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HomeMy WebLinkAboutResolution - 2003-R0191 - Agreement To Provide Assistance To Metadata Creation For Lubbock GIS - 05_22_2003Resolution No. 2003-RO191 May 22, 2003 Item No. 24 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 associated documents to the Federal Geographic Data Committee National Spatial Data Infrastructure 2003 Cooperative Agreement Program, to provide assistance for metadata creation for the City of Lubbock Geographic Information System. Said Agreement is attached hereto and incorporated in this Resolution as if fully set forth herein and shall be included in the minutes of the Council. Passed by the City Council this 22nd day of May '2003. ATTEST: Re ecca Garza, City Secretary APPRO AS TO TENT: Craig Farrder, Ndanaging Director Planning and Transportation APPROVED AS TO FORM: _...... _._ �.:.._-�-::1 e.... �ar.,,,..�•� � ter...-�- Linda L. Chamales, Supervising Attorney Lc: UATTY/Linda & cc does/RESOLUTIONS/metadata Grant May 12, 2003 Resolution No. 2003—RO191 Nay 22, 2003 Item No. 24 OMB Approval No. 0348-0043 Art-1-1I.A 1 I V N r V m 2. DATE SUBMITTED Applicant Identifier FEDERAL ASSISTANCE 05/27/03 1. TYPE OF SUBMISSION: 3. DATE RECEIVED BY STATE State Application Identifier Application Preapplication El Construction ❑ Construction 4. DATE RECEIVED BY FEDERAL AGENCY Federal Identifier ❑ Non -Construction ❑ Non -Construction 756000590 5. APPLICANT INFORMATION Legal Name: Organizational Unit: City of Lubbock Planning Dept. Address (give city, county, state, and zip code): Name and telephone number of the person to be contacted on matters involving this 1625 13th St. application (give area code) P.O. Box 2000 Sally Still Abbe Lubbock, TX 79457 (806) 775-2106 6. EMPLOYER IDENTIFICATION NUMBER (EIN): 7. TYPE OF APPLICANT: (enter appropriate letter in box) El 7 S 6 0 0 10 IS 19 1 0 A. State H. Independent School Dist. B. County I. State Controlled Institution of Higher Learning C. Municipal J. Private University 8. TYPE OF APPLICATION: D. Township K. Indian Tribe ® New ❑ Continuation ❑ Revision E. Interstate L. Individual F. Intennunicipal M. Profit Organization If Revision, enter appropriate letter(s) in box(es): ❑ ❑ G. Special District N. Other (Specify): A. Increase Award B. Decrease Award C.Increase Duration D. Decrease Duration Other (specify) 9. NAME OF FEDERAL AGENCY: U.S. Geological Survey Fede al o i Data Committee 10. CATALOG OF FEDERAL DOMESTIC 11. DESCRIPTIVE TITLE O AP LICANT,S PROJECT: ASSISTANCE NUMBER: — City of Lubbock, Texas FY 2003 Cooperative Agreements TITLE: Category One Metadata Creation for the City of Lubbock 12. AREAS AFFECTED BY PROJECT (cities, counties, states, etc.): City of Lubbock 13. PROPOSED PROJECT: 14. CONGRESSIONAL DISTRICTS OF: Start Date Ending Date a. Applicant b. Project 9/l/03 7/l/04 19th ,� 19th 15. ESTIMATED FUNDING: 16. IS APPLICATION SUBJECT TO REVIEW BYSTATE EXECUTIVE ORDER 12372 PROCESS? a. YES, THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE TO THE STATE EXECUTIVE a. Federal $ 00 9000 ORDER 12372 PROCESS FOR REVIEW ON: DATE b. Applicant $ .00 4500 b. NO C❑ PROGRAM IS NOT COVERED BY E.O. 12372 ❑ OR PROGRAM HAS NOT BEEN SELECTED STATE FOR REVIEW c. State $ .00 d. Local $ .00 a. Other $ .00 f. Program Income $ .00 17. IS APPLICATION DELINQUENT ON ANY FEDERAL DEBT? ❑ YES If "Yes," attach an explanation. ® No g. TOTAL $ 13 5 0 0 .00 18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATIOWPREAPPLICATION ARE TRUEAND CORRECT, THE DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANTAND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED a. Typed Name of Authorized Representative b. Title c. Telephone number Marc McDougal Mayor. (806) 775-3000 d. Signa of Au ized Rep rve e. Date Signed May 22, 2003 revi 5 Editions NO ale A mm1QCT. /'\ Standard Form 424 (Rev 4-881 EF 4----- a Prescribed by OMB CircularA-162 Rebe ca Garza, City Secretary OMB Approval No. 0348-0040 ASSURANCES - NON -CONSTRUCTION PROGRAMS Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the applicant, I certify that the applicant: 1. Has the legal authority to apply for Federal assistance and the institutional, managerial and financial capability (including funds sufficient to pay the non -Federal share of project cost) to ensure proper planning, management and completion of the project described in this application. 2. Will give the awarding agency, the Comptroller General of the United States and, if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §§4728-4763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F). 6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C_ §§1681- 1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and, Q) the requirements of any other nondiscrimination statute(s) which may apply to the application. Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally -assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases. 8. Will comply, as applicable, with provisions of the Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds. Previous Edition Usable Standard Form 424B (Rev. 7-97) Authorized for Local Reproduction Prescribed by OMB Circular A-102 9. Will comply, as applicable, with the provisions of the Davis - Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act (40 U.S.C. §276c and 18 U.S.C. §874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. §§327- 333), regarding labor standards for federally -assisted construction subagreements. 10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more. 11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of Federal actions to State (Clean Air) Implementation Plans under Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. §§7401 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. §§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. §§4801 et seq.) which prohibits the use of lead -based paint in construction or rehabilitation of residence structures. 17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, "Audits of States, Local Governments, and Non -Profit Organizations." 18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, and policies governing this program. SIGNATURE OF AUTHO D CERTIF OFFICIAL TITLE Mayor API A T ORGANI ON DATE SUBMITTED City of Lubbock, Texas May 8, 2003 ATTEST' Standard Form 424E (Rev. 7-97) Back Rebecca Garza, City Secretary Page 1 of 2 (Rev. 8/95) U.S. DEPARTMENT OF THE INTERIOR CERTIFICATIONS FOR FEDERAL ASSISTANCE PART A: Certifications Regarding Debarment, Suspension and Other Responsibility Matters - Primary Covered Transactions, Applies to all grantees and cooperators. This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 43 CFR Part 12, Section 12.510, Participants' responsibilities. The regulations were published as Part VII of the May 25, 1988 Federal Register (pages 19160-19211). For further assistance in obtaining a copy of the regulations, contact the issuing office. (a) The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals: (1) are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (2) have not within a 3-year period preceding this proposal been convicted of 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) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (3) 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 (a)(2) of this certification; and (4) 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. (b) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. The prospective primary participant further agrees by submitting this proposal that it will include the following clause, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions (see Appendix A of Subpart D of 43 CFR Part 12): PART B: Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions. (a) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. (b) Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. PART C: Certification Regarding Drug -Free Workplace. Alternate 1. Applies to grantees other than individuals. This certification is required by the regulations implementing the drug -free workplace requirements for Federal grant recipients under the Drug -Free Workplace Act of 1988 (43 CFR Part 12, Subpart D). A copy of the regulation is available from the issuing office. A. The grantee certifies that it will or continue to provide a drug -free workplace by: (a) 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; (b) Establishing an on -going 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, rehabilitation, and employee assistance programs; and (4) the penalties that may be imposed upon employee for drug abuse violations occurring 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 paragraph (a); (d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will (1) abide by the terms of the statement; and (2) 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; (e) Notifying the agency, in writing, within ten calendar days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to every grant officer or other designee on whose grant activity the convicted employee was working, unless the Federal agency has designated a central point for the receipt of such notices. Notice shall include the identification number(s) of each affected grant; (0 Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted: (1) 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 (2) 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; U.S. DEPARTMENT OF THE INTERIOR CERTIFICATIONS, continued Page 2 of 2 (Rev. 8/95) (g) Making a good faith effort to continue to maintain a drug -free workplace through implementation of paragraphs (a), (b), (c), (d), (e) and (f). 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) 1625 13th St. Lubbock. TX 79457 Check _ if there are workplaces on file that are not identified here. PART D: Certification Regarding Drug -Free Workplace. Alternate ll. Applies to grantees who are individuals. This certification is required by the regulations implementing the drug -free workplace requirements for Federal grant recipients under the Drug -Free Workplace Act of 1988 (43 CFR Part 12, Subpart D). A copy of the regulation is available from the issuing office. (a) The grantee certifies that, as a condition of the grant, he or she will not engage in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance in conducting any activity with the grant; (b) If convicted of a criminal drug offense resulting from a violation occurring during the conduct of any grant activity, he or she will report the conviction, in writing, within 10 calendar days of the conviction, to the grant officer or other designee, unless the Federal agency designates a central point for the receipt of such notices. When notice is made to such a central point, it shall include the identification number(s) of each affected grant. Part E: Certification Regarding Lobbying - Certification for Contracts, Grants, Loans, and Cooperative Agreements. Applies to recipients of awards exceeding $100,000. This certification is required by Section 1352, title 31, U.S. Code, entitled "Limitation on use of appropriated funds to influence certain Federal contracting and financial transactions." The undersigned certifies, to the best 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 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 awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) 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 contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. As the authorized certifying official, I hereby certify that the above specified c9ofications are true. name Marc City of Lubtock, Texas ATTEST: Rebe ca Garza, City Secreta Resolution No. 2003 RO191 U.S. DEPARTMENT OF THE INTERIOR A (Rev 1/2000) U.S. GEOLOGICAL SURVEY USGS science fora changing warfd ASSISTANCE AWARD fi AP ;: IPA QWTITWA PATE,. City of Lubbock, Texas FY 2003 Cooperative Agreements Category One Metadata Creation for the City of Lubbock, dated 05/22/03. 7 JAWARD PERIODS 8 FISCAL DATA Budget Period: _ Federal Share: $9,000 Date of Signature through July 1, 2004 Non -Federal Share: $ Total Project Period: Total Project Cost: $9,000 Date of Signature through July 1, 2004 Appropriation/Object Class: Obligated: Effective Date: Date of Signature 03-6011-OOB10 411C $9,000 DCN: 03HQAGO179 9 PRINCIPAL, INVESTIGATOR ` 10 JUSG4, PROGRAO OFFICER Sally Still Abbe David Painter City of Lubbock US Geological Survey 1625 13th Street Geographic Information Office Lubbock, TX 79457 Federal Geographic Data Committee Secretariat (806) 775-2106 MS 590 12201 Sunrise Valley Drive Reston VA 20192 703-648-5513 MARC MCDOUGAL, Mayor TYPED NAME AND TITLE October 9, 2003 Date SE P 1 U 2003 Date Pansy R. Yeatts, Contracting Officer TYPED NAME AND TITLE ATTEST: Garza, City Secretary 1 TABLE OF CONTENTS Pages Section A - Cooperative Agreement Form and Table of Contents .................................................... 1 & 2 SectionB - Scope.............................................................................................................................. 3 SectionC - Statement of Work .............................. ....................................I... ............................... 3 Section D - Performance and Deliverable........................................................................................ 3-4 Section E - Cooperative Agreement Administration Data..........................:.................................... 4-6 Section F - General Provisions......................................................................................................... 6 -10 Section G - Documents Incorporated by Reference........................................................... :............. .10 SectionH - Attachments................................................................................................................... 10 2 SECTION B - SCOPE This Cooperative Agreement is to provide support to the City of Lubbock to acquire the knowledge, ability and experience documenting (creating metadata) geospatial data held by the organization. Recipient shall provide all necessary personnel, equipment, and facilities required to implement the work as stated in the Recipient's proposal, entitled "City of Lubbock, Texas FY 2003 Cooperative Agreements Category One Metadata Creation for the City of Lubbock, dated 05/22/03.", in accordance with the stated goals, results, standards, and deliverables. SECTION C - STATEMENT OF WORK The project outcomes/goals are to: (1) Resulting metadata posted to a Clearinghouse node will provide for the discovery of geospatial data over the internet through the National Spatial Data Clearinghouse. SECTION D - DELIVERABLES D.1 Period of Performance This award supports Budget Period Date of Signature through 07-01-04, as specified in Block 7 of page 1, Project Period. D.2 Technical Reports The following reports documenting activities and outcomes shall be submitted as follows: Description Copies Destination Due Date Interim report Original +1 CAP Program Contact 120 day after start of project Final report Original +1 CAP Program Contact within 90 days of end of project period Report format will be posted at the FGDC 2003 CAP Administration Page at www.fgdc.gov. 3 D.3 Financial Status Report The Recipient shall submit a SF-269 "Financial Status Report" to the address in Section E.1 within 90 days after the last day of the project period. SECTION E - COOPERATIVE AGREEMENT ADMINISTRATIVE DATA EA Cooperative Agreement Administration (1) This Cooperative Agreement will be administered by: U.S. Geological Survey Office of Acquisition and Grants National Assistance Programs Branch 12201 Sunrise Valley Drive, MS 205G Reston, VA 20192 Attn: Karen L. Staubs, Grant Specialist Telephone (703) 648-7393 FAX: 703-648-7901 Email: kstaubs@usgs.gov Written communications shall make reference to the Cooperative Agreement number and shall be mailed to the above address. (2) CAP Program Contact David Painter Cooperative Agreements Program (CAP) Coordinator Federal Geographic Data Committee Voice: (703) 648-5513 Fax: (703) 648-5755 Email: dpainterR-fgdc.gov E.2 Consideration (1) The total estimated cost of the USGS share for the performance of this Cooperative Agreement is $9,000. Costs reimbursed hereunder shall in no event exceed that amount without prior written approval of the Contracting Officer. (2) The amount obligated under this Cooperative Agreement is $9,000 for the period of Date of Signature through 07-01-04. In no event shall costs be incurred in performance of the agreement in excess of the funds currently obligated. Funds for future Fiscal Years are contingent upon availability of funds. Should funds 4 become available, a modification to the Cooperative Agreement will be issued to obligate the additional funds. (3) Prior approval of the Contracting Officer is not required for transfer of funds between direct cost categories when the cumulative amount of the transfers during the performance period does not exceed ten percent (10%) of the total USGS cash award. Prior written approval is required from the Contracting Officer for transfers of funds in excess of the ten percent limitation. E. 3 Obligation of Funds Funds in the amount of $9,000 are hereby obligated under this Cooperative Agreement and shall be available for payment of agreement costs incurred by the Recipient in performance of this agreement. In no event shall costs be incurred in performance of this agreement in excess of the funds currently obligated. E.4 Method of Payment The U. S. Geological Survey (USGS) is using the Health and Human Services (HHS) Payment Management System (PMS) to provide electronic invoicing and payment for assistance award recipients. The Recipient has established or will establish an account with PMS. With the award of each grant/cooperative agreement, a sub -account will be set up from which the Recipient can draw down funds. The sub -account number will be shown in block 4 of the face page of each award or modification. Payments will be made available through PMS. The PMS is administered by the Department of Health and Human Services (DHHS), Division of Payment Management of the Financial Management Service, Program Support Center. The DHHS will forward instructions for obtaining payments to the recipients. Inquiries regarding payment should be directed to: Division of Payment Management Department of Health and Human Services P. O. Box 6021 Rockville, MD 20852 The Division of Payment Management web address is www.dpm.psc.gov. Problems or questions with electronic drawdown procedures should be directed to Tonja Thomas at (301) 443-9141 or Nancy Weiger at (301) 443-9240. Payments may be drawn in advance only as needed to meet immediate cash disbursement needs. E.5 FINANCIAL REPORTING REQUIREMENTS (a) STANDARD FORM 272, FEDERAL CASH TRANSACTIONS REPORT is required quarterly for each PMS subaccount. Quarterly reports are due 15 working days after the end of each fiscal quarter and will be submitted to the contracting officer, unless otherwise instructed. 5 (b) STANDARD FORM 269, FINANCIAL STATUS REPORT (original and 1 copy) is required annually and is due 30 calendar days after the end of the annual budget period. (c) FINAL FINANCIAL STATUS REPORT. The recipient will liquidate all obligations incurred under the award and submit a final SF 269 Financial Status Report no later than 90 calendar days after the grant/cooperative agreement completion date. 'Recipient will promptly return any unused federal cash advances or will complete a final draw from PMS to obtain any remaining amounts due. E.6 Involvement Statement The FGDC will collaborate closely with the awarded projects to promote data discovery and access through the implementation of metadata and publication in the clearinghouse. The FGDC will jointly monitor and agree on the milestones and accomplishments on work performed as part of this agreement. The FGDC will provide assistance to those organizations needing identification of registered clearinghouse nodes for serving their metadata over the Internet E.7 Proiect Extension A request for change in the project period requires advance written approval by the CO. The request must be submitted in writing, stating the basis for the request, to the CO at least 30 calendar days prior to the expiration of the Cooperative Agreement. The Recipient shall submit a revised budget indicating the planned use of all unexpended funds during the extension period. The CO will notify the Recipient in writing within 15 calendar days after receipt of the request for revision or adjustment whether the request has been approved. E.8 Preagreement Costs Pre -agreement costs are not authorized under this Cooperative Agreement E.9 Modification The scope of work and terms of the agreement may be modified at any time by mutual consent of the signatory parties. SECTION F - GENERAL PROVISIONS F.1 Applicable Circulars The following Office of Management and Budget (OMB) Circulars are applicable to this Cooperative Agreement: n. (1) OMB Circular A-21, Cost Principles for Educational Institutions. (2) OMB Circular A-110, Uniform Administrative Requirements for Grants and other Agreements with Institutions of Higher Education, Hospitals and Other Non -Profit Organizations. (3) OMB Circular A-133, Audits of States, Local Governments, and Non -Profit Organizations. F.2 Applicable Code of Federal Regulation (CFR) The following CFRs are hereby incorporated by reference: -43 CFR Part 12, Subpart A: Admin, Audit and Cost Principles - 43 CFR Part 12, Subpart D: Government Debarment and Suspension (Non - procurement) and Government wide Requirements for Drug Free Workplace - 43 CFR Part 12, Subpart E: Buy American Requirements for Assistance Programs - 43 CFR Part 12, Subpart F: Admin — Higher Education, Hospitals, and Other Non - Profit Organizations 43 CFR Part 17, Subpart A: Nondiscrimination of the Basis of Race, Color, or National Origin - 43 CFR Part 17, Subpart B: Nondiscrimination on the Basis of Handicap - 43 CFR Part 17, Subpart C: Nondiscrimination on the Basis of Age - 43 CFR Part 18, Lobbying F.3 Rights in Technical Data The Government may publish, reproduce, and use all technical data developed as a result of this Cooperative Agreement in any manner, and for any purpose, without limitation, and may authorize others to do the same. F.4 Patents --Small Business and Nonprofit Organizations Subject to the provisions set forth in 37 CFR 401, 35 U.S.C. 203 and 35 U.S.C. 205, a Recipient may retain the entire right, title, and interest throughout the world to each subject invention. With respect to any subject invention in which the Recipient retains title, the Federal Government will have a nonexclusive, nontransferable, irrevocable, paid -up license to practice or have practiced for or on behalf of the United States the subject invention throughout the world. 7 F.5 Buy American Act Requirements Notice: Pursuant to Section 307(b) of the Department of the Interior (DOI) and Related Agencies Appropriations Act, FY 2000, Public Law 106-113, please be advised on the following: In the case of any equipment or product that may be authorized to be purchased with financial assistance provided using funds made available in FY 2000 and thereafter, it is the sense of the Congress that entities receiving the assistance should, in expending the assistance, purchase only American -made equipment and products. F.6 Metric Conversion All progress and final reports, other reports, or publications /produced under this award shall employ the metric system of measurements to the maximum extent practicable. Both metric and inch -pound units (dual units) may be used if necessary during any transition period(s). However, the recipient may use non -metric measurements to the extent the recipient has supporting documentation that the use of metric measurements is impracticable or is likely to cause significant inefficiencies or loss of markets to the recipient, such as when foreign competitors are producing competing products in non - metric units. F.7 Travel and Transportation The Recipient shall be reimbursed for actual transportation costs and.travel allowances of employees in accordance with the Government Travel Regulations for travel within the United States. Travel and transportation expenses which exceed those amounts established in the Government Travel Regulations for individuals engaged in official travel under this program are not reimbursable. F.8 Nonexpendable Personal Property Title to the following nonexpendable personal property shall vest with the Recipient upon acquisition, with no further obligation to the Government: N/A F.9 Publications Produced (1) Publication of the results of any project carried out under this assistance award is authorized in professional journals, trade magazines, or may be made by the USGS. Manuscripts submitted to journals or professional publications for publication shall be accompanied by the following notation: 8 "This manuscript is submitted for publication with the understanding that the United States Government is authorized to reproduce and distribute reprints for Governmental purposes." One copy of each article planned for publication shall be submitted to the USGS Project Officer simultaneously with its submission for publication. One reprint of each published article shall be submitted to the USGS Project Office immediately following publication. (2) Disclaimer. All manuscripts submitted for publication in magazines, journals or trade papers shall carry the following notation: "The views and conclusions contained in this document are those of the authors and should not be interpreted as necessarily representing the official policies, either expressed or implied, of the U.S. Government." (3) Departmental Manual Requirements 505 DM requires that two copies of each publication produced under a Grant or Cooperative Agreement be sent to the Natural Resources Library with a transmittal that identifies the sender and the publication. The address of the library is: U.S. Department of the Interior Natural Resources Library Division of Information and Library Services Gifts and Exchange Section 18th and C Streets, NW Washington, DC 20240 Publications issued on the work performed under this agreement must acknowledge the support and collaboration of the Department of the Interior, USGS and the City of Lubbock under 03HQAG0179. F.10 Anti-Lobbvin Recipient shall not use any part of the Department of the Interior funds provided hereunder for any activity or the publication or distribution of literature that in any way tends to promote public support or opposition to any legislative proposal on which Congressional action is not complete. F.11 Seat Belt Provision Recipients of grants/cooperative agreements and/or sub -awards are encouraged to. adopt and enforce on-the-job seat belt use policies and programs for their employees when operating company -owned, rented, or personally owned vehicles. These E measures include, but are not limited to, conducting education, awareness, and other appropriate programs for their employees about the importance of wearing seat belts and the consequences of not wearing them. F.12 Endorsement Provision Recipient shall not publicize or otherwise. circulate, promotional material (such as advertisements, sales brochures, press releases, speeches, still and motion pictures, articles, manuscripts or other publications) which states or implies governmental-, Departmental, bureau, or government employee endorsement of product, services, or position which the recipient represents. No release of information relating to this award may state or imply that the Government approves of the recipient's work products, or considers the recipient's work product to be superior to other products or services. SECTION G - DOCUMENT INCORPORATED BY REFERENCE Recipient's original proposal entitled "City of Lubbock, Texas FY 2003 Cooperative Agreements Category One Metadata Creation for the City of Lubbock, dated 05/22/03°; Standard Form 424 "Application for Federal Assistance; Standard Form 424B "Assurances - Non -/Construction Programs"; and "U.S. Department of the Interior Certifications for Federal Assistance" are hereby incorporated by reference. SECTION H - ATTACHMENTS Identifier Description No. of Pages A SF 269A Financial Status Report 2 B SF 1199A Direct Deposit Sign -Up Form 1 C Instructions for Completing S 1199A 1 D Contact Information Sheet 1 E SF 272 Federal Cash Transaction Report 3 —END OF COOPERATIVE AGREEMENT 03HQAGO179 -- 10 FINANCIAL STATUS REPORT - - (Short Form) (Follow insfrrrctions on the back) = 1_ Federal Agency and 0rgan¢2tional Element 2 Federal Grant or Other Identi lying Number Assigned OMB Approval Page . 'of to Yakh Repod.is Steed By Federal Agency No 034"038 paws 3. RecVmA Organkabon (Name and complete address, Inckxing ZIP code) 4. Employer Identification Number . 5. RecVwd Account Number or lderrdiying Number & Finaf Report 7 Basis El Yes No Cash D Accrual & Fun&� Period (See fnstrucff0 s) 9. Period Covered by this Report Fnxw.(Montlk Day, Year) To. (Month. Day. Year) Front (Mon#h, Day. Year) To (Mor►th,-Day. Year) iQ-Transactions Previously . This (umulatixe Reported - Period 2k. Total outlays b. Redp[ent share of outlays cw Federal share of outlays d.- Total imAcjirdated CIA936orls e. Recipient share of unliquidated obligations I. Federal share of unriquidated obligabons g. Total Federal share (Sum of Fnes-c and 1) IL Total Federal funds authwiied for this_hxx** period. t. Unobligated balance of Federal funds (Cime h minus tine s) a: Type of Rate #Uft -X-in apprvpdate 1wx) 1 t: imduect ❑ Provisional Predetermined ' Final 0 F'aed Eqense. b Rate G Base d. Total Arrwunt e. Federal Sham 12 Remarks: Affacr any explanations deemed necessary or inkmu tien required by Fedw W sponsonng agency kr compafance MM govW7* hVisla}ion 13. Cedificatiom I c"fy to the but of my knowledge and belief that obis report is correct and complete and that all outlays and nnl;yuidated obligations are for the purposes set forib in the award documents. Typed or Printed Name and We Telephone (Area code, number and wdensm) Signature of Authon¢ed. Certifying £giicial Date Report Submitted NSl1754401-2i8 t387 MmAxd Form 26M (REV 2-92) Ibis Imm was e:ecWankr h podamd M Elie Federal Forms, ht Prescrked by OW Ckct"S A402 and A-110 -' I:INANCiAL tTA70S REFOR7 P► creporarptxirden&SSig cdtectWnof.;AWft%nises>arr0edto"W"09R.mlrms"per.rsW"a. OudkV*"forwAmigirn,�oMtieno!#r+g :ooWtrp Ott so> s: q se+^Q aead m , rig ms data:iseded;ind campis�i� ar4wvl6w of ins-bolt,cfion a Motmabon: Send. : Comenews io pro tom ►dEot'iriir atom isped a ris colfectior►ci'intomn.�wi,IcTrdirg soi�silAic ttk s�ociaj; iNastii► or1. DE �06 :LEE DO 1l1` HMMENTANb BUfTYFTOF 980� THEADDFOPROVDED-BY7HE:SPONSQRING-AGE,EY._ _ !saes type or Print bgk*. mm genaral irrstnrctions s fi" how tc use Me'forrii lilt.• You Print need oaf cortecty, or to decide whether a spftft itam Isapp6caDle:to this sward. a7Mov. tisich:lr&rrnatimwm_ be end to M-fedora( s ,or in.the toms end=nd'dio is o?iheSward- Yvrar�sy also-ix�rdad � Fsdwst-a �r�y:.. -1. -Zsr4 Xr saK-minatory : - - the ;;ahie. a .Nrich�d. cot l�irliQn': appKed i�ld.:�►e _ Inc ease or dose"in :the a "ft owed bj► tt>e - Eidel' the L�rnpto ref ldeifii�caiion; :Nt a (EirJ�" : '. toi -96O0 _ ! ►�- ! " �►* U;S: fir�eina�l Fiev�tis Service. Pew¢: by :empWye*n -'a►ii arl4ess� 'payees, arxi• ntAer .areoti$..iie�ri>irp 'owed tinde<. .'S: Spade as i ed for an 'i ccooiA r ir�tiiEir or otho'r . - : o9ramsaor wliictt eio.i rireltt seYanCes-w pwWww i are' -_ - - - •idertitjrir,�'�,rxr�r assi�ti'ed bj� die re�isrit: ` - � - .. - - �t+ed;" s�h;a3 artile�;-'siice� cIair�; = aid¢ "o`er '- . the jam, Ilk eiadstgvMnin ierri a: - 'ibb. 7. Self-eioanatory. 10c.'SBt[-explanatory. :i S . ."r:3 iipWs yoti. have.'received other"instrvciion5 from 1Dd. Enisr Elie total ambunt"afeu�liquu%isdi the- awarda►g � agency: ° entei =the ` be uuun - , and : '<: 9'- ob antees iirld =.eni�irig dates ot-.the c iisent #undmg period. flatus is-- :_-Z. :-s.rett year°prb ahi. Federal-mi eiq. pa*Aght... =TQt�tNtB:CUfntr%tN@ tepOrtmg_through cot1rS@C we, tJrdiq�iidated ObGgatwns OR-al•.�astr:besis-a7e`O CIls7:� s ' atpi1dr%•einQd.:mpegs.idQadtseestotri the gram period;;arid k=e►s9t .. 'ic?'btp•_ %pa�. mFa-fse;'enter .e:dt oicmd, .. accrtraF_ba�• t►tsy ara� :-` but toy awiiictiT'ari it{ay:fi �rot�j :., .' -of: these; `t;[ubsiiiute: the :.temR 'ilrant'- ::� _ beeruer�oted. _dp:-y.. _�Z. �-��-..(e``./-'�-iji F�..'.iai- XjO ft !, •Se�l Xplim-dorjt_- ::inchrded im tiFis i ./ u�,.�__ l.c _`•u �i �y 1�_ l ate, �/�� .w.,� Pam'!'•-'=''`� of- cohnrms-'l.��a,,,.pp..-sWij��,t;{,J,.A YIo - _ - 'Ni•1116"f re'ori♦,#IQ =�W �H�As 4.1 '' 's •:�- • r 1�i - - r--C- ell�%•. d `>Y"'r�'1I _Stl++•s :haS. :' - - _ - _ axrw�aleve" �nanE jai# status:=TMF-Stt�Dwr?S erttt in `' 4 + 100, i.-fj; h. b end Ssifi siSplanlstory. '? : ?4 colurirrt 1 wigtiorrnaNy Ds-►e" :In' > -d 1Mar Po ahE :.JCS Ax> , Vperw.'.it is'ihe rust or .ifre _. f tb Eider thv k**od cost rate lrf effect ' , tending. psiribd. leave:coAxlrns -t pnd q blank..a irotr dui3r+Q the' tsporb`r+p�-- roWto adjust wrour ts-entered on proviotis'roptxts. Dew _ itiopw the coiirrnn l entry on Oft report and attach . of fhb' bad sph. tiiiiltiti► yltia sM was : - . IDOL Eraw total program: 'outlays 1Sss arry_. tib8iss; refunds; of 6tlist'i tilts: o i p6 is prepsrt d on a cash bask oudaya. are "'am m of ack*- cash ..&burcwwft to -direct costs_ for goods Wand - __ _ seivices. the :till ot:;3rici'r-ies� ekQer>se t�►ay9ed: the value of 1n-rand- contrbuti ms applied; and the : WfIbU rt d cash advances and" payments mide to VWft .. For rep_ orts prepared. on ecixusi basis. wsitlays _ate Ile aurn - d actual :cash deliurseriients for -d"d c►iarpes for goods and serv�cas. the asEin um of indaecl. expanse Incurred. S, ticnrenie�et Pn,wp O�rca /0➢d - ssi-tt�rlel289 lid. Elder the total arnowit (A Ir 6d-Cods `' :-` - -" H"ft period. 41e. t` 4 r the redsTO-soars vI the amtautd Ir►1 tid:. _ : Note: N more than one -rate was. In .effect during the period strown In. Vern. S. attach a - sc *dine- stwwkv -the . bases. against. whkh'>he dllerent rates were applied: the respoc sates, the calendar periods -they were in ethnk arnourts of indted expense charged to the _project, and the Fodard share of irmred expense charged to the projed ID date.. InsUracxions for Completing SF 119911 (please Read This Carefully) Section l-: To: be'Completed ly:Pi ce A,_, Type .or print your wAnizatioa's ! FGAL naive, address, and telephone number. Do - notenteran indiv duars naive in this block_ Forms containing white-out'or -handwritten changes to the payee name aiemikaeceptable. B. - Do -Vet enterand indiwidual's same in this field. Leave field _blank or eaterihe name of the organization. C. Mandatory Field - The formcannot be -processed widiWt this inforimation: your Federal Employer Identification Number. This is.your .9=digit tax ID nuriuber, issued bgthe-MS. Do.not enters tax-exempt number in.this field. A_ Check type of Bank accDimt "(ieckmg» or "Savings:' - = M The account number- at your Financial insfi"on to wbkh the funds will b_ _e "Ily Deposited." Do not use white-ouYor make any changes to the account number. F , This box has already been co wpleted by the U.S. Geological Survey.(USGS). G. Leave Blank . Tim individual(s) having -signature authority for the bank account should sign and date - Section l"on the left side: Soect —2: To be completed by the .payee or financial institution This section has already been" completed by the USGS. You are not required to. complete Section Z. ._ - -- Section►-3_ Tv�ecomplete tiyyotu financial imstitutio�i - - - - - _ - _ The bank's representative must sika the form add provide a telephone number for contact purposes. The depositor amount .tide MDST'be filled iM and should mateb the payee name W most cases. Please maintaina copy for your . Please inail SF_1199A and Contact Information form to the address below: U_& Geological Sim" Bey 'ice ofAcquisition and Grants, NAPB Amr Mond Kommarucy 12201 Swwbe -Valley Dr_, M_S-205G Reston, VA 20192 rvn JALC tar tilt bVVEHIN I ENUENI tW WCUMENTS. US GOVERNMENT PRINTING OFFICE WASH3NGTON_ pC 20402 STOCK NO- 048-000CQ363-0 standard form 1199A TRev_ July 1984) Government Financial .Operations Treasury Dept_Cic 107b. 1,1111 SIGN_UP FORM DEFT OF .111E INTERIOR . DIRECTIONS US GBDIAGICAL. SURVEY • To sign up for Direct Deposit. the payee is'to read the. back of this . The claim number, and. type of payment are printed on Government, form and fill in the information requested in Sections 1 and 2- Then, checks_ (See the sample check on the back of :this form.) This informa- take or mail this fouls to the financial institution_ The. financial in- tion is_ also stated on berief'Iciarytannuitant award letters and other. stitutlon will verity the information in Sections 1 and 2, and will com-' documents from the Government agency, plete Section 3_ The completed form will be returned to the Govern- rrientagency identified below_ Payees most keep the Government agency informed of any address changes in order to receive important information about benefits and A separate form must be completed for each type of payment to be to remain qualified for payments. sent by Direct 'Deposit_ . SECTION 1 (TO BE COMPLETED BY PAYEE) A. NAME OF PAY EE(last, lust, middle initial) D TYPE OF. OEPOS.ITOR ACCOUNT_ QCHECKING, aSAVINGS = E DEPOSITOR ACCO' ONT. "MBER AOORESS (Street, route, P O Box, APU/FPOj CiTY STATE ZIP CODE ¢ TYPE OF PAYMENT {,Check only one) fl. social Securisy - : s El. Salary/Mil_ Civiliatl Pay' QSupplementalSe"drylnco_me..-.MiLActive O:Railroad Retirement ❑Mir_ Retire_ CiJirservi. Retiiernerit IOPM) 13- Mil_ Survivco�r�` - � VA Cor6llensatiori of Pension (w0iher =ti,��S- TE_LEPHQNE:NUMBER AREA CODE" "D �T, + �+ r7u!+eRTi�7 ! L t T,LT" r+ B- MANE C ts► U-41 N 11U.111JJJ 10 i�l C CLAIM OR PAYROLL ID NUMBER MN/TIN (9 Digits;). G THIS BOX FOR'ALL'OT.MENT OF PAYMENT ONLY (ifapplicable) TYPE _ " - Prefix Suffix 7:AMOUNT: - - PAYEEfJOINT PAYEE CERTIFICATION JOINT ACCOUNT HOLDERS CERTIFICATION foptional) I certify that 1 am entitled to the payment- identified above, and that I have read and understood the back of this forrrL in signing this form, I I certify that I have re.ad-and understood the back of this form, including the SPECIAL NOTICE TO JOINT ACCOUNT HOLDERS_ authorize my payment to be sent to the financial institution named - below to be deposited to the designated account. SIGNATURE DATE- SIGNATURE DATE SIGNATURE DATE SIGNATURE DATE SECTION 2 TTO BE COMPLETED BY PA;YEE OR FiNAXIAL. INSTITUTION) GOVERNMENT AGENCY NAME GOVERNMENT AGENYCApDRt_SS ' -12201'Sunrise Valley Drive' AS 205E US" GBDIAGICAL SURVEY Reston:, VA- - 20192 SECTION 3 (TO BE COMPLETED BY FINANCIAL :INSTITUTION) NAME AND ADDRESS OF FINANCIAL INSTITUTION ROUTING NUMBER CHECK DIGIT aaaaaa�aa .- - a DEPOSITOR ACCOUNT TITLE FINANCIAL INSTITUTION CERTIFICATION t confirm the identity of the above -named payees) and the -account number and title. As representative of the above -named financial institution, I cer- tify that the financial institution agrees to receive and deposit the payment identified above in accordance with 31 CFR Parts 240, 2009, and 210_ PRINT OR TYPE REPRESENTATIVE'S NAME SIGNATURE OF REPRESENTATIVE TELEPHONE NUMBER DATE Financial instautions shouid refer to the GREEN BOOK for further instructions - THE FINANCIAL INSTITUTION SHOULD MAIL THE COMPLETED FORM TO THE GOVERNMENT AGENCY IDENTIFIED ABOVE. CONTACT MFORMATION - _ - =.fir c`iintacfi . - - _ -, .. - - •� - - - : - - - , . Tide. _ En ad Address -_A Albeiinate Contic t PhoneNumber Vinafl Address - x � (7tusfoms rsxtRte4[ed 2. RECIPIENT• ORGANIZATION (i _FEDERAL GRANTOR OTHER . IDENTIFICATION NUMBER (Show a subdivision by other identr7ying numbers if required. by the Federal Sponsoring Agency) (a) mrrie or+l -be sAown in a7ern S 27"1}. 'r: 3 PERIQq.C-OV1 RED't3Y.:TFUS f2EPORT,{}ts sirr3tvn on Sri2). Ft2OM'(mor�h a'. year, TO: (month `day year), or other agreement © --ed bye t ioet 1Use.add-d'a6na1-fonns.if more space is required: RECIPIENT. ACCOUNT NUMBER FEDERAL SNARE OF-NET4 BURSEMENTS OR OTHER;. IDENTIFYING NUMBER NET DISBURSEMENTS (Gross CUMULATIVE disbursements less program income NET DISBURSEMENTS received) FOR REPORTING•PERIOD (b) (c) (d) $ g 5_ TOTALS (Should correspond with amounts shown on SF 272 as follows: $ caumn (c) the same as fine 114- column (d) the sum offines. and- 11i of the SF 272 and cumglaLtve disbursernenfs shown on last report AUach explanation of any di/ierences,) Public reporting burden. for this collection of information is estimated to.average 120 minutes per response, including time for -reviewing instructions, searching existing data sources, gathering and maintainingthe_ data needed, and completing and reviewing the collection of information. Send comments regard -mg the burden estimate or anyother aspect of this collection of information, inducting suggestions for reducing this burden, to.the`Oifrce of Managementand Budget, Paperwo Reduction < .. . Projcxt��48:-0Oh3). Wastwtylon,.DC 20503 . PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. AUTHORMM FOR LOCAL REPRODUCTION STANDARD FORM 272A (Rev. 7-9T) Previous Edition Usable Prescribed by OMB Circulars A-102 and A-110 272-2013 R +7 Axal,,.fi�`ya..i-,fir-Fa x,iF yi`t i;�'src'ry f2" i 14;< '^ - ' 1.d'x=S..'I' 1 „¢ .sr.,,. .'F$,• �ON '� H �,� �. � `'�r"`�.,✓ „� ,.�-�',e•,�e a' q � Y�;T�aa� 5•$"� : � 9`a�.'�•?-'a�C�s � - - ME I Pc+olic repcxbr}g�burNKer`r� {��afi_o �5�� �t.:rhv�rew�ng iru�tons searchmgex�sbngdaiasoursga#earx%m��nlarmngitIle; d"� N tttcoe�6oir rnCiirmabo�ia Sendcnrtients regarding -the bttrdi* reducing; this burden to the' Orfice of Managementanti•Budget PaperworkReducbwProtect'(034"003) W shington W3 2Q�5Lf � PLEASE DO NOT RETURN YOUR' COMPLETED FORM TO THE OF ICkE (iF`MANAGEMENT AND` $UDG.ET. SEND 1T TO THE ADDRESS PROVIDED BY THE SPONSORING AGEfi�CY. Y Please type or print legibly_ items 1, 2, $, 9, 10, 11d, 11e, 1 ih, and 15 are self explanatory, specific instructions for other items are as follows: Item Entry . 3 Enter Employer Identification Number (EIN) assigned .by the U_S_ Intemal Revenue Service or the FICE (institution) code. 4 1f this - report covers more : than one grant or ,other agreement, leave items 4 and :5 blank and provide the information on Standard- Form 272A, Report of Federal Cash Transactions - Contirr iced. Enter Federal.grant number, agreement number, or other identifying numbers if requested by sponsoring agency. 5 This space reserved for an- account number or other identifying number that may be assigned by the recipient. 6 Enter the.letter of credit number that applies to this. report If all advances were made by. Treasurycheck, enter "NA" for not applicable and leave.rtems 7 and 8 blank. Item Entry benefits if. treated as a direct cost, interdepartmertat charges for supplies and services, a;.d the zriza,it to which the. recipient is entitled for indirect costs. 1 ig Enter the Federal share of.program income that was required to be used o11 the project or program by the terms of the grant or agreement._ 11i Enter the amount of all adjustments pertaining to prior periods affecting the ending balance that have-not -been included in any limes above. Identify each :grant 'or agreement for whk* adjustment was made and enter an explanation. for each adjustment under "Remarks." Use plain sheets of paper if additional space is req:jxad. 11j Enter the total amount of Federal Gash t,n i.and at vl;e- end of the reporting period. This amount:should include all funds on deposit, imprest funds, and undepos;ted . funds (fine e, less line h, plus or minus line i). 7 Enter the voucher number of the last letter -of -credit payment voucher (Form TUS.5401) that was credited to 12. Enter the estimated number of days until the cash on your account hand, shown on line 11j, :will be expended. If more than three days cash .requirements are oar hand, provide an 110 Enter the total amount of Federal cash on hand at the explanation under: "Remarks' as to why the.drawdow1i beginning of gte, reporting' period. including' all of the was made prematurely,.or.other reasons for the excess Federal funds bn deposit; imprest funds, and undeposited cash. The requirement for the explanation dues not Treasury checks. ' apply to prescheduled or automatic advances: 11b Enter total amount of: Federal funds received through 13a Eater the amount of interest earned on advan. es of payment vouchers (Form-TUS 5401) that were credited to Federal funds but not remitted to the Federal agency= if your account during the reporting period. this includes any amount earned and not remitted to the Federal sponsoring agency for over 60 days, explain 1 1c Enter the total amount of all Federal funds received under "Remarks." Do not report interest earned on during the reporting period through Treasury checks, advances to States. whether or not deposited. 13b Enter the amount of advance to secondary recipients 1 if Enter.the total Federal cash disbursements; made during included in item 11h. the reporting .period, including cash received as program income. Disbursements as used here also include the 14. In addition to providing explanations as required -bone, amount of advances and payments less refunds to give additional explanation deemed necessary by the subgrantees or contractors;_ the gross amount of direct recipient and for information required by the Federai salaries and wages, including the. employee's share of sponsoring agency in compliance with governing legislation. Use plain sheets of paper if additional space is required. STANDARD FORM 272 JRz - 7-i i; dec,-