HomeMy WebLinkAboutAgenda - 06-20-2017 - 4-c - USDA Rural Business Development Grant Award for the Piedmont Food & Agricultural Processing Center (PFAP) and Approval of Budget Amendment #10-B 1
ORD-2017-013
ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: June 20, 2017
Action Agenda
Item No. 4-c
SUBJECT: USDA Rural Business Development Grant Award for the Piedmont Food &
Agricultural Processing Center (PFAP) and Approval of Budget Amendment
#10-B
DEPARTMENT: County Manager
ATTACHMENT(S): INFORMATION CONTACT:
Bonnie Hammersley, 919-245-2300
USDA Letter of Conditions with DRAFT Mike Ortosky, Agriculture Economic
Addenda Developer, 919-245-2336
L. Eric Hallman, Executive Director, PFAP
919-241-4212
PURPOSE: To:
1) receive a brief presentation from staff from the United States Department of Agriculture
(USDA) (Henderson, NC Area Office) regarding the Letter of Conditions, along with the
Draft Addenda, for the award of a USDA Rural Business Development Grant in the
amount of $145,511 to Orange County and the Piedmont Food and Agricultural
Processing Center;
2) approve Budget Amendment #10-B to accept the award, its Conditions and the
associated Draft Addenda, subject to final review and approval by the County Attorney's
Office; and
3) authorize the Manager to sign any paperwork associated with grant subject to final review
and approval by the County Attorney's Office.
BACKGROUND: Orange County and the Piedmont Food and Agricultural Center applied for
funding through the USDA Rural Business Development grant program and has been awarded
$145,511. Of these funds, $92,186 will be used to purchase additional capital equipment with
which to expand the capabilities and capacity of PFAP to serve the region's food entrepreneurs.
In addition, $53,325 is directed at providing business support services and creation of a "road
map" for start-up food businesses in collaboration with Carolina Farm Stewardship Association
(CFSA).\
A pre-condition of accepting the award is a presentation of the grant conditions to the governing
board of the grant recipient, in this case the Board of Commissioners for Orange County. A
representative from the Henderson, NC Area Office will provide a brief presentation at the
meeting, after which it is proposed that the Board approve Budget Amendment #10-B to accept
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the award, its Conditions and the Draft Addenda, subject to final review and approval by the
County Attorney's Office.
FINANCIAL IMPACT: PFAP is a vital part of the food and agricultural economy in Orange
County. In calendar year 2016, PFAP clients produced over $2.6M in retail value and created
over 25 full time and 60 part-time jobs. This grant will allow PFAP to increase its service to local
food and agricultural entrepreneurs, helping them launch and grow their businesses in Orange
County. This grant will be managed by PFAP and require no overhead or matching funds from
Orange County sources. This Budget Amendment #10-B provides for the acceptance of these
grant funds, and establishes the following Grant Project Ordinance:
USDA Rural Business Development Grant-Project# 71077
Revenues for this project:
Current FY 2016-17 FY 2016-17
FY 2016-17 Amendment Revised
USDA Grant Funds $0 $145,511 $145,511
Total Project Funding $0 $145,511 $145,511
Appropriated for this project:
Current FY FY 2016-17 FY 2016-17
2016-17 Amendment Revised
USDA Rural Business $0 $145,511 $145,511
Development Project
Total Costs $0 $145,511 $145,511
SOCIAL JUSTICE IMPACT: The following Orange County Social Justice Goals are applicable
to this agenda item:
• GOAL: FOSTER A COMMUNITY CULTURE THAT REJECTS OPPRESSION AND
INEQUITY
The fair treatment and meaningful involvement of all people regardless of race or color;
religious or philosophical beliefs; sex, gender or sexual orientation; national origin or
ethnic background; age; military service; disability; and familial, residential or economic
status.
PFAP is open to and embraces all people, regardless of race or color; religious or philosophical
beliefs; sex, gender, or sexual orientation; national origin or ethnic background; age; military
service; disability; and familial, residential, or economic status.
• GOAL: ENSURE ECONOMIC SELF-SUFFICIENCY
The creation and preservation of infrastructure, policies, programs and funding necessary
for residents to provide shelter, food, clothing and medical care for themselves and their
dependents.
PFAP promotes the creation of food and farm related businesses, jobs, and training across the
region.
• GOAL: ESTABLISH SUSTAINABLE AND EQUITABLE LAND-USE AND
ENVIRONMENTAL POLICIES
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The fair treatment and meaningful involvement of people of all races, cultures, incomes
and educational levels with respect to the development and enforcement of
environmental laws, regulations, policies, and decisions. Fair treatment means that no
group of people should bear a disproportionate share of the negative environmental
consequences resulting from industrial, governmental and commercial operations or
policies.
PFAP embraces and promotes the environmental and conservation standards of Orange
County with particular attention to recycling, energy usage, and waste management.
• GOAL: ENABLE FULL CIVIC PARTICIPATION
Ensure that Orange County residents are able to engage government through voting and
volunteering by eliminating disparities in participation and barriers to participation.
The highly regulated environment at PFAP precludes open public access but PFAP
management encourages organized tours and the use of the facility's conference room to
promote awareness and support of Orange County food entrepreneurs.
RECOMMENDATION(S): The Manager recommends that the Board:
1) receive a brief presentation from staff from the United States Department of Agriculture
(USDA) (Henderson, NC Area Office) regarding the Letter of Conditions, along with the
Draft Addenda, for the award of a USDA Rural Business Development Grant in the
amount of $145,511 to Orange County and the Piedmont Food and Agricultural
Processing Center;
2) approve Budget Amendment #10-B to accept the award, its Conditions and the
associated Draft Addenda, subject to final review and approval by the County Attorney's
Office; and
3) authorize the Manager to sign any paperwork associated with grant subject to final review
and approval by the County Attorney's Office.
Final Letter with DRAFT Addenda Attached
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S LA
United States Department of Agriculture
Rural Development June 12, 2017
North Carolina Dr. Eric Hallman
Henderson Area Orange County
Office 200 South Cameron St.
P. O. Box 8181
853 S. Beckford Dr.
Hillsborough, NC 28289
Suite A
Henderson,NC 27636
SUBJECT: Letter of Conditions
Voice 252.438.3134 Rural Business Development Grant
Fax 544.3256826 Grant Amount: $145,511.00
Dear Dr. Hallman,
The Rural Business-Cooperative Service (hereafter, Agency) hereby establishes
conditions which must be understood and agreed to by you, the applicant and
prospective Recipient of grant funds, before further consideration may be given to
your application. Any changes in project cost, sources of funds, scope of services,
and/or any other significant changes in the project or applicant must be reported to,
and approved by the Agency, by written amendment to this letter. Any changes not
approved by the Agency shall be cause to discontinue processing your application.
This letter is not to be considered as grant approval or as a representation as to the
availability of funds. The docket may be completed on the basis of a grant not to
exceed $145, 511.00.
The funding period for this project will begin on the Award Date, which is the same
date the Agency completes execution of the Grant Agreement. The projected
timeframe for completion of this project is 12 months from Award Date. Project
activities may not begin, and project costs may not be incurred, prior to the Award
Date.
Please complete and return the attached Form RD 1942-46, "'Letter of Intent to Meet
Conditions,'" if you desire that further consideration be given your application. By
signing Form RD 1942-46, "Letter of Intent to Meet Conditions," you are hereby
agreeing and acknowledging that this Rural Business Development Grant is a non-
continuous, non-renewable grant and that any ultimate approval of this grant does
not constitute any assurance that future grants will be available.
if the conditions set forth in this letter are not met within 60 days from the date
hereof, the Agency reserves the right to discontinue the processing of the
application. This is not appealable.
Applicants expecting funds from other sources for use in completing projects
partially financed with Agency funds will present evidence of commitment and
availability of funds from those other sources. This evidence will be made available
to the Agency before grant closing. Matching funds provided by the applicant or
USDA is an equal opportunity provider,employer,and tender.
To file a program discrimination complaint,complete the USDA Program Discrimination Complaint Form,AD-3027,
found online at lititiywww.ascr usdAkoviconvlaint p.Ist httrtB and at any USDA office or write a letter addressed to
USDA and provide in the letter all of the information requested in the form To request a copy of the form,call(866)632-
9992.Submit your completed form or letter to USDA by mail to:U.S.Department of Agriculture, Office of the Assistant
Secretary for Civil Rights, 1400 independence Avenue,SW,Washington,D.C.20250-9410,by fax(202)690-7442 or
email at programintake@usda.gov.
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other sources must be disbursed for eligible project purposes, pro rata, with the use
of Agency grant funds.
FEDERAL INTEGRITY ACT
To assure the high standards of honesty, integrity, and impartiality maintained by
Agency employees,we need to identify any Agency assistance to be provided to
Agency employees, their relatives, or their business or close personal associates.
This includes grants to organizations. If you know of any relationship or association
you may have with an Agency employee, please provide this information.
1. REQUIREMENT FOR SYSTEM FOR AWARD MANAGEMENT (SAM)
This grant is further conditioned upon your providing the Agency with evidence of
your Dun and Bradstreet Data Universal Numbering System (DUNS) number and
evidence that you are registered and active in the System for Award Management
(SAM). Your organization is actively registered with an expiration date of
12/1/2017. Please ensure that this account is kept current and active. Please note that
the System for Award Management allows for at least 60 days prior to expiration.
You must maintain the currency of your information in the SAM until you submit
the final financial report required under this award and all grant funds under this
award have been disbursed or de-obligated;whichever is later. This requires that you
review and update the information at least annually after the initial registration, and
more frequently if required by changes in your information or another award term.
2. USE OF FUNDS
The proposed grant funds will be used to purchase equipment and provide technical
assistance for the Piedmont Food and Agriculture processing Center(PFAF)to
enable entrepreneurs to start and grow food-related businesses and provide a
regulatory-complaint facility. The project will support the development of small and
emerging private business enterprises in rural areas in accordance with the
application package as submitted for an enterprise or opportunity type project, or as
amended and approved by the Agency.
Any changes in the proposed use of funds must be submitted in writing to the Agency
and receive prior written approval.
3. APPLICANT CONTRIBUTION
The Rural Development Business funding consideration was not inclusive of a
requirement for an applicant contribution,therefore there will not be a requirement for
the same in this "Letter of Conditions" for matching funds. Prior to any release of
grant funds,you must provide documentation acceptable to the Agency that matching
funds have been expended on the approved project.
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4. PROGRAM INCOME
If program income is earned during the grant period, you must comply with the
requirements in 2 CFR Part 200.307. Costs incidental to the generation of program
income may be deducted from gross income to determine net program income,
provided these costs have not been charged to the project costs as grant or matching
funds.
5. SCOPE OF WORK
You must administer the grant in accordance with the approved Scope of Work.
Agency comments and required changes, if any, must be implemented in the project.
If the Scope of Work indicates you will sub-contract any portion of the project
activities,then you agree not to turn the responsibility of the project over to the
contracted party and you will continue to oversee and control the project through
completion. The technical assistance component of your project indicates the use of
a sub-contracted party, this information also needs to be reflected in your post award
duties noted in item 17.
Any proposed changes in the Scope of Work must be approved in writing by the
Agency.
Should your project fall behind the schedule indicated in the Scope of Work, you
may request an extension of time to complete the project. You must notify the
Agency in writing at least 10 days prior to the original expiration date and provide
explanation for your request to extend the expiration date, including a revised budget
and timeline for project completion.
The Agency may,at its discretion (not appealable) and under certain conditions,
consider a one-time extension of the expiration date of the award for up to 12
months. This one-time extension may not be exercised merely for the purpose of
using unobligated balances, but must be related to circumstances beyond your
control that prevented completion of the project on schedule. Please refer to 2 CFR
200308 for additional requirements.
6. GRANTEE INSURANCE AND BONDING
You must provide evidence satisfactory to the Agency that you will maintain sufficient
hazard insurance, workman's compensation insurance and liability insurance, as
recommended by your attorney and referenced in the Grant Agreement,to protect your
interests and the Agency's interests in project matters.
You must provide evidence satisfactory to the Agency that all officers and personnel
in your organization authorized to receive and/or disburse Federal funds are
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adequately covered by bonding and/or employee dishonesty insurance to protect the
Federal Government's interest, or for the total amount of the grant, whichever is less,
and as authorized by the Agency. See 2 CFR 200 sections 304 and 310 and the Grant
Agreement requirements.
7. FINANCIAL MANAGEMENT
The Recipient must provide for Financial Management Systems that adhere to 2
CFR 200.302:
a. Accurate, current and complete disclosure of the financial results of each grant;
b. Records that identify adequately the source and application of funds for grant-
supported activities,together with documentation to support the records. Those
records must contain information pertaining to grant awards and authorizations,
obligations, unobligated balances, assets, liabilities, outlays and income;
c. Effective control over and accountability for all funds to ensure compliance with
Federal statutes, regulations, and the terms and conditions of the Federal award.
Recipient must adequately safeguard all such assets and must ensure that funds are
used solely for authorized purposes; and
d. Recipient must retain financial records, supporting documents, statistical records,
and all other records pertinent to the grant for a period of at least 3 years after
Agency receipt of the FINAL Federal Financial Status Reports; except when audit
findings and litigation issues have not been resolved,then the records must be
retained beyond the 3-year period or until such findings and/or issues have been
resolved. The Recipient must provide the Agency and Comptroller General of the
United States, or any of their duly authorized representatives, access to any books,
documents, papers, and records of the grantee that are pertinent to the specific grant
program for the purpose of making audit, examination, excerpts, and transcripts.
S. DISBURSEMENT OF GRANT FUNDS
Grant funds will be disbursed by the Agency on a reimbursement basis not to exceed
one disbursement every 30 days. One original Standard Form (SF) 270, "Request for
Advance or Reimbursement," or one original Standard Form (SF) 271, "Outlay
Report and Request for Reimbursement for Construction Programs,will be submitted
to the Agency with supporting documentation to validate eligible costs incurred. The
financial management system of the Recipient organization shall provide for effective
control over and accountability for all funds,property,and other assets. Expenditures
may be reported on a cash or accrual basis, as long as the methodology is disclosed
and consistently applied.
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Grant funds will not be disbursed until all provisions of any phased environmental
review process are complete in accordance with Agency regulations.
The last quarterly payment, or the last three months of reimbursements, may be
withheld by the Agency until all reports are received and approved by the Agency.
Grant funds will be transferred to you via Electronic Funds Transfer(EFT). You must
complete Form SF-3881, Electronic Funds Transfer Payment Enrollment Form.
It is the program intent that all grant funds be fully disbursed within one year from the
date of this letter or in accordance with the Scope of Work approved by the Agency.
In accordance with RD Instruction 4280-E, 4280.451 (b), "any funds not disbursed
within 42 months from the date of obligation will be deobligated." This is not
appealable. Copies of paid invoices, receipts, cancelled checks, etc., will be required
as supporting documentation for each reimbursement.
9. ENVIRONMENTAL REVIEW
He scope of your project has been determined according to Regulation 1970 category
to be excluded.
10. RURAL AREA
The project must be located in, or the project activities must only directly serve and
benefit,a rural area, as defined by RD Instruction 4280-E and 7.U.S.C. 1991 (a) (13)
(a) and (d) et seq.
11. CONFLICT OF INTEREST
In accordance with RD Instruction 4280-E, 4280.406, no conflict of interest or
appearance of conflict of interest will be allowed. Grant and matching funds may not
be used to support costs for services or goods going to, or coming from, a person or
entity with a real or apparent conflict of interest. All transactions must be third-party,
arm's-length transactions.
12. DEBARMENT
You must execute Form AD-1047, "Certification Regarding Debarment, Suspension,
and Other Responsibility Matters-Primary Covered Transactions,"to certify that your
organization is not debarred or suspended from Government assistance. You also
must obtain a certification on Form AD-1048, "Certification Regarding Debarment,
Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered
Transactions," from any person or entity you do business with as a result of this
Government assistance, indicating that they are not debarred or suspended from
Government assistance.
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13. DRUG-FREE WORKPLACE
You must execute Form AD-1049, "Certification Regarding Drug-Free Workplace
Requirements(Grants)Alternative I-For Grantees Other Than Individuals,"to certify
that you will provide a drug-free awareness program for employees.
14. EQUAL OPPORTUNITY AND NONDISCRIMINATION
REQUIREMENTS
You must comply with Title VI of the Civil Rights Act of 1964, "Nondiscrimination
in Federally Assisted Programs, "42 U.S.C. 2000d, Section 504 of the Rehabilitation
Act for Federally Conducted Programs and Activities,the Age Discrimination Act of
1975 and the Americans with Disabilities Act. You must execute RD Forms 400-1,
"Equal Opportunity Agreement (construction)" and 400-4, "Assurance Agreement."
You will be subject to Agency compliance reviews.
15. COMPLIANCE REVIEWS
You must collect and maintain data on the gender, race, and ethnicity or
national origin of your membership, ownership and employees, and the data
must be available for Agency reviews to determine your compliance with the
regulations. You must maintain racial and ethnic data showing the extent to
which members of minority groups are beneficiaries of your project activities.
16. NONDISCRIMINATION STATEMENT
Recipients must post the following Nondiscrimination Statement in its entirety in
their office in public view and in full on all print and non-print materials (including,
but not limited to, audio,video,website,brochures,newsletters, by-laws, etc.):
In accordance with Federal civil rights law and the U.S. Department of Agriculture
(USDA) civil rights regulations and policies,the USDA, its Agencies, offices,and
employees, and institutions participating in or administering USDA programs are
prohibited from discriminating based on race, color, national origin, religion, sex,
gender identity(including gender expression), sexual orientation, disability, age,
marital status, family/parental status, income derived from public assistance
program, political beliefs, or reprisal or retaliation for prior civil rights activity, in
any program or activity conducted or funded by USDA (not all bases apply to all
programs). Remedies and complaint filing deadlines vary by program or incident.
Persons with disabilities who require alternative means of communication for
program information (e.g., Braille, large print, audiotape, American Sign Language,
etc.) should contact the responsible Agency or USDA's Target Center at (202) 720-
2600 (voice and TTY)or contact USDA through the Federal Relay Service at(800)
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877-8339. Additionally, program information may be made available in languages
other than English.
To file a program discrimination complaint, complete the USDA Program
Discrimination Complaint Form, AD-3027, found online at
httpt//www aset,usda,LQN/complainl tilihg_eust htthl and at any USDA office or
write a letter addressed to USDA and provide in the letter all of the information
requested in the form. To request a copy of the complaint form, call (866) 632-9992.
Submit your completed form or letter to USDA by:
i. mail: U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410;
2. fax: (202) 690-7442; or
3. email: Er qgyarn Ontake(ei LA sda,gov
USDA is an equal opportunity provider, employer, and lender.
If the size of the material is too small to include the full statement, the material will
at a minimum, include the following statement in the same size as the text:
"This institution is an equal opportu ilty provider."
The attached USDA poster, "And Justice for All," Form Al) 475-A, must be utilized
to inform customers of their rights and must be displayed where it can be viewed by
customers.
17. REPORTING
Per RD Instruction 4280-E, 4280.449 and 2 CFR 200.328, Forms SF-425, "Federal
Financial Status Report" and a narrative Project Performance Report will be required
from you on a quarterly basis (due 30 working days after end of each quarter), until
all grant funds have been disbursed, and annually thereafter, for equipment and real
property, unless otherwise directed by the Agency.
Project reporting will begin on the Award Date, which is the date the Agency
completes execution of the Grant Agreement. You must constantly monitor
performance to ensure that time schedules are met, projected work by time periods is
being accomplished, and other performance objectives are being achieved. AGENCY
FUNDS WILL NOT BE RELEASED UNLESS ALL REPORTING
REQUIREMENTS ARE FULFILLED AND CURRENT.
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Project Performance Report
The narrative report shall include, but not be limited to, the following:
a. A comparison of actual accomplishments to the objectives established for
that period and reasons why established objectives were not met, if any.
b. Problems, delays, or adverse conditions which will affect attainment of
overall project objectives, prevent meeting time schedules or objectives, or
preclude the attainment of particular project work elements during
established time periods. This disclosure shall be accompanied by a
statement of the action taken or planned to resolve the situation.
c. Objectives and timetable established for the next reporting period.
d. Any special reporting requirements such as jobs supported and created,
businesses assisted,or economic development which results in improvements
in median household incomes, and as stated herein.
Final Report
A final SF-425 and a final Project Performance Report will be required within 90
days after all grant funds have been expended or the.Performance End Date,
whichever date is sooner. The final report may also serve as the last quarterly report.
The final reports must provide complete information regarding the jobs created and
supported as a result of the project, the Recipient's assessment and evaluation of the
outcomes of the project, and commentary on other performance objectives.
Other Report
Following completion of projects where grant funds were used to acquire or improve
an asset, such as a business incubator,real estate, or equipment, the Recipient will
verify and report to the Agency annually on the status of any real or personal
property acquired with Federal funds, including whether or not the property
continues to be used for originally authorized purposes, is not encumbered in title or
interests, and is owned by the Recipient.
The Agency may require that you prepare a report suitable for public distribution
that describes the accomplishments made through use of the grant funds, including
when the grant funded the development or application of a "best practice."
18. BASIS FOR SUCCESS OR FAILURE
You must provide a basis for determining the success or failure of the main elements
of the project and outline procedures that will be taken to assess the project's impact
at its conclusion.
19. AUDITS BASED UPON FEDERAL FINANCIAL ASSISTANCE
RECEIVED
A Recipient that expends $750,000 or more during its fiscal year in Federal awards
must have a single or program-specific audit conducted for that year in accordance
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with requirements in 2 CFR Part 200, subpart F. Audit requirements apply to the
year(s)in which grant funds are received and the years in which work is accomplished
that will be paid for with grant funds. If grant expenditures are less than $750,000,
then a Recipient is exempt from Federal audit requirements for that year, except as
noted in 2 CFR 200.503 in relation to other audit requirements; but records must be
available for review or audit by appropriate officials of the Agency, pass-through
entity, and the Government Accountability Office.
A Recipient will be responsible for any additional requirements set forth by the
Agency as they pertain to the certification of the expenditure of grant funds when the
Recipient expends less than$750,000 in Federal funds during its fiscal year.
20. GRANT AGREEMENT, PROCUREMENT, AND PROPERTY
MANAGEMENT
Grant Agreement: Form RD 4280-2 Grant Agreement will be attached to Form RD
1940-1, "Request for Obligation of Funds." Recipient must comply with the
requirements set forth in RD Instruction 4280-E,and Form RD 4280-2.
Recipient must comply with all applicable laws, regulations, Executive Orders, and
other generally applicable requirements, including those contained in 2 CFR 200 and
2 CFR 400 in effect on the date of grant approval, and all requirements in the Agency
Letter of Conditions.
Recipient must comply with the procurement requirements of 2 CFR Part 200, Subpart
D, as required in 2 CFR 200.324C(2), and maintain compliance with all applicable
State, Local, and Tribal laws and regulations relating to contracting and procurement
as identified in 2 CFR Part 200.318.
Proeurementt Property Management, and Disposition: Recipient must comply
with procurement, property management, and disposition standards established by 2
CFR Part 200 for real and personal property. The Recipient must not dispose of or
encumber the property and must file a Notice of Federal Interest on real property and
a UCC on equipment with a unit acquisition cost of$5,000 or more and a useful life
of one year or more. When real or personal property is no longer needed for originally
authorized purposes, including unused supplies with an aggregate value exceeding
$5,000 upon completion of the project, the Recipient must obtain disposition
instructions from the Agency.
Equipment must be used by the Recipient in the project for which it was acquired as
long as needed, whether or not the project continues to be supported by the Federal
award. Property records must be maintained that include a description of the property,
a serial number or other identification number, the source of funding for the property,
Recipient name on title, the acquisition date, cost of the property, percentage of
Federal participation in the project costs for the Federal award under which the
property was acquired, the location, use and condition of the property, and any
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ultimate disposition data including the date of disposal and sale price of the property
with Agency approval. A physical inventory of the property must be taken and the
results reconciled with the property records at least once every two years. Adequate
safeguards to prevent loss, damage or theft; and adequate maintenance procedures
must be developed to keep the property in good condition.
At a minimum, Recipient must provide insurance coverage for real property and
equipment acquired or improved with Federal funds equivalent to insurance provided
for other property owned by the Recipient, and acceptable to the Agency.
Recipient must notify and obtain approval from the Agency before disposing of any
real property or equipment,and must maintain property standards for real and personal
property, including equipment and supplies, in accordance with 2 CFR Part 200,
Subpart D.
Additional requirements related to methods of procurement, standards of conduct,
open and free competition, price analysis, avoiding real or apparent conflicts of
interest in project transactions, access to contractor records, unnecessary or
duplicative items, and equal employment opportunity are applicable. See 2 CFR Part
200, Subpart D.
21. CONSTRUCTIN MANAGEMENT
Not applicable.
22. TITLE OF PROPERTY
Not applicable.
23. START OF PROJECT
Project activities may not begin, and expenditures may not be incurred, until
the date that the Agency has executed the Grant Agreement. An executed copy
of the Grant Agreement will be mailed to you as written notification of the
Award Date and commencement of the project funding period. .
24. PROGRAMMATIC CHANGES
You must obtain prior written approval from the Agency for any change to the
scope or objectives of the approved project. Failure to obtain prior written
approval for changes to the scope can result in suspension or termination of
grant funds.
25. OTHER REQUIREMENTS
You will be responsible for any additional requirements of Federal, State or local
Governments that may apply in accordance with applicable Notices published in the
Federal Register and all other applicable laws,regulations,Executive Orders and other
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generally applicable requirements including those contained in Departmental
Regulations and other Program-Related Instructions, including but not limited to, 7
CFR 4280, Subpart E; the integrated applicable general provisions of 7 CFR 4284,
Subpart A; 7 CFR Part 1942, Subpart A; 2 CFR Part 417; and 2 CFR Part 200, the
Uniform Administrative Requirements, Cost Principles and Audit Requirements for
Federal Awards.
26. GRANT MONITORING AND SERVICING
The grant project will be monitored and serviced in accordance with RD Instruction
4280-E, the grant agreement, and 2 CFR Chapter IV (see RD Instruction 4280.443).
Recipient will allow the Agency, or its representatives,to conduct site visits as needed
to monitor progress and to audit the Recipient's real and personal property
development and narrative and financial records related to the performance of
activities under the Grant Agreement. Failure to allow the Agency to conduct site
visits shall be grounds for terminating the grant.
27. ADDITIONAL PROJECT-SPECIFIC REQUIREMENTS
Update enterprise equipment and technical assistance. We need a confirmed and
approved a final project budget. Be sure to include procurement/property
management/disposition clause, require the grantee to file a UCC on all
equipment with a unit acquisition cost of$5,000 or more, add applicant reporting
element(s)for basis of evaluating project success or failure (project impact at
conclusion), require a copy of the equipment lease agreement at near-market
rental rates between Orange County and PFAP, and be sure to highlight Program
Income requirements and responsibilities for the grantee_
The above conditions are based on the proposed use of funds as indicated. The
conditions stated may be modified if the scope or cost of the project is changed or the
financial arrangements are adjusted. Any change or modification of the conditions of
the project must have prior written approval from the Agency.
If you have any questions concerning this letter,please contact me at this office.
Sincerely,
GEORGE L. VITAL
Area Office Director
ENCLOSURES
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ENCLOSURES FOR LETTER OF CONDITIONS
• RD 1940-1, "Request for Obligation of Funds"
• RD 1942-46, "Letter of Intent To Meet Conditions"
♦ Scope of Work(with any changes and as ultimately Approved)
t SF 425, "Federal Financial Report"
• SF 270, "Request For Advance or Reimbursement"
♦ SF-3881, "Electronic Funds Transfer Payment Enrollment Form"
• Form AD-1047, "Certification Regarding Debarment, Suspension, and.Other
Responsibility Matters - Primary Covered Transactions"
♦ Form AD-1048, "Certification Regarding Debarment, Suspension, Ineligibility and
Voluntary Exclusion - Lower Tier Covered Transactions"
• Form AD-1049, "Certification Regarding Drug-Free Workplace Requirements
(Grants) Alternative I --For Grantees Other Than individuals"
a Form RD 400-1, "Equal Opportunity Agreement"
+ Form RD 400-4, "Assurance Agreement"
o RD Inst. 1940-0 Exhibit A-1, "Certification for Contracts, Grants & Loans"
♦ SF-LLL, "Disclosure of Lobbying Activities"
• "And Justice for All" Poster
♦ "Equal Employment Opportunity is the Lave" Poster
16
USDA
Form RD-1940-1 REQUEST FOR OBLIGATION OF FUNDS FORM APPROVED
(Rev.06-10) OMB No.0570-0062
INSTRUCTIONS-TYPE IN CAPITALIZED ELITE TYPE IN SPACES MARKED( )
Complete Items 1 through 29 and applicable items 30 through 34.See FMI.
1.CASE NUMBER LOAN NUMBER FISCAL YEAR
ST CO BORROWER I£]
38-068-566000327 00
2.BORROWER NAME 3.NUMBER NAME FIELDS
ORANGE COUNTY 3 I a.2,or 3 from Ilan 2J
4.STATE NAME
200 SOUTH CAMERON STREET NORTH CAROLINA
5.COUNTY NAME
HILLSBOROUGH, NC 27278 ORANGE
GENERAL BORROWER/LOAN INFORMATION
6.RACE/ETHNIC 7.TYPE OF APPLICANT 8.COLLATERAL CODE 9.EMPLOYEE
CLASSIFICATION 1-INDIVIDUAL 9-ORD OF FARMERS 1-REAL ESTATE 4-MRCHINERY ONLY
2•PARTNERSHIP 7-NONPROFITSECDL,AR SECURED S-LIVESTOCKONLY RELATIONSHIP CODE
3-CORPORATION 8-NONPROFIT-FAITH BASED 1-EMPLOYEE
2-B 1 H 5=,H41�SPRN:C q•PUBLIC BODY
2-REAL ESTATE E-CROPS ONLY 2-MEMBER OF FAMILY• 9-L1EL!y TRIPE A{iD CHATTEL 7-SECURED BY
10-PUBLIC COLLEGBAIN NERSITY 1 3-NOTE ONLY CR PONDS
3-AVAN 4 ]S•ASSOG.OF 3-CLOSE RELATIVE
1 i FWih1ERA 11.-OTHER CHATTEL ONLY 8.RLFACCT
4•A$SOC
10.tSEX CODE ;_o"�L;';,;,gILEO hNEb 11.MARITAL STATUS 12.VETERAN CODE 13.CREDIT REPORT
I 1-MALE 5--ORGAN FEMALE ORNEO I 1-MARRIED 2-UNMARR'Et)IINC IIDES 1•YE3 1-YES
4 2-FEMALE EPUELEC 9ODY 2-SEPARATED IYIDOVIEDIDIVORCEDI I2-NO ;ZS
14.DIRECT PAYMENT 15.TYPE OF PAYMENT 16.FEE INSPECTION
F•6
MONTHLY 3.
SEMI-ANNUALLY 1.V e
s l See FMI
2-ANN
DALLY 9-ODART
ERLY
12-NO
17.COMMUNITY SIZE 18.USE OF FUNDS CODE
112-- 105 oR Lcss iFOR sFH ANp
I z-OVER 10.000 HOC ONLY) (See FMI)
COMPLETE FOR OBLIGATION OF FUNDS
19.TYPE OF 20.PURPOSE CODE. 21.SOURCE OF FUNDS i 22_TYPE OF ACTION
ASSISTANCE
I .1-Q9LIGg7EIN ONLY
694 (SOB FAR) it 2.CORRECTIO Cf1EC RSATION
_ 6I 1 3-CORRIwCTION OF09 LlCrgTli]N
23.TYPE OF SUBMISSION 24.AMOUNT OF LOAN 25.AMOUNT OF GRANT
1-INITIAL
1 2-SUBSEQUENT
$0.00
26.AMOUNT OF 27.DATE OF 28.INTEREST RATE 29.REPAYMENT TERMS
IMMEDIATE ADVANCE APPROVAL
MO DAY YR
. D % 0 I
COMPLETE FOR COMMUNITY PROGRAM AND CERTAIN MULTIPLE-FAMILY HOUSING LOANS
30.PROFIT TYPE
2•L M17E❑PR rT
t-FULL PROFIT NONPROFIT 3-NONPR
I r
PROF
,T
COMPLETE FOR EM LOANS ONLY COMPLETE FOR CREDIT SALE-ASSUMPTION
31.DISASTER DESIGNATION NUMBER 32.TYPE OF SALE
loon FM!) ] 1-CREDIT SALE ONLY 3 CRE f SALE L4[TH SUESEOVENT LOAN 4 SUBSEQUENT LOAN-ASSUMPTION WITH
FINANCE OFFICE USE ONLY !! COMPLETE FOR FP LOANS ONLY
33.OBLIGATION DATE 34.BEGINNING FARMER/RANCHER
MO DA YR
I (See FMF]
lfrdie decrsmn coma:ned shove rn tins results at denial reduction or cancellata m of USD 1 assistance.yon rnay appeal this decision and have a hearing Si-faa may request a rewew in lien of hearing.
!lease rise the forma we bare lnclre:led for des propose
Position 2
ORIGINAL-Borrower's Case Folder COPY 1 -Finance Office COPY 2-Applicant/Lender COPY 3-State Office
diicardt•y;to the Paperwork Redazcnnn.du of 1995..rtr aget53 may trat conduct or sponsor.and 47 pC11022 I,e tau required ra respoIrd III collernou ofmforsMilen milers N rI splay>a a Wild 041$control number (lie voted
OMB nntrni ailether fur ills rnfornrarimr collecton is 05 70-0062. The lime rrgrured to complete this atformatron collection I.i Csnmmctl In average 13+mmimics per resporse,inchirhng rho nme for revtewingirrstrnetror c
searching ceistn g data sources,gathermg and rr:ainrarr:rug the data needed and complcnngamd rewc-wing the collection of rnjErruotion.
17
CERTIFICATION APPROVAL
For All Farmers Programs EM,OL,PO,and SW Loans
This loan is approved subject to the availability of funds.If this loan does not close for any reason within 90 days from the
date of approval on this document,the approval official will request updated eligibility information.The undersigned loan
applicant agrees that the approval official will have 14 working days to review any updated information prior to submitting
this document for obligation of funds.If there have been significant changes that may affect eligibility,a decision as to
eligibility and feasibility will be made within 30 days from the time the applicant provides the necessary information.
If this is a loan approval for which a lien and/or title search is necessary,the undersigned applicant agrees that the
I5-working-day loan closing requirement may be exceeded for the purposes of the applicant's legal representative
completing title work and completing loan closing.
35. COMMENTS AND REQUIREMENTS OF CERTIFYING OFFICIAL
The compliance requirements referenced in Exhibit A are included with this award"
and attaching the Exhibit A to your 1940-1.
36. I HEREBY CERTIFY that I am unable to obtain sufficient credit elsewhere to finance my actual needs at reasonable rates
and terms,taking into consideration prevailing private and cooperative rates and terms in or near my community for loans
for similar purposes and periods of time. I agree to use the sum specified herein,subject to and in accordance with
regulations applicable to the type of assistance indicated above,and request payment of such sum.I agree to report to
USDA any material adverse changes,financial or otherwise,that occur prior to loan closing. I certify that no part of the sum
specified herein has been received.I have reviewed the loan approval requirements and comments associated with this loan
request and agree to comply with these provisions.
(For FP loans at eligible terms only)If this loan is approved,I elect the interest rate to be charged on my loan to be the lower of the
interest rate in effect at the time of loan approval or loan closing.If 1 check"NE P,the interest rate charged on my
loan will he the rate specified in Item 28 of this form. YES NO
WARNING: Whoever,in any matter within the jurisdiction of any department or agency of the United States
knowingly and willfully falsifies,conceals or covers up by any trick,scheme,or device a material
fact,or makes any false,fictitious or fraudulent statements or representations,or makes or uses
any false writing or document knowing the same to contain any false,fictitious or fraudulent
statement or entry,shall be fined under this title or imprisoned not more than five years,or both."
Date 20
(Signature of Applicant)
Date 20
(Signature of Co-Applicant)
37. I HEREBY CERTIFY that all of the committee and administrative determinations and certifications required by regulations
prerequisite to providing assistance of the type indicated above have been made and that evidence thereof is in the docket,and
that all requirements of pertinent regulations have been complied with. €hereby approve the above-described assistance in the
amount set forth above,and by this document,subject to the availability of funds,the Government agrees to advance such
amount to the applicant for the purpose of and subject to the availability prescribed by regulations applicable to this type of
assistance.
(Signature of Approving Official)
Typed or Printed Name:
Date Approved: Title:
38. TO THE APPLICANT:As of this date ,this is notice that your application for financial assistance
from the USDA has been approved,as indicated above,subject to the availability of funds and other conditions required by
the USDA.If you have any questions contact the appropriate USDA Servicing Office.
18
Position 3
Form RD 1942-46 UNITED STATES DEPARTMENT OF AGRICULTURE FORM APPROVED
(Rev.6-98) RURAL,DEVELOPMENT OMB NO.0575-0015
FARM SERVICE AGENCY
LETTER OF INTENT TO MEET CONDITIONS
Date
TO:United States Department of Agriculture
USDA-Rural Development
(Name of USDA Agency)
(USDA Agency Office Address)
We have reviewed and understand the conditions set forth in your letter dated •It is our intent to meet all of
them not later than
ORANGE COUNTY
(Name ofAtssociation)
BY
(Title)
According to the Paperwork Reduction Act of 1995,no persons are required to respond to a collection of information unless it displays a valid 0lw'5 control nrmrber.
The valid OMB control number for this information collection is 0575-0015.The lime required to complete this information collection is estimated to arm-age 1 hour
per response,including.the time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and
reviewing the collection of information
Form RD 1942-46(Rev.6-98)
19
FEDERAL FINANCIAL REPORT
(Follow form instructions)
1. Federal Agency and Organizational Element 2. Federal Grant or Other Identifying Number Assigned by Federal Agency Page of
to Which Report is Submitted (To report multiple grants,use FFR Attachment)
, pages
3. Recipient Organization(Name and complete address Including Zip code)
4a. DUNS Number 4b. EIN 5. Recipient Account Number or Identifying Number 6. Report Type 7. Basis of Accounting
(To report multiple grants,use FFR Attachment) r Quarterly
C Semi-Annual
r Annual
0 Final t'l Cash El Accrual
8. Project"Grant Period g. Reporting Period End Date
From: (Month,Day,Year) 1To: (Month,Day,Year) (Month,Day,Year)
10. Transactions
Cumulative
(Use lines a-c for single or multiple grant reporting)
Federal Cash (To report multiple grants,also use FFR Attachment):
a. Cash Receipts
b. Cash Disbursements
c. Cash on Fland(line a minus b)
(Use lines d-o for single grant reporting)
Federal Expenditures and Unobligated Balance:
d. Total Federal funds authorized
e. Federal share of expenditures
f. Federal share of untiquidated obligations
g. Total Federal share(sum of lines a and f)
h. Unobligaled balance of Federal funds(line d minus g)
Recipient Share:
i. Total recipient share required
j. Recipient share of expenditures
k. Remaining recipient share to be provided One t minus j)
Program Income:
1. Total Federal program Income caned
m. Program income expended in accordance with the deduction alternative
n. Program income expended in accordance with the addition alternative
o. Unexpended program income(line I minus line m or line n)
a. Type b.Rate c.Period From Period To d.Base e. Amount Charged f.Federal Share
11.Indirect
Expense
g.Totals:
12. Remarks: Attach any explanations deemed necessary or information required by Federal sponsoring agency in compliance with governing legislation:
13. Certification: By signing this report,1 certify that it is true,complete,and accurate to the best of my knowledge, l am aware that
any false,fictitious,or fraudulent information may subject me to criminal,civil,or administrative penalities. (U.S.Code,Title 18,Section 1001)
a. Typed or Printed Name and Title of Authorized Certifying Official c. Telephone(Area code,number and extension)
d. Email address
b. Signature of Authorized Certifying Official e. Hate Report Submitted (Month,Day,Year)
14.A efCN user>:::
Standard Fenn 425
❑Mg Approve!Number:5348-DO51
Expiration Oats'1013112d11
Paperwork Burden Statement
According to the Paperwork Reduction Act,as amended,no persons are required to respond tea collection of information unless it displays a valid OMB Control Number.The valid OMB control
number for this information collection is 0348.0061. Public reporting burden for this collection of information is estimated to average 1.5 hours per response,including time for reviewing instructions,
searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information.Send comments regarding the burden estimate or any other
aspect of this collection of information,including suggestions for reducing this burden.to the Office of Management and Budget,Paperwork Reduction Project(0348-0060),Washington,DC 20503.
20
OMB APPROVAL NO PAGE OF
0348-0004 , PAGES
REQUEST FOR ADVANCE a. 'X"obe or both boxes 2.BASIS OF REQUEST
OR REIMBURSEMENT (ADVANCE n REIMBURSE-
TYPE of CASH
PAYMENT I 1 MENT 0
REQUESTED b X"ihe applicable box ACCRUAL
(See instructions on back) FINAL 0 PARTIAL
3 FEDERAL SPONSORING AGENCY AND ORGANIZATIONAL ELEMENT TO d.FEDERAL GRANT OR OTHER 5.PARTIAL PAYMENT REQUEST
WHICH THIS REPORT IS SUBMITTED IDENTIFYING.NUMBER ASSIGNED NUMBER FOR THIS REQUEST
BY FEDERAL AGENCY
6 EMPLOYER IDENTIFICATION 7.RECIPIENTS ACCOUNT NUMBER 8. PERIOD COVERED BY THIS REQUEST
NUMBER OR IDENTIFYING NUMBER
FROM (menlh,day,year] TO (month,day,year)
9.RECIPIENT ORGANIZATION 10.PAYEE (Where check is to be sent if different than item 9)
Name: Name:
Number Number
and Street: and Street:
City, State City,State
and,ZIP Code: and ZIP Code:
11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED
(b)
PROGRAMS/FUNCTIONS/ACTIVITIES 1 -
TOTAL
a.Total program (As of dale)
outlays to date
b.Less: Cumulative pro.ram income ,
c.Net program outlays (Line a minus .
line b)
d.Estimated net cash outlays for advance ■
period
e.Total (Sum of lines c&d) ■
f.Non-Federal share of amount on line e
q.Federal share of amount on line e �� ■
h.Federal payments previously requested
i. Federal share now requested (Line g
minus line h)
j. Advances required by .
month,when requested •1st month
by Federal grantor
agency for use in 2nd month
making preseheduled ■
advances 3rd month
12. ALTERNATE COMPUTATION FOR ADVANCES ONLY
a.Estimated Federal cash outlays that will be made during period covered by the advance $
b.Less: Estimated balance of Federal cash on hand as of beginning of advance period
c'.Amount requested(Line a minus line b) $
AUTHORIZED FOR LOCAL REPRODUCTION (Continued on Reverse) STANDARD FORM 270 (Rev.7-57}
Prescribed by OMB Circulars A-102 and A-110
21
13- CERTIFICATION
SIGNATURE OR AUTHORIZED CERTIFYING OFFICIAL DATE REQUEST
I certify that to the best of my knowledge
SUBMITTED
and belief the data on the reverse are
correct and that all outlays were made in
accordance with the grant conditions or TYPED OR PRINTED NAME AND TITLE TELEPHONE(AREA
other agreement and that payment is due CODE,NUMBER,
and has not been previously requested. EXTENSION)
This space for agency use
Public reporting burden for this collection of information is estimated to average 80 minutes per
response,including time for reviewing instructions,searching existing data sources,gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the Office of Management and Budget,
Paperwork Reduction Project(0348-0004),Washington,DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT
AND BUDGET.SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
INSTRUCTIONS
Please type or print legibly. Items 1,3,5,9, 10, 11 e, '11f, 11g, 11 i, 12 and 13 are self-explanatory; specific
instructions for other items are as follows:
Item Entry Item Entry
2 Indicate whether request is prepared on cash or accrued as many additional forms as needed and indicate page
expenditure basis. All requests for advances shall be number in space provided in upper right; however, the
prepared on a cash basis. summary totals of all programs, functions, or activities
should be shown in the"total"column on the first page.
4 Enter the Federal grant number,or other identifying number
assigned by the Federal sponsoring agency. If the advance
or reimbursement is for more than one grant or other 11 a Enter in "as of date," the month, day, and year of the
agreement, insert N/A; then, show the aggregate amounts. ending of the accounting period to which this amount
On a separate sheet, list each grant or agreement number applies. Enter program outlays to date (net of refunds,
and the Federal share of outlays made against the grant or rebates, and discounts), in the appropriate columns. For
agreement. requests prepared on a cash basis, outlays are the sum of
actual cash disbursements for goods and services, the
6 Enter the employer identification number assigned by the amount of indirect expenses charged, the value of in-kind
U.S. Internal Revenue Service, or the FICE (institution) contributions applied, and the amount of cash advances
code if requested by the Federal agency. and payments made to subcontractors and subrecipients.
For requests prepared on an accrued expenditure basis,
7 This space is reserved for an account number or other outlays are the sum of the actual cash disbursements,the
identifying number that may be assigned by the recipient. amount of indirect expenses incurred,and the net increase
(or decrease) in the amounts owed by the recipient for
8 Enter the month, day, and year for the beginning and goods and other property received and for services
ending of the period covered in this request. If the request oer by employees, contracts, subgrantees and
is for an advance or for both an advance and other r payees.
reimbursement, show the period that the advance will
cover. If the request is for reimbursement, show the period 11 b Enter the cumulative cash income received to date, if
for which the reimbursement is requested. requests are prepared on a cash basis. For requests
prepared on an accrued expenditure basis, enter the
Note: The Federal sponsoring agencies have the option of cumulative income earned to date. Under either basis,
requiring recipients to complete items 11 or 12, but not enter only the amount applicable to program income that
both. Item 12 should be used when only a minimum was required to be used for the project or program by the
amount of information is needed to make an advance and terms of the grant or other agreement.
outlay information contained in item 11 can be obtained in
a timely manner from other reports. lid Only when making requests for advance payments, enter
the total estimated amount of cash outlays that will be
11 The purpose of the vertical columns (a), (b), and (c) is to made during the period covered by the advance.
provide space for separate cost breakdowns when a
project has been planned and budgeted by program, 13 Complete the certification before submitting this request.
function,or activity.If additional columns are needed,use
STANDARD FORM 270(Rev.7-571 Back
22
OMB No.1510-0055
ACH VENDOR/MISCELLANEOUS PAYMENT
ENROLLMENT FORM
This form is used for Automated Clearing House (ACH) payments with an addendum record that contains
payment-related information processed through the Vendor Express Program. Recipients of these payments
should bring this information to the attention of their financial institution when presenting this form for
completion. See reverse for additional instructions.
PRIVACY ACT STATEMENT
The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All
information collected on this form is required under the provisions of 31 U.S.C. 3322 and 31 CFR 210.
This information will be used by the Treasury Department to transmit payment data, by electronic means
to vendor's financial institution. Failure to provide the requested information may delay or prevent the
receipt of payments through the Automated Clearing House Payment System.
AGENCY INFORMATION
FEDERAL PROGRAM AGENCY
AGENCY IDENTIFIER: AGENCY LOCATION CODE(ALC): ACH FORMAT:
❑CCO+ n CTX
ADDRESS:
CONTACT PERSON NAME: TELEPHONE NUMBER:
ADDITIONAL INFORMATION:
PAYEE/COMPANY INFORMATION
NAME SSN NO.OR TAXPAYER ID NO
ADDRESS
•
CONTACT PERSON NAME: 'TELEPHONE NUMBER:
{
FINANCIAL INSTITUTION INFORMATION
NAME:
ADDRESS:
ACH COORDINATOR NAME. TELEPHONE NUMBER:
NINE-DIGIT ROUTING TRANSIT NUMBER: { }
DEPOSITOR ACCOUNT TITLE:
DEPOSITOR ACCOUNT NUMBER: LOCKBOX NUMBER:
TYPE OF ACCOUNT:
❑CHECKING ❑SAVINGS ❑LOCKBOX
SIGNATURE AND TITLE OF AUTHORIZED OFFICIAL: TELEPHONE NUMBER:
(Could be the same as ACH Coordinator)
AUTHORIZED FOR LOCAL REPRODUCTION { SF 3881(Rev.212003)
Prescribed by Department of Treasury
31 U S C 3322;31 CFR 210
23
Instructions for Completing SF 3881 Form
Make three copies of form after completing. Copy 1 is the Agency Copy; copy 2 is the Payee/
Company Copy; and copy 3 is the Financial Institution Copy.
1. Agency Information Section - Federal agency prints or types the name and address of the
Federal program agency originating the vendor/miscellaneous payment, agency identifier,
agency location code, contact person name and telephone number of the agency. Also, the
appropriate box for ACH format is checked.
2. Payee/Company Information Section - Payee prints or types the name of the payee/company
and address that will receive ACH vendor/miscellaneous payments, social security or
taxpayer ID number, and contact person name and telephone number of the payee/company.
Payee also verifies depositor account number, account title, and type of account entered by
your financial institution in the Financial Institution Information Section.
3. Financial Institution Information Section - Financial institution prints or types the name and
address of the payee/company's financial institution who will receive the ACH payment, ACH
coordinator name and telephone number, nine-digit routing transit number, depositor (payee/
company) account title and account number. Also, the box for type of account is checked, and
the signature, title, and telephone number of the appropriate financial institution official are
included.
Burden Estimate Statement
The estimated average burden associated with this collection of information is 15 minutes per
respondent or record keeper, depending on individual circumstances. Comments concerning the
accuracy of this burden estimate and suggestions for reducing this burden should be directed to
the Financial Management Service, Facilities Management Division, Property and Supply Branch,
Room B-101, 3700 East West Highway, Hyattsville, MD 20782 and the Office of Management and
Budget, Paperwork Reduction Project(1510-0056), Washington, DC 20503.
24
U.S. DEPARTMENT OF AGRICULTURE
Certification Regarding Debarment, Suspension,and Other
Responsibility Matters-Primary Covered Transactions
This certification is required by the regulations implementing Executive Order 12549,Debarment and.Suspension,7
CFR Part 3017,Section 3017.510,Participants'responsibilities.The regulations were published as Part IV of the
January 30, 1989,Federal Register(pages 4722-4733).Copies of the regulations may be obtained by contacting the
Department of Agriculture agency offering the proposed covered transaction.
(BEFORE COMPLETING CERTIFICATION,READ INSTRUCTIONS ON REVERSE)
(1) The prospective primary participant certifies to the best of its knowledge and belief,that it and its
principals:
(a)are not presently debarred,suspended,proposed for debarment,declared ineligible,or
voluntarily excluded from covered transactions by any Federal department or agency;
(b)have not within a three-year period preceding this proposal been convicted of or had
a civil judgment rendered against them for commission of fraud or a criminal offense
in connection with obtaining,attempting to obtain,or performing a public(Federal
State or local)transaction or contract under a public transaction;violation of Fed-
eral or State antitrust statutes or commission of embezzlement,theft,forgery,
bribery,falsification or destruction of records,making false statements,or receiving
stolen property;
(c)are not presently indicted for or otherwise criminally or civilly charged by a
governmental entity(Federal,State or local)with commission of any of the offenses
enumerated in paragraph(1)(b)of this certification;and
(d)have not within a three-year period preceding this application/proposal had one or
more public transactions(Federal,State or local)terminated for cause or default.
(2) Where the prospective primary participant is unable to certify to any of the statements in this
certification,such prospective participant shall attach an explanation to this proposal.
ORANGE COUNTY
Organization Name PR/Award Number or Project Name
Name(s)and Title(s)of Authorized Representative(s)
Signature(s)
Date
Form AD- 1047(1/92)
25
Instructions for Certification
1. By signing and submitting this form,the prospective primary participant is providing the certification
set out on the reverse side in accordance with these instructions.
2. The inability of a person to provide the certification required below will not necessarily result in denial
of participation in this covered transaction.The prospective participant shall submit an explanation of why it cannot
provide the certification set out on this form.The certification or explanation will be considered in connection with
the department or agency's determination whether to enter into this transaction.However,failure of the prospective
primary participant to furnish a certification or an explanation shall disqualify such person from participation in this
transaction.
3. The certification in this clause is a material representation of fact upon which reliance was placed when
the department or agency determined to enter into this transaction. if it is later determined that the prospective
primary participant knowingly rendered an erroneous certification,in addition to other remedies available to the
Federal Government,the department or agency may terminate this transaction for cause or default.
4. The prospective primary participant shall provide immediate written notice to the department or agency
to whom this proposal is submitted if at any time the prospective primary participant learns that its certification was
erroneous when submitted or has become erroneous by reason of changed circumstances.
5. The terms"covered transaction,'"debarred,""suspended, "ineligible,""lower tier covered transaction,'
"participant,""person, 11"primary covered transaction,""principal,""proposal,"and"voluntarily excluded,"as
used in this clause,have the meanings set out in the Definitions and Coverage sections of the rules implementing
Executive Order 12549.You may contact the department or agency to which this proposal is being submitted for
assistance in obtaining a copy of those regulations.
6. The prospective primary participant agrees by submitting this form that,should the proposed covered
transaction be entered into,it shall not knowingly enter into any lower tier covered transaction with a person who is
debarred,suspended,declared ineligible,or voluntarily excluded from participation in this covered transaction,
unless authorized by the department or agency entering into this transaction.
7. The prospective primary participant further agrees by submitting this form that it will include the clause titled
"Certification Regarding Debarment,Suspension,Ineligibility and Voluntary Exclusion-Lower Tier Covered
Transactions,"provided by the department or agency entering into this covered transaction,without modification,in
all lower tier covered transactions and in all solicitations for lower tier covered transactions.
S. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier
covered transaction that it is not debarred,suspended, ineligible,or voluntarily excluded from the covered
transaction,unless it knows that the certification is erroneous.A participant may decide the method and frequency
by which it determines the eligibility of its principals.Each participant may,but is not required to,check the
Nonprocurement List.
9. Nothing contained in the foregoing shall be construed to require establishment of a system of records
in order to render in good faith the certification required by this clause.The knowledge and information of a
participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of
business dealings.
10. Except for transactions authorized under paragraph 6 of these instructions,if a participant in a covered
transaction knowingly enters into a lower tier covered transaction with a person who is suspended,debarred,
ineligible,or voluntarily excluded from participation in this transaction,in addition to other remedies available to
the Federal Government,the department or agency may terminate this transaction for cause or default.
2
Form AD- 1 047(1/92)
*U.S.GPD:19.99-757-034185012
26
U.S. DEPARTMENT OF AGRICULTURE
Certification Regarding Debarment2 Suspension,Ineligibility
and Voluntary Exclusion -Lower Tier Covered Transactions
This certification is required by the regulations implementing Executive Order 12549,Debarment and Suspension,7
CFR Part 3417,Section 3017.510, Participants'responsibilities.The regulations were published as Part IV of the
January 30, 1989,Federal Register(pages 4722-4733).Copies of the regulations may be obtained by contacting the
Department of Agriculture agency with which this transaction originated.
(BEFORE COMPLETING CERTIFICATION,READ INSTRUCTIONS ON REVERSE)
(1) The prospective lower tier participant certifies,by submission of this proposal,that neither it nor its
principals is presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from participation in this transaction by any Federal department or agency.
(2) Where the prospective lower tier participant is unable to certify to any of the statements in this
certification,such prospective participant shall attach an explanation to this proposal.
ORANGE COUNTY
Organization Name PRJAward Number or Project Name
Name(s)and Title(s)of Authorized Representative(s)
Signature(s) Date
1
Form AD-1048(1/92)
27
Instructions for Certification
1. By signing and submitting this form,the prospective lower tier participant is providing the certification
set out on the reverse side in accordance with these instructions.
2. The certification in this clause is a material representation of fact upon which reliance was placed when
this transaction was entered into.If it is later determined that the prospective lower tier participant knowingly
rendered an erroneous certification,in addition to other remedies available to the Federal Government,the
department or agency with which this transaction originated may pursue available remedies,including suspension
and/or debarment.
3. The prospective lower tier participant shall provide immediate written notice to the person to which this
proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous
when submitted or has become erroneous by reason of changed circumstances.
4. The terms"covered transaction," "debarred," "suspended,""ineligible,""lower tier covered transaction,'
"participant,""person,""primary covered transaction,""principal," "proposal,"and"voluntarily excluded,"as used in this
clause,have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549.
You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations.
5. The prospective lower tier participant agrees by submitting this form that,should the proposed covered
transaction be entered into,it shall not knowingly enter into any lower tier covered transaction with a person who is
debarred,suspended,declared ineligible,or voluntarily excluded from participation in this covered transaction,unless
authorized by the department or agency with which this transaction originated.
6. The prospective lower tier participant further agrees by submitting this form that it will include this
clause titled"Certification Regarding Debarment,Suspension,Ineligibility and Voluntary Exclusion-Lower Tier
Covered Transactions,"without modification,in all lower tier covered transactions and in all solicitations for lower
tier covered transactions.
7. A participant in a covered transaction may rely upon a certification of a prospective participant in a
lower tier covered transaction that it is not debarred,suspended,ineligible,or voluntarily excluded from the covered
transaction,unless it knows that the certification is erroneous.A participant may decide the method and frequency by
which it determines the eligibility of its principals.Each participant may,but is not required to,check the
Nonprocurement List.
8. Nothing contained in the foregoing shall be construed to require establishment of a system of records
in order to render in good faith the certification required by this clause.The knowledge and information of a
participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of
business dealings.
9. Except for transactions authorized under paragraph 5 of these instructions,if a participant in a covered
transaction knowingly enters into a lower tier covered transaction with a person who is suspended,debarred,
ineligible,or voluntarily excluded from participation in this transaction,in addition to other remedies available to the
Federal Government,the department or agency with which this transaction originated may pursue available remedies,
including suspension and/or debarment.
Form AD-1048(l/92)
28
U.S. DEPARTMENT OF AGRICULTURE
CERTIFICATION REGARDING
DRUG-FREE WORKPLACE REQUIREMENTS (GRANTS)
ALTERNATIVE I-FOR GRANTEES OTHER THAN INDIVIDUALS
This certification is required by the regulations implementing Section 5151-5160 of the Drug-Free Workplace
Act of 1988(Pub.L.100-690,Title V,Subtitle D:41 U.S.C.701 et seq.),7 CFR Part 3017.Subpart F,Section
3017.600, Purpose.The January 13,1989,regulations were amended and published as Part 11 of the May 25,
1990 Federal Register (pages 21681-21691).Copies of the regulations may be obtained by contacting the
Department of Agriculture agency offering the grant.
(BEFORE COMPLETING CERTIFICATION,READ INSTRUCTIONS ON PAGE 3)
Alternative I
A. The grantee certifies that it will or will continue to provide a drug-free workplace by:
(a) Publishing a statement notifying employees that the unlawful manufacture,distribution,
dispensing,possession,or use of a controlled substance is prohibited in the grantee's workplace and specifying the
actions that will be taken against employees for violation of such prohibition;
(b) Establishing an ongoing drug-free awareness program to inform employees about-
(1)The dangers of drug abuse in the workplace;
(2)The grantee's policy of maintaining a drug-free workplace;
(3)Any available drug counseling,rehabilitation,and employee assistance programs;and
(4)The penalties that may be imposed upon employees for drug abuse violations occurring
in the workplace.
(c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy
of the statement required by paragraph(a);
(d) Notifying the employee in the statement required by paragraph(a)that,as a condition of employment
under the grant,the employee will-
(1)Abide by the terms of the statement;and
(2)Notify the employer in writing of his or her conviction for a violation of a criminal drug
statute occurring in the workplace no later than five calendar days after such conviction;
(e)Notifying the agency in writing,within ten calendar days after receiving notice under
subparagraph(d)(2)from an employee or otherwise receiving actual notice of such conviction.
Employers of convicted employees must provide notice,including position
AD-1049(REV 5/90)
29
title,to every grant officer on whose grant activity the convicted employee was working,unless the Federal
agency has designated a central point for the receipt of such notices.Notice shalt include the identification
number(s)of each affected grant;
(f) Taking one of the following actions,within 30 calendar days of receiving notice under
subparagraph(d)(2),with respect to any employee who is so convicted-
(1)Taking appropriate personnel action against such an employee,up to and including termination,
consistent with the requirements of the Rehabilitation Act of 1973,as amended;or
(2)Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation
program approved for such purposes by a Federal,State,or,local health,law enforcement,or other
appropriate agency;
(g) Making a good faith effort to continue to maintain a drug-free workplace through implementation
of paragraphs(a),(b),(c),(d),(e),and(f).
B. The grantee may 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)
ORANGE COUNTY
200 SOUTH CAMERON STREET
HILLSBOROUGH, ORANGE, NC 27278
Check ❑ If there are workplaces on file that are not identified here.
ORANGE COUNTY PIEDMONT FOOD & AG CENTER
Organization Name Award Number or Project Name
Name and Title of Authorized Representative
Signature Date
AO-1049(REV 5194
30
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this form,the grantee is providing the certification set out on pages 1 and 2.
2. The certification set out on pages 1 and 2 is a material representation of fact upon which reliance is placed when the
agency awards the grant.If it is later determined that the grantee knowingly rendered a false certification,or
otherwise violates the requirements of the Drug-Free Workplace Act,the agency,in addition to any other remedies
available to the Federal Government,may take action authorized under the Drug-Free Workplace Act.
3. Workplaces under grants,for grantees other than individuals,need not be identified on the certification.If known,
they may be identified in the grant application.If the grantee does not identify the workplaces at the time of
application,or upon award,if there is no application,the grantee must keep the identity of the workplace(s)on file
in its office and make the information available for Federal inspection.Failure to
identify all known workplaces constitutes a violation of the grantee's drug-free workplace-requirements.
4. Workplace identifications must include the actual address of buildings(or parts of buildings)or other sites where
work under the grant takes place.Categorical descriptions may be used(e.g.,all vehicles of a mass transit
authority or State highway department while in operation,State employees in each local unemployment office,
performers in concert halls or radio studios).
5. If the workplace identified to the agency changes during the performance of the grant,the grantee shall
inform the agency of the change(s).If it previously identified the workplaces in question(see paragraph three).
6. Definitions of terms in the Nonprocurement Suspension and Debarment common rule and Drug-Free
Workplace common rule apply to this certification.Grantees'attention is called,in particular,to the
following definitions from these rules:
"Controlled substance"means a controlled substance in Schedules I through V of the Controlled
Substances Act(21 U.S.C.812)and as further defined by regulation(21 CFR 1308.11 through 1308.15);
"Conviction"means a finding of guilt(including a plea of nolo contendere)or imposition of sentence,or
both,by any judicial body charged with the responsibility to determine violations of the Federal or
States criminal drug statutes;
"Criminal drug statute"means a Federal or non-Federal criminal statute involving the manufacture,
distribution,dispensing,use,or possession of any controlled substance;
"Employee"means the employee of a grantee directly engaged in the performance of work under a grant,
including:(i)all"direct charge"employees;(ii)all"indirect charge"employees unless their impact or
involvement is insignificant to the performance of the grant;and,(iii)temporary personnel and consultants
who are directly engaged in the performance of work under the grant and who are on the grantee's payroll.
This definition does not include workers not on the payroll of the grantee(e.g.volunteers,even if used to meet
a matching requirement;consultants or independent contractors not on the grantee's payroll;or employees of
subrecipients or subcontractors in covered workplaces)
AD-1049(REV 5/90)
31
Form RD 400.1 FORM APPROVED
(Rev.5.00) UNITED STATES DEPARTMENT OF AGRICULTURE OMB No.0575-0018
EQUAL OPPORTUNITY AGREEMENT
This agreement,dated between
ORANGE COUNTY
(herein called"Recipient"whether one or more)and United States Department of Agriculture(USDA),pursuant to the rules and
regulations of the Secretary of Labor(herein called the'Secretary')issued under the authority of Executive Order 11246 as amended,
witnesseth:
In consideration of financial assistance(whether by a loan,grant,loan guaranty,or other form of financial assistance)made or to be
made by the USDA to Recipient.Recipient hereby agrees,if the cash cost of construction work performed by Recipient or a construction
contract financed with such financial assistance exceeds S 10,000-unless exempted by rules,regulations or orders of the Secretary of
Labor issued pursuant to Section 204 of Executive Order 11246 of September 24, 1965.
1. To incorporate or cause to be incorporated into any contract for construction work,or modification thereof,subject to the
relevant rules,regulations,and orders of the Secretary or of any prior authority that remain in effect,which is paid for in whole or in part
with the aid of such financial assistance,the following"Equal Opportunity Clause":
During the performance of this contract,the contractor agrees as follows:
(a)The contractor will not discriminate against any employee or applicant for employment because of race,color,religion,sex or
national origin.The contractor will take affirmative action to ensure that applicants are employed,and that employees are
treated during employment,without regard to their race,color,religion,sex or national origin. Such action shall include,but
not be limited,to the following:employment,upgrading,demotion or transfer;recruitment or recruitment advertising; layoff
or termination;rates of pay or other forms of compensation;and selection for training, including apprenticeship.The contractor
agrees to post in conspicuous places,available to employees and applicants for employment,notices to be provided by the
USDA setting forth the provisions of this nondiscrimination clause.
(b)The contractor will,in all solicitations or advertisements for employees placed by or on behalf of the contractor,state that all
qualified applicants will receive consideration for employment without regard to race,color,religion,sex or national origin.
(c)The contractor will send to each labor union or representative of workers with which he has a collective bargaining agreement
or other contract or understanding,a notice,to be provided by the USDA,advising the said labor union or workers'
representative of the contractor's commitments under this agreement and shall post copies of the notice in conspicuous places
available to employees and applicants for employment.
(d)The contractor will comply with all provisions of Executive.Order 11246 of September 24,1965,and of all rules,regulations
and relevant orders of the Secretary of Labor.
(e)The contractor will furnish all information and reports required by Executive Order 11246 of September 24, 1965,rules,
regulations,and orders,or pursuant thereto,and will permit access to his books,records,and accounts by the USDA Civil
Rights Office,and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules,
regulations,and orders.
(f) In the event of the contractor's noncompliance with the nondiscrimination clauses of this contract or with any of the said rules,
regulations,or orders,this contract may be cancelled,terminated,or suspended in whole or in part and the contractor may be
declared ineligible for further Government contracts or federally assisted construction contracts in accordance with procedures
authorized in Executive Order No. 11246 of September 24, 1965,and such other sanctions may be imposed and remedies
invoked as provided in Executive Order No. 11246 of September 24, 1965,or by rule,regulation or order of the Secretary of
Labor,or as otherwise provided by Law.
(g)The contractor will include the provisions of paragraph 1 and paragraph(a)through(g)in every subcontract or purchase order,
unless exempted by the rules,regulations,or orders of the Secretary of Labor issued pursuant to Section 204 of Executive Order
No. 11246 of September 24, 1965,so that such provisions will be binding upon each subcontractor or vendor.The
contractor will take such action with respect to any subcontract or purchase order as the USDA may direct as a means of
enforcing such provisions,including sanctions for noncompliance:Provided,however,that in the event the contractor becomes
involved in,or is threatened with,litigation with a subcontractor or vendor as a result of such direction by the USDA,the
contractor may request the United States to enter into such litigation to protect the interest of the United States.
According to the Paperwork Reduction Act of 1995,an agency may not conduct or sponsor,and a person is not required to respond
to,a collection of information unless it displays a valid OMB control number. The valid OMB control number for this iformation
collections is 0575-0018. The time required to complete this information collection is estimated to average 10 minutes per response,
including the time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and
completing and reviewing the collection of inforinatkin.
Position 6 RD 400-1 (Rev.5-00)
32
2. To be bound by the above equal opportunity clause with respect to its own employment practices when it participates in federally
assisted construction work:Provided,that if the organization so participating is a State or local government,the above equal
opportunity clause is not applicable to any agency,instrumentality or subdivision of such government which does not participate in
work on or under the contract.
3. To notify all prospective contractors to file the required'Compliance Statement',Form RD 400-6,with their bids.
4. Form AD-425,Instructions to Contractors,will accompany the notice of award of the contract.Bid conditions for all nonexempt
federal and federally assisted construction contracts require inclusion of the appropriate"Hometown"or"Imposed"plan affirmative
action and equal employment opportunity requirements.All bidders must comply with the bid conditions contained in the invitation to
be considered responsible bidders and hence eligible for the award.
5. To assist and cooperate actively with USDA and the Secretary in obtaining the compliance of contractors and subcontractors with
the equal opportunity clause and rules,regulations,and relevant orders of the Secretary,that will furnish USDA and the Secretary such
information such as,but not limited to,Form AD-560,Certification of Nonsegregated Facilities,to submit the Monthly Employment
Utilization Report,Form CC-257,as they may require for the supervision of such compliance,and that it will otherwise assist USDA in
the discharge of USDA's primary responsibility for securing compliance.
6. To refrain from entering into any contract or contract modification subject to such Executive Order 11246 of September 24, 1965,.
with a contractor debarred from,or who has not demonstrated eligibility for,Government contracts and Federally assisted construction
contracts pursuant to the Executive Order and will carry out such sanctions and penalties for violation of the equal opportunity clause as
may be imposed upon contractors and subcontractors by USDA or the Secretary of Labor pursuant to Part II,Subpart 0,of the
Executive Order.
7. That if the recipient Fails or refuses to comply with these undertakings,the USDA may take any or all of the following actions:
Cancel,terminate,or suspend in whole or in part this grant(contract,loan,insurance,guarantee);refrain from extending any further
assistance to the organization under the program with respect to which the failure or refund occurred until satisfactory assurance of
future compliance has been received from such organization;and refer the case to the Department of Justice for appropriate legal
proceedings.
Signed by the Recipient on the date first written above.
Recipient Recipient
(CORPORATE SEAL)
Name of Corporate Recipient
Attest:
By
Secretary President
33
Position 3
USDA FORM APPROVED
Form RD 400-4 ASSURANCE AGREEMENT OMB No.0575-0018
(Rev.06-10) (Under Title VI,Civil Rights Act of 1964) OMB No.0570-0062
Orange County
(name of recipient)
200 South Cameron St. P. O. Box 8181, Hillsborough,NC 28289
(address)
("Recipient"herein)hereby assures the U. S.Department of Agriculture that Recipient is in compliance with and will continue to comply
with Title VI of the Civil Rights Act of 1964(42 USC 2000d et.seq.),7 CFR Part 15,and Rural Housing Service, Rural Business-
Cooperative Service, Rural Utilities Service, Risk Management Agency,or the Farm Service Agency,(hereafter known as the"Agency")
regulations promulgated thereunder, 7 C.F.R. § 1901.202. In accordance with that Act and the regulations referred to above, Recipient
agrees that in connection with any program or activity for which Recipient receives Federal financial assistance(as such term is defined
in 7 C.F.R. § 15.2)no person in the United States shall,on the ground of race,color,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination.
1. Recipient agrees that any transfer of any aided facility,other than personal property,by sale, lease or other conveyance of
contract,shall be,and shall be made expressly,subject to the obligations of this agreement and transferee's assumption thereof.
2. Recipient shall:
(a)Keep such records and submit to the Government such timely,complete, and accurate information as the Government may
determine to be necessary to ascertain our/my compliance with this agreement and the regulations.
(b) Permit access by authorized employees of the Agency or the U..S. Department of Agriculture during normal business hours
to such books,records,accounts and other sources of information and its facilities as may be pertinent to ascertaining such
compliance.
(c) Make available to users,participants,beneficiaries and other interested persons such information regarding the provisions
of this agreement and the regulations, and in such manner as the Agency or the U. S.Department of Agriculture finds necessary
to inform such persons of the protection assured them against discrimination.
3. The obligations of this agreement shall continue:
(a)As to any real property, including any structure,acquired or improved with the aid of the Federal financial assistance,so
long as such real property is used for the purpose for which the Federal financial assistance is made or for another purpose which
affords similar services or benefits,or for as long as the Recipient retains ownership or possession of the property,whichever is
longer.
(b)As to any personal property acquired or improved with the aid of the Federal financial assistance,so long as Recipient
retains ownership or possession of the property.
(c)As to any other aided facility or activity, until the last advance of funds under the loan or grant has been made.
4. Upon any breach or violation this agreement the Government may, at its option:
(a)Terminate or refuse to render or continue financial assistance for the aid of the property, facility,project,service or activity.
(b) Enforce this agreement by suit for specific performance or by any other available remedy under the laws of the United States
or the State in which the breach or violation occurs.
Rights and remedies provided for under this agreement shall be cumulative.
1n witness whereof, on this
(name of recipient)
date has.caused this agreement to be executed by its duly authorized officers and its seal affixed hereto, or, if a natural person,has
hereunto executed this agreement.
Recipient
(SEAL)
Date
Attest:
Title Title
According to the Paperwork Reduction Act of 1995,no persons are required to respond to a collection of information unless a displays a valid OMB control number.The
valid OMB control number for this information collection is 0570-0018 and 0570-0062 The time required to complete this information is estimated to average 15
mrmrtes per response,including the lime for revieur'ing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and
reviewing the collection of information.
34
RD Instruction 1940-Q
Exhibit A-1
CERTIFICATION FOR CONTRACTS, GRANTS AND LOANS
The undersigned certifies, to the best of his or her knowledge and belief,
that:
1. No Federal appropriated funds have been paid or will be paid, by or
on behalf of the undersigned, to any person for influencing or attempting to
influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in
connection with the awarding of any Federal contract, the making of any
Federal grant or Federal loan, and the extension, continuation, renewal,
amendment, or modification of any Federal contract, grant or loan.
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 or loan, the undersigned shall complete and
submit Standard Form -- LLL, "Disclosure of Lobbying Activities, " in accordance
with its instructions.
3. The undersigned shall require that the language of this certification
be included in the award documents for all subawards at all tiers (including
contracts, subcontracts, and subgrants under grants and loans) and that all
subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which
reliance was placed when this transaction was made or entered into.
Submission of this certification is a prerequisite for making or entering into
this transaction imposed by section 1352, title 31, U.S. Code. Any person who
fails to file the required certification shall be subject to a civil penalty
of not less than $10, 000 and not more than $100,000 for each such failure.
(name) (date)
(title)
oOo
(08-21-91) PN 171
35
DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-4045
(See reverse for public burden disclosure.)
1.Type of Federal Action: `2. Status of Federal Action: 3. Report Type:
a. contract [ I a. bid/offer/application ` a. initial filing
b. grant b. initial award ' b. material change
c. cooperative agreement c. post-award For Material Change Only:
d. loan year quarter
e. loan guarantee date of last report
f. loan insurance
4. Name and Address of Reporting Entity: 5. If Reporting Entity in No.4 is a Subawardee, Enter Name
El Prime ❑Subawardee and Address of Prime:
Tier if known:
ORANGE COUNTY
200 SOUTH CAMERON STREET
HILLSBOROUGH,NC 27278
Congressional District,if known: 0 Congressional District,if known:
6. Federal Department/Agency: 7. Federal Program Name/Description:
RBCS BUSINESS ENTERPRISE GRANTS
CFDA Number, if applicable: 10.3 51
8. Federal Action Number,if known: 9.Award Amount, if known:
10.a. Name and Address of Lobbying Entity b.Individuals Performing Services (including address if
(if individual, last name, first name, MI): different from No. 10a)
(last name, first name, Ml):
11.Amount of Payment(check all that apply): 13.Type of Payment(check ail that apply):
❑actual ❑planned ❑a.retainer
❑b.one-time fee
12. Form of Payment(check all that apply): ❑c.commission
El a.cash ❑d.contingent fee
❑b.in-kind;specify:nature ❑e.deferred
value ❑f.other;specify:
14,Brief Description of Services Performed or to be Performed and Date(s)of Service,including officer(s),employee(s),or
Member(s)contacted,for Payment Indicated in Item 11:
RBCS ENTERPRISE GRANTS
(attach Continuation Sheet(s)SP-LLLA,if necessary)
15.Continuation Sheet(s)SF-LLLA attached: ❑Yes ❑No
16-l]n 3o Tabhias n d resqessutere d o hf lroobugyh i hng is a ctifom,eis s a ta h omrazted ri abl y r ehpEfe re Sse n]U ta tiS o Cn.osf cocon
i upon Signature:
Which reliance was placed by the filer above when this transaction was made or
entered into.This disclosure is required pursuant to 31 U.S C.1352 This Print Name:
infoumabun will be reported to the Congress semi-annually and wilt be available for
public inspection.Any person who faits to Me the required disclosure shall be sub ect Title:
to a dvi]penalty of not less that 510.000 and not more than 5100.000 for each such
failure- Telephone No.: Date:
: zLy Authorized for Local Reproduction
° x � I ��� c �_ Standard Farm LLL(Rev.7-97)
36
Approved by OMB
0348-0046
DISCLOSURE OF LOBBYING ACTIVITIES
CONTINUATION SHEET
Reporting Entity: Page of
Authorized for Local Reproduction
Standard Form-LLL-A
37
DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046
(See reverse for public burden disclosure.)
1.Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
a. contract a. bid/offer/application [ a. initial filing
b. grant b.initial award b. material change
c.cooperative agreement c. post-award For Material Change Only:
d. loan year quarter
e, loan guarantee date of last report
f. loan insurance
4. Name and Address of Reporting Entity: 5.If Reporting Entity in No.4 is a Subawardee, Enter Name
1 Prime ❑Subawardee and Address of Prime:
Tier if known:
ORANGE COUNTY
200 SOUTH CAMERON STREET
HILLSBOROUGH,NC 27278
Congressional District, if known: 0 Congressional District, if known:
6. Federal Department/Agency: 7. Federal Program Name/Description:
RBCS BUSINESS ENTERPRISE GRANTS
CFDA Number,if applicable: 10.3s 1
8. Federal Action Number,if known: 9.Award Amount, if known:
10.a- Name and Address of Lobbying Entity b. Individuals Performing Services (including address if
(if individual, last name, first name, MI): different from No. 10a)
(last name, first name, Ml):
11.Amount of Payment(check all that apply): 13.Type of Payment(check all that apply):
$ Ei actual ❑planned E a. retainer
❑b.one-time fee
12. Form of Payment(check all that apply): ❑c.commission
❑a.cash ❑d.contingent fee
❑b.in-kind;specify:nature ❑e.deferred
value ❑f.other;specify:
14.Brief Description of Services Performed or to be Performed and Date(s)of Service,including officer(s),employee(s),or
Member(s)contacted,for Payment indicated in Item 11:
RBCS ENTERPRISE GRANTS
(attach Continuation Sheet(s)SF-LLIA,if necessary)
15.Continuation Sheet(s)SF-LLLA attached: ['Yes ❑ No
16.tnlonnaeari requested through this form is authorized by title 3i US.C-sedies
1352 This disclosure of lobbying agWiues is a materi al representation OTfact upon Signature:
which reliance was placed by the tier above when this transaction was made or
entered into.This disclosure is required pursuant to 31 U.S C-1352.This Print Name:
information will be reported to the Congress semi-annually and will be available for
public inspection Any person who fails to file the required disclosure shall be subject Title:
to a dvif penalty of not less that$10,000 and not more than 5100,000 for each auch —
failure. Telephone No.: Date:
'� c.� �,:. � � � Authorized far Local Reproduction
si r - Standard Form LLL(Rev.7-97)
38
Approved by OMB
0348-0046
DISCLOSURE OF LOBBYING ACTIVITIES
CONTINUATION SHEET
Reporting Entity: Page of
Authorized for Local Reproduction
Standard Form-LLL-A
39
USIA
united
Department of
Agriculture
Field Contact:
Phone:
Obligation Date:
PROJECT INFORMATION
Rural Development has approved a grant of$
Program: Rural Business Development Grant
State: North Carolina
County: Orange
Congressman, District: David E.
Price 4th
Senators: Richard Burr
Tom Tiflis
Recipient:
Orange County
Recipient Contact: 200 South
Cameron St., P.O. Box 8181
Hillsborough„ NC
Mailing Address: same
Email
Address:eric.hallman@pfapne.org
Telephone: 919-241-4212
Project Description: This proposed grant funds will be used to purchase equipment and
provide technical assistance for the Piedmont Food and Agriculture
processing Center(PFAF)to enable entrepreneurs to start and grow
food-related businesses and provide a regulatory-complaint facility.
Other Funding: 5-0-
Total Project Cost: $145,511.00
USDA is an equal opportunity pntwider and employer
Of you wish to file a Civil Rights program complaint of discrimination,complete the USDA Program Discrtmination Complaint Form,found online at
httmlivroowascrusda.govhcomplaint_filing_cust,land,or at arty USDA office,or call(866)632-9992 to request the form,You may also write a letter
containing all of the information requested in the form.Send your completed complaint form or later to as by mail at U.S.Department of Agriculture,
Director,Office of Adjudication,1400 Independence Avenue,S.W.,Washington,D.C.2,0250-9410,by fax(202)590-7442 or email at
proimarmintake@usda.gov.