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HomeMy WebLinkAboutAgreements/Contracts - BOCC (002)WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES CERTIFICATION REGARDING LOBBYING Each person shall file the most current edition of this certification and disclosure form, if applicable, with each submission that initiates agency consideration of such person for an award of a federal contract, grant, or cooperative agreement of $100,000 or more. 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 or not morethan $100,000 for each such failure. As required by 31 U.S.C. § 1352, as implemented by 28 C.F.R. Part 69, the Applicant certifies and assures (to the extent applicable) the following: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the Applicant, to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or any employee of a Member of Congress, in connection with the making of any Federal grant, the entering into of any cooperative agreement, or the extension, continuation, renewal, amendment, or modification of any Federal grant or cooperative agreement. If the Applicant's request for Federal funds is in excess of $100,000, and 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 grant or cooperative agreement, the Applicant shall complete and submit Standard Form - LLL, "Disclosure of Lobbying Activities" in accordance with its (and any DOJ awarding agency's) instructions; and (2) The Applicant shall require that the language of this certification be included in the award documents for all subgrants and procurement contracts (and their subcontracts) funded with Federal award funds and shall ensure that any certifications or lobbying disclosures required of recipients of such subgrants and procurement contracts (or their subcontractors) are made and filed in accordance with 31 U.S.C. § 1352. Carter, Chair N�me�d,Titl��fAuthorized Representative Sig o4/z7/zozl Date Grant County, dba New Hope 311 W. Third Ave., Moses Lake, WA 98837 Agency Name and Address Updated March 2021 https://www. oip. pov/sites/q/files/xyckuh241/files/media/document/certifications. pdf Certification of Suitability to Interact with Participating Minors To assist the Department of Social and Health Services (DSHS) in monitoring new contract requirements for federal funds, please complete this form to certify that your organization has completed the required background checks for all covered individuals that interact with any minor in the course of activities under your contract (employees paid by the contract, volunteers used as match under the contract, and volunteers supporting contract activities). Contractors are required to have documentation that the search was conducted, and this documentation should be maintained in accordance with your document retention policies. Contractor Name: Grant County Contract Number: Agreement #: 2063-86880 Contract Code: 3089CS-63 For full list of requirements, Go to htt s www.o' . ov fundin ex lore interact -minors Background checks must include: • Public sex offender and child abuse websites/registries • Criminal history registries and similar repositories of criminal history records An eligible fingerprint search/background check has been completed Select one: N I hereby certify that the recipient (and any subrecipients) have complied with the above regulations, as applicable. OR ❑ I hereby certify that no minors will be served by staff being directly charged or staff/volunteers used as match for this federally funded contract. Signature of Authorized Official oo Printed Name of Authorized Official Cindy Carter, Chair Date 4/27/2021 Updated 3/26/21 Page 1 of 1 WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion (BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON REVERSE) This certification is required by the regulations on nonprocurement debarment and suspension implemented at 2 C.F.R. Part 2867, and to other related requirements. The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals: (1) are presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions by any Federal department oragency. (2) has within a three-year period preceding this application been convicted of a felony criminal violation under any Federal law, or been convicted or had a civil judgment rendered against it for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, tribal, or local) transaction or private agreement or transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion or receiving stolen property, making false claims, or obstruction of justice, or commission of any offense indicating a lack of business integrity or business honesty that seriously and directly affects its (or its principals') present responsibility (3) are presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, tribal, or local) with commission of any of the offenses enumerated in paragraph (b) of this certification; and/or (4) has within a three-year period preceding this application had one or more public transactions (Federal, State, tribal, or local) terminated for cause or default. 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. Where the Applicant or any of its principals was convicted, within a three-year period preceding this application, of a felony criminal violation under any Federal law, the Applicant also must disclose such felony criminal conviction in writing to the Department, unless such disclosure has already been made. Cindy Carter, C air a a Ti le of A ho ' d Representative April 27, 2021 Signature Date Grant County, dba New Hope Name of Organization 311 W. Third Ave., Moses Lake, WA 98837 Address of Organization Updated March 2021 htt,Qs.-11www.oip.goyIsitesAileslxvckuh2411ileslmedia.,Locument certi ications. d Instructions for Certification 1. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out below. 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. 5. The prospective lower tier participant agrees by submitting this proposal 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 proposal that it will include the 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 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 are 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 voluntary excluded from participation on 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. Updated March 2021 h ttps://www. oip. pov/sites/p/files/xyckuh241/files/media/document/certifications. pdf Compliance with the Equal Employment Opportunity Plan (EEOP) Requirements Please read carefidly the Instructions (see below) and then complete Section A or Section B or Section C., not all three. If recipient sing completes Section A or C and sub -grants a le award over $500, 000, in addition, please coinplete Section D. ell Recipient's Name: Grant Count yj,ba New Hope Address: 311 W 3rd Ave, Moses Lake, WA 98837 Is agency a; o Direct or x Sub recipient of OJP, OVW or COPS fu ?=Law Enforcement Agency? o Yes ExNo DUNS Number: 010202562 Vendor Number (only if direct recipient) Name and Title of Contact Person: Suzi Fode, Director Telephone Number: (509) 764-8402 E -Mail Address: sfoderantcountvwa._qov Section A—Declaration Claiming Complete Exemption from the EEOP Requirement Please check all thef ollowing boxes that appky. o Less than fifty employees. o Indian Tribe o Medical Institution. o Nonprofit Organization o Educational Institution o Receiving a single award(s) less than $259000. [responsible official], certify that ------------ - ----- - [recipient] is not required to -prepare an EEOP for the reason(s) checked above, pursuant to 28 CER § 42.302. I further certify that [recipient] will comply with applicable federal civil rights laws that prohibit discrimination in employment and in the delivery of services., If recipient sub -grants a single award over $500, 000, in addition, please complete Section D Print, or Type Name and Title --- ------ - ------- Signature Date Section B—Declaration Claiming Exemption from the EEOP Submission Requirement and Certifying That an EEOP Is on File for Review If a recipient agency has j4- y or more employees and is receiving a single award or, subaward, of $25, 000 or more, but less than $500, 000, then the recipient agency does not have to submit an ESOP to the OCR for review as long as it certifies thefiollowing (42 C.F.R. § 42.305): L Cindy Carter [responsible official], certify that rant County [recipient], which has fifty or more employees and is receiving a single award or subaward for $25,000 or more, but less than $500,000, has formulated an EEOP in accordance with 28 CFR pt. 42, subpt. E. I further certify that within the last twenty-four months, the proper authority has formulated and signed into effect the EEOP and, as required by applicable federal law, it is available for review by the public, employees, the appropriate state planning agency, and the Office for Civil Rights, Office of Justice Programs, U.S. Department of Justice. The EEOP is on file at the following office: Grant Countv wp-h-Rite, HR Office [organization], www.grantcountywa.gov (HRAaO.Box A7, Ep rata, WA 98823 [address]. Cindy Carter, Chair April 27, 2021 Print or Tive Name and Title ,/ 11 C�.;Ye V1 Date Section C—Declaration Stating that an EEOP Short Form Has Been Submitted to the Office for Civil Rights for Review- ff a recipient agency hasfifty or more employees and is receiving a single award, or subaward, of $500, 000 or more, then the recipient agency must send an ESOP Short Form to the OCR, for review.. L [responsible official], certify that [recipient], which has fifty or more employees and is receiving a single award of $500,000 or more, has formulated an EEOP in accordance with 28 CFR pt. 42, subpt. E, and sent it for review on [date] to the Office for Civil Rights, Office of Justice Programs, U.S. Department of Justice. If recipient sub -grants a single award over $500, 000, in addition, please complete Section D Print or Type Name and Title Signature Date OMB Control No. 1121-0340 Expiration Date: 12/31/2015 INSTRUCTIONS Completing the Certification Form Compliance with the Equal Employment Opportunity Plan (EEOP) Requirements The federal regulations implementing the Omnibus Crime Control and Safe Streets Act (Safe Streets Act) of 1968, as amended, require some recipients of financial assistance from the U.S. Department of Justice subject to the statute's administrative provisions to create, keep on file, submit to the Office for Civil Rights (OCR) at the Office of Justice Programs (OJP) for review, and implement an Equal Employment Opportunity Plan (EEOP). See 28 C.F.R. pt. 42, subpt. E. All awards from the Office of Community Oriented Policing Services (COPS) are subject to the EEOP requirements; many awards from OJP, including awards from the Bureau of Justice Assistance (BJA), the Office of Juvenile Justice and Delinquency Prevention (OJJDP), and the Office for Victims of Crime (OVC) are subject to the EEOP requirements; and many awards from the Office on Violence Against Women (OVW) are also subject to the EEOP requirements. If you have any questions as to whether your award from the U.S. Department of Justice is subject to the Safe Streets Act's EEOP requirements, please consult your grant award document, your program manager, or the OCR. Recipients should complete either Section A or Section B or Section C, not all three. If recipient completes Section A or C and sub -grants a single award over $500,000, in addition, please complete Section D. Section A The regulations exempt some recipients from all of the EEOP requirements. Your organization may claim an exemption from all of the EEOP requirements if it meets any of the following criteria: it is a nonprofit organization, an educational institution, a medical institution, or an Indian tribe; or it received an award under $25,000; or it has less than fifty employees. To claim the complete exemption from the EEOP requirements, complete Section A. Section B Although the regulations require some recipients to create, maintain on file, and implement an EEOP, the regulations allow some recipients to forego submitting the EEOP to the OCR for review. Recipients that (1) are a unit of state or .local government, an agency of state or local government, or a private business; and (2) have fifty or more employees; and (3) have received a single grant award of $25,000 or more, but less than $500,000, may claim the limited exemption from the submission requirement by completing Section B. In completing Section B, the recipient should note that the EEOP on file has been prepared within twenty-four months of the date of the most recent grant award. Section C Recipients that (1) are a unit of state or local government, an agency of state or local government, or a private business, and (2) have fifty or more employees, and (3) have received a single grant award of $500,000 or more, must prepare, maintain on file, submit to the OCR for review, and implement an EEOP. Recipients that have submitted an EEOP Utilization, Report (or in the process of submitting one) to the OCR, should complete Section C. Section D Recipients that (1) receive a single award over $500,000; and (2) subaward a single award of $500,000 or more must provide a list; including, name, address and DUNS # of each such sub -recipient by completing Section D. Submission Process Recipients should download the online Certification Forni, complete required sections, have the appropriate official sign it, electronically scan the signed document, and then send the signed document to the following e-mail address: EEOPForms@usdoj.gov. The document must have the following title: EEOP Certification. If you have questions about completing or submitting the Certification Form, please contact the Office for Civil Rights, Office of Justice Programs, 810 7th Street, NW, Washington, DC 20531 (Telephone: (202) 307-0690 and TTY: (202) 307-2027). OMB Approval No. 1121-0340'Expiration Date: 12/31/15 Public Reporting Burden Statement Paperwork Reduction Act Notice. Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a current valid OMB control number. We try to create forms and instructions that are accurate, can be easily -understood, and which impose the least possible burden on you to provide us with information. The estimated minimum average time to complete and file this application is 20 minutes per form. If you have any comments regarding the accuracy of this estimate, or suggestions for mal6ng this form simpler, you can write to the Office of Justice Programs, 810 7th Street, N.W., Washington, D.C. 20531. 9:00 am Welcome & Land Recognition Judy Chen BMGF Welcome & Greeting Marie Sauter 9:15 am Introduction & Day's Agenda Linda Olsen DVHF Background & WSCADV Video 9:40 am Meet the South Central Agencies! - New Hope - Yakima YMCA - DVS Benton Franklin - The Lighthouse 10:05 am South Central Agency Panel 10:10 am Break 10:30 am Domestic Violence Housing Findings -Cris Sullivan., PhD - Gabriela Lopez Zexon, PhD 11:45 am Break 11:55 am Meet the King County Agencies! - LifeWire - Interlm - Northwest Network for BLGT Survivors - New Beginnings 12:20 pm Family Advocacy Project Evaluation Katie Gregory, PhD 12:35 pm King County Agency Panel 12:55 pm Closing with Judy Chen & Marie Sauter