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HomeMy WebLinkAbout195-23 RESOLUTION113 West Mountain Street Fayetteville, AR 72701 (479) 575-8323 Resolution: 195-23 File Number: 2023-1017 2023 PROJECT SAFE NEIGHBORHOODS (GRANT ACCEPTANCE): A RESOLUTION TO AUTHORIZE ACCEPTANCE OF A PROJECT SAFE NEIGHBORHOOD GRANT AWARD IN THE AMOUNT OF $18,114.00 FOR THE FAYETTEVILLE POLICE DEPARTMENT, AND TO APPROVE A BUDGET ADJUSTMENT Section 1: That the City Council of the City of Fayetteville, Arkansas hereby authorizes acceptance of a Project Safe Neighborhood Grant award in the amount of $18,114.00 for the Fayetteville Police Department. Section 2: That the City Council of the City of Fayetteville, Arkansas hereby approves a budget adjustment, a copy of which is attached to this Resolution. PASSED and APPROVED on September 5, 2023 Page 1 0111"Mt1<<► �•.' •G\T Y 0,C,'.�'G'% o FAYMEVILU . • V sy.� �11N�����, X� N. CITY OF FAYETTEVILLE ARKANSAS MEETING OF SEPTEMBER 5, 2023 TO: Mayor Jordan and City Council THRU: CITY COUNCIL MEMO 2023-1017 FROM: Mike Reynolds, Police Chief DATE: SUBJECT: Project Safe Neighborhoods (PSN) Grant Award for the Fayetteville Police Department RECOMMENDATION: Staff recommends acceptance of the non -matching Project Safe Neighborhoods (PSN) grant award and approval of a budget adjustment in the amount of $18,114.00. BACKGROUND: The Fayetteville Police Department (FPD) first received PSN grant funds in the total amount of $14,100 beginning in 2020. The department applied to renew this funding on December 2, 2022, with the Department of Finance & Administration, Office of Intergovernmental Services with a proposed budget of $18,114.00. The budget and application were approved by staff on December 2, 2022, and on August 1, 2023, the police department was notified of this grant award. The PSN grant is designed to create and foster safer neighborhoods through a sustained reduction of violent crime and works in partnership with the U.S. Attorney's Office for the Western District of Arkansas. The program's effectiveness relies on the collaboration of local, state, and federal law enforcement agencies working together with the communities they serve. DISCUSSION: FPD proposes to utilize the grant award of $18,114.00 as follows: $5,269 for gun violence investigations overtime, $2,108 for community events overtime, and $1,237 for the fringe benefits associated with the overtime allocations, $2,000 for printing costs of a PSN themed coloring book, $3,000 for the purchase of gun locks with the PSN logo which will be used when educating the public on firearm safety, and $3,000 for the purchase of first aid kits, which will be utilized as training aids for our community. Funding in the amount of $1,500 will be used to supplement the cost of three community events, which include scholarships for a self- defense course, miniature golf with sworn staff, and a community hoops event. The grant period for this award is from August 1, 2023, to July 1, 2024. BUDGET/STAFF IMPACT: There are no matching funds associated with this grant. A budget adjustment in the amount of $18,114.00 will be added to the 2023 operating budget. There is no impact on staffing. ATTACHMENTS: PSN Staff Review Form & Staff Review Memo, 2023-1017 BA Police Safe Neighborhoods Grant, PSN grant award documents Mailing address: 113 W. Mountain Street www.fayetteville-ar.gov Fayetteville, AR 72701 Mailing address: 113 W. Mountain Street www.fayetteville-ar.gov Fayetteville, AR 72701 _= City of Fayetteville, Arkansas 113 West Mountain Street Fayetteville, AR 72701 (479)575-8323 - Legislation Text File #: 2023-1017 Project Safe Neighborhoods (PSN) Grant Award for the Fayetteville Police Department A RESOLUTION TO AUTHORIZE ACCEPTANCE OF A PROJECT SAFE NEIGHBORHOOD GRANT AWARD IN THE AMOUNT OF $18,114.00 FOR THE FAYETTEVILLE POLICE DEPARTMENT, AND TO APPROVE A BUDGET ADJUSTMENT Section 1: That the City Council of the City of Fayetteville, Arkansas hereby authorizes acceptance of a Project Safe Neighborhood Grant award in the amount of $18,114.00 for the Fayetteville Police Department. Section 2: That the City Council of the City of Fayetteville, Arkansas hereby approves a budget adjustment, a copy of which is attached to this Resolution. Page 1 Mike Reynolds Submitted By City of Fayetteville Staff Review Form 2023-1017 Item ID 9/5/2023 City Council Meeting Date - Agenda Item Only N/A for Non -Agenda Item 8/15/2023 POLICE (200) Submitted Date Division / Department Action Recommendation: Staff recommends acceptance of the non -matching Project Safe Neighborhoods (PSN) grant award for the Fayetteville Police Department and approval of a budget adjustment in the amount of $18,114.00. 1010.200.2920 - various Account Number 32210.2301 Project Number Budgeted Item? No Does item have a direct cost? No Is a Budget Adjustment attached? Yes Budget Impact: General Fund Police PSN 2023 Grant Total Amended Budget Expenses (Actual+Encum) Available Budget Item Cost Budget Adjustment Remaining Budget Project Title F $ 18,114.00 18,114.00 V20221130 Purchase Order Number: Previous Ordinance or Resolution # Change Order Number: Approval Date: Original Contract Number: Comments: CITY OF FAYETTEVILLE ARKANSAS MEETING OF SEPTEMBER 9, 2023 TO: Mayor and City Council FROM: Mike Reynolds, Chief of Police DATE: August 15, 2023 SUBJECT: Project Safe Neighborhoods (PSN) Grant Award for the Fayetteville Police Department CITY COUNCIL MEMO RECOMMENDATION: Staff recommends acceptance of the non -matching Project Safe Neighborhoods (PSN) grant award and approval of a budget adjustment in the amount of $18,114.00. BACKGROUND: The Fayetteville Police Department (FPD) first received PSN grant funds in the total amount of $14,100 beginning in 2020. The department applied to renew this funding on December 2, 2022, with the Department of Finance & Administration, Office of Intergovernmental Services with a proposed budget of $18,114.00. The budget and application were approved by staff on December 2, 2022, and on August 1, 2023, the police department was notified of this grant award. The PSN grant is designed to create and foster safer neighborhoods through a sustained reduction of violent crime and works in partnership with the U.S. Attorney's Office for the Western District of Arkansas. The program's effectiveness relies on the collaboration of local, state, and federal law enforcement agencies working together with the communities they serve. DISCUSSION: FPD proposes to utilize the grant award of $18,114.00 as follows: $5,269 for gun violence investigations overtime, $2,108 for community events overtime, and $1,237 for the fringe benefits associated with the overtime allocations, $2,000 for printing costs of a PSN themed coloring book, $3,000 for the purchase of gun locks with the PSN logo which will be used when educating the public on firearm safety, and $3,000 for the purchase of first aid kits, which will be utilized as training aids for our community. Funding in the amount of $1,500 will be used to supplement the cost of three community events, which include scholarships for a self-defense course, miniature golf with sworn staff, and a community hoops event. The grant period for this award is from August 1, 2023, to July 1, 2024. BUDGET/STAFF IMPACT: There are no matching funds associated with this grant. A budget adjustment in the amount of $18,114.00 will be added to the 2023 operating budget. There is no impact on staffing. Attachments: Budget Adjustment Project Safe Neighborhoods award documents Mailing Address: 113 W. Mountain Street www.fayetteville-ar.gov Fayetteville, AR 72701 City of Fayetteville, Arkansas - Budget Adjustment (Agenda) Budget Year Division POLICE (200) Adjustment Number /Org2 2023 Requestor: TTannehill BUDGET ADJUSTMENT DESCRIPTION / JUSTIFICATION: Establish a revenue and expense budget for tracking the FY2023 Police Project Safe Neighborhoods grant award in project accounting. Grant # PW- COUNCIL DATE: 9/5/2023 ITEM ID#: 2023-1017 Holly Black 6'/16/2023 6:30 ANI RESOLUTION/ORDINANCE Budget Division Date TYPE: D - (City Council) JOURNAL#: GLDATE: CHKD/POSTED: TOTAL Account Number 18,114 18,114 Increase / (Decrease) Expense Revenue Project.Sub# Project Sub.Detl AT v.202388 Account Name 1010.200.2920-4302.01 - 18,114 32210 2301 RE State Grants - Operational 1010.200.2920-5120.00 1010.200.2920-5201.00 8,614 - 8,000 - 32210 32210 2301 EX 2301 EX Personnel Other - Contra Crime Prevent/Investigate 1010.200.2920-5314.00 1,500 - 32210 2301 EX Professional Services I of 1 ARKANSAS DEPARTMENT OF OFFICE OF INTERGOVERNMENTAL SERVICES H .} •; 1515 West Seventh Street, Suite 404 FINANCE AND ADMINISTRATION P.O. Box 8031 Little Rock, Arkansas 72203-8031 Phone: (501) 682-1074 Fax: (501) 682-5206 htt s: www rlla .irl.�il�.ar..Fnv/intf=rpnvernmental services ❑CATALOG OF DOMESTIC FEDERAL ASSISTANCE JAG ❑ RSAT (CFDA Number)16.609. — Project Safe Neighborhoods (PSN) ❑Federal Award Number: 2020-GP-BX-0016 DCF 7 PSN Federal Award Date: 11/05/2020 1. SUBGRANTEE NAME AND ADDRESS (Including Zip Code) 6. SUBGRANT NUMBER: 247331-20WL Mr. Lioneld Jordan, Mayor City of Fayetteville 7. START DATE: August 1, 2023 100 West Rock Street END DATE: July 1, 2024 Fayetteville, AR 72701 2. FEDERAL IDENTIFICATION NUMBER/UEI: 8• AWARD DATE: August 3, 2023 71-6018462/71607688 9. ACTION: Initial 3. MODIFICATION EFFECTIVE DATE: Modification 4. MODIFICATION AMOUNT: $ 10. AWARD AMOUNT: $18,114.00 FEDERAL AMOUNT: $ FEDERAL AMOUNT: $18,114.00 STATE AMOUNT: $ STATE AMOUNT: N/A LOCAL MATCH: $ LOCAL MATCH: N/A No Indirect Rate Cost S. PROJECT DESCRIPTION PSN is a nationwide initiative that brings together federal, state, local, tribal, and territorial law enforcement officials, prosecutors, community - based partners, and other stakeholders to identify the most pressing violent crime problems in a community and develop comprehensive solutions to address them. PSN is coordinated by the U.S. Attorneys' Offices in the 94 federal judicial districts throughout the 50 states and U.S. territories. 11. SPECIAL CONDITIONS (Check If applicable) THE ABOVE GRANT PROJECT IS APPROVED SUBJECT TO SUCH CONDITIONS OR LIMITATIONS ASSET FORTH IN IrS APPLICATION AND ALL CERTIFICATIONS, ASSURANCES AND SPECIAL CONDITIONS PREVIOUSLY AGREED TO. This project is supported under FY20 (BJA-PSN) pub L No. 116-6, 113 stat. 13, 112; Pub. L No. 115-185, 132 Stat. 1485. AGENGY APPROVAL SUBGRANTEE APPROVAL 12. TYPED NAME AND TITLE OFAPPROVING IGS OFFICIAL 15. TYPED NAME AND TITLE OF AUTHORIZED SUBGRANTEE OFFICIAL Doris Smith, DFA Administrator Lioneld Jordan, Mayor Intergovernmental Services City of yetteville 13.SIGNAT E FAPPRO GOFFICIAL 14. DATE: GNATURE F HORIZE OFFICIAL 17. DATE: 105712 Department of Justice (DOJ) Office of Justice Programs Bureau of Justice Assistance PROJECTNUMBER 2020-GP.BX-0016 AWARD CONTINUATION SHEET Grant AWARD DATE SPECIAL CONDITIONS 1. Requirements of the award; remedies for non-compliance or for materially false statements PAGE 2 OF 19 The conditions of this award are material requirements of the award, Compliance with any assurances or certifications submitted by or on behalf of the recipient that relate to conduct during the period of performance also is a material requirement of this award. Limited Exceptions, In certain special circumstances, the U.S. Department of Justice ("DOJ") may determine that it will not enforce, or enforce only in part, one or more requirements otherwise applicable to the award. Any such exceptions regarding enforcement, including any such exceptions made during llte period of performance, are (or will be during the period of performance) set out through the Office of Justice Programs ("OJP") webpage entitled "Legal Notices: Special circumstances as to particular award conditions" (ojp.gov/funding/Explore/LegalNotices-AwardRcgts.htm), and incorporated by reference into the award. By signing and accepting this award on behalf of the recipient, the authorized recipient official accepts all material requirements of the award, and specifically adopts, as if personally executed by the authorized recipient official, all assurances or certifications submitted by or on behalf of the recipient that relate to conduct during the period of performance. Failure to comply with one or more award requirements — whether a condition set out in full below, a condition incorporated by reference below, or an assurance or certification related to conduct during the award period -- may result in OJP taking appropriate action with respect to the recipient and the award. Among other things, the OJP may withhold award funds, disallow costs, or suspend or terminate the award. DOJ, including OJP, also may take other legal action as appropriate. Any materially false, fictitious, or fraudulent statement to the federal government related to this award (or concealment or omission of a material fact) may be the subject of criminal prosecution (including under 18 U.S.C. 1001 and/or 1621, and/or 34 U.S.C. 10271-10273), and also may lead to imposition of civil penalties and administrative remedies for raise claims or otherwise (including under 31 U.S.C. 3729-3730 and 3801-3812). Should any provision of a requirement of this award be held to be invalid or unenforceable by its terms, that provision shall first be applied with a limited construction so as to give it the maximum effect permitted by law. Should it be held, instead, that the provision is utterly invalid or -unenforceable, such provision shall be deemed severable from this award. OJP FORM 4000/2 (REV. 4-88) Department of Justice (DOJ) Office of Justice Programs Bureau of Justice Assistance PROJECT NUMBER 2020-GP-BX-0016 AWARD CONTINUATION SHEET Grant AWARD DATE SPECIAL CONDITIONS 2. Applicability of Part 200 Uniform Requirements PAGE 3 OF 19 The Uniform Administrative Requirements, Cost Principles, and Audit Requirements in 2 C.F.R. Part 200, as adopted and supplemented by DOJ in 2 C.F.R. Part 2800 (together, the "Part 200 Uniform Requirements") apply to this FY 2020 award from OJP. The Pan 200 Uniform Requirements were first adopted by DOJ on December 26, 2014. I f this FY 2020 award supplements funds previously awarded by OJP under the same award number (e.g., funds awarded during or before December 2014), the Part 200 Uniform Requirements apply with respect to all funds under that award number (regardless of the award date, and regardless of whether derived from the initial award or a supplemental award) that are obligated on or after the acceptance date of this FY 2020 award. For more information and resources on the Part 200 Uniform Requirements as they relate to OJP awards and subawards ("subgrants"), see the OJP website at https://ojp.gov/funding/Part200UniformRequirements.htm. Record retention and access: Records pertinent to the award that the recipient (and any subrecipient ("subgrantee") at any tier) must retain -- typically for a period of 3 years from the date of submission of the final expenditure report (SF 425), unless a different retention period applies -- and to which the recipient (and any subrecipient ("subgrantee") at any tier) must provide access, include performance measurement information, in addition to the financial records, supporting documents, statistical records, and other pertinent records indicated at 2 C.F.R. 200.333. In the event that an award -related question arises from documents or other materials prepared or distributed by OJP that may appear to conflict with, or differ in some way from, the provisions of the Part 200 Uniform Requirements, the recipient is to contact OJP promptly for clarification. 3. Compliance with DOJ Grants Financial Guide References to the DOJ Grants Financial Guide are to the DOJ Grants Financial Guide as posted on the OJP website (currently, the "DOJ Grants Financial Guide" available at https://ojp.gov/financialguide/DOJ/indcx.htm), including any updated version that may be posted during the period of performance. The recipient agrees to comply with the DOJ Grants Financial Guide. 4. Reclassification of various statutory provisions to a new Title 34 of the United States Code On September I, 2017, various statutory provisions previously codified elsewhere in the U.S. Code were editorially reclassified (that is, moved and renumbered) to a new Title 34, entitled "Crime Control and Law Enforcement" The reclassification encompassed a number of statutory provisions pertinent to OJP awards (that is, OJP grants and cooperative agreements), including many provisions previously codified in Tidc 42 of the U.S. Code. Effective as of September 1, 2017, any reference in this award document to a statutory provision that has been reclassified to the new Title 34 of the U.S. Code is to be read as a reference to that statutory provision as reclassified to Title 34. This rule of construction specifically includes references set out in award conditions, references set out in material incorporated by reference through award conditions, and references set out in other award requirements. OJP FORM 4000/2 (REV. 4-88) Department of Justice (DOJ) Office of Justice Programs t Bureau of Justice Assistance PROJECT NUMBER 2020-GP-BX-0016 AWARD CONTINUATION SHEET Grant AWARD DATE SPECIAL CONDITIONS 5. Required training for Point of Contact and all Financial Points of Contact PAGE 4 OF 19 Both the Point of Contact (POC) and all Financial Points of Contact (FPOCs) for this award must have successfully completed an "OJP financial management and grant administration training" by 120 days after the date of the recipient's acceptance of the award. Successful completion of such a training on or after January 1, 2018, will satisfy this condition. In the event that either the POC or an FPOC for this award changes during the period of performance, the new POC or FPOC must have successfully completed an "OJP financial management and grant administration training" by 120 calendar days after -- (1) the date of OJP's approval of the "Change Grantee Contact" GAN (in the case of a new POC), or (2) the date the POC enters information on the new FPOC in GMS (in the case of a new FPOC). Successful completion of such a training on or after January 1, 2018, will satisfy this condition. A list of OJP trainings that OJP will consider "OJP financial management and grant administration training" for purposes of this condition is available at hUps://www.ojp.gov/training/fmts.htm. All trainings that satisfy this condition include a session on grant fraud prevention and detection. The recipient should anticipate that OJP will immediately withhold ("freeze") award funds if the recipient fails to comply with this condition. The recipient's failure to comply also may lead OJP to impose additional appropriate conditions on this award. 6. Requirements related to "de minimis" indirect cost rate A recipient that is eligible under the Part 200 Uniform Requirements and other applicable law to use the "de minimis" indirect cost rate described in 2 C.F.R. 200.414(f), and that elects to use the "de minimis" indirect cost rate, must advise OJP in writing of both its eligibility and its election, and must comply with all associated requirements in the Part 200 Uniform Requirements. The "de minimis" rate may be applied only to modified total direct costs (MTDC) as defined by the Part 200 Uniform Requirements. 7. Requirement to report potentially duplicative funding If the recipient currently has other active awards of federal funds, or if the recipient receives any other award of federal funds during the period of performance for this award, the recipient promptly must determine whether funds from any of those other federal awards have been, are being, or are to be used (in whole or in part) for one or more of the identical cost items for which funds are provided under this award. If so, the recipient must promptly notify the DOJ awarding agency (OJP or OVW, as appropriate) in writing of the potential duplication, and, if so requested by the DOJ awarding agency, must seek a budget -modification or change -of -project -scope grant adjustment notice (GAN) to eliminate any inappropriate duplication of funding. OJP FORM 4000/2 (REV. 4-88) Department of Justice (DOJ) SWOffice of Justice Programs Bureau of Justice Assistance PROJECTNUMBER 2020-GP-BX-0016 AWARD CONTINUATION SHEET Grant AWARD DATE PAGE 5 OF 19 SPECIAL CONDITIONS 8. Requirements related to System for Award Management and Universal Identifier Requirements The recipient must comply with applicable requirements regarding the System for Award Management (SAM), currently accessible at https://www.sam.gov/. This includes applicable requirements regarding registration with SAM, as well as maintaining the currency of information in SAM. The recipient also must comply with applicable restrictions on subawards ("subgrants") to first -tier subrecipients (first -tier "subgrantees"), including restrictions on subawards to entities that do not acquire and provide (to the recipient) the unique entity identifier required for SAM registration. The details of the recipient's obligations related to SAM and to unique entity identifiers are posted on the OJP web site at https://ojp.gov/funding/Explore/SAM.htm (Award condition: System for Award Management (SAM) and Universal Identifier Requirements), and are incorporated by reference here. This condition does not apply to an award to an individual who received the award as a natural person (i.e., unrelated to any business or non-profit organization that he or she may own or operate in his or her name). OJP FORM 4000/2 (REV, 4-88) Department of Justice (DOJ) Office of Justice Programs ..� r ►' . Bureau of Justice Assistance PROJECTNUMBER 2020-GP-BX-0016 AWARD CONTINUATION SHEET PAGE 6 OF 19 Grant AWARD DATE SPECIAL CONDITIONS 9. Employment eligibility verification for hiring under the award 1. The recipient (and any subrecipient at any tier) must -- A. Ensure that, as part of the hiring process for any position within the United States that is or will be funded (in whole or in part) with award funds, the recipient (or any subrecipient) properly verifies the employment eligibility of the individual who is being hired, consistent with the provisions of 8 U.S.C. 1324a(a)(1) and (2). B. Notify all persons associated with the recipient (or any subrecipient) who are or will be involved in activities under this award of both-- (1) this award requirement for verification of employment eligibility, and (2) the associated provisions in 8 U.S.C. 1324a(a)(1) and (2) that, generally speaking, make it unlawful, in the United States, to hire (or recruit for employment) certain aliens. C. Provide training (to the extent necessary) to those persons required by this condition to be notified of the award requirement for employment eligibility verification and of the associated provisions of 8 U.S.C. 1324a(a)(1) and (2). D. As pan of the recordkceping for the award (including pursuant to the Part 200 Uniform Requirements), maintain records of all employment eligibility verifications pertinent to compliance with this award condition in accordance with Form 1-9 record retention requirements, as well as records of all pertinent notifications and trainings. 2. Monitoring The recipient's monitoring responsibilities include monitoring of subrecipient compliance with this condition. 3. Allowable costs To the extent that such costs are not reimbursed under any other federal program, award finds may be obligated for the reasonable, necessary, and allocable costs (if any) of actions designed to ensure compliance with this condition. 4. Rules of construction A. Staff involved in the hiring process For purposes of this condition, persons "who are or will be involved in activities under this award" specifically includes (without limitation) any and all recipient (or any subrecipient) officials or other staff who are or will be involved in the hiring process with respect to a position that is or will be funded (in whole or in part) with award funds. B. Employment eligibility confirmation with E-Verify For purposes of satisfying the requirement of this condition regarding verification of employment eligibility, the recipient (or any subrecipient) may choose to participate in, and use, E-Verify (www.e-verify.gov), provided an appropriate person authorized to act on behalf of the recipient (or subrecipient) uses E-Verify (and follows the proper E-Verify procedures, including in the event of a "Tentative Nonconfirmation" or a "Final Nonconfirmation") to confirm employment eligibility for each hiring for a position in the United States that is or will be funded (in whole or in part) with award funds. C. "United States" specifically includes the District of Columbia, Puerto Rico, Guam, the Virgin Islands of the United States, and the Commonwealth of the Northern Mariana Islands. D. Nothing in this condition shall be understood to authorize or require any recipient, any subrecipient at any tier, or OJP FORM 4000/2 (REV. 4-88) Department of Justice (DOJ) Office of Justice Programs Bureau of Justice Assistance PROJECT NUMBER 2020-GP-BX-0016 AWARD CONTINUATION SHEET AWARD DATE SPECIAL CONDITIONS Grant PAGE 7 OF 19 any person or other entity, to violate any federal law, including any applicable civil rights or nondiscrimination law E. Nothing in this condition, including in paragraph 4.B., shall be understood to relieve any recipient, any subrecipient at any tier, or any person or other entity, of any obligation otherwise imposed by law, including 8 U.S.C. 1324a(a)(1) and (2). Questions about E-Verify should be directed to DHS. For more information about E-Verify visit the E-Verify website (https://www.e-vcrify.gov/) or email E-Verify at E-Verify(cr�,dhs.gov. E-Verify employer agents can email E- Verify at E-VerifyEmployerAgent(@,,dhs.gov. Questions about the meaning or scope of this condition should be directed to OJP, before award acceptance 10. Requirement to report actual or imminent breach of personally identifiable information (PII) The recipient (and any "subrecipient" at any tier) must have written procedures in place to respond in the event of an actual or imminent "breach" (OMB M-17-12) if it (or a subrecipient) -- (1) creates, collects, uses, processes, stores, maintains, disseminates, discloses, or disposes of "personally identifiable information (PII)" (2 CFR 200.79) within the scope of an OJP grant -funded program or activity, or (2) uses or operates a "Federal information system" (OMB Circular A-130). The recipient's breach procedures must include a requirement to report actual or imminent breach of PII to an OJP Program Manager no later than 24 hours after an occurrence of an actual breach, or the detection of an imminent breach. 11. All subawards ("subgrants") must have specific federal authorization The recipient, and any subrecipient ("subgrantee") at any tier, must comply with all applicable requirements for authorization of any subaward. This condition applies to agreements that -- for purposes of federal grants administrative requirements -- OJP considers a "subaward" (and therefore does not consider a procurement "contract"). The details of the requirement for authorization of any subaward are posted on the OJP web site at https:Hojp.gov/funding/Explore/SubawardAuthorization.htm (Award condition: All subawards ("subgrants") must have specific federal authorization), and are incorporated by reference here. 12. Specific post -award approval required to use a noncompetitive approach in any procurement contract that would exceed $250,000 The recipient, and any subrecipient ("subgrantee") at any tier, must comply with all applicable requirements to obtain specific advance approval to use a noncompetitive approach in any procurement contract that would exceed the Simplified Acquisition Threshold (currently, $250,000). This condition applies to agreements that -- for purposes of federal grants administrative requirements -- OJP considers a procurement "contract" (and therefore does not consider a subaward). The details of the requirement for advance approval to use a noncompetitive approach in a procurement contract under an OJP award are posted on the OJP web site at https://ojp.gov/funding/Explore/NoncompctitiveProcurement.htm (Award condition: Specific post -award approval required to use a noncompetitive approach in a procurement contract (if contract would exceed $250,000)), and are incorporated by reference here. OJP FORM 4000/2 (REV. 4-88) Department of Justice (DOJ) Office of Justice Programs t Bureau of Justice Assistance PROJECT NUMBER 2020-GP-BX-0016 AWARD CONTINUATION SHEET Grant AWARD DATE SPECIAL CONDITIONS 13. Unreasonable restrictions on competition under the award; association with federal government PAGE 8 OF 19 SCOPE. This condition applies with respect to any procurement of property or services that is funded (in whole or in part) by this award, whether by the recipient or by any subrecipient at any tier, and regardless of the dollar amount of the purchase or acquisition, the method of procurement, or the nature of any legal instrument used. The provisions of this condition must be among those included in any subaward (at any tier). 1. No discrimination, in procurement transactions, against associates of the federal government Consistent with the (DOJ) Part 200 Uniform Requirements -- including as set out at 2 C.F.R. 200.300 (requiring awards to be "manage[d] and administer[ed] in a manner so as to ensure that Federal funding is expended and associated programs are implemented in full accordance with U.S. statutory and public policy requirements") and 200.319(a) (generally requiring "[aJll procurement transactions [to] be conducted in a manner providing full and open competition" and forbidding practices "restrictive of competition," such as "[p]lacing unreasonable requirements on firms in order for them to qualify to do business" and taking "[a]ny arbitrary action in the procurement process") -- no recipient (or subrecipient, at any tier) may (in any procurement transaction) discriminate against any person or entity on the basis of such person or entity's status as an "associate of the federal government" (or on the basis of such person or entity's status as a parent, affiliate, or subsidiary of such an associate), except as expressly set out in 2 C.F.R. 200.319(a) or as specifically authorized by USDOJ. 2. Monitoring The recipient's monitoring responsibilities include monitoring of subrecipient compliance with this condition. 3. Allowable costs To the extent that such costs are not reimbursed under any other federal program, award funds may be obligated for the reasonable, necessary, and allocable costs (if any) of actions designed to ensure compliance with this condition. 4. Rules of construction A. The term "associate of the federal government" means any person or entity engaged or employed (in the past or at present) by or on behalf of the federal government -- as an employee, contractor or subcontractor (at any tier), grant recipient or -subrecipient (at any tier), agent, or otherwise -- in undertaking any work, project, or activity for or on behalf of (or in providing goods or services to or on behalf of) the federal government, and includes any applicant for such employment or engagement, and any person or entity committed by legal instrument to undertake any such work, project, or activity (or to provide such goods or services) in future. B. Nothing in this condition shall be understood to authorize or require any recipient, any subrecipient at any tier, or any person or other entity, to violate any federal law, including any applicable civil rights or nondiscrimination law. OJP FORM 4000/2 (REV. 4-88) Department of Justice (DOJ) Office of Justice Programs Bureau of Justice Assistance PROJECT NUMBER 2020-GP-BX-0016 AWARD CONTINUATION SHEET Grant AWARD DATE SPECIAL CONDITIONS PAGE 9 OF 19 14. Requirements pertaining to prohibited conduct related to trafficking in persons (including reporting requirements and OJP authority to terminate award) The recipient, and any subrecipient ("subgrantee") at any tier, must comply with all applicable requirements (including requirements to report allegations) pertaining to prohibited conduct related to the trafficking of persons, whether on the part of recipients, subrecipients ("subgrantees"), or individuals defined (for purposes of this condition) as "employees" of the recipient or of any subrecipient. The details of the recipient's obligations related to prohibited conduct related to trafficking in persons are posted on the OJP web site at https://ojp.gov/funding/Explore/ProhibitedConduct-Traffcking.litm (Award condition: Prohibited conduct by recipients and subrecipients related to trafficking in persons (including reporting requirements and OJP authority to terminate award)), and are incorporated by reference here. 15. Determination of suitability to interact with participating minors SCOPE. This condition applies to this award if it is indicated — in the application for the award (as approved by DOJ)(or in the application for any subaward, at any tier), the DOJ funding announcement (solicitation), or an associated federal statute -- that a purpose of some or all of the activities to be carried out under the award (whether by the recipient, or a subrecipient at any tier) is to benefit a set of individuals under 18 years of age. The recipient, and any subrecipient at any tier, must make determinations of suitability before certain individuals may interact with participating minors. This requirement applies regardless of an individual's employment status. The details of this requirement are posted on the OJP web site at https://ojp.gov/funding/Explore/Interact-Minors.htm (Award condition: Determination of suitability required, in advance, for certain individuals who may interact with participating minors), and arc incorporated by reference he1e. 16. Compliance with applicable rules regarding approval, planning, and reporting of conferences, meetings, trainings, and other events The recipient, and any subrecipient ("subgrantee") at any tier, must comply with all applicable laws, regulations, policies, and official DOJ guidance (including specific cost limits, prior approval and reporting requirements, where applicable) governing the use of federal funds for expenses related to conferences (as that term is defined by DO)). including the provision of food and/or beverages at such conferences, and costs of attendance at such conferences. Information on the pertinent DOJ definition of conferences and the rules applicable to this award appears in the DOJ Grants Financial Guide (currently, as section 3.10 of "Postaward Requirements" in the "DOJ Grants Financial Guide"). 17. Requirement for data on performance and effectiveness under the award The recipient must collect and maintain data that measure the performance and effectiveness of work under this award. The data must be provided to OJP in the manner (including within the timeframes) specified by OJP in the program solicitation or other applicable written guidance. Data collection supports compliance with the Government Performance and Results Act (GPRA) and the GPRA Modernization Act of 2010, and other applicable laws. 18. OJP Training Guiding Principles Any training or training materials that the recipient — or any subrecipient ("subgrantee") at any tier -- develops or delivers with OJP award funds must adhere to the OJP Training Guiding Principles for Grantees and Subgrantees, available at https:Hojp.gov/funding/Implement/TrainingPrinciplesForGrantees-Stibgrantces.htm. OJP FORM 4000/2 (REV. 4-88) Department of Justice (DOJ) Office of Justice Programs Bureau of Justice Assistance PROJECT NUMBER 2020-GP-BX-0016 AWARD CONTINUATION SHEET Grant AWARD DATE SPECIAL CONDITIONS 19. Effect of failure to address audit issues PAGE 10 OF 19 The recipient understands and agrees that the DOJ awarding agency (OJP or OVW, as appropriate) may withhold award funds, or may impose other related requirements, if (as determined by the DOJ awarding agency) the recipient does not satisfactorily and promptly address outstanding issues from audits required by the Part 200 Uniform Requirements (or by the terms of this award), or other outstanding issues that arise in connection with audits, investigations, or reviews of DOJ awards. 20. Potential imposition of additional requirements The recipient agrees to comply with any additional requirements that may be imposed by the DOJ awarding agency (OJP or OVW, as appropriate) during the period of performance for this award, if the recipient is designated as "high - risk" for purposes of the DOJ high -risk grantee list. 21. Compliance with DOJ regulations pertaining to civil rights and nondiscrimination - 28 C.F.R. Part 42 The recipient, and any subrecipient ("subgrantee") at any tier, must comply with all applicable requirements of 28 C.F.R. Part 42, specifically including any applicable requirements in Subpart E of 28 C.F.R. Part 42 that relate to an equal employment opportunity program. 22. Compliance with DOJ regulations pertaining to civil rights and nondiscrimination - 28 C.F.R. Part 54 The recipient, and any subrecipient ("subgrantee") at any tier, must comply with all applicable requirements of 28 C.F.R. Part 54, which relates to nondiscrimination on the basis of sex in certain "education programs." 23. Compliance with DOJ regulations pertaining to civil rights and nondiscrimination - 28 C.F.R. Part 38 The recipient, and any subrecipient ("subgrantee") at any tier, must comply with all applicable requirements of 28 C.F.R. Part 38 (as may be applicable from time to time), specifically including any applicable requirements regarding written notice to program beneficiaries and prospective program beneficiaries. Currently, among other things, 28 C.F.R. Part 38 includes rules that prohibit specific forms of discrimination on the basis of religion, a religious belief, a refusal to hold a religious belief, or refusal to attend or participate in a religious practice. Part 38, currently, also sets out rules and, requirements that pertain to recipient and subrecipient ("subgrantee") organizations that engage in or conduct explicitly religious activities, as well as rules and requirements that pertain to recipients and subrecipients that are faith -based or religious organizations. The text of 28 C.F.R. Part 38 is available via the Electronic Code of Federal Regulations (currently accessible at https://www.ecfr.gov/cgi-bin/ECFR?page=browse), by browsing to Title 28-Judicial Administration, Chapter 1, Part 38, under a-CFR "current" data. OJP FORM 4000/2 (REV.4-88) Department of Justice (DOJ) Office of Justice Programs j Bureau of Justice Assistance PROJECT NUMBER 2020-GP-BX-0016 24. Restrictions on "lobbying" AWARD CONTINUATION SHEET PAGE 11 OF 19 Grant AWARD DATE SPECIAL CONDITIONS In general, as a matter of federal law, federal funds awarded by OJP may not be used by the recipient, or any subrecipient ("subgrantee") at any tier, either directly or indirectly, to support or oppose the enactment, repeal, modification, or adoption of any law, regulation, or policy, at any level of government. See 18 U.S.C. 1913. (There may be exceptions if an applicable federal statute specifically authorizes certain activities that otherwise would be barred by law.) Another federal law generally prohibits federal funds awarded by OJP from being used by the recipient, or any subrecipient at any tier, to pay any person to influence (or attempt to influence) a federal agency, a Member of Congress, or Congress (or an official or employee of any of them) with respect to the awarding of a federal grant or cooperative agreement, subgrant, contract, subcontract, or loan, or with respect to actions such as renewing, extending, or modifying any such award. See 31 U.S.C. 1352. Certain exceptions to this law apply, including an exception that applies to Indian tribes and tribal organizations. Should any question arise as to whether a particular use of federal funds by a recipient (or subrecipient) would or might fall within the scope of these prohibitions, the recipient is to contact OJP for guidance, and may not proceed without the express prior written approval of OJP. 25. Compliance with general appropriations -law restrictions on the use of federal funds (FY 2020) The recipient, and any subrecipient ("subgrantee") at any tier, must comply with all applicable restrictions on the use of federal funds set out in federal appropriations statutes. Pertinent restrictions that may be set out in applicable appropriations acts are indicated at https:Hojp.gov/funding/Explore/FY20AppropriationsRestrictions.htm, and are incorporated by reference here. Should a question arise as to whether a particular use of federal funds by a recipient (or a subrecipient) would or might fall within the scope of an appropriations -law restriction, the recipient is to contact OJP for guidance, and may not proceed without the express prior written approval of OJP. 26. Reporting potential fraud, waste, and abuse, and similar misconduct The recipient, and any subrecipients ("subgrantees") at any tier, must promptly refer to the DOJ Office of the Inspector General (01G) any credible evidence that a principal, employee, agent, subrecipient, contractor, subcontractor, or other person has, in connection with funds under this award-- (1) submitted a claim that violates the False Claims Act; or (2) committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct. Potential fraud, waste, abuse, or misconduct involving or relating to funds under this award should be reported to the OIG by --(I) online submission accessible via the OIG webpage at https://oig.justice.gov/hotline/contact-grants.htm (select "Submit Report Online"); (2) mail directed to: U.S. Department of Justice, Office of the Inspector General, Investigations Division, ATTN: Grantee Reporting, 950 Pennsylvania Ave., NW, Washington, DC 20530; and/or (3) by facsimile directed to the DOJ OIG Investigations Division (Attn: Grantee Reporting) at (202) 616-9881 (fax). Additional information is available from the DOJ OIG website at https://oig.justice.gov/hotline. OJP FORM 4000/2 (REV. 4-88) a� Department of Justice (DOJ) Office of Justice Programs Bureau of Justice Assistance PROJECT NUMBER 2020-GP-BX-0016 AWARD CONTINUATION SHEET Grant AWARD DATE SPECIAL CONDITIONS 27. Restrictions and certifications regarding non -disclosure agreements and related matters PAGE 12 OF 19 No recipient or subrecipient ("subgrantee") under this award, or entity that receives a procurement contract or subcontract with any funds under this award, may require any employee or contractor to sign an internal confidentiality agreement or statement that prohibits or otherwise restricts, or purports to prohibit or restrict, the reporting (in accordance with law) of waste, fraud, or abuse to an investigative or law enforcement representative of a federal department or agency authorized to receive such information. The foregoing is not intended, and shall not be understood by the agency making this award, to contravene requirements applicable to Standard Form 312 (which relates to classified information), Form 4414 (which relates to sensitive compartmented information), or any other form issued by a federal department or agency governing the nondisclosure of classified information. 1. In accepting this award, the recipient -- a. represents that it neither requires nor has required internal confidentiality agreements or statements from employees or contractors that currently prohibit or otherwise currently restrict (or purport to prohibit or restrict) employees or contractors from reporting waste, fraud, or abuse as described above; and b. certifies that, if it learns or is notified that it is or has been requiring its employees or contractors to execute agreements or statements that prohibit or otherwise restrict (or purport to prohibit or restrict), reporting of waste, fraud, or abuse as described above, it will immediately stop any further obligations of award funds, will provide prompt written notification to the federal agency making this award, and will resume (or permit resumption of) such obligations only if expressly authorized to do so by that agency. 2. If the recipient does or is authorized under this award to make subawards ("subgrants"), procurement contracts, or both -- a. it represents that-- (1) it has determined that no other entity that the recipient's application proposes may or will receive award funds (whether through a subaward ("subgrant"), procurement contract, or subcontract under a procurement contract) either requires or has required internal confidentiality agreements or statements from employees or contractors that currently prohibit or otherwise currently restrict (or purport to prohibit or restrict) employees or contractors from reporting waste, fraud, or abuse as described above; and (2) it has made appropriate inquiry, or otherwise has an adequate factual basis, to support this representation; and b. it certifies that, if it learns or is notified that any subrecipient, contractor, or subcontractor entity that receives funds under this award is or has been requiring its employees or contractors to execute agreements or statements that prohibit or otherwise restrict (or purport to prohibit or restrict), reporting of waste, fraud, or abuse as described above, it will immediately stop any further obligations of award funds to or by that entity, will provide prompt written notification to the federal agency making this award, and will resume (or permit resumption of) such obligations only if expressly authorized to do so by that agency. OJP FORM 4000/2 (REV 4-88) Department of Justice (DOJ) Office of Justice Programs Bureau of Justice Assistance AWARD CONTINUATION SHEET Grant PROJECT NUMBER 2020-GP-BX-0016 AWARD DATE SPECIAL CONDITIONS 28. Compliance with 41 U.S.C. 4712 (including prohibitions on reprisal; notice to employees) PAGE 13 OF 19 The recipient (and any subrecipient at any tier) must comply with, and is subject to, all applicable provisions of 41 U,S.C. 4712, including all applicable provisions that prohibit, under specified circumstances, discrimination against an employee as reprisal for the employee's disclosure of information related to gross mismanagement of a federal grant, a gross waste of federal funds, an abuse of authority relating to a federal grant, a substantial and specific danger to public health or safety, or a violation of law, rule, or regulation related to a federal grant. The recipient also must inform its employees, in writing (and in the predominant native language of the workforce), of employee rights and remedies under 41 U.S.C. 4712. Should a question arise as to the applicability of the provisions of 41 U.S.C. 4712 to this award, the recipient is to contact the DOJ awarding agency (OJP or OVW, as appropriate) for guidance. 29. Encouragement of policies to ban text messaging while driving Pursuant to Executive Order 13513, "Federal Leadership on Reducing Text Messaging While Driving," 74 Fed. Reg. 51225 (October 1, 2009). DOJ encourages recipients and subrecipients ("subgrantces") to adopt and enforce policies banning employees from text messaging while driving any vehicle during the course of performing work funded by this award, and to establish workplace safety policies and conduct education, awareness, and other outreach to decrease crashes caused by distracted drivers. 30. Requirement to disclose whether recipient is designated "high risk" by a federal grant -making agency outside of DOJ If the recipient is designated "high risk" by a federal grant -making agency outside of DOJ, currently or at any time during the course of the period of performance under this award, the recipient must disclose that fact and certain related information to OJP by email at OJP.ComplianceReporting(a)ojp.usdoj.gov. For purposes of this disclosure, high risk includes any status under which a federal awarding agency provides additional oversight due to the recipient's past performance, or other programmatic or financial concerns with the recipient. The recipient's disclosure must include the following: 1. The federal awarding agency that currently designates the recipient high risk, 2. The date the recipient was designated high risk, 3. The high -risk point of contact at that federal awarding agency (name, phone number, and email address), and 4. The reasons for the high -risk status, as set out by the federal awarding agency. 31. FFATA reporting: Subawards and executive compensation The recipient must comply with applicable requirements to report first -tier subawards ("subgrants") of $25,000 or more and, in certain circumstances, to report the names and total compensation of the five most highly compensated executives of the recipient and first -tier subrecipients (first -tier "subgrantees") of award funds. The details of recipient obligations, which derive from the Federal Funding Accountability and Transparency Act of 2006 (FFATA), arc posted on the OJP web site at https://ojp.gov/funding/Explore/T-FATA.him (Award condition: Reporting Subawards and Executive Compensation), and are incorporated by reference here. This condition, including its reporting requirement, does not apply to-- (1) an award of less than $25,000, or (2) an award made to an individual who received the award as a natural person (i.e., unrelated to any business or non-profit organization that he or she may own or operate in his or her name). OJP FORM 4000/2 (REV. 4-88) Department of Justice (DOJ) Office of Justice Programs Bureau of Justice Assistance PROJECTNUMBER 2020-GP-BX-0016 AWARD CONTINUATION SHEET Grant AWARD DATE PAGE 14 OF 19 SPECIAL CONDITIONS 32. The recipient agrees to submit to BJA for review and approval any curricula, training materials, proposed publications, reports, or any other written materials that will be published, including web -based materials and web site content, through funds from this grant at least thirty (30) working days prior to the targeted dissemination date. Any written, visual, or audio publications, with the exception of press releases, whether published at the grantee's or government's expense, shall contain the following statements: "This project was supported by Grant No. 2020-GP-BX-0016 awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Department of Justice's Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office for Victims of Crime, and the SMART Office. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice." The current edition of the DOJ Grants Financial Guide provides guidance on allowable printing and publication activities. 33. The recipient agrees to cooperate with any assessments, national evaluation efforts, or information or data collection requests, including, but not limited to, the provision of any information required for the assessment or evaluation of any activities within this project. 34. Verification and updating of recipient contact information The recipient must verify its Point of Contact(POC), Financial Point of Contact (FPOC), and Authorized Representative contact information in GMS, including telephone number and e-mail address. If any information is incorrect or has changed, a Grant Adjustment Notice (GAN) must be submitted via the Grants Management System (GMS) to document changes. 35. Recipient understands and agrees that it must submit quarterly Federal Financial Reports (SF-425) and semi-annual performance reports through GMS (hftps:Hgrants.ojp.usdoj.gov), and that it must submit quarterly performance metrics reports through BJA's Performance Measurement Tool (PMT) website (https://bjapmt.ojp.govn. For more detailed information on reporting and other requirements, refer to BJA's website. Failure to submit required reports by established deadlines may result in the freezing of grant funds and High Risk designation. 36. Required attendance at BJA-sponsored events The recipient (and its subrecipients at any tier) must participate in BJA-sponsored training events, technical assistance events, or conferences held by BJA or its designees, upon BJA's request. 37. The recipient agrees to comply with OJP grant monitoring guidelines, protocols, and procedures, and to cooperate with BJA and OCFO on all grant monitoring requests, including requests related to desk reviews, enhanced programmatic desk reviews, and/or site visits. The recipient agrees to provide to BJA and OCFO all documentation necessary to complete monitoring tasks, including documentation related to any subawards made under this award. Further, the recipient agrees to abide by reasonable deadlines set by BJA and OCFO for providing the requested documents. Failure to cooperate with BJA's/OCFO's grant monitoring activities may result in sanctions affecting the recipient's DOJ awards, including, but not limited to: withholdings and/or other restrictions on the recipient's access to grant funds; referral to the Office of the Inspector General for audit review; designation of the recipient as a DOJ High Risk grantee; or termination of an award(s). 38. The award recipient agrees to participate in a data collection process measuring program outputs and outcomes. The data elements for this process will be outlined by the Office of Justice Programs. OJP FORM 4000/2 (REV. 4-88) Department of Justice (DOJ) Office of Justice Programs i Bureau of Justice Assistance PROJECT NUMBER 2020-GP-BX-0016 AWARD CONTINUATION SHEET Grant AWARD DATE SPECIAL CONDITIONS 39. Protection of human research subjects PAGE 15 OF 19 The recipient (and any subrecipient at any tier) must comply with the requirements of 28 C.F.R. Part 46 and all OJP policies and procedures regarding the protection of human research subjects, including obtainment of Institutional Review Board approval, if appropriate, and subject informed consent. 40. Confidentiality of data The recipient (and any subrecipient at any tier) must comply with all confidentiality requirements of 34 U.S.C. 10231 and 28 C.F.R. Part 22 that are applicable to collection, use, and revelation of data or information. The recipient further agrees, as a condition of award approval, to submit a Privacy Certificate that is in accord with requirements of 28 C.F.R. Part 22 and, in particular, 28 C.F.R. 22.23. 41. Copyright; Data rights The recipient acknowledges that OJP reserves a royalty -free, non-exclusive, and irrevocable license to reproduce, publish, or otherwise use, and authorize others to use (in whole or in part, including in connection with derivative works), for Federal purposes: (1) any work subject to copyright developed under an award or subaward (at any tier); and (2) any rights of copyright to which a recipient or subrecipient (at any tier) purchases ownership with Federal support. The recipient acknowledges that OJP has the right to (1) obtain, reproduce, publish, or otherwise use the data first produced under any such award or subaward; and (2) authorize others to receive, reproduce, publish, or otherwise use such data for Federal purposes. "Data" includes data as defined in Federal Acquisition Regulation (FAR) provision 52.227-14 (Rights in Data - General). It is the responsibility of the recipient (and of each subrecipient (at any tier), if applicable) to ensure that the provisions of this condition are included in any subaward (at any tier) under this award. The recipient has the responsibility to obtain from subrecipients, contractors, and subcontractors (if any) all rights and data necessary to fulfill the recipient's obligations to the Government under this award. If a proposed subrecipient, contractor, or subcontractor refuses to accept terms affording the Government such rights, the recipient shall promptly bring such refusal to the attention of the OJP program manager for the award and not proceed with the agreement in question without further authorization from the OR program office. 42. Any Web site that is funded in whole or in part under this award must include the following statement on the home page, on all major entry pages (i.e., pages (exclusive of documents) whose primary purpose is to navigate the user to interior content), and on any pages from which a visitor may access or use a Web -based service, including any pages that provide results or outputs from the service: "This Web site is funded in whole or in part through a grant from the Bureau of'Justice Assistance, Office of Justice Programs, U.S. Department of Justice. Neither the U.S. Department of Justice nor any of its components operate, control, are responsible for, or necessarily endorse, this Web site (including, without limitation, its content, technical infrastructure, and policies, and any services or tools provided)." The full text of the foregoing statement must be clearly visible on the home page. On other pages, the statement may be included through a link, entitled "Notice of Federal Funding and Federal Disclaimer," to the full text of the statement. OJP FORM 4000/2 (REV. 4-88) Department of Justice (DOJ) Office of Justice Programs Bureau of Justice Assistance PROJECTNUMBER 2020-GP-BX-0016 AWARD CONTINUATION SHEET Grant AWARD DATE SPECIAL CONDITIONS PAGE 16 OF 19 43. Applicants must certify that Limited English Proficiency persons have meaningful access to the services under this program(s). National origin discrimination includes discrimination on the basis of limited English proficiency (LEP). To ensure compliance with Title VI and the Safe Streets Act, recipients are required to take reasonable steps to ensure that LEP persons have meaningful access to their programs. Meaningful access may entail providing language assistance services, including oral and written translation when necessary. The U.S. Department of Justice has issued guidance for grantees to help them comply with Title VI requirements. The guidance document can be accessed on the Internet at www.lep.gov. 44. The grantee agrees to secure and maintain on file signed statements by each member of the selection committee appointed by the United States Attorney or the PSN Task Force indicating that in making recommendations or decisions regarding contracts or subgrants paid for by this grant, the member had no conflict of interest. Such statements must include all of the language included in the PSN Conflict of Interest Certification, however, the grantee may use a different format or may add other related certifications of their own. 45. Justification of consultant rate Approval of this award does not indicate approval of any consultant rate in excess of $650 per day. A detailed justification must be submitted to and approved by the OJP program office prior to obligation or expenditure of such funds. 46. The recipient agrees to coordinate the project with the U.S. Attorney and Project Safe Neighborhoods Task Force for the district covered by the award. The recipient also is encouraged to coordinate with other community justice initiatives, and other ongoing, local gun prosecution and law enforcement strategies. 47. The recipient agrees to ensure that 30 percent of PSN funding is used to support gang task forces in the United States regions experiencing a significant or increased presence of criminal or transnational organizations engaging in high levels of violent crime, firearms offenses, human trafficking, and drug trafficking. 48. The recipient agrees to submit to DOJ for review and approval, any proposal or plan for Project Safe Neighborhoods media -related outreach. DOJ approval must be received prior to any obligation or expenditure of grant funds related to the development of media -related outreach projects. 49. PSN Fiscal Agent Definition References in this award document to "recipient' and "fiscal agent' both refer equally to the entity or organization receiving this award directly. 50. The recipient understands and agrees that no more than 10 percent of the total amount of this award may be used by the recipient for costs associated with administering the award. 51. Required monitoring of subawards The recipient must monitor subawards under this award in accordance with all applicable statutes, regulations, award conditions, and the DOJ Grants Financial Guide, and must include the applicable conditions of this award in any subaward. Among other things, the recipient is responsible for oversight of subrecipient spending and monitoring of specific outcomes and benefits attributable to use of award funds by subrecipients. The recipient agrees to submit, upon request, documentation of its policies and procedures for monitoring of subawards under this award. OJP FORM 4000/2 (REV. 4-88) Department of Justice (DOJ) Office of Justice Programs Bureau of Justice Assistance PROJECT NUMBER 2020-GP-BX-0016 AWARD CONTINUATION SHEET Grant AWARD DATE SPECIAL CONDITIONS PAGE ] 7 OF 19 52. No use of funds to interfere with federal law enforcement: information -communication restrictions; ongoing compliance 1. Throughout the period of performance, no State or local government entity, -agency, or -official may use funds under this award (including under any subaward, at any tier) to prohibit or in any way restrict-- (1) any government entity or -official from sending or receiving information regarding citizenship or immigration status to/from DHS; or (2) a government entity or -agency from sending, requesting or receiving, or exchanging information regarding immigration status to/from/with DHS, or from maintaining such information. Any prohibition (or restriction) that violates this condition is an "information -communication restriction" under this award. 2. The recipient's monitoring responsibilities include monitoring of subrecipient compliance with the requirements of this condition. 3. Allowable costs. Compliance with these requirements is an authorized and priority purpose of this award. To the extent that such costs are not reimbursed under any other federal program, award funds may be obligated for the reasonable, necessary, and allocable costs (if any) that the recipient, or any subrecipient at any tier that is a State, a local government, or a public institution of higher education, incurs to implement this condition. 4. Rules of Construction A. For purposes of this condition: (1) "State" and "local government" include any agency or other entity thereof (including any public institution of higher education), but not any Indian tribe. (2) A "public" institution of higher education is defined as one that is owned, controlled, or directly funded (in whole or in substantial part) by a State or local government. (Such a public institution is considered to be a "government entity," and its officials to be "government officials.") (3) "Program or activity" means what it means under title VI of the Civil Rights Act of 1964 (see 42 U.S.C. 2000d-4a). (4) "Immigration status" means what it means under 8 U.S.C. 1373 and 8 U.S.C. 1644; and terms that are defined in 8 U.S.C. 1101 mean what they mean under that section 1101, except that "State" also includes American Samoa. (5) "DHS" means the U.S. Department of Homeland Security. B. Nothing in this condition shall be understood to authorize or require any recipient, any subrecipient at any tier, any State or local government, any public institution of higher education, or any other entity (or individual) to violate any federal law, including any applicable civil rights or nondiscrimination law. IMPORTANT NOTE: Any questions about the meaning or scope of this condition should be directed to OJP, before award acceptance. OJP FORM 4000/2 (REV. 4-88) Department of Justice (DOJ) Office of Justice Programs �;�• Bureau of Justice Assistance PROJECT NUMBER 2020-GP-BX-0016 AWARD CONTINUATION SHEET Grant AWARD DATE SPECIAL CONDITIONS PAGE 18 OF 19 53. Authority to obligate award funds contingent on no use of funds to interfere with federal law enforcement: information -communication restrictions; unallowable costs; notification 1. If the recipient is a "State," a local government, or a "public" institution of higher education: A. The recipient may not obligate award funds if, at the time of the obligation, the "program or activity" of the recipient (or of any subrecipient at any tier that is a State, a local government, or a public institution of higher education) that is funded in whole or in part with award funds is subject to any "information -communication restriction." B. In addition, with respect to any project costs it incurs "at risk," the recipient may not obligate award funds to reimburse itself if -- at the time it incurs such costs -- the program or activity of the recipient (or of any subrecipient, at any tier, described in paragraph LA of this condition) that would be reimbursed in whole or in part with award funds was subject to any information -communication restriction. C. Any drawdown of award funds by the recipient shall be considered, for all purposes, to be a material representation by the recipient to OJP that, as of the date the recipient requests the drawdown, the recipient and each subrecipient (regardless of tier) described in paragraph LA of this condition, is in compliance with the award condition entitled "No use of funds to interfere with federal law enforcement: information -communication restrictions; ongoing compliance." D. The recipient must promptly notify OJP (in writing) if the recipient, from its requisite monitoring of compliance with award conditions or otherwise, has credible evidence that indicates that the funded program or activity of the recipient, or of any subrecipient (at any tier) described in paragraph LA of this condition, may be subject to any information -communication restriction. In addition, any subaward (at any tier) to a subrecipient described in paragraph LA of this condition must require prompt notification to the entity that made the subaward, should the subrecipient have such credible evidence regarding an information -communication restriction. 2. Any subaward (at any tier) to a subrecipient described in paragraph LA of this condition must provide that the subrecipient may not obligate award funds if, at the time of the obligation, the program or activity of the subrecipient (or of any further such subrecipient at any tier) that is funded in whole or in part with award funds is subject to any information -communication restriction. 3. Absent an express written determination by DOJ to the contrary, based upon a finding by DOJ of compelling circumstances (e.g., a small amount of award funds obligated by the recipient at the time of a subrecipient's minor and transitory non-compliance, which was unknown to the recipient despite diligent monitoring), any obligations of award funds that, under this condition, may not be made shall be unallowable costs for purposes of this award. In making any such determination, DOJ will give great weight to evidence submitted by the recipient that demonstrates diligent monitoring of subrecipient compliance with the requirements set out in the "No use of funds to interfere ... information -communication restrictions; ongoing compliance" award condition. 4. Rules of Construction A. For purposes of this condition "information -communication restriction" has the meaning set out in the "No use of funds to interfere ... information -communication restrictions; ongoing compliance" condition. B. Both the "Rules of Construction" and the "Important Note" set out in the "No use of funds to interfere ... information -communication restrictions; ongoing compliance" condition are incorporated by reference as though set forth here in full. OJP FORM 4000/2 (REV. 4-88) Department of Justice (DOJ) Office of Justice Programs Bureau of Justice Assistance PROJECT NUMBER 2020-GP-BX-0016 AWARD CONTINUATION SHEET Grant AWARD DATE SPECIAL CONDITIONS 54. Requirement to collect certain information from subrecipients PAGE 19 OF 19 Except as provided in this condition, the recipient may not make a subaward to a State, a local government, or a "public" institution of higher education, unless it first obtains from the proposed subrecipient responses to the questions identified in the program solicitation as "Information regarding Communication with the Department of Homeland Security (DHS) and/or Immigration and Customs Enforcement (ICE)." All subrecipient responses must be collected and maintained by the recipient, consistent with document retention requirements, and must be made available to DOJ upon request. Responses to these questions are not required from subrecipients that are either a tribal government/organization, a nonprofit organization, or a private institution of higher education. 55. Withholding of funds: DHS questions The recipient may not obligate, expend or drawdown funds until the Office of Justice Programs has received and approved the required application attachment(s) described in the program solicitation ac "Information regarding Communication with the Department ofilomcland Security (DHS) and/or Immigration and Customs Enforcement (ICE)," and has issued a Grant Adjustment Notice (GAN) releasing this special condition. OJP FORM 4000/2 (REV. 4-88) c xra ARKANSAS DEPARTMENT OF FINANCE AND ADMINISTRATION OFFICE OF INTERGOVERNMENTAL SERVICES VICTIM JUSTICE AND ASSISTANCE PROGRAM yaJ `lt ti • CONTACT INFORMATION FOR AUTHORIZED OFFICIAL IGS/VJA utilizes electronic mail as the primary form of correspondence with subgrant organizations. It is therefore imperative that accurate contact information for each authorized official be maintained. To ensure that all pertinent correspondence from IGS/VJA is received by the subgrant organization, please provide the information requested below. Thank you for your cooperation in this matter. SUBGRANT #: 247331-20WL GRANT PERIOD: 8/1/2023TO 7/1/2024 SUBGRANT ORGANIZATION: City of Fayetteville NAME/TITLE OF AUTHORIZED OFFICIAL: Lioneld Jordan, Mayor ROUTINE COMMUNICATION: PLEASE ADVISE US ON HOW YOU WOULD LIKE FOR US TO REACH YOU UNDER ROUTINE CIRCUMSTANCES: MAILING ADDRESS: CITY: ARKANSAS ZIP CODE: 113 W. Mountain Street, Fayetteville, AR 72701 EMAIL ADDRESS: mayor@fayetteville-ar.gov DAYTIME TELEPHONE: 479 - 575 - 8330 FAX: 479 - 575 - 8257 TIME -SENSITIVE COMMUNICATION: AT TIMES, ISSUES ARISE THAT REQUIRE THE IMMEDIATE ATTENTION OF THE AUTHORIZED OFFICIAL. PLEASE ADVISE US ON HOW WE CAN REACH YOU DIRECTLY, IF NEEDED: ❑x SAME AS ABOVE MAILING ADDRESS: CITY: ARKANSAS ZIP CODE: EMAIL ADDRESS: DAYTIME TELEPHONE: - - FAX: - - PLEASE ADD ANY ADDITIONAL CONTACT INFORMATION YOU WISH TO SHARE. THANK YOU. VJA-ADM-006 REVISED: DECEMBER 2009 NOTE: To ensure timely receipt of correspondence from this office, the authorized official should notify us in writing of any changes. ARKANSAS DEPARTMENT OF FINANCE AND ADMINISTRATION )rf/ OFFICE OF INTERGOVERNMENTAL SERVICES VICTIM JUSTICE AND ASSISTANCE PROGRAM REQUEST TO DESIGNATE AN ACTING AUTHORIZED OFFICIAL SUBGRANT Fayetteville Police Department ORGANIZATION SUBGRANT 247331-20WL - SUBGRANT August 1, 2023 TO July 1, zoza NUMBER PERIOD FROM: As the highest-ranking official of the above named organization's governing body, I hereby request the Office of Intergovernmental Services, Victim Justice and Assistance Program to recognize the individual listed below as authorized to act on my behalf in matters regarding the above -referenced subgrant and project period. I will ensure that I am kept appropriately apprised of project performance, expenditures and other areas of administra ive respo s flity thro gh this individual. 1 understand and accept that my designation of authority will in no �ay releas �I� organiAation from any liability. OFF. ��`� ❑ Board President ❑ County Judge SIGNATURE ® Mayor _ [J Elected Prosecutor PROPOSED ACTING AUTHORIZED OFFICIAL NAMEITITLE Tonyia Tannehill, Assistant Support Services Manager, Fayetteville Police Department TELEPHONE 479-587-3579 E-MAIL Tannehill@fayetteville-ar.gov NUMBER IF THIS INDIVIDUAL IS AN EMPLOYEE OF THE SUBGRANT ORGANIZATION, PLEASE IDENTIFY POSITION IS PAID ALL SOURCE(S) FROM WHICH THIS 1. Name of Funding General Fund - City of Fayetteville Percent of Salary Source Paid 2. Name of Funding Percent of Salary Source Paid s. Name of Funding Source 4. Name of Funding Source Percent of Salary Percent of Salary Paid 100% PLEASE DESCRIBE THE INTERNAL MECHANISM THAT WILL BE IMPLEMENTED TO ENSURE THAT THE AUTHORIZED' OFFICIAL IS ADEQUATELY APPRISED OF PROJECT PROGRESS, AS WELL AS CRITICAL ISSUES THAT MAY ARISE Regular communication between the Authorized Official, Mayor Lioneld Jordan, and the Chief of Police, Mike Reynolds, ensuring the grant funds and project progress are satisfactory. Progress meetings are held quarterly addressing the performance measures and mandatory reporting are completed in accordance with the grant requirements. Grant funds are tracked in the City of Fayetteville's project accounting system, and all City of Fayetteville purchasing policies are applied to grant funds and the reimbursement process. Having read the above referenced subgrant and all attachments, I certify that I will perform on behalf of this organization's authorized official, 1 am prepared to oversee all matters related to the subgrant in accordance with all state and federal laws and regulations. ACTING OFFICIAL TURE DATE 0 //'&,2- VJA-ADM-007 REVISED: DECEMBER 2009 OMB Number: 4040-0004 Expiration Date: 10/31/2019 Application for Federal Assistance SF-424 * 1. Type of Submission: ❑ Preapplication ® Application Changed/Corrected Application * 2. Type of Application: " If Revision, select appropriate letter(s): ® New ❑ Continuation Other (Specify): F1 Revision * 3. Date Received: 4. Aoniican: Identifier: 5a. Federal Entity Identifier: 5b. Federal Award Identifier: State Use Only: 6. Date Received by State: 7. State Application Identifier: 8. APPLICANT INFORMATION: "a. Legal Name: City of Fayetteville ` b. Employerf taxpayer Identification Number (EIN/TIN): 71-6018462 * c. Organizational DUNS: 0756577420000 d. Address: "Street1: 113 W. Mountain Street Street2: "City: Fayetteville County/Parish: "State: AR: Arkansas Province: "Country: USA: UNITED STATES "Zip / Postal Code: 72701-6057 e. Organizational Unit: Department Name: Division Name: Fayetteville Police Department f. Name and contact information of person to be contacted on matters involving this application: Prefix: * First Name: Middle Name: Tonyia * Last Name: Tannehill Suffix: Title: Assistant Support Services Manager Organizational Affiliation: "Telephone Number: 479-587-3579 Fax Number: 479-587-3570 "Email: ttannehill@fayetteville-ar.gov Application for Federal Assistance SF-424 " 9. Type of Applicant 1: Select Applicant Type: C: City or Township Government Type of Applicant 2: Select Applicant Type: I _ Type of Applicant 3: Select Applicant Type: " Other (specify) * 10. Name of Federal Agency, DS Department of Justice, Office of Justice Program, Bureau I 11. Catalog of Federal Domestic Assistance Number: 16.609 CFDA Title: Project Safe Neighborhoods ' 12. Funding Opportunity Number: Solicitation FY2020 and 2021 " Title: The Project Safe Neighborhoods FY2020 and FY2021 Grant Announcement 13. Competition Identification Number: IN/A - - Title: N/A 14. Areas Affected by Project (Cities, Counties, States, etc.): Add Attachment I Delete Attachmeni 15. Descriptive Title of Applicant's Project: Project Safe Neighborhoods (Arkansas) Attach supporting documents as specified in agency instructions. Add Attachments I I !eiele ACtNchmtmts View Attachmei Application for Federal Assistance SF-424 16. Congressional Districts Of: *a. Applicant I3rd , "b.Program/Project 3rd Attach an additional list of Program/Project Congressional Districts if needed, Add Allachment] 17. Proposed Project: *a. Start Date: 108 /O1/2023 ' b, End Date: 07 /01/2029 18. Estimated Funding (S): *a. Federal 18, 119.00 " b. Applicant F 0.00 "c. State I 0_001 • d. Local j 0_001 "e.Other f 0_00 • f. Program Income 0.00 " g. TOTAL 18,114.001 " 19. Is Application Subject to Review By State Under Executive Order 12372 Process? ® a. This application was made available to the State under the Executive Order 12372 Process for review on 12/01/2oz2 b. Program is subject to E.O. 12372 but has not been selected by the State for review. c. Program is not covered by E.O. 12372. " 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.) Yes ® No If "Yes", provide explanation and attach 1 1 4u L' Et•. iiTr-;r 00e-ir: At;, .hnianl tliFU, Atlarhm-nt 21. "By signing this application, I certify (1) to the statements contained in the list of certifications'" and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances'" and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001) ® "" I AGREE "* The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions. Authorized Representative: Prefix L 1 • First Name: Middle Name: " Last Name: Jordan Suffix "Title: ;I yor "Telephone Number:I479_575-8330 I Fax Number:[ 1 "Email'innyor@fayetteville-ar.gov / " Signature of Authorized Representative: • Date Signed OMB Number: 4040-0007 Expiration Date: 02/28/2022 ASSURANCES - NON -CONSTRUCTION PROGRAMS Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND 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, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the applicant, I certify that the applicant: 1 Has the legal authority to apply for Federal assistance 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 the project described in this application. 2. Will give the awarding agency, the Comptroller General of the United States and, if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related 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 presents the appearance of personal or organizational conflict of interest, or personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §§4728-4763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F). 6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C.§§1681- 1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (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; (f) 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 alcoholism; (g) §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee- 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and, 0) the requirements of any other nondiscrimination statute(s) which may apply to the application. Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired 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 applicable, with provisions of the Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds. Previous Edition Usable Standard Form 424B (Rev. 7-97) Authorized for Local Reproduction Prescribed by OMB Circular A-102 9, Will comply, as applicable, with the provisions of the Davis - Bacon Act (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 standards for federally -assisted construction subagreements. 10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L, 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood 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 following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of Federal 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 at seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water 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 protecting components or potential components of the national wild and scenic rivers system. SIGNATURE OF AUTHO IZED C [LIld Jordan APPLICANT Ctf26A IZATION City of Fayetteville NG OFF191AL 13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic 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 1974 (16 U.S.C. §§469a-1 et seq.). 14, Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities supported 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.) pertaining to the care, handling, and treatment 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 Prevention Act (42 U.S.C. §§4801 et seq.) which prohibits the use of lead -based paint in construction or rehabilitation of residence structures. 17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, "Audits of States, Local Governments, and Non -Profit Organizations." 18, Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, and policies governing this program. 19. Will comply with the requirements of Section 106(g) of the Trafficking Victims Protection Act (TVPA) of 2000, as amended (22 U.S.C. 7104) which prohibits grant award recipients or a sub -recipient from (1) Engaging in severe forms of trafficking in persons during the period of time that the award is in effect (2) Procuring a commercial sex act during the period of time that the award is in effect or (3) Using forced labor in the performance of the award or subawards under the award. TITLE ji',,yor DATE SUBMITTED WRIAtIWi/I, Standard Form 424B (Rev. 7-97) Back OMB APPROVAL NO. 1 121-140 EXPIRES 6/30/2021 STANDARD ASSURANCES The Applicant hereby assures and certifies compliance with all applicable Federal statutes, regulations, policies, guidelines, and requirements, including 2 C.F.R. Part 2800 (Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards by the Department of Justice), and Ex. Order 12372 (intergovernmental review of federal programs). The applicant also specifically assures and certifies that: 1. It has the legal authority to apply for federal assistance and the institutional, managerial, and financial capability (including funds sufficient to pay any required non-federal share of project cost) to ensure proper planning, management, and completion of the project described in this application. ' 2. It will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain. 3. It will give the awarding agency or the Government Accountability Office, through any authorized representative, access to and the right to examine all paper or electronic records related to the financial assistance. 4. It will comply with all lawful requirements imposed by the awarding agency, specifically including any applicable regulations, such as 28 C.F.R. pts. 18, 22, 23, 30, 35, 38, 42, 61, and 63, and the award term in 2 C.F.R. § 175.15(b). 5. It will assist the awarding agency (if necessary) in assuring compliance with section 106 of the National Historic Preservation Act of 1966 (16 U.S.C. § 470), Ex. Order 11593 (identification and protection of historic properties), the Archeological and Historical Preservation Act of 1974 (16 U.S.C. § 469a-1 et seq.), and the National Environmental Policy Act of 1969 (42 U.S.C. § 4321). 6. It will comply (and will require any subrecipients or contractors to comply) with any applicable nondiscrimination provisions, which may include the Omnibus Crime Control and Safe Streets Act of 1968 (42 U.S.C. § 3789d); the Victims of Crime Act (42 U.S.C. § 10604(e)); the Juvenile Justice and Delinquency Prevention Act of 2002 (42 U.S.C. § 5672(b)); the Violence Against Women Act (42 U.S.C. § 13925(b)(13)); the Civil Rights Act of 1964 (42 U.S.C. § 2000d); the Indian Civil Rights Act (25 U.S.C. §§ 1301-1303); the Rehabilitation Act of 1973 (29 U.S.C. § 794); the Americans with Disabilities Act of 1990 (42 U.S.C. §§ 12131- 34); the Education Amendments of 1972 (20 U.S.C. §§ 1681, 1683, 1685-86); and the Age Discrimination Act of 1975 (42 U.S.C. §§ 6101-07). It will also comply with Ex. Order 13279, Equal Protection of the Laws for Faith - Based and Community Organizations; Executive Order 13559, Fundamental Principles and Policymaking Criteria for Partnerships With Faith -Based and Other Neighborhood Organizations; and the DOJ implementing regulations at 28 C.F.R. Part 38. 7. If a governmental entity — a) it will comply with the requirements of the Uniform Relocation Assistance and Real Property Acquisitions Act of 1970 (42 U.S.C.§ 4601 et seq.), which govern the treatment of persons displaced as a result of federal and federally -assisted programs; and b) it will comply with requirements of 5 U.S.C.§§ 1501-08 and §§7324-28, which limit certain political activities of State or local government employees whose principal employment is in connection with an activity financed in wl f le or in hart by ederal assistance. b2'3 Dat Lloneld Jordan, U.S. DEPARTMENT OF JUSTICE OFFICE OF JUSTICE PROGRAMS OFFICE OF THE COMPTROLLER Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions (Sub -Recipient) This certification is required by the regulatioons implementing Executive Order 12549, Debarment and Suspension, 28 CFR Part 67, Section 67.510, Participants' responsibilities. The regulations were published as Part VI I of the May 26, 1988 Federal Register (pages 19160.19211). (BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON REVERSE) (1) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department of agency. (2) Where the prospective lower tier participant is unable to certify to any of the statements in this certificaiton, such prospective participant shall attach an explanation to this proposal. Lioneld J rdan, Mayo - Name d Title of A'�tho ized Replesentative Alffil - - � � -3 ignature Date City of Fayet Name of Organization 113 W. Mountain Street, Fayetteville, AR 72701 Address of Organization OJP FORM 4061/1 (REV. 2/89) Previous editions are obsolete CERTIFICATION FORM Compliance with the Equal Employment Opportunity Plan (EEOP) Requirements Please read carefully the Instructions (see below) and then complete Section A or Section B or Section C, not all three. ff recipient cwntpletes Section A or C and sub -grants a sink -le award over $500.000. in addition_ n/roce r an,nla6• .cact;nn n Recipient's Name: City of Fayettevillc Address: 11 . Mountam, Fryettevt e, AR 7. 701 Is agency a, ❑ Direct or d4Sub recipient of OJP, OVW or COPS funding? Law Enforcement Agency'? dtYes ❑ No DUNS Numberl%50.)— Vendor Number (only if direct recipient) Name and Title of Contact Person: 'l'onyiaTannchill, FiscalOfficer Telephone Number: 479-587-3579 E-Mail Address: ttannc ii I cif avctteville-ar.gov Section A —Declaration Claiming Complete Exemption from the EEOP Requirement Please check all the following boxes that apply. o Less than fifty employees. ❑ Indian Tribe o Medical Institution. ❑ Nonprofit Organizadon ❑ Educational Institution ❑ Receiving a single award(s) less than $25,000. I, [responsible official], certify that [recipient] is not required to prepare an EEOP for the reason(s) checked above, pursuant to 28 C.F.R § 42.302. I further certify that [recipient] will comply with applicable federal civil rights laws that prohibit discrimination in employment and in the delivery of services. If recipient sub -grants a single award over $500, 000, in addition, please complete Section D Print or TP re Name and Title Signature Date Section B Declaration Claiming Exemption from the EEOP Submission Requirement and Certifying That an EEOP Is on File for Review If a recipient agency has fifty or more employees and is receiving a single award or, subaward, of $25,000 or more, but less than $500,000, then the recipient agency does not have to submit an EEOP to the OCR for review as long as it certifies the following (42 C.F.R. § 42.305): 1, Lioneld Jordan [responsible ryriciall, certify that City of Fayetteville. Arkansas [recipient], which has fifty or more employees and is receiving a single award or subaward for $25,000 or more, but less than $500,000, has formulated an EEOP in accordance with 28 CFR pt. 42, subpt. E. I further certify that within the last twenty-four months, the proper authority has formulated and signed into effect the EEOP and, as required by applicable federal law, it is available for review by the public, employees, the appropriate state planning agency, and the Office for Civil Rights, Ol'lice of Justice Programs, U.S. Department of Justice. The EEOP is on file at the following office: Human Resources Division _ [organization], 113 West Mountain Street,/Fayettevi le, R 72701 [address] . - Lioneld Jordan, Mayor, Print or 71 )e Name onAlldSi n,u' w~ t ate Section C—Declaration St ingAliat an EEOP Short Form Has Been Submitted to the Office for Civil Rights for Review If a recipient agency has fiftyor more employees and is receiving a single award, or subaward, of $500,000 or more, then the recipient agency must send an EEOP Short Form to the OCR for review. I, [responsible official], certify that [recipient], which has fifty or more employees and is receiving a single award of $500,000 or more, has formulated an EEOP in accordance with 28 CFR pt. 42, subpt. E, and sent it for review on [date] to the Office for Civil Rights, Office of Justice Programs, U.S. Department of Justice. If recipient sub -grants a single award over $500, 000, in addition, please complete Section D Print or Y)pe Name and Title Date Form ■■-9 (nay. October 2018) Department of the Treasury Internal Revenue Senico 1 Norte (as shown on your Inc 'ity of Fayetteville 2 Business namerdisrogarded Request for Taxpayer Identification Number and Certification ► Go to www.irs.gov/FormW9 for instructions and the latest information. tax reiwn). Name Is required on this line; do not leave 1hs line name, a aiiterent from above 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes, ❑ Individual/sole proprietor or 11 C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate single -member LLC ❑ Umited liability company Enter the tax classlllratlon (C=C corporation, S--S corporation, P=Parinership) ► Note: Chock the appropriate box to the line above for the tax classification of the single -member owner. Do not check LLC If the I LC is classified as a single-momber LLC that is disregarded from the owner unless the owner of the LLC is another LLC that Is not disregarded from the owner for U.S. federal tax purposes, Otherwise, a single-mambor LLC IN Is disregarded from the ovmer should check the appropriate box for the lax classification of Its owner. [{.j other (sod Instructions) ► Government/Inc 5 Address (number, street, and apt, or suite rho.) Sao Instructions. 113 W Mounti 6 City, state, and account Give Form to the requester, Do not send to the IRS. 4 Exemptions (codes apply only to certain entities, not Individuals; see Instructions on page 3): Exempt payee code (if any) Exemption from FATCA reporting code (it any) 1.1gJdq l� ecraun6s meMleMeJ uulsWe the U.S) Requesters name and address Enter your TIN in the appropriate lox, The TIN provided must match the name given on line 1 to avoid S backup withholding. For individuals, this Is generally your social security number (SSN), However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other L entities, it is your employer identification number (EIN). If you do not have a number, see How to get a 77N, later. or Note, If the account is in more than one name, see the instructions for line 1. Also see What Name and C Number To Give the Requester for guidelines on whose number to enter. r— M00000MMME Under penalties of perjury, I certify that: — 1. The number shown on this form is my Correct taxpayer Identification number (or I am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA co*s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct, Certification instructions. You must cross out item 2 above If you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all Interest and dividends at your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured properly, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. —... .........._ Sign Signature o1 /yy1G Here U.S. person► , r/r� i7 Date► 6 j /o�YA^-a,? General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted alter they were published, go to www.ks.gov/FormW9. Purpose of Form An Individual or entity (Form W-9 requester) who Is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number ISSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns Include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) • Form 1099-DIV (dividends, including those front stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. Ifyou do not return Form W-9 to the requester with a ON, you might be subject to backup withholding. See What is backup:withholding, lifer. Cat. No, 10231X Form W-9 (Rev. 10-2018) O�FA • � 2 AO Initials STATE OF ARKANSA S Department of Finance and Administration OFFICE OF INTF.RGOVERNML-NTAI, SERVICES 1515 West Seventh Street, Suite 400 Post Office Box 8031 Little Rock, Arkansas 72203,8031 Phone: (501) 682-1074 Fox:(501)682-5206 I1111):/;\1'\V1\'.(Ihil.ill'{iillililti.�/\' GENERAL TERMS AND SPECIAL SUBGRANT CONDITIONS The applicant assures that federal funds made available under the Project Safe Neighborhoods (PSN) Program will not be used to supplant state and local funds, but will be used to increase the amount of funds that would, in the absence of federal funds, be made available for the activities of this project. The subrecipient shall ensure that federal and/or state matching funds are used to supplement existing funds for program activities and must not replace those funds that have been appropriated for the same purpose. Federal and/or state matching funds made available under this grant will be used to increase the amount of funds that would, in the absence of federal and/or state matching funds, be made available for law enforcement activities. If there is a potential presence of supplanting, the subrecipient will supply documentation demonstrating that the reduction in non - Federal resources occurred for reasons other than the receipt or expected receipt of Federal funds. For example, no maintenance and operation costs previously funded by a state, city or county government may be supported with Drug Crime Fund and/or state matching funds. Any federal and/or state matching funds budgeted to supplement existing state and/or local funds due to increased maintenance and operation costs (e.g. fuel, utilities, etc.) shall not be used until all state and/or local funds budgeted for those costs are exhausted. The applicant assures that fund accounting, auditing, monitoring, and evaluation procedures as may be necessary to keep such records as the Department of Justice and the Department of Finance and Administration shall be provided to assure fiscal control, proper management, and effective disbursement/reimbursement of funds received under this sub award. The applicant assures that it will maintain an appropriate grant administration system to ensure that all terms, conditions and specifications of the grant, including these assurances, are met. The applicant assures that it will comply with the OJP Financial Guide in its administration of the grant. The OJP Financial Guide can be accessed online at https://www.iustice.gov/ovw/pape/file/1228061/download . The applicant assures that it shall maintain such data and Information and submit such reports in such form, at such times, and containing such data and information as the as the Department of Justice and the Department of Finance and Administration may require. The applicant agrees to use the grant and matching funds only for the purposes stated in this application. Additionally, the applicant agrees that any grant and matching funds approved for personnel for this project will be based on the percent of time the personnel actually devote to the project. PSN 18—Project Safe Nelghborhoods Grant Program 1 OF 5 STATE OF ARKANSAS Department of Finance and Administration OFFICE OF INTERGOVERNMENTAL SERVICES 1515 West Seventh Street, Suite 400 Post Office Box 8031 Little Rock, Arkansas 72203-8031 Phone: (501) 682-1074 I .[� 1?I1110X2-52m, 01wHw�%N� il:i.iukansas.mov The applicant assures that in the event a federal/state court or federal/state administrative agency makes a finding of discrimination after a due process hearing on the grounds of race, color, religion, national origin or sex against a recipient of funds, the recipient will forward a copy of the finding to the Office of Justice Programs, Office of Civil Rights Compliance (OCRC) and the Arkansas Department of Finance and Administration, Office of Intergovernmental Services. The applicant assures that if it is required to formulate an Equal Employment Opportunity Program (EEOP) in accordance with 28 CFR 42.301, et. seq., it should submit a certification to the state that it has a current ESOP on file which meets the requirements therein. The applicant assures that it will comply with the provisions of 28 CFR applicable to grants and cooperative agreements including Part 18, OJP Hearing and Appeals Procedures; Part 20, Criminal Justice Information Systems; Part 22, Confidentiality of Identifiable Research and Statistical Information; Part 23, Criminal Intelligence Systems Operating Policies; Part 30, Department of Justice Programs and Activities; Part 42, Nondiscrimination Equal Employment Opportunity Policies and Procedures; Part 61, Procedures for Implementing the National Environmental Policy Act; and Part 63, Floodplain Management and Wetland Protection Procedures. The applicant assures that in addition to all other audit requirements, it will allow the Division of Legislative Audit or any other independent or internal auditors of the Department of Finance and Administration to have access to the applicant's records and financial statements; (A) as may be necessary for the Department of Finance and Administration to comply with 2 C.F.R. 200 and other rules and/or regulations governing financial accounting and auditing guidelines, principles, and procedures; and (B) as may be requested by the Department of Finance and Administration to comply with any State or local government rules and/or regulations. The applicant assures that it will fully participate in the compilation of statistical information as required by state agencies, i.e., providing complete finger print arrest information. The applicant assures that both federal, state, and matching funds used for this project will be used exclusively to support defined in Justice Assistance Grant (JAG) Program activities and will not be used to support any general purpose law enforcement or other activity maintained by the applicant. PSN 18—Project Safe Neighborhoods Grant Program 2 OF 5 STATE OFARKANSAS OFFICE OF TNTCRGOVERN h tl?N'TAL SERVICES 1515 West Seventh Street, Suite 400 Post Office Box 8031 Department of Finance Little Rock, Arkansas 72203-8031 Phone: (501) 682-1074 and Administration Fax: (501)682-5206 hllh;/lww��.tllii.at'kans:ts.j; The applicant assures that if the grant funds are used to support a Task Force, the Task Force Board N/A of Directors or'Control Group' will hold regularly scheduled meetings every two (2) months, and will provide DFA-IGS and the State Drug Director with copies of the agenda and minutes of each meeting. The applicant assures that if the grant funds are used to support a Task Force, appropriate and N/A adequate staffing would be maintained for the duration of the project period. For efficiency in project implementation, the State Drug Director's Office highly recommend that appropriate staff include a full-time Drug Task Force Commander (certified law enforcement officer) and a Fiscal Officer regardless if funds are used to pay salaries. The applicant assures that if grant funds are used to support a Task Force, the Task Force N/A Administrator/Director/Commander and the Board of Directors will develop and/or maintain a detailed policy and procedures manual forthe guidance of task force operations. Copies of the Policy and Procedures Manual as well as updates and revisions shall be forwarded to DFA-IGS and the State Drug Director's Office. (Updates and Revisions shall be submitted when occurred.) The applicant assures that all proposals for out of state travel for conference and training will be submitted for approval prior to any expense being incurred. N/A If Drug Crime Funds are awarded, the sub -recipient must comply with Act 1086 of 2007: The State Drug Crime Enforcement and Prosecution Grant Fund htto://www.arklea.state.ar.uslassen►bly/200 7/R/Acts/Act IO86.t)df If applicable, the sub -recipient agrees to prepare and submit an Inventory Report for equipment purchased with federal, state, and/or local matching funds with the 1st Quarterly Report. (Updates to Inventory Reporting shall be submitted with quarterly reports.) The sub -recipient agrees to prepare and submit a Monthly Request for Reimbursement Form (with copies of invoices, cancelled checks, and other documentation of expenditures by line item) by the 151h day of each month following the month for which subgrant expenditures were paid. A supporting document(s) (Excel Spreadsheet) reporting the allocation of subgrant expenditures between federal, state and/or local funds shall accompany each Request for Reimbursement. Reimbursement requests must be timely. Documentation must be appropriate, legible, and accurate. Sub -recipients are required to submit requests monthly, even if the request is zero. Failure to submit monthly reimbursement requests in a timely manner may impose additional special conditions. Please note and acknowledge the additional items below. a. Grant funds will be used only in accordance with the approved budget. Expenditures incurred or made outside the approved budget line items/categories will be disallowed. b. All lease agreements (i.e, vehicle, storage, office space, and/or rental) must be submitted to DFA-IGS forthe file within 60 days of the award date. c. Preapproval is required for out of state travel. Prior to travel, sub - recipient must submit an out-of-state travel request form to IGS for approval no later than 30 days before the travel. IGS will provide the PSN 18 — Project Safe Neighborhoods Grant Program 3OF5 STATE OF ARKANSAS Department of Finance and Administration OFFICE OF Dfl E,RGOVERNMENTAL SERVICES 1515 West Seventh Street, Suite 400 Post Office Box 8031 Little Rock, Arkansas 72203-8031 Phone: (501) 682-1074 Fax: (501) 682-5206 hl (p://www.d lii.arkansas.mov standard form to use. Expense incurred for out of state travel that is not pre -approved by IGS will be disallowed. d. Before unique purchases, review federal/state solicitations and be aware of other unallowable items or items that require special conditions for approval. The sub -recipient agrees to prepare and submit Quarterly Reports by the 1011 of the month following the end of a quarter. Report due dates are October loth, January loth, April loth, and July loth. Sub - recipient must utilize the Accountability Measures Quarterly Report Tool when submitting quarterly reports. Failure to submit quarterly reports In a timely manner may result in suspension of funds. The sub -recipient agrees to prepare and submit Monthly Reports by the loth of each month to both DFA-IGS and the State Drug Director's Office. Monthly Reports are to be submitted in an excel format utilizing DFA-IGS Reporting Tool #2. Failure to submit quarterly reports in a timely manner may result in suspension of funds. Budget Modifications/Revision Requests must be submitted by the 10th of the month in order for them to be considered for expenditures made during that month. Budget revisions will not be accepted during the last month of the grant period absent extraordinary circumstances. Sub - recipient may request modification of the approved budget to reallocate funds between existing categories. Requests for the addition of new budget categories or line items may not be approved. The final budget request modification/revision must be submitted no later than October lot'. DFA- IGS will only accept four (4) budget modifications request during the awarded project period. This does not include the initial budget modification which is due within 45 days of the Award Date. The subrecipient agrees to submit within thirty (30) days of the end of the grant period a Cumulative Financial Report and Annual Narrative Report "MARKED FINAL." Reimbursement requests not submitted by ninety days past the final day of the grant period will be denied payment subject extraordinary circumstances. Absent such circumstances, the federal and/or state funds will be de - obligated from the subaward. The sub -recipient agrees to provide notification to IGS of all changes made to the General Project Information, i.e. scope, contact information -name, address, telephone, fax, e-mail, etc. and changes made to authorized officials and/or staffing. The sub -recipient will assure that DFA-IGS has complete and correct contact information for the Contract Official for the grant. Changes in contact information will include physical address, phone, fax and e-mail information as well as any updated Memorandum of Understanding. Replacement or changes of DTF officers/staff who are paid directly by the grant or whose salary is used in whole or in part as match to the grant must also be reported the DFA-IGS. The sub -recipient agrees to attend any required DFA-IGS sponsored trainings/meetings as deemed necessary as well as other local trainings/meetings. )ject Safe Nelghborhoods Grant Program 4 OF 5 r lioneld STATE OFARKANSAS Department of Finance and Administration OFFICE OF INTE11GOVERNMF,NTAL SERVICES 1515 West Seventh Street, Suite 400 Post Office Box 8031 Little Rock, Arkansas 72203-8031 Phone: (501) 682-1074 Pas:(501)682.5200 ww%a Afa.arkansas.t ov The sub -recipient understands that prior written approval is required for subgrant expenditures from federal and/or state funds budgeted In equipment and travel and training line items. The subreciplent shall submit to IGS a written request to purchase small equipment items not approved in the initial budget and submit a written request for use of funds for out-of-state travel and training. Federal and/or state funds budgeted for these purposes shall neither be obligated nor expended until approved by DFA-IGS. All approvals will be transmitted in written form to the subrecipient. The sub -recipient understands that should it fall to comply with the Federal Award Special Conditions and State Terms and Conditions of this subaward, including civil rights requirements, whether stated in a Federal or State statute, regulation, assurance, application, or notice of award, IGS may take one or more of the following actions, as appropriate in the circumstances: (1) temporarily withhold cash payments pending correction of the deficiency by the recipient; (2) disallow (that is, deny both use of funds and any applicable matching credit for) all or part of the cost of the activity or action not in compliance; (3) wholly or partly suspend orterminate the current award; (4) withhold further awards forthe project or program and (5) take other remedies that may be legally available. I Official) v (Print Name) �-O7 d . �gnatt�jreoj Fiscal Officer) Tonyla Tannehill (Print Name) PSN 18 — Project Safe Neighborhoods Grant Program 09105 /2_0 2-3 (Date) Mayor (Title) (Date) Asst. Support Services Manager (Title) 5OF5 ARKANSAS NOTICE TO POLICYHOLDER CLARIFICATION TO CERTIFICATE OF NONCOVERAGE LAW THIS NOTICE CONTAINS A BRIEF SYNOPSIS OF THE SIGNIFICANT CHANGES THAT MAY OCCUR TO YOUR PREMIUM CHARGED. PLEASE READ YOUR POLICY AND ALL FORMS ATTACHED TO YOUR POLICY CAREFULLY. NO COVERAGE IS PROVIDED BY THIS POLICYHOLDERS NOTICE NOR CAN IT BE CONSTRUED TO REPLACE OR PROVIDE ANY PROVISIONS IN YOUR POLICY. Your Workers Compensation and Employers Liability Insurance Policy contains rates and classifications that apply to your business for the purpose of determining the premium you must pay. Pursuant to House Bill 1700 of 2007 amending § 11-9-402, an uninsured intermediate contractor cannot present Certificate of Noncoverage (CnCs) for workers of the subcontractor(s) to the prime contractor to satisfy the requirement for workers compensation insurance coverage. If the intermediate contractor does not have workers compensation coverage insurance for its workers, additional premium for the workers of the subcontractor(s) must be charged on the prime contractor's workers compensation policy in accordance with NCCI's Basic Manual for Workers Compensation and Employers Liability Insurance Rule 2-H. If the intermediate contractor does have workers compensation coverage, all employees are reported under this policy, and additional premium for the workers of the subcontractor(s) must be charged on the intermediate contractor's workers compensation policy in accordance with NCCI's Basic Manual for Workers Compensation and Employers Liability Insurance Rule 2-H. The policyholder may select to be excluded from the policy. If the intermediate contractor does not have workers compensation coverage and does not have any employees, a CnC may be presented to the prime contractor to satisfy the requirement for workers compensation insurance coverage for the intermediate contractor. Effective July 31, 2007, on new and renewal policies, House Bill 1700 has the potential to affect how much workers compensation insurance may cost as a result of presenting Certificates of Noncoverage. 30-0819 0907 1 of 1 WESCO INSURANCE COMPANY 874 Walker Rd, Suite C Dover, DE 19904 WORKERS' COMPENSATION and EMPLOYERS' LIABILITY INSURANCE POLICY In Witness Whereof, we have caused this policy to be executed and attested, and, if required by state law, this policy shall not be valid unless countersigned by our authorized representative. Stephen Ungar, Secretary Christopher H. Foy, President To obtain information, please contact your agent or Wesco Insurance Company at 877- 528-7878. You may also write Wesco Insurance Company Consumer Relations at: 800 Superior Avenue East, 21 st Floor Cleveland, OH 44114 WC990000A FA AmTrust North America An AmTrust Financial Company Provide 2417 Toll -Free Claim Reporting For ALL States Phone: (866) 272-9267 Fax: (775) 908-3724 or (877) 669-9140 Email: Amtrustclaims@qrm-inc.com Online: www.amtrustfinancial.com (Must Register) Information Required for All Claims reported. 1. Name of the insured and policy number 2. Date, Time & Place of Accident 3. Description of accident or incident 4. Name, phone and/or e-mail of person making the report Additional Information Required for Specific Claim Types A. For Workers' Compensation 1. MUST have the injured employee's social security number as it is required by law 2. Description of injury B. For Property Claims 1. Physical address of the loss 2. If more than one building on property must have specific building(s) involved 3. Type of loss, i.e., Fire, Theft, etc. 4. Description of loss or damage C. For Motor Vehicle (Auto) Claims 1. Name, address and contact information of ALL parties involved. 2. Make, model and VIN of the insured vehicle 3. Make, model of all other vehicles involved 4. Current location of all vehicles 5. Name and contact information for each driver and all Passengers 6. Name and contact information any known witnesses D. For General Liability Claims 1. Physical address of where the loss occurred 2. Name, address and contact information for all persons claiming injury or damage 3. Name and contact information any known witnesses FA AmTrust North America An AmTrust Financial Company Reporte De Reclamo Gratuito 2417 Para todos los Estados - Demanda Informes Solo Telefono: (866) 272-9267 Fax: (775) 908-3724 o (877) 669-9140 Correo electr6nico: Amtrustclaims@qrm-inc.com En linea: www.amtrustfinancial.com (deben registrarse) Informaci6n necesaria Para todos los reclamos registrados. 1. Nombre de la cantidad asegurada y la politica 2. Fecha, hora y lugar del accidente 3. Descripci6n del accidente o incidente 4. Nombre, telefono y/o correo electronico de la persona que hace el informe Informaci6n adicional requerida Para los tipos de demanda especifica A. Para la compensaci6n 1. Debe tener numero de sec►uro social del emvleado lesionado como es reauerido Aor la lev 2. Descripci6n de la lesi6n B. Para reclamos de propiedad 1. Direcci6n fisica de la perdida 2. Si mas de un edificio en propiedad debe tener edificios especificos involucrados 3. Tipo de perdida, es decir, incendio, robo, etc. 4. Descripci6n de la perdida o dano C. Para reclamaciones de vehiculos de Motor (Auto) 1. Nombre, direcci6n a informaci6n de contacto de todas las partes involucradas. 2. Marca, modelo y VIN del vehiculo asegurado 3. Marca, modelo de todos los otros vehiculos involucrados 4. Ubicaci6n actual de todos los vehiculos 5. Nombre y datos de contacto Para cada conductor v todos los aasaieros 6. Nombre y datos de contacto de cualquier testigo conocido D. Para las demandas de responsabilidad General 1. Direcci6n fisica de donde se produjo la perdida 2. Nombre, direcci6n a informaci6n de contacto para todas las personas que lesiones o danos 3. Nombre y datos de contacto de cualquier testigo conocido PARA PREGUNTAS GENERALES DE RECLAMAcift LLAME AL 888-239-3909 LA AmTrust North America An AmTrust Financial Company Dear Valued Policyholder, Thank you for placing your Workers' Compensation Coverage with AmTrust. For your convenience, we now offer electronic versions of our Claims Kits. Please see the instructions and FAQs below for more information. Where's my claims kit? All the States' Claims Kits are online for insured to download which contains all the necessary WC notices. Please note, for the states we are unable to place online, including CO, CT, FL, GA, MD, ME, PA, TN, AmTrust will mail additional notices to the insured's main address. 1. Visit the Talispoint Direct Link at httos://www-sf.talispoint.com/amtrust/external/ a. Click State Rules/Kits, choose corresponding state and open the PDF link to view and print. have an injured worker; how do I find a doctor? We will provide completed Panel of Physicians for the 4 states that require a panel to be posted (CO, GA, PA & TN). We offer our online physician search for all other states. There are 2 ways to access this information: 1. Visit the Talispoint Direct Link at https://www-sf.talispoint.com/amtrust/external/ 2. Visit the AmTrust Financial Website at https://amtrustfinancial.com/ a. Click Claims b. Click Provider Directory or California MPN under "Find a Provider" c. State specific laws for directing medical treatment are listed on the State Rules Tab d. Search for physicians by Name, Address or Region Where are my posting notices? All states claim kits areavailable online, including applicable postings. There are states (CO, CT, FL, MD, ME) we cannot place online. For these states, we will mail additional posting notices to the main address on the policy. I have a question about my claims kit, posting notice, panel or accessing the website's physician searches, who do I contact? You maysend an email to clientservices(@amtrustizroup.com. Please make sure to include your policy number along with your request. I have a question about a claim or injured worker, who do I contact? Customer Service can direct you to the appropriate person. Please contact them at 888-239- 3909. (p) 888.239.3909 • (f) 678.258.8399 •www.amtrustnorthamerica.com AmTrust North America An AmTrust Financial Company August 26, 2021 Dear Policyholder, In an effort to continue to provide AmTrust customers with a variety of billing options, we have updated our fee structure to help customers meet payment due dates, ensure that valid and properly funded payments are submitted, and provide an incentive for paid -in -full options. Our updated fee structure is as follows: Fee Title Fee Amount Description Returned Payment Fee $25 A returned payment fee applied to any returned payment. Late Fee $20 Late fee applied if payment not received on or before payment due date. Installment Fee $15 A "paper' billing fee that is assessed for each mailed installment invoice. Excludes down payment and annual payment plans. Fee is billed at the account level. Reinstatement Fee $50 Fee applied upon reinstatement of a non-payment cancellation. EFT Fee $3 An "electronic" billing fee that is assessed for each ACH Direct Debit transaction. Fee is billed at the account level. "Fee amount may vary by state and program of business For policyholders who choose to pay their annual premium on installments, we plan to implement an installment fee, which will be displayed on your renewal invoice. Thank you for your attention to this fee structure change. If you have any questions, feel free to contact our Customer Service Department at 877.528.7878. We value you as a policyholder and appreciate the opportunity to serve you. Sincerely, AmTrust North America Customer Service Department 800 Superior Avenue E • 21st Floor • Cleveland, OH 44114 (p) 866.203.3037 • (f) 800.487.9654 • www.amtrustnorthamerica.com Wesco Insurance Company A Stock Insurance Company WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Ncci Code: 26135 Insured: NWA Center for Sexual Assualt 1670 W. Sunset Ave. Suite B 1 Springdale, AR 72762 Other workplaces not shown above: None Producer: Acrisure, LLC dba The Hatcher Agency P. O. Box 3505 Little Rock, AR 72201 WC990001 B 1 of 5 INFORMATION PAGE Policy Number: WWC3550901 _ Individual Corporation Federal Tax ID: Risk Id: Renewal of: Partnership X Other 710567897 WWC3492058 2. The policy period is from 10/17/2021 to 10/17/2022 12:01 a.m. at the insureds mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: Arkansas B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: State Bodily Injury by Accident Bodily Injury by Disease Bodily Injury by Disease $500,000 each accident $500,000 policy limit $500,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: All states except ND, OH, WA, WY and State(s) Designated in Item 3A. D. This policy includes these endorsements and schedules: See Extension of Information Page 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. See Extension of Information Page TOTAL ESTIMATED ANNUAL PREMIUM STATE ASSESSMENT TOTAL ESTIMATED COST Minimum Premium Deposit Premium Issue Date: 8/26/2021 Countersigned by: Authorized Representative 3,559 0 3,559 350 1,423 Wesco Insurance Company is required to provide its policyholders with certain accident prevention services at no additional cost as required by Ark. Code Ann. Sec. 11-9-409(d) and AWCC Rule 32. If you would like more information, call Wesco Insurance Company Loss Control Department at 888486-7466. If you have any questions about this requirement, call the Health and Safety Division, Arkansas Workers' Compensation Commission at 1-800-622-4472. Wesco Insurance Company WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Insured: NWA Center for Sexual Assualt WC990001 B 2 of 5 INFORMATION PAGE Policy Number: WWC3550901 EXTENSION OF INFORMATION PAGE FOR ITEM #1 ITEM 1: NAMED INSURED and WORKPLACES NAMED INSURED: NWA Center for Sexual Assualt Fein: 710567897 WORKPLACES: Location Number 1. 1670 W Sunset Avenue, Suite B Springdale, AR 72762 Wesco Insurance Company WC 99 00 01 B 3 of 5 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Insured: NWA Center for Sexual Assualt Policy Number: WWC3550901 EXTENSION OF INFORMATION PAGE FOR ITEM #3.D ITEM 3.13: ENDORSEMENT SCHEDULE State Form Number Description WC000000C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC990001 B DECLARATIONS PAGE WC000404 PENDING RATE CHANGE ENDORSEMENT WC000406 PREMIUM DISCOUNT ENDORSEMENT WC000414A NOTIFICATION OF CHANGE IN OWNERSHIP ENDORSEMENT WC000419 PREMIUM DUE DATE ENDORSEMENT WC000421 E Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement WC000422C TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT WC000424 AUDIT NONCOMPLIANCE CHARGE ENDORSEMENT WC000425 EXPERIENCE RATING MODIFICATION FACTOR REVISION ENDORSEMENT AR WC030601 B ARKANSAS AMENDATORY ENDORSEMENT Wesco Insurance Company WC 99 00 01 B 4 of 5 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Insured: NWA Center for Sexual Assualt Policy Number: WWC3550901 EXTENSION OF INFORMATION PAGE FOR ITEM #4 ITEM 4: SCHEDULE OF PREMIUMS Premium Basis Rate Per Estimated # of Code Total Est. Annual $100 of Annual Classifications Emps No. Remuneration Remuneration Premium Arkansas Social Services Organization - All Employees, Drivers 12 8864 Manual Premium Total Manual Premium Premium for Increased Limits Part Two: 0.8% (500/500/500) 9807 Premium to Equal Increased Limits Minimum Charge 9848 Total Premium Subject To Experience Modification Experience Modification 89% Schedule Modifier -20% 9887 Terrorism 0.8% 9740 Catastrophe (other than Terrorism) 2% 9741 Expense Constant 0900 Total AR Premium Total AR Cost TOTAL ESTIMATED ANNUAL PREMIUM STATE ASSESSMENT TOTAL COST 522,000 0.85 4.437 4,437 4,437 35 40 4,512 4,016 -803 42 104 200 3,559 3,559 3,559 0 3,559 Wesco Insurance Company WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Insured: NWA Center for Sexual Assualt PAYMENT SCHEDULE WC990001 B 5of5 INFORMATION PAGE Policy Number: WWC3550901 Statement Payment Closing Date Due Date Description Amount Due 10/17/2021 Downpayment $1,423.00 1/17/2022 Installment 1 of 3 $712.00 4/17/2022 Installment 2 of 3 $712.00 7/17/2022 Installment 3 of 3 $712.00 Total Cost $3,559.00 WORKERS COMPENSATION AND PLOYERS LIABILITY INSURANCE POI WC 00 00 00 C (Ed. 1-15) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY In return for the payment of the premium and subject to all terms of this policy, we agree with you as follows: GENERAL SECTION A. The Policy This policy includes at its effective date the Infor- mation Page and all endorsements and schedules listed there. It is a contract of insurance between you (the employer named in Item 1 of the Infor- mation Page) and us (the insurer named on the In- formation Page). The only agreements relating to this insurance are stated in this policy. The terms of this policy may not be changed or waived except by endorsement issued by us to be part of this policy. B. Who is Insured You are insured if you are an employer named in Item 1 of the Information Page. If that employer is a partnership, and if you are one of its partners, you are insured, but only in your capacity as an em- ployer of the partnership's employees. C. Workers Compensation Law Workers Compensation Law means the workers or workmen's compensation law and occupational disease law of each state or territory named in Item 3.A. of the Information Page. It includes any amendments to that law which are in effect during the policy period. It does not include any federal workers or workmen's compensation law, any fed- eral occupational disease law or the provisions of any law that provide nonoccupational disability benefits. D. State State means any state of the United States of America, and the District of Columbia. E. Locations This policy covers all of your workplaces listed in Items 1 or 4 of the Information Page; and it covers all other workplaces in Item 3.A. states unless you have other insurance or are self -insured for such workplaces. PART ONE WORKERS COMPENSATION INSURANCE A. How This Insurance Applies This workers compensation insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. Bodily injury by accident must occur during the policy period. 2. Bodily injury by disease must be caused or ag- gravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily in- jury by disease must occur during the policy period. B. We Will Pay We will pay promptly when due the benefits required of you by the workers compensation law. C. We Will Defend We have the right and duty to defend at our expense any claim, proceeding or suit against you for benefits payable by this insurance. We have the right to in- vestigate and settle these claims, proceedings or suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. D. We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding or suit we defend: 1. reasonable expenses incurred at our request, but not loss of earnings; 2. premiums for bonds to release attachments and for appeal bonds in bond amounts up to the amount payable under this insurance; 3. litigation costs taxed against you; 4. interest on a judgment as required by law until we offer the amount due under this insurance; and 5. expenses we incur. E. Other Insurance We will not pay more than our share of benefits and costs covered by this insurance and other 1 of 6 m Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. WC000000C (Ed. 1-15) WOE :RS COMPENSATION AND EMPLOYEF _IABILITY INSURANCE POLICY insurance or self-insurance. Subject to any limits of liability that may apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance will be equal until the loss is paid. F. Payments You Must Make You are responsible for any payments in excess of the benefits regularly provided by the workers compensation law including those required because: 1. of your serious and willful misconduct; 2. you knowingly employ an employee in violation of law; 3. you fail to comply with a health or safety law or regulation; or 4. you discharge, coerce or otherwise discriminate against any employee in violation of the workers compensation law. If we make any payments in excess of the benefits regularly provided by the workers compensation law on your behalf, you will reimburse us promptly. G. Recovery From Others We have your rights, and the rights of persons enti- tled to the benefits of this insurance, to recover our payments from anyone liable for the injury. You will do everything necessary to protect those rights for us and to help us enforce them. H. Statutory Provisions These statements apply where they are required by law. 1. As between an injured worker and us, we have notice of the injury when you have notice. 2. Your default or the bankruptcy or insolvency of you or your estate will not relieve us of our du- ties under this insurance after an injury occurs. 3. We are directly and primarily liable to any per- son entitled to the benefits payable by this in- surance. Those persons may enforce our duties; so may an agency authorized by law. Enforce- ment may be against us or against you and us. 4. Jurisdiction over you is jurisdiction over us for purposes of the workers compensation law. We are bound by decisions against you under that law, subject to the provisions of this policy that are not in conflict with that law. 5. This insurance conforms to the parts of the workers compensation law that apply to: a. benefits payable by this insurance; b. special taxes, payments into security or oth- er special funds, and assessments payable by us under that law. 6. Terms of this insurance that conflict with the workers compensation law are changed by this statement to conform to that law. Nothing in these paragraphs relieves you of your du- ties under this policy. PART TWO EMPLOYERS LIABILITY INSURANCE A. How This Insurance Applies This employers liability insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. The bodily injury must arise out of and in the course of the injured employee's employment by you. 2. The employment must be necessary or inci- dental to your work in a state or territory listed in Item 3.A. of the Information Page. 3. Bodily injury by accident must occur during the policy period. 4. Bodily injury by disease must be caused or ag- gravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily in- jury by disease must occur during the policy period. 5. If you are sued, the original suit and any related legal actions for damages for bodily injury by ac- cident or by disease must be brought in the United States of America, its territories or pos- sessions, or Canada. B. We Will Pay We will pay all sums that you legally must pay as damages because of bodily injury to your employ- ees, provided the bodily injury is covered by this Employers Liability Insurance. The damages we will pay, where recovery is permit- ted by law, include damages: 1. For which you are liable to a third party by rea- son of a claim or suit against you by that third party to recover the damages claimed against 2 of 6 0 Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND '� 'JLOYERS LIABILITY INSURANCE POL, WC 00 00 00 C (Ed. 1-15) such third party as a result of injury to your em- ployee; 2. For care and loss of services; and 3. For consequential bodily injury to a spouse, child, parent, brother or sister of the injured em- ployee; provided that these damages are the di- rect consequence of bodily injury that arises out of and in the course of the injured employee's employment by you; and 4. Because of bodily injury to your employee that arises out of and in the course of employment, claimed against you in a capacity other than as employer. C. Exclusions This insurance does not cover: 1. Liability assumed under a contract. This exclu- sion does not apply to a warranty that your work will be done in a workmanlike manner; 2. Punitive or exemplary damages because of bodi- ly injury to an employee employed in violation of law; 3. Bodily injury to an employee while employed in violation of law with your actual knowledge or the actual knowledge of any of your executive offic- ers; 4. Any obligation imposed by a workers compensa- tion, occupational disease, unemployment com- pensation, or disability benefits law, or any simi- lar law; 5. Bodily injury intentionally caused or aggravated by you; 6. Bodily injury occurring outside the United States of America, its territories or possessions, and Canada. This exclusion does not apply to bodily injury to a citizen or resident of the United States of America or Canada who is temporarily outside these countries; 7. Damages arising out of coercion, criticism, de- motion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimina- tion against or termination of any employee, or any personnel practices, policies, acts or omis- sions; 8. Bodily injury to any person in work subject to the Longshore and Harbor Workers' Compensation Act (33 U.S.C. Sections 901 et seq.), the Nonap- propriated Fund Instrumentalities Act (5 U.S.C. Sections 8171 et seq.), the Outer Continental Shelf Lands Act (43 U.S.C. Sections 1331 et seq.), the Defense Base Act (42 U.S.C. Sections 1651-1654), the Federal Mine Safety and Health Act (30 U.S.C. Sections 801 et seq. and 901- 944), any other federal workers or workmen's compensation law or other federal occupational disease law, or any amendments to these laws; 3 of 6 9. Bodily injury to any person in work subject to the Federal Employers' Liability Act (45 U.S.C. Sec- tions 51 et seq.), any other federal laws obligat- ing an employer to pay damages to an employee due to bodily injury arising out of or in the course of employment, or any amendments to those laws; 10.Bodily injury to a master or member of the crew of any vessel, and does not cover punitive dam- ages related to your duty or obligation to provide transportation, wages, maintenance, and cure under any applicable maritime law; 11.Fines or penalties imposed for violation of federal or state law; and 12.Damages payable under the Migrant and Sea- sonal Agricultural Worker Protection Act (29 U.S.C. Sections 1801 et seq.) and under any other federal law awarding damages for violation of those laws or regulations issued thereunder, and any amendments to those laws. D. We Will Defend We have the right and duty to defend, at our ex- pense, any claim, proceeding or suit against you for damages payable by this insurance. We have the right to investigate and settle these claims, proceed- ings and suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. We have no duty to defend or continue defending after we have paid our applicable limit of liability under this insurance. E. We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding, or suit we defend: 1. Reasonable expenses incurred at our request, but not loss of earnings; 2. Premiums for bonds to release attachments and for appeal bonds in bond amounts up to the limit of our liability under this insurance; 3. Litigation costs taxed against you; 4. Interest on a judgment as required by law until we offer the amount due under this insurance; and 5. Expenses we incur. 0 Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. WC 00 00 00 C (Ed. 1-15) WOI :RS COMPENSATION AND EMPLOYER ]ABILITY INSURANCE POLICY F. Other Insurance We will not pay more than our share of damages and costs covered by this insurance and other in- surance or self-insurance. Subject to any limits of li- ability that apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is ex- hausted, the shares of all remaining insurance and self-insurance will be equal until the loss is paid. G. Limits of Liability Our liability to pay for damages is limited. Our limits of liability are shown in Item 3.B. of the Information Page. They apply as explained below. 1. Bodily Injury by Accident. The limit shown for "bodily injury by accident —each accident" is the most we will pay for all damages covered by this insurance because of bodily injury to one or more employees in any one accident. A disease is not bodily injury by accident unless it results directly from bodily injury by accident. 2. Bodily Injury by Disease. The limit shown for "bodily injury by disease —policy limit" is the most we will pay for all damages covered by this insurance and arising out of bodily injury by dis- ease, regardless of the number of employees who sustain bodily injury by disease. The limit shown for "bodily injury by disease —each em- ployee" is the most we will pay for all damages because of bodily injury by disease to any one employee. Bodily injury by disease does not include dis- ease that results directly from a bodily injury by accident. 3. We will not pay any claims for damages after we have paid the applicable limit of our liability un- der this insurance. H. Recovery From Others We have your rights to recover our payment from anyone liable for an injury covered by this insurance You will do everything necessary to protect those rights for us and to help us enforce them. I. Actions Against Us There will be no right of action against us under this insurance unless: 1. You have complied with all the terms of this poli- cy; and 2. The amount you owe has been determined with our consent or by actual trial and final judgment. This insurance does not give anyone the right to add us as a defendant in an action against you to deter- mine your liability. The bankruptcy or insolvency of you or your estate will not relieve us of our obliga- tions under this Part. PART THREE OTHER STATES INSURANCE A. How This Insurance Applies 1. This other states insurance applies only if one or more states are shown in Item 3.C. of the Infor- mation Page. 2. If you begin work in any one of those states after the effective date of this policy and are not in- sured or are not self -insured for such work, all provisions of the policy will apply as though that state were listed in Item 3.A. of the Information Page. 3. We will reimburse you for the benefits required by the workers compensation law of that state if we are not permitted to pay the benefits directly to persons entitled to them. 4. If you have work on the effective date of this pol- icy in any state not listed in Item 3.A. of the In- formation Page, coverage will not be afforded for that state unless we are notified within thirty days. B. Notice Tell us at once if you begin work in any state listed in Item 3.C. of the Information Page. PARTFOUR YOUR DUTIES IF INJURY OCCURS Tell us at once if injury occurs that may be covered by this policy. Your other duties are listed here. 1. Provide for immediate medical and other ser- vices required by the workers compensation law. 2. Give us or our agent the names and addresses of the injured persons and of witnesses, and other information we may need. 3. Promptly give us all notices, demands and legal 4 of 6 m Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND �LOYERS LIABILITY INSURANCE POL. WC 00 00 00 C (Ed. 1-15) papers related to the injury, claim, proceeding or suit. 4. Cooperate with us and assist us, as we may re- quest, in the investigation, settlement or defense of any claim, proceeding or suit. 5. Do nothing after an injury occurs that would in- terfere with our right to recover from others. 6. Do not voluntarily make payments, assume obli- gations or incur expenses, except at your own cost. PART FIVE PREMIUM A. Our Manuals All premium for this policy will be determined by our manuals of rules, rates, rating plans and classifica- tions. We may change our manuals and apply the changes to this policy if authorized by law or a gov- ernmental agency regulating this insurance. B. Classifications Item 4 of the Information Page shows the rate and premium basis for certain business or work classifi- cations. These classifications were assigned based on an estimate of the exposures you would have during the policy period. If your actual exposures are not properly described by those classifications, we will assign proper classifications, rates and premium basis by endorsement to this policy. C. Remuneration Premium for each work classification is determined by multiplying a rate times a premium basis. Remu- neration is the most common premium basis. This premium basis includes payroll and all other remu- neration paid or payable during the policy period for the services of: 1. all your officers and employees engaged in work covered by this policy; and 2. all other persons engaged in work that could make us liable under Part One (Workers Com- pensation Insurance) of this policy. If you do not have payroll records for these persons, the con- tract price for their services and materials may be used as the premium basis. This paragraph 2 will not apply if you give us proof that the em- ployers of these persons lawfully secured their workers compensation obligations. D. Premium Payments You will pay all premium when due. You will pay the premium even if part or all of a workers compensa- tion law is not valid. E. Final Premium The premium shown on the Information Page, schedules, and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, premi- um basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. If the final premium is more than the premium you paid to us, you must pay us the bal- ance. If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classifications covered by this policy. If this policy is canceled, final premium will be de- termined in the following way unless our manuals provide otherwise: 1. If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. 2. If you cancel, final premium will be more than pro rata; it will be based on the time this policy was in force, and increased by our short -rate cancelation table and procedure. Final premium will not be less than the minimum premium. F. Records You will keep records of information needed to com- pute premium. You will provide us with copies of those records when we ask for them. G. Audit You will let us examine and audit all your records that relate to this policy. These records include ledg- ers, journals, registers, vouchers, contracts, tax re- ports, payroll and disbursement records, and pro- grams for storing and retrieving data. We may con- duct the audits during regular business hours during the policy period and within three years after the pol- icy period ends. Information developed by audit will be used to determine final premium. Insurance rate service organizations have the same rights we have under this provision. 5 of 6 0 Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. WC 00 00 00 C (Ed. 1-15) WOF RS COMPENSATION AND EMPLOYER IABILITY INSURANCE POLICY PART SIX CONDITIONS A. Inspection We have the right, but are not obliged to inspect your workplaces at any time. Our inspections are not safety inspections. They relate only to the insurabil- ity of the workplaces and the premiums to be charged. We may give you reports on the conditions we find. We may also recommend changes. While they may help reduce losses, we do not undertake to perform the duty of any person to provide for the health or safety of your employees or the public. We do not warrant that your workplaces are safe or healthful or that they comply with laws, regulations, codes or standards. Insurance rate service organiza- tions have the same rights we have under this provision. B. Long Term Policy If the policy period is longer than one year and six- teen days, all provisions of this policy will apply as though a new policy were issued on each annual anniversary that this policy is in force. C. Transfer of Your Rights and Duties Your rights or duties under this policy may not be transferred without our written consent. If you die and we receive notice within thirty days af- ter your death, we will cover your legal representa- tive as insured. D. Cancelation 1. You may cancel this policy. You must mail or de- liver advance written notice to us stating when the cancelation is to take effect. 2. We may cancel this policy. We must mail or de- liver to you not less than ten days advance writ- ten notice stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 3. The policy period will end on the day and hour stated in the cancelation notice. 4. Any of these provisions that conflict with a law that controls the cancelation of the insurance in this policy is changed by this statement to com- ply with the law. E. Sole Representative The insured first named in Item 1 of the Information Page will act on behalf of all insureds to change this policy, receive return premium, and give or receive notice of cancelation. 6 of 6 ® Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 04 (Ed. 04-84) PENDING RATE CHANGE ENDORSEMENT A rate change filing is being considered by the proper regulatory authority. The filing may result in rates different from the rates shown on the policy. If it does, we will issue an endorsement to show the new rates and their effective date. If only one state is shown in Item 3.A. of the Information Page, this endorsement applies to that state. If more than one state is shown there, this endorsement applies only in the state shown in the Schedule. Schedule State AR This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 10/17/2021 Policy No. WWC3550901 Endorsement No. 0 Insured NWA Center for Sexual Assualt Premium $ 3,559 Insurance Company Wesco Insurance Company Countersigned by WC 00 04 04 (Ed. 04-84) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 06 (Ed. 8-84) PREMIUM DISCOUNT ENDORSEMENT The premium for this policy and the policies, if any, listed in Item 3 of the Schedule may be eligible for a discount. This endorsement shows your estimated discount in Items 1 or 2 of the Schedule. The final calculation of premium discount will be determined by our manuals and your premium basis as determined by audit. Premium subject to retrospective rating is not subject to premium discount. Schedule 1. State Estimated Eligible Premium First Next Next Arkansas 2. Average Percentage Discount: 0% 3. Other policies: $5,000 $95,000 $400,000 Balance 0% 9.5% 11.9% 12.4% 4. If there are no entries in Items 1, 2 and 3 of the Schedule, see the Premium Discount Endorsement attached to your policy number: This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 10/17/2021 Policy No. WWC3550901 Endorsement No. 0 Insured NWA Center for Sexual Assualt Premium $ 3,559 Insurance Company Wesco Insurance Company Countersigned by WC 00 04 06 (Ed. 8-84) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC000414A (Ed. 01-19) 90-DAY REPORTING REQUIREMENT —NOTIFICATION OF CHANGE IN OWNERSHIP ENDORSEMENT You must report any change in ownership to us in writing within 90 days of the date of the change. Change in ownership includes sales, purchases, other transfers, mergers, consolidations, dissolutions, formations of a new entity, and other changes provided for in the applicable experience rating plan. Experience rating is mandatory for all eligible insureds. The experience rating modification factor, if any, applicable to this policy, may change if there is a change in your ownership or in that of one or more of the entities eligible to be combined with you for experience rating purposes. Failure to report any change in ownership, regardless of whether the change is reported within 90 days of such change, may result in revision of the experience rating modification factor used to determine your premium. This reporting requirement applies regardless of whether an experience rating modification is currently applicable to this policy. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Insured Insurance Company WC 00 04 14 A (Ed. 01-19) 10/17/2021 Policy No. WWC3550901 Endorsement No. 0 NWA Center for Sexual Assualt Premium $ 3,559 Wesco Insurance Company Countersigned by © Copyright 2017 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION.4 EMPLOYERS LIABILITY INSURANCE P _ZY WC 00 0419 (Ed. 1-01) PREMIUM DUE DATE ENDORSEMENT This endorsement is used to amend: Section D. of Part Five of the policy is replaced by this provision. PART FIVE PREMIUM D. Premium is amended to read: You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid. The due date for audit and retrospective premiums is the date of the billing. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 10/17/2021 Policy No. WWC3550901 Endorsement No. Insured NWA Center for Sexual Assualt Premium $3,559 Insurance Company Wesco Insurance Company Countersigned by WC 00 0419 (Ed. 1-01) 0 2000 National Council on Compensation Insurance, Inc. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 21 E (Ed. 01-21) CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUM ENDORSEMENT This endorsement is notification that your insurance carrier is charging premium to cover the losses that may occur in the event of a Catastrophe (Other Than Certified Acts of Terrorism) as that term is defined below. Your policy provides coverage for workers compensation losses caused by a Catastrophe (Other Than Certified Acts of Terrorism). This premium charge does not provide funding for Certified Acts of Terrorism contemplated under the Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 C), attached to this policy For purposes of this endorsement, the following definitions apply: Catastrophe (Other Than Certified Acts of Terrorism): Any single event, resulting from an Earthquake, Noncertified Act of Terrorism, or Catastrophic Industrial Accident, which results in aggregate workers compensation losses in excess of $50 million • Earthquake: The shaking and vibration at the surface of the earth resulting from underground movement along a fault plane or from volcanic activity. • Noncertified Act of Terrorism: An event that is not certified as an Act of Terrorism by the Secretary of the Treasury pursuant to the Terrorism Risk Insurance Act of 2002 (as amended) but that meets all of the following criteria: a. It is an act that is violent or dangerous to human life, property, or infrastructure; b. The act results in damage within the United States, or outside of the United States in the case of the premises of United States missions or air carriers or vessels as those terms are defined in the Terrorism Risk Insurance Act of 2002 (as amended); and c. It is an act that has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. • Catastrophic Industrial Accident: A chemical release, large explosion, or small blast that is localized in nature and affects workers in a small perimeter the size of a building. The premium charge for the coverage your policy provides for workers compensation losses caused by a Catastrophe (Other Than Certified Acts of Terrorism) is shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate AR 0.02 Premium $104.00 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 10/17/2021 Policy No. WWC3550901 Endorsement No. 0 Insured NWA Center for Sexual Assualt Premium $ 3,559 Insurance Company Wesco Insurance Company Countersigned by WC 00 04 21 E (Ed. 01-21) © Copyright 2020 National Council on Compensation Insurance, Inc. All rights reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 22 C (Ed. 01-21) TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2019. It serves to notify you of certain limitations under the Act, and that your insurance carrier is charging premium for losses that may occur in the event of an Act of Terrorism. Your policy provides coverage for workers compensation losses caused by Acts of Terrorism, including workers compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. Definitions The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act. If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply. "Act" means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments thereto, including any amendments resulting from the Terrorism Risk Insurance Program Reauthorization Act of 2019. "Act Of Terrorism" means any act that is certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security, and the Attorney General of the United States, as meeting all of the following requirements: a. The act is an act of terrorism. b. The act is violent or dangerous to human life, property, or infrastructure. The act resulted in damage within the United States, or outside of the United States in the case of the premises of United c. States missions or certain air carriers or vessels. The act has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United d. States or to influence the policy or affect the conduct of the United States Government by coercion. "Insured Loss" means any loss resulting from an act of terrorism (and, except for Pennsylvania, including an act of war, in the case of workers compensation) that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels. "Insurer Deductible" means, for the period beginning on January 1, 2021, and ending on December 31, 2027, an amount equal to 20% of our direct earned premiums during the immediately preceding calendar year. Limitation of Liability The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a calendar year and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up to $100,000,000,000, we will pay only a pro rata share of such Insured Losses as determined by the Secretary of the Treasury. Policyholder Disclosure Notice 1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured Losses occurring in any calendar year exceed $200,000,000, the United States Government would pay 80% of our Insured Losses that exceed our Insurer Deductible. 2. Notwithstanding item 1 above, the United States Government will not make any payment under the Act for any portion of Insured Losses that exceed $100,000,000,000. 3. The premium charge for the coverage your policy provides for Insured Losses is included in the amount shown in Item 4 of the Information Page or in the Schedule below. WC 00 04 22 C (Ed. 01-21) © Copyright 2020 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Schedule State Rate AR 0.008 WC 00 04 22 C (Ed. 01-21) Premium $42.00 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Insured Insurance Company WC 00 04 22 C (Ed. 01-21) 10/17/2021 Policy No. WWC3550901 Endorsement No. 0 NWA Center for Sexual Assualt Premium $ 3,559 Wesco Insurance Company Countersigned by © Copyright 2020 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY AUDIT NONCOMPLIANCE CHARGE ENDORSEMENT WC 00 04 24 (Ed. 1-17) Part Five —Premium, Section G. (Audit) of the Workers Compensation and Employers Liability Insurance Policy is revised by adding the following: If you do not allow us to examine and audit all of your records that relate to this policy, and/or do not provide audit information as requested, we may apply an Audit Noncompliance Charge. The method for determining the Audit Noncompliance Charge by state, where applicable, is shown in the Schedule below. If you allow us to examine and audit all of your records after we have applied an Audit Noncompliance Charge, we will revise your premium in accordance with our manuals and Part 5—Premium, E. (Final Premium) of this policy. Failure to cooperate with this policy provision may result in the cancellation of your insurance coverage, as specified under the policy. Note: For coverage under state -approved workers compensation assigned risk plans, failure to cooperate with this policy provision may affect your eligibility for coverage. Schedule States(s) Estimated Annual Premium Maximum Audit Noncompliance Amount Charge Multiplier AR $3,213 2X This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Insured Insurance Company WC 00 04 24 (Ed. 1-17) 10/17/2021 Policy No. WWC3550901 Endorsement No. 0 NWA Center for Sexual Assualt Premium $ 3,559 Wesco Insurance Company Countersigned by © Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 25 (Ed. 5.17) EXPERIENCE RATING MODIFICATION FACTOR REVISION ENDORSEMENT This endorsement is added to Part Five —Premium of the policy. The premium for the policy is adjusted by an experience rating modification factor. The factor shown on the Information Page may be revised and applied to the policy in accordance with our manuals and endorsements. We will issue an endorsement to show the revised factor, if different from the factor shown, when it is calculated. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 10/17/2021 Policy No. WWC3550901 Endorsement No. 0 Insured NWA Center for Sexual Assualt Premium $ 3,559 Insurance Company Wesco Insurance Company Countersigned by WC 00 04 25 (Ed. 5-17) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 03 06 01 B (Ed. 3-18) ARKANSAS AMENDATORY ENDORSEMENT This endorsement applies because Arkansas is shown in Item 3.A. of the Information Page. Part Two —Employers Liability Insurance, Section C. (Exclusions), Item 2 of the policy is replaced by the following: 2. Punitive or exemplary damages because of bodily injury to an employee employed in violation of law; punitive or exemplary damages are defined by Arkansas Bulletin No. 4-82 as those damages which are imposed to punish a wrongdoer and to deter others from similar conduct; Part Six —Conditions, Section D. (Cancellation) of the policy is replaced by the following: D. Cancellation 1. You may cancel this policy. You must mail or deliver at least 30 days' advance written notice of cancellation to us. Cancellation is effective at 12:01 a.m. 30 days after we receive notice unless you specify a later date for cancellation. You may cancel coverage effective less than 30 days after written notice has been received by us if you have obtained other coverage or become a self -insurer. 2. We may cancel this policy. If we cancel because you fail to pay all premium when due, we will mail or deliver to you and to the Arkansas Workers Compensation Commission not less than 10 days advance written notice stating when the cancellation is to take effect. If we cancel for any other reason, we will mail or deliver to you and to the Arkansas Workers Compensation Commission not less than 30 days' advance written notice stating when the cancellation is to take effect. Mailing notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient notice. 3. The policy period will end on the day and hour stated in the cancellation notice. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 10/17/2021 Policy No. WWC3550901 Endorsement No. Insured NWA Center for Sexual Assualt Premium: $3,559 Wesco Insurance Company Insurance Company Countersigned by WC 03 06 01 B (Ed. 3-18) © Copyright 2017 National Council on Compensation Insurance, Inc. All Rights Reserved. Wesco Insurance Company IMPORTANT NOTICE SMALL DEDUCTIBLE ELECTION FORM POLICY NUMBER WWC3550901 INSURED NWA Center for Sexual Assualt POLICY PERIOD FROM: 10/17/2021 TO: 10/17/2022 Arkansas law permits an employer to purchase workers' compensation insurance with a deductible. The deductible is applicable to medical and indemnity benefits and shall apply separately to each claim for bodily injury or disease, regardless of the number of people who sustain injury by such claim. The deductibles available are as follows: (DEDUCTIBLE AMOUNT EACH CLAIM a $1,000 ❑ $1,500 ❑ $2,000 ❑ $2,500 ❑ $3,000 $3,500 ❑ $4,000 $4,500 ❑ $5,000 You are not required to select a deductible. However, if you choose to exercise this option, you may choose only one deductible amount. It is to be understood that we will pay the deductible amount for you and that you must reimburse us for any deductible amounts paid. Non -reimbursement of the deductible(s) will result in cancellation of your policy. Please check the option you have elected and return this form to us as soon as possible. ❑ No, I do not want the deductible described in this Notice. ❑ Yes, I want the deductible checked above to apply to medical and indemnity benefits under the Arkansas Workers' Compensation Law. I understand that the Company shall pay the deductible amount and be reimbursed by the employer shown above. If you fail to respond promptly to the Company, it will be construed to mean you have not elected the small deductible option. If you have any questions, please contact your agent or broker. INSURED's SIGNATURE AND TITLE Policyholder Notice AR-SDEF 01 (11/03) DATE Project Safe Neighborhoods Mike Reynolds Submitted By City of Fayetteville Staff Review Form 2023-1086 Item ID N/A City Council Meeting Date - Agenda Item Only N/A for Non -Agenda Item 10/18/2023 POLICE (200) Submitted Date Division / Department Action Recommendation: Staff recommends approval and execution of agency certification related to the Project Safe Neighborhoods (PSN) grant award as approved by City Council on September 5, 2023 via Resolution 195-23. Budget Impact: Account Number Project Number Budgeted Item? No Total Amended Budget Expenses (Actual+Encum) Available Budget Does item have a direct cost? No Item Cost Is a Budget Adjustment attached? No Budget Adjustment Remaining Budget Fund Project Title V20221130 Purchase Order Number: Previous Ordinance or Resolution # 195-23 Change Order Number: Approval Date: 10120�2b23 Original Contract Number: Comments: CITY OF FAYETTEVILLE ARKANSAS TO: Lioneld Jordan, Mayor FROM: Mike Reynolds, Chief of Police DATE: October 18, 2023 SUBJECT: Approval and Execution of Agency Certification STAFF MEMO RECOMMENDATION: Staff recommends approval and execution of agency certification related to the Project Safe Neighborhoods (PSN) grant award as approved by City Council on September 5, 2023 via Resolution #195-23. BACKGROUND: Fayetteville City Council previously approved this grant award via Resolution number 195-23. This document was not provided until after the execution of the grant award and is part of the reporting documentation required by the Department of Finance and Administration (DF&A) prior to the release of grant funds. DISCUSSION: The DF&A, Office of Intergovernmental Services requires the execution of an agency certification by the authorized official prior to any reimbursement requests being processed. BUDGET/STAFF IMPACT: There is no effect on budget nor staffing with this document. Attachments: Agency Certification — 247331-20WL Resolution 195-23 Mailing Address: 113 W. Mountain Street www.fayetteville-ar.gov Fayetteville, AR 72701 f� A 113 West Mountain Street Fayetteville, AR 72701 (479)575-8323 Resolution: 195-23 File Number: 2023-1017 2023 PROJECT SAFE NEIGHBORHOODS (GRANT ACCEPTANCE): A RESOLUTION TO AUTHORIZE ACCEPTANCE OF A PROJECT SAFE, NEIGHBORHOOD GRANT AWARD IN THE AMOUNT OF $18,114,00 FOR THE FAYETTEVILLE POLICE DEPARTMENT, AND TO APPROVE A BUDGET ADJUSTMENT Section I.: That the City Council of the City of Fayetteville, Arkansas hereby authorizes acceptance of a Project Safe Neighborhood Grant award in the amount of $18,114.00 for the Fayetteville Police Department. Section 2: That the City Council of the City of Fayetteville, Arkansas hereby approves a budget adjustment, a copy of which is attached to this Resolution. PASSED and APPROVED on September 5, 2023 Page 1 Attest:rr I LL.�I Kara Paxton, City Clc.r "Treasurer_ __ + ..a .: DEPARTMENT OF FINANCE AND ADMINISTRATION PAGE 1 OF 1 OFFICE OF INTERGOVERNMENTAL SERVICES AGENCY CERTIFICATION SUBGRANT NUMBERS : 247331-20WL SUBGRANT ORGANIZATION: City of Fayetteville MAILING ADDRESS: 113 West Mountain Street CITY/STATE/ZIP CODE Fayetteville, AR 72701 TELEPHONE NUMBER: 479-575-8330 FAX NUMBER: n/a EMAIL ADDRESS: mayor@fayetteville-ar.gov FUNDING SOURCE: 2020-GP-BX-0016 AUTHORIZED OFFICIAL: Lioneld Jordan, Mayor ACTING AUTHORIZED OFFICIAL: Willie Newman CERTIFICATION As the Authorized Official of the organization named above, I certify that the information contained and entered in to this workbook is true and accurate. I acknowledge the obligation of the organization to Department of Finance and Administration regarding the funding source as identified above. I understand and agree that by accepting a contract with DFA/IGS that the organization will provide the services set forth in the subaward agreement and will remain in compliance with the terms and conditions set forth in the contract, as well as all special conditions. Lioneld Jordan, Mayor NANfrz AND TITLE OF AUTHORIZED OFFICIj 10/20/2023 AUTHO"-Eb &FICIAL SIGNATUF DATE C:\Users\TTannehill\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\X8LBIM2M\Fayetteville Workbook_ : AGENCY CERTIFICATION 10/17/2023 11:57 AM Project Safe Neighborhoods Revised Grant Award Document City of Fayetteville Staff Review Form 2023-1130 Item ID ARCHIVED N/A City Council Meeting Date-Agenda Item Only N/A for Non-Agenda Item Mike Reynolds 11/7/2023 POLICE (200) Submitted By Submitted Date Division / Department Action Recommendation: Staff recommends approval and execution of the revised grant award document for Project Safe Neighborhoods (PSN) grant award, 2023 via Resolution 195-23. Budget Impact: Account Number Fund Project Number Project Title Budgeted Item? No Total Amended Budget $ Expenses (Actual+Encum) $ Available Budget Does item have a direct cost? No Item Cost $ Is a Budget Adjustment attached? No Budget Adjustment $ Remaining Budget V20221130 Purchase Order Number: Previous Ordinance or Resolution# 195-23 Change Order Number: Approval Date: 11/1q2023 Original Contract Number: Comments: CITY OF FAYETTEVILLE STAFF MEMO ippota,- ARKANSAS TO: Lioneld Jordan, Mayor FROM: Mike Reynolds, Chief of Police DATE: November 7, 2023 SUBJECT: Approval of Revised Project Safe Neighborhoods Grant Award RECOMMENDATION: Staff recommends approval and execution of the revised grant award document for Project Safe Neighborhoods (PSN), which was approved by City Council on September 5, 2023 via resolution #195-23. BACKGROUND: Fayetteville City Council previously approved this grant award via Resolution number 195-23. This document was sent as an email attachment with revisions to the Federal Identification Number/ UEI section of the document. DISCUSSION: The DF&A, Office of Intergovernmental Services requires the execution of an award document including these revisions by the authorized official prior to any reimbursement requests being processed. BUDGET/STAFF IMPACT: There is no effect on budget nor staffing with this document. Attachments: Award document Resolution 195-23 Mailing Address: 113 W. Mountain Street www.fayetteville-ar,gov Fayetteville, AR 72701 T`vtr . '�,sow ARKANSAS DEPARTMENT OF OFFICE OF INTERGOVERNMENTAL SERVICES a • FINANCE AND ADMINISTRATION 1515 West Seventh Street,Suite 404 IQ '+, P.O.Box 8031 sr, Little Rock,Arkansas 72203-8031 144$A0 Phone:(501)682-1074 Fax:(501)682-5206 https://www.dfa.arkansas.gov/intergovernmental- services CATALOG OF DOMESTIC FEDERAL ASSISTANCE DTF RSAT (CFDA Number)16.609—Project Safe Neighborhoods(PSN) X Federal Award Number: 2020-GP-BX-0016 PSN COAP/COSSAP Federal Award Date: 11/05/2020 1. SUBGRANTEE NAME AND ADDRESS(Including Zip Code) 6. SUBGRANT NUMBER: 247331-20WL Mr.Lioneld Jordan,Mayor City of Fayetteville 100 W.Rock Street 7. START DATE: August 1,2023 Fayetteville,AR 72701 END DATE: July 1,2024 8. AWARD DATE: August 3,2023 2. FEDERAL IDENTIFICATION NUMBER/UEI: 71-6018462/MXZNALCP4W19 9. ACTION: Initial X Modification 3. MODIFICATION EFFECTIVE DATE: .14. MODIFICATION AMOUNT: $ 10. AWARD AMOUNT: $18,114.00 FEDERAL AMOUNT: $ FEDERAL AMOUNT: $18,114.00 STATE AMOUNT: $ STATE AMOUNT: N/A LOCAL MATCH: $ LOCAL MATCH: N/A No Indirect Rate Cost 5. PROJECT DESCRIPTION PSN is a nationwide initiative that brings together federal,state,local,tribal,and territorial law enforcement officials,prosecutors, community-based partners,and other stakeholders to identify the most pressing violent crime problems In a community and develop comprehensive solutions to address them.PSN is coordinated by the U.S.Attorney's Offices in the 94 federal judicial districts throughout the d 50 states and U.S.Territories. 11.SPECIAL CONDITIONS(Check if applicable) XTHE ABOVE GRANT PROJECT IS APPROVED SUBJECT TO SUCH CONDITIONS OR LIMITATIONS ASSET FORTH INIVSAPPUCATION AND ALL CERTIFICATIONS, ASSURANCES AND SPECIAL CONDMONS PREVIOUSLY AGREED TO. This project Is supported under FY20(8JA-PSN)pub L No.116-6,113 stat.13,112;Pub.L No.115-185,132 Stat. 1485 AGENCY APPROVAL SUBGRANTEE APPROVAL 12.TYPED NAME AND TITLE OF APPROVING IGS OFFICIAL 15.TYPED NAME AND TITLE OF AUTHORIZED SUBGRANTEE OFFICIAL Doris Smith,DFA Administrator Lioneld Jordan,Mayor Intergovernmental Services City of F etteville 13.SIGNA ?OF APP VING OFFICIAL 14. DATE: 16 Si ATURE 0 A IZED O' ICIAL 17. DATE: jatc.‘ �d (� , 11 110 12023