HomeMy WebLinkAboutResolution - 4505 - Grant Application - DHHS, PHS -HIV Early Intervention Services - 05_26_1994Resolution No. 4505
May 26, 1994
Item #18
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 an application and associated documents for
grant funding under the Categorical Grant Program to provide outpatient early intervention
services with respect to HIV Disease, attached herewith, by and between the City of Lubbock
and the U. S. Public Health Service Department of Health and Human Resources, which
application 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
ATTEST: J :
etty . Johnson, ty Secretary
APPROVED AS TO CONTENT:
01 WORK
�• ••.th Director
APPROVED AS TO FORM:
G. Vandivr, First Assistant City Attorney
DGV:da1ccdocvU1VDIS.rcs
May 16, 1994
OMS Approvat No. 034-W43
APPLICATION FOR
E, "TT SUSIKMD
Applicant Identifier
FEDERAL ASSISTANCE
6/01 /94
1. TYPE OF &UBMISs)ON:
S. DATE RECEIVED BY STATE
State Application Identifier
Application Prvapplksoon
❑ Construction ❑ Construction
4. DATE RECEIVED SY FEDERAL AGENCY
Federal Identifier
Non -Construction ❑ Non -Construction
t APPLICANT WFORMATaN
Legal Name.
Organizational Unit:
City of Lubbock
Health Department
Address (Dive city, county, state, and rip code).
Name and telephone number of the person to be contacted on matter$ involving
this application (g" an;& code)
P.O. Box 2548
Mary Strange (806) 767-2899
Lubbock, TX 79408
Nancy Haney (806) 767-2950
a. EMPLOYER IDENTIFICATION NUMBER (EINr
F. TYPE Of APPLICANT: (enter appropriate letter in pox) 13
0. State N. Independent School Dist.
7 5 6 0 0� 0 5 9 0
S. County 1. State Controlled IrWitution of Higher Learning
C. Municipal J. Private IkMversity
4 TYPE ��
D. Township K. Indian Tribe
® New ❑ Corilinuation ❑ Revision
E. Intenta% L. Individual
F. Intermunicipal M Profit Organization
If Revision, enter appropriate letter(:) in box(es): ❑ ❑
0. Special District N. other (Specify)
A. Increase Award S. Decrease Award C. Increase Duration
0. Decrease Duration Other (specify):
a. NAME Of FEDERAL AGENCY:
DHHS — Public Health Service
It CAATaATONuiteAL OWESTIC 9 3 • 1
I1. DESCRIMM TITLE OF APPLICANT'S PROJECT:
Categorical Grant Program to Provid
La Clinica de Buena Salud
Outpatient Early Intervention Services witl
Early Intervention Services for
HIV —Infected Individuals
4 FE D WAOR! states, •a:.k
Lubbock County
is. PROPOSED PROJECT:
14. CONGRESSIONAL DISTRICTS OF:
Start Date
Ending Date
a. Applicant : b. Prolect
10/1/94
9/30/95
19
is. ESTIMATED FUNOINO:
is. IS APPUCATtOk SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS?
I. YES. THIS PREAPPLICATMIAPPLICATION WAS MADE AVAILABLE TO THE
a Federal
= 40
107,535
STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON
DATE 6/ 1/ 94
b. Applicant
i O m
c- State
= .OD
0
b NO. ❑ PROGRAM IS NOT COVERED BY E O. 12372
d.local
i A0
OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW
a Other
= 0g
0
f. Program Income
= .00
17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DCST7
0
❑ Yes R -Yes.- attach on txplanstion. ❑ No
q TOTAL
>j fl0
107 535
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF. ALL DATA IN rMS APPLICATIO"REAPPLICATION ARE TRUE AND CORRECT, THE DOCUMENT HAS BEEN DULY
AUTH
2!jMD4Xj,ME GOVERNING BODY OF THE APPLICANT AMC THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSMTANCE 13 AWARDED
Typed Name 01 zed Repr sentat"
b Title
c Telephone number
D id Lan s
Mayor
767-2000
d Sig r• I A ad �e a rve
a Date Signed
T'o�
05/26/94
PrevioukUditmifNct Usable 11% tarWar
arm 4 4 OREV 4-98)
`t7 v Prescnbed by 01A8 L,m..ra, A.102
OMS Approval No. 0348-M"
BUDGET INFORMATION — Non -Construction Programs
SECTION A - BUDGET SUMMARY
Grant Program
Catalog of Federal
Estimated Unobligated Funds
Now or Revised Budget
fw+etiorl
Domestic Asshtante
a ActMt)►
(a)
Numbs
(b)
federal
Non-federal
Federal
Mom -Federal
Total
(c)
(d)
(e)
(f)
(g)
Services w
"Respect
S
$
to HIV
93-918
107,535
2.
3.
4.
S. TOTALS
s
S
S 107,535
S
S 107,535
SECTOR B - BUDGET CATEGORIES
6 Owd Chit caftoorlls
*RAW PWMRAM MH$CnCW4 OR AC nVM
Total
(1) pRq
(2)
(3)
(4)
S
a. farsonme(
S -o-
S
S
S
S -{}-
b. Fringa Benefits
-�
-0-
t. Travel
1,000
d. Equipment
-o-
-0-
a. Supplies
3,000
f. Contractual - Patient Care
98,535
98,535
g. Conmuetion
-o-
-0-
h. Omer
5,000
5,000
L Total Direct Charges (sun+ of 6a - 6h)
107,535
1 Indirect Charges
It. TOTALS (sum of 6i and 61)
$
S
S
S
S
107,535
107,535
i ►rogram� Imcon+e
S
S
S
S 700
S 700
5I&MIwd Fam 424A 14.88)
SECTION t -NON-FEDERAL RESOURCES
a On�M
b A leans
c Slar
d ONer Soureaa
• TOTALS
s A
s
s
$
s
9.
10.
11.
12. TOTALS (sum of Imes 8 and 11)
s
S
S
S —0—
SECTION D - FORECASTED CASH NEEDS
13feMral
Tolel for 1e1 Your
f•1 0110164,
Ind Own«
2.d ouMor
•M OwrNr
S 107,535
s 26,885
S 26,880
S 26,885
: 26,885
14. 1lonfederal
---
---
---
---
---
15. TOTAL (suns of Imes 13 and 14)
TS-107,535
FS 26,885 TS
26 880
$26 885 T
26-885
SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
(a) aim
Fasl
(d Second
Third
(e)Fourth
1s E.I. Services with Respect to HIV
$ 1071,535
S 107,535
; 107,535
S 10
17.
It
19.
20. TOTALS (sum of lines 16.19)
s 107,535
S 107535
;107,535
Is
SECTION F - OTHER BUDGET INFORMATION
(Attach additional Sheets if Necessary)
21. Direct Charges:
22. h+dired Charges:
23. Remarks
SF 424A 14-88) Ppa 2
Plow by OM8 CwcWw A-102
POLICY INFORMATION NOTICE
Categorical Grants
Early Intervention Services
Title XXVI PHS Act
As Amended by
Ryan White Comprehensive AIDS Resources
Emergency Act of 1990
Additional Agreements and Assurances
I, the authorized representative of the city of Lubbock in applying
for a grant under Part C of Title XXVI, Public Health Service Act, as amended by the Ryan
White Comprehensive AIDS Resources Act of 1990, P. L. 101-381, 42 USC 300ff--51 -
300ff-67 ere y • ify that:
I haver ived a y f the Tit XVI, P ct Part C Subparts II and III and have full
knowledge of ' s o t ts.
1
Name:
11avid R. Lang~
Title: Mayor
In addition, I certify that:
(1) as required in section 2651 (b):
Grant funds will be expended for the purposes of providing, on an outpatient basis, each of
the following early intervention services:
a. Required Services
1. Counseling individuals with respect to HIV disease in accordance with section
2662;
2. Testing to confirm the presence of HIV infection; to diagnose the extent of immune
deficiency; to provide clinical information on appropriate therapeutic measures for
preventing and treating the deterioration of the immune system and for preventing and
treating conditions arising from the disease;
3. Other clinical preventive and diagnostic services regarding HIV disease, and
periodic medical evaluations of individuals with the disease;
4. Providing the therapeutic measures described in 2. above; and
5. Referrals described in section 2651(3);
b. Each of the early intervention services in a. will be available through the applicant
entity.
C. Grant funds may also be expended to provide, on an optional basis, the following
34
POLICY INFORMATION NOTICE #94 -22
Attachment B
Early Intervention Services
Title XXVI PHS Act
As Amended by
Ryan White Comprehensive AIDS Resources
Emergency Act of 1990
Additional Agreements and Assurances
The authorized representative of the applicant must include a signed original copy of the
attached form with the grant application. This form lists the program assurances which must
be satisfied in order to qualify for a Part C grant, as required by section 2665.
NOTE: The text of the assurances has been abbreviated on this form, in, for ease of
understanding; however, grantees are required to �pmply with. ill ,�s ts'pf a assurances
as they stated in the Act. k
_i
33
POLICY INFORMATION NOTICE #94 -22
services:
1. Outreach services to individuals who may have HIV disease or may be at risk
benefits; and who may be unaware of the availability and potential benefits of early
treatment of the disease, and to provide outreach services to health care professionals
who may be unaware of such availability and potential benefits; and
2. Case -management services to provide coordination in the provision of the health
services to the individuals and to review the extent of utilization of the services by the
individuals; and
3. Provide assistance to the individuals regarding establishing the eligibility of the
individuals for financial assistance and services under Federal, State, or local
programs providing for health services, mental health services, social services, and
other appropriate services.
(2) As required under section 2651 (c):
The applicant for the grant agrees to make reasonable efforts to participate in a consortium
established with a grant under section 2612(a)(1), if such a consortium exist in the
geographic area.
(3) As required under section 2654 (a):
Provisions of services to persons with hemophilia will be made and/or coordinated with the
network of comprehensive hemophilia diagnostic and treatment centers.
(4) As required under section 2661 (a) (2):
The confidentiality of all information relating to the person(s) receiving services will be
maintained.
(5) As required under section 2661 (b) (1): .
Informed consent will be obtained.
(6) As required under section 2663:
All testing, without regard as to whether funded by Federal funds, will be carried out in
accordance with sections 2661 and 2662.
(7) As required under section 2664 (a) (2):
A report to the Secretary in the form and on the schedule specified by the Secretarywill be
submitted.
(8) As required under section 2664 (b):
35
POLICY INFORMATION NOTICE #94 -22
Opportunities for anonymous counseling and testing will be provided.
(9) As required under section 2664 (c):
Individuals seeking services will not have to undergo testing as a condition of receiving other
health services.
(10) As required under section 2664 (d):
The level of pre -grant expenditures for early intervention services.will be maintained at the
level of the year prior to the grant year.
(11) As required under section 2664 (e):
A sliding fee schedule with limits and conditions specified in section 2664 (e) will be
utilized.
(12) As required under'section 2664 (f):
Funds will not be expended for services covered, or which could reasonably be expected to
be covered, under any State compensation program, insurance policy, or any Federal or State
health benefits program; or by an entity that provides health services on a prepaid basis.
(13) As required under section 2664 (g):
Funds will be expended only for the purposes awarded, such procedures for fiscal control
and fund accounting as may be necessary will be established, and not more than 5 percent of
the grant will be expended for administrative expenses.
(14) As required under section 2667:
Agreement that counseling programs shall not be designed to promote or encourage, directly,
intravenous drug abuse or sexual activity, homosexual or heterosexual; .shall be designed to
reduce exposure to and transmission of HIV disease by providing accurate information; and
shall provide information on the health risks of promiscuous_ sexual activity and intravenous
drug abuse.
Name:
David R. Langston
Title: Mayor
Name of Applicant
Organization: City of Lubbock
Date: 6 / 1 / 94
30
OMB Approval No. 0348.0040
ASSURANCES — NON -CONSTRUCTION PROGRAMS
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 costs) to
ensure proper planning, management and com-
pletion 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. If 4728-4763)
relating to prescribed standards for merit systems
for programs funded under one of the nineteen
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. If 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. 1 794), which prohibits dis-
crimination on the basis of handicaps; (d) the Age
Discrimination Act of 1975, as amended (42
U.S.C. 1 6101-6107), which prohibits discrim-
ination 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) If 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
VilI of the Civil Rights Act of 1968 (42 U.S.C. 1
3601 et seq.), as amended, relating to non-
discrimination 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 Q) the requirements of any other
nondiscrimination statute(s) which may apply to
the application.
7. 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 with the provisions of the Hatch Act
(5 U.S.C. If 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.
9. Will comply, as applicable, with the provisions of
the Davis -Bacon Act (40 U.S.C. 4f 276a to 276a-
7), the Copeland Act (40 U.S.C. € 276c and 18
U.S.C. If 874). and the Contract Work Hours and
Safety Standards Act (40 U.S.C. if 327-333),
regarding labor standards for federally assisted
construction subagreements.
Standard Form 4248 (4.88;
Prescnbed by 06AS Circular A.102
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 andto 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. It 1451 et seq.); (O
conformity of Federal actions to State (Clear Air)
Implementation Plans under Section 176(c) of the
Clear Air Act of 1955, as amended (42 U.S.C. i
7401 et 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. if 1271 et seq.) related to
protecting components or potential components of
the national wild and scenic rivers system.
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. if 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 of 1984.
18. Will comply with all applicable requirements of all
other Federal laws, executive orders, regulations
and policies governing this program.
SF 4248 4448) Bac►
PHS_5161-1 (7/92) Page 17
CERTIFICATIONS
I. CERTIFICATION REGARDING DEBARMENT
AND SUSPENSION
The undersigned (authorized official signing for the
applicant organization) certifies to the best of his
or her knowledge and belief, that the applicant,
defined as the primary participant in accordance
with 45 CFR Part 76, and its principals:
(a) are not presently debarred, suspended, pro-
posed for debarment, declared ineligible, or
voluntarily excluded from covered transactions
by any Federal Department or agency;
(b) have not within a 3-year period preceding this
proposal been convicted of or had a civil judg-
ment 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) transaction or
contract under a public transaction; violation of
Federal or State antitrust statutes or commis-
sion of embezzlement, theft, forgery, bribery,
falsification or destruction of records, making
false statements, or receiving stolen property;
(c) are not presently indicted or otherwise crimi-
nally 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 3-year period preceding this
application/proposal had one or more public
transactions (Federal, State, or local) terminated
for cause or default.
Should the applicant not be able to provide this certifi-
cation, an explanation as to why should be placed
after the assurances page in the application package.
The applicant agrees by submitting this proposal that it
will include, without modification, the clause titled
"Certification Regarding Debarment, Suspension, In-
eligibility, and Voluntary Exclusion —Lower Tier Cov-
ered Transaction" (Appendix B to 45 CFR Part 76) in
all lower tier covered transactions (i.e., transactions
with subgrantees and/or contractors) and in all solicha-
tions for lower tier covered transactions.
OMB Appv.A No. 0937-0189
Ecpimdm Date: March 31. 1995
2. CERTIFICATION REGARDING DRUG -FREE
WORKPLACE REQUIREMENTS
The undersigned (authorized official signing for the
applicant organization) certifies that it will provide
a drug -free workplace in accordance with 45 CFR
Part 76 by:
(a) Publishing a statement notifying employees that
the unlawful manufacture, distribution, dispens-
ing, 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;
(b) Establishing a drug -free awareness program to
inform employees about—
(1) The dangers of drug abuse in the workplace;
(2) The grantee's policy of maintaining a drug -
free workplace;
(3) Any available drug counseling, rehabilita-
tion, and employee assistance programs; and
(4) The penalties that may be imposed upon
employees for drug abuse violations occur-
ring in the workplace;
(c) 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 para-
graph (a) above;
(d) Notifying the employee in the statement re-
quired by paragraph (a), above, that, as a con-
dition of employment under the grant, the
employee will—
(1) Abide bythe terms of the statement; and
(2) Notify the employer of any criminal drug
statute conviction for a violation occurring
in the workplace no later than five days
after such conviction;
(e) Notifying the agency within ten days after re-
ceiving notice under subparagraph (d)(2),
above, from an employee or otherwise receiving
actual notice of such conviction;
(f) Taking one of the following actions, within 30
days of receiving notice under subparagraph
(d)(2), above, with res". to any employee who
is so convicted—
Page 18 PH54161-1 (7/92)
(1) Taking appropriate personnel action against
such an employee, up to and including ter-
mination; or
(2) Requiring such employee to participate satis-
factorily in a drug abuse assistance or reha-
bilitation program approved for such pur-
poses by a Federal, State, or local health,
law enforcement, or other appropriate
agency;
(9) Making a good faith effort to continue to main-
tain a drug free workplace through implementa-
tion of paragraphs (a), (b), (c), (d), (e), and (f),
above.
3. CERTIFICATION REGARDING LOBBYING
Title 31, United States Code, Section 1352, entitled
"Limitation on use of appropriated funds to in-
fluence certain Federal contracting and financial
transactions," generally prohibits recipients of Fed-
eral grants and cooperative agreements from using
Federal (appropriated) funds for lobbying the
Executive or Legislative Branches of the Federal
Government in connection with a SPECIFIC grant
or cooperative agreement. Section 1352 also
requires that each person who requests or receives
a Federal grant or cooperative agreement must dis-
close lobbying undertaken with non -Federal (non -
appropriated) funds. These requirements apply to
grants and cooperative agreements EXCEEDING
$100,000 in total costs (45 CFR Part 93).
The undersigned (authorized official signing for the
applicant organization) certifies, to the beat of his
or her knowledge and belief, that-
(1) No Federal appropriated funds have been paid
or will be paid, by or on behalf of the under-
signed, to any person for influencing or attempt-
ing 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
awarding of any Federal contract, the making of
any Federal grant, the making of any Federal
loan, the entering into of any cooperative agree-
ment, and the extension, continuation, renewal,
amendment, or modification of any Federal con -
grant, to ooperative agreement.
(2) If any funds other than Federally 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 Mem-
ber of Congress, an officer or employee of Con-
gress, or an employee of a Member of Congress
in connection with this Federal contract, grant,
loan, or cooperative agreement, the undersigned
shall complete and submit Standard Form-LLL,
"Disclosure of Lobbying Activities," in accor-
dance with its instructions. (If needed, Standard
Form-LLL, "Disclosure of Lobbying Activities,"
its instructions, and continuation sheet are
included at the end of this application form.)
(3) The undersigned shall require that the language
of this certification be included in the award
documents for all subawards at all tiers (includ-
ing subcontracts, subgrants, and contracts under
grants, loans and cooperative agreements) and
that all subrecipients shall certify and disclose
accordingly.
'Ibis certification is a material representation of fact
upon which reliance was placed when this transac-
tion was made or entered into. Submission of this
certification is a prerequisite for making or entering
into this transaction imposed by Section 1352, U.S.
Code. Any person who fails to file the required cer-
tification shall be subject to a civil penalty of not
less than $10,000 and not more than $100,000 for
each such failure."
4. CERTIFICATION REGARDING PROGRAM
FRAUD CIVIL REMEDIES ACT (PFCRA)
The undersigned (authorized official signing for the
applicant organization) certifies, to the best of his
or her knowledge and belief, that the statements
herein are true, accurate, and complete, and agrees
to comply with the Public Health Service terms and
conditions if an award is issued as a result of this
application. Willful provision of false information is
a criminal offense (Title 18, U.S. Code, Section
1001). Any person making any false, fictitious, or
fraudulent statement may, in addition to other
remedies available to the Government, be subject to
civil penalties under the Program Fraud Civil
Remedies Act of 1986 (45 CFR Part 79).
0A
AP
M Iwo
OPIallaliAT6N 'DATE
SUBMTED
LubbockCity of