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HomeMy WebLinkAbout1999 S HR&R Amendment to Cooperative Agreement with U.S. Department of Housing and Urban Development Assistance Award/ U.S. Department of Housing Amendment and Urban Development Office of Administration 1.Assistance Instrument 2.T of Action RD Cooperative Agreement � Grant ff Award X� Amendment 3.Instrument Number 4.Amendment Number 5.Effective D�fe o tt�s ac ion 6.Control Number FF204K984022 1 04123/9� 7.Name and Address of Recipient 8.HUD Administering Office HUB DIRECTOR, SE CARIBBEAN OFFICE OF FHEO ORANGE COUNTY HUMAN RELATIONS COMMISSION GEORGIA STATE OFFICE RM 230 75 SPRING ST. , S.W. P.O. BOX 8181 ATLANTA, GEORGIA 30303-3388 hILLSBOROUGJ, NORTH CAROLINA 27278 Be.Name of Administrator Bb.Telephone Number GREGORY BERNARD KING (404)331-5140 10.Recipient Project Manager 9.HUD Govemment Technical Representative Annette M. Moore, Director FANNY CHESTNUT—HAIRSTON 11.Assistance Arrangement 12.Payment Method 13.HUD Payment Office Cost Reimbursement Treasury Check Reimbursement CHUD FO ACCOUNTING CENTER ❑ Cost Sharing ❑Advance Check P.O. BOX 2905, FT.WORTH, TX 76113-2905 Fixed Price Automated Clearinghouse 14.Assistance Amount 15.HUD Accounting and Appropriation Data Previous HUD Amount $ 100 000.0 15a.A ogtion Number 0EO-98-4022.Reservation Number HUD Amount this action $ 115 000.0 869 j( 0144 Total HUD Amount $ 215,000.00 Amount Previously Obligated $ 100,000.00 Recipient Amount $ Obligation by this action $ 115,000.00 Total Instrument Amount $ 215,000.01 Total Obligation $ 215,000.00 16.Description CAPACITY BUILDING AGREEMENT FY'98 COOPERATIVE AGREEMENT FOR FAIR HOUSING ASSISTANCE PROGRAM (FHAP) This agreement consists of the following, which incorporated herein and made a part hereof: 2. Schedule of Articles 3. Statement of Work 4. Section 3 Clause 5. Assurances 6. Criteria for Processing 7. Administrative Requirements for Grants and Cooperative Agreements Order of Precedence: Notwithstanding any provision to the contrary, in the event of a conflict among any of the documents pertaining to the duties and res onsibilities of the parties, the Statement of Work shall take precedence over the Schedule o Articles. The FY199 Cooperative Agreement will be $115,000 for Capacity Building agency. 17- Recipient is required to sign and return three (3) copies 18. ❑ Recipient is not required to sign this document. of this document to the HUD Administering Office. 19.Reci 'ent(By Name: 20. HUD IBy Name): Signat e&Title: Dat Signature e: Date: Gre or B na Kin CAO ;� O;f Previous editions are obsolete form HUD-1044(8190) ref.Handbook 2210.17 U.S.Department of Housing and Urban Development FUNDS RESERVATION & CONTRACT AUTHORITY IA. NAME AND ADDRESS OF PROJECT IDENTIFICATION 1 B. PROJECT CONTRACT, IAA OR PURCHASE ORDER NUMBER Orange County Human Relations Commission FF204K984022 P.O. Box 8181 2.DATE OF PREPARATION Hillsborough, North Caroliana 27278 (Month, Day and Year) 3. RESERVATION NUMBER 4.NAME AND TITLE OF SOURCE OFFICER 04/23/99 FHEO 04-98-4022 Gregory Bernard King, Hub Director 5. Funding and Accounting Classification COST SUB-OBJECT CENTER CLASS RESERVATION INCREASE NET APPROPRIATION OR FUND SYMBOL CODE CODE OUTSTANDING (Decrease) AMOUNT A B C D E F 869/00144 115,000.00 115,000.0 NET TOTALS 115,000.00 115,000.0 6. Purpose of This Action (Check Applicable Box(es)) A. F--1 INITIAL RESERVATION B. ® INCREASE OR (Decrease) RESERVATION (Amendment Number 1 J C. 0 CANCEL RESERVATION (Bracket Amount in 5E) D. 0 EXECUTE, AMEND OR WAIVE CONTRACT 7A.DESCRIPTION OF PROJECT 7B. CONTRACT CONDITIONS (if any) Funds to assist State and local agencies in Agencies must be recognized as substantially processing fair housing complaints. equivalent or have agreement for interim referral of complaints. 8A.DATE(Mo., Day and Year) 88. SIGNATURE OF SOURCE OFFICER 9. To Be Completed by the Originating Office RECOMMENDATION AND AUTHORIZATION fKRequired): In accordance with authority vested in or delegated to the undersigned;in consequence of provisions and requirements of appli- cable law;under decisions of record regarding the project or program identified in Block 18 above;and with determination that the actions in Block 5 are in the public interest,those actions are recomme and authorized herewith: A. RECOMMENDED (Signature/ D. A RIZED (Signat G eqo ar Ring B.TITLE E.TITLE r(_ r gn � I ) s Hub Director, Southeast Caribbean Office of � l Fair Housin and Eclual Opportunity C.DAT4� d Mo' Day&Year) F. DATE(Mo., a Year) q C, G.OFFICIAL PRESS RELEASE DATE(Month,Day and Year) For Accounting Use-only FUNDS AVAILABLE 0 RESERVATION RECORDED OR ADJUSTED TO AMOUNT SHOWN IN 5F By Date Previous Edition Is Obsolete ----- HUD-718(3-76) 1 . SCOPE OF WORK (FIXED PRICE) The Recipient (or Agency) shall furnish all the necessary personnel, materials, services, equipment, facilities, (except as otherwise specified herein) and otherwise do all things necessary for or incidental to the performance of the work set forth in the Statement of Work and all Attachments for the firm fixed price set forth herein. Including, but not limited to, identifying staff assigned to carry out fair housing activities by name, position, salary, percentage of time spent carrying out fair housing responsibilities, and experience . 2 . PERIOD OF PERFORMANCE The Recipient shall provide all services hereunder for the period ending April 23, 1999 for FY198 funds disbursement and September 21, 1999 for FY199 funds disbursement. 3 . INSPECTION AND ACCEPTANCE Inspection and acceptance of all but the final products may be accomplished by the Government Technical Monitors (GTMs) , if so delegated. Final acceptance is the responsibility of the Government Technical Representative (GTR) . 4 . CONDUCT OF WORK A. During the effective period of this instrument, the GTR and/or the GTM identified in Block 9 of the cover page shall be responsible for monitoring the technical effort of the Recipient, unless the Recipient is notified in writing by the Grant/Cooperative Agreement Officer (G/CAO) of a replacement. B. Only the G/CAO identified in Block 8a has the power to authorize deviations from this instrument, including deviations from the Statement of Work. In the event the Recipient does deviate without written approval of the G/CAO, such deviation shall be at the risk of the Recipient, and any costs related thereto shall be borne by the Recipient. 5. INSTRUMENT AMOUNT AND REQUESTS FOR PAYMENT A. The maximum amount for performance under the Statement of Work and all other requirements of this instrument is $100, 000 for payments for activities carried out under the FY198 funds and $115,000 for activities carried out under the FY199 funds to support the Agency' s fair housing efforts in accordance with Appendix A, Statement of Work. Payments shall be made in accordance with paragraph B, below. B. DATE FOR RECIPIENT' S CAPACITY VOUCHER PERIODS IN LOCCS BUILDING AMOUNT April 23, 1999 or as soon 100% of FY198 thereafter as possible CB funds remaining 30 days after the closeout 50% of FY199 of the FY198 CB Agreement CB award amount 60 days after first award of 30% of remaining FY199 funds disbursed FY199 funds 30 days after receipt of 20% (all funds second award of FY199 funds remaining) of FY199 but not later than 9/21/99 funds remaining C. The Recipient shall follow the instructions provided by the GTR/GTM for using the Line of Line of Credit Control System (LOCCS) for vouchering under this Cooperative Agreement in accordance with the time periods stipulated above. Payment may be withheld if it is the judgment of the GTR/GTM that the Recipient is not complying with all terms of the Cooperative Agreement, Statement of Work, and all Attachments hereto. D. The Recipient shall submit a Narrative Report when a draw down is requested. The Report for Capacity Building agencies should provide information on the Agency' s investigative and conciliation techniques, performance criteria; and, the deliverables due as described in the Recipient' s funding application and the Statement of Work as approved by the GTR and G/CAO. Any Reports for data and information systems should be accompanied by a listing of all hardware and software acquired during the billing period. The Agency should also provide an education and outreach plan for the review and approval of the GTR/GTM for projects expected to be carried out. E. The Criteria for Processing are hereby incorporated as Attachment A, FY198, to the Schedule of Articles . The Criteria for Processing has not been changed for the implementation of the FY199 FHAP guidance. F. The Administrative Requirements for Grants and Cooperative Agreements (Part 85) are hereby incorporated as Attachment D to the Schedule of Articles. G. The Government shall remit all payments to the following address on the depository form: AGENCY TO PROVIDE NAME AND ADDRESS OF FINANCIAL .INSTITUTION TO GTR AND GTM 6. USE OF COOPERATIVE AGREEMENT FUNDS The Agency is entitled to receive the fixed amount stated in the Cooperative Agreement for satisfactory completion of the work to be performed regardless of costs incurred. However, the program regulations and this Schedule of Articles require that all activities for which FHAP funds are used must address, or have relevance to, matters affecting fair housing which are cognizable under the Fair Housing Act (42 U.S .C. 3600-19) . 7 . MAINTENANCE OF EFFORT The Agency must not unilaterally reduce the level of financial resources currently committed to fair housing complaint processing. Budget and staff reductions occasioned by legislative action outside the control of the Agency will not, alone, result in a determination of ineligibility. However, HUD will take such actions into consideration in assessing the ongoing viability of an Agency' s fair housing program. 8 . HUDIS SUBSTANTIAL INVOLVEMENT A. HUD intends to have substantial involvement in the review and approval of all aspects of the work to be carried out as a result of an award under this agreement. B. Anticipated substantial involvement shall include, but not be limited to the following: 1 . Review and guidance in progress and upon completion of case investigations; 2 . Requests for additional information on cases dual-filed to provide clarification or for completeness of a case investigation or file; 3 . Development and presentation of National and/or field office location fair housing investigative training; 4 . Participation in the development and presentation of in-house investigative training; 5. Participation in presentation of education and outreach programs; 6. Provision of appropriate directives and guidance on case processing; and 7 . Assistance in the investigation, settlement, and/or enforcement of fair housing cases dual-filed with the Department. 9. ASSURANCES The Recipient of FHAP funds agrees that it will not engage in any discriminatory actions in its administration of or in its employment and treatment of employees and/or clients and makes the following assurances to HUD as a condition for the receipt of FHAP funds . The .Recipient also assures that it will . 1 . Provide a drug-free workplace; 2 . Cause to be performed required financial and compliance audits in accordance with the Single Audit Act; 3 . Comply with the provisions of the Hatch Act (5 U.S .C. ) Sections 1501-1508 and 7324-7328) which limit the political activities of employees whose principle employment activities are funded in whole or in part with Federal funds; 4 . Establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain; 5. Comply with the Intergovernmental Personnel Act of 1970 (42 U.S .C. Sections 4728-4763) relating to prescribed standards for merit systems for programs funded under one of the nineteen statutes or regulations specified in Appendix A of' OPM' s Standards for a Merit System of Personnel Administration (5 C. F.R. 900, Subpart F) ; 6. Comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S .C. Sections 1681-1683, and 1685-1686) , which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U. S .C. Section 794) , which prohibits discrimination on the basis of disability; or (d) the Age Discrimination Act of 1975, as amended (42 U.S .C. Sections 6101-6107) , which prohibits discrimination on the basis of age; 7 . Comply with all applicable requirements of all Federal laws, executive orders, regulations, and policies governing this program; and 8 . Comply with the requirements of the Resource Conservation and Recovery Act which mandates that State agencies using Federal funds have procurement programs which give preference to products containing recycled materials when purchasing specific products identified in guidelines developed by the Environmental Protection Agency (40 CFR 247-253) . 10 . USE OF CONSULTANTS Salary payments to consultants under this instrument shall be based on their current salary as evidenced by current pay vouchers and shall not exceed the equivalent of the maximum daily rate paid to GS 15 Step 1 Federal employees . Further guidance on procurement actions which the Recipient is required to follow under this instrument is contained in 24 CFR Part 85. 36 (Attachment C to this Cooperative Agreement) . 11 . PUBLICATIONS AND NEWS RELEASES A. Definition. For the purpose of this clause "publication" includes : 1 . Any document containing information for public consumption; or 2 Any act of, or any act which may result in, disclosing information to the public. B. The results of any education and outreach efforts of the Agency can be made available to the public through dedication, assignment by the Government, or other such means as the Secretary may determine . C. Government Ownership of official Products of Work All interim and final reports and information, data analyses, special methodology, findings, and their related documents and work products, including reports, work sheets, survey instruments, computer tapes, and any other physical materials and products produced directly under the Statement of Work of this instrument are considered official Products of Work, owned by the U.S . Government and held for the benefit of the public. D. Publication of Official Products of Work Official Products of Work, quotations therefrom, paraphrasing, or disclosures of interim findings may not be published without the approval of the GTR for a ' period of sixty (60) days after acceptance of the product by the GTR. Thereafter, the Recipient shall be free to publish without HUD approval . E. Acknowledgment and Disclaimer All Official Products of Work, or any part thereof, and any Independent Products and Special Products arising out of this instrument, when published by Recipient or other participants in the work, shall contain the following acknowledgment and disclaimer: "The work that provided the basis for this publication was supported by funding under a Cooperative Agreement with the U.S . Department of Housing and Urban Development. The substance and findings of the work are dedicated to the public. The author and publisher are solely responsible for the accuracy of the statements and interpretations contained in this publication. Such interpretations do not necessarily reflect the views of the Government. " F. Notice of News Release and Public Announcements Two copies of all press releases, formal announcements, and other planned, written issuances containing news or information concerning this instrument that may be made by the Recipient or its staff, or any subcontractor or other person or organization participating in the work of this instrument shall be provided to the GTR at the earliest possible time. News releases and other public announcements may not disclose any interim finding or quote or paraphrase any part of any Official Product of Work without complying with Paragraph E, above . The Recipient agrees that no news releases, publications, studies, or other products involving FHAP funded activities will be released to the public without prior HUD approval . The Recipient further agrees that it will submit any press release/news announcement, study and/or other product developed as part of the grant funded activities to the GTR for review and approval at least two weeks prior to its release, unless HUD agrees to waive the at least two weeks submission requirement. Publications, flyers and other routine documents previously approved by the GTR and/or the Department may be published without further HUD approval . 12 . REPRODUCTION OF REPORTS In accordance with Government Printing and Binding Regulations, reproduction of reports, data or other written materials, if required herein, is authorized provided that the materials produced do not exceed 5, 000 production units of any page and the items consisting of multiple pages do not exceed 25, 000 production units in aggregate. 13 . FLOW DOWN PROVISIONS The Recipient shall include provisions to carry out the purposes of this instrument in all contracts of employment with persons who perform any part of the work under this instrument, and with all subcontractors and other persons or organizations participating in any part of the work under this instrument. There shall be provisions for a further flow down of such requirements to each subtier of employees and subcontractors to the extent feasible. 14 . DISPUTES During performance of the instrument; disagreements may arise between the Recipient and the GTR on various issues, such as the acceptability of complaints forwarded for approval . If a dispute concerning a question of fact arises, the G/CAO shall be the final authority on the matter and shall prepare a final decision, taking into account all facts and documentation presented. The decision of G/CAO shall be communicated to the Recipient. CAPACITY BUILDING AGREEMENT APPENDIX A - FY'98/' 99 STATEMENT OF WORK A. GENERAL REQUIREMENTS The Recipient agrees to process those housing discrimination complaints arising within its jurisdiction, except as otherwise stated in this Statement of Work. The Recipient agrees to cooperate with HUD in handling and processing housing discrimination complaints filed under the Fair Housing Act and the fair housing law enforced by the Agency in accordance with the Interim Agreement and any amendments ' or revisions thereto executed during the course of this agreement by the signatories. The Recipient agrees to implement appropriate directives provided to it by the Department. The Recipient agrees to follow HUD' s Technical Guidance ,in processing all dual-filed complaints vouchered for under this Cooperative Agreement until the Department rescinds the requirement in writing to the Recipient . The Recipient agrees to furnish all staffing information as required by Article 1 of this Cooperative Agreement. The Recipient may be required to participate in customer satisfaction research and evaluation activities under this Cooperative Agreement. The Recipient agrees to furnish all information collected from its customers to HUD in a form to be defined by the Department. B. CAPACITY BUILDING The Recipient agrees to develop a complaint processing capability sufficient to enable the Recipient to process all housing discrimination complaints arising under its jurisdiction in future years . The Recipient also agrees to process housing discrimination complaints in accordance with A. above, General Requirements, and in accordance with the Criteria for Processing which are incorporated herein as Attachment A to the Schedule of Articles. The Recipient further agrees to implement the Capacity Building activities set forth in its application for funding. A list of product deliverables and timetables is at the end of this Statement of Work. C. REPORTING REQUIREMENTS The Recipient agrees to provide the GTR/GTM timely information on the progress of all dual-filed cases providing the information required using a data and information system agreed to and accepted by the GTR. D. TRAINING The Recipient agrees to participate in mandatory FHAP training sponsored by HUD. The mandatory training will require Agency attendance in HUD-sponsored field office training and, if held, during this funding cycle, the National policy conference. The Recipient also agrees to train at least one staff person on data and information systems and design and implement education and outreach activities during its Capacity Building period. 1 CAPACITY BUILDING PRODUCTS PRODUCT DELIVERABLES DATE DUE 1 . 2 . 3 . 4 . S. (CONTINUE TO LIST ALL SIGNIFICANT WORK PRODUCTS IN THE APPLICATION AND A DUE DATE FOR COMPLETION AS SET FORTH IN THE TIMETABLE) . Approved Government Technical Monitor Approved Government Technical Representative U.S.Depard&Dnt of Housing acid Urban Development Georgia State Office Richard B.Russell Federal Building 75 Spring Street, S.W. Atlanta,Georgia 30303-3386 (http:lhvww.hud.gov) September 21, 1998 SEP 23 W Dear: EXECUTIVE DIRECTOR OF THE FAIR HOUSING I —ORANGE COM DEFE OF ASSISTANCE PROGRAM(FHAP) AGENCY HUMAN RIGHTS&RELAVOINS SUBJECT: TAG#59: FUNDING OF FY'98 COOPERATIVE AGREEMENTS Enclosed is one copy of the 1998/9 Cooperative Agreement package for your files. Also enclosed are five (5) copies of the Form HUD 1044 for your original signature. Included in the Attachments at Attachment C are five(5)copies OMB Standard Assurances-SF 4248,Drug Free Certification which should also be signed. Retain one copy for your records, and return the remaining four. You may also retain the remaining Attachments to the Cooperative Agreement package,however, the Form HUD 1044 and Attachment C should be returned to this office by EXPRESS MAIL to: Gregory Bernard King,Hub Director U. S. Department of Housing and Urban Development Southeast/Caribbean Office of Fair Housing and Equal Opportunity Richard B. Russell Federal Building Room 230, 75 Spring Street, S. W. Atlanta, GA 30303-3388 In our efforts to obligate funds before the end of this fiscal year, this agreement covers funding for CASE PROCESSING and TRAINING(AgencyMD Snonsored). Your Jump sum Cooperative Agreement amount either includes $15,000.00 or$20,000.00 for training depending upon the number of employees you identified as being trained, i.e., 3-6 or 7-10. As you will note,this year's funding principles include funds for Training,Administrativmst and Special Enforcement Efforts. Eligibility for these funds require documentation from the agencies to establish the level of funding. Therefore,this Cooperative Agreement will be amended to include new 1998/9 funding for Administrative Costs and Special Enforcement Efforts funding. Training funds have been included in the enclosed Agreement,however,documentation for all training will be necessary in order for the payment to be approved. Capacity Building agencies are not eligible for the aforementioned funds. 2 We have included with this letter a list of the eligibility requirements for your information. An amended agreement will be formulated after verification or documentation of eligibility. Should you have any questions,please call your assigned monitor. Sincerely yours, G King, Hub Director Southeast/Caribbean Office of Fair Housing and Equal Opportunity Enclosures Assistance Award U.S. Dapartment of Housing Amendment and Urban Development Office of Administration 1.Assistance Instrument 2.�T of Action 91 Cooperative Agreement F-1 Grant L°�! Award Amendment 3.instrument Number 4.Amendment Number S.Effective Date of tMs coon S.Control Number FF204K984022 10/0198 Name and Address of Recipient 8.HUD Administering Office HUB DIRECTOR, SE/CARIBBEAN OFFICE OF FHEO ORANGE COUNTY HUMAN RELATIONS COMMISSION GEORGIA STATE OFFICE,RM 230 75 SPRING ST. , S.W. P.O. BOX 8181 ATLANTA, GEORGIA 30303-3388 }$LLSBOROUGA, NORTH CAROLINA 27278 75 Spring Street Be.Name of Administrator 8b.Telephone Number GREGORY BERNARD KING (404)331-5140 10.Recipient Manager 9.HUD Government Technical Representative LUCKY LEWIS, DIRECTOR FANNY CHESTNUT-HAIRSTON 11.Assistance Arrangement 12.Payment Medhod 13.HUD payment OfNce Cost Reimbursement` E]Treasury Check Reimtwnter wrt U'S' DEPT. OF MJB, SEATTLE FEDBRL OFFICE BLDG. 909 FIRST AVZ1WZ , SUITE 200 Cost Sharing Advance Cheek SEATTLE, WA 98154-1000 Fixed Price Automated Clearinghouse 14.Assistance Amount 15.HUD Accounting and Appropriation Data Previous HUD Amount $ 15a.A propristion Number ISb.Reservation Number HUD Amount this action $ 100 000.00 868790144 IFHBO-98-4022 Total HUD Amount $ 100,000.00. Amount Previously Obligated $ 100,000.00 Recipient Amount $ Obligation by this action $ Total Instrument Amount $ 100,000.00 Total Obligation $ 100,000.00 te.Description CAPACITY BUILDING AGREEMENT FY198 COOPERATIVE AGREEMENT FOR FAIR HOUSING ASSISTANCE PROGRAM (FHAP) -`tis agreement consists of the following, which incorporated herein and ide a part hereof: 2. Schedule of Articles 3. Statement of Work 4. Section 3 Clause S. Assurances 6. Criteria for Processing 7. Administrative Requirements for Grants and Cooperative Agreements Order of Prededence: Notwithstanding any rovision to the contrarryy in the event of a conflict among an of the documents pertaining to the duties and responsibilities of the parties, the Statement of Work shall take precedence over the Schedule of Articles. 17. Recipient is required to sign and return three (I copies 18• of this document to the HUD Administering Office. Recipient is not required to sign this document. Ill.Reoi t(8y Nano): j 20.HUD Jay Namel. 1 l/7CT Signs a 3 Title: Dot Sign A This: Oate: re a B and Kin CAO Previous/editions are obsolete V form HUD-104(8/90) ref.Handbook 2210.17 CAPACITY BUILDING AGREEMENT FY'98 SCHEDULE OF ARTICLES 1. SCOPE OF WORK (FIXED PRICE) 2. PERIOD OF PERFORMANCE 3. INSPECTION _AND ACCEPTANCE 4. CONDUCT OF WORK 5. INSTRUMENT AMOUNT AND REQUESTS FOR PAYMENT 6. USE OF COOPERATIVE AGREEMENT FUNDS 7. MAINTENANCE OF EFFORT 8. HUD'S SUBSTANTIAL INVOLVEMENT 9. ASSURANCES 10. USE OF CONSULTANTS 11. PUBLICATIONS AND NEWS RELEASES 12. REPRODUCTION OF REPORTS 13. FLOW DOWN PROVISIONS 14. DISPUTES APPENDIX AND ATTACHMENTS APPENDIX A - STATEMENT OF WORK (CAPACITY BUILDING AGENCIES ONLY) ATTACHMENTS ATTACHMENT A - CRITERIA FOR PROCESSING - ATTACHMENT B - PART 115 ATTACHMENT C - INSTRUCTIONS FOR PREPARATION AND SUBMISSION OF DIRECT DEPOSIT SIGN-UP FORM (SF-1199A) AND INSTRUCTIONS FOR THE LOCCS VOICE RESPONSE SYSTEM ACCESS ATTACHMENT D - PART 85 1 . SCOPE OF WORK (FIXED PRICE) The Recipient (or Agency) shall furnish all the necessary personnel, materials, services, equipment, facilities, (except as otherwise specified herein) and otherwise do all things necessary for or incidental to the performance of the work set forth in the Statement of Work and all Attachments for the firm fixed price set forth herein. Including, but not limited to, identifying staff assigned to carry out fair housing activities by name, position, salary, percentage of time spent carrying out fair housing responsibilities, and experience. 2 . PERIOD OF PERFORMANCE The Recipient shall provide all services hereunder for a period — not to exceed twelve (12) months from the effective date of the instrument. 3. INSPECTION AND ACCEPTANCE Inspection and acceptance of all but the final products may be accomplished by the Government Technical Monitors (GTMs) , if so delegated. Final acceptance is the responsibility of the regional Government Technical Representative (GTR) . 4. CONDUCT OF WORK "A. During the effective period of this instrument, the GTR and/or the GTM identified in Block 9 of the cover page shall be responsible for monitoring the technical effort of the Recipient, unless the Recipient is notified in writing by the Grant/Cooperative Agreement Officer (G/CAO) of a replacement. B. Only the G/CAO identified in Block 8a has the power to authorize deviations from this instrument, including deviations from the Statement of Work. In the event the Recipient does deviate without written approval of the G/CAO, such deviation shall be at the risk of the Recipient, and any costs related thereto shall be borne by the Recipient. 5. INSTRUMENT AMOUNT AND REQUESTS FOR PAYMENT A. The maximum amount for performance under the Statement of Work and all other requirements of this instrument is $100, 000 to support the agency's fair housing efforts in accordance with Appendix A, Statement of Work. Payments shall be made in accordance with paragraph B, below. . B. DATE FOR RECIPIENT'S CAPACITY VOUCHER PERIODS IN LOCCS BUILDING AMOUNT 70 days after the effective 30% of Capacity date of instrument Building Amount 120 Days after the effective 30% of Capacity date of instrument Building Amount 250 days after the effective 30% of Capacity date of instrument Building Amount Final submission on or before 10% of Capacity the completion date of Building Amount instrument C. The Recipient shall follow the instructions provided by the GTR/GTM for using the Line of Line of Credit Control system (LOCCS) for vouchering under this Cooperative Agreement in.accordance with the time periods stipulated above. Payment may be withheld if it is the judgment of the GTR/GTM that the Recipient is not complying with all terms of the Cooperative Agreement, Statement of Work, and all Attachments hereto. D. The Recipient shall submit a Narrative Report when a draw down is requested. The Report for Capacity n Building agencies should provide information on the agency' s investigative and conciliation techniques, performance criteria; and, the deliverables due as described in the Recipient's funding application and the Statement of Work as approved by the GTR and G/CAO. Any Reports for data and information systems should be accompanied by a listing of all hardware and software acquired during the billing period. The agency should _ also provide an education and outreach plan for the review and approval of the GTR/GTM. covered project. E. The Criteria for Processing are hereby incorporated as Attachment A, FY198, to the Schedule of Articles. F. The Administrative Requirements for Grants and Cooperative Agreements (Part 85) are hereby incorporated as Attachment D to the Schedule of Articles. G. The Government shall remit all payments to the following address on the depository form: AGINCr W PROW= RAW AND ADLOWS OF FlXANCZAL INSTITUTIOff W GTR AND &W 6. USE OF COOPERATIVE AGIMEM1ENT FUNDS The Agency is entitled to receive the fixed amount stated in the Cooperative Agreement for satisfactory completion of the work to be performed regardless of costs incurred. However, the program regulations and this Schedule of Articles require that all activities for which FHAP funds are used must address, or have relevance to, matters affecting fair housing which are cognizable under the Fair Housing Act (42 U.S.C. 3600-19) . 7. MAINTENANCE OF EFFORT The Agency must not unilaterally reduce the level of financial resources currently committed to fair housing complaint processing. Budget and staff reductions occasioned by legislative action outside the control of the agency will not, alone, result in a determination of ineligibility. However, HUD will take such actions into consideration in assessing the ongoing viability of an Agency's fair housing program. S. HUDIS SUBSTANTIAL INVOLVEMENT A. HUD intends to have substantial involvement in the review and approval of all aspects of the work to be carried out as a result of an award under this agreement. B. Anticipated substantial involvement shall include, but not be limited to the following: 1. Review and guidance in progress and upon completion of case investigations; 2. Requests for additional information on cases dual-filed to provide clarification or for completeness of a case investigation or file; 3. Development and presentation of National and/or field office location fair housing investigative training; 4. Participation in the development and presentation of in-house investigative training; 5. Participation in presentation of education and outreach programs; and 6. Provision of appropriate directives and guidance on case processing. 9. ASSURANCES The Recipient of FHAP funds agrees that it will not engage in any discriminatory actions in its administration of or in its employment and treatment of employees and/or clients and makes the following assurances to HUD as a condition for the receipt of FHAP funds. The Recipient also assures that it will. 1 . Provide a drug-free workplace; 2. Cause to be performed required financial and compliance audits in accordance with the Single Audit Act; 3. Comply with the provisions of the Hatch Act (5 U.S.C. ) Sections 1501-2508 and 7324-7328) which limit the political activities of employees whose principle employment activities are funded in whole or in part with Federal funds; 4. Establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain; 5. Comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. Sections 4728-4763) relating to prescribed standards for merit systems for programs funded under one of the nineteen statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F) ; 6. Comply with all Federal statutes relating to nondiscrimination. These include but are not limited - to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. Sections 1681-1683, and 1685-1686) , which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation- Act of 1973, as amended (29 U.S.C. Section 794) , which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. Sections 6101-6107) , which prohibits discrimination on the basis of age; 7. Comply with all applicable requirements of all Federal laws, executive orders, regulations, and policies governing this program; and 8. Comply with the requirements of the Resource Conservation and Recovery Act which mandates that State agencies using Federal funds have procurement programs which give preference to products containing recycled materials when purchasing specific products identified in guidelines developed by the Environmental Protection Agency (40 CFR 247-253) . 10. USE OF CONSULTANTS As required by HUD's Appropriations Act, salary payments to consultants under this instrument shall not exceed the equivalent of the maximum daily rate paid to SES Level 4 Federal employees. Further guidance on procurement actions which the Recipient is required to follow under this instrument is contained in 24 CFR Part 85.36 (Attachment C to this cooperative agreement) . 11. PUBLICATIONS AND NEWS RELEASES A. Definition. For the purpose of this clause "publication" includes: 1. Any document containing information for public consumption; or 2. Any act of, or any.act which may result in, disclosing information to the public. B. The results of any education and outreach efforts of the agency can be made available to the public through dedication, assignment by the Government, or other such means as the Secretary may determine. C. Government Ownership of Official Products of Work All Interim and final reports and information, data analyses, special methodology, findings, and their related documents and work products, Including reports, work shoots-, survey instruments, computer tapes, and any other physical materials and products produced directly under the Statement of Work of this instrument are considered Official Products of Work, owned by the U.S. Government and hold for the benefit of the public. D. Publication of Official Products of Work Official Products of Work, quotations therefrom, paraphrasing, or disclosures of interim findings may not be published without the approval of the GTR for a period of sixty (60) days after acceptance of the product by the GTR. Thereafter, the Recipient shall be free to publish without HUD approval. E. Acknowledgment and Disclaimer All Official Products of 'Work, or any part thereof, - and any Independent Products and Special Products arising out of this instrument, when published by Recipient or other participants in the work, shall contain the following acknowledgment and disclaimer: "The work that provided the basis for this publication was supported by funding under a Cooperative Agreement with the U.S. Department of Housing and Urban Development. The substance and findings of the work are dedicated to the public. The author and publisher are solely responsible for the accuracy of the statements and interpretations contained in this publication. Such interpretations do not necessarily reflect the views of the Government. " F. Notice of News Release and Public Announcements Two copies of all press releases, formal announcements, and other planned, written issuances containing news or information concerning this instrument that may be made by the Recipient or its staff, or any subcontractor or other person or organization participating in the work of this instrument shall be provided to the GTR for approval at the earliest possible time. News releases and other public announcements may not disclose any interim finding or quote or paraphrase any part of any Official Product of Work without complying with Paragraph E, above. 12. REPRODUCTION OF REPORTS In accordance with Government Printing .and Binding Regulations, reproduction of reports, data or other written materials, if required herein, is authorized provided that the materials produced do not exceed 5, 000 production units of any page and the items consisting of multiple pages do not exceed 25, 000 production units in aggregate. 13. FLAW DOWN PROVISIONS The Recipient shall include provisions to carry out the purposes of this instrument in all contracts of employment with persons who perform any part of the work under this instrument, and with all subcontractors and other persons or organizations participating in any part of the work under this instrument. There shall be provisions for a further flow down of such requirements to each subtier of employees and subcontractors to the extent feasible. 14. DISPUTES During performance of the instrument, disagreements may arise between the Recipient and the GTR on various issues, such as the acceptability of complaints forwarded for approval. If a dispute concerning a question of fact arises, the G/CAO shall be the final authority on the matter and shall prepare a final decision, taking into account all facts and documentation presented. The decision .of G/CAO shall be communicated to the Recipient. CAPACITY BUILDING AGREEMENT APPENDIX A - FY'98 STATEMENT OF WORK A. GENERAL REQUIREMENTS The" Recipient agrees to process those housing discrimination complaints arising within its jurisdiction, except as otherwise stated in this Statement of Work. The Recipient agrees to cooperate with HUD in handling and processing housing discrimination complaints filed under the Fair Housing Act and the fair housing law enforced by the agency in accordance with the Memorandum of Understanding or Interim Agreement and any amendments or revisions thereto executed during the course of this agreement by the signatories. The Recipient agrees to implement appropriate directives provided to it by the Department. The Recipient agrees to follow HUD' s Technical Guidance in processing all dual-filed complaints vouchered for under this Cooperative Agreement until the Department rescinds the requirement in writing to the Recipient. " The Recipient agrees to furnish all staffing information as required by Article 1 of this Cooperative Agreement. The Recipient may be required to participate in customer satisfaction research and evaluation activities under this cooperative agreement. The Recipient agrees to furnish all information collected from its customers to HUD in a form to be defined by the Department. B. CAPACITY BUILDING The Recipient agrees to develop a complaint processing capability sufficient to enable the Recipient to process all housing-discrimination complaints arising under its jurisdiction in future years. The Recipient also agrees to process hoti'sing discrimination complaints in accordance with A. above, General Requirements, and in accordance with the Criteria for Processing which are incorporated herein as Attachment A to the Schedule of Articles. The Recipient further agrees to implement the Capacity Building activities set forth in its application for funding. A list of product deliverables and timetables is at the end of this Statement of Work. 1 C. REPORTING REQUIREMENTS The Recipient agrees to provide the GTR/GTM timely information on the progress of all dual-filed cases providing the information required using a data and information system agreed to and accepted by the GTR. D. TRAINING The Recipient agrees to participate in mandatory FHAP training sponsored by HUD. The mandatory training will require agency attendance in HUD-sponsored field office training and, if held, during this funding cycle, the National policy conference. The Recipient also agrees to train at least one staff person on data and information systems and design and implement education and outreach activities during its Capacity Building period. 1 CAPACITY BUILDING PRODUCTS PRODUCT DELIVERABLES DATE DUE 1 . 2. 3. 4 . 5. (CONTINUE TO LIST ALL SIGNIFICANT WORK PRODUCTS IN THE APPLICATION AND A DUE DATE FOR COMPLETION AS SET FORTH IN THE TIMETABLE) . Approved Government Technical Monitor Approved Government Technical Representative "Atsisf6rice Award/ U.S. Department of Housing Amendment and Urban Development Office of Administration 1.Assistance Instrument 2.T e of Action aCooperative Agreement F-1 Grant Award Amendment ntrol Number 04K984022 10� `'etrument Number 4.Amendment Number 5.Effective Date o A98 this etion 6.co 7.Name and Address of Recipient S.HUD Administering Office HUB DIRECTOR, SE/CARIBBEAN OFFICE OF FHEO ORANGE COUNTY HUMAN RELATIONS COMMISSION GEORGIA STATE OFFICE,RM 230 75 SPRING ST. , S.W. O. BOX 8181 ATLANTA, GEORGIA 30303-3388 ILLSBOROUGO, NORTH CAROLINA 27278 75 Spring Street 8a. Name of Administrator 8b.Telephone Number GREGORY BERNARD KING (404) 331-5140 10.Recipient Project Manager 9.HUD Government Technical Representative LUCKY LEWIS, DIRECTOR FANNY CHESTNUT-HAIRSTON 11.Assistance Arrangement 12.Payment Method 13.HUD Payment Office Cost Reimbursement F]Treasury Check Reimbursement U.S. DEPT. OF HUB, SEATTLE FEDERL OFFICE BLDG. 909 FIRST AVENUE, , SUITE 200 Cost Sharing Advance Check SEATTLE, WA 98104-1000 Fixed Price Automated Clearinghouse 14.Assistance Amount 15.HUD Accounting and Appropriation Data Previous HUD Amount $ 15a.A propriation Number 15b. Reservation Number HUD Amount this action $ 100 000.00 86890144 FHEO-98-4022 Total HUD Amount $ 100 000.00 Amount Previously Obligated $ 100,000.00 Recipient Amount $ Obligation by this action $ Total Instrument Amount $ 100,000.001 Total Obligation $ 100, 000.00 16.Description CAPACITY BUILDING AGREEMENT FY'98 COOPERATIVE AGREEMENT FOR FAIR HOUSING ASSISTANCE PROGRAM (FHAP) This agreement consists of the following, which incorporated herein and made a part hereof: 2. Schedule of Articles 3. Statement of Work 4. Section 3 Clause 5. Assurances 6. Criteria for Processing 7. Administrative Requirements for Grants and Cooperative Agreements Order of Prededence: Notwithstanding any provision to the contrary, in the event of a conflict among an of the documents pertaining to the duties and responsibilities of the parties, the Statement of Work shall take precedence over the Schedule of Articles. 17. [:] Recipient is required to sign D and return three (3) copies 18, Recipient is not required to sign this document. of this document to the Administering Office. °. Recipient(By Name): 20.HUD(By Name): ,(mature&Title: l Date: 7re'q re&Title: Date: 91.10 rnar d Kin CAO 3� Previous editions are obsolete 90) ref.Handbook 2210.17 8022.1 Appendix 12c ATTACHMENT C OMB STANDARD ASSURANCES - SF 4248 Drug Free Certification 12c-1 6/90 8022.1 . Appendix 12t ATTACHMENT C Ow&wows,so*so coat ASSURANCES—WON-CONSTRUCTION PROORAMS Nat:: Ceruia of these assurances may not W applicable to your preject or program If you have questions. !please contact the awarding agency Further,ceruin Federal awarding agencies stray require spplicanu to ctrUly to additional assurances Usuch is the east.You will be ootlfaed As the duly outhorirtd rtrprtseritative of the applicant I certJ1 that the appticent: I. Has the legal authority to apply tar Federal (el the Drug Abuse Offaos and Trtsteftnt Act of assistanct.and the Institutional, managerial and 1072 (P.L. 92.2SS). as amended. relating to financial capability (including funds sufficient to sondiscrimination on the basis of drug abuse. (f) pay the non-Federal share of prejtct costs) to the Comprehensive Alcohol Abuse and Alcoholism ,ensure proper planning. snansgtment and "in- Prevention.Treatment and Rehabilitation Act of ptttion of the project described in this applic0on. 1970 (P.L. 91.6161, at amended. relating to 2 Will girt the awarding agency. the Comptroller eiondisc minstion on the basis of al oM,l abuse or General of the Vnited States, and if appropriate, alcoholism.(g)11 $23 and$27 of the Pub.ac Health the State.through any authorised representative, Service Act of 1912(42 US C.290 dd-3 oral 290 te- access to and the right to a:amine all records, 31. as amended. relating to eonfidtntiality of books.papers.or documents relsttd to the award; alcohol and drug abuse patient records. IN Title and will tstabIish'a proper accounting tyttera in VIII of the Civil Rights Act of 1946 142 VS C 1 accordance with generally accepted accounting 360t et seq I. as amended. vetting to non- accordance or agency with g directives. discrimination in the sale.rental or f rancing of housing; (1) any other nondiscrimination 3. Will establish safeguards to prohibit employees provisions in the sprcitic ststut:(s) under which from using their positions for a purpose that application for Federal assistance is be:ng made. constitutes or presents the appearance of personal and (j) the requirements of any other or organizational conflict of interest.or personal nondiscrimination statutes) which may apply to gain. the application. 4. Will initiatt and complete the work within the 7. Will comply. or has already complied. with the applicable time frame after receipt of approval of requirements of Titles It and III of the uniform the awarding agtncy. Relocation Assistance and Real Property S. W iII comply with the Intergovernmental Acquisition Policies Act of 1970 (P.L 91.6461 which provide for fair and equitable treatment of Personnel Act of 19'10 (42 US C. If 4726.4761) acquired to prescribed standards for merit systems persons displaced or whose property is acvirtd as a result of Federal or federally assisted programs for programs funded under one of the nineteen U statutes or regulations specilaed in Appendix A of property requirements apply all interests in real OPM's Standards for a Merit System of Personnel property acquired for project purposes reprditss Administration(S C.F.R.900.Subpart F)• of Fidtral participation bn purchases. S. Will comply with all Federa3 aiatuitt relating to i• Will comply with the provisions of the Hatch Act nondiscrimination. These include but are suet (S U3 C.111S01.1S06 and 7324•?3261 which Limit limited la- (a)Title VI of the Civil Rights Act of the political activities of employees whose 3964 (P.L. 4S•3S2}which Prohibits die-tiasination principal em ts employment actiritits are funded i whole the basis of rare.color or national origin; (b) hele or U part with Federal funds. Title IX of tht Uucstion Amendments of 1972.as 9. Will comply,as applicable.with the provisions of amended(70 US C.If 1641.1643.and 1665.1611,6). the Davis-Bacon Act(40 US C.11276+ to 2+66- which prohibits discrimination on the basis of sex. 7).the Copeland Act (40 US C. 12'6c and 14 (c)Section$04 of the Rthabilitation Act of 1973.as C.S.C.11474).and the Contract Work Hours and amended (29 LS C. 1794). which prohiblu dis• Saltty Standards Act (40 VA.C. It 327.333), eximination on the basis of handicaps;(d)the AP regarding labor standards for feders'.'.Y assisted Discrimination Act of 1975, as smtndtd (42 tonsit"60nsubagrtemenu. V.S C 11 6101.6107). which prohibits discrim• motion on the basis of age; tA+we er va c+aav Mx*e+r4 A Cr! verve aur Autt+o& d for Local Reprodvc9on 6190 12c-2 8022.1 Appendix 12c 30 Will comply, tf appiica►le. with' flood insurance 13 Will assist the awarding agency in assuring purchase requirements of Section 102(al of the tompiiance with Section 106 of the Xsti*nsl Flood Disaster Protection Act of 1973(P.1. 93.236) Historic preservation Act of 1966,as amended(16 •hick requires recipients in a special flood'hisard US C. 470). EO 11693 (lit ntificslion and area to participate In the program andto purchase protection of historic properties). and the flood insurance if the total cost of insurable Archaeological and Historic Preservation Act of construction and acquisition Is i 10.000 or more. 1974(16 us C.4696-1 It"41. It. Wiil eompiy with environmental standards which 34. Will comply with P.L. 93.349 regarding the awy be prescribed ponuant to the following (a) protection of human aubjte4 Involved in research. Institution of environmental quality control development.and MAW activities supported by measures under the National Environmentail this a ward ofassistance. Policy Act of 1969 (P.L. 91.190) and Executive 13. Will comply with the Laboratory Animal Welfare Order MO) 31514. (b) notification of violating Act of 1966 (P.L 99.544. as amended, 7 V S.C. facilities purs4snt to EO 11738. (c) protection of 2131 at seq.)pertaining to the are.handling,and wetlands pursuant to EO 11990.(d)evaluation of treatment of warm blooded animals held for flood hazards in Aoodplains In accordance with EO research.teaching.M ether activities supponed by 31993. (e)assurance of project consistency with this award ofassistance the approved State management program developed under the Coastal Zone Management 16. 1>1i11 comply with the Ltsd•Bawd Paint Poisoning Act of 19?2 (16 V.S C. If 1431 at seq ); (A Prtvention Act (42 L'S C. If 4301 at stq t which eordormit) of Federal actions to State (Clear Air) prohibits the use of lead based paint in implementation Plans under Section 176(c)of the construction or rehabilitation of residence Clear Air Act of 1955. as amended (42 U.S.C. ! structures. 7401 et seq 1.(g)protection of underground sourcts 37. Will cause to be performed the required fwneial Of drinking water under the Safe Drinking Water and compliance audits In accordance with the Act of 1974. as amended. (P.L. 93.323). and (h) Single Audit Act of 1994 protection of endangered species under the Endangered Species Act or 1973.as arnended.(P.L. 18. Will comply with all applieable rtquiremenu of all 93.205). other Federal laws. taecut.1ve orders, regulations 32. Will comply with the Wild and Scenic Rivers Act and policies govtrning this program. Of 1963 (16 L'.S C. 11 1271 It seq ) related to 'Protecting components or potential components of the national wild and scenic rivers system. fA"U�Uky 4ftAlWRt Of AMMO+t.=t0Ctall OstKti►t ME Chair Orange County Board of Commissioners NQAT*ft OATtMW ED range County Human Relations Commission 9/29/98 128-3 6/90 ! 4284 041 awn 8022.1 Appendix 12c ATTACMPMKT C ) CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS 1. Instructions for Certification a. By submitting this application, the applicant is providing the certification set out below. b. The certification set out below is a material representation of fact upon which reliance will be placed if HUD determines to award a grant to the applicant. if it is later determined that the applicant knowingly rendered a false certification, or otherwise violates the requirements of the Drug-Free Workplace Act, HUD, in addition to aRy other remedies available to the Federal Government, may take action authorised under the Drug-Free Workplace Act. 2. Certification Regarding Drug-Free Workplace Requirements a. The applicant certifies that it will provide a drug-free workplace by: 1. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensation, possession or use of a controlled substance is prohibited in the grantee's workplace and specifying the actions that Nil be taken against employees for violation of such prohibition; 2. Establishing a drug-free awareness program to inform employees about: I. the dangers of drug abuse in the workplace; ii. the applicant's policy of maintaining a drug-free workplace; III. any available drug counseling, rehabilitation, and employee assistance programs; and iv. the penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; 3. M4aking 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 l; 6/90 12c-4 8022.1 Appendix 12c -2- 4. Notifying the employee in the statement required by paragraph 1 that, n a condition of employment under the grant, the employee Mill: 1. abide by the terns of the statement; and ii. notify the employer of any criminal drug statute convic- tion for a violation occurring in the workplace no later than five days after such conviction; S. Notifying HUD within ten days after receiving notice under subparagraph 4 (11) from any employee or otherwise receiving actual notice of such conviction; 6. Taking one of the following actions, within 30 days of receiving notice under subparagraph 4 (11), with respect to any employee who is so convicted: I. taking appropriate personnel action against such an employee, up to and including termination; or ii. 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; 7. Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs 1, 2, 3, 4, S and 6. b. The applicant shall insert in the-space provided below the site(s) for the performance of work done in connection with the specific grant: Place of Performance (Street address, city, county, state, zip code) < > < > 12c-5 6/90 8022.1 Appendix 12c RESTRICTIONS ON LOBBYING - CERTIFICATION By submitting this application, the applicant certifies, to the best of Us or her knowledge and belief, thats (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 :taking of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, cooperative agreement, or loan. (2) 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, cooperative agreement, or loan, the undersigned shall complete and submit Standard Form-LLL, 'Disclosure Form to Report Lobbying,* in accordance with its instructions. 1% (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) 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, D.S.C. 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. 6/90 12c-6 CAPACITY BUILDING AGREEMENT FY' 9 8/' 9 9 SCHEDULE OF ARTICLES 1 . SCOPE OF WORK (FIXED PRICE) 2 . PERIOD OF PERFORMANCE 3 . INSPECTION AND ACCEPTANCE 4 . CONDUCT OF WORK 5. INSTRUMENT AMOUNT AND REQUESTS FOR PAYMENT 6. USE OF COOPERATIVE AGREEMENT FUNDS 7 . MAINTENANCE OF EFFORT 8 . HUD' s SUBSTANTIAL INVOLVEMENT 9. ASSURANCES 10 . USE OF CONSULTANTS 11 . PUBLICATIONS AND NEWS RELEASES 12 . REPRODUCTION OF REPORTS 13 . FLOW DOWN PROVISIONS 14 . DISPUTES APPENDIX AND ATTACHMENTS APPENDIX A - STATEMENT OF WORK (CAPACITY BUILDING AGENCIES ONLY) ATTACHMENTS ATTACHMENT A - CRITERIA FOR PROCESSING ATTACHMENT B - PART 115 ATTACHMENT C - INSTRUCTIONS FOR PREPARATION AND SUBMISSION OF DIRECT DEPOSIT SIGN-UP FORM (SF-1199A) AND INSTRUCTIONS FOR THE LOCCS VOICE RESPONSE SYSTEM ACCESS ATTACHMENT D - PART 85