HomeMy WebLinkAboutS Application for Federal Assistance for Retired Senior Volunteer Program (RSVP) VM7-D
APPLICATION FOR OMB Avoroval No.0348-0043
2 DATE SUBMITTED Applicant Identifier
FEDERAL ASSISTANCE 09-23-94 NONE
1.TYPE OF SUBMISSION: Z DATE RECEIVES BY STATE State Application Identifier
Application Preapplication 9300000720
❑Construction ❑ Construction
❑Non-ConSwWon : ❑ Nor-Construction 4.DATE RECEIVED BY FEDERAL AGENCY Federal Identifier
S APPLICANT INFORMATION
Legal Name: Organizational Unit
ORANGE COUNTY COUNTY GOVERNMENT
Address(give city,county,state,and MP code): Name and telephone number of the person to be contacted on matters
involving this application(give area code):
ORANGE COUNTY Katherine P. Mangum (Kathy), RSVP Director
P.O. BOX 8181 (919) 968-2054
HILLSBOROUGH, NC 27278
& EMPLOYER IDENTIFICATION NUMBER(E1M 7. TYPE OF APPLICANT:(enter appropriate letter in box)
A. Stale H. Independent School Distriw
B. County 1. State Controlled Institution of Higher Learning
C. Municipal J. Private University
a. TYPE OF APPLICATION: D. Township K. Indian Tribe
❑ New ES Continuation ❑ Revision E. Interstate L Individual
F. Intermunicipal M. Profit Organization
If Revision,enter appropriate letter(s)in box(es): ❑ - G. Special District N. Other(Specify):
A. Increase Award B. Decrease Award C. Increase Duration
9. NAME OF FEDERAL AGENCY:
D. Decrease Duration Other(specify):
ACTION
10. CATALOG OF FEDERAL DOMESTIC 11. DESCRIPTIVE TITLE OF APPLICANTS PROJECT: MM RJ)P prmdcbs
ASSISTANCE NUMBER: 7 2 0 2 fc it- ividmjs 55 & LPL' the cpp=tjuty to ser�e
the CCIIIT xrit ies rm t
TITLE: Retired Senior Volunteer Program and wing�p�ots. p;T U
12. AREAS AFFECTED BY PROJECT(cities,counties,states,etc.): b3� Cn t� w1 mteerl S skills, e'pe `�„„_, jl'ltm:iests
& the weds of the a9axnes. Agaicaes are mad
Hillsborough, Chapel Hill, Carrbor ,tO SLimit detailed jcb deesCriptirns of each
Orange County, North Carolina assigrrEnt.
13. PROPOSED PROJECT: 14. CONGRESSIONAL DISTRICTS OF: Ps�gj nn TNT
Starr Date Ending Date a. Applicant b. Project
Fourth Fourth
07-01-94 06-30-97
15. ESTIMATED FUNDING: 1S IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS?
a. Federal $ 112,545 .00 a. YES. THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE TO THE
STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON:
b. Applicant $ 133,107 •00
DATE
c. State S .00 --
b. NO. ❑ PROGRAM IS NOT COVERED BY E.O.12372
d. Local $ 38,331 'D0 ❑ OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW
e. Other $ 00
I. Program Income $ 17.IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
❑ Yes If'Yes,'attach an explanation. No
g. TOTAL $283,983
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF,ALL DATA IN THIS APPLICATIOWPREAPPLICATION ARE TRUE AND CORRECT,THE DOCUMENT HAS BEEN DULY
AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED
a. Typed Name of Authorized Representative b. Title c. Telephone Number
Moses Carey orrmiss
Chair Orange Co. Cione 919-732-8181
d. Signatu I rized Represent e. D igned
Previous Edi ona Not Usable utnorvrd to Local epr lit Pa;e 1 Stanoaro Form 424(Rev.4-a&) rescmwc ay OMn ircnar A-102
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CERTIFICATE OF RECORDING OFFICER
The undersigned duly qualified and Clerk of the Orange
County Board of Commissioners does hereby certify:
That the attached resolution is a true and correct copy of
the resolution to authorize the County Manager to submit an
application to ACTION for a $112,545 three year grant ($37,515
per annual budget period) for continuation of the Retired
Senior Volunteer Program for thirty-six months and to assure
minimum annual support of this program of 30% in cash, goods ,
and services, and further, that such resolution has been fully
recorded in the journal of proceedings and recorded in my
office.
IN WHITNESS WHEREOF, I have hereunto set my hand this day
of April 4, 1994 .
ORANGE COUNTY BOARD OF COMMISSIONERS
BY:
Bever y A.6ZDythe, C e
OMB Approval No.0348-0040
ASSURANCES—NON-CONSTRUCTION PROGRAMS
Note: Certain of these assurances may not be applicable to your project or program.If you have questions,please contact the awarding agency.
Furt her,certain Federal awarding agencies mayrequire applicants to certify to additional assurances.If such is the case,you will benotified.
As the duly authorized representative of the applicant,I certify that the applicant:
1. Has the legal authority to apply for Federal assistance, and the in- 8. Will comply with the provisions of the Hatch Act(5 U.S.C.§§1501-1508
stitutional,managerial and financial capability(including funds suffi- and 7324-7328)which limit the political activities of employees whose
cient to pay the non-Federal share of project costs)to ensure proper principal employment activities are funded in whole or in part with
planning,management and completion of the project described in this Federal funds.
application. 9. Will comply,as applicable,with the provisions of the Davis-Bacon Act
2. Will give the awarding agency,the Comptroller General of the United (40 U.S.C.§§276a and 276a-7),the Copeland Act(40 U.S.C.§276c and
States,and if appropriate,the State,through any authorized representa- 18 U.S.C.§§874),and the Contract Work Hours andSafety Standards Act
tive,access to and the right to examine all records,books,papers,or (40 U.S.C.§§327-333),regarding labor standards for federally assisted
documents related to the award.and will establish a proper accounting construction subagteements.
system in accordance with generally accepted accounting standards or 10. Will comply,if applicable,with flood insurance purchase requirements of
agency directives. Section 102(a)of the Flood Disaster Protection Act of 1973(P.L.93-234)
3. Will establish safeguards to prohibit employees from using their posi- which requires recipients in a special flood hazard areato participate in the
tions for apurpose that constitutes orpresents the appearance ofpersonal program and to purchase flood insurance if the total cost of insurable
or organizational conflict of interest,or personal gain. construction and acquisition is$10,000 or more.
4. Will initiate and complete the work within the applicable time frame 11. Will comply with environmental standards which may be prescribed
after receipt of approval of the awarding agency. pursuant to the following:(a)institution of environmental quality control
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 measures under the National Environmental Policy Act of 1969(P.L.91-
U.S.C.§§4728-4763)relating to prescribed standards for merit systems 190) and Executive Order (EO) 11514; (b) notification of violating
for programs funded under one of the nineteen statutes or regulations facilities pursuant to EO 11738;(c)protection of wetlands pursuant to EO
specified in Appendix A of OPM's Standards for a Merit System of 11990;(d)evaluation of flood hazards in floodplains in accordance with
Personnel Administration(5 C.F.R.900,Subpart F). I EO 11988;(e)assurance of project consistency with the approved State
6. Will comply with all Federal statutes relating to nondiscrimination. management program developed under the Coastal Zone Management
These include but are not limited to:(a)Title VI of the Civil Rights Act Act of 1972(16 U.S.C.§§1451 et seq.);(f)conformity of Federal actions
of 1964(P.L. 88-352)which prohibits discrimination on the basis of to State(Clean Air)Implementation Plans under Section 176(c)of the
race,color or national origin;(b)Title IX of the Education Amendments Clean Air Act of 1955, as amended (42 U.S.C. § 7401 et seq.); (p)
of 1972,as amended(20 U.S.C.§§1681-1683,and 1685-1686),which protection of underground sources of drinking water under the Safe
prohibits discrimination on the basis of sex; (c) Section 504 of the Drinking WaterAc t of 1974,as amended(P.L.93-523);and(h)protection
Rehabilitation Act of 1973, as amended (29 U.S.C. § 794), which of endangered species under the Endangered Species Act of 1973,as
prohibits discrimination on the basis of handicaps;(d)theAge Discrimi- amended(P.L.93-205).
nation Act of 1975, as amended (42 U.S.C. §§ 6101-6107), which 12. Will comply with the Wild and Scenic Rivers Act of 1968(16 U.S.C.§§
prohibits discrimination on the basis of age;(e)the Drug Abuse Office 1271 et seq.)related to protecting components or potential components of
and Treatment Act of 1972 (P.L. 92-255), as amended, relating to the national wild and scenic rivers system.
nondiscrimination on the basis of drug abuse; (f)the Comprehensive 13. Will assist the awarding agency in assuring compliance with Section 106
Alcohol Abuse and Alcoholism Prevention,Treatment and Rehabilita- ofthe National Historic Preservation Act of 1966,as amended(16 U.S.C.
tion Act of 1970(P.L.91-616),as amended,relating to nondiscrimina 470),EO 11593(identification and protection of historic properties),and
tion on the basis of alcohol abuse or alcoholism;(g)§§523 and 527 of the Archaeological and Historic Preservation Act of 1974 (16 U.S.C.
the Public Health Service Act of 1912(42 U.S.C.290 dd-3 and 290 ee- 469a-1 et seq.).
3),as amended,relating to confidentiality of alcohol and drug abuse 14. Will comply with P.L.93-348 regarding the protection of human subjects
patient records;(h)Title VIII of the Civil Rights Act of 1968(42 U.S.C. involved in research,development,and related activities supported by this
§3601 et seq.),as amended,relating to nondiscrimination in the sale, award of assistance.
rental or financing of housing,(i)any other nondiscrimination provi- 15. Will comply with the Laboratory Animal Welfare Act of 1966(P.L.89-
sions in the specific statute(s) under which application for Federal 544,as amended,7 U.S.C.2131 et seq.)pertaining to the care,handling,
assistance is being made;and 0)the requirements of any other nondis- and treatment of warm blooded animals held for research,teaching,or
crimination statute(s)which may apply to the application._ _ other activities supported by this award of assistance.
7. Will comply,or has already complied,with the requirements of Titles H 16. Will comply with the Lead-Based Paint Poisoning Prevention Act(42
and III of the Uniform Relocation Assistance and Real Property Acqui- U.S.C.§§4801 et seq.)which prohibits the use of lead-based paint in
sition Policies Act of 1970(P.L. 91-646)which provide for fair and construction or rehabilitation of residential structures.
equitable treatment of persons displaced or whose property is acquired 17. Will cause to be performed the required financial and compliance audits
as aresult of Federal or federally assisted programs.These requirements in accordance with the Single Audit Act of 1984.
apply to all interests in real property acquired for project purposes 18. Will comply with all applicable requirements of all other Federal laws,
regardless of Federal participation in purchases. executive orders,regulations and policies governing this program.
SIGNA OF AUTHOR CERTIFYING OFFICIAL TIM C
drlwls S 14're e T
APPLI ORGANI TION DATE SUBMITTED
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Page 9
Authorized for Local Reproduction Standard Form 424B(4-88)
Prescribed by OMB Circular A-102
(e) Notify the cognizant ACTION Grants Officer
within ten calendar days after receiving notice of C. LOBBYING
such conviction under subparagraph(d)(2)from As required by Section 1352,Title 31 of the U.S. Code,
the employee, or otherwise receiving actual no- and implemented at 45 CFR Part 1230,for organizations
tice. The notice shall include the title of the
employee's position and the identification entering into a grant or cooperative agreement over
$100,000, as defined at 45 CFR Part 1230, Sections
number(s)of each affected grant; 1230.105 and 1230.110,the applicant certifies that:
(f) Take one of the following actions, within 30
calendar days of receiving notice under 1. No Federal appropriated funds have been paid or will
subparagraph 4b, with respect to any employee be Paid, by or on behalf of the undersigned, to any
who is so convicted— person for influencing or attempting to influence an
officer or employee of any agency, a Member of
(1) Take appropriate personnel action against Congress,an officer or employee of Congress,or an
such an employee up to and including termi-
nation consistent with the requirements of the employee of a Member of Congress in connection
with the awarding of any Federal contract,the making
Rehabilitation Act of 1973,as amended; or of any Federal grant,the making of any Federal loan,
(2) Require such employee to participate satis- the entering into of any cooperative agreement,or the
factorily in a drug abuse assistance or reha- extension, continuation, renewal, amendment, or
bilitation program approved for suchpurposes modification of any Federal contract,grant,loan, or
by a Federal, State or local health, law en- cooperative agreement.
forcement,or other appropriate agency;
2. If any funds other than Federal appropriated funds
(g) Make a good faith effort to continue to maintain have been paid or will be paid to any person for
a drug-free workplace through implementation influencing or attempting to influence an officer or
of paragraphs 1(a) through 1(f). employee of any agency,a Member of Congress,an
2. The grantee shall insert in the space provided below officer or employee of Congress,or an employee of a
the site(s) for the performance of work done in Member of Congress in connection with this Federal
connection with the specific grant: contract, grant, loan, or cooperative agreement, the
Place of Performance(Street address,city,county,state, undersigned shall complete and submit Standard
zip code): Forth-LLL,"Disclosure Form to Report Lobbying,"
in accordance with its instructions.
3. The undersigned shall require that the language of
this certification be included in the award documents
for all subcontracts at all tiers (including subcon-
tracts, subgrants, and contracts under grants, loans,
Check here if there are grantee workplaces that are and cooperative agreements)and that all subrecipients
not identified above. shall certify and disclose accordingly.
As the duly authorized representative of the applicant,I hereby certify that the applicant will comply with the above
certification(s). (A copy of the governing body's authorization for me to sign this certification as official represen-
tative is on file in the applicant's office.)
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Applicant Organization
A PS f Romd O- ,6115 S�d7ll�C�S
Printed Name and Title of utho ' Representative
Signaturf of Authorized Certifying Official Date
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