NEVADA COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
ANNUAL PARTICIPATION STATEMENT (2013-2014)
______is a unit of general local government eligible to participate in the
(City/County)
U.S. Department of Housing and Urban Development Community Development Block Grant
Program as administered by the Governor’s Office of Economic Development on behalf of the
non-entitlement cities and counties within Nevada. As a condition of participation in the program, the participants must agree to abide by the terms and conditions set forth in the following documents, assurances and certifications:
1. Statement of Assurances 6. Certification-Anti-Displacement Plan
2. Grantee Questionnaire 7. Certification-Section 504 (Handicapped Persons)
3. Program Assurances8. Certification-Activities Furthering Fair Housing
4. Financial Assurances 9. Certification-Prohibiting Use of Excessive Force
5. Lobbying Assurances
______agrees to abide by the terms and conditions of said documents.
(City/County)
Furthermore, this agreement shall apply to any and all applications, grants and loans under the
Nevada State Community Development Block Grant program without exception or qualification
for the program year 2013-2014. Signed and dated original copies of each of the above mentioned documents are attached hereto.
______Mayor/Chairman Name Signature Date
Grant Title: ______Grant Number: ______
STATEMENT OF ASSURANCES
The federal Department of Housing and Urban Development requires the State of Nevada to obtain a certification from all grant recipients that applicable federal and state requirements will be observed. The following list summarizes the standard requirements.
Federal:
1.Assume Status of responsible federal official under the National Environmental Policy Act of 1969 (NEPA) and other provisions of law which further the purpose of NEPA.
2.National Historic Preservation Act.
3.Executive Order 11593 - Protection and Enhancement of Cultural Environment.
4.Reservoir Salvage Act.
5.Flood Disaster Protection Act.
6.Executive Order 11988 - Floodplain Management.
7.Executive Order 11990 - Protection of Wetlands.
8.Coastal Zone Management Act.
9.Safe Drinking Water Act.
10.Endangered Species Act.
11.Wild & Scenic Rivers Act.
12.Clean Air Act.
13.HUD Environmental Standards.
14.Farmland Protection Policy Act.
15.Title I of the Housing & Community Development Act of 1974 as amended.
16.Davis Bacon Act.
NEVADA COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
17.Contract Work Hours & Safety Standards Act.
18.Federal Fair Labor Standards Act.
19.Title VI of the Civil Rights Act of 1964 - Nondiscrimination.
20.Title VIII of the Civil Rights Act of 1968 - Nondiscrimination in Housing.
21.Age Discrimination Act of 1975.
22.Executive Order 12259 - Leadership & Coordination of Fair Housing.
23.Section 109, Housing & Community Development Act of 1974 - Nondiscrimination.
24.Section 504 of Rehabilitation Act of 1973, as amended.
25.Executive Order 11063 - Equal Opportunity in Housing.
26.Executive Order 11246 - Nondiscrimination.
27.Section 3, Housing & Urban Development Act of 1968 - Employment/Training of Lower Income Residents and Local Business Contracting.
28.Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.
29.Anti-Kickback (Copeland) Act.
30.Hatch Act.
31.Title IV Lead-Based Paint Poisoning Prevention Act.
32.OMB Circulars A-87, A-102 and A-128, as revised.
33.Treasury Circular 1075 regarding drawdown of CDBG funds.
34.Minimize displacement and adopt anti-displacement plan.
35.Affirmatively further fair housing.
36.Single Audit Act of 1984.
NEVADA COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
37.Provide opportunities for citizen participation, meetings, access to information regarding the Community Development Block Grant, and will follow the state's Citizen Participation Plan.
38.Will not attempt to recover any capital costs of public improvements assisted in wholeor in part with CDBG funds by assessing properties owned and operated by low and moderate income persons unless: (A) CDBG funds are used to pay the proportion of such assessment that relates to non-CDBG funding; or (B) it is certified that, for the purpose of assessing properties owned and occupied by low and moderate income persons who are not very low income, we as applicant, do not have sufficient CDBG funds to comply with the provisions of (A) above.
39.Comply with requirements of Section 109 of Public Law 100-202, which restricts awarding contracts for work on public buildings or public works to contractors or subcontractors from foreign countries that deny fair trade practices.
40.Armstrong/Walker "Excessive Force" Amendment-Section 519 of the Department of Veteran Affairs and Housing & Urban Development & Independent Agencies Appropriations Act of 1990.
State:
1.NRS 338.010 - 338.130 - Public Works Projects.
2.NRS 613.330 - Equal Employment Opportunity.
3.NRS 118.100 - Equal Housing Opportunity.
4.NRS 332.005 - 332.225 - Local Government Purchasing Act.
The applicant hereby certifies that it will comply with the above stated assurances in the administration of its State Community Development Block Grant Program.
______
Mayor/Chairman Name Signature Date
NEVADA COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
CDBG GRANTEE QUESTIONNAIRE**
GRANTEE NAME:
GRANTEE ADDRESS:
CDBG CONTACT PERSON:
TITLE:
PHONE NUMBER:
YEARS IN CURRENT POSITION:
FISCAL CONTACT PERSON:
TITLE:
PHONE NUMBER:
YEARS IN CURRENT POSITION:
AUDIT CONTACT PERSON (if different than fiscal contact person):
TITLE:
PHONE NUMBER:
YEARS IN CURRENT POSITION:
GRANTEE FISCAL YEAR END:
_____ Do you expect to expend $500,000 or more total in direct and indirect (for example,
through state agencies) federal financial assistance during any fiscal year of the project
period?
_____ Have you received federal financial assistance from GOED before? If “yes”, attach
details of the projects funded for the last 5 years (titles, dates, CDBG amount, matching
funds, current project status).
_____ If “no”, have you received federal financial assistance from any source, directly or
indirectly in the current or most recent fiscal year? Please attach details.
** If the City/County is sponsoring a non-profit organization then the non-profit also must submit a Grantee Questionnaire with the CDBG application.
PROGRAM ASSURANCES
The undersigned certifies, to the best of his or her knowledge and belief, that:
- Budget or program revisions cannot be made without prior approval from GOED
- Grantee must begin the draw of funds within nine (9) months of this grant award and in accordance with the GOED Sub Recipient Financial Procedures Manual. Extensions beyond nine (9) months will be made at the staff’s discretion based on the circumstances of the request
- Grantee, at their own expense, will send a representative to a CDBG Administration Workshop prior to commencement of the grant and to the CDBG Annual Forum. Exceptions to this grant condition must be approved in advance by the Director of Rural Community Development, GOED.
- Grantee will submit the following reports:
- Quarterly Program Report – to CDBG by the 15th of the month following the end of each quarter. (Due dates: April 15, July 15, October 15, January 15)
- Minority Business Enterprise Activity Report – to CDBG staff by September 30 for the preceding 12 months (October to September)
- Grantee’s Notification of Contracts and Subcontracts Awarded – to CDBG upon awarding contracts
- Project Benefits Report and Outcome Measurement Reports – to CDBG staff at completion of the project (or as otherwise directed).
NOTE: For direct benefit grants, grantees shall collect and report data on the Project Benefits Report on the race and ethnicity/national origin characteristics of beneficiaries in a method consistent with “OMB Standards for Federal Data on Race and Ethnicity: HUD Policy Statement and Implementing Guidelines” dated August 13, 2002 and as instructed on the CDBG Project Benefits Report. Any Grantee forms used in the collection of such data shall ensure compliance with the OMB Standards and CDBG form.
- Grantee will comply with the State CDBG Citizen Participation Plan as adopted by GOED.
- Grantee will ensure that contractors and subcontractors submit appropriate certifications and wage reports.
- Grantee will verify payrolls and take appropriate action when necessary.
- Real property purchased with CDBG funds will be used to meet one of the national objectives for a minimum of five years after grant close out. If the property is disposed of in less than five years, the CDBG program will be reimbursed in the amount of the current market value less any value of the property attributable to non-CDBG funds. If a change in use occurs within five (5) years of close out, CDBG will review the change in use and determine appropriate measures to be taken.
______
Mayor/Chairman Name Signature Date
NEVADA COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
FINANCIAL ASSURANCES
The undersigned certifies, to the best of his or her knowledge and belief, that:
- A signed Certification Letter must be on file with GOED before any funds are released.
- Expenditures are to be in accordance with the State and Federal regulations, which are further explained in the CDBG Sub Recipient Financial Procedures manual; all project expenditures are to be reasonable, allocable and allowable as determined by the relevant OMB Circulars.
- All project expenditures are to be made in accordance with specific categories as they appear in the approved budget. All budget revisions must be approved by CDBG staff.
- Records must be maintained which adequately identify grant receipts and expenditures. These records will be made available to GOED or their designated agent upon request.
- A Monthly Financial Report will be submitted to GOED for each monthwhere financial activity occurs for the life of the grant. The report will be filed 15 days after the end of the month. Late reports, unless approved by GOED, may result in the withholding of funds.
- The Final Financial Report will be submitted to GOED, together with the Financial Summary, within 60 days (maximum) of the end of the project.
- Grantee will send a copy of their annual audit and management letter toGOED within 30 days of the audit. Local governments and non-profit organizations will comply with audit requirements of the Single Audit Act of 1984 and OMB Circular A-133.
______
Mayor/Chairman Name Signature Date
NEVADA COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
LOBBYING ASSURANCES
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 or 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, 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 sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all sub recipients 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 failure.
______
Mayor/Chairman Name Signature Date
NEVADA COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
ANTI-DISPLACEMENT PLAN
FOR COMMUNITY DEVELOPMENT BLOCK GRANT PROJECTS
will replace all occupied and vacant occupiable low/moderate (City/County)
income dwelling units demolished or converted to a use other than as low/moderate income housing as a direct result of activities assisted with funds provided under the Housing and Community Development Act of 1974, as amended, as described in 24 CFR 580.496a (b).
All replacement housing will be provided within three years of the commencement of the demolition or rehabilitation relating to conversion.
______will provide relocation assistance, as described in
(City/County)
570.496 a (b) (2) to each low/moderate income household displaced by the demolition of housing or by the conversion of a low/moderate income dwelling to another use as a direct result of assisted activities.
1)A description of the proposed assisted activity;
2)The general location on a map and approximate number of dwelling units by size (number of bedrooms) that will be demolished or converted to a use other than as low/moderate income dwelling units as a direct result of the assisted activity;
3)A time schedule for the commencement and completion of the demolition or conversion;
4)The general location on a map and approximate number of dwelling units by size (number of bedrooms) that will be provided as replacement dwelling units;
5)The source of funding and a time schedule for the provision of replacement dwelling units; and
6)The basis for concluding that each replacement dwelling unit will remain a low/moderate income dwelling unit for at least 10 years from the date of initial occupancy.
Consistent with the goals and objectives of activities assisted under the Act,
______will take steps to minimize the displacement
(City/County)
of persons from their homes. will make public and inform
(City/County)
the Governor’s Office of EconomicDevelopment in writing before implementing Community Development Block Grant funded activities that result in displacement.
NEVADA COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
CERTIFICATION
ANTI-DISPLACEMENT PLAN
I hereby certify that has adopted an Anti-
(City/County)
Displacement Plan as required for participation in the Community Development Block Grant
Program and as set forth in 24 CFR 570.606 (May 1, 1996). The plan was initially adopted
on (date) . The most recent amendment to the plan was adopted on (date) ______and is on file with the Community Development Block Grant Program of the Governor’s Office of Economic Development Economic Development.
______
Mayor/Chairman Name Signature Date
NEVADA COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
CERTIFICATION
SECTION 504: Non-discrimination on Basis of Handicap
I hereby certify that has adopted a Section 504: Non-
(City/County)
discrimination on Basis of Handicap Policy and met requirements by:
1.performing a selfevaluation;
2.modifying policies and procedures, as necessary;
3.developing a transition plan for structural changes, as necessary;
4.designating a responsible employee to oversee the compliance efforts;
5.adopting and implementing a grievance procedure, which provides for timely resolution of discrimination complaints; and
6.publishing notification of nondiscrimination on the basis of handicap.
The policy was initially adopted on (date) . The most recent amendment to the plan was adopted on (date) and is on file with the Community Development Block Grant Program of the Governor’s Office on Economic Development.
______
Mayor/Chairman Name Signature Date
NEVADA COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
CERTIFICATION
ACTIVITIES FURTHERING FAIR HOUSING
I certify that will fulfill its responsibility in carrying out activities
(City or County)
approved by the State of Nevada which are designed to affirmatively further fair housing at the
local level and conform to the requirements of 24 CFR 570.487(b). Evidence of such activity will
be kept in a master file at the City or County receiving Community Development Block Grant
funds.
______
Mayor/Chairman Name Signature Date
NEVADA COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
CERTIFICATION
PROHIBITINGUSE OF EXCESSIVE FORCE
hereby adopts a policy in accordance with the
(City or County)
requirements of Section 104 of the Housing and Community Development Act of 1974
(42 U.S.C. 5304), as amended and certifies that the policy:
1.Prohibits the use of excessive force by law enforcement agencies within its jurisdiction against any individuals engaged in nonviolent civil rights demonstrations; and
2.Enforces applicable State and local laws against physically barring entrance to or exits from a facility or location that is the subject of such nonviolent civil rights demonstration within its jurisdiction.
The policy was initially adopted on (date) .
______
Mayor/Chairman Name Signature Date