USDA 5
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.
Civil Rights Act of 1964.
C. The Americans with Disabilities Act (ADA) of 1990.
d. Age Discrimination Act of 1975.
e. Limited English Proficiency (LEP) under Executive Order 13166
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. Prior to 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
09/19/2022
Date
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 maintains a reserve in the Fleet & Equipment Services Internal Service Fund to enable the timely replacement of vehicles and depreciable equipment. A ten-year Vehicle and Equipment Replacement Plan has been established. Additionally, Fleet Fund has $291k of vehicle purchases according to the replacement program, of which $160k depends on USDA granted funds. The City's Fleet consist of all City vehicles, heavy equipment, and other large pieces of equipment owned by the City.
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.
The City of Fort Bragg would like to purchase (2) two 2023 Ford F150 Pick-up Trucks and (1) one new Dump Truck that are necessary for the daily operations of the city. These and any new vehicles to be purchased are expected to meet all required safety requirements as per law.
One new truck is for the use of the City's Police Department force to include a complete build kit and light bar. The second truck is designated for the use of Water Operations' staff. The dump truck is for the use of sewer and water operations.
3. Need for the Facility. Indicate why the proposed facility is needed.
The current vehicles and equipment have reached their maximum expected service span.
4. Service Area. Indicate what area the proposed facility will serve and, if known, the population or number of families served.
The new service vehicles and equipment will be used for the City of Fort Bragg Police and Public Works Department's Jurisdiction; with a population of approximately 8,000 habitants and the City's high volume of year round tourist.
Please DO NOT RETURN this form to this address. Forward to the local USDA office only.
Position 8 Form RD 1942-54 (Rev. 10-96)
5. Cost Estimate.
Development and construction.. $
Land and rights..
Legal fees... .....
Architect and Engineer.
quipment. 214, 800.00
financing
Other (describe)
Total $214, 800.00
6. Income. List the sources and estimate the amount of expected revenue for a typical year.
These purchases are non-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).
The applicants contributions/matching funds have been identified in the Fleet & Equipment Services Internal Service fund, approved by the City Council during their 2022/23 Fiscal Year Adopted Budget as per Resolution No. 4560-2022 under the Vehicle Replacement Plan.
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. non-applicable
mature and Title of Applicant Official Date
Резду Диску 09-19-2022
RD 1942-54
(Reverse)
10 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:
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 - ILL, "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. Code. 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.
Pegzy Suary 09/19/2022
(date)
City Manager
(title)
000
(08-21-91) PN 171
USDA
United States Department of Agriculture
Tete entering remin cape sector re 2372 the props it eringous 65) listed below:
California State Clearinghouse All Counties Merced County Association Merced of Governments (MCAG)
Link for submissions: 369 W. 18th St.
http://cfda.opr.ca.gov/#/ Merced, CA 95340
Phone: (209) 723-3153 Fax: (209) 723-0322
Association of Bay Area Alameda, Marin, Sacramento Area COG El Dorado, Placer, Governments (ABAG) Santa Clara, Solano, 1415 L St., Ste. 300 Sacramento, Sutter, 375 Beale St. Ste 700, Sonoma, San Mateo, Sacramento, CA 95814 Yolo, Yuba San Francisco, CA 946 Contra Costa, Napa Phone: (916) 321-9000 Fax: (916) 321-9551 Phone: (415) 820-7900 Fax: (415) 660-3500
Association of Monterey Bay Monterey, Santa San Diego Association San Diego Area Governments (AMBAG) Cruz, San Benito of governments P.O. Box 2453 401 B St., Ste. 800
Seaside, CA 93955 San Diego, CA 92101
Phone: (831) 883-3750 Fax: (831) 883-3755 Phone: (619) 699-1900 Fax: (619) 699-1905 Council of Fresno Fresno San Joaquin County COG San Joaquin County Governments 555 E. Weber Ave.
2035 Tulare St., Ste. 201 Stockton, CA 95202
Fresno, CA 93721 Phone: (209) 235-0600 Fax: (209) 235-0438 Phone: (559) 233-4148 Fax: (559) 233-9645
Kern Council of Governments Kern Santa Barbara County Santa Barbara 1401 19" St., Ste. 300 Association of Governments
Bakersfield, CA 93301 260 N. San Antonio Rd., Ste. B
Phone: (661) 861-2191 Fax: (661) 324-8215 Santa Barbara, CA 93110 Phone: (805) 961-8900 Fax: (805) 961-8901
Southern California Association Imperial, Orange, Stanislaus Area Association Stanislaus of Governments (SCAG) Los Angeles, of Governments (SAAG) 900 Wilshire Blvd, Ste. 1700 San Bernardino, 1111 I St. Ste. 308 Los Angeles, CA 90017 Riverside, Ventura Modesto, CA 95354 Phone: (213) 236-1800 Fax: (213) 425-0936 Phone: (209) 525-4600 Fax: (209) 558-7833 Tulare Kings County Community Kings
Development Agency
1400 W. Lacey Blvd., Bldg. #6
Visalia, CA 93291 Hanford, CA 93230
Phone: (559) 623-0450 Fax: (559) 733-6720 Phone: (559) 852-2670 Fax: (559) 584- 8989 Butte County Association of Butte
326 Huss Drive St., Ste. 150
Chico. CA 95928
Phone 530-809-4616 ext.1157 Fax 530-879-2444
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. §794), 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 VIII 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, (j) the requirements of any other time frame after receipt of approval of the awarding nondiscrimination statute(s) which may apply to the agency. application.
7. Will comply, or has already complied, with the
5. Will comply with the Intergovernmental Personnel Act of requirements of Titles Il and Ill of the Uniform
1970 (42 U.S.C. §84728-4763) relating to prescribed Relocation Assistance and Real Property Acquisition 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 fair and equitable treatment of persons displaced or Appendix A of OPM's Standards for a Merit System of whose property is acquired as a result of Federal or Personnel Administration (5 C.F.R. 900, Subpart F). federally-assisted programs. These requirements apply to all interests in real property acquired for
6. Will comply with all Federal statutes relating to project purposes regardless of Federal participation in purchases.
8. Will comply, as applicable, with provisions of the
Hatch Act (5 U.S.C. §81501-1508 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-102
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 insurable construction and acquisition is $10,000 or more. 1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et 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 16. 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. §$7401 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- 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
Peggy Duay
APPLICANT ORGANIZATION DATE SUBMITTED
City of Fort Bragg 09/19/2022
Standard Form 424B (Rev. 7-97) Back
Form RD 400-1 FORM APPROVED
(Rev. 5-00) UNITED STATES DEPARTMENT OF AGRICULTURE OMB No. 0575-0018
EQUAL OPPORTUNITY AGREEMENT
This agreement, dated 09-19-2022 between
The City of Fort Bragg
(egritions d Re Secretary of abor herein called the seerstay sued under the giority usecutive order 1246 as amended, 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 Labor issued pursuant to Section 204 of Executive Order 11246 of September 24, 1965.
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, regulations, and orders.
(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.
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 assistance to the organization under the program with respect to which the failure or refund occurred until satisfactory assurance of future compliance has been received from such organization; and refer the case to the Department of Justice for appropriate legal proceedings.
Signed by the Recipient on the date first written above.
Recipient Recipient
Peggy Ducey, City Manager
(CORPORATE SEAL)
Name of Corporate Recipient
Attest:
By -
Secretary President
Position 3
USDA FORM APPROVED
Form RD 400-4 ASSURANCE AGREEMENT OMB No. 0575-0018
(Rev. 06-10) (Under Title VI, Civil Rights Act of 1964) OMB No. 0570-0062 The City of Fort Bragg
(name of recipient)
416 N. Franklin Street, Fort Bragg CA 95437
("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 Business- Cooperative Service, Rural Utilities Service, Risk Management Agency, or the Farm Service Agency, (hereafter known as the "Agency") regulations promulgated thereunder, 7 C.F.R. § 1901.202. In accordance with that Act and the regulations referred to above, Recipient agrees that in connection with any program or activity for which Recipient receives Federal financial assistance (as such term is defined in 7 C.F.R. § 15.2) no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation 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, 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 C/o Peggy Ducey
Recipient
09-19-2022
BUDGET INFORMATION - Non-Construction Programs OMB Number: 4040-0006 Expiration Date: 01/31/2019
SECTION A - BUDGET SUMMARY
Grant Program Catalog of Federal Estimated Unobligated Funds New or Revised Budget Function or Domestic Assistance
Activity Number Federal Non-Federal Federal Non-Federal Total (a) (b) (c) (d) (e) (1) (g)
1. 2023 Ford F150 Truck 10.766 $/ $ 24,145.00$ 19,755.00 $ 43,900.00 including light bar
package - Police
Department
2. 2023 Ford F150 Truck 10.766 21,945.00 17,955.00 39,900.00 - Water Department
3. 2022 Dump Truck- 10.766 72,050.00 58,950.00 131,000.00 Sewer/Water
Department
4. 5. Totals $[ 118,140.00 96,660.00 $ 214,800.00
Standard Form 424A (Rev. 7-97)
Prescribed by OMB (Circular A - 102) Page 1
SECTION B - BUDGET CATEGORIES
6. Object Class Categories GRANT PROGRAM, FUNCTION OR ACTIVITY Total (1) (3) (4) (5)
2023 Ford F150 Truck 2023 Ford F150 Truck 2022 Dump Truck- including light bar - Water Department Sewer/Water
package - Police Department
Department
a. Personnel 2,148,562.00 $ 405, 256.00 $ $ $ 2,553,818.00 b. Fringe Benefits 1,050, 346.00 262,137.00 1,312, 483.00 c. Travel 35,000.00 5,000.00 40,000.00
d. Equipment 30,000.00 3,500.00 33,500.00
e. Supplies 40, 700.00 60,000.00 100, 700.00
f. Contractual 426, 332.00 158,242.00 584,574.00
g. Construction 0.00 0.00 0.00
h. Other 426,332.00 8,000.00 434, 332.00
i. Total Direct Charges (sum of 6a-6h) 4,157,272.00 902,135.00 5,059,407.00 j. Indirect Charges 1,417,103.00 729,825.00 2,146,928.00 5,574, 375.00 $ 1,631,960.00 $ $_
k. TOTALS (sum of 6i and 6j) 7,206,335.00
7. Program Income $ I 129,924.00 $ 58, 348.00 $ 188,272.00 Authorized for Local Reproduction Standard Form 424A (Rev. 7- 97) Prescribed by OMB (Circular A -102) Page 1A
SECTION C - NON-FEDERAL RESOURCES
(a) Grant Program (b) Applicant (c) State (d) Other Sources (e)TOTALS
8. opa Ford F250 truck including light bar packago - polico $ 19,755.00 19,755.00 2023 Ford F150 Truck - Water Department
9. 17,955.00 17,955.00
10. 2022 Dump Truck- Sewer/Water Department 58,950.00 58,950.00
11. 12. TOTAL (sum of lines 8-11) $ 96,660.00 $ $ $ 96,660.00
SECTION D - FORECASTED CASH NEEDS
Total for 1st Year 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter
13. Federal $ $
14. Non-Federal $
15. TOTAL (sum of lines 13 and 14) $
SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT (a) Grant Program FUTURE FUNDING PERIODS (YEARS)
(b)First (c) Second (d) Third (e) Fourth
2023 Ford F150 Truck including light bar package - Police $ $
16. Department 24,145.00 $
17. 2023 Ford F150 Truck - Water Department 21,945.00
18. 2022 Dump Truck- Saver/ator Department 72,050.00
19. 20. TOTAL (sum of lines 16 - 19) $ 118,140.00 $ ] $L $
SECTION F - OTHER BUDGET INFORMATION
21. Direct Charges: 22. Indirect Charges:
23. Remarks: (20, a Ros an one no, 0 202/2028 fload on for the purchao of chao vantos using budged fund scounta, Authorized for Local Reproduction Standard Form 424A (Rev. 7-97) Prescribed by OMB (Circular A -102) Page 2
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
X Application ] Continuation * Other (Specify):
• Changed/Corrected Application Revision
* 3. Date Received: 4. Applicant Identifier:
09/19/2022 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 M5YOXA938V9
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 & PW DEPARTMENT WATER/WASTEWATER
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:
* 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:
(1) Dump Truck and (2) F150 Fords Trucks for Police, Sewer/Water Departments.
13. Competition Identification Number:
Title:
14. Areas Affected by Project (Cities, Counties, States, etc.):
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* 15. Descriptive Title of Applicant's Project:
(1) Dump Truck and (2) F150 Fords Trucks for POLICE, Sewer/Water Departments.
Attach supporting documents as specified in agency instructions.
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Application for Federal Assistance SF-424
16. Congressional Districts Of:
*a. Applicant 02 * b. Program/Project
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 118,140.00
*b. Applicant 96, 660.00
* c. State
* d. Local
* e. Other
*f. Program Income
* g. TOTAL 214,800.00
* 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 X No
If "Yes", provide explanation and attach
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21. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to 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**| 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: 09/19/2022 Pezzy Dcay