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HomeMy WebLinkAboutDISTRICT ATTORNEY VWAP SUGRANT AWARD GRANT PERIOD 10/01/09 -09/30/10 REFERENCE NO.: 13xxx OFFICE OF THE GOVERNOR CRIMINAL JUSTICE COORDINATING COUNCIL SUBGRANT AWARD SUBGRANTEE: Richmond County IMPLEMENTING AGENCY: Augusta/Richmond County FUNDING CATEGORY: District Attorney VWAP SUB GRANT NUMBER: C09-8-010 FEDERAL FUNDS: $ MATCHING FUNDS: $ TOTAL FUNDS: $ 35,261 8,815 44,076 GRANT PERIOD: 10/01/09-09/30/10 Award is hereby made in the amount and for the period shown above for a grant under the Victims of Crime Act of 1984, Title II, of Public Law 98-473. The award is made accordance with the plan set forth in the application of the subgrantee and subject to any attached special conditions. The subgrantee has agreed through the previously executed copy of certified assurances to be subject to all applicable rules, regulations, and conditions of the Victims of Crime Act. This subgrant shall become effective on the beginning date of the grant period, provided that within forty-five (45) days of the award execution date (below) the properly executed original of this "Subgrant Award" is returned to the Criminal Justice Coordinating Council. AGENCY APPROVAL SUBGRANTEE APPROVAL cf) ~-4. Signature 0 / I It-'t 1~1 Date Council Date Executed: 10/01/09 Deke Copenhaver, Mayor Typed Name & Title of Authorized Official 58-2204274-004 Employer Tax Identification Number (EIN) ************************************************************************************** ONLY TRANS CD REFERENCE ORDER EFF DATE TYPE PAY DATE INVOICE CONTRACT # 102 13xxx 1 10/01/09 9 ** C09-8-010 OVERRIDE ORGAN CLASS PROJECT VENDOR CODE 2 46 4 13yy2 ITEM CODE DESCRIPTION 25 CHARACTERS EXPENSE ACCT AMOUNT 1 VOCA 624.41 $ 35,261 CRIMINAL JUSTICE COORDINATING COUNCIL SPECIAL CONDITIONS SUBGRANTEE: Richmond County FUNDING CATEGORY: District Attorney VWAP SUBGRANT NUMBER: C09-8-010 SUBGRANT AWARD: $35,261 1. The subgrantee agrees to take reasonable steps to provide meaningful access to their programs and activities for persons with limited English proficiency (LEP). For more information on the civil rights responsibilities that recipients have in providing language services to LEP individuals, please see the website at http://www.lep.gov. In addition, subgrantees who provide hotline service will provide documentation of a contract for 24-hour language interpretation service for callers who do not speak English. Subgrantees who provide hotline service will ensure that their TTY machine is operable at all times and that all staff, volunteers and interns who answer the hotline receive training and ongoing reV~TTY answering procedures. Initials 2. The subgrantee agrees to comply with the Equal Treatment Regulation (28 C.F.R. part 38) which prohibits recipients from using federal grant funding for inherently religious activities. While faith-based organizations can engage in non-funded inherently religious activities, the activities must be held separately from the grant-funded program, and customers or beneficiaries cannot be compelled to participate in them. The Equal Treatment Regulation makes clear that organizations receiving federal grant funding are not permitted to discriminate when providing services on the basis of a ~ne~ciary's religion. Initials ~ 3. In accordance with Federal regulations, your organization must comply with the following EEOP reporting requirements: If your organization has received an award for $500,000 or more and has 50 or more employees (counting both full- and part-time employees but excluding political appointees), then it has to prepare an EEOP and submit it to the Office of Civil Rights (OCR), Office of Justice Programs, u.s. Department of Justice for review within 60 days from the date of this award. For assistance in developing an EEOP, please consult OCR's website at http://www.ojp.usdoj.gov/ocr/eeop.htm. You may also request technical assistance from an EEOP specialist at OCR by dialing (202) 616-3208. If your organization received an award between $25,000 and $500,000 and has 50 or more employees, your organization must prepare an Equal Employment Opportunity Plan (EEOP), but it does not have to submit the EEOP to OCR for SUBGRANT NUMBER: C09-B-010 SPECIAL CONDITIONS (page ~J review. Instead, your organization has to maintain the EEOP on file and make it available for review on request. In addition, your organization has to complete Section B of the Certification Form and return it to OCR within 60 days from the date of this award. The Certification Form can be found at http://www.ojp.usdoj.gov/ocr/eeop.htm. If your organization received an award for less than $25,000; or if your organization has less than 50 employees, regardless of the amount of the award; or if your organization is a medical institution, educational institution, nonprofit organization or Indian tribe, then your organization is exempt from the EEOP requirement. However, your organization must complete Section A of the Certification Form and return it to OCR within 60 days from the date of this award. The Gertification Form can be found at http://www.ojp.usdoj.gov/ocr/eeop.htm. The subgrantee must maintain proof of compliance with the above requirements and be able to provide such proof to the Criminal Justice Coordinating Council upon requ~st. Initials ~ 4. In the event a federal or state court or federal or state administrative agency makes an adverse finding of discrimination against your organization after a due process hearing, on the ground of race, color, national origin, or sex, your organization must submit a copy of the finding to the Office of Civil Right~~~~ the Criminal Justice Coordinating Council. Initials ~ 5. The subgrantee certifies that federal funds will not be used to supplant funds that would otherwise be made available for grant-funded initiatives. Federal funds must be used to supplement existing funds for program activities and not replace funds appropriated for the same purpose. Potential supplanting will be the subject of application review, as well as pre-award review, post-award monitoring, and audit. If there is a potential presence of supplanting, the subgrantee will be required to document that the reduction in non-federal resources occurred for reasons other than the receipt or a91i,cilpated receipt of federal funds. Initials ~ 6. The subgrantee certifies that all matching non-federal portion of the project awarded addition to~~nd' otherwise made available Initials ~ funds required to pay the subgrant funds will be in for project activities. 7. The subgrantee certifies that l)title to all equipment and/or supplies purchased with funds under this subgrant shall vest in the agency that purchased the property; 2) equipment and/or supplies will be maintained in accordance with established local or state procedures as long as the equipment and/or supplies are used for program-related purposes; and 3) once the project concludes and/or equipment is no longer utilized for its grant-funded purpose, the Criminal Justice Coordinating Council will be informed of the available equipment and determine its future use to assure it is utilized in furtherance of the goals and objectives of the grant program and the State of Georgia. ~uo~~~~ ~v~~~; ~v~-o-v~v ~~~~~~ ~u~u~~~v~~ \r~~~ ~I Initials 8. The subgrantee agrees to abide by all administrative and financial guidelines as stipulated in the Office of Justice Program's Financial Guide for Grants (http://www.ojp.usdoj.gov/financialguide/index.htm). All services paid by federal and/or matching funds must have a valid contract that has been pre-approved by the Criminal Justice Coordinating Council to ensure com~~ with federal and state guidelines and statutes. Initials 9. The subgrantee must submit Subgrant Adjustment Request #1 with the completed award package. The adjustment request must be accompanied by a detailed project budget that itemizes all projected expenditures, a revised project summary and revised implementation. The project budget, summary and implementation plan will not be established, or officially approved, until the subgrantee receives a written approval notice from the Criminal Justice Coordinating Council. All project costs and project activities must coincide with the approved budget, summary and limplementation plan unless subsequent revisions are approved by the Criminal Justice Coordinating Council. III ,) Initials l~ 10. The subgrantee must submit subsequent requests to revise the budget, project summary and implementation plan prior to any substantial changes, but no la~e~ than 6~.d~s prior to the end of the subgrant period. Inltlals ~ 11. All project costs not exclusively related to this approved project must be prorated, and only the costs of project-related activities will be re~~ursablae ~pd~r the subgrant award. Inltlals __~ 12. The subgrantee agrees to submit requests for reimbursement on either a monthly or quarterly basis, as selected by the subgrantee at the time of award. Subgrant Expenditure Reports are due 15 days after the end of the month (if reporting monthly) or 30 days after the end of the quarter (if re~o~ting qu}\rt~rly) . Inltlals ~ 13. The subgrantee agrees that per eight hour day ($56.25 Of~i~e of ~ Programs Inltlals consultant/contractor fees in excess of $450.00 per hour) must have prior approval from the and the Criminal Justice Coordinating Council. 14. If any changes occur in the subgrantee's lobbying status or activities, a revised Disclosure of Lobbying Activities Form must be submitted. Recipient further understands and agrees that it cannot use any federal funds, either directly or indirectly, in support of the enactment, repeal, modification, or adoption of any law, regulation or policy, at any level of government, without tht)~~pkess prior written approval of Office of Justice Programs. Initials Ll){j 15. If any changes occur in the subgrantee's eligibility status regarding debarment, a revised Certification Regarding Debarment, Suspension, ~UDU~~~ ~U~~~; ~V~-O-V~V ~~~~~~ ~V~U~~~V~~ \~age ~/ Ineligibility, and Voluntary Exclusion form must be submitted to the Criminal JUS~s~foordinating Council. Initials ~ 16. Repeatedly late submission of any reports will result in a recommendation to the Criminal Justice Coordinating Council for a 5% reduction to your award. These reports include but are not limited to Subgrant Expenditure Reports, Progress Reports, Outcome Performance Measures and Annual Local Victim Assistance AJ1;?, Fund Reports. Initials ~ 17. All nonprofit organizations shall comply fully with the requirements set forth in the Official Code of Georgia Annotated, Chapter 50-20, and submit, prior to the drawdown of any funds, completed financial statements (including balance sheet, income statement and statement of cash flows) and salary info~~tfqn for all personnel whether grant funded or not. Initials ~ 18. Subgrantees who provide emergency shelter agree that, if their agency cannot shelter a domestic violence victim, they will identify available resources and assist the victim in developing and implementing a feasible plan to access oth~rgenCY shelter. Initials 19. Subgrantees who provide emergency shelter will conduct appropriate screening so as not to discriminate against individuals based on physical or mental disability, including mental health concerns and substance abuse issues, or deny shelter solely upon the presence of these factors, and ensure that re~s~nable tfr9fodations are documented and made available to those victims. Inltlals ~ 20. The subgrantee must maintain its certification to receive Local Victim Assistance Add-On Funds (5% Funds). In addition, the subgrantee must submit an annual report to the Criminal Justice Coordinating Council regarding the receipt and expenditure of these funds by January 30 each year per O.C.G.A. ~ 15-21-132~J ,) Initials ~ 21. The subgrantee agrees that each project employee (new or existing) will attend and sucessfully complete at least eight (8) hours of training in victim assistance. A training request will be submitted to the Criminal Justice Coordinating Council for approval at least 15 days prior to the proposed tr~~~\ date. Initials ~ 22. The subgrantee agrees to of Rights" 11 ,s:\ipulated Initials ~ The subgrantee agrees to adhere to the Program Guidelines for the Victims of Crime Act Vi~.~,~ sistance Grant Program. Initials ~ The subgrantee agrees to comply with the organizational audit requirements abide by the provisions of the "Crime Victims' Bill under Georgia law (O.C.G.A. Chapter 17). 23. 24. SUBGRANT NUMBER: C09-8-010 SPECIAL CONDITIONS (Page 5) of the Single Audit Act as detailed in OMB Circular A-133. The CFDA number fo~ ~his gra~~~~gram is 16.575. Inltlals ~ 25. The subgrantee agrees to abide by Georgia law regarding the utilization of professional counselors, social workers, and marriage and family therapists. (O.C.G.A. ~ j1'10}-1, et. seq). Initials ~ 26. The subgrantee agrees to abide by Georgia law regarding the utilization of PSYCh01ogistl1 ,/Y.C.G.A. ~ 43-39-1, et. seq). Initials ~ 27. The subgrantee agrees to utilize project volunteers that provide direct services as defined under the Victims of Crime Act. In order to comply with this requirement, the subgrantee shall furnish a listing of all project volunteers that provide direct services, a copy of the contract between each volunteer and the subgrantee identifying responsibilities for both parties, and a written job description indicating what types of direct services the volunteer ~rovide. Initials 28. The subgrantee agrees to satisfy 25% of the required match (20%) through the in-kind donation of volunteer hours. The standard rate for the provision of direct services by a volunteer is $12.00 per hour. Higher rates must be pre-approved by the Criminal Justice Coordinating Council. Any deviation from this requirement must be submitted in writing to the Criminal Justice Coordinating Council utilizing the volunteer requirement waiver request form. Initials ~ 29. The subgrantee agrees to advise victims on their eligibility for benefits under the Georgia Crime Victims Compensation Program, and assist them with application forms and procedures, obtaining necessary documentation, and/or checking on 1t.~irl status. Initials ~ 30. Statistical data describing project performance from programs providing direct victim services must be submitted to the Criminal Justice Coordinating Council using the Victim Services Statistical Report (VSSR) provided to the subgrantee. VSSRs describing program outputs (total services delivered, total clients served, etc.) are due quarterly on January 30, April 30, July 30, and October 30. The fourth quarter report, due to October 30, requires subgrantees to complete an additional section included with that quarter's statistical report. Performance Reports describing program outcomes (changes in clients as a result of services delivered) must be based on surveys administered to individual clients. Each program should include the appropriate performance measures for their respective type of program on their client surveys. Programs are required to follow the CJCC Data Collection Guidelines and report on the on-line reporting system. Subgrantees are encouraged, but not required, to use the Excel-based spreadsheets to enter and tally their SUBGRANT NUMBER: cOg-a-OlD SPECIAL CONDITIONS (Page 6) individual client outcome data. Totals reported for outputs may not match totals reported for outcomes since outcomes are collected from clients only at the substantial completion of services. Beginning in 2010, the first Performance Report is due April 30 to include the period between October 1, 2009 and March 31, 2010. The second Performance Report is due October 30, 2010 and will include the entire year from October 1, 2009 through September 30, 2010. Initials ()J;J 31. The subgrantee agrees to fully cooperate with any monitoring or evaluation activities, and any related training activities, initiated and/or conducted by the Criminal Justice Coordinating Council during and subsequent to the award perio~/J ) Initials ~ 32. The subgrantee authorizes the Criminal Justice Coordinating Council, Office for Victims of Crime (OVC) and/or the Office of the Chief Financial Officer (OCFO), and its representatives, access to and the right to examine all records, boo~s~ ,Pjper or documents related to the VOCA grant. Initials ~ 33. The subgrantee agrees to promptly refer to the DOJ OIG any credible evidence that a principal, employee, agent, contractor, subcontractor, or other person has either 1) submitted a false claim for grant funds under the False Claims Act; or 2) committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving grant funds. Potential fraud, waste, abuse, or misconduct should be reported to the OIG by mail: Office of the Inspector General u.S. Department of Justice Investigations Division 950 Pennsylvania Avenue, N.W. Room 4706 Washington, DC 20530 e-mail: oig.hotline@usdoj.gov hotline: (contact information in English and Spanish): (800) 869-4499 or hotline fax: (202) 616-9881 Additional information is available from the DOJ OIG website at www.usctoj.g;W{,i)). Initials ~ Please be advised that failure to comply with any of the Special Conditions will result in material noncompliance with the Subgrant Agreement, thus subjecting the Subgrant Agreement to possible termination by the Criminal Justice Coordinating Council. Typed name of Authorized Official: Deke Copenhaver Title Mayor Signature cf)~y - Date /-z, / I /oC( PRINT DATE: 10/16/09 GMIS DOCUMENT 3A CRIMINAL JUSTICE COORDINATING COUNCIL SUBGRANT ADJUSTMENT REQUEST FEDERAL GRANT # REQUEST DATE: 11- 23- 09 PAGE 1 OF 2 ADJ REQUEST #: 1 SUBGRANTEE: Richmond County FUNDING CATEGORY: District Attorney VWAP SUBGRANT #: COg-a-OlD NATURE OF ADJUSTMENT: XX REVISED BUDGET Go To SECTION I Mark all that apply. PROJECT PERIOD AND/OR EXTENSION. Go To SECTION II PROJECT OFFICIALS/ADDRESSES. Go To SECTION III Adjustments of each type PROJECT PERSONNEL. Go To SECTION III shown should be entered GOALS AND OBJECTIVES Go To SECTION III in the section indicated. OTHER. Go To SECTION III MUST BE JUSTIFIED AND EXPLAINED THOROUGHLY IN SECTION IV. SECTION I. REQUEST FOR BUDGET CHANGE - JUSTIFY IN SECTION IV. CURRENT APPROVED REVISIONS +/- REVISED BUDGET PERSONNEL $ 44,076 -$6607 $37,469 EQUIPMENT 0 SUPPLIES 0 TRAVEL 0 PRINTING 0 OTHER 0 +$hh07 $hh07 TOTAL $ 44,076 lii4.4.,076 Federal $ 35,261 535.261 Match $ 8,815 $8,815 SECTION II. REQUEST FOR CHANGE IN PROJECT PERIOD - JUSTIFY IN SECTION IV. CURRENT GRANT PERIOD Start Date: 10/01/09 End Date: 09/30/10 REQUESTED GRANT PERIOD Start Date: End Date: FOR EXTENSION, # OF MONTHS: NOTE: The maximum extension req~est cannot exceed 12 months. SECTION III. REQUESTS FOR REVISIONS TO PROJECT OFFICIALS/ADDRESSES, PROJECT PERSONNEL, GOALS AND OBJECTIVES, AND/OR OTHER NON-BUDGET, NON-PERIOD CHANGES (JUSTIFY IN SECTION IV.) CONTINUED ON NEXT PAGE PRINT DATE: 10/16/09 GMIS DOCUMENT 3A CRIMINAL JUSTICE COORDINATING COUNCIL SUBGRANT ADJUSTMENT REQUEST FEDERAL GRANT # PAGE 2 of 2 ADJ REQUEST #: 1 REQUEST DATE: 11-23-09 SUBGRANTEE: Richmond County FUNDING CATEGORY: District Attorney VWAP SUBGRANT #: COg-a-ala SECTION IV. JUSTIFICATION OF ALL REQUESTED ADJUSTMENTS, REVISIONS, AND/OR CHANGES All requested adjustments in Sections I, II & III (page 1) must be justified in detail in this Section. Include item costs, descriptions, equipment lists, detailed explanations, and any other information that would further clarify and support your request for adjustment. Attach additional pages as needed. This BAR is to trans~er $6607 from the Personnel category to the Other category. The "Other" amount is the total match amount via our office rental expense. SUBMITTED BY: VOY1/}/! dLf (~CiJYL<) .:}/1& 1/1 CLJ J)/i -e cfvrc Signature of Financial Officer or Project Director Title /1 So 07 Date CJCC ROUTING AND APPROVALS: Approval Disapproval Reviewer Signature Reviewed By: Authorized By: CRIMINAL JUSTICE COORDINATING COUNCIL REIMBURSEMENT SELECTION FORM SUBGRANT NUMBER: _C09-8-010 AGENCY NAME: _Augusta Richmond County Board of Commissioners 1. SELECT A SCHEDULE FOR SUBMITTING REIMBURSEMENTS (CHECK ONE BOX) D MONTHLY (Requests for reimbursement are due 15 days after the end of the month) X QUARTERLY (Requests for reimbursement are due 30 days after the end of the quarter) 2. SELECT A PROCESS FOR RECEIVING REIMBURSEMENT PAYMENTS (CHECK ONE BOX) D ELECTRONIC FUNDS TRANSFER (Reimbursements will be deposited into the bank account listed below. A voided check must be attached to ensure proper routing of funds.) BANK NAME: BANK ROUTING NUMBER: BANK ACCOUNT NUMBER: AGENCY CONTACT NAME: AGENCY CONTACT TELEPHONE NUMBER: AGENCY AUTHORIZED OFFICIAL NAME AND TITLE: AGENCY AUTHORIZED OFFICIAL SIGNATURE: X CHECK (Reimbursements will be mailed in the form of a check to the address listed below) MAILING ADDRESS: _501 Greene Street, Suite 400 CITY, STATE & ZIP: _Augusta, GA 30901 ATTENTION: _Kathy Rogers AGENCY AUTHORIZED OFFICIAL SIGNATURE: For CJCC Use ONLY CJCC Auditor: Phone Number: Grant Award Number: GBI Entry InitiallDate: OMB APPROVAL NO. 1121-0140 EXPIRES Dl/31/2006 STANDARD ASSURANCES The Applicant hereby assures and certifies compliance with all applicable Federal statutes, regulations, policies, guidelines, and requirements, including OMB Circulars A-21, A-87, A-102, A-1I0, A-122, A- 133; Ex. Order 12372 (intergovernmental review offederal programs); and 28 C.F.R. pts. 66 or 70 (administrative requirements for grants and cooperative agreements). The applicant also specifically assures and certifies that: 1. It has the legal authority to apply for federal assistance and the institutional, managerial, and financial capability (including funds sufficient to pay any required non-federal share of project cost) to ensure proper planning, management, and completion of the project described in this application. 2. It 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. 3. It will give the awarding agency or the General Accounting Office, through any authorized representative, access to and the right to examine all paper or electronic records related to the financial assistance. 4. It will comply with all lawful requirements imposed by the awarding agency, specifically including any applicable regulations, such as 28 C.F.R. pts. 18,22,23,30,35,38,42,61, and 63. 5. It will assist the awarding agency (if necessary) in assuring compliance with section 106 of the National Historic Preservation Act of 1966 (16 U.S.C. 9 470), Ex. Order 11593 (identification and protection of historic properties), the Archeological and Historical Preservation Act of 1974 (16 US.C. 9 469 a-I m gm.), and the National Environmental Policy Act of 1969 (42 U.S.C. S 4321). 6. It will comply (and will require any subgrantees or contractors to comply) with any applicable statutorily-imposed nondiscrimination requirements, which may include the Omnibus Crime Control and Safe Streets Act of 1968 (42 U.S.C. 9 3789d); the Victims of Crime Act (42 U.S.c. g10604(e)); The Juvenile Justice and Delinquency Prevention Act of 2002 (42 US.C. g 5672(b)); the Civil Rights Act of 1964 (42 U.S.C. 9 2000d); the Rehabilitation Act of 1973 (29 U.S.C.S7 94); the Americans with Disabilities Act of 1990 (42 U.S.c.g 12131-34); the Education Amendments of 1972 (20 U.S.C. SS1681, 1683,1685-86); and the Age Discrimination Act of 1975 (42 U.S.C. SS 6101-07); see Ex. Order 13279 (equal protection ofthe laws for faith-based and community organizations). 7. Ifa governmental entity- a) it will comply with the requirements of the Uniform Relocation Assistance and Real Property Acquisitions Act of 1970 (42 US.C.g 4601 m gm.), which govern the treatment of persons displaced as a result of federal and federally-assisted programs; and b) it will comply with requirements of5 U.S.C.SS 1501-08 and gS7324-28, which limit certain political activities of State or local government employees whose principal employment is in connection with an activity financed in whole or in part by federal assistance. Signature Date Disclosure of Lobbying Activities Approved by OMB 0348-0046 Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse slele lor InslnJc:tlcJns.) Public Reporllng Burden for Ihla collection of Information is eslimalBd to average 30 minutes per IfIspansa..Including ttl9 UIIIll for ravlewlng Instnlctions, searching exlsUng data sources. gathering and maintaining lhe data l1gedGd. lIIld completing and reviewing the. eclectlon ollnformallon. Send comments regarding lhis burden estlmeta or any olhsr aspect 01 111 Is collecllon of Inlormallon,llIGludlng suggestions lor reducing this ~rden, 10 lhe Offioe 01 Management and BudgBl. Paperwork Reduction PrQjecl (0348-0046), Washington, D.C. 20500. 1, Type of Federlll Acllon: 2. Slatus of Federal Acllon: rn1 a contract rm a. bid/offer/application CJ b. gram L::J b. initial award c. cooperative agreemenr c. post-award d. loan e. loan guarantee I. loan Insurance 4. Name and Address of Reporting Entity: o Prime ~ Subawardee l1er , If known: 3. Report Typ.: nr1 a Initial 'Ring ~ b.rna1enalchange For M.rIIIl Change Only: year qlWler dalv aflast ",pm I 5. II Reporting Enllty In No, 4 Is SUbawsnlee, enter NamelUld Addre88 of I Prime: i State of Georgia i Criminal Justice Coordinating Council I 104 Marietta Street, Suite 440 I Atlanta, GA 30303-2743 Augusta Richmond County Board of Commissioners Room 806 530 Greene Street, Augusta, GA 30901 Congressional Dblrict, If known: 6. Fedel'ill DepartrnenllAgency: 9th and 12th Congressional OIsIrlc:t,lIknown: ! 7. Federal Program Name/DeSCl'lpUOn: I Victims of Crime Act ; Formula Grant Program I , i j CFDA Number, if applicable; I i 9. Award Amount, if known: I $ b. Individuals Performing Services (Including ada'ress lfdlll8rentfrom No. 10a) (lasl name, ftrsJ namo, MI): U.S. Department of Justice Office of Justice Programs 8. Federal Ac:\lon Number, If knewn: 108. Name and Addreflll of lobbying Registrant QllndMduaJ. last name. first name, Mil: I I I The Augusta Judicial Circuit VWAP I does not condu~t lobyying activitiest i , i i ! i I . 11. Information requested through this form Is authorized by 5eo.319, i Pub. L. t 01-121, tQ3Stat. 750, as amended by sec. to; Pub. L 104. i Signature' 65. Stat. 700 (31 U.S.C. 1352). This disclosure of lobbying activities ! . is a material representatIon of fact upon which reliance was placed I by the above when this transaction Was made or entered into. This I Print Name: disclosure Is required pursuant to 31 U.S.C. t 352. This informallon I will be reported to th e Congress semiannually and wm be available I for public Inspection. Any person who falls to file the required TIDe: disclosure shall be subject to a civil penally of nolless than $10,000 ! and not more than $100.000 for each such failure. i Telephone No.: Deke Copenhaver Mayor 706-821-1831 Date: Authorized lor Local Raproduc:tlon SlandBrd Form-LlL (1196) 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 determ ine 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 (Nonpro-curement) 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. 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 in- fluencing 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 at- tempting 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- recipients shall certify and disclose accordingly. 2. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS (DIRECT RECIPIENT) 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 principals: (a) Are not presently debarred, suspended, proposed for debar- ment, declared ineligible, sentenced to a denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three-year period preceding this applica- tion been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal 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, theft, forgery, bribery, falsification 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 B. 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 CFR Part 67, Subpart F, for grantees, as defined at 28 CFR Part 67 Sections 67.615 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 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 state- ment required by paragraph (a); (d) 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 406116 (3-91) REPLACES OJP FORMS 4061/2,4061/3 AND 4061/4 WHICH 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 occurring 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 iden- tification 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 enforce- ment, 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) Check 0 if there are workplaces on file that are not indentified 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 ap- plication 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 OJP Form 4061/7. DRUG-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, posses- sion, 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, 633 Indiana Avenue, N.W., Washington, D.C. 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: Augusta Richmond County Board of Commissioners 530 Greene Street, Room 806 Augusta, GA 30901 2. Application Number and/or Project Name 3. Grantee IRS/Vendor Number Augusta Judicial Circuit Victim/Witness Assistance Program 582204274 4. Typed Name and Title of Authorized Representative Deke Copenhaver Mayor, Augusta Richmond County Government 5. Signature 6. Date cY~.~ ~'t; 1", (91 'U.S. Govemment Printing Office: 1996. 405-037/40014