Grant Subaward Certification ofAssurance ofCompliance
Information and Instructions
The Certification of Assurance of Compliance is a binding affirmation that the Subrecipient will comply with the requirements and restrictions outlined in this document and the FY2021 State Grant Assurances.
The Official Designee and the individual granting that authority (i.e., City/County Financial Officer, City/County Manager, or Governing Board Chair) must sign this form. For State agencies, only the Official Designee must sign this form.
Complete all sections of this form and then submit:
• As part of the Grant Subaward Application,
• With a Grant Subaward Amendment (Cal OES Form 2-213) if a new fund source is being added to the Grant Subaward, (applicable Certification of Assurance of Compliance would be needed), or
• With a Grant Subaward Modification (Cal OES Form 2-223) if the Official Designee or Board Chair changes and the Resolution identifies them by name Grant Subaward Certification of Assurance of Compliance – Cal OES JUMPSTART Rev 5/12/22
Grant Subaward Certification of Assurance of Compliance Subrecipient:______________________________________________________________________ Cal OES Program Name Grant
Subaward #:
Grant Subaward
Performance Period
1 2
3 4
5 6
I, (Official Designee; same person as
Section 15 of the Grant Subaward Face Sheet) hereby certify that the above Subrecipient is responsible for reviewing the all documents and adhering to all of the Grant Subaward requirements as directed by Cal OES including, but not limited to, the following areas:
I. Proof of Authority
The Subrecipient certifies it has written authority by the governing board (e.g., County Board of Supervisors, City Council, or Governing Board) granting authority for the Subrecipient/Official Designee (same person as Section 15 of the Grant Subaward Face Sheet)to enter into a specific Grant Subaward (indicated by the Cal OES Program name and initial Grant Subaward performance period) and applicable Grant Subaward Amendments with Cal OES. The authorization includes naming of an Official Designee for the agency/organization who is granted permission to sign Grant Subaward documents on behalf of the Subrecipient.
Written proof of authority includes one of the following: signed Board Resolution or approved Board Meeting minutes.
II. Civil Rights Compliance
The Subrecipient acknowledges awareness of, and the responsibility to comply with all state and federal civil rights laws. The Subrecipient certifies it will not discriminate in the delivery of services or benefits based on any protected class.
III. Equal Employment Opportunity
The Subrecipient certifies it will promote Equal Employment Opportunity by prohibiting discrimination or harassment in employment because of any status protected by state or federal law.
Grant Subaward Certification of Assurance of Compliance – Cal OES JUMPSTART Rev 5/12/22
IV. Drug-Free Workplace Act of 1990
The Subrecipient certifies it will comply with the Drug-Free Workplace Act of 1990.
V. California Environmental Quality Act (CEQA)
The Subrecipient certifies that, if the activities of the Grant Subaward meet the definition of a “project” pursuant to the CEQA, Section 20165, it will comply with all requirements of CEQA.
VI. Lobbying
The Subrecipient certifies it will not use Grant Subaward funds, property, or funded positions for any lobbying activities.
All appropriate documentation must be maintained on file by the Subrecipient and available for Cal OES upon request. Failure to comply with these requirements may result in suspension of payments under the Grant Subaward(s), termination of the Grant Subaward(s), and/or ineligibility for future Grant Subawards if Cal OES determines that any of the following has occurred: (1) the Subrecipient has made false certification, or (2) the Subrecipient violated the certification by failing to carry out the requirements as noted above.
CERTIFICATION
I, the official named below, am the same individual authorized to sign the Grant Subaward [Section 15 on Grant Subaward Face Sheet], and hereby affirm that I am duly authorized legally to bind the Subrecipient to the above-described certification. I am fully aware that this certification, executed on the date, is made under penalty of perjury under the laws of the State of California.
Official Designee’s Signature: _________________________________________________ Official Designee’s Typed Name: _________________________________________________ Official Designee’s Title: _________________________________________________ Date Executed: _________________________________________________ AUTHORIZED BY:
I grant authority for the Subrecipient/Official Designee to enter into the specific Grant Subaward(s) (indicated by the Cal OES Program name and initial Grant Subaward performance period identified above) and applicable Grant Subaward Amendments with Cal OES.
City Financial Officer County Financial Officer
City Manager County Manager
Governing Board Chair
Signature: _________________________________________________ Typed Name: _________________________________________________ Title: _________________________________________________ Date Executed: _________________________________________________ Grant Subaward Certification of Assurance of Compliance – Cal OES JUMPSTART Rev 5/12/22