HomeMy WebLinkAbout115-13 RESOLUTIONRESOLUTION NO. 115-13
A RESOLUTION APPROVING AN APPLICATION FOR A 2013 COPS
HIRING PROGRAM MATCHING GRANT IN THE AMOUNT OF $375,000.00
TO FUND THREE (3) POLICE OFFICERS FOR A PERIOD OF FOUR (4)
YEARS WITH THE $348,494.00 MATCHING REQUIREMENT SPLIT
PROPORTIONALLY BETWEEN THE CITY AND THE FAYETTEVILLE
SCHOOL DISTRICT
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
FAYETTEVILLE, ARKANSAS:
Section 1. That the City Council of the City of Fayetteville, Arkansas hereby approves an
application for a 2013 COPS Hiring Program matching grant in the amount of $375,000.00 to
fund three (3) police officers for a period of four (4) years with the $348,494.00 matching
requirement split proportionally between the City and the Fayetteville School District.
PASSED and APPROVED this 21St day of May, 2013.
A PPR CIVET)-
ATTEST:
By: 1
LISA BRANSON, Deputy City Clerk
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City of Fayetteville Staff Review Form
City Council Agenda Items
and
Contracts, Leases or Agreements
5/21 /2013
City Council Meeting Date
Agenda Items Only
G. Tabor Patrol Police
Submitted By Division Department
$ 723,494.00 $ - COPS Hiring Grant
Cost of this request Category / Project Budget Program Category / Project Name
1010-2920-5120.00 $ - Grant
Account Number Funds Used to Date Program / Project Category Name
$ - General
Project Number Remaining Balance Fund Name
Budgeted Item Budget Adjustment Attached
Depa Di Date
rney Date
Pg, J '::k (� , ),.k, 5- 4-2,0t3
Finance and Internal Services Director Date
Date
Efate
Previous Ordinance or Resolution #
Original Contract Date:
Original Contract Number:
Received in City"-`"-' 3 A 1 1 D
Clerk's Office
Received in
Mayor's Office
Revised January 15, 2009
THE CITY OF FAYETTEVILLE, ARKANSAS
DEPARTMENT CORRESPONDENCE
CITY COUNCIL AGENDA MEMO
To: Mayor Lioneld Jordan and Members of the City Council
From: Greg Tabor, Police Chief�
Date: May 3, 2013
Subject: Approval of Grant Application to 2013 COPS Hiring Program
PROPOSAL:
The 2013 COPS Hiring Program (CHP) is a competitive grant program that provides funding for three
(3) years directly to law enforcement agencies to create and preserve jobs and to increase their community
policing capacity and crime prevention efforts. Funding will be based on our current entry-level salaries and
benefits for sworn officer positions plus annual step increases per our current pay plan policy. Any additional
costs for positions hired under the CHP grant beyond salaries and benefits must be paid for by local match.
Also, at the conclusion of the three year federal funding, grantees must retain all sworn officer positions
awarded under the CHP grant for an additional budget cycle.
The Fayetteville Police Department will utilize the CHP grant funding to hire three (3) currently frozen
police officer positions. These officers will be used to expand our School Resource Officer (SRO) program.
Fayetteville Public Schools has previously requested additional SROs for their junior high and middle schools,
but our staffing and budget levels have not allowed for these positions. Fayetteville Public Schools has agreed
to pay their proportionate share of the $348,494 local match requirements. The attached spreadsheet shows the
total cost for three new officers throughout the four (4) year grant period and the sources of funding needed to
meet the local match requirements of this grant. We are projecting the City's portion of the local match
requirements to be approximately $110,000 with Fayetteville Public Schools reimbursing approximately
$238,000.
RECOMMENDATION:
Staff recommends approval of the 2013 COPS Hiring Program grant application to fund three (3) police
officers to be assigned to the Fayetteville Public Schools for a period of up to four (4) years for a total project
amount of $723,494. COPS Hiring Grant will fund $375,000 while Local Match requirements will be
$348,494. Local match requirements are planned to be split proportionately between the Fayetteville Public
Schools and City of Fayetteville.
THE CITY OF'FAYETTEVILLE, ARKANSAS
BUDGET IMPACT:
There is no budget impact for applying to the 2013 COPS Hiring Grant Program. If grant is awarded,
the City Council would be asked to accept the grant award, approve a budget adjustment to appropriate funding
for the grant's local match requirement, and approve an agreement with Fayetteville Public Schools to cost -
share the SRO expenses.
A RESOLUTION APPROVING AN APPLICATION FOR A 2013 COPS
HIRING PROGRAM MATCHING GRANT IN THE AMOUNT OF $375,000.00
TO FUND THREE (3) POLICE OFFICERS FOR A PERIOD OF FOUR (4)
YEARS WITH THE $348,494.00 MATCHING REQUIREMENT SPLIT
PROPORTIONALLY BETWEEN THE CITY AND THE FAYETTEVILLE
SCHOOL DISTRICT
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
FAYETTEVILLE, ARKANSAS:
Section 1. That the City Council of the City of Fayetteville, Arkansas hereby approves an
application for a 2013 COPS Hiring Program matching grant in the amount of $375,000.00 to
fund three (3) police officers for a period of four (4) years with the $348,494.00 matching
requirement split proportionally between the City and the Fayetteville School District.
PASSED and APPROVED this 21" day of May, 2013.
APPROVED:
LE
LIONELD JORDAN, Mayor
ATTEST:
SONDRA E. SMITH, City Clerk/Treasurer
FPD / FPS COPS Hiring Grant
Sources and Uses of Funds
2014-2017
Use of Funds
Base Salary per New Officer
Fringe Benefits per Officer
Medicare
Health Insurance
Life Insurance
Retirement
Workers Comp
Professional Liability Insurance
Fringe Benefits per Officer
Total Salary & Fringe per Officer
Uniform, Equipment, & Training Per Officer
Uniform
Bulletproof Vest
Taser w/ Cam
Academy Training - OT
Academy Training - Per Diem
FTO Trainer
Total Equip & Training per Officer
Total Operating Costs per Officer
Total Expense for 3 Officers
Year 1
Year 2
Year 3
Year 4
Total
$ 37,181 $
38,916 $
40,650 $
42,384 $
159,131-
539
564
589
615
2,307
6,801
7,141
7,498
7,873
29,313
113
118
122
128
123
7,377
8,110
8,878
9,681
34,045
683
715
747
775
2,920
300
300
300
300
1,200
$ 15,813 $
16,948 $
18,134 $
19,371 $
70,266
$ 52,994 $
55,864 $
58,784 $
61,755 $
229,398
3,050
500
500
500
4,550
785
-
-
-
785
1,940
-
-
-
1,940
3,167
-
-
-
3,167
365
-
-
-
365
960
960 - - -
$ 10,267 $ 500 $ 500 $ 500 $ 11,767
$ 63,261 $ 56,364 $ 59,284 $ 62,255 $ 241,165
$ 189,783 $ 169,091 $ 177,853 $ 186,766 $ 723,494
Total Source of Funds
Grant Program ($125,000 max per position over 3 years) 125,000 125,000 125,000 - 375,000
Local Match plus excess ofntaxgrant 64,783 44,091 52,853 186,766 348,494
Total Sources $ 189,783 $ 169,091 $ 177,853 $ 186,766 $ 723,494
Proposed Split Out of Local Match
Police Department share of Local Match (82 days annually)
School District share of Local Match (178 days annually)
Total Local Match (260 days annually)
% S lit Local Match Work Hours Hourly Rate
31.54% 109,909.55
68.46% 238,584.14 13,884 $ 17.18
100.00% 348,493.69
% Split - Days at School divided by total annual days (178 / 260 = 68.46%)
Local Match at School - 68.46% x $348,494 = $238,584
Work Hours at School - 178 days x 8 hours x 3 officers x 3.25 years = 13,884
School Hourly Rate - $238,584 School Local Match divided by 13,884 work hours at school = $17.18
Opportunity Title:
Offering Agency:
CFDA Number:
CFDA Description:
Opportunity Number:
Competition ID:
- Opportunity Open Date:
Opportunity Close Date:
Agency Contact:
COPS-Hiring-Program-Application-2013
Community Oriented Policing Services
16.710
Public Safety Partnership and Community Policing Grants
COPS-HIRING-PROGRAM-APPLICATION-2013
04/22/2013
05/23/2013
COPS Office Response Center
Phone: 1-800-421-6770
Email: AskCOPSRC@usdoj.gov
Grant Application Package
This opportunity is only open to organizations, applicants who are submitting grant applications on behalf of a company, state, local or
tribal government, academia, or other type of organization.
* Application Filing Name: FCity of Fayetteville, Arkansas
Optional Documents
Move Form to
Complete
Move Form to
Delete
. uDmission
cation for Federal Assistance (SF-424)
Short Application Attachment to SF-424
Move Form to Optional Documents for Submission
Submission List
Move Form to
Delete
Enter a name for the application in the Application Filing Name field.
This application can be completed in its entirety offline; however, you will need to login to the Grants.gov website during the submission process.
You can save your application at any time by clicking the "Save" button at the top of your screen.
The "Save & Submit" button will not be functional until all required data fields in the application are completed and you clicked on the "Check Package for Errors" button and
confirmed all data required data fields are completed.
%Y Open and complete all of the documents listed in the "Mandatory Documents" box. Complete the SF-424 form first.
ff
- It is recommended that the SF-424 form be the first form completed for the application package. Data entered on the SF-424 will populate data fields in other mandatory and
optional forms and the user cannot enter data in these fields.
- The forms listed in the "Mandatory Documents" box and "Optional Documents" may be predefined forms, such as SF-424, forms where a document needs to be attached,
such as the Project Narrative or a combination of both. "Mandatory Documents" are required for this application. "Optional Documents" can be used to provide additional
support for this application or may be required for specific types of grant activity. Reference the application package instructions for more information regarding "Optional
Documents".
-To open and complete a form, simply click on the form's name to select the item and then click on the => button. This will move the document to the appropriate "Documents
for Submission" box and the form will be automatically added to your application package. To view the form, scroll down the screen or select the form name and click on the
"Open Form" button to begin completing the required data fields. To remove a form/document from the "Documents for Submission" box, click the document name to select it,
and then click the <= button. This will return the form/document to the "Mandatory Documents" or "Optional Documents" box.
- All documents listed in the "Mandatory Documents" box must be moved to the "Mandatory Documents for Submission" box. When you open a required form, the fields which
must be completed are highlighted in yellow with a red border. Optional fields and completed fields are displayed in white. If you enter invalid or incomplete information in a
field; you will receive an error message.
Click the "Save & Submit" button to submit your application to Grants.gov.
- Once you have properly completed all required documents and attached any required or optional documentation, save the completed application by clicking on the "Save"
button.
- Click on the "Check Package for Errors" button to ensure that you have completed all required data fields. Correct any errors or if none are found, save the application
package.
The "Save & Submit" button will become active; click on the "Save & Submit" button to begin the application submission process.
You will be taken to the applicant login page to enter your Grants.gov username and password. Follow all onscreen instructions for submission.
OMB Number: 4040-0004
Expiration Date: 03/31/2012
Application for Federal Assistance SF-424
* 1. Type of Submission:
Preapplication
FXJ Application
Changed/Corrected Application
* 2. Type of Application: * If Revision, select appropriate letter(s):
❑X New
n Continuation * Other (Specify):
❑ Revision
* 3. Date Received: 4. Applicant Identifier:
Completed by Grants.gov upon submission.
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, Arkansas
* b. Employer/Taxpayer Identification Number (EIN/TIN):
* c. Organizational DUNS:
0756577420000
71-6018462
d. Address:
* Streetl: 113 Est Mountain Street
Street2:
* City: Fayetteville
County/Parish:
* State:
AR: Arkansas
Province:
*Country:
USA: UNITED STATES
* Zip / Postal Code: 72701-6069
e. Organizational Unit:
Department Name:
Division Name:
Community Oriented Policing
Fayetteville Police Department
f. Name and contact information of person to be contacted on matters involving this application:
Prefix: * First Name:
Middle Name:
Judy
* Last Name: Cohea
Suffix:
Title: Project Manager
Organizational Affiliation:
* Telephone Number: 479-587-3581
Fax Number: 479-587-3570
*Email: jcohea@ci.fayetteville.ar.us
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:
Type of Applicant 3: Select Applicant Type:
Other (specify):
* 10. Name of Federal Agency:
Community Oriented Policing Services
11. Catalog of Federal Domestic Assistance Number:
16.710
CFDA Title:
Public Safety Partnership and Community Policing Grants
* 12. Funding Opportunity Number:
COPS-HIRING-PROGRAM-APPLICATION-2013
* Title:
COPS-Hiring-Program-Application-2013
13. Competition Identification Number:
Title:
14. Areas Affected by Project (Cities, Counties, States, etc.):
�Acf i Atte hmeft �
Dele# A a4�{i ent i�w Aita ir1� t
* 15. Descriptive Title of Applicant's Project:
r3 COPS Hiring Grant
Attach supporting documents as specified in agency instructions.
Ad MttaG>nen �Dletel,acenf57W AtaChrn#s
Application for Federal Assistance SF-424
16. Congressional Districts Of:
* a. Applicant AR-003 b. Program/Project AR-003
Attach an additional list of Program/Project Congressional Districts if needed.
17. Proposed Project:
* a. Start Date: 10/O1/2013 * b. End Date: 09/30/2017
18. Estimated Funding ($):
* a. Federal 375, 000.00
* b. Applicant 0.00
* c. State 0.00
*d.Local 348,494.00
* e. Other 0.00
*f. Program Income 0.00
*g.TOTAL 723,494.00
* 19. Is Application Subject to Review By State'Under Executive Order 12372 Process?
FRI a. This application was made available to the State under the Executive Order 12372 Process for review on 04/30/2013
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 OX No
If "Yes", provide explanation and attach
Rd Atta>rl�mertt �?et�te��� ac ent` 1�tew Attachtne�i q
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)
❑X ** 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: * First Name: Lioneld
Middle Name:
* Last Name: Jordan
Suffix:
* Title: Mayor
* Telephone Number: 479-575-8330 Fax Number: 479-575-8257
*Email: mayor@ci.fayetteville.ar.us
* Signature of Authorized Representative: lCompleted by Grants.gov upon submission. * Date Signed: Completed by Grants.gov upon submission.
OMB Number: 1103-0098
Expiration Date: 01/31/2015
COPS Application Attachment to SF-424
Section 1: COPS PROGRAM REQUEST
Federal assistance is being requested under the following COPS program:
Select the COPS grant program for which you are requesting federal assistance. A separate application
must be completed for each COPS program for which you are applying. Please ensure that you read,
understand, and agree to comply with the applicable grant terms and conditions as outlined in the COPS
Application Guide before finalizing your selection.
ONLY ONE PROGRAM OPTION MAY BE CHECKED
0 COPS Hiring Program
Community Policing Development
Micro Grants for Law Enforcement Agencies
Applicant ORI Number: AR07201
Re-enter Applicant ORI Number: AR07201
The ORI number is assigned by the FBI and is your agency's unique identifier. The COPS Office uses the
first seven characters of this number. The first two letters are your state abbreviation, the next three
numbers are your county's code, and the next two numbers identify your jurisdiction within your county. If
you do not currently have an ORI number, the COPS Office will assign one to your agency for the purpose
of tracking your grant. ORI numbers assigned to agencies by the COPS Office may end in "ZZ."
ORI# Standard Application Forms
SECTION 15A: ASSURANCES
Several provisions of federal law and policy apply to all grant programs. The Office of Community Oriented Policing Services needs to secure your assurance
that the applicant will comply with these provisions. If you would like further information about any of these assurances, please contact your state's COPS
Grant Program Specialist at 800-421-6770.
By signing this form, the applicant assures that it will comply with all legal and administrative requirements that govern the applicant for acceptance and use
of federal grant funds. In particular, the applicant assures us that:
1. It has been legally and officially authorized by the appropriate governing body (for example, mayor or city council) to apply for this grant and that the
persons signing the application and these assurances on its behalf are authorized to do so and to act on its behalf with respect to any issues that may arise
during processing of this application.
2. It will comply with the provisions of federal law, which limit certain political activities of grantee employees whose principal employment is in
connection with an activity financed in whole or in part with this grant. These restrictions are set forth in 5 U.S.C. § 1501, et seq.
3. It will comply with the minimum wage and maximum hours provisions of the Federal Fair Labor Standards Act, if applicable.
4. It will establish safeguards, if it has not done so already, to prohibit employees from using their positions for a purpose that is, or gives the appearance of
being, motivated by a desire for private gain for themselves or others, particularly those with whom they have family, business or other ties.
5. It will give the Department of Justice or the Comptroller General access to and the right to examine records and documents related to the grant.
6. It will comply with all requirements imposed by the Department of Justice as a condition or administrative requirement of the grant, including but not
limited to: the requirements of 28 CFR Part 66 and 28 CFR Part 70 (governing administrative requirements for grants and cooperative agreements); 2
CFR Part 225 (OMB Circular A-87), 2 CFR 220 (OMB Circular A-21), 2 CFR Part 230 (OMB Circular A-122) and 48 CFR Part 31.000, et seq. (FAR
31) (governing cost principles); OMB Circular A-133 (governing audits) and other applicable OMB circulars; the applicable provisions of the Omnibus
Crime Control and Safe Streets Act of 1968, as amended; 28 CFR Part 38.1; the applicable COPS Application Guidelines; the applicable COPS Grant
Owner's Manuals; and with all other applicable program requirements, laws, orders, regulations, or circulars.
7. It will, to the extent practicable and consistent with applicable law, seek, recruit and hire qualified members of racial and ethnic minority groups and
qualified women in order to further effective law enforcement by increasing their ranks within the sworn positions in the agency.
8. It will not (and will require any subgrantees, contractors, successors, transferees, and assignees not to), on the ground of race, color, religion, national
origin, sex, disability, or age, unlawfully exclude any person from participation in, deny the benefits of or employment to any person, or subject any
person to discrimination in connection with any programs or activities funded in whole or in part with federal funds. These civil rights requirements are
found in the non-discrimination provisions of Title VI of the Civil Rights Act of 1964, as amended (42 U.S.C. § 2000d); the Omnibus Crime Control and
Safe Streets Act of 1968, as amended (42 U.S.C. § 3789d); Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. § 794); the Age
Discrimination Act of 1975 (42 U.S.C. §6101, et seq.); Title IX of the Education Amendments of 1972, as amended (20 U.S.C. 1681 et seq.); and the
corresponding DOJ regulations implementing those statutes at 28 C.F.R. part 42 (subparts C, D, E, G, and 1). It will also comply with Executive Order
13279 Equal Treatment for Faith -Based Organizations and its implementing regulations at 28 C.F.R Part 38, which requires equal treatment of religious
organizations in the funding process and nondiscrimination of beneficiaries by Faith -Based Organizations on the basis of belief or non -belief.
A. In the event that any court or administrative agency makes a finding of discrimination on grounds of race, color, religion, national origin, gender,
disability or age against the applicant after a due process hearing, it agrees to forward a copy of the finding to the Office for Civil Rights, Office of
Justice Programs, 810 7th Street, NW, Washington, D.C. 20531.
B. If your organization has received an award for $500,000 or more and has 50 or more employees, then it has to prepare an Equal Employment
Opportunity Plan (EEOP) and submit it to the Office for Civil Rights ("OCR"), Office of Justice Programs, 810 7th Street, N.W., Washington, DC
20531, for review within 60 days of the notification of the award. If your organization received an award between $25,000 and $500,000 and has 50 or
more employees, your organization still has to prepare an EEOP, but it does not have to submit the EEOP to OCR for review. Instead, your
organization has to maintain the EEOP on file and make it available for review on request. hi addition, your organization has to complete Section B of
the Certification Form and return it to OCR. If your organization received an award for less than $25,000; or if your organization has less than 50
employees, regardless of the amount of the award; or if your organization is a medical institution, educational institution, nonprofit organization or
Indian tribe, then your organization is exempt from the EEOP requirement. However, your organization must complete Section A of the Certification
Form and return it to OCR.
9. Pursuant to Department of Justice guidelines (June 18, 2002 Federal Register (Volume 67, Number 117, pages 41455-41472)), under Title VI of the Civil
Rights Act of 1964, it will ensure meaningful access to its programs and.activities by persons with limited English proficiency.
10. It will ensure that any facilities under its ownership, lease or supervision which shall be utilized in the accomplishment of the project are not listed on the
Environmental Protection Agency' (EPA) list of Violating Facilities and that it will notify us if advised by the EPA that a facility to be used in this grant
is under consideration for such listing by the EPA.
11. If the applicant's state has established a review and comment procedure under Executive Order 12372 and has selected this program for review, it has
made this application available for review by the state Single Point of Contact.
12. It will submit all surveys, interview protocols, and other information collections to the COPS Office for submission to the Office of Management and
Budget for clearance under the Paperwork Reduction Act of 1995 if required.
0RI# Standard Application Forms
13. It will comply with the Human Subjects Research Risk Protections requirements of 28 CFR Part 46 if any part of the funded project contains non-exempt
research or statistical activities which involve human subjects and also with 28 CFR Part 22, requiring the safeguarding of individually identifiable
information collected from research participants.
14. Pursuant to Executive Order 13043, it will enforce on-the-job seat belt policies and programs for employees when operating agency -owned, rented or
personally -owned vehicles.
15. It will not use COPS funds to supplant (replace) state, local, or Bureau of Indian Affairs funds that otherwise would be made available for the purposes of
this grant, as applicable.
16. If the awarded grant contains a retention requirement, it will retain the increased officer staffing level and/or the increased officer redeployment level, as
applicable, with state or local funds for a minimum of 12 months following expiration of the grant period.
17. It will not use any federal funding directly or indirectly to influence in any manner a Member of Congress, -a jurisdiction, or -an -official -of any
government, to favor, adopt, or oppose, by vote or otherwise, any legislation, law ratification, policy or appropriation whether before or after the
introduction of any bill, measure, or resolution proposing such legislation, law, ratification, policy or appropriation as set forth in the Anti- Lobby Act, 18
U.S.C. 1913.
18. In the event that a portion of grant reimbursements are seized to pay off delinquent federal debts through the Treasury Offset Program or other debt
collection process, it agrees to increase the non-federal share (or, if the awarded grant does not contain a cost sharing requirement, contribute anon -
federal share) equal to the amount seized in order to fully implement the grant project.
19. None of the funds made available under this award may be distributed to the Association of Community
Organizations for Reform Now (ACORN) or its subsidiaries.
False statements or claims made in connection with COPS grants (including cooperative agreements) may result in fines, imprisonment, disbarment from
participating in federal grants or contracts, and/or any other remedy available by law.
I certify that the assurances provided are true and accurate to the best of my knowledge.
Elections or othef sele tions of new -cials will not relieve the grantee entity of its obligations under this grant.
Signature of Law n Executive/Agency Executive Date
(For your electronic signature, please type in your name)
Signature of Government Executive/Financial Official
(For your electronic signature, please type in your name)
' a.. cx
S 3 - 2,01
Date
Rev. 01 /2012
e08097228
ORI# Standard Application Forms
SECTION 15B: CERTIFICATIONS
Regarding Lobbying; Debarment, Suspension and Other Responsibility Matters; Federal Taxes and Assessments; Drug -Free Workplace
Requirements; and Coordination with Affected Agencies.
Although the Department of Justice has made every effort to simplify the application process, other provisions of federal law require us to seek your agency's
certification regarding certain matters. Applicants should read the regulations cited below and the instructions for certification included in the regulations to
understand the requirements and whether they apply to a particular applicant. Signing this form complies with certification requirements under 28 CFR Part 69,
"New Restrictions on Lobbying," 2 CFR Part 2867, "Nonprocurement Debarment and Suspension," Public Law 111-117 or the most recent applicable
appropriations Act, 28 CFR Part 83, "Government -Wide Requirements for Drug -Free Workplace (Grants)," and the coordination requirements of the Public
Safety Partnership and Community Policing Act of 1994. The certifications shall be treated as a material representation of fact upon which reliance will be
placed when the Department of Justice determines to award the covered grant.
1. Lobbying
As required by Section 1352, Title 31 of the U.S. Code, and implemented at 28 CFR Part 69, for persons entering into a grant or cooperative agreement over
$100,000, as defined at 28 CFR Part 69, the applicant certifies that:
A. No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to
influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress
in connection with the making of any federal grant; the entering into of any cooperative agreement; and the extension, continuation, renewal,
amendment or modification of any federal grant or cooperative agreement;
B. If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or
employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with this
federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL, "Disclosure of Lobbying Activities," in
accordance with its instructions; and
C. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including
subgrams, contracts under grants and cooperative agreements, and subcontracts) and that all sub -recipients shall certify and disclose accordingly.
2. Debarment, Suspension and Other Responsibility Matters (Direct Recipient)
Pursuant to Executive Order 12549, Debarment and Suspension, as implemented at 2 CFR Part 2867, for prospective participants in primary covered
transactions, as defined at 2 CFR Part 2867.20(a), and other requirements, the applicant certifies that it and its principals:
A. Are not presently debaiTed, suspended, proposed for debarment, declared ineligible, sentenced to a denial of federal benefits by a state or federal court,
or voluntarily excluded from covered transactions by any federal department or agency;
B. Have not within a three-year period preceding this application been convicted of a felony criminal violation under any Federal law, or been convicted or
had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or
performing a public (federal, state or local) or private agreement or transaction; violation of federal or state antitrust statutes or commission of
embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion or receiving stolen property, making
false claims, or obstruction of justice, or commission of any offense indicating a lack of business integrity or business honesty that seriously and
directly affects your present responsibility;
C. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state or local) with commission
of any of the offenses enumerated in paragraph (B) of this certification; and
D. Have not within a three-year period preceding this application had one or more public transactions (federal, state or local) terminated for cause or
default.
3. Federal Taxes and Assessments
A. If applicable, an applicant who receives an award in excess of $5,000,000 certifies that, to the best of its knowledge and belief, the applicant has filed all
Federal tax returns required during the three years preceding the certification, has not been convicted of a criminal offense under the Internal Revenue
Code of 1986, and has not, more than 90 days prior to certification, been notified of any unpaid Federal tax assessment for which the liability remains
unsatisfied, unless the assessment is the subject of an installment agreement or offer in compromise that has been approved by the Internal Revenue
Service and is not in default, or the assessment is the subject of a non -frivolous administrative or judicial proceeding.
B. The applicant certifies that it does not have any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies
have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting
the tax liability.
4. Drug -Free Workplace (Grantees Other Than Individuals)
As required by the Drug -Free Workplace Act of 1988, and implemented at 28 CFR Part 83, for grantees/recipients, as defined at 28 CFR Part 83.660 -
A. The applicant certifies that it will, or will continue to, provide a drug-fi-ee workplace by:
(i) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled
substance is prohibited in the grantee's workplace and specifying the actions that will be taken against employees for violation of such
prohibition;
(ii) Establishing an on -going drug -free awareness program to inform employees about -
(a) The dangers of drug abuse in the workplace;
(b) The grantee's policy of maintaining a drug -free workplace;.
(c) Any available drug counseling, rehabilitation and employee assistance programs; and
(d) The penalties that may be imposed upon employees for drug -abuse violations occurring in the workplace;
ORW Standard Application Forms
(iii) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph
(i);
(iv) Notifying the employee in the statement required by paragraph (i) that, as a condition of employment under the grant, the employee will -
(a) Abide by the terms of the statement; and
(b) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five
calendar days after such conviction;
(v) Notifying the agency, in writing, within 10 calendar days after receiving notice under subparagraph (iv)(b) from an employee or otherwise
receiving actual notice of such conviction. Employers of convicted employees -must -provide notice, including position title, to: COPS Office,-145 N---
St, NE, Washington, D.C. 20530. Notice shall include the identification number(s) of each affected grant;
(vi) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (iv)(b), with respect to any employee who is
so convicted -
(a) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the
Rehabilitation Act of 1973, as amended; or
(b) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a
federal, state or local health, law enforcement or other appropriate agency;
(vii) Making a good faith effort to continue to maintain a drug -free workplace through implementation of paragraphs (i), (ii), (iii), (iv), (v), and (vi).
Grantee Agency Name and Address:
B. The grantee may insert in the space provided below the site(s) for the performance of work done in connection with the specific grant:
Place of performance (street address, city, county, state, zip code)
Check ❑ if there are workplaces on file that are not identified here.
5. The Public Safety Partnership and Community Policing Act of 1994 requires applicants to certify that there has been appropriate coordination with all
agencies that may be affected by the applicant's grant proposal if approved. Affected agencies may include, among others, the Office of the United States
Attorney, state or local prosecutors, or correctional agencies. The applicant certifies that there has been appropriate coordination with all affected
agencies.
Where the applicant is unable to certify to any of the statements in this Certifications form, he or she shall attach an explanation to this application
regarding the particular statement that cannot be certified. Please check here ❑ if an explanation is attached to this application. Please note that the
applicant is still required to sign the Certiftcationsform to certify to all the other applicable statements.
Grantee Agency Name and Address:
Grantee IRS/ Vendor Number:
False statements or claims made in connection with COPS grants (including cooperative agreements) may result in fines, imprisonment, disbarment from
participating in federal grants or contracts, and/or any other remedy available by law.
I certify that the assurances provided are true and accurate to the best of my knowledge.
Elections or other selections of officials will not relieve the grantee entity of its obligations under this grant.
Signature of Law En o ecutive/Agency Executive Date
(For your electronic signature, please type in your name)
Signature of Government Executive/Financial Official Date
(For your electronic signature, please type in your name)
Rev. 01/2012
e08097228
ORW Standard Application Forms
SECTION 16: DISCLOSURE OF LOBBYING ACTIVITIES
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal
action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to
make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or
employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial
filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a followup report caused by a material change to the information previously reported,
enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered
Federal action.
4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate
classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the
first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.
5. If the organization filing the report in item 4 checks "Subawardee," then enter the full name, address, city, State and zip code of the prime Federal
recipient. Include Congressional District, if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known.
For example, Department of Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance
(CFDA) number for grants, cooperative agreements, loans, and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number;
Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number
assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan
commitment for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting
entity identified in item 4 to influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name, First Name, and
Middle Initial (MI).
11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB Control Number.
The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is estimated to average 10
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 (0348-0046), Washington, DC 20503.
ORW
Application Forms
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
(See reverse for public burden disclosure.)
1. Type of Federal Action:
2. Status of Federal Action:
3. Report Type:
❑a. contract
❑a. bid/offer/application
� a. initial filing
b. grant
b. initial award
b. material change
c. cooperative agreement
c. post -award
For Material Change Only:
d.loan
year quarter
e. loan guarantee
date of last report _
f. loan insurance
4. Name and Address of Reporting Entity:
5. If Reporting Entity in No.4 is Subawardee, Enter Name -
Prime ❑ Subawardee
and Address of Prime:
Tier , if known:
Congressional District, if known: 4c
Congressional District, if known:
6. Federal Department/Agency:
7. Federal Program Name/Description:
CFDA Number, if applicable:
8. Federal Action Number, if known:
9. Award Amount, if known:
$
10. a. Name and Address of Lobbying Registrant
b. Individuals Performing Services (including address if
(if individual, last name, first name, MI):
different from No. 10a )
(last name, first name, MI):
11Information requested through this form is authorized by title 31 U.S.C. section
.1352. This disclosure of lobbying activities is a material representation of fact
Signature:
upon which reliance was placed by the tier above when this transaction was made
print L i o -e �( �Bi' Name:
or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This
information will be available for public inspection. Any person who fails to file the
required disclosure shall be subject to a civil penalty of not less than $10,000 and
Title: a4rr
Telephone No.: (k99? 5-75-'8330 Date: 2'f !3
not more than $100,000 for each such failure.
Federal Use Only:
Authorized for Local Reproduction
Standard Form LLL (Rev. 7-97)
Approved by OMB
0348-0046
ORI# Standard Application Forms
SECTION 17: REVIEWS AND CERTIFICATIONS
1) Federal Civil Rights and Grant Reviews:
Please be advised that an application may not be funded and, if awarded, a hold may be placed on the award if it is
deemed that the applicant is not in compliance with federal civil rights laws, and/or is not cooperating with an ongoing
federal civil rights investigation, and/or is not cooperating with a Department of Justice grant review or audit.
2) Certification of Review of 28 C.F.R. Part 23/Criminal Intelligence Systems:
Please review the COPS Application Guide: Legal Requirements Section for additional information.
Please check one of the following, as applicable to your agency's intended use of this grant:
[]No, my agency will not use these COPS grant funds (if awarded) to operate an interjurisdictional criminal
intelligence system.
❑ Yes, my agency will use these COPS grant funds (if awarded) to operate an interjurisdictional criminal
intelligence system. By signing below, we assure that our agency will comply with the requirements of 28 C.F.R.
Part 23.
3) Certification of Review and Representation of Compliance with Requirements:
The signatures of the Law Enforcement Executive/Agency Executive, Government Executive/Financial Official, and
the Person Submitting this Application on the Reviews and Certifications represent to the COPS Office that:
a) the signatories have been legally and officially authorized by the appropriate governing body to submit this
application and act on behalf of the grant applicant entity;
b) the applicant will comply with all legal, administrative, and programmatic requirements that govern the
applicant for acceptance and use of federal funds as outlined in the applicable COPS Application Guide, the COPS
Grant Owner's Manual, Assurances, Certifications, and all other applicable program regulations, laws, orders, and
circulars;
c) the applicant understands that false statements or claims made in connection with COPS programs may result in
fines, imprisonment, debarment from participating in federal grants, cooperative agreements, or contracts, and/or
any other remedy available by law to the federal government; AND
d) the information provided in this application, including any amendments, shall be treated as material
representations of fact upon which reliance will be placed when the Department of Justice determines to award the
covered grant.
The signatures of the Law Enforcement Executive/Agency Executive and the Government Executive/Financial Official
on this application must be the same as those identified in Section 4 of this application. Applications with missing,
incomplete, or inaccurate signatories or responses may not be considered for funding.
ORI#
Application Forms
Signature of Law-77 c ent Executive/Agency Executive
(For your electronic signature, please type in your name)
Date
Signature of Government Executive/Financial Official Date
(Foryour electronic signature, please type in your name)
T 0.
Signature of the Person Submitting This Application
(For your electronic signature, please type in your name)
Date
By clicking this box, ❑ the applicant understands that the use of typed names in this grant application and the required
grant forms, including the Assurances and Certifications, constitute electronic signatures and that the electronic
signatures are the legal equivalent of handwritten signatures.
0RI# Standard Application Forms
SECTION 18: APPLICATION DATA VERIFICATION
By signing below, I certify that I have read, understand and agree to the following:
a) my agency has been requested by the COPS Office to review, confirm and/or update specific data items that
were previously submitted in our COPS application and our failure to respond to the request may eliminate
our application from 2013 funding consideration;
b) my agency has reviewed, confirmed and/or updated the specific data items identified by the COPS Office,
and certify that the information is true and accurate; - - - -
c) I am authorized by the appropriate governing body to act on behalf of the grant applicant entity to make
changes to our COPS application which will be considered for 2013 funding;
d) the information provided in this application, including any amendments, shall be treated as material
representations of fact upon which reliance will be placed when the Department of Justice determines to
award the covered grant; and
e) the applicant understands that false statements or claims made in connection with COPS programs may
result in fines, imprisonment, debarment from participating in federal grants, cooperative agreements, or
contracts, and/or any other remedy available by law to the federal government.
VC
Signature of the Person Completing this Form Date Completed
(For your electronic signature, please type in your name)
ELECTRONIC SIGNATURE: By clicking this box 0, I understand that typing in my name on this form constitutes
an electronic signature and that the electronic signature is the legal equivalent of a handwritten signature.
In order for your agency to be considered for COPS grant funding, all application updates must be submitted through
the COPS website (www.co s.usdoi.gov) by «f nter Date>>. For technical assistance with submitting your updates or
to withdraw your agency's application from funding consideration, please call the COPS Office Response Center at
800-421-6770.