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