HomeMy WebLinkAboutResolution - 233 - Grant Application - CSA - Summer Youth Recreation Program - 08/09/1979..�. II LGB:cl RESO 46233 - 8/9/79
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RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock BE and is hereby authorized and
directed to execute for and on behalf of the City of Lubbock a grant application
and related documents for a Summer Youth Recreation Program, attached herewith
which shall be spread upon the minutes of the Council and as spread upon the
minutes of this Council shall constitute and be a part of this Resolution as if
fully copied herein in detail.
Passed by the City Council this 9th day of August ,1979.
DI WEST, MAYOR
ATTEST:
":Evelyn Gaffga, ity Se ear reasurer
APPROVED AS TO CONTENT:
Lawrence Banks,'Community Facilities Asst.
APPROVED AS TO FORM:
Leon G. Bean, Assistant City Attorney
r FEDERAL ASSISTANCE
Z APPLI-
CANrs
APPLI-
1. TYPE ❑ PREAPPUCATiON
OF
ACTION ® APPUCATION
CATION
Leaoe
(Mark ap. ❑ NOTIFICATION OF INTENT (Opti
❑ REPORT OF FEDERAL ACTION
Junk
4. LEGAL APPLICANT/RECIPIENT
TIED TO RESO #233 - 8/9/79
OMB Approval No. 29-RO218
a. NUMBER 3, STATE
APPLICA-
TION
b. DATEIDENTh_
. w Yoar %1tA day FIER
a. NUMBER
b. DATE Year mouth day
ASSIGNED 19
5. FEDERAL EMPLOYER IDENTIFICATION NO.
23. a. TYPED NAME AND TIT" 11. SIGNATURE
CERTIFYING
REPRE- Di rk .West, Mayor
SENTATIVE
24. AGENCY: NAME
26. ORGANIZATIONAL UNIT 27. ADMINISTRATIVE OFFICE
21.'ACTION.TAKEN ZZ: FUNDING
a. DATE SIGNED
Year month day
19
2S. APPLICA- Year month day
TION
RECEIVED 19
28. FEDERAL APPLICATION
IDENTIFICATION
30. FEDERAL GRANT
IDENTIFICATION
Year month day 34. 1. Year month day
STARTING
r .
a. Applicant Name City of Lubbock -
7,000
_.
b. Organization Unit _ e Parks and Recreation Department
6
OF:
15. TYPE OF CHANGE (For zte or 2te)
C. StreM/P.O.`lax : P.O. Box 2000
PRO-
a. NUMBER 41 91a, 10'' 1151
AD
d. CityLubbock a. County Lubbock
GRAM
b. TITLE .
„
L stat. Texas g. ZIP cede: 79457
Feral
SYRP
ENDING
b. Contac Person (Nass
& John Alford 806/762-6411 ext. 2660
Catalog)
b. APPLICANT .00
r
telephone No.)
D -Decrease Duration
7. TITLE AND DESCRIPTION OF APPLICANTS PROJECT
8. TYPE OF APPLICANT/RECIPIENT
t
16. PROJECT START
A -State H -Community Action Agency
iJ
DATE Yearday
B -Interstate I- Higher Educational Institution
Enter 6P;-
Summer Youth Recreation Program for disadvantaged
C-Substate J- Indian Tribe
District K -Other (Specify):
.00
youth 8-13 years of age:
nly
City
'f Months
prate icor;(.)
F -School Distrix
t- =
a. OTHER .00
G�peeial Purpose
'et
Year month day
FAXMPPrO4V0 d
D Enter appropriate letter ❑
E
FEDERAL AGENCTYO►
P. TYPE OF ASSISTANCE
3&
A41a3ie Grant D. -Insurance
b. FEDERAL AGENCY M95 OFFICIAL
20. FEDERAL AGENCY TO RECEIVE REQUEST (Name, City. State. ZIP aode)
B -Supplemental Grant E -Other Ester appro-
21. REMARKS ADDED
sidered. If agency response is due
C-Loan priate letter(.)
(Name and tdephone mo.)
10. AREA OF PROJECT IMPACT (Names of cities, counties.
11. ESTIMATED NUM.
12. TYPE OF APPLICATION
22.
States, ate.)
BER OF PERSONS
A -New C -Revision E -Augmentation
a
A--95 ACTION
BENEFITING
I:ct:e:u therein, to appropriate clearinghouses and all responses are attached: spouse
23. a. TYPED NAME AND TIT" 11. SIGNATURE
CERTIFYING
REPRE- Di rk .West, Mayor
SENTATIVE
24. AGENCY: NAME
26. ORGANIZATIONAL UNIT 27. ADMINISTRATIVE OFFICE
21.'ACTION.TAKEN ZZ: FUNDING
a. DATE SIGNED
Year month day
19
2S. APPLICA- Year month day
TION
RECEIVED 19
28. FEDERAL APPLICATION
IDENTIFICATION
30. FEDERAL GRANT
IDENTIFICATION
Year month day 34. 1. Year month day
STARTING
r .
City of Lubbock
7,000
B -Renewal D-Conuouauon Enter appropriate letter
33. ACTION DATE ►
13. PROPOSED FUNDING 14. CONGRESSIONAL DISTRICTS
OF:
15. TYPE OF CHANGE (For zte or 2te)
b. REJECTED
A -Increase Dollars F Other (Specify) :
B -Decrease Dollars
AD
a. FEDERAL S .00
a. APPLICANT
b. PROTECT
„
19th
19th
C -Increase Duration
ENDING
...._._
b. APPLICANT .00
a. RETURNED FOR
a. STATE -
D -Decrease Duration
E -Cancellation
�--
a STATE .00
16. PROJECT START
17. PROJECT
AD
DATE Yearday
DURtTION
Enter 6P;-
1 _
e ' OTHER
.00
d. LOCAL 00
19 1
'f Months
prate icor;(.)
t- =
a. OTHER .00
18. ESTIMATED DATE TO
Year month day
19. EXISTING FEDERAL IDENTIFICATION NUMBER
FEDERAL AGENCTYO►
1979 8 15
3&
C TOTAL S 29,995 .00
b. FEDERAL AGENCY M95 OFFICIAL
20. FEDERAL AGENCY TO RECEIVE REQUEST (Name, City. State. ZIP aode)
21. REMARKS ADDED
sidered. If agency response is due
Communit Services Administration Dallas,'Texas
(Name and tdephone mo.)
0 Yes (3 No
=
22.
a. To the best of my knowledge and belie(,
b. If tegnirad by OMB Circular A-95 this application was submitted, pursuant to in- Nora-
J2eaponee
a
A--95 ACTION
data In this prapptiation/application aro
I:ct:e:u therein, to appropriate clearinghouses and all responses are attached: spouse
auaehed
-
+
true and correct, the document has been
_
STANDARD FORM 424 PAGE 1 (10-75)
„y........
t
PTHE
APPLICANT
duly authorized by the governing body of
(u South
Plains Association of Governments ❑
11
CERTIFIES
THAT ►
the applicant and the applicant will comply
with the attached assurances U the auist-
❑
❑
anca is approved.
n
r'j
23. a. TYPED NAME AND TIT" 11. SIGNATURE
CERTIFYING
REPRE- Di rk .West, Mayor
SENTATIVE
24. AGENCY: NAME
26. ORGANIZATIONAL UNIT 27. ADMINISTRATIVE OFFICE
21.'ACTION.TAKEN ZZ: FUNDING
a. DATE SIGNED
Year month day
19
2S. APPLICA- Year month day
TION
RECEIVED 19
28. FEDERAL APPLICATION
IDENTIFICATION
30. FEDERAL GRANT
IDENTIFICATION
Year month day 34. 1. Year month day
STARTING
r .
D AWARDED
a. FEDERAL S
.00
33. ACTION DATE ►
19
DATE 19
b. REJECTED
b. APPLICANT
AD
35. CONTACT FOR ADDITIONAL
1NFORMA-
36. Year mrontA day
„
0
TION (Name and telephone number)
ENDING
...._._
a. RETURNED FOR
a. STATE -
.00
DATE 19
�--
C
AMENDMENT
Q, IOGFL _
AD
37. REMARKS ADDED
1 _
e ' OTHER
.00
i] d. DEFERRED
t- =
f. ` MALS t
- .00Yes
0 a. WITHDRAWN
0No
3&
a. in taking above action, our comments received frorrr clearinghouses were con-
b. FEDERAL AGENCY M95 OFFICIAL
sidered. If agency response is due
ander provisions of Part 1, OMB Circular A45,
(Name and tdephone mo.)
FEDERAL AGENCY
N has been or It being made.
A--95 ACTION
-
-
+
STANDARD FORM 424 PAGE 1 (10-75)
„y........
t
_ _ .. _
_ ..... ....
PreaersW by GSA. Federal J(famagamerst Circular 74-7
i
t SECT M W4tEMARKS (Please reference the proper item number from Sections 1,11 or Ill, if appiicablo)
Form Approved
to �.
Ew
t
FOR USE WITH MULTIPLE PROGRAMS ONLY (As a breakout of Items 6, 23 and 32)
6. PROGRAM PROGRAM PROGRAM PROGRAM TOTAL. _
a. Cat. No. k:`'' ? »' °:N>;a _
w
b. Prop. Title"
(Abbreviate)
Prop. Aeet.No.
13. PROPOSED FUNDING
a. Federal S .00 S .00 S .00 S .00 $ .00 _
b. Applicant .00 .00 .00 .00 .00
c. State .00 .00 .00 .00 .00
d. Local .00 .00 .00 .00 .00
e. Other .00 .00 .00 .00 .00
f. TOTAL !$ .00 Is .001S .001S .00 Is .00
32, FUNDING
i. Federal S .00 S .00 S .00 $ .00 S .00
b. Applicant .00 .00 .00 .00 .00
c. State .00 .00 .00 .00 .00
d. Local .00 .00 .00 .00 .00
e. Other .00 .00 .00 .00 .00
f. TOTAL !$ OOT$ .08 S .00 -Ti- -001s .00
NOTE: Place an asterisk (') next to Program Account No. if project is not subject to A-95.
STANDARD FORM 424 PAGE 2 (10775)
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Consumable Supplies
$2,000.00 Class Supplies - records, rhythm band equipment, cooking utensils
and food supplies, batons, archery supplies,
puppets and puppet -making materials, life jackets
pilo -polo sets, backgammon, craft supplies (glue,
crayons, felt, scissors, yarn, paints, brushes,
felt, popscicle sticks)
$2,000.00 Special -Event
Supplies - decorations (ballons, crepe paper, construction
paper, glitter), game supplies (bean bags, jump -
ropes, flannel boards, whistles, air pumps, fris-
bees, slip 'n' slides, hula hoops, marbles, hip -
pity hops, carroms, yo yos, stop watches, cones),
awards (ribbons, tropheys, rosetts, certificates)
and refreshment supplies (popcorn, watermelon, _
cookies, kool aide, paper cups, ice, candy)
$2,400.00 Athletic :.
Supplies - playground balls, volleyballs, volleyball nets,
volleyball standards, softballs, bases, bats, bat
ting helmets, catchers masks, gloves, footballs, -
flag football belts, table tennis bats, table -
tennis balls, table -tennis nets, equipment bags.
$1,500.00 Free Play -Table -.
Game Supplies -Chess sets, checkers, dominoes, playing cards, be
hockey, sockey, pool sticks and stick -maintenance
materials, pool balls, racks, foosballs
$1,000.00 General
Equipment - first-aidkits, registration supplies, art pane'
records players, Show and.Tells, poster board,
marks -a -lot, safety pins.
Rental Lease, Purchase of Equipment
$2,000.00Rental of the following: Buses to transport children to athletic
and talent competition, rental sound -and -lighting equipment for
dances and parties, rental of films and props, costumes, and
D.J.'s for Special Events.
$1,100.00 Other Costs - Schedule fliers to inform children of.activities, f:
and film processing, invitations. - $600.00.
_ Auditing.Fees $500.00
OFFICE OF ECONOMIC OPPORTUNITY
Community Action Program
Assurance of Compliance with the Office of
Economic Opportunity's Regulations under
Title VI of the Civil Rights Act of 1864
City of Lubbock Parks and Recreation
(hereinafter called the "Applicant")
(Name of Applicant or Delegate Agency)
AGREES THAT it will comply with title VI of the Civil Rights Act of 1964 (P.L. 88-352) and the Regulations
of the Office of Economic Opportunity issued pursuant to that title (45 C.F.R. Part 1010), to the end that nc)
person in the United States shall, on the ground of race, color, or national origin,,be excluded from partici-
pation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity
for which the Applicant receives Federal financial assistance either directly or indirectly from the Office of
Economic Opportunity; and HEREBY GIVES ASSURANCE THAT it will immediately, in all phases and levels
of programs and activities, install an affirmative action program to achieve equal opportunities for partici-
pation, with provisions for effective periodic self-evaluation.
In the case where the Federal financial assistance is to provide or improve or is in the form of personal
property, or real property or interest therein or structures thereon, the assurance shall obligate the Applicant,
or, in the case of a subsequent transfer, the transferee, for the period during which the property is used for a
purpose for which the Federal financial assistance is extended or for another purpose involving the provision
of similar services and benefits, or for as long as the Applicant retains ownership or possession of the prop-
erty, whichever is longer. In all other cases, this assurance shall obligate the Applicant for the period dur-
ing which the Federal financial assistance is extended to it. -
THIS .ASSURANCE is given in consideration of and for the purpose of obtaining either directly or indirectly
any and all Federal grants, loans, contracts, property, or discounts, the referral or assignment of VISTA
volunteers, or other Federal financial assistance extended after the date hereof to the Applicant by the
Office of Economic Opportunity, including installment payments after such data on account of applications
for Federal financial assistance which were approved before such date. The Applicant recognizes and agrees
that such Federal financial assistance will be extended in reliance on the representations and agreements
made in this assurance, and that the United States shall have the right to seek judicial enforcement of this
assurance. This assurance is binding on the Applicant, its successors, transferees, and assignees, and the
person or persons whose signatures appear below are authorized to sign this assurance on behalf of the
Applicant.
8/9/79
Date City of Lubbock Parks and Recreation
(Name of Applicant or Delegate Agency)
By , Mayor
(President, Chairman of Board, or comparable
w authorized official)
P.O. _Box 2000
For
APpro .
tib'
Lubbock, Texas 79457
4"
(Mailing Address)
CAP FORM 11 (REV.. JUN 69) PREVIOUS EDITIONS ARE OBSOLETE. U.& 6"CONN[NT►MNT/NG OT/K!: 19400 -7f4 -baa
907.408
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' OFFICE OF ECONOMIC OPPORTUNITY - COMMUNITY ACTION PROGRAM Form Approved.
Budget Bureau No. 126-ROISO
ORGANIZATION NO.
DELEGATE AGENCY BASIC INFORMATION
DATE PREPARED
8-2-79
SECTION I. IDENTIFICATION OF COMMUNITY ACTION AGENCY
1. NAME OF GAA T. GRANT NO.
City of Lubbock Community Services Department
SECTION It. IDENTIFICATION OF DELEGATE AGENCY
3. NAME OF DELEGATE AGENCY
City of Lubbock Parks and Recreation Department
s MAILING ADDRESS _
NO. AND STREET CITY COUNTY T
TATE ZIP CODE
P.O. Box 2000Lubbock Lubbock Texas79457
S. TELEPHONE NO. (include Area Code) S. IRS EMPLOYER IDENTIFICATION NO.
806/762-6411 ext. 2660 1-75-6000590-6
SECTION III. TYPE OF AGENCY
7. ® PUBLIC AGENCY:
c. GOVERNMENT: O STATE (:]COUNTY ® CITY 0 TERRITORY Q TRIBAL COUNCIL
O OTHER (Identify)
b. PUBLIC AGENCY: O INSTITUTION OF HIGHER EDUCATION EMPI.OYMENT ELEMENTARY OR SECONDARY
SCHOOL
O NEALTH O WELFARE [D OTHER (Identify)
e. O PRIVATE NONPROFIT ORGANIZATION:
Q INSTITUTION OF NIGHER EDUCATION RELIGIOUS ORGANIZATION O ELEMENTARY OR SECONDARY SCHOOL
Q LEGAL SOCIETY O HEALTH O WELFARE Q EMPLOYMENT O NEIGHBORHOOD BASED ORGANIZATION
�__.....
MOTHER (Identify)
-
SECTION IV. PROGRAM ADMINISTRATION
g. PROGRAM DIRECTOR
-
a. NAME
-
Tn'hn A1fnrA, Parka anA RArrp inn Directnr
b. ATTACH A STATEMENT OF THE JOB QUALIFICATIONS, THE JOB DESCRIPTION AND A BIOGRAPHICAL RESUME FOR THE
PROGRAM DIRECTOR
=====
-
10. WHAT PROGRAM ACCOUNTS WILL THE DELEGATE AGENCY ADMINISTER?
SYRP
SECTION! V. SUMMARY EVALUATION OF DELEGATE AGENCY (To be completed by the CAA)
r^rw
11. IS THIS A NEW DELEGATE AGENCY OF THE CAA)
[:]YES _O NO
V. DESCRIBE HOW THE CAA WILL MAKE SURE THAT THE DELEGATE AGENCY COMPLIES WITH OEO AND CAA POLICIES AND
FULFILLS THE WORK PROGRAM OBJECTIVES.
13. IF THE DELEGATE AGENCY HAS PREVIOUSLY OPERATED CAA PROGRAMS. PROVIDE A BRIEF EVALUATION OF ITS
_
PERFORMANCE TO DATE. IF NOT, DESCRIBE ITS QUALIFICATIONS TO OPERATE THE DELEGATED PROGRAM.
CAP FORM ST AUG 68 GPO •61.380
M
3
Agreement for Delegation of Activities
Under Grant No.---
This agreement entered into as of AI&R t 2 changes, including any increase or decrease in the
19. 79., including all attachments and conditions amount of the Delegate's compensation, which
annexed hereto (which are expressly made part are mutually agreed upon by and between the
hereof), shall govern certain activities,. -of the Grantee and the Delegate, must be incorporated
Summer Y.auth 1Zecreation Program
, - _ , . , , in written amendments to this contract.
(name of . program account for the delegated 16. COMPLIANCE WITH LOCAL LAWS. The
activities) financed under Grant No....:::..... Delegate shall comply with all applicable laws,
during the period . 6-1779, , _ , to 9-30-79.... ordinances, and codes of the state and local gov-
which are to be carried out by .City. Pf ....... ernments.
LubI#!gk . Paz)cs grit) ..IRt r -AA -A A94. .. . , ...... 6. COVENANT AGAINST CONTINGENT
(name of delegate agency), hereinafter referred FEES. The Delegate warrants that no person or
to as the "Delegate", on behalf of City. of ., , ; ; selling agency or other organization has been em -
Lubbock
. .....:.. . . .. .. . ... . . . . . . _ . , , , , , ployed or retained to solicit or secure this contract
(name of grantee), hereinafter referred to as the upon an agreement or understanding for a com-
"Grantee." . _ 1 11- mission, percentage, brokerage, or contingent fee.
The Grantee and Delegate agree as follows: For breach or violation of this warrant the
1. WORK TO . BE PERFORMED. The Delegate Grantee shall have the right to annul this contract
shall, in a satisfactory manner as determined by without liability or, in its discretion, to deduct
the Grantee, perform all activities in Attachment from the contract or otherwise recover the full
amount of such commission, percentage, broker -
2. COMPLIANCE WITH APPROVED PRO- age, or contingent fee, or to seek such other
GRAM. All activities authorized by this agree- remedies as legally may be available.
ment will be performed in accordance with the 7. SCHEDULE OF PAYMENT. Subject to re-
approved work program, the approved budget, ceipt of funds from OEO, the Grantee agrees to
the grant conditions and relevant OEO directives. reimburse the Delegate for authorized expendi-
3. REPORTS, RECORDS & EVALUATIONS. tures. An advance of $......... for estimated
The Grantee shall supervise, evaluate, and pro- expenditures for ......... (months) will be
vide guidance and direction to the Delegate in the made to the Delegate, who will submit to the
conduct of activities delegated under this con- Grantee vouchers that are sufficient to support
tract. The Delegate agrees to submit to the payment under the Grantee's accounting proce-
Grantee such reports as may be required by OEO dures established or approved by the Grantee's
directives or by the Grantee, including the re- accountant. Within ......... days the Grantee
ports listed in Attachment 'B" according to the will approve or disapprove payment of the vouch -
schedule there set out. ers, and will make additional payments equal to
The Delegate also agrees to prepare and retain, the amount of such approved expenditures to the
and permit the Grantee to inspecct as it deems Delegate. In no event, however, will the Delegate
necessary for grant purposes (in addition to in- receive reimbursement for personnel costs ex-
spections authorized by the conditions in the. grant ceeding $ .......... or for non -personnel costs
from OEO) the records listed in Attachment "C", exceeding $ .......... except as it has received
as well as all other records that may be required prior written authorization from the Grantee,
by relevant OEO directives, with the exception which is incorporated into and shall be attached
of confidential client information: The Delegate to this contract.
further agrees that the -Grantee may carry out 8. TERMINATION. The Grantee may, by giv-
monitoring and evaluation -activities to include, ing reasonable written notice specifying the ef-
at a minimum, 'those .listed in Attachment I'D",-- fective date, terminate this contract in whole or
and will effectively ensure the cooperationof the in part for cause, which shall include: (1) failure,
Delegate's employees and board members"in such for any reason, of the Delegate to fulfill in a
efforts. timely and proper manner its obligations under
4. CHANGES. The Grantee may, from .time to this contract,- including compliance with the ap-
time, request changes in the scope of the services - proved program and attached conditions, with
of the Delegate to be performed hereunder. Such statutes and Executive Orders, and with such
OEO FORM 280 AUG 70
.... - -------- - - ..
I
OEO directives as may become generally appli- reimbursed expenses reasonably and necessarily
cable at any time; (2) submission by the Dele- incurred in satisfactory performance of the con-
gate to OEO or to the Grantee of reports that are tract. Notwithstanding the above, the Delegate
incorrect or incomplete in any material respect; shall not be relieved of liability to the Grantee
(3) ineffective or improper use of funds provided for damages sustained by the Grantee by virtue
.........
under this contract; and (4) suspension or ter- of anybreach of the contract by the Delegate
mination by OEO of the grant to the Grantee and the Grantee may withhold any reimburse-
under which this contract is made, or the portion ment to the Delegate for the purpose of set-off
thereof delegated by. this contract.. The Grantee until such time as the exact amount'of damages - -
may also assign and transfer . this contract to due the Grantee from the Delegate is agreed upon _
another grantee when required 'to do so by OEO or otherwise determined: '
direction. 9. NON-FEDERAL SHARE. The Delegate
If the Delegate is unable or unwilling to'com- will contribute $. 17a,995. to the program funds.
ply with such additional conditions 'as may, be Such contribution shall be in cash in the amount
lawfully applied by OEO to the grant to the of $.Kone, , , and in-kind in the amount of --=
Grantee, the Delegate shall terminate the contract (If none, state "none.")
by giving reasonable written notice to the Grantee, 10. REVIEW OF NEW DIRECTIVES. -The===-
signifying the effective date:- thereof., In such Grantee will submit promptly to the Delegate for -_
event the grantee may require the delegate to comment those proposed additional directives
ensure that adequate arrangements have been that it receives from OEO for comment. -
made for the transfer .of the delegated activities In witness whereof, the Grantee and the Dele- _
to another Delegate or to the-Grantee.., gate have executed this agreement as of the date
In the event -of any termination, all property first. above written.--=
and finished or unfinished- documents, data, Parks and Recreation'---
studies, and reports purchased or prepared by ' ' '
the Delegate under this contract shall be disposed Delegate • .. .. • • • • Grantee
of according to OEO directives, and the ,Delegate By: ..............By :................."
shall be entitled to compensation for any un- Position: Position: -
Parks and Recreation_ Mayor.
.December 1968. _
Director
form Approved
TT,t r
.. L�a.f" ..a 1'.
GPO 698.062 -�'-»
--, ,,'APPLICANT CERTIFICATION'S
(Far select, -d programs under Section 222. Research and
Pilot Programs under Section 232 and Community Eco-
aoV7Development Grants under Title V11 of the Com..
mtanity Services Act.)
1. TYPE OF i PPLICATION
ONEw t-...JCONTINUATION OF
GRANT NO -
2. NAME OF CSA PROJECT MANAGER
FOR CSA USE ONLY
ORGANIZATION I DATE RECEIVED.
NO.
SECTION 1. FORMER COMMUNITY SERVICES ADMINISTRATION EMPLOYEES
(CAec4 "Yes"below if the answer to ony of these questions is positive.)
1. Does any person who was employed by GSA within the last 12 months (whether as a regular or part-eime employee or consultane)servr as
chief executive officer of, or serve an the governing board of, or have any financial interest in: (a) the applicant agency; (b) an agency to
which the applicant will delegate the adminivtration of any part of the program; a (e) a pro.pective contractor or subcontractor who will have
a contract for $25.000 cc -carr?
2. Docs any such person serve in any executive capacity, in a position paying more than (18,000 per year'. for any of the above
agencies?
j. Is any such person expected to work -on the program which is to be supported by the grant?
3. Has any such person participated, or will any such person participate, in the preparation of this application or in communica-
tions with CSA concerning the requested grant?
YES ONO (if -Yrs-. attach a listing of the names of any CSA employers involved. their positions with CSA .
and the relationships with the applicant.)
SECTION 11. CERTIFICATION OF COMPENSATION COMPARABILITY
The salaries and fringe benefits of all employees of this applicant which arc supported by CSA funds, or are counted as contri-
bution to the non -Federal .hart: under a grant made by CSA have been reviewed according to CSA instructions and comparability
has been established'. '
Documentation of the methods by which the applicant established comparability is available in applicant's files for review by
persons authorized by CSA and personnel of the General Accounting Office.
Any amendment is the future to the CSX approved salary schedule resulting in a general raise in salaries or any change or in- j
crease in fringe benefits for all employees shall be based on a current determination of compensation comparability.
SECTION 1% TITLE V1 OF THE LIYIL RIGHTS ACT
The applicant AGRFES cont it will comply wick Title VI of the Civil Rights Act of 19(•1 (P.L. RR -1521 and the Regulations of the
Community Strvicea Aernit.isaLtica issued pursutnt to that title (45 C.F.R. Part.1010). to the end that no person in the United States
shall, on the ground o. race, colo.. or r+t:ionel origin, be excluded from participation in. be denied the benefits of, or be othrrwise
sub+eered to diseriminption upde:-sty pregran or activity for which the Applicant receives Federal financial assistance either
directly or indirectly from the Cerrarm:if Services Administration; and HERESY GIVES ASSURANCE THAT it will immediately. in
all phases and levels of programs and activities, install an affirmative action program to achieve equal opportunities for partici-
pation, with provisions for effective ,periodic self-evaluation. :
In the case where the Federal fin>;aCial assistance is to provide or improve or is in the form of personal property. or real property
or interest thercia or structures thereon, this assurance shall obligate the Applicant, or. in the case of a subsequent transfer, the
transferee, for the.period durin; which the property is used for a purpose for which the Federal financial assistance is exten'ied
or for another purpose-involvir_I the provision of similar services and benefits, or for as long as the Applicant retains ownernhtp
or possession of the prorierty, whichever is !onger. In all other cases, this assurance shall obligate the Applicant for the period
during which the f=ederal financial assistance is extended to it.
THIS ASSURANCE is given in consideration of and for the purpose of obtaining either directly or indirectly any and all Federal
grants, loans, contracts, property, or discounts, or rather Federal financial assistance extended after the date hereof to the appli-
Cantby the Community Services Administration, including installment payments after such date on account of applications for
Federal financial assistance -which were approved rbefore such date. The Applicant recognizes and agrees that such Federal
financial assistance will be extended in reliance on the representations and agreements made in this assurance. and that the
United States shall have the right to seek, judicial enforcement of this assurance. This assurance is binding on the Applicant.
its sudeessorr<. transferees, and assignees, and the person or persons whore signatures appear below are authorized to saga
this. -assurance on behalf of the Applicant" Y'
SECTION IV. __ . __ : MAINTENANCE OF EFFORT
(applicable to pants atade ander Secsions 322. 712 and 747 of the Community Services acct of 1474.)
Funds or other. resources devoted to programs -or activities designed to meet the needs of the poor within the Community will not be _
diminished in order to provide non -Federal share contributions for the Grantee.
With respect to -each program account in this funding request-.
(I) The amounts claimed as non -Federal share represent a net increase over expenditures from non -Federal -sources made for _
similar activities during the twelve months prior to initial application to CSA for the program account. _
(2) The program account services will be in addition to, not in substitution for. services previously provided without
.........
-Community Services Act assistance. -
CSAFORM301 IREV.MAV sat
,,.t.FQRMERLY oeo-rowr. 301.CAVED NOV 71. - - (COMTJA'G'ED ON REVERSE) ----=
_. ... rrrwtttCM .tt V4ua 4 si.> _ '_••---
_.
. . .............
SECTION
CERTIFICATION
V-.. ............
The srplicant agency agrees that any funds received as a result of this application will be expended in accordance with the terms
of the great and in accordance with regulations of the Community Services Administ.rat;CC6
The undersigned CERTIFIES that he is authorized to supehit this application an behalf of the applicant agency. and to make the
commitments contained in it.
140TE: If the applicant agency is recognized by CSA as a Community Action Agency under Title 11 of the Community
rerviccs Act. of is seeking fundx under Title VII of the Act, this application must be signed by the Chairman of its
governing board or. it a Community Action Agency is a political jurisdiction, by the principal governing official of
the juris6clion, in other cases, the npplication should ntwmally be signed by the chief executive officer of the
agency. Other signatures will be accepted
epted only if evidence of their authority to Commit the applicant is submitted
to CSA. 7
TYPED NAME ANO TITLE SIGNATURE GATE
Dirk West, Mayor 8/9/79
TYPEO NAME OF BOARD C14AIRMAN OR COMPARABLE OFFICIAL (If 9611trORS YrOm mato' 0"
Form Approved
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