USDA
United States Department of Agriculture
COMMUNITY FACILITIES GRANT CERTIFICATION
The undersigned certifies that:
1. The organization is aware of and in compliance with other Federal statute requirements including but not limited to:
a. Section 504 of the Rehabilitation Act of 1973.
b. Civil Rights Act of 1964.
C. The Americans with Disabilities Act (ADA) of 1990.
d. Age Discrimination Act of 1975.
2. The organization is unable to finance the proposed project from its own resources or through commercial credit at reasonable rates and terms.
3. The organization has no known relatives or close associates that are current USDA Rural Development employees.
4. Priorto USDA Rural Development approval, you will not take action (e.g., initiation of construction) or incur obligations which would limit the range of alternatives to be considered or which would have an adverse effect on the environment.
City of Fort Bragg
Name of Organization
08/26/2022
Date
Position 3
USDA FORM APPROVED
Form RD 400-4 ASSURANCE AGREEMENT OMB No. 0575-0018
(Rev. 3-97) (Under Title VI, Civil Rights Act of 1964)
The City of Fort Bragg
(name of recipient)
416 North Franklin Street, Fort Bragg, CA, 95437
(address)
("Recipient" herein) hereby assures the U.S. Department of Agriculture that Recipient is in compliance with and will continue to comply with Title VI of the Civil Rights Act of 1964 (42 USC 2000d et. seq.), 7 CFR Part 15, and Rural Housing Service, Rural in, be denied the benefits of, or be otherwise subjected to discrimination.
1. Recipient agrees that any transfer of any aided facility, other than personal property, by sale, lease or other conveyance of contract, shall be, and shall be made expressly, subject to the obligations of this agreement and transferee's assumption thereof.
2. Recipient shall:
(a) Keep such records and submit to the Government such timely, complete, and accurate information as the Government may determine to be necessary to ascertain our/my compliance with this agreement and the regulations. (b) Permit access by authorized employees of the Agency or the U.S. Department of Agriculture during normal business hours to such books, records, accounts and other sources of information and its facilities as may be pertinent to ascertaining such compliance.
(c) Make available to users, participants, beneficiaries and other interested persons such information regarding the provisions of this agreement and the regulations, and in such manner as the Agency or the U.S. Department of Agriculture finds necessary to inform such persons of the protection assured them against discrimination.
3. The obligations of this agreement shall continue:
(a) As to any real property, including any structure, acquired or improved with the aid of the Federal financial assistance, so long as such real property is used for the purpose for which the Federal financial assistance is made or for another purpose which affords similar services or benefits, or for as long as the Recipient retains ownership or possession of the property whichever is longer.
(b) As to any personal property acquired or improved with the aid of the Federal financial assistance, so long as Recipient retains ownership or possession of the property.
(c) As to any other aided facility or activity, until the last advance of funds under the loan or grant has been made.
4. Upon any breach or violation this agreement the Government may, at its option:
(a) Terminate or refuse to render or continue financial assistance for the aid of the property, facility, project, service or activity.
(b) Enforce this agreement by suit for specific performance or by any other available remedy under the laws of the United States or the State in which the breach or violation occurs.
Rights and remedies provided for under this agreement shall be cumulative.
In witness whereof, Peggy Ducey, City of Fort Bragg on this (name of recipient)
date has caused this agreement to be executed by its duly authorized officers and its seal affixed hereto, or, if a natural person, has hereunto executed this agreement.
City of Fort Bragg
Recipient
(SEAL) 08-26-2022
Date
Attest: lizzy succy Peggy Ducey, City Manager
Title Title
According to the Paperwork Reduction Act of 95, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB penel number on, earing eting in 0570, ren ant ang a a set and contes and revenge leper repeat acting the me or U.S. DEPARTMENT OF AGRICULTURE
CERTIFICATION REGARDING
DRUG-FREE WORKPLACE REQUIREMENTS (GRANTS)
ALTERNATIVE I - FOR GRANTEES OTHER THAN INDIVIDUALS
This certification is required by the regulations implementing Section 5151-5160 of the Drug-Free Workplace Act of 1988 (Pub. L. 100-690, Title V, Subtitle D: 41 U.S.C. 701 et seq.), 7 CFR Part 3017. Subpart F, Section 3017.600, Purpose. The January 13, 1989, regulations were amended and published as Part II of the May 25 1990 Federal Register (pages 21681-21691). Copies of the regulations may be obtained by contacting the Department of Agriculture agency offering the grant.
(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON PAGE3) Alternative I
A. The grantee 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 ongoing 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 statement required by paragraph (a); (d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will -
(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction; (e) Notifying the agency in writing, within ten calendar days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction.
Employers of convicted employees must provide notice, including position AD-1049 (REV 5/90)
title, to every grant officer on whose grant activity the convicted employee was working, unless the Federal agency has designated a central point for the receipt of such notices. Notice shall include the identification numbers) 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. Tonnection way in specith space provided below the sites) for the performance of work done in Place of Performance (Street address, city, county, State, zip code) City of Fort Bragg
Check Z If there are workplaces on file that are not identified here.
City of Fort Bragg PD Vehicle/Sec. Camera System
Organization Name Award Number or Project Name
Peggy Ducey, City Manager
and Title of Authorized Representative
Peggy Doing August 26, 2022
Date
AD-1049 (REV 5/90)
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this form, the grantee is providing the certification set out on pages 1 and 2.
2. The certification set out on pages 1 and 2 is a material representation of fact upon which reliance is placed when the agency awards the grant. If it is later determined that the grantee knowingly rendered a false certification, or otherwise violates the requirements of the Drug-Free Workplace Act, the agency, in addition to any other remedies available to the Federal Government, may take action authorized under the Drug-Free Workplace Act.
3. Workplaces under grants, for grantees other than individuals, need not be identified on the certification. If known, they may be identified in the grant application. If the grantee does not identify the workplaces at the time of application, or upon award, if there is no application, the grantee must keep the identity of the workplace(s) on file in its office and make the information available for Federal inspection. Failure to identify all known workplaces constitutes a violation of the grantee's drug-free workplace requirements.
4. Workplace identifications must include the actual address of buildings (or parts of buildings) or other sites where work under the grant takes place. Categorical descriptions may be used (e.g., all vehicles of a mass transit authority or State highway department while in operation, State employees in each local unemployment office, performers in concert halls or radio studios).
5. If the workplace identified to the agency changes during the performance of the grant, the grantee shall inform the agency of the changes). If it previously identified the workplaces in question (see paragraph three).
6. Definitions of terms in the Nonprocurement Suspension and Debarment common rule and Drug-Free Workplace common rule apply to this certification. Grantees' attention is called, in particular, to the following definitions from these rules:
"Controlled substance" means a controlled substance in Schedules I through V of the Controlled Substances Act (21 U.S.C. 812) and as further defined by regulation (21 CFR 1308.11 through 1308.15);
"Conviction" means a finding of guilt (including a plea of nolo contendere) or imposition of sentence, or both, by any judicial body charged with the responsibility to determine violations of the Federal or States criminal drug statutes;
"Criminal drug statute" means a Federal or non-Federal criminal statute involving the manufacture, distribution, dispensing, use, or possession of any controlled substance; "Employee" means the employee of a grantee directly engaged in the performance of work under a grant, including: (i) all "direct charge" employees; (ii) all "indirect charge" employees unless their impact or involvement is insignificant to the performance of the grant; and, (iii) temporary personnel and consultants who are directly engaged in the performance of work under the grant and who are on the grantee's payroll. This definition does not include workers not on the payroll of the grantee (e.g. volunteers, even if used to meet a matching requirement; consultants or independent contractors not on the grantee's payroll; or employees of subrecipients or subcontractors in covered workplaces) AD-1049 (REV 5/90)
U.S. DEPARTMENT OF AGRICULTURE
Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions
CFR Part 3017, Section 3017.510, Participants' responsibilities. (BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON REVERSE) (1) The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals:
(a) are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; have not within a three-year period preceding this proposal been convicted of or had a civil judgement rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; 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 application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default. (2) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.
City of Fort Bragg PD Veh/Sec Cameras
Organization Name PR/Award Number or Project Name
Peggy Ducey, City Manager
Name(s) and Titles) of Authorized Representatives)
08/26/2022
Pazy Decay
Date
Form AD-1047 (1/92)
Instructions for Certification
1. By signing and submitting this form, the prospective primary participant is providing the certification set out on the reverse side in accordance with these instructions.
2. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out on this form. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default.
4. The prospective primary participant shall provide immediate written notice to the department or agency to whom this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.
5. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," "person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of those regulations.
6. The prospective primary participant agrees by submitting this form that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transaction.
7. The prospective primary participant further agrees by submitting this form that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions," provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.
8. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List.
9. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.
10. Except for transactions authorized under paragraph 6 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default. 2 Form AD-1047 (1/92)
Form RD 1942-54 U.S. Department of Agriculture FORM APPROVED (Rev. 10-96) Rural Development OMB No. 0575-0120
APPLICANT'S FEASIBILITY REPORT
1. Existing Facility. Briefly describe what facilities you currently have or how service is currently provided.
The City does not have an "integrated" security camera system in place.
2. Proposed Facility. Describe what you want to purchase or construct. Indicate what the facility will be used for, approximate size, and expected method of procurement. For buildings indicate location, basic materials or type of construction, and attach a sketch or working drawings. For items of major equipment, indicate new or used, existing or custom-built, and any special features. 'he Fort Bragg Police Department would like to purchase an electric patrol vehicle including the necessary full build out siren and light kit. This and an new vehicle to be purchased are expected to meet all required safety features.
Also, proposed PD Access Control Security Camera System to secure city facility buildings, including city community parks.
3. Need for the Facility. Indicate why the proposed facility is needed.
New vehicles and security equipment are essential to the Fort Bragg Police Department.
The ability to use new vehicles for more than one use i.e.: as a back-up patrol, is key to the efficiency of PD staffs' time and safety due to the time and distance realities of our remote, rural community. Also, the current conditions of current vehicles due to the water damage within the roof top panels and structure have been attempted to be repaired, however its extensive rust damage is only worsening with time. An additional patrol vehicle with its "Prepared for Service" potential is an essential asset to the Fort Bragg Police workforce should a significant emergency occur when additional patrol vehicles be required.
4. Service Area. Indicate what area the proposed facility will serve and, if known, the population or number of families served.
The new service vehicle to be used by PD staff and the new security camera system to be installed on City facility premises will be used for the City of Fort Bragg Police Department's Jurisdiction; with a population of approximately 8,000 habitants and the City's high volume of year round tourist.
Public reporting burden for this collection of information is estimated to average 3 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to U.S Denariment of Agriculture, Clearance Officer, OIRM AG Box 7630, Washington, D. C. 20250; and to the Office Management and Budget, Paperwork Reduction Project (OMB No. 0575-0120), Washington, D. C. 20S03.
Please DO NOT RETURN this form to this address. Forward to the local USDA office only.
Form RD 1942-54 (Rev. 10-96)
Position 8
5. Cost Estimate.
Development and construction... $
....
Land and rights..
Legal fees...
....
Architect and Engineer.
Equipment... 68,000.00
Refinancing.
Other (describe) 78,000.00
......
Total. $146,000.00
6. Income. List the sources and estimate the amount of expected revenue for a typical year.
This equipment is none revenue generating.
7. Other Funds. List the sources and amount of funds that may be available other than from USDA, to fund part of the project (such as applicant's contributions, commercial loans, or loans or grants from other government agencies). he applicants contributions have been identified using Fleet & Equipment Services internal Service funds, approved by the City Council during their 2022/23 Fiscal Year Adopted Budget as per Resolution No.4560-2022 under the Vehicle Replacement Plan.
Matching funding for the purchase of the new Security Camera System to be obtained through several budgeted accounts; I.T., Fleet, Water Enterprise, Wastewater Enterprise, Parks and Facilities.
8. Operating History. If you have operated a similar facility, attach audits, financial statements, or lists of income and expenses for the past five years.
9. Signature and Title of Applicant Official Date
, City Manager 08-26-2022
RD 1942-54
(Reverse)
Form RD 400-1 FORM APPROVED
(Kev. 5-00) UNITED STATES DEPARTMENT OF AGRICULTURE OMB No. 0575-0018
EQUAL OPPORTUNITY AGREEMENT
This agreement, dated 08-26-2022 between
The City of Fort Bragg
herein called "Recipient" whether one or more) and United States Department of Agriculture (USDA), pursuant to the rules anc egulations of the Secretary of Labor (herein called the 'Secretary') issued under the authority of Executive Order 11246 as amendec witnesseth:
In consideration of financial assistance (whether by a loan, grant, loan guaranty, or other form of financial assistance) made or to be made by the USDA to Recipient, Recipient hereby agrees, if the cash cost of construction work performed by Recipient or a construction contract financed with such financial assistance exceeds $10,000 - unless exempted by rules, regulations or orders of the Secretary of
1. To incorporate or cause to be incorporated into any contract for construction work, or modification thereof, subject to the relevant rules, regulations, and orders of the Secretary or of any prior authority that remain in effect, which is paid for in whole or in part with the aid of such financial assistance, the following "Equal Opportunity Clause":
During the performance of this contract, the contractor agrees as follows:
(a) The contractor will not discriminate against any employee or applicant for employment because of race, color, religion, sex or national origin. The contractor will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, color, religion, sex or national origin. Such action shall include, but not be limited, to the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the USDA setting forth the provisions of this nondiscrimination clause. (b) The contractor will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex or national origin. (c) The contractor will send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract or understanding, a notice, to be provided by the USDA, advising the said labor union or workers' representative of the contractor's commitments under this agreement and shall post copies of the notice in conspicuous places available to employees and applicants for employment.
(d) The contractor will comply with all provisions of Executive Order 11246 of September 24,1965, and of all rules, regulations and relevant orders of the Secretary of Labor.
(e) The contractor will furnish all information and reports required by Executive Order 11246 of September 24, 1965, rules, regulations, and orders, or pursuant thereto, and will permit access to his books, records, and accounts by the USDA Civil Rights Office, and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules, (f) In the event of the contractor's noncompliance with the nondiscrimination clauses of this contract or with any of the said rules, regulations, or orders, this contract may be cancelled, terminated, or suspended in whole or in part and the contractor may be declared ineligible for further Government contracts or federally assisted construction contracts in accordance with procedures authorized in Executive Order No. 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order No. 11246 of September 24, 1965, or by rule, regulation or order of the Secretary of Labor, or as otherwise provided by Law.
(g) The contractor will include the provisions of paragraph 1 and paragraph (a) through (g) in every subcontract or purchase order, unless exempted by the rules, regulations, or orders of the Secretary of Labor issued pursuant to Section 204 of Executive Order No. 11246 of September 24, 1965, so that such provisions will be binding upon each subcontractor or vendor. The contractor will take such action with respect to any subcontract or purchase order as the USDA may direct as a means of enforcing such provisions, including sanctions for noncompliance: Provided, however, that in the event the contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction by the USDA, the contractor may request the United States to enter into such litigation to protect the interest of the United States. completing and reviewing the collection of information.
Position 6 RD 400-1 (Rev. 5-00)
2. To be bound by the above equal opportunity clause with respect to its own employment practices when it participates in federally assisted construction work: Provided, that if the organization so participating is a State or local government, the above equal opportunity clause is not applicable to any agency, instrumentality or subdivision of such government which does not participate in work on or under the contract.
3. To notify all prospective contractors to file the required 'Compliance Statement, Form RD 400-6, with their bids.
4. Form AD-425, Instructions to Contractors, will accompany the notice of award of the contract. Bid conditions for all nonexempt federal and federally assisted construction contracts require inclusion of the appropriate "Hometown" or "Imposed" plan affirmative action and equal employment opportunity requirements. All bidders must comply with the bid conditions contained in the invitation to be considered responsible bidders and hence eligible for the award.
5. To assist and cooperate actively with USDA and the Secretary in obtaining the compliance of contractors and subcontractors with the equal opportunity clause and rules, regulations, and relevant orders of the Secretary, that will furnish USDA and the Secretary such information such as, but not limited to, Form AD-560, Certification of Nonsegregated Facilities, to submit the Monthly Employment Utilization Report, Form CC-257, as they may require for the supervision of such compliance, and that it will otherwise assist USDA in the discharge of USDA's primary responsibility for securing compliance.
6. To refrain from entering into any contract or contract modification subject to such Executive Order 11246 of September 24, 1965, with a contractor debarred from, or who has not demonstrated eligibility for, Government contracts and Federally assisted construction contracts pursuant to the Executive Order and will carry out such sanctions and penalties for violation of the equal opportunity clause as may be imposed upon contractors and subcontractors by USDA or the Secretary of Labor pursuant to Part II, Subpart D, of the Executive Order.
7. That if the recipient fails or refuses to comply with these undertakings, the USDA may take any or all of the following actions:
Cancel, terminate, or suspend in whole or in part this grant (contract, loan, insurance, guarantee); refrain from extending any further ssistance to the organization under the program with respect to which the failure or refund occurred until satisfactory assurance o ture compliance has been received from such organization; and refer the case to the Department of Justice for appropriate lega proceedings.
Signed by the Recipient on the date first written above.
Peggy severy
Recipient Recipient
(CORPORATE SEAL) Name oF Corporate Recipient
Attest:
By -
Secretary President
OMB Number: 4040-0004
Expiration Date: 10/31/2019
Application for Federal Assistance SF-424
* 1. Type of Submission: * 2. Type of Application: * If Revision, select appropriate letters):
reapplication X New
• Application Continuation * Other (Specify):
• Changed/Corrected Application Revision
* 3. Date Received: 4. Applicant Identifier:
CITY OF FORT BRAGG
5a. Federal Entity Identifier: 5b. Federal Award Identifier:
04-023-625323606
State Use Only:
6. Date Received by State: 7. State Application Identifier:
8. APPLICANT INFORMATION:
* a. Legal Name: CITY OF FORT BRAGG
* b. Employer/Taxpayer Identification Number (EIN/TIN): * c. Organizational DUNS:
946000335
d. Address:
* Street: 416 N. FRANKLIN STREET
Street2:
* City: FORT BRAGG
County/Parish: MENDOCINO
* State: CA: California
Province:
* Country: USA: UNITED STATES
* Zip / Postal Code: 95437
e. Organizational Unit:
Department Name: Division Name:
POLICE DEPARTMENT
f. Name and contact information of person to be contacted on matters involving this application:
Prefix: * First Name: SANDY
Middle Name:
* Last Name: ARELLANO
Suffix:
Title: PUBLIC WORKS ADMINISTRATIVE ANALYST
Organizational Affiliation:
* Telephone Number: |(707) 961-2823 EXT. 131 Fax Number: (707) * Email: [email protected]
Application for Federal Assistance SF-424
*9. Type of Applicant 1: Select Applicant Type:
C: City or Township Government
Type of Applicant 2: Select Applicant Type:
Type of Applicant 3: Select Applicant Type:
* Other (specify):
*10. Name of Federal Agency:
USDA RD SANTA ROSA CA
11. Catalog of Federal Domestic Assistance Number:
10.766
CFDA Title:
COMMUNITY FACILITIES LOANS AND GRANTS
*12. Funding Opportunity Number:
* Title:
POLICE DEPARTMENT VEHICLE REPLACEMENT/SECURITY CAMERAS SYSTEM
13. Competition Identification Number:
Title:
14. Areas Affected by Project (Cities, Counties, States, etc.):
Add Attachment Delete Attachment View Attachment
* 15. Descriptive Title of Applicant's Project:
POLICE DEPARTMENT VEHICLE REPLACEMENT/SECURITY CAMERAS SYSTEM/NEW EQUIPMENT PURCHASE Attach supporting documents as specified in agency instructions.
Add Attachments Delete Attachments View Attachments
Application for Federal Assistance SF-424
16. Congressional Districts Of:
*a. Applicant 102 *b. Program/Project 02
Attach an additional list of Program/Project Congressional Districts if needed.
Add Attachment Delete Attachment View Attachment
17. Proposed Project:
* a. Start Date: *b. End Date:
18. Estimated Funding ($):
*a. Federal 80,300.00
*b. Applicant 65, 700.00
* c. State
* d. Local
* e. Other
*f. Program Income
* g. TOTAL 146,000.00
* 19. Is Application Subject to Review By State Under Executive Order 12372 Process? X a. This application was made available to the State under the Executive Order 12372 Process for review on b. Program is subject to E.O. 12372 but has not been selected by the State for review. c. Program is not covered by E.O. 12372.
* 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.) • Yes
If "Yes", provide explanation and attach
Add Attachment Delete Attachment View Attachment
2ery are rue, complet an accurate to the best my knowntage in the profe raine a a as has agree comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001) X*I AGREE
** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions.
Authorized Representative:
Prefix: * First Name: PEGGY
Middle Name:
* Last Name: DUCEY
Suffix:
* Title: CITY MANAGER
* Telephone Number: (707) 961-2823 EXT. 131 Fax Number:
* Email: [email protected]
* Signature of Authorized Representative: * Date Signed: 08/26/2022
2. Ямат.
OMB Number: 4040-0007
Expiration Date: 01/31/2019
ASSURANCES - NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE:
Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances.
If such is the case, you will be notified
As the duly authorized representative of the applicant, I certify that the applicant:
1. Has the legal authority to apply for Federal assistance Act of 1973, as amended (29 U.S.C. 8794), which and the institutional, managerial and financial capability prohibits discrimination on the basis of handicaps; (d) (including funds sufficient to pay the non-Federal share the Age Discrimination Act of 1975, as amended (42 U. of project cost) to ensure proper planning, management S.C. §§6101-6107), which prohibits discrimination on and completion of the project described in this the basis of age; (e) the Drug Abuse Office and application. Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug
2. Will give the awarding agency, the Comptroller General abuse; (f) the Comprehensive Alcohol Abuse and of the United States and, if appropriate, the State, Alcoholism Prevention, Treatment and Rehabilitation through any authorized representative, access to and Act of 1970 (P.L. 91-616), as amended, relating to the right to examine all records, books, papers, or nondiscrimination on the basis of alcohol abuse or documents related to the award; and will establish a alcoholism; (g) §§523 and 527 of the Public Health proper accounting system in accordance with generally Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 accepted accounting standards or agency directives. ee- 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIll of the Civil
3. Will establish safeguards to prohibit employees from Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as using their positions for a purpose that constitutes or amended, relating to nondiscrimination in the sale, presents the appearance of personal or organizational rental or financing of housing; (i) any other conflict of interest, or personal gain. nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being
4. Will initiate and complete the work within the applicable made; and, (i) the requirements of any other time frame after receipt of approval of the awarding nondiscrimination statute(s) which may apply to the application.
agency.
7. Will comply, or has already complied, with the
5. Will comply with the Intergovernmental Personnel Act of requirements of Titles II and Ill of the Uniform
1970 (42 U.S.C. §§4728-4763) relating to prescribed
standards for merit systems for programs funded under Policies Act of 1970 (P.L. 91-646) which provide for one of the 19 statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of faiose properties angerent of are or real or Personnel Administration (5 C.F.R. 900, Subpart F).
federally-assisted programs. These requirements
apply to all interests in real property acquired for
project purposes regardless of Federal participation in purchases.
(a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color 8. Will comply, as applicable, with provisions of the or national origin; (b) Title IX of the Education Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328) Amendments of 1972, as amended (20 U.S.C.S$1681- which limit the political activities of employees whose 1683, and 1685-1686), which prohibits discrimination or principal employment activities are funded in whole he basis of sex; (C) Section 504 of the Rehabilitatior or in part with Federal funds.
Previous Edition Usable Standard Form 424B (Rev. 7-97)
Authorized for Local Reproduction Prescribed by OMB Circular A-10:
9. Will comply, as applicable, with the provisions of the Davis- 13. Will assist the awarding agency in assuring compliance Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act with Section 106 of the National Historic Preservation (40 U.S.C. §276c and 18 U.S.C. §874), and the Contract Act of 1966, as amended (16 U.S.C. §470), EO 11593 Work Hours and Safety Standards Act (40 U.S.C. §§327- (identification and protection of historic properties), and 333), regarding labor standards for federally-assisted the Archaeological and Historic Preservation Act of construction subagreements 1974 (16 U.S.C. §§469a-1 et seq.).
10. Will comply, if applicable, with flood insurance purchase 14. Will comply with P.L. 93-348 regarding the protection of requirements of Section 102(a) of the Flood Disaster human subjects involved in research, development, and Protection Act of 1973 (P.L. 93-234) which requires related activities supported by this award of assistance. recipients in a special flood hazard area to participate in the Will comply with the Laboratory Animal Welfare Act of
program and to purchase flood insurance if the total cost of 1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et
insurable construction and acquisition is $10,000 or more. seq.) pertaining to the care, handling, and treatment of
11. Will comply with environmental standards which may be warm blooded animals held for research, teaching, or prescribed pursuant to the following: (a) institution of other activities supported by this award of assistance. environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Will comply with the Lead-Based Paint Poisoning Executive Order (EO) 11514; (b) notification of violating Prevention Act (42 U.S.C. §84801 et seq.) which facilities pursuant to EO 11738; (c) protection of wetlands prohibits the use of lead-based paint in construction or pursuant to EO 11990; (d) evaluation of flood hazards in rehabilitation of residence structures. floodplains in accordance with EO 11988; (e) assurance of
17. Will cause to be performed the required financial and project consistency with the approved State management compliance audits in accordance with the Single Audit program developed under the Coastal Zone Management Act Amendments of 1996 and OMB Circular No. A-133, Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of "Audits of States, Local Governments, and Non-Profit Federal actions to State (Clean Air) Implementation Plans Organizations." under Section 176(c) of the Clean Air Act of 1955, as
amended (42 U.S.C. §87401 et seq.); (g) protection of 18. Will comply with all applicable requirements of all other underground sources of drinking water under the Safe Federal laws, executive orders, regulations, and policies Drinking Water Act of 1974, as amended (P.L. 93-523); governing this program. and, (h) protection of endangered species under the
Endangered Species Act of 1973, as amended (P.L. 93- 19. Will comply with the requirements of Section 106(g) of the Trafficking Victims Protection Act (TVPA) of 2000, as amended (22 U.S.C. 7104) which prohibits grant award
12. Will comply with the Wild and Scenic Rivers Act of recipients or a sub-recipient from (1) Engaging in severe 1968(16 U.S.C. §§1271 et seq.) related to protecting forms of trafficking in persons during the period of time components or potential components of the national that the award is in effect (2) Procuring a commercial wild and scenic rivers system. sex act during the period of time that the award is in effect or (3) Using forced labor in the performance of the award or subawards under the award.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE
City Manager
Lessey lucy
APPLICANT ORGANIZATION DATE SUBMITTED
City of Fort Bragg 08/26/2022
Standard Form 424B (Rev. 7-97) Back
RD Instruction 1940-Q
Exhibit A-1
CERTIFICATION FOR CONTRACTS, GRANTS AND LOANS
The undersigned certifies, to the best of his or her knowledge and belief, that:
1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant or Federal loan, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant or loan.
If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant or loan, the undersigned shall complete and submit Standard Form - LLL, "Disclosure of Lobbying Activities," in accordance with its instructions.
The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including contracts, subcontracts, and subgrants under grants and loans) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into.
Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S.
Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
repay nace leggy sides 8/26/2022_
(name) (date)
City Manager
(title)
(08-21-91) PN 171
ALIFORNI
CITY OF FORT BRAGG
Incorporated August 5, 1889
416 N. Franklin Street
Fort Bragg, CA 95437
Fax: (707) 961-2913
Phone: (707) 961-2825
August 26, 2022
Reef Atwell-Smith
Area Specialist
Santa Rosa Office, Rural Development
United States Department of Agriculture
777 Sonoma Ave, 'E' Street Annex
Santa Rosa, CA 95404
Re: Fort Bragg Project Selected for Funding - PD Vehicles Greetings Reef,
The City of Fort Bragg's matching contributions for the police vehicle have been identified in its Fleet and Equipment Services Internal Service Fund, approved by the City Council during the June 27, 2022 meeting through Resolution No. 4560-2022 2022/23 Fiscal Year Adopted Budget meeting under the Vehicle Replacement Plan.
Matching funding for the Security Camera Systems to be obtained using budgeted fund accounts; I.T., Fleet, Water Enterprise, Wastewater Enterprise, Parks and Facilities.
Best regards,
Sandy Arellana
Sandy Arellano
Public Works Administrative Analyst
ADMINISTRATION/ENGINEERING FINANCE/ATER WORKS ECONOMIC/COMMUNITY DEVELOPMENT (707) 961-2823 (707)961-2825 (707) 961-2828