AgeSmart Community Resources (AgeSmart)
GRANT APPLICATION ASSURANCES for FISCAL YEAR 2018
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1. The funding for this Grant shall be for the Fiscal Year 2017, beginning 01/01/18 and ending 9/30/18. See the attached Notification of Grant Award for amounts.
2. The Grantee shall perform the activities and services consistent with Illinois Department on Aging (IDOA) rules, standards, policies and procedures. (See AgeSmart Service Guidelines.) The Grantee also agrees to meet all policies and procedures issued by AgeSmart pertaining to such service(s) and conducted under the Older Americans Act.
3. The Grantee shall perform the activities within and throughout geographical location(s) listed below:
(Please check the geographical location)
Bond / ClintonMadison / Monroe
Randolph / St. Clair
Washington
/ Entire Public Service Area (PSA 08)4. AgeSmart reserves the right to adjust the payment amounts as may be required by the IDOA.
5. Payments of costs incurred with the program are in accordance with the IDOA standards and procedures of the Older Americans Act. In addition, obligations of AgeSmart and the IDOA cease immediately without penalty of further payment, if in any fiscal year the state or federal funding source fails to appropriate sufficient funds for the program.
6. The Grantee agrees to abide by all rules, standards, policy, procedures and direction promulgated by and adopted by AgeSmart for the activities under this Grant.
7. This Notification of Grant Award may be suspended, reduced, or revoked for not complying with the applicable state and federal regulations, under spending, or non-compliance with the approved grant application as interpreted by the Illinois Department on Aging and AgeSmart.
8. Upon determination by AgeSmart, the Grantee shall promptly refund any amount that has been advanced but for which the Grantee has not earned according the terms of the Grant.
9. Time is of the essence when any action is required under this Grant to be completed by a stated time. Failure by the Grantee to complete such actions within the required time limits may result in a disallowance of payment for service rendered under this Grant, unless a written Amendment is executed by the Grantee and AgeSmart.
10. This Grant shall be governed and construed in accordance with the laws of the State of Illinois.
11. The Grantee understands that IDOA, acting in concert with AgeSmart, has the exclusive right, power and privilege to develop and interpret State rules, policy and procedures.
12. In the event any provision, term or condition of this Grant is declared void, unenforceable or against public policy, said agreement shall be construed as though said provision, term, or condition did not exist.
13. The Grantee is expressly prohibited from sub-granting or otherwise arranging for transfer of activities under this Grant without prior written approval from AgeSmart, unless expressly indicated in this Grant. This Grant, including the rights, benefits and duties hereunder, shall not be assigned.
14. The Grantee certifies under Section 50-5 of the Illinois Procurement Code that the Grantee (i) has not been convicted of bribery or attempting to bribe an officer or employee of the State of Illinois; (ii) has not had an official, agent, or employee of the Grantee who committed bribery or attempted bribery on behalf of the Grantee and pursuant to the direction or authorization of a responsible official of Grantee, 30 ILCS 500/50-5.
15. The Grantee certifies compliance with Section 50-10 of the Illinois Procurement Code, 30 ILCS 500/50-10, that no person or business convicted of a felony shall do business with the State from the date of conviction until five years after the date of completion of the sentence for that felony, unless no person held responsible by a prosecutorial office for the facts upon which the conviction was based continues to have any involvement with the business.
16. The Grantee in accordance with 30 ILCS 500/50-10.5 that no officer, partner or other managerial agent of the contracting business has been convicted of a felony under the Sarbanes-Oxley Act of 2002 or a Class 3 or Class 2 felony under Illinois Securities Law of 1953 for a period of 5 years prior to the date of the Grant. The Grantee acknowledges that AgeSmart shall declare the Grant void if this certification is false.
17. The Grantee certifies that they are not barred from being awarded a contract under 30 ILCS 500. Section 50-11 prohibits a person from entering into a contract with a State agency if they know or should know they are delinquent in the payment of any debt to the State as defined by the Debt Collection Board. The Grantee further acknowledges that AgeSmart may declare the Grant void if this certification is false or if the Grantee is determined to be delinquent in the payment of any debt during the term of the Grant.
18. The Grantee agrees to comply with Section 50-13 of the Illinois Procurement Code prohibiting conflict of interest, 30 ILCS 500/50-13.
19. The Grantee certifies that the Grantee is not barred from contracting with the Department on Aging or Department of Public Health because of inducements to bid on a contract or from inducement to withhold bid on a contract pursuant to Section 50-25 of the Illinois Procurement Code, 30 ILCS 500-50-25.
20. If the Grantee is a charitable organization subject to the Charitable Trust Act, 760 ILCS 55/Act, or the Solicitation for Charity Act, 225 ILCS 460/Act, the Grantee certifies that all information required by these Acts has been filed with the Illinois Attorney General.
21. The Grantee certifies that the Grantee has not been barred from contracting with a unit of state or local government as a result of violation of bid-rigging or bid-rotating provisions in Sections 33E-3, 33E-5, and 33EO-11 of the Criminal Code of 1961, 720, ILCS 5/33E-4, and 5/33E-11.
22. The Grantee certifies under the Discriminatory Club Act that the Grantee is not prohibited from selling goods or services to the State of Illinois because it pays dues or fees on behalf of its employees or agents, or subsidizes or otherwise reimburses them, for payment of their dues or fees to any club, which unlawfully discriminates, 775 ILCS 25/Act.
23. The Grantee certifies that no Federal appropriations have been paid or will be paid, by or on behalf of the Grantee, 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 contract, the making of any Federal loan, the entering into of any grant or cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, Contract, loan, grant or cooperative agreement.
24. The Grantee certifies that no funds provided pursuant to this Grant will be used for publicity or propaganda purposes, for the preparation, distribution, or use of any kit, pamphlet, booklet, publication, radio, television, or video presentation designed to support or defeat legislation pending before Congress or the Illinois General Assembly, and further certifies that no funds provided pursuant to this Grant shall be used to pay the salary or expenses of any person which are related to any activity designed to influence legislation or appropriations pending before Congress or the Illinois General Assembly.
25. The Grantee certifies compliance with the Davis-Bacon Act in construction and modification of buildings, 40 USC 276a.
26. The Grantee certifies that neither it nor any substantially owned affiliated company is participating or shall participate in an international boycott in violation of the provisions of the U.S. Export Administration Act of 1979 or the regulations of the U.S. Department of Commerce promulgated under that Act.
27. The Grantee agrees to act in conformity with Article 2 of the Illinois Human Rights Act, 775 ILCS 5/Art. 2 and with Appendix A of the Procedures Applicable to All Agencies, 44 Ill. Admin. Code 750, APP. A. In addition, the Grantee refrains from unlawful discrimination based on citizenship status in employment and undertakes affirmative action to assure equality of employment opportunity, and has written sexual harassment policies.
28. The Grantee agrees to comply with the Federal Civil Rights Act of 1964, the Federal Rehabilitation Act of 1973, the Americans with Disabilities Act, 42 U.S.C. 12101 et seq. And Rule 28 CFR 35.130 and all other federal and State of Illinois laws, regulations or orders which prohibit discrimination because of race, color, religion, sex, national origin, ancestry, age, marital status, or physical or mental handicap.
29. The Grantee shall abide by the Federal Immigration Reform and Control Act of 1986.
30. The Grantee certifies that it is not in default of an educational loan as provided in Public Act 85-827.
31. AgeSmart assumes no liability for the actions of the Grantee under this Grant. The Grantee is an independent organization and assumes all risk and loss occasioned by its performance of this Grant. The Grantee further agrees to hold the State of Illinois, IDOA, AgeSmart and their officers, agents and employees harmless from any and all liabilities, claims, damages, suits, costs, fees, and expenses incident thereto, for injuries or death to persons or for loss of or damage to property because of the Grantee’s actions.
32. The terms and conditions of this Grant constitute the entire present agreement between AgeSmart and the Grantee and shall be considered public information in accordance with provisions of the Freedom of Information Act (5ILCS 140 tense.).
33. This Grant may be amended by the mutual consent of both parties at any time during its term. Amendments to this Grant shall be in writing, signed by both parties or their authorized representatives. Grantee non-compliance with the terms of this Grant may result in its immediate termination. The Grantee must give (30) thirty-day’ notice of voluntary Grant termination.
34. The Grantee must obtain prior approval of all promotional or media activities associated with the service from AgeSmart and credit AgeSmart as the source of funds for the service using the following statement:
The grantee ______(insert agency name) is in compliance with Title VI of the Civil Rights Act and operates with financial assistance from AgeSmart Community Resources, the Illinois Department on Aging and the United States Administration for Community Living.
35. The Grantee certifies to the following in fulfilling the Requirements of the Drug Free Workplace Act:
(Please check one)
That I am doing business as an individual and I certify that I will not engage in the unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance in the performance of the contract.The Drug Free Workplace Act does not apply (either the contract is less than $5,000 or the contractor or Grantee is a corporation, partnership or other entity that has less than 25 employees).
The Drug Free Workplace Act does apply and I have completed the attached required certification form. (The Drug Free Workplace Act applies to contracts or grants of $5,000 or more with corporations, partnerships, or other entities with 25 or more employees at the time the contract or grant is awarded)
36. Under penalties of perjury, I certify that the Name, Taxpayer Identification Number, and legal status listed below are correct:
Name: ______
Social Security Number: ______
Or
Employer Identification Number: ______
(If you are an individual, enter your name and SSN as it appears on your Social Security Card. If completing this certification for a sole proprietorship, enter the owner’s name followed by the name of the business and the owner’s SSN. For all other entities, enter the name of the entity as used to apply for the entity’s EIN and the EIN.)
Legal Status (check one):
Individual / Estate or legal trustOwner of sole proprietorship Partnership, estate or trust / Foreign Corporation
Partnership/Legal Corporation / Corporation providing or billing Medical and/or health care services
Tax-exempt hospital or extended care facility / Corporation NOT providing or billing medical and/or health care services
Governmental entity / Other: ______
Non-Profit Organization
37. The Grantee shall maintain, for a minimum of 3 years after the completion of this Grant, adequate books, records, and supporting documents to verify the amounts, recipients, and uses of all disbursements of funds passing in conjunction with the Grant. All books, records, and supporting documents related to the Grant shall be available for review and audit by AgeSmart. The Grantee further agrees to cooperate fully with any audit conducted by AgeSmart and to provide full access to all relevant materials. Failure to maintain the books, records, and supporting documents required shall establish a presumption in favor of AgeSmart for the recovery of any funds paid by AgeSmart under the Grant for which adequate books, records, and supporting documentation are not available to support their purported disbursement.
38. All notices required or desired to be sent by either party shall be sent to the following respective addresses:
AgeSmart Community Resources2365 Country Road
Belleville, IL 62221
Grantee name and address if different from above:
39. In Witness whereof, the parties hereto caused this Grant to be executed by their duly authorized representatives:
AgeSmart Community ResourcesName of Grantee
Signature / Signature
Joy Paeth, Chief Executive Officer
Name and title of Authorized Representative / Name and title of Authorized Representative
Date / Date
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