 actlon (item 1). I( known, enter the tull Cataiog of Federal Domestlc Ass(stance
(CFDA) number tor grants, cooperetive agreements, loans, and loan comm:finents.
B. Enter the most appropriate Federal identi(ying number availablefor the Federel actfon IdenUfied in item 1(e.g., Request for Proposal (RFP) number,
Invitatlon tor Bid (IFB) number, grent announcementnumher; the conlrect, grant, or loan award number, the applicatioNproposalconWl number
assigned by the Federal agenty). Inciude prefizes, e.g.,'RFP-DE-94001 ' .
9. For a covered Federel acllon where there has been an award or loan commiVnenl by the Federei agency, enter the Fedaral amount ol the ewardlloan
commitmenl for the pdme enUty itlentifled in ttem 4 or S.
10. (a) Enter the full name, address, ctty. State and zfp code of the lobbying entity engaged by the reporting entity identifiad in flem 4 to InMence the covered
Federel acUon.
(b) Enter the tull names of the individual(s) perfortning services, end include lull address H diHerent from 10 (a). Enter Last Name, First Name, and
MiCdle INtial (MI). -
Enlertheamountofcompensalionpaidorreasonablyexpectedto6epaidbylherepoNngentily(item4)Wthelobbyingentlry(iteml0).IndiwtewheNer
the payment has been made (actual) or will be made (planned). Check all bozes Nat appiy. If this Is a mateAal change report, enter the cumulative
amount of payment made w planned to be made. .
12. Check the appropriatebox(es). Check all boxes that apply. if paymentis made through an in-kind cantribuUon, specHy the nature and value of the in-kfnd
paymenL
73. Check the appropriale box(es). Cheek all boxes that appiy. If other, specify naNre.
74. Provide a specific end detaiieddascripdon of the services that the Iobbyist has perfortned, or will be expected to peAorm, end the date(s) ot any services
rendered. Include ail preparetory and related activity, not Just Uma spant in ectual wntad with Federal oKCials. Identily the Federai olficial(s) w
employee(s) conWcted or the officer(s), employee(s), ar Member(s) of Congress Ihat were eonlacted.
15. Check whether or not e SFLLLA Contlnuatbn Sheet(s) Is attached.
18. The eertHying ofAClal shatl aign and date the fortn, pdnl hisTher name, llUe, and telephone number. ,
According W the PaperworkReduction Act, es amended, no parsons are required to reapond to e cdleeUon of Informatlon unteea It displays a valid OMB Control
Number. The valid OMB control wmber for thls Infwmatbn collecllan Is OMB No. 0348-0048. Pubtle repoNng burdan fa Nls eolleetlon of kdortnatbn b
estimeted W everage30 minutes per response, Induding tlme tw revtewirg InsWCtbna, searchinp axisting data sourees, gathering and meintaining the data
needed, and ampleting and reviewing the collectlon of informatlon. Send comments regarding the burden estlmate or any other espect of Mis wtlectlon o(
IntamaUon. Induding suggestions for reduGng this buMen, W the O(Bee ot Managementend Budget, Paperwork Raduction ProJeG (0348-0648), WashingWn.
DC 20503.