HomeMy WebLinkAboutCHILDREN AND YOUTH COORDINATING COUNCIL PASS THROUGH GRANT
Augusta Richmond County, Georgia
New Grant Proposal/Application
Before a Department/agency may apply for the grant/award on behalf of Augusta
Richmond County, they must first obtain approval signature from the Administrator
and the Finance Director. The Administrator will obtain information on the grant
program and requirements from the funding agency and review these for feasibility to
determine if this grant/award will benefit Augusta Richmond County. The Finance
Director will review the funding requirement to determine if the grant will fit within
our budget structure and financial goals.
Date of Grant Request: (~- 1/. 01
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7 ~J5'- 0 ~I
Grant Description: C \! C _L-
A '/t(f~.J/'4 PQ~iw"<:;~/f
Grant Amount: $ q / sV
A4t1'lL..$!-"" PCtrlntVS !-.'f- J;y- cln, Idre 11\
Pa ~<:; 'if) t/'J c. ~ /.. 91(' (' V\ ~ ~
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Department Requesting Grant:
(Matching Funding Required jgJ Yes 0 No
Fiscal Year of Grant: ':;;007
~~C-~ lijdp,/
Dopartm.eBt!El~cteaoffic' I Signature . Date
_._._._._._r!~~nft._._._._._._._._._._._._._._._._._._.-.-.-.-.-.-.-.-.
1.) I have reviewed the grant application and enclosed materials and:
~pprove, the Department/Agency to move forward with the application
o Deny the Request:
) L!/j/O ?
Date
2.) I have reviewed the grant application and enclosed materials and:
I Find the grant/award to be feasible to the needs of Augusta Richmond ~ l~ ,)J-l:J/
County
o Deny the Request:
f)~ $. t.iJ~_~
Finance Director
Id.- //- 0'1
Date
This form will also be used to provide the external auditors with information on all
grants for compliance and certification requirements as required by the State and
Federal Government.
ATB003 Form-l
........
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,'176
STATE OF GEORGIA
CHILDREN AND YOUTH COORDINATING COUNCIL
Pete Colbenson, Ph.D.
Director
August 2, 2007
Honorable Deke Copenhaven
Augusta-Richmond County Commission
530 Green Street, Room 806
Augusta, GA 30901
Dear Mayor Copenhaven:
Thank you for submitting a grant application to the Children and Youth Coordinating Council. It is my pleasure to announce
that your application for grant funds has been approved for funding of $9, 754.00. Your program, Just the Two of Us, has been
designated as sub grant 04P-10-09-0006 with a grant period of 8/1/2007 -9/30/2007.
Enclosed is the Statement of Subgrant Award, General Conditions and Special Conditions (if applicable) placed on the
sub grant. After careful study of the conditions, please acknowledge your acceptance by signing the original Statement of
Subgrant Award, General and Special Conditions and retum them to my office by August 10,2007. It is important that you
retain a copy of the Award and Conditions for your files and reference. Failure to return these documents by the deadline
may result in the loss of the grant award.
As stated in the General Conditions, the Council requests that you include a statement as to the funding source of this program
on all correspondence, publications and media releases, etc. If you have any questions regarding this grant, please do not
hesitate to contact my staff at (404) 508-6574.
Sincerely,
~:-~
Executive DIrector
cc: Ms. Maggie Graves, Finance Director
Central Savannah Regional Commission
Fourth Floor. 3408 Covington Highway' Decatur, Georgia 30032-1513. (404) 508-6574. Fax (404) 508-7336
www.cycc.state.ga.us
AN EQUAL OPPORTUNITY EMPLOYER
CHILDREN AND YOUTH COORDINATING COUNCIL
3408 Covington Highway, 4th Floor
DECATUR, GEORGIA 30032
STATEMENT OF SUBGRANT AWARD
Subgrantee:
Augusta-Richmond County Commission
Just the Two of Us
Date of Award:
8/1/2007
Project Title:
Federal Funds:
$9,754.00
Grant Period: 8/1/2007 - 9/30/2007
Matching Funds:
$4,877.00
Grant Number 04P-10-09-0006
Total Project Cost:
$14,631.00
Award is hereby made in the amount and for the period shown above of a grant underthe Juvenile Justice and Delinquency Prevention
Act of 1974,P.L. 93-415, as amended, to the above-mentioned subgrantee, in accordance with the plan set forth in the application of
the above-mentioned subgrantee and subject to the attached general and special conditions.
This award is subject to all applicable rules, regulations and conditions as prescribed by the Children and Youth Coordinating Council's
Subgrantee Finance Manual, OMS Circulars A-87, A-110, A-122 and A-133 and the U.S. Office of Justice Programs Financial Guide. It
is also subject to such further rules, regulations and policies as may be reasonably prescribed by the State of Georgia and the United
States Department of Justice, consistent with the purposes and authorization of P.L. 93-415, as amended..
This grant shall become effective on the beginning date of the grant period, provided that within thirty (30) days of the award execution
date (below), the properly executed original of the "Statement of Subgrant Award" is returned to the Children and Youth Coordinating
Council.
nd Youth Coordinating Council
8/2/2007
Date Executed
I, , acting under my authority to contract on behalf of the subgrantee, hereby signify
acceptance for the subgrantee of the above-described grant on the terms and conditions stated above or incorporated by reference
\]V i'le "(fie. 7
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Original Signature
Subgrantee Federal Employer Identification Number
i4It'{t,j--
Title
INTERNAL USE ONLY
T1F-EA
REFERENCE
47-063002
PROGRAM
0510101
EFFECTIVE DATE
8/1/2007
CONTRACT #
04P10090006
DEPARTMENT CODE
CLASS
PROJECT
FUNDING SOURCE
4610047001
680
28447001
DESCRIPTION (23 MAX)
FEMALE PREV.lINTERVN
ACCOUNT
707002
AMOUNT
$9,754.00
Augusta-Richmond County Commission
04P-10-09-0006
GENERAL CONDITIONS
1.
The subgrantee agrees and understands that neither this grant award nor its successful implementation commits the
Children and Youth Coordinating Council to any future funding.
2.
. ., , . '-- :,..":",/;,,, :._' \
All contracts and purchases must be awarded in accordance with stat'e and federal regulations as specified in the
CYCC Subgrantee Finance and Manual. Purchases (individual or several on one purchase order) totaling $5,000 or
more must follow state regulations in regard to soliciting competitive bids.
Requests for proposals or invitations for bid issued by the subgrantee to implement the grant project are to provide
notice to prospective bidders that the JJDP organization conflict of interest provision is applicable in that contractors
who develop or draft specifications, requirements, statements of work and/or RFPs for proposed procurement shall
be excluded from bidding or submitting a proposal to compete for the award of such procurement. Ref: U.S.
Department of Justice Financial Guide.
3.
4.
The subgrantee agrees that when issuing statements, press releases, RFPs, bid solicitations, and other documents
describing the project, funded in whole or in part with CYCC money, shall clearly state (1) the percentage of the total
cost of the project which will be financed with federal/state money, (2) the dollar amount of federal/state funds for the
project, and (3) the source of grant funds.
5.
Subgrantee must provide written notification to the Children and Youth Coordinating Council that the project has
been implemented within sixty (60) days of the date of this grant award. FAILURE TO DO SO MAY RESULT IN
LOSS OF GRANT FUNDS.
6.
The subgrantee agrees to submit a Quarterly Progress Report within thirty (30) days of the end of each quarter (3
months) based on the project grant period. Therefore, it is mandatory for the subgrantee to file a Quarterly Progress
Report and Request for Reimbursement to receive reimbursement. PLEASE NOTE: REIMBURSEMENT WILL BE
WITHHELD IF THESE REPORTS ARE NOT RECEIVED BY THE DATE DUE.
7.
The subgrantee agrees to submit a Final Evaluation Report and a Final Request for Reimbursement within thirty (30)
days of the end of the grant period. Failure to submit a completed Final Evaluation Report and Final Request for
Reimbursement will adversely affect continuation funding and/or opportunities for future funding.
Continuation awards (if applicable) are subject to termination if a final evaluation report for the preceding grant year
is not filed within thirty (30) days of the conclusion of that grant year. This report must include data regarding each
objective described in the grant application for that year.
It is the responsibility of the subgrantee to adhere to audit requirements outlined in the CYCC Subgrantee Financial
Manual.
8.
9.
10. All financial records must be maintained in good order and must be available at all times during the regular business
day for audit purposes to the CYCC, U.S. Department of Justice, the Comptroller General of the United States, or
their representatives.
11. Subgrantee agrees not to purchase or use in the course of this project any electronic, mechanical or other device for
surveillance purposes in violation of 18 USC2511 and any applicable state statute related to wiretapping and
surveillance.
12 CYCC requires all subgrantees to establish and enforce an Internet Security Policy when minor participants and/or
staff have access (supervised or unsupervised) to the Internet. This includes any technology provided by CYCC
funding and technology utilized by participants during a CYCC funded program component. The Internet Security
Policy is intended to restrict access to inappropriate and harmful materials, such as obscene or pornographic
content and/or e-mail or chat rooms that may comprise participant personal identification information. CYCC does
not recommend or require any specific security or filter program, however a list of .Internet security programs is
available from CYCC upon request. .
13. In the event of a finding of discrimination by a federal or state court/administrative agency, subgrantee agrees to
forward a copy of such finding to both the Children and Youth Coordinating Council and the Office for Civil Rights,
Office of Justice Programs, 810 7th Street, N.W., Washington, D.C. 20531.
14. Subgrantee agrees that services provided under this grant award will not be withheld from participants based on a
protected class as defined by the Omnibus Crime Control and Safe Streets Act of 1968.
15 The subgrantee agrees to conduct ciminial background checks (via Georgia Crime Information Center) on all
personnel and volunteers who will have direct contact with youth served by the grant project. These background
checks will take place prior to the provision of services by program personnel, and the subgrantee will maintain a
copy of these records for CYCC auditing purposes.
16. Programs may not provide incentives (e.g., trophies/plaques, rewards for individual accomplishments, gift
certificates, gas cards, etc.). Items such as motivational tools, training aids, and educational materials may be
purchased. These items must be provided to all participants.
(). .14.. ~
Original nature
f'AVOI-'
ff(tJ7 Date
Title
Augusta-Richmond County Commission
04p-10-09-o006
Special Conditions
1. Prior to reimbursement, subgrantee must submit the following completed certification(s) signed
by the Executive Director: Certification of Equal Employment Program
2. Prior to the reimbursement of funds, subgrantee must submit a letter of consent signed by the
Chairman of the Richmond County Board of Commissioners.
3. Subgrantee acknowledges that all published material and written reports produced in
conjunction with subgrant or contracts must acknowledge that publication was supported in part by
a subgrant from the CYCC under a grant from { enter name of appropriate federal/state funding
source}. Please refer to page 15 of the 2007 CYCC Subgrantee Finance Manual. If you have any
questions/concerns, please do not hesitate to contact Tonya Fair @ 404-508-6576 or
T onyaF air@cycc.state.ga.us
4. Prior to reimbursement, subgrantee must provide verification of donation of space.
5. Prior to reimbursement, subgrantee must submit at least two letters of support for their program
from other sources.
6. Please note that the grant award covers two months, with no possibility of an extension or
continuation funding
Li ~1m~;gf!--
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I I
Date
.t.t Iti 0 t-
Title
DateDue:
DateDue:
DateDue:
DateDue:
DateDue:
DateDue:
U\.f!; .\PPflOv..\L '0. : ::':.,);.11)
ASSVR.\NCES
The Applicant hereby assures JIlJ Lc'rtilies compliancc with all Federal statutes. regulations, policies, guidelines and requirements, including
~)MB llrcul~rs~o. 1\-21. ..\-110. A-I22. ..\-128, A-W:': E.O. 12372 and Cnifoml Administrative Requirements for Grant, and Cooperative
t\greernents-.cS lFl{, Part (,6. Common Rule, that govern the application, acceptance and use of Federal funds for Ihis federcllly-assisteJ project
Also the Applicant assures and cenilies that: .
It possesses legal Juthority to .IPply for the grant: that .1 resolution.
mC!.tron or sunIlar action has, been duly adopted or passed as an
l~fhclal act of the applIcant s "ovemmg body, authorizing the
IIlrng of the applicauon,. mJ1udmg all understandings and
assurances co_nta1l1ed th.:rcl11, and dlft:cting and authoriz1l1g the
person IdenlIlIed as the offiCial rC(~res.:ntauve of the applicant to
act .1!1 connectIOn With the applicatIOn and to provide such
addltlOnalmformatlon as may be r.:quired.
2. It will comply ",:ith requirements of the provisions of the Uniform
RelocatIOn ASSistance and Real Propel!)' ACCjuisitions Act of
1970 P.L. 91-646) wh.ich provides for fair and equitable
treatment of persons dtsplaced as a result of Federal and
federally-assisted programs.
3. [t ",:ill complY.lYith provisions of Federal law which limit certain
polrucal actIvIties of ell1ployees of a State or local unit of
go,:,eITIment whose pnnclpal employment is in connection with an
actIvIty financed 111 whole or III part by Federal grants, (5 USC
150I,elseq.)
4. It wi.!I comply with the minimum wage and maximum hours
provIsIOns of the Federal Fair l.abor Standards Act if applicable.
5. It will establish safeguards to prohibit employees from using their
Posl.lIons for a purpose that .IS or glye the appearance of being
mot!vated by a des~re for pm'ate galll for themselves or others,
partIcularly those wlth whom they nave family. business. or other
lies.
6. It will give the sponsoring agency. or the Comptroller General,
thwugli any authonzed reprt'sentatIve, access to and the right to
examme all records, books, papcrs, or documents related to the
grant.
7. It will comply with all requirt:ments imposed by the Federal
Sponsonng ,!gency conccrnmg spe.ci;}1 requirem"nts of law,
program reqUIrements, and other admmlstratIve reqUIrements.
R. It .will insure that the facilities )lnder its o""nership lease or
sup~rvlslOn which shall be utIlIzed in the accomplishment of the
proJect.are no~hsted III the. EnvIronmenta.! protection Agency's
(E.PA-IIst of \ IOliltmg Fac.lhtles and that It will n.otifv tfie Federal
gr.antor agency ot the receIpt of any commulllcallon from the
Dlre~tor of the EPA Office of Federal Activities indicating that a
facility to be used m the projcctls under consideration for listing
by the EPA.
9. It will comply with the flood i!1surance purchase requirements of
Secllon 102(a) of the Flood DIsaster Protection Act of 1973 Public
Law 93-234. 8":' Stat. 9":'5 approvt:d December 3], 1976. Section
.I02(a) requlft:s. on and after \-larch 2, .1975. the purchase of flood
. IIlsurance m commullltles Ivhere such IIlsurance IS available as a
condlllon for the n:ceIpt of any Federal financial assistanct: for
construcTion or aCl.juISltlOn purposes for use in any an:a that had
h~enldentIfied by the S.:crerary of the Depanmcnt of Housing and
Lrb,lI1 Development as :m ~lf(:a havll1g sReclal t100d hazards the
phrase: "Fcderaltinancial assistanct:"rncludes any form' of loan,
grant, guaranty. msur:lI1ce payment, rebate. subsiav. disaster
assistance loan oJr grant. l1f ,my other form of direc't .Jr indirect
Federal assIstance.
Si::m:ttllrc
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',;iP h.'F\f"; ..: 'I; '.
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10. It ""iII assist tJ:le Federal gran~or :Igency in its compliance ""ith
St:ctlOn 100 of the NatIOnal Hlstonc Preservation Act of 1966 as
amended (16 USC 470), Executive Order I] 593, and the
.~\rche()logical and Historical PreservJtion Act of 1966 (16 CSC
)69a-1 ~t seq.) by (a) consultmg With the State Historic
Preservation . Officer on the ('onlluct of investigations as
necessary, .to Identify properties listed in or eligible lor incIl;sion
m the National RegIster of Hlstonc Places tnat are subject to
adverse effects (see 36CFR PartXOO.8) by the activity, and
noufYmg the Federal grantor agency of the. existence of any such
properties, and by (b) complymg WIth all requirements
establIsht:d by the Federal grant~r agency to avoid or mitigate
adverse dfects upon such properties.
11. It will comply, and assure the compliance of all its subgrantees and
co,:\tractors, With the apphcable provISIons of TItle I oflhe Omnibus
Cnmt: (ontrol and Safe Streets Act of 196R, as amended the
Juvenile Justice and Delinquency Prevention Act or the Victims of
Crime Act, as approllriate: the provisions of the e'uITent edition of
the Office of Justice Programs Financia} and Administrative Guide
for Grants, M7 I 00. !: and all other applIcable F ederallaws. orders,
CIrculars, or regulations.
12. [t will comply with the provisions of 28 CFR aRPlicable to grants
and. cooperative agreements .m<:ludmg part Ill', Administrative
Revle"" Procedure; "part 20, Cnmlllal JustIce Information Systems'
Part 22,. Confidentlahty of .ldt:ntlfiable Research and Statistical
[nlomlatlon; Part 23, Cnmmal Intelligence Sy~tems Operating
Poh~les' Part 30, Intergovernmental ReVIeW of Department of
J,ustlce Programs and Activities('. Part 42, Nondiscrimination/Equal
Employment Opportulllty Po ICles and Procedurt:s: Part 61
Procedures for rmplem~nting the National Environmental Policy
Act; Part 63, Floodplam Management and Wetland Protection
Proceduresi-,and Federal laws or regulations applicable to Federal
Asslstanct: l'rograms.
13. It will cOIl1Ply,' and al.1 its contractors wil! comply, with the
nondlscnmmatlon reqUIrements of the Omlllbus Cnme Control
a!ld Safe Stret:ts Act of 196R, as amended 42 USC 3789(d). or
VictIms of Cnme Act (as appropriate); title V[ of the Civil
Rights. . Act of 1964. ~ as amended; Section 504 of the
Rehabilitation Act of 19, 3, a~ amended; Subtitle A. Title II of
the Amencans 'IV Ith DISablhtles Act \ADA) (1990); Title IX of
the Education Amendments of 1972; t 1e Age Discnmination Act
of 1975; Department of Justice Non-Discrimination Regulations
28 ~FR Part 42, Subpa.rts C, D. .E, an~ Gi and DCfJartment of
Justice regUlatIOns an dlsablhty dlscnmmatlOn. 28 CFR Part 35
and Part 3'9.
14. In th~ cv.ent a Federal or Slate court or Federal or State
admmlstratlve agency makes a finding of discrimination after a
due proce~s heanng an. tht;. grounds of race,. color, religion,
natloral ongul, sex, or dlsabllItv agamst a recipient of funds, the
reCipient wiTl lorward a copy of the findll1g to the Offke for Civil
Rights, Oftict: of Justice Progr:lITIS.
15. [t I\ill proviJean Equal Employment Opportunity Pro<>ram if
rc'qlllfed to mall1tain one. where th.: application is {or 5500.000
or more.
10. [t II ill c,)mply with rhe pro\ isi'.lns .Jf rhe CO,I"tal Barrit:[.
Resources ,\ct (P.L. 9"'-348) dakd Ocrober 19.1 '1512 (/6l'SC
~5111 et. "eq.) Iyhich pr'Jhibirs the e:~penditure of most nell
tcueral tU'lds II nhlll the lInHS 01 the L l'.:istal Bamer Re,ourc<.:s
~y"tem.
D.He
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DETAILED BUDGET SUMMARY
Au usta-Richmond Count Commission
Grants Funds
CYCC USE ONLY
04P-10-09-0006
Subgrant Number
Re
Matching Funds
Percent of Budget
2. Fringe Benefits
Sub-Total $0.00 $0.00
B. REGULAR OPERATING:
Instructional Materials $1,584.00 $1,584.00
Nutritional Snacks $960.00 $960.00
Printing $320.00 $320.00
Media Awareness $270.00 $270.00
Field Trip $3,620.00 $3,620.00
Television, Radio, Media $3,000.00 $3,000.00 $3,000.00
Sub-Total $9,754.00 $9,754.00 $3,000.00
C. TRAVEL:
Sub-Total
$0.00
D. EQUIPMENT:
Meeting Space & Transportation
Sub-Total
E. PER DIEM, FEES & CONTRACTS:
$0.00
Sub-Total
F. TELECOMMUNICATIONS:
$0.00
Sub-Total
$0.00
$9,754.00
GRAND TOTALS
Revised November 2005
$0.00
$1,877.00
$0.00
$1,877.00
$0.00
$0.00
$9,754.00
$4,877.00
$4,880.00
100%
CERTIFICATION OF EQUAL EMPLOYMENT PROGRAM
(appUes to state and local governments)
CD I,
David S. Copenhaver
(agency executive officer)
, certify that
Augusta-Richmond County
(applying agency)
has fromulated an
Equal Employment Opportunity Program in accordance with 28 CFR 42.301,
et ~, subpart E, that it has been signed into effect by the proper agency
authority ,and ,disserninated,toaILemployees, and that it is 0" Jilein the office of:
Diana Darris
(person's name)
500 Greene Street, Augusta, GA.
(address)
EEO Coordinator
(title)
for review or audit by officials of the Children and Youth Coordinating Council
or the Office for Civil Rights, U.S. Office of Justice Programs, as required by
relevant laws and regulations.
u.:{>{,~ --
(Signature of Age y Executive Officer)
1jf/Jl
(Dite)
*******************************************************
()~ ********************.*******************~******.*******
Certification (no EEOP required)
(g) /,
(agency executive officer)
, hereby certify that the
(applying agency)
, has less than that employees and
is not required to maintain an EEOP, pursuant to 28 CFR 42.301, et seq.
(Signature of Agency Executive Officer)
(Date)
O~
. I '. ,', ,
.. .
U.S. DEPARTMENT OF JUSTICE
OFFICE OF JUSTICE PROGRAMS
OFFICE OF THE COMPTROLLER
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT; SUSPENSION AND
OTHER RESPONSIBILITY MATTERS; AND DRUG.FREE WORKPLACE REQUIREMENTS
Applicants should refer to the regulations cited below to determine the certification to which they are required to
attest. Applicants should also review the instructions for certification included in the regulations before completing this
form. Signature of this form provides for compliance with certification requirements under 28 CFR Part 69, "New
Restrictions on Lobbying" and 28 CFR Part 67, "Government-wide Debarment and Suspension (Nonprocurement) and
Government-wide Requirements for Drug-Free Workplace (Grants)." The certifications shall be treated as a material
representation of fact upon which reliance will be placed when the Department of Justice determines to award the
covered transaction, grant, or cooperative agreement.
",0". ,
',.1'. ".', t
1. Lobbying
As required by Section 1352, Title 31 of the U.S. Code, and
implemented at 28 CFR Part 69. for persons entering into a
grant or cooperative agreement over $100,000, as defined at
28 CFR Part 69, the applicant certifies that:
(a) No federal appropriated funds have been paid or will be
paid, by or on behalf of the undersigned, to any person for
influencing or attempting to influence an officer or employee of
any agency, a Member of Congress, an officer or employee of
Congress. or an employee of a Member of Congress in con-
nection with the making of any Federal grant, the entering into
of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any Federal grant or
cooperative agreement.
(b) If any funds other than Federal appropriated funds have
been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with this
Federal grant or cooperative agreement, the undersigned shall
complete and submit Standard Form - LLL, "Disclosure of
Lobbying activities," in accordance with its instructions;
(c) The undersigned shall require that the language of this cer-
tification be included in the award documents for all subawards
at all tiers (including subgrants, contracts under grants and
cooperative agreements, and subcontracts) and that all sub-
recepients shall certify and disclose accordingly.
1. Debarment, Suspension, and other
Responsibility Matters (Direct Recepient)
As required by Executive Order 12549, Debarment and
Suspension, and implemented at 28 CFR Part 67. for prospec-
tive participants in primary covered transactions, as defined at
28 CFR Part 67. Section 67.510-
A. The applicant certifies that it and its partiCipants:
(a) Are not presently disbarred. suspended, proposed for
debarment, declared ineligible. sentenced to a denial of
Federal benefits by a State or Federal court, or voluntanly
excluded from covered transactions by any Federal depart-
ment or agency;
Ib) Have not within a three-year period proceedmg this applica-
tion been convicted of or had a Civil Judgment rendered against
them for commission of fraud or a cnminal offense in connec-
tion 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, thett, forgery, bribery, falsifica-
tion or destruction of records, making false statements, or
receiving stolen property;
(c) Are not presently indicted for or otherwise criminally or
civilly charged by a governmental entity (Federal, State, or
local) with commission of any of the offenses enumerated in
paragraph (1 )(b) of this certification; and
(d) Have not within a three-year period preceding this applica-
tion had one or more public transactions (Federal, State, or
local) terminated for cause or default; and
S. Where the applicant is unable to certify to any of the
statements in this certification, he or she shall attach an
explanation to this application.
3. Drug-Free Workplace
(Grantees Other Than Individuals)
As required by the Drug-Free Workplace Act of 1988, and
implemented at 28 CFA Part 67, Subpart F, for grantees, as
defined at 28 CFR Part 67 Sections 67J~1' and 67.620-
A. The applicant certifies that it will or will 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 employees for
drug abuse Violations occunng 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 state-
ment required by paragraph (a);
id) Notifying the employee In the statement required by para-
graph (a) that. as a condition of employment under the grant,
the employee will-
OJP FORM 4C61EI3.91) REP~ACES OJPFORMS 4061,2, 4061 3 AND 40')61,4 ,';HiCH ARE OBSOLETE
( 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 occuring in the workplace no
later than five calendar days after such conviction;
(e) Notifying the agency, in writing, within 10 calendar days
after receiving notice under subparagraph (d)(2) from an
employee or otherwise receiving actual notice of such convic-
tion. Employers of convicted employees must provide notice,
including position title, to: Department of Justice, Office of
Justice Programs. ATTN: Control Desk, 633 Indiana Avenue,
NW., Washington, D.C. 20531. Notice shall include the identifi-
cation number(s) of each affected grant;
(f) 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;
(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)
CheckOif there are workplaces on file that are not identified
here.
Section 67, 630 of the regulations provides that a grantee that
is a State may elect to make one certification in each Federal
fiscal year. A copy of which should be included with each appli-
cation for Department of Justice funding. States and State
agencies may elect to use OJP Form 4061/7.
Check 0 if the State has elected to complete OJPForm
4061/7.
Dru9"Free Workplace
(Grantees Who Are Individuals)
As required by the Drug-Free Workplace Act of 1988, and
implemented at 28 CFR Part 67, Subpart F, for grantees, as
defined at 28 CFR Part 67; Sections 67.615 and 67.620-
A. As a condition of the grant, I certify that I will not engage in
the unlawful manufacture, distribution, dispensing, possession,
or use of a controlled substance in conducting any activity with
the grant; and
B. If convicted of a criminal drug offense resulting from a
violation occurring during the conduct of any grant activity, I
will report the conviction, in writing, within 10 calendar days of
the conviction, to: Department of Justice, Office of Justice
Programs, ATTN: Control Desk, 810 Seventh Street NW.,
Washington, DC 20531.
As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above
certifications.
1. Grantee Name and Address:
2. Application Number and/or Project Name
Augusta-Richmond County, 530 Greene Street, Augusta, Ga. 30911
3. Grantee IRSNendor Number
04P-1 0-09-0006~'
4. Typed Name and 1itle of Authorized Representative
5. S,gcaloe" U .A~. v----
August 8. 2007
6. Date
'U.S. Gcwrnm8nt Pnntln'] OHI,:e: 1896.405-03740014
NON-SUPPLANTING CERTIFICATION
(to be completed by all appUcants)
Regulations adopted by the U.S. Office of Juvenile Justice and Delinquency Prevention
(OJJDP) require certification to the effect that federal funds have not been used to
increase state or local funds that would, in the absence of such federal aid, be made
available for juvenile justice and delinquency prevention. This certification is required as
part of the initial proposal for grant funds to the Children and Youth Coordinating
Council.
CERTIFICATION:
I certify that OJJDP funds will not be used to supplant state or local funds that would .
otherwise be available for juvenile justice assistance. I further certify that the project
proposed in the grant application meets all the requirements of the Juvenile Justice and
Delinquency Prevention Act and its implementing guidelines; that all the information
presented is correct; that there has beenappropriate coordination with affected
agencies; and that the applicant will complywith the provisions of the OJJDP Act, all
applicable federal and state laws, and the above-mentioned certification should a grant
be awarded.
Signature of App cant Executive Officer
David S. Copenhaver
Typed Name and Title
August 8, 2007
Date
SERVICE DELIVERY STRATEGY ACT COMPLIANCE
CERTIFICA TION
(applies to local governments and authorities)
I, David S. Copenhaver
(county commission chair)
, certify that
Richmond
(county name)
County is in
compliance with the Service Delivery Strategy Act (House Bill 489). I also understand that if my
county is not in compliance, the county and city governments contained therein are not eligible to
receive state-administered financial assistance, grants, loans, or permits.
c1 ~-,{.
Signature of Co
Augusta-Richmond County
Typed Name and Title
August 8, 2007
Date
CHILDREN AND YOUTH COORDINATING COUNCIL
41h Floor, 3408 Covington Highway, Decatur, Georgia 30032
ACCOUNTING SYSTEM AND FINANCIAL CAPABILITY INFORMATIONAL QUESTIONNAIRE
SECTION A: PURPOSE
The financial responsibility of subgrantees must be such that the subgrantee can properly discharge thc public trust, which
accompanies the authority to expend public funds. Adequate accounting systems should meet the following criteria as outlined in the
CYCC Subgrantec Finance Manual.
1. Accounting records should provide information needed to adequately identify the receipt of funds under each grant awarded
and the expenditure of funds for each grant, for each action program covered by a State's grants and for each subgrant
awarded by the State.
2. Entries in accounting records should refer to subsidiary records and/or documentation which support the entry and which can
be readily loc'ated. . .
3. The accounting system should provide accurate and current financial reporting information.
4. The accounting system should be integrated with an adequate system of internal controls to safeguard the funds and assets
covered, check the accuracy and reliability of accounting data, promote operational efficiency, and encourage adherence to
prescribed management policies.
SECTION B: ACCOUNTING SYSTEM
I. Has any Government Agency rendered an official written opinion concerning the adequa~f the accounting system for the
collection, identification and allocation of costs under Federal contracts/grants? 0 Yes LJNo
a. If yes, provide name and address of Agency performing review:
b. Attach a copy of the latestreview and any subsequent
correspondence, clearance documents, etc.
(Note: Ifreview occurred within the past three years, omit
questions 2-9 of this Section and Section C.
2. Which of the following best describes the accounting system? 0 Manual
3. Does the organization use a double-entry system in accounting for program funds?
4. Does the accounting system identify the receipt and expenditures of program funds
separately for each contract/grant?
5. Does the accounting system provide for the recording of expenditures for each grant/
contract by the component project and budget cost categories shown in the approved
budget?
6. Are time distribution records maintained for an employee when hislher effort can be
specifically identified to a particular cost objective?
7. Does the accounting/financial system include budgetary controls to preclude incurring obligations in excess of:
a. Total funds available for a grant? ~Yes DNo
b. Total funds available for a budget cost category (e.g. Personnel, Travel, etc.)? Yes BNO
8. Is the finn generally familiar with the existing regulations and guidelines containing the Yes No
cost principles and procedures for the determination and allowance of costs in
connection with Federal contracts/grants?
SECTION C: FUND CONTROL
I. Is a separate bank account maintained for grant/contract funds?
2. If Federal granLcontract funds are commingled with organization funds, can the Federal
grant funds and related costs and expenses be readily identified?
SECTION D: APPLICATION CERTIFICATION
I certify that the above infonnation is complete and correct to the best of my knowledge.
I. Signature of APR icant Executiv Officer
. " . f1------'
OAutomatedu 0 Combination
BYes DNo []Not Sure
Yes DNo []Not Sure
DYes DNo DNotSure
DYes DNo []Not Sure
DNot Sure
[]Not Sure
DNot Sure
DYes 0 No
DYes 0 No
[]Not Sure
[]Not Sure
b. Finn Name, Address, and Telephone Number
a. Title:
1f1 h-(" J.-
AUDIT INFORMATION
(to be completed by all applicants)
AGENCY'S
FISCAL YEAR:
11/ iliL.4/
~j-1VJjI /) (
Enter Appropriate 1 2-Month Cycle
(e.g., Jan. 1-Dec. 31; July 1-June 30; Oct. 1-Sept. 30)
DATE OF LAST AUDIT: rA66 G
DA TE OF NEXT AUDIT: ~ DO 7
If a grant award is issued to your agency, note the approximate date the
audit/compilation will be submitted to CYCC:
~rl~t
(to be submitted verifying receipt &
expenditure of CYCC funding)
Ap'plying Agency Name
Note: Most grants will cover two fiscal periods, and thus, two audits/compilations
will need to be submitted to CYCC.