Project Title
Empathy Unleashed: Navigating Autism andMental Health
Federal Estimated Funding (FederalShare)
51949.0
Total Estimated Funding
51949.0
92584
92585
92586
92587
92596
Proposed Project Start Date
10/1/24
Applicant Estimated Funding (Non-Federal Share)
0.0 Proposed Project End Date
9/30/26
Program Income Estimated Funding
0.0 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):
——
Application POC Prefix Name
——
Application POC First Name
Christine
Application POC Middle Name
Ann
Application POC Last Name
Booker
Application POC Suffix Name
——
Standard Applicant Information
Project Information
Areas Affected by Project (Cities, Counties, States, etc.) Type Of Applicant
Application Submitter Contact Information
Organizational Affiliation Title Email ID
City of Menifee- Police DepartPolice Budget & Grants Analyst [email protected] Phone Number
951-723-1513
Fax Number
——
ORINumber
——
Is Application Subject to Review by State Under Executive Order 12372? c. Program is not covered by E.O. 12372.
Is the Applicant Delinquent on Federal Debt?
No
Name
Form SF424_4_0-V4.0.pdf
Date Added
5/7/24
Name
Form SFLLL_2_0-V2.0.pdf
Date Added
5/7/24
Name
SF424_4_0-1234-Affected Areas.docx
Date Added
5/7/24
Name
GrantApplication.xml
Date Added
5/7/24
Authorized Representative
Executive Order and Delinquent Debt Information
SF424 Attachments (4)
Title
Budget and Grants Analyst
Prefix Name
Mrs.
First Name ChristineMiddle Name —— Last Name Booker
Suffix Name
——
Title
Financial Services Manager
Prefix Name
Ms.
First Name MARGARITAMiddle Name —— Last Name CORNEJO
Suffix Name
——
Verify Legal Name, Doing Business As, and Legal Address Legal Name
CITY OF MENIFEE
Doing Business As
UEI
K2DEKYTD12J6
Street 1
29844 HAUN ROAD
Street 2
City
MENIFEE
State
CA
Zip/Postal Code
92586
CongressionalDistrict
41 Country
USA
The legal name + Doing Business As (DBA) and legal address define a unique entity in the system as represented in its entity profile. The profile legal nameand address is applicable to ALL applications and awards associated to this fiscal agent.
1. If this information is correct confirm/acknowledge to continue with completion of this application.
I confirm this is the correct entity.
Signer Name
Christine Booker
Certification Date / Time
05/07/2024 12:35 PM
2. If the information displayed does not accurately represent the legal entity applying for federal assistance: a. Contact your Entity Administrator. b. Contact the System for Award Management (SAM.gov) to update the entity legal name/address.
Law Enforcement Executive InformationGovernment Executive Information Legal Addess
Certification
3. If the above information is not the entity for which this application is being submitted, Withdraw/Delete this application. Please initiate a new application inGrants.gov with using the correct UEI/SAM profile.
Sworn Officer Positions: $0.00
Civilian or Non-Sworn Personnel: $0.00
Travel: $8,156.00
Equipment: $0.00
Supplies: $43,793.00
SubAwards: $0.00
Procurement Contracts: $0.00
Other Costs: $0.00
Total Direct Costs: $51,949.00
IndirectCosts: $0.00
Proposal Abstract
This proposal outlines the development of an innovative training course aimed at fostering comprehensive understanding and practical skillsamong diverse stakeholders. Drawing upon interdisciplinary research and expertise, the course will blend theoretical knowledge with real-worldscenarios, equipping participants with the tools to recognize, communicate, and support individuals with autism and other special needseffectively. Additionally, this proposal seeks to outfit police department staff with the tools necessary to facilitate peaceful interactions withagitated persons to limit unfavorable interactions with law enforcement.
Data Requested with Application
FY24 CPD MG Eligibility
FY24 CPD MG App Quest
Inv Fed Prior Policing
CPA Gen Solicitation Quest
CPA Information
Proposal Narrative
Budget and Associated Documentation
Budget Summary
Budget Category Total Cost
Indirect Costs: $0.00
Total Project Costs: $51,949.00
Federal Funds: $51,949.00
Match Amount: $0.00
Program Income: $0.00
No documents have been uploaded for Non-Competitive Justification No documents have been uploaded for Indirect Cost Rate Agreement No documents have been uploaded for Consultant Rate Justification Name
City of Menifee- BudgetNarrative.docx
Category
Budget Narrative
Created by
Christine Booker
Date Added
5/15/2024 12:46 PM
Budget and Associated Documentation
DOES THIS BUDGET CONTAIN CONFERENCE COSTS WHICH IS DEFINED BROADLY TO INCLUDE MEETINGS, RETREATS, SEMINARS, SYMPOSIA, ANDTRAINING ACTIVITIES? —— List each position by title and name of employee, if available. Show the annual salary rate and the percentage of time to be devoted to the project. Compensationpaid for employees engaged in grant activities must be consistent with that paid for similar work within the applicant organization. In the narrative section, pleaseprovide a specific description of the responsibilities and duties for each position, and explain how the responsibilities and duties support the project goals andobjectives outlined in your application.
No items
Budget / Financial Attachments
Non-competitive Justification
Indirect Cost Rate Agreement
Consultant Rate Justification
Additional Attachments
Base Salary and Fringe Benefits for Sworn Officer
Personnel
Instructions
Year 1
Year 1
Personnel Detail
NamePositionSalaryRate TimeWorkedPercentageof Time (%)TotalCost Fringe benefits should be based on the actual known costs or an approved negotiated rate by a Federal Agency. If not based on an approved negotiated rate, listthe composition of the fringe benefit package. Fringe benefits are for the personnel listed in Personnel budget category listed and only for the percentage of timedevoted to the project. In the narrative section, please provide a specific description for each item Itemize travel expenses of staff personnel (e.g. staff to training, field interviews, advisory group meeting, etc.). Describe the purpose of each travelexpenditure in reference to the project objectives. Show the basis of computation (e.g., six people to 3-day training at $X airfare, $X lodging, $X subsistence).In training projects, travel and meals for trainees should be listed separately. Show the number of trainees and the unit costs involved. Identify the location oftravel, if known; or if unknown, indicate "location to be determined." Indicate whether applicant's formal written travel policy or the Federal Travel Regulationsare followed. Note: Travel expenses for consultants should be included in the “Consultant Travel” data fields under the “Subawards (Subgrants)/ProcurementContracts” category. For each Purpose Area applied for, the budget should include the estimated cost for travel and accommodations for two staff to attendtwo three-day long meetings, with one in Washington D.C. and one in their region, with the exception of Purpose Area 1, which should budget for onemeeting in Washington D.C, and Purpose Areas 6 and 7, which should budget for 3 meetings within a 3 year period, with 2 in Washington D.C, and 1 withintheir region. All requested information must be included in the budget detail worksheet and budget narrative.
Personnel Total Cost
$0
Additional Narrative
No items
Fringe Benefits Total Cost $0
Additional Narrative
AssaultCrisisTrainingOnlineOther N/A $2,718.751.00 3.00 1.00 $8,156.25 $8,156.25 Fringe Benefits
Instructions
Year 1
Fringe Benefit Detail
NameBaseRate (%)Total Cost
Travel
Instructions
Year 1
Travel Detail
PurposeofTravel
LocationType ofExpense
BasisCost Quantity# OfStaff# OfTrips
Total CostNon-FederalContributionFederalRequest
List non-expendable items that are to be purchased (Note: Organization’s own capitalization policy for classification of equipment should be used). Expendableitems should be included in the “Supplies” category Applications should analyze the cost benefits of purchasing versus leasing equipment, especially high costitems and those subject to rapid technological advances. Rented or leased equipment costs should be listed in the “Contracts” data fields under the “Sub awards”(Sub grants)/Procurement Contracts” category. In the budget narrative, explain how the equipment is necessary for the success In the budget narrative, explainhow the equipment is necessary for the success of the project, and describe the procurement method to be used. All requested information must be included inthe budget detail worksheet and budget narrative.
List items by type (office supplies, postage, training materials, copy paper, and expendable equipment items costing less than $5,000, such as books, handheld tape recorders) and show the basis for computation. Generally, supplies include any materials that are expendable or consumed during the course of theproject. All requested information must be included in the budget detail worksheet and budget narrative.
Travel Total Cost
$8,156
Additional Narrative
No items
Equipment Total Cost
$0
NIUBEE 2packacrylic brochureholder 3.00 $31.48 $94.44 $94.44 Quartet Easel70" high 3.00 $153.33$459.99 $459.99
Xuhal 12 pc Kidsnoise cancellingheadphones30.00$79.38 $2,381.40 $2,381.40 The department is requesting the Pro-Act Restraint Training course to be attended by the three staff being assigned as instructors for the Menifee PoliceDepartments autism and other special needs awareness class. This course will be necessary for providing non restraint methods for handling situationsthat will then be integrated into the course being created by the Menifee Police Department. This is online training that will be completed by staff duringtheir regular shifts and will not require any travel costs in addition to the course cost.
Equipment
Instructions
Year 1
Equipment Detail
EquipmentItem # ofItemsCostTotalCost Non-FederalContributionFederalRequest Supply Items
Instructions
Year 1
Supply Item Detail
Purpose ofSupply Items# ofItemsUnit CostTotal CostNon-FederalContributionFederalRequest T-Signcorrugated5.00 $32.61 $163.05 $163.05
plastic sheet 2-pack
Storexclassroom craftproject box 5pack
1.00 $42.28 $42.28 $42.28
Quartet Easelcollapsiblewhiteboard3.00 $367.42$1,102.26 $1,102.26 IRIS USALetterbox 4 pack1.00 $48.93 $48.93 $48.93
Nicpro upgradedart portfolio bag2.00 $52.84 $105.68 $105.68 JUJIAJIA 6qtclear storage box6 pack 2.00 $26.09 $52.18 $52.18 Xuhal 9 pieceearmuffs- adult30.00$70.68 $2,120.40 $2,120.40 MyLifeUnit StickyNotes 3x3 54pads 3.00 $39.14 $117.42 $117.42 208pc binderclips paperclamps 1.00 $25.59 $25.59 $25.59 Citylife 3pieceplastic storagebin with lid2.00 $31.51 $63.02 $63.02 AutismNonverbal helpbelt 9" cover100.00$13.87 $1,387.00 $1,387.00 Stress ballssquishy fidgettoy 32 pack2.00 $32.25 $64.50 $64.50 Nortix stickyeasel pads15.00$92.43 $1,386.45 $1,386.45
2 in 1 hand truckdolly with foldingbasket 1.00 $184.86$184.86 $184.86 I-Pad MiniCovers 30.00$54.36 $1,630.80 $1,630.80
AssistiveTechnology AP 30.00$135.93$4,077.90 $4,077.90
Calm Down Kits50.00$195.74$9,787.00 $9,787.00
Citylife 17qtStorage Box2.00 $38.05 $76.10 $76.10
Expo Markers-Color 5.00 $32.61 $163.05 $163.05
WeLiu PaintersTape 10 rolls2.00 $25.00 $50.00 $50.00
LOUKIN 4 packdry erasers2.00 $27.18 $54.36 $54.36
Expo Marker-Black 5.00 $22.23 $111.15 $111.15
As a rule, construction costs are not allowable. In some cases, minor repairs or renovations may be allowable. Consult with the DOJ grant-making componentbefore budgeting funds in this category. In the narrative section, please provide a specific description for each item, and explain how the item supports theproject goals and objectives outlined in your application.
Subawards (see "Subaward" definition at 2 CFR 200.92) : Provide a description of the Federal Award activities proposed to be carried out by any subrecipientand an estimate of the cost (include the cost per subrecipient, to the extent known prior to the application submission). For each subrecipient, enter thesubrecipient entity name, if known. Please indicate any subaward information included under budget category Subawards (Subgrants) Contracts by includingthe label "(subaward)" with each subaward category.
Pens- 400 Pack2.00 $49.99 $99.98 $99.98
I-Pad Mini30.00$598.11 $17,943.30 $17,943.30
Supplies Total Cost
$43,793
Additional Narrative
No items
Construction Total Cost
$0
There are three main categories that the supplies needs are broken down into for our project. The first is technology needs for the trainingprograms which include the Ipad minis, their cases and the program for the Ipads which is Assistive Technology AP. These will be used in thetraining courses to show participants how to communicate with non verbal special needs individuals, and can be used in the field for similarsituations as well.
The second category for supplies include the calm down kits and accompanying items to assist in officer involved situations with persons withspecial needs who are agitated. These include the full calm down kits, the adult and child headphones, stress balls, and non-verbal seat beltidentifiers.
The last category for supplies is general items that will be used in the training course. This includes the white boards, markers, pens and storagecontainers for transporting the handouts and materials.
Construction
Instructions
Year 1
Construction Detail
Purpose ofConstructionDescriptionof Work # ofItemsCostTotalCost Non-FederalContributionFederalRequest Subawards
Instructions
Year 1
Subaward (Subgrant) Detail
DescriptionPurposeConsultantCountryState/U.S.TerritoryCity TotalCost Non-FederalContributionFederalRequest Procurement contracts (see “Contract” definition at 2 CFR 200.1): Provide a description of the product or service to be procured by contract and an estimateof the cost. Indicate whether the applicant’s formal, written Procurement Policy or the Federal Acquisition Regulation is followed. Applicants are encouragedto promote free and open competition in awarding procurement contracts. A separate justification must be provided for noncompetitive procurements inexcess of the Simplified Acquisition Threshold set in accordance with 41 U.S.C. 1908 (currently set at $250,000).
Consultant Fees: For each consultant enter the name, if known, service to be provided, hourly or daily fee (8-hour day), and estimated time on the project.Written prior approval and additional justification is required for consultant fees in excess of the DOJ grant-making component's threshold for an 8-hour day.
In the narrative section, please provide a specific description for each item, and explain how the item supports the project goals and objectives outlined inyour application.
List items (e.g., rent, reproduction, telephone, janitorial or security services, and investigative or confidential funds) by type and the basis of the computation.
No items
Subawards Total Cost
$0
Add Consultant Travel
——
No items
Do you need Consultant Travel? No
Procurement Cost
$0
Procurement contracts (see “Contract” definition at 2 CFR 200.22): Provide a description of the product or service to beprocured by contract and an estimate of the cost. Indicate whether the applicant’s formal, written Procurement Policy or theFederal Acquisition Regulation is followed. Applicants are encouraged to promote free and open competition in awardingprocurement contracts. A separate justification must be provided for sole source procurements in excess of the SimplifiedAcquisition Threshold set in accordance with 41 U.S.C. 1908 (currently set at $250,000) for prior approval. Please provide aspecific description for each item, and explain how the item supports the project goals and objectives outlined in yourapplication. Consultant Fees: For each consultant enter the name, if known, service to be provided, hourly or daily fee (8-hourday), and estimated time on the project. Unless otherwise approved by the COPS Office, approved consultant rates will be basedon the salary a consultant receives from his or her primary employer. Consultant fees in excess of $650 per day requireadditional written justification, and must be pre-approved in writing by the COPS Office if the consultant is hired via anoncompetitive bidding process. Please provide a specific description for each item, and explain how the item supports theproject goals and objectives outlined in your application. Please visit https://cops.usdoj.gov/grants for a list of allowable andunallowable costs for this program.
Instructions
Year 1
Procurement Contract Detail
DescriptionPurposeConsultantCountryState/U.S.TerritoryCity TotalCost Non-FederalContributionFederalRequest Other Direct Costs
Instructions
For example, provide the square footage and the cost per square foot for rent, or provide a monthly rental cost and how many months to rent. All requested information must be included in the budget detail worksheet and budget narrative.
Indirect costs are allowed only if: a) the applicant has a current, federally approved indirect cost rate; or b) the applicant is eligible to use and elects to use the“de minimis” indirect cost rate described in 2 C.F.R. 200.414(f). (See paragraph D.1.b. in Appendix VII to Part 200—States and Local Government and IndianTribe Indirect Cost Proposals for a description of entities that may not elect to use the “de minimis” rate.) An applicant with a current, federally approvedindirect cost rate must attach a copy of the rate approval, (a fully-executed, negotiated agreement). If the applicant does not have an approved rate, one canbe requested by contacting the applicant’s cognizant Federal agency, which will review all documentation and approve a rate for the applicant organization, orif the applicant’s accounting system permits, costs may be allocated in the direct costs categories. (Applicant Indian tribal governments, in particular, shouldreview Appendix VII to Part 200—States and Local Government and Indian Tribe Indirect Cost Proposals regarding submission and documentation of indirectcost proposals.) All requested information must be included in the budget detail worksheet and budget narrative. In order to use the “de minimis” indirect ratean applicant would need to attach written documentation to the application that advises DOJ of both the applicant’s eligibility (to use the “de minimis” rate)and its election. If the applicant elects the de minimis method, costs must be consistently charged as either indirect or direct costs, but may not be doublecharged or inconsistently charged as both. In addition, if this method is chosen then it must be used consistently for all federal awards until such time as theapplicant entity chooses to negotiate a federally approved indirect cost rate.
No items
Other Costs Total Cost
$0
No items
Indirect Costs Total Cost
$0
Additional Narrative
Year 1
Other Cost Detail
DescriptionQuantityBasis Costs LengthofTime Total CostsNon-FederalContributionFederalRequest Indirect Costs
Instructions
Year 1
Indirect Cost Detail
Description Base IndirectCostRate Total CostNon-FederalContributionFederalRequest Memoranda of Understanding (MOUs) and Other Supportive Documents Memoranda of Understanding (MOUs) and Other Supportive Documents Upload
The recommended files to upload are PDF, Microsoft Word and Excel.
No documents have been uploaded for Memoranda of Understanding (MOUs) and Other Supportive Documents Disclosure of Lobbying Activities
Name
Form SFLLL_2_0-V2.0.pdf
Category
LobbyingActivitiesDisclosure
Created by
——
Name
Resume- Jason Kaub.docx
Category
Curriculum Vitae orResumes
Created by
Christine Booker
Date Added
5/15/2024 2:02 PM
Name
Resume- Sheila Lawton.pdf
Category
Curriculum Vitae orResumes
Created by
Christine Booker
Date Added
5/15/2024 12:54 PM
Name
Resume- ChristineBooker.doc
Category
Curriculum Vitae orResumes
Created by
Christine Booker
Date Added 5/15/2024 12:48 PM
No documents have been uploaded for Letters of Support
No documents have been uploaded for Additional Attachments Additional Application Components
Curriculum Vitae or Resumes
Letters of Support
Additional Attachments
Disclosures and Assurances
DOJ Certified Standard Assurances
OMB APPROVAL NUMBER 1121-0140
EXPIRES 05/31/2019
U.S. DEPARTMENT OF JUSTICE
CERTIFIED STANDARD ASSURANCES
On behalf of the Applicant, and in support of this application for a grant or cooperative agreement, I certify under penalty of perjury to the U.S. Department ofJustice ("Department"), that all of the following are true and correct:
(1) I have the authority to make the following representations on behalf of myself and the Applicant. I understand that these representations willbe relied upon as material in any Department decision to make an award to the Applicant based on its application. (2) I certify that the Applicant has the legal authority to apply for the federal assistance sought by the application, and that it has the institutional,managerial, and financial capability (including funds sufficient to pay any required non-federal share of project costs) to plan, manage, and complete the project described in the application properly. (3) I assure that, throughout the period of performance for the award (if any) made by the Department based on the application-- a. the Applicant will comply with all award requirements and all federal statutes and regulations applicable to the award; b. the Applicant will require all subrecipients to comply with all applicable award requirements and all applicable federal statutes andregulations; and c. the Applicant will maintain safeguards to address and prevent any organizational conflict of interest, and also to prohibit employees fromusing their positions in any manner that poses, or appears to pose, a personal or financial conflict of interest.
(4) The Applicant understands that the federal statutes and regulations applicable to the award (if any) made by the Department based on theapplication specifically include statutes and regulations pertaining to civil rights and nondiscrimination, and, in addition-- a. the Applicant understands that the applicable statutes pertaining to civil rights will include section 601 of the Civil Rights Act of 1964 (42 U.S.C. § 2000d); section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 794); section 901 of the Education Amendments of 1972 (20U.S.C. § 1681); and section 303 of the Age Discrimination Act of 1975 (42 U.S.C. § 6102); b. the Applicant understands that the applicable statutes pertaining to nondiscrimination may include section 809(c) of Title I of the OmnibusCrime Control and Safe Streets Act of 1968 (34 U.S.C. § 10228(c)); section 1407(e) of the Victims of Crime Act of 1984 (34 U.S.C. § 20110(e)); section 299A(b) of the Juvenile Justice and Delinquency Prevention Act of 2002 (34 U.S.C. § 11182(b)); and that the grantcondition set out at section 40002(b)(13) of the Violence Against Women Act (34 U.S.C. § 12291(b)(13)), which will apply to all awards made by the Office on Violence Against Women, also may apply to an award made otherwise; c. the Applicant understands that it must require any subrecipient to comply with all such applicable statutes (and associated regulations);and d. on behalf of the Applicant, I make the specific assurances set out in 28 C.F.R. §§ 42.105 and 42.204. (5) The Applicant also understands that (in addition to any applicable program-specific regulations and to applicable federal regulations that pertain to civil rights and nondiscrimination) the federal regulations applicable to the award (if any) made by the Department based on theapplication may include, but are not limited to, 2 C.F.R. Part 2800 (the DOJ "Part 200 Uniform Requirements") and 28 C.F.R. Parts 22 (confidentiality - research and statistical information), 23 (criminal intelligence systems), 38 (regarding faith-based or religious organizationsparticipating in federal financial assistance programs), and 46 (human subjects protection). (6) I assure that the Applicant will assist the Department as necessary (and will require subrecipients and contractors to assist as necessary) with the Department's compliance with section 106 of the National Historic Preservation Act of 1966 (54 U.S.C. § 306108), the Archeological andHistorical Preservation Act of 1974 (54 U.S.C. §§ 312501-312508), and the National Environmental Policy Act of 1969 (42 U.S.C. §§ 4321-4335), and 28 C.F.R. Parts 61 (NEPA) and 63 (floodplains and wetlands). (7) I assure that the Applicant will give the Department and the Government Accountability Office, through any authorized representative, access to, and opportunity to examine, all paper or electronic records related to the award (if any) made by the Department based on the application. (8) If this application is for an award from the National Institute of Justice or the Bureau of Justice Statistics pursuant to which award funds may be made available (whether by the award directly or by any subaward at any tier) to an institution of higher education (as defined at 34 U.S.C. § 10251(a)(17)), I assure that, if any award funds actually are made available to such an institution, the Applicant will require that, throughout theperiod of performance-- a. each such institution comply with any requirements that are imposed on it by the First Amendment to the Constitution of the United States;and b. subject to par. a, each such institution comply with its own representations, if any, concerning academic freedom, freedom of inquiry anddebate, research independence, and research integrity, at the institution, that are included in promotional materials, in official statements, in formal policies, in applications for grants (including this award application), for accreditation, or for licensing, or in submissions relating tosuch grants, accreditation, or licensing, or that otherwise are made or disseminated to students, to faculty, or to the general public. (9) I assure that, if the Applicant is a governmental entity, with respect to the award (if any) made by the Department based on the application-- a. it will comply with the requirements of the Uniform Relocation Assistance and Real Property Acquisitions Act of 1970 (42 U.S.C. §§ 4601-4655), which govern the treatment of persons displaced as a result of federal and federally-assisted programs; and b. it will comply with requirements of 5 U.S.C. §§ 1501-1508 and 7324-7328, which limit certain political activities of State or localgovernment employees whose principal employment is in connection with an activity financed in whole or in part by federal assistance. (10) If the Applicant applies for and receives an award from the Office of Community Oriented Policing Services (COPS Office), I assure that as i db34USC§ 10382()(11)it illt th t t ti bl d i t t ith li bll i l di bt tli itdt thI di Please Acknowledge
Signed
SignerID
[email protected]
Signing Date / Time
5/15/24 2:14 PM
required by 34 U.S.C. § 10382(c)(11), it will, to the extent practicable and consistent with applicable law--including, but not limited to, the Indian Self- Determination and Education Assistance Act--seek, recruit, and hire qualified members of racial and ethnic minority groups and qualified women in order to further effective law enforcement by increasing their ranks within the sworn positions, as provided under 34 U.S.C. § 10382(c) (11).
(11) If the Applicant applies for and receives a DOJ award under the STOP School Violence Act program, I assure as required by 34 U.S.C. § 10552(a)(3), that it will maintain and report such data, records, and information (programmatic and financial) as DOJ may reasonably require.
I acknowledge that a materially false, fictitious, or fraudulent statement (or concealment or omission of a material fact) in this certification, or in the application that it supports, may be the subject of criminal prosecution (including under 18 U.S.C. §§ 1001 and/or 1621, and/or 34 U.S.C.§§ 10271-10273), and also may subject me and the Applicant to civil penalties and administrative remedies for false claims or otherwise (including under 31 U.S.C. §§ 3729-3730 and 3801-3812). I also acknowledge that the Department's awards, including certifications provided in connection with such awards, are subject to review by the Department, including by its Office of the Inspector General.
DOJ Certifications Regarding Lobbying; Debarment, Suspension and Other Responsibility Matters; and Drug-Free WorkplaceRequirements; Law Enforcement and Community Policing U.S. DEPARTMENT OF JUSTICE
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS; DRUG-FREE WORKPLACE REQUIREMENTS;LAW ENFORCEMENT AND COMMUNITY POLICING
Applicants should refer to the regula ons and other requirements cited below to determine the cer fica on to which they are required to a est.Applicants should also review the instruc ons for cer fica on included in the regula ons or other cited requirements before comple ng this form. Thecer fica ons shall be treated as a material representa on of fact upon which reliance will be placed when the U.S. Department of Jus ce (“Department”)determines to award the covered transac on, grant, or coopera ve agreement.
1. LOBBYING
As required by 31 U.S.C. § 1352, as implemented by 28 C.F.R. Part 69, the Applicant cer fies and assures (to the extent applicable) the following:
(a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the Applicant, to any person for influencing or a emp ng to influencean 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 connec onwith the making of any Federal grant, the entering into of any coopera ve agreement, or the extension, con nua on, renewal, amendment, ormodifica on of any Federal grant or coopera ve agreement; (b) If the Applicant’s request for Federal funds is in excess of $100,000, and any funds other than Federal appropriated funds have been paid or will bepaid to any person for influencing or a emp ng to influence an officer or employee of any agency, a member of Congress, an officer or employee ofCongress, or an employee of a member of Congress in connec on with this Federal grant or coopera ve agreement, the Applicant shall complete andsubmit Standard Form - LLL, “Disclosure of Lobbying Ac vi es” in accordance with its (and any DOJ awarding agency’s) instruc ons; and (c) The Applicant shall require that the language of this cer fica on be included in the award documents for all subgrants and procurement contracts (andtheir subcontracts) funded with Federal award funds and shall ensure that any cer fica ons or lobbying disclosures required of recipients of suchsubgrants and procurement contracts (or their subcontractors) are made and filed in accordance with 31 U.S.C. § 1352.
2. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS A. Pursuant to Department regula ons on nonprocurement debarment and suspension implemented at 2 C.F.R. Part 2867, and to other relatedrequirements, the Applicant cer fies, with respect to prospec ve par cipants in a primary er “covered transac on,” as defined at 2 C.F.R. § 2867.20(a),that neither it nor any of its principals-- (a) is presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of Federal benefits by a State or Federal court, orvoluntarily excluded from covered transac ons by any Federal department or agency; (b) has within a three-year period preceding this applica on been convicted of a felony criminal viola on under any Federal law, or been convicted or hada civil judgment rendered against it for commission of fraud or a criminal offense in connec on with obtaining, a emp ng to obtain, or performing apublic (Federal, State, tribal, or local) transac on or private agreement or transac on; viola on of Federal or State an trust statutes or commission ofembezzlement, the , forgery, bribery, falsifica on or destruc on of records, making false statements, tax evasion or receiving stolen property, makingfalse claims, or obstruc on of jus ce, or commission of any offense indica ng a lack of business integrity or business honesty that seriously and directlyaffects its (or its principals’) present responsibility; (c) is presently indicted for or otherwise criminally or civilly charged by a governmental en ty (Federal, State, tribal, or local) with commission of any ofthe offenses enumerated in paragraph (b) of this cer fica on; and/or (d) has within a three-year period preceding this applica on had one or more public transac ons (Federal, State, tribal, or local) terminated for cause ordefault.
B. Where the Applicant is unable to cer fy to any of the statements in this cer fica on, it shall a ach an explana on to this applica on. Where theApplicant or any of its principals was convicted, within a three-year period preceding this applica on, of a felony criminal viola on under any Federal law,the Applicant also must disclose such felony criminal convic on in wri ng to the Department (for OJP Applicants, to OJP atOjpcompliancerepor [email protected]; for OVW Applicants, to OVW at [email protected]; or for COPS Applicants, to COPS at [email protected]),unless such disclosure has already been made.
3. FEDERAL TAXES
A. If the Applicant is a corpora on, it cer fies either that (1) the corpora on has no unpaid Federal tax liability that has been assessed, for which alljudicial and administra ve remedies have been exhausted or have lapsed, that is not being paid in a mely manner pursuant to an agreement with theauthority responsible for collec ng the tax liability, or (2) the corpora on has provided wri en no ce of such an unpaid tax liability (or liabili es) to theDepartment (for OJP Applicants, to OJP at Ojpcompliancerepor [email protected]; for OVW Applicants, to OVW at [email protected]; or for COPSApplicants, to COPS at [email protected]).
B. Where the Applicant is unable to cer fy to any of the statements in this cer fica on, it shall a ach an explana on to this applica on.
4. DRUG-FREE WORKPLACE (GRANTEES OTHER THAN INDIVIDUALS) As required by the Drug-Free Workplace Act of 1988, as implemented at 28 C.F.R. Part 83, Subpart F, for grantees, as defined at 28 C.F.R. §§ 83.620 and83.650:
A. The Applicant cer fies and assures that it will, or will con nue to, provide a drug-free workplace by-- (a) Publishing a statement no fying employees that the unlawful manufacture, distribu on, dispensing, possession, or use of a controlled substance isprohibited in its workplace and specifying the ac ons that will be taken against employees for viola on of such prohibi on; (b) Establishing an on-going drug-free awareness program to inform employees about-- (1) The dangers of drug abuse in the workplace;
(2) The Applicant’s policy of maintaining a drug-free workplace; (3) Any available drug counseling, rehabilita on, and employee assistance programs; and (4) The penal es that may be imposed upon employees for drug abuse viola ons occurring in the workplace; (c) Making it a requirement that each employee to be engaged in the performance of the award be given a copy of the statement required by paragraph(a); (d) No fying the employee in the statement required by paragraph (a) that, as a condi on of employment under the award, the employee will-- (1) Abide by the terms of the statement; and
(2) No fy the employer in wri ng of the employee’s convic on for a viola on of a criminal drug statute occurring in the workplace no later than fivecalendar days a er such convic on; (e) No fying the Department, in wri ng, within 10 calendar days a er receiving no ce under subparagraph (d)(2) from an employee or otherwisereceiving actual no ce of such convic on. Employers of convicted employees must provide no ce, including posi on tle of any such convicted employeeto the Department, as follows:
For COPS award recipients - COPS Office, 145 N Street, NE, Washington, DC, 20530; For OJP and OVW award recipients - U.S. Department of Jus ce, Office of Jus ce Programs, ATTN: Control Desk, 810 7th Street, N.W., Washington, D.C.20531.
No ce shall include the iden fica on number(s) of each affected award; (f)Takingoneofthefollowingac onswithin30calendardaysofreceivingno ceundersubparagraph(d)(2)withrespecttoanyemployeewhoisso Please Acknowledge
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(f) Taking one of the following ac ons, within 30 calendar days of receiving no ce under subparagraph (d)(2), with respect to any employee who is soconvicted:
(1) Taking appropriate personnel ac on against such an employee, up to and including termina on, consistent with the requirements of the Rehabilita onAct of 1973, as amended; or (2) Requiring such employee to par cipate sa sfactorily in a drug abuse assistance or rehabilita on program approved for such purposes by a Federal,State, or local health, law enforcement, or other appropriate agency; and (g) Making a good faith effort to con nue to maintain a drug-free workplace through implementa on of paragraphs (a), (b), (c), (d), (e), and (f).
5. LAW ENFORCEMENT AGENCY CERTIFICATION REQUIRED UNDER DEPARTMENT OF JUSTICE DISCRETIONARY GRANT PROGRAMS (“SAFE POLICINGCERTIFICATION”) If this applica on is for a discre onary award pursuant to which award funds may be made available (whether by the award directly or by any subawardat any er) to a State, local, college, or university law enforcement agency, the Applicant cer fies that any such law enforcement agency to which fundswill be made available has been cer fied by an approved independent creden aling body or has started the cer fica on process. To become cer fied, alaw enforcement agency must meet two mandatory condi ons:
(a) the agency’s use of force policies adhere to all applicable federal, State, and local laws; and (b) the agency’s use of force policies prohibit chokeholds except in situa ons where use of deadly force is allowed by law.
For detailed informa on on this cer fica on requirement, see https://cops.usdoj.gov/SafePolicingEO .
The Applicant acknowledges that compliance with this safe policing cer fica on requirement does not ensure compliance with federal, state, or local law,and that such cer fica on shall not cons tute a defense in any federal lawsuit. Nothing in the safe policing cer fica on process or safe policingrequirement is intended to be (or may be) used by third par es to create liability by or against the United States or any of its officials, officers, agents oremployees under any federal law. Neither the safe policing cer fica on process nor the safe policing cer fica on requirement is intended to (or does)confer any right on any third-person or en ty seeking relief against the United States or any officer or employee thereof. No person or en ty is intendedto be (or is) a third-party beneficiary of the safe policing cer fica on process, or, with respect to the safe policing cer fica on requirement, such abeneficiary for purposes of any civil, criminal, or administra ve ac on.
6. COORDINATION REQUIRED UNDER PUBLIC SAFETY AND COMMUNITY POLICING PROGRAMS As required by the Public Safety Partnership and Community Policing Act of 1994, at 34 U.S.C. § 10382(c)(5), if this applica on is for a COPS award, theApplicant cer fies that there has been appropriate coordina on with all agencies that may be affected by its award. Affected agencies may include,among others, Offices of the United States A orneys; State, local, or tribal prosecutors; or correc onal agencies.
I acknowledge that a materially false, fic ous, or fraudulent statement (or concealment or omission of a material fact) in this cer fica on, or in theapplica on that it supports, may be the subject of criminal prosecu on (including under 18 U.S.C. §§ 1001 and/or 1621, and/or 34 U.S.C. §§ 10271-10273), and also may subject me and the Applicant to civil penal es and administra ve remedies for false claims or otherwise (including under 31 U.S.C.§§ 3729-3730 and 3801-3812). I also acknowledge that the Department’s awards, including cer fica ons provided in connec on with such awards, aresubject to review by the Department, including by its Office of the Inspector General.
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Declaration and Certification to the U.S. Department of Justice as to this Application Submission By [taking this action], I --
1. Declare the following to the U.S. Department of Justice (DOJ), under penalty of perjury: (1) I have authority to make this declaration andcertification on behalf of the applicant; (2) I have conducted or there was conducted (including by the applicant’s legal counsel as appropriate,and made available to me) a diligent review of all requirements pertinent to and all matters encompassed by this declaration and certification.
2. Certify to DOJ, under penalty of perjury, on behalf of myself and the applicant, to the best of my knowledge and belief, that the following aretrue as of the date of this application submission: (1) I have reviewed this application and all supporting materials submitted in connectiontherewith (including anything submitted in support of this application by any person on behalf of the applicant before or at the time of theapplication submission and any materials that accompany this declaration and certification); (2) The information in this application and in allsupporting materials is accurate, true, and complete information as of the date of this request; and (3) I have the authority to submit thisapplication on behalf of the applicant.
3. Declare the following to DOJ, under penalty of perjury, on behalf of myself and the applicant: (1) I understand that, in taking (or not taking)any action pursuant to this declaration and certification, DOJ will rely upon this declaration and certification as a material representation; and(2) I understand that any materially false, fictitious, or fraudulent information or statement in this declaration and certification (or concealmentor omission of a material fact as to either) may be the subject of criminal prosecution (including under 18 U.S.C. §§ 1001 and/or 1621, and/or34 U.S.C. §§ 10271-10273), and also may subject me and the applicant to civil penalties and administrative remedies under the federal FalseClaims Act (including under 31 U.S.C. §§ 3729-3730 and/or §§ 3801-3812) or otherwise.
Other
Not Certified