National Register Programs Guideline (Nps-49)
OMB
ASSURANCES NONCONSTRUCTION PROGRAMS Approval No. 03480040
Note: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal-awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant I certify that the applicant:
1. Has the legal authority to apply for Federalrelating to nondiscrimination on the basis of drug
assistance, and the institutional, managerial andabuse (f) the Comprehensive Alcohol Abuse and
financial capability (including funds sufficient to payAlcoholism Prevention, Treatment and Rehabilitation
the nonFederal share of project costs) to ensureAct of 1970 (P.L. 91616), as amended, relating to
proper planning, management and completion of thenondiscrimination on the basis of alcohol abuse or
project, described in this application.alcoholism; (g) § 523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. 290 dd3 and 290
2. Will give the awarding agency, the Comptrolleree3), as amended, relating to confidentiality of
General of the United States, and if appropriate, thealcohol and drug abuse patient records; (h) Title VIII
State, through any authorized representative, accessof the Civil Rights Act of 1968 (42 U.S.C. § 3601 et
to and the right to examine all records, books,seq.), as amended, relating to nondiscrimination in
papers, or documents related to the award; and willthe sale, rental or financing of housing; (i) any other
establish a proper accounting system in accordancenondiscrimination provisions in the specific statute(s)
with generally accepted accounting standards orunder which application for Federal assistance is
agency directives.being made, and (j) the requirements of any other
nondiscrimination statute(s) which may apply to the
3. Will establish safeguards to prohibit employeesapplication.
from using their positions for a purpose that
constitutes or presents the appearance of personal or7. Will comply, or has already complied, with the
organizational conflict of interest, or personal gain.requirements of Titles II and III of the Uniform
Relocation Assistance and Real Property Acquisition
4. Will initiate and complete the work within thePolicies Act of 1970 (P.L. 91646) which provide for
applicable time frame after receipt of approval of thefair and equitable treatment of persons displaced or
awarding agency.whose property is acquired as a result of Federal or
federally assisted programs. These requirements
5. Will comply with the Intergovernmental Personnelapply to all interests in real property acquired for
Act of 1970 (42 U.S.C. § § 47284763) relating toproject purposes regardless of Federal participation in
prescribed standards for merit systems for programspurchases.
funded under one of the nineteen statutes or
regulations specified in Appendix A of OPM's8. Will comply with the provisions of the Hatch Act
Standards for a Merit System of Personnel(5 U.S.C. § § 15011508 and 73247328) which limit
Administration (5 C.F.R. 900, Subpart F).the political activities of employees who’s principal
employment activities are funded in whole or in part
6. Will comply with all Federal statutes relating towith Federal funds.
nondiscrimination. These include but are not limited
to: (a) Title VI of the Civil Rights Act of 1964 (P.L.9. Will comply, as applicable, with the provisions of
88352) which prohibits discrimination on the basisthe DavisBacon Act (40 U.S.C. § 276a to 276a7),
of race, color or national origin; (b) Title IX of thethe Copeland Act (40 U.S.C. § 276c and 18 U.S.C.
Education Amendments of 1972, as amended (20§ 874), and the Contract Work Hours and Safety
U.S.C. § 16811683, and 16851686), whichStandards Act (40 U.S.C. § 327333), regarding
prohibits discrimination on the basis of sex; (c)labor standards for federally assisted construction
Section 504 of the Rehabilitation Act of 1973, assubagreements.
amended (29 U.S.C. § 794), which prohibits dis-
crimination on the basis of handicaps; (d) the Age10. Will comply, if applicable, with flood insurance
Discrimination Act of 1975, as amended (42 U.S.C.purchase requirements of Section 102(a) of the Flood
§ 61016107), which prohibits discrimination onDisaster Protection Act of 1973 (P.L. 93234) which
the basis of age; (e) the Drug Abuse Office andrequires recipients in a special flood hazard area to
Treatment Act of 1972 (P.L. 92255), as amended,participate in the program and to purchase flood
7C2
insurance if the total cost of insurable construction13. Will assist the awarding agency in assuring
and acquisition is $10,000 or more.compliance with Section 106 of the National Historic
Preservation Act of 1966, as amended (16 U.S. C.
11. Will comply with environmental standards which470), E.0. 11593 (identification and protection of
may be prescribed pursuant to the following: (a)historic properties), and the Archaeological and
institution of environmental quality control measuresHistoric Preservation Act of 1974 (16 U.S.C. 469a1
under the National Environmental Policy Act of 1969et seq.).
(P.L. 91190) and Executive Order (EO) 11514; (b)
notification of violating facilities pursuant to EO14. Will comply with P.L. 93348 regarding the
11738; (c) protection of wetlands pursuant to EOprotection of human subjects involved in research,
1 1990; (d) evaluation of flood hazards in floodplainsdevelopment, and related activities supported by this
in accordance with EO 11988, (e) assurance ofaward of assistance.
project consistency with the approved State
management program developed under the Coastal15. Will comply with the Laboratory Animal Welfare
Zone Management Act of 1972 (16 U.S.C. § 1451Act of 1966 (P.L. 89544, as amended, 7 U.S.C.
et seq.); (f) conformity of Federal actions to State2131 et seq.) pertaining to the care, handling, and
(Clear Air) Implementation Plans under Sectiontreatment of warm-blooded animals held for research,
176(c) of the Clear Air Act of 1955, as amended (42teaching, or other activities supported by this award
U.S.C. § 7401 et seq.); (g) protection ofof assistance.
underground sources of drinking water under the
Safe Drinking Water Act of 1974, as amended, (P.L.16. Will comply with the LeadBased Paint Poisoning
93523); and (h) protection of endangered speciesPrevention Act (42 U.S.C. § 4801 et seq.) which
under the Endangered Species Act of 1973, asprohibits the use of lead based paint in construction
amended, (P.L. 93205).or rehabilitation of residence structures.
12. Will comply with the Wild and Scenic Rivers Act17. Will cause to be performed the required financial
of 1968 (16 U. S. C. § 1271 et seq.) related toand compliance audits in accordance with the Single
protecting components or potential components ofAudit Act of 1984.
the national wild and scenic rivers system.
18. Will comply with all applicable requirements of all
other Federal laws, executive orders, regulations and
policies governing this program.
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SIGNATURE OF AUTHORIZED CERTIFYING OFFICIALTITLE
Dawn Welch______
APPLICANT ORGANIZATIONDATE SUBMITTED
AUTHORIZED FOR LOCAL REPRODUCTIONSF 424B (4/88)
U.S. Department of the InteriorEXHIBIT 7D
Certifications Regarding Debarment, Suspension, and
Other Responsibility Matters, DrugFree Workplace
Requirements and Lobbying
Persons signing this form should refer to theCertification Regarding Debarment, Suspension,
regulations referenced below for completeIneligibility and Voluntary Exclusion Lower Tier
instructions:Covered Transactions (See Appendix 8 of Subpart D
of 43 CFR Part 12)
Certification Regarding Debarment, Suspension, and
Other Responsibility Matters Primary CoveredCertification Regarding DrugFree Workplace
Transactions [The prospective primary participantRequirements Alternate 1. (Grantees Other Than
further agrees by submitting this proposal that itIndividuals) and Alternate 11. (Grantees Who are
will include the clause titled, "Certificationindividuals) (See Appendix C of Subpart D of 43 CFR
Regarding Debarment, Suspension, Ineligibility andPart 12)
Voluntary Exclusion Lower Tier Covered
Transaction," provided by the department or agencySignature on this form provides for compliance with
entering into this covered transaction, withoutcertification requirements under 43 CFR Parts 12 and
modification, in all lower tier covered transactions18. The certifications shall be treated as a
and in all solicitations for lower tier coveredmaterial representation of fact upon which reliance
transactions. See below for language to be used; usewill be placed when the Department of the Interior
this form for certification and sign; or usedetermines to award the covered transaction, grant,
Department of the Interior Form 1954 (DI1954). Seecooperative agreement or Loan.
Appendix A of Subpart D of 43 CFR 12.
PART A: Certification Regarding Debarment. Suspension, and other Responsibility Matters Primary Covered Transactions
CHECK X IF THIS CERTIFICATION IS FOR A PRIMARY COVERED TRANSACTION AND IS APPLICABLE.
(1) The prospective primary recipient 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 threeyear 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 federal 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.
PART B. Certification Regarding Debarment. Suspension. ineligibility and Voluntary Exclusion Lower Tier Transactions
CHECK X IF THIS CERTIFICATION IS FOR A LOWER TIER COVERED TRANSACTION AND IS APPLICABLE.
(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, debarred 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.
Form DI2010 (page 1)
March 1995 Release
PART C: Certification Regarding DrugFree Workplace Requirements
CHECK IF THIS CERTIFICATION IS FOR AN APPLICANT WHO IS NOT AN INDIVIDUAL
Alternate I. (Grantees Other Than Individuals)
A.The grantee certifies that it will provide or continue to provide a drugfree 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 drugfree awareness program to inform employee’s about
(1) The dangers of drug abuse in the workplace;
(2) The grantee's policy of maintaining a drugfree 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 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 shall 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 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 drugfree 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)
CHECK ______if there are workplaces on file that are not identified here.
PART D: Certification Regarding DrugFree Workplace Requirements
CHECK X IF THIS CERTIFICATION IS FOR AN APPLICANT WHO IS AN INDIVIDUAL
Alternate II. (Grantees Who Are Individuals)
(a)The grantee certifies that, as a condition of the grant, he or she wilt not engage in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance in conducting any activity with the grant;
(b)If convicted of a criminal drug offense resulting from a violation occurring during the conduct of any grant activity, he or she will report the conviction, in writing, within 10 calendar days of the conviction, to the grant officer or other designee, unless the Federal agency designates a central point for the receipt of such notices. When notice is made to such a central point, it shall include the identification number(s) of each affected grant.
Form DI2010 (page 2)
Part E:Certification Regarding Lobbying
Certification for Contracts, Grants, Loans, and Cooperative Agreements
CHECKIF CERTIFICATION IS FOR THE AWARD OF ANY OF THE FOLLOWING AND
THE AMOUNT EXCEEDS $100,000: A FEDERAL GRANT OR COOPERATIVE AGREEMENT;
SUBCONTRACT, OR SUBGRANT UNDER THE GRANT OR COOPERATIVE AGREEMENT.
CHECKIF CERTIFICATION IS FOR THE AWARD OF A FEDERAL
LOAN EXCEEDING THE AMOUNT OF $150,000, OR A SUBGRANT OR
SUBCONTRACT EXCEEDING $100,000 UNDER THE LOAN.
Theundersigned 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 an 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, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, Loan, or cooperative agreement.
(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, loan, or cooperative agreement, the undersigned shall complete and submit Standard FormLLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3)The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify 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.
As the authorized certifying official, I hereby certify that the above-specified certifications are true.
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SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
Dawn Welch______
TYPED NAME AND TITLE
______
DATE SIGNED
(This consolidated form may be used in place of the DI1953, DI1954, DI1955, DI1956, and DI1963 forms.)
Form DI2010 (page 3)